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  • 1.
    Abbott, Allan
    et al.
    Karolinska University Hospital, Sweden; Karolinska Institute, Sweden; Bond University, Australia.
    Kjellman, Görel
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Multidimensional assessment of pain related disability after surgery for cervical disc disease2013In: APA Conference 2013: New moves, Australian Physiotherapy Association , 2013, p. 2-2Conference paper (Other academic)
    Abstract [en]

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

    Design: Cross-sectional observational study.

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

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

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

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

    Key Practice Points:

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

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

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

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

  • 3.
    Ahlden, M.
    et al.
    Orthocenter IFK-kliniken, Sahlgrenska akademin, Göteborgs universitetGöteborg, Sweden.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Samuelsson, K.
    Ortopedkliniken, Sahlgrenska universitetssjuk huset.
    Eriksson, K.O.
    Sahlgrenska akademin, Göteborgs universitet, Sweden; Sahlgrenska akademin, Göteborgs universitet, Sweden.
    Karlsson, J.
    Ortopedkliniken, Institutionen för klinisk forskning och utbildning, Södersjukhuset, Karolinska institutetStockholm, Sweden.
    Individualiserad terapi viktigt vid främre korsbandsskada2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 36, p. 1440-Article in journal (Refereed)
    Abstract [en]

    Anterior cruciate ligament (ACL) injury is a common injury and is often associated with concomitant injuries to the menisci and cartilage and, in the long term, osteoarthritis. Preventive training programs have shown to be highly effective in terms of reducing the risk for ACL injury in sports. ACL reconstruction is indicated when the patient experiences symtoms of instability (»giving way«) despite rehabilitation with a physiotherapist aiming to gain neuromuscular control of the knee. Early ACL reconstruction may be indicated, for example when the patient desires to return to pivoting contact-sports at high level. Modern surgical technique for ACL reconstruction has evolved rapidly and includes »anatomic reconstruction« and individualized treatment, where each patient’s unique anatomy, injury and requests on knee function are taken into consideration. In Sweden, more than 90% of all ACL reconstructions performed are included into the Swedish National ACL Register.

  • 4.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Österberg, Annika
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Uppsala Univ, Ctr Clin Res Sormland, Eskilstuna, Sweden.
    Tagesson (Sonesson), Sofi
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Gauffin, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Webster, Kate E.
    La Trobe University, Australia.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction2014In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 48, no 22, p. 1613-U50Article in journal (Refereed)
    Abstract [en]

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

  • 5.
    Bengtsson, Hakan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Match Injury Rates in Professional Soccer Vary With Match Result, Match Venue, and Type of Competition2013In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 41, no 7, p. 1505-1510Article in journal (Refereed)
    Abstract [en]

    Background: Player activities in soccer matches are influenced by the match result and match venue. It is not known whether injury rates are influenced by these factors. Purpose: To investigate whether there are associations between injury rates and the match result, venue, and type of competition in male soccer. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-six professional clubs from 10 countries were followed prospectively during 9 seasons (2001-2002 to 2009-2010). All matches, and injuries occurring in these matches, were registered by the teams medical staff. An injury was registered if it resulted in player absence from training or matches. Information about match result, venue, and type of competition for all reported matches was gathered by the authors from online databases. Injury rates in matches with varying match characteristics were compared by use of generalized estimating equations. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: A total of 2738 injuries during 6010 matches were registered. There were no associations between odds of 1 injury occurrence and match result or type of competition, whereas the odds were decreased in matches played away compared with home matches (OR, 0.89; 95% CI, 0.80-0.99). The odds of 2 or more injury occurrences in a match were increased in matches resulting in a draw (OR, 1.39; 95% CI, 1.15-1.69) or loss (OR, 1.66; 95% CI, 1.38-1.98) compared with matches won and were decreased in other cup matches compared with league matches (OR, 0.57; 95% CI, 0.39-0.84) and in matches played away compared with home matches (OR, 0.70; 95% CI, 0.60-0.82). Finally, injuries with more than 1 weeks absence occurred more frequently in Champions League matches compared with league matches both for matches with 1 injury (OR, 1.26; 95% CI, 1.09-1.45) and matches with 2 or more injuries (OR, 1.57; 95% CI, 1.13-2.20). Conclusion: The odds of 2 or more injury occurrences in professional soccer were higher in matches resulting in a loss or a draw compared with a win, whereas the odds of injury occurrences were lower in matches played away compared with home matches. The rate of moderate and severe injuries increased with the importance of the match.

  • 6.
    Bengtsson, Håkan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Muscle injury rates in professional football increase with fixture congestion: an 11-year follow-up of the UEFA Champions League injury study2013In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 47, no 12, p. 743-747Article in journal (Refereed)
    Abstract [en]

    Background The influence of fixture congestion on injury rates and team performance has only been scarcely investigated.

    Aim To study associations between recovery time and match load and injury rates and team performance in professional football.

    Methods Exposure and time loss injuries were registered prospectively from 27 teams over 11 seasons. Matches were grouped according to recovery days before each match (≤3 vs >3 days, and ≤4 vs ≥6 days). Injury rates and team performance were compared between groups. Match load in match sequences containing five consecutive matches was determined by the number of days separating the first match and the last training session during that match sequence. Linear regression was used to study associations between match load and injury rates and team performance.

    Results Team performance showed no association with match load, or recovery days prior to matches, except for Europa League matches that indicated more matches lost with short recovery (≤3 days) (p=0.048). Total injury rates and muscle injury rates were increased in league matches with ≤4 days compared with ≥6 days’ recovery (RR 1.09, 95% CI 1.00 to 1.18, and RR 1.32, 95% CI 1.15 to 1.51, respectively), specifically hamstring and quadriceps injuries. High match load was associated with increase in muscle injury rate in matches in the same match sequence (p=0.012), and increase in ligament injury rate in training in the subsequent match sequence (p=0.003).

    Conclusions Fixture congestion was associated with increased muscle injury rates but had no, or very limited, influence on team performance.

  • 7.
    Bernhardsson, Susanne
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Johansson, Kajsa
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. 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.
    Larsson, Maria E. H.
    Regional Vastra Gotaland, Sweden Gothenburg University, Sweden .
    Determinants of Guideline Use in Primary Care Physical Therapy: A Cross-Sectional Survey of Attitudes, Knowledge, and Behavior2014In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 94, no 3, p. 343-354Article in journal (Refereed)
    Abstract [en]

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

  • 8.
    Bernhardsson, Susanne
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Regional Vastra Gotaland, Sweden .
    Larsson, Maria E H
    Regional Vastra Gotaland, Sweden .
    Measuring Evidence-Based Practice in Physical Therapy: Translation, Adaptation, Further Development, Validation, and Reliability Test of a Questionnaire2013In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 93, no 6, p. 819-832Article in journal (Refereed)
    Abstract [en]

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

  • 9.
    Bernhardsson, Susanne
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Region Västra Götaland.
    Larsson, Maria
    Region Västra Götaland, Göteborgs universitet.
    Eggertsen, Robert
    Region Västra Götaland, Göteborgs universitet.
    Fagevik Olsén, Monika
    Göteborgs universitet.
    Johansson, Kajsa
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Nordeman, Lena
    Region Västra Götaland.
    van Tulder, Maurits
    VU University, Amsterdam, The Netherlands.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: a non-randomized controlled trial.2014In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, no 1, p. 105-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

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

    METHODS:

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

    RESULTS:

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

    CONCLUSIONS:

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

  • 10.
    Björnsson Hallgren, Hanna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Holmgren, Theresa
    Linköping University, Department of Medical and Health Sciences, Division of 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.
    Johansson, Kajsa
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Adolfsson, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    A specific exercise strategy reduced the need for surgery in subacromial pain patients2014In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 48, no 19, p. 1431-1436Article in journal (Refereed)
    Abstract [en]

    Background and purpose A programme based on eccentric exercises for treating subacromial pain was in a previous study found effective at 3-month follow-up. The purposes of the present study were to investigate whether the results were maintained after 1 year and whether the baseline Constant-Murley score, rotator cuff status and radiological findings influenced the outcome. Patients and methods 97 patients on the waiting list for arthroscopic subacromial decompression had been randomised to a specific exercise programme or unspecific exercises (controls). After 3 months of exercises, the patients were asked whether they still wanted surgery and this option was available until a 1-year follow-up. 1 year after inclusion or 1 year after surgery, the number of patients who decided to have surgery in each group was compared. The choice of surgery was related to the baseline Constant-Murley score, ultrasound and radiographs taken at inclusion. Results All patients had improved significantly (pless than0.0001) in the Constant-Murley score at the 1-year follow-up. Significantly more patients in the control group decided to have surgery (63%) than those in the specific exercise group (24%; pless than0.0001). Patients who decided to have surgery had a significantly lower baseline Constant-Murley score and more often a full-thickness tear. Patients with partial tears did not differ from those with intact tendons. Interpretation The positive short-term results of specific exercises were maintained after 1 year, and this exercise strategy reduces the need for surgery. Full-thickness tear and a low baseline Constant-Murley score appear to be a predictive marker for a less good outcome.

  • 11.
    Dannapfel, Petra
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. 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.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Applying self-determination theory for improved understanding of physiotherapists rationale for using research in clinical practice: a qualitative study in Sweden2014In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 30, no 1, p. 20-28Article in journal (Refereed)
    Abstract [en]

    Physiotherapists are generally positive to evidence-based practice (EBP) and the use of research in clinical practice, yet many still base clinical decisions on knowledge obtained during their initial education and/or personal experience. Our aim was to explore motivations behind physiotherapists use of research in clinical practice. Self-Determination Theory was applied to identify the different types of motivation for use of research. This theory posits that all behaviours lie along a continuum of relative autonomy, reflecting the extent to which a person endorses their actions. Eleven focus group interviews were conducted, involving 45 physiotherapists in various settings in Sweden. Data were analysed using qualitative content analysis and the findings compared with Self-Determination Theory using a deductive approach. Motivations underlying physiotherapists use of research in clinical practice were identified. Most physiotherapists expressed autonomous forms of motivation for research use, but some exhibited more controlled motivation. Several implications about how more evidence-based physiotherapy can be achieved are discussed, including the potential to tailor educational programs on EBP to better account for differences in motivation among participants, using autonomously motivated physiotherapists as change agents and creating favourable conditions to encourage autonomous motivation by way of feelings of competence, autonomy and a sense of relatedness.

  • 12.
    Dedering, Åsa
    et al.
    Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden .
    Halvorsen, Marie
    Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Cleland, Joshua
    Franklin Pierce University, Denver, CO, USA .
    Svensson, Mikael
    Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden .
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Neck-specific training with a cognitive behavioural approach compared with prescribed physical activity in patients with cervical radiculopathy: a protocol of a prospective randomised clinical trial2014In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 15, no 274Article in journal (Refereed)
    Abstract [en]

    Background: Patients with cervical radiculopathy often have neck- and arm pain, neurological changes, activity limitations and difficulties in returning to work. Most patients are not candidates for surgery but are often treated with different conservative approaches and may be sick-listed for long periods. The purpose of the current study is to compare the effectiveness of neck- specific training versus prescribed physical activity. Methods/Design: The current protocol is a two armed intervention randomised clinical trial comparing the outcomes of patients receiving neck specific training or prescribed physical activity. A total of 144 patients with cervical radiculopathy will be randomly allocated to either of the two interventions. The interventions will be delivered by experienced physiotherapists and last 14 weeks. The primary outcome variable is neck- and arm pain intensity measured with a Visual Analogue Scale accompanied with secondary outcome measures of impairments and subjective health measurements collected before intervention and at 3, 6, 12 and 24 months after base-line assessment. Discussion: We anticipate that the results of this study will provide evidence to support recommendations as to the effectiveness of conservative interventions for patients with cervical radiculopathy.

  • 13.
    Domellöf, Erik
    et al.
    Umeå universitet, Institutionen för psykologi.
    Hedlund, Ludmilla
    Umeå universitet, Institutionen för psykologi.
    Ödman, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Health-related quality of life of children and adolescents with functional disabilities in a northern Swedish county2014In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 23, no 6, p. 1877-1882Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Health-related quality of life (HRQoL) studies in children and adolescents with disabilities tend to report lower self-reported health than in the typical population. However, reports are not always consistent and HRQoL appears to vary depending on diagnosis, cultural setting and clinical context. The aim of this study was to explore HRQoL in children and adolescents with various disabilities in Västerbotten County, Sweden.

    METHODS: A total of 175 children and adolescents [57 girls, 118 boys; mean age 11.7 years (range 7-17 years)] divided into four different diagnostic groups (intellectual disabilities, autism spectrum disorders, movement disorders and hearing disabilities) participated in the study. The EuroQol Five Dimensions Health Questionnaire, Youth version (EQ-5D-Y) was used as HRQoL measure.

    RESULTS: Significant differences in various EQ-5D-Y dimensions between the different diagnostic groups were found, but no differences in overall health status. HRQoL in children and adolescents with hearing disabilities was found similar to the typical child population in Sweden whereas children and adolescents with other diagnoses reported evidently more problems.

    CONCLUSIONS: Findings suggest that there is an increased risk for children with functional disabilities other than hearing disabilities in northern Sweden to experience difficulties in various health domains and lowered general health.

  • 14.
    Eckerblad, Jeanette
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Tödt, Kristina
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Respiratory Medicine.
    Jakobsson, Per
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Respiratory Medicine.
    Unosson, Mitra
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Skargren, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Kentsson, M.
    Ryhov Hospital, Jönköping, Sweden.
    Theander, K.
    Karlstad University, Sweden; Värmland County Council, Karlstad, Sweden.
    Symptom burden in stable COPD patients with moderate or severe airflow limitation2014In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 43, no 4, p. 351-357Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    To describe a multidimensional symptom profile in patients with stable chronic obstructive pulmonary disease (COPD) and determine whether symptom experience differed between patients with moderate or severe airflow limitations.

    BACKGROUND:

    Patients with severe airflow limitation experience numerous symptoms, but little is known regarding patients with moderate airflow limitation.

    METHODS:

    A multidimensional symptom profile (Memorial Symptom Assessment Scale) was assessed in 42 outpatients with moderate and 49 with severe airflow limitations.

    RESULTS:

    The mean number of symptoms in the total sample was 7.9 (±4.3) with no difference between patients with moderate and severe airflow limitations. The most prevalent symptoms with the highest MSAS symptom burden scores were shortness of breath, dry mouth, cough, sleep problems, and lack of energy in both groups.

    CONCLUSIONS:

    Patients with moderate or severe airflow limitations experience multiple symptoms with high severity and distress. An assessment of their multidimensional symptom profile might contribute to better symptom management.

  • 15.
    Ekberg, Kerstin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Wåhlin, Charlotte
    Institute of Environmental Medicine, Karolinska Institutet.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. 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, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Predictive values for early and late return to work of the Work Ability Index (WAI), the single-item question (WAI-1), and EQ-5D among sick listed in musculoskeletal and mental disorders2013Conference paper (Refereed)
  • 16.
    Ekstrand, Jan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Askling, Carl
    Swedish School Sport and Health Science, Sweden .
    Magnusson, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Mithoefer, Kai
    Harvard University, MA USA .
    Return to play after thigh muscle injury in elite football players: implementation and validation of the Munich muscle injury classification2013In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 47, no 12, p. 769-774Article in journal (Refereed)
    Abstract [en]

    Background Owing to the complexity and heterogeneity of muscle injuries, a generally accepted classification system is still lacking. less thanbrgreater than less thanbrgreater thanAims To prospectively implement and validate a novel muscle injury classification and to evaluate its predictive value for return to professional football. less thanbrgreater than less thanbrgreater thanMethods The recently described Munich muscle injury classification was prospectively evaluated in 31 European professional male football teams during the 2011/2012 season. Thigh muscle injury types were recorded by team medical staff and correlated to individual player exposure and resultant time-loss. less thanbrgreater than less thanbrgreater thanResults In total, 393 thigh muscle injuries occurred. The muscle classification system was well received with a 100% response rate. Two-thirds of thigh muscle injuries were classified as structural and were associated with longer lay-off times compared to functional muscle disorders (pandlt;0.001). Significant differences were observed between structural injury subgroups (minor partial, moderate partial and complete injuries) with increasing lay-off time associated with more severe structural injury. Median lay-off time of functional disorders was 5-8 days without significant differences between subgroups. There was no significant difference in the absence time between anterior and posterior thigh injuries. less thanbrgreater than less thanbrgreater thanConclusions The Munich muscle classification demonstrates a positive prognostic validity for return to play after thigh muscle injury in professional male football players. Structural injuries are associated with longer average lay-off times than functional muscle disorders. Subclassification of structural injuries correlates with return to play, while subgrouping of functional disorders shows less prognostic relevance. Functional disorders are often underestimated clinically and require further systematic study.

  • 17.
    Ekstrand, Jan
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Healy, Jeremiah C
    University of London Imperial Coll Science Technology and Med.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lee, Justin C
    University of London Imperial Coll Science Technology and Med.
    English, Bryan
    University of London.
    Hägglund, Martin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy.
    Hamstring muscle injuries in professional football: the correlation of MRI findings with return to play2012In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 46, no 2, p. 112-117Article in journal (Refereed)
    Abstract [en]

    Background Hamstring injury is the single most common injury in professional football. MRI is commonly used to confirm the diagnosis and provide a prognosis of lay-off time. less thanbrgreater than less thanbrgreater thanObjective To evaluate the use of MRI as a prognostic tool for lay-off after hamstring injuries in professional football players and to study the association between MRI findings and injury circumstances. less thanbrgreater than less thanbrgreater thanMethods Prospective cohort study where 23 European professional teams, were followed between 2007 and 2011. Team medical staffs recorded individual player exposure and time-loss injuries. Radiological grading was performed using a modified Peetrons classification into four grades where grades 2 and 3 represent fibre disruption. less thanbrgreater than less thanbrgreater thanResults In total, 516 hamstring injuries occurred and 58% of these were examined by MRI. Thirteen per cent were grade 0 injuries, 57% grade 1, 27% of grade 2 and 3% of grade 3. Grade 0 and 1 injuries accounted for 56% (2141/3830 days) of the total lay-off. The layoff time differed between all four radiological grades of injury (8 +/- 3, 17 +/- 10, 22 +/- 11 and 73 +/- 60 days, p andlt; 0.0001). Eighty-three per cent of injuries affected the biceps femoris while 11% and 5% occurred to the semimembranosus and semitendinosus, respectively. Re-injuries (N=34/207) constituted 16% of injuries. All re-injuries occurred to the biceps femoris. less thanbrgreater than less thanbrgreater thanConclusion MRI can be helpful in verifying the diagnosis of a hamstring injury and to prognosticate layoff time. Radiological grading is associated with lay-off times after injury. Seventy per cent of hamstring injuries seen in professional football are of radiological grade 0 or 1, meaning no signs of fibre disruption on MRI, but still cause the majority of absence days.

  • 18.
    Ekstrand, Jan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Kristenson, Karolina
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Magnusson, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Walden, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Fewer ligament injuries but no preventive effect on muscle injuries and severe injuries: an 11-year follow-up of the UEFA Champions League injury study2013In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 47, no 12, p. 732-+Article in journal (Refereed)
    Abstract [en]

    Background less thanbrgreater than less thanbrgreater thanLimited information is available on the variation in injury rates over multiple seasons of professional football. less thanbrgreater than less thanbrgreater thanAim less thanbrgreater than less thanbrgreater thanTo analyse time-trends in injury characteristics of male professional football players over 11 consecutive seasons. less thanbrgreater than less thanbrgreater thanMethods less thanbrgreater than less thanbrgreater thanA total of 1743 players comprising 27 teams from 10 countries were followed prospectively between 2001 and 2012. Team medical staff recorded individual player exposure and time loss injuries. less thanbrgreater than less thanbrgreater thanResults less thanbrgreater than less thanbrgreater thanA total of 8029 time loss injuries were recorded. The match unavailability due to injury was 14% and constant over the study period. On average, a player sustained two injuries per season, resulting in approximately 50 injuries per team and season. The ligament injury rate decreased during the study period (R-2=0.608, b=-0.040, 95% CI -0.065 to -0.016, p=0.005), whereas the rate of muscle injury (R-2=0.228, b=-0.013, 95% CI -0.032 to 0.005, p=0.138) and severe injury (R-2=0.141, b=0.015, 95% CI -0.013 to 0.043, p=0.255) did not change over the study period. In addition, no changes in injury rates over the 11-year period were found for either training (R-2=0.000, b=0.000, 95% CI -0.035 to 0.034, p=0.988) or match play (R-2=0.282, b=-0.015, 95% CI -0.032 to 0.003, p=0.093). less thanbrgreater than less thanbrgreater thanConclusions less thanbrgreater than less thanbrgreater thanThe injury rate has decreased for ligament injuries over the last 11years, but overall training, match injury rates and the rates of muscle injury and severe injury remain high.

  • 19.
    Ekstrand, Jan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Tornqvist, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Kristenson, Karolina
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Bengtsson, Håkan
    Linköping University, Department of Electrical Engineering, Electronic Devices. Linköping University, The Institute of Technology.
    Magnusson, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Upper extremity injuries in male elite football players2013In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 21, no 7, p. 1626-1632Article in journal (Refereed)
    Abstract [en]

    To investigate the epidemiology of upper extremity injuries in male elite football players and to describe their characteristics, incidence and lay-off times. less thanbrgreater than less thanbrgreater thanBetween 2001 and 2011, 57 male European elite football teams (2,914 players and 6,215 player seasons) were followed prospectively. Time-loss injuries and exposure to training and matches were recorded on individual basis. less thanbrgreater than less thanbrgreater thanIn total, 11,750 injuries were recorded, 355 (3 %) of those affected the upper extremities giving an incidence of 0.23 injuries/1,000 h of football. The incidence in match play was almost 7 times higher than in training (0.83 vs. 0.12 injuries/1,000 h, rate ratio 6.7, 95 % confidence interval 5.5-8.3). As much as 32 % of traumatic match injuries occurred as a result of foul play situations. Goalkeepers had a significantly higher incidence of upper extremity injuries compared to outfield players (0.80 vs. 0.16 injuries/1,000 h, rate ratio 5.0, 95 % confidence interval 4.0-6.2). The average absence due to an upper extremity injury was 23 +/- A 34 days. less thanbrgreater than less thanbrgreater thanUpper extremity injuries are uncommon among male elite football players. Goalkeepers, however, are prone to upper extremity injury, with a five times higher incidence compared to outfield players. less thanbrgreater than less thanbrgreater thanII.

  • 20.
    Ekstrand, Jan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science.
    Timpka, Toomas
    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, Division of Physiotherapy.
    Risk of injury in elite football played on artificial turf versus natural grass: a prospective two-cohort study.2006In: British journal of sports medicine, ISSN 1473-0480, Vol. 40, no 12, p. 975-80Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To compare injury risk in elite football played on artificial turf compared with natural grass.

    DESIGN: Prospective two-cohort study.

    SETTING: Male European elite football leagues.

    PARTICIPANTS: 290 players from 10 elite European clubs that had installed third-generation artificial turf surfaces in 2003-4, and 202 players from the Swedish Premier League acting as a control group.

    MAIN OUTCOME MEASURE: Injury incidence.

    RESULTS: The incidence of injury during training and match play did not differ between surfaces for the teams in the artificial turf cohort: 2.42 v 2.94 injuries/1000 training hours and 19.60 v 21.48 injuries/1000 match hours for artificial turf and grass respectively. The risk of ankle sprain was increased in matches on artificial turf compared with grass (4.83 v 2.66 injuries/1000 match hours; rate ratio 1.81, 95% confidence interval 1.00 to 3.28). No difference in injury severity was seen between surfaces. Compared with the control cohort who played home games on natural grass, teams in the artificial turf cohort had a lower injury incidence during match play (15.26 v 23.08 injuries/1000 match hours; rate ratio 0.66, 95% confidence interval 0.48 to 0.91).

    CONCLUSIONS: No evidence of a greater risk of injury was found when football was played on artificial turf compared with natural grass. The higher incidence of ankle sprain on artificial turf warrants further attention, although this result should be interpreted with caution as the number of ankle sprains was low.

  • 21.
    Engquist, Markus
    et al.
    Department of Orthopaedics, Ryhov Hospital, Sweden and Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Sweden.
    Löfgren, Håkan
    Neuro-Orthopedic Center, Ryhov Hospital, Jönköping, Sweden.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Holtz, Anders
    Department of Neuroscience, Neurosurgery, Uppsala University Hospital, Uppsala, Sweden.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Söderlund, Anne
    Department of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Vavruch, Ludek
    Neuro-Orthopedic Center, Ryhov Hospital, Jönköping, Sweden .
    Lind, Bengt
    Spine Center Göteborg, Gothenburg, Sweden and Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Sweden.
    Surgery Versus Non-Surgical Treatment for Cervical Radiculopathy: A prospective, randomized study comparing surgery plus physiotherapy with physiotherapy alone with a two year follow-up2013In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 38, no 20, p. 1715-1722Article in journal (Refereed)
    Abstract [en]

    Study Design. Prospective randomized controlled trial.Objective. To study the outcome of anterior cervical decompression and fusion (ACDF) combined with a structured physiotherapy program compared to the same physiotherapy program alone for patients with cervical radiculopathy.Summary of Background Data. Knowledge concerning the effects of interventions for patients with cervical radiculopathy is scarce due to a lack of randomized studies.Methods. 63 patients were randomized to surgery with postoperative physiotherapy (n = 31) or physiotherapy alone (n = 32). The surgical group was treated with ACDF. The physiotherapy program included general/specific exercises and pain coping strategies. The outcome measures were disability (Neck Disability Index, NDI), neck- and arm-pain intensity (VAS) and the patient's global assessment. Patients were followed for 24 months.Results. The result from the repeated-measures ANOVA showed no significant between group difference for NDI (p = 0.23).For neck-pain intensity, the repeated-measures ANOVA showed a significant between group difference over the study period in favor of the surgical group (p = 0.039).For arm-pain intensity, no significant between group differences was found according to the repeated-measures ANOVA (p = 0.580).87% of the patients in the surgical group rated their symptoms as "better/much better" at the 12-month follow-up, compared to 62% in the non-surgical group (p<0.05). At 24 months the corresponding figures were 81% and 69% (p = 0.28). The difference was significant only at the 12-month follow-up in favor of the surgical group.Significant reduction in NDI, neck-pain and arm-pain compared to baseline was seen in both groups (p<0.001).Conclusion. In this prospective, randomized study of patients with cervical radiculopathy, it was shown that surgery with physiotherapy resulted in a more rapid improvement during the first postoperative year, with significantly greater improvement in neck pain and the patient's global assessment compared to physiotherapy alone, but the differences between the groups decreased after two years. Structured physiotherapy should be tried before surgery is chosen.

  • 22.
    Engstrand, Christina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Krevers, Barbro
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Nylander, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Hand function and quality of life before and after fasciectomy for Dupuytren contracture2014In: Journal of Hand Surgery-American Volume, ISSN 0363-5023, E-ISSN 1531-6564, Vol. 39, no 7, p. 1333-1343Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    To describe changes in joint motion, sensibility, and scar pliability and to investigate the patients' expectations, self-reported recovery, and satisfaction with hand function, disability, and quality of life after surgery and hand therapy for Dupuytren disease.

    METHODS:

    This prospective cohort study collected measurements before surgery and 3, 6, and 12 months after surgery and hand therapy. Ninety patients with total active extension deficits of 60° or more from Dupuytren contracture were included. Outcomes measures were range of motion; sensibility; scar pliability; self-reported outcomes on expectations, recovery, and satisfaction with hand function; Disabilities of the Arm, Shoulder, and Hand scores; safety and social issues of hand function; physical activity habits; and quality of life with the Euroqol.

    RESULTS:

    The extension deficit decreased, and there was a transient decrease in active finger flexion during the first year after surgery. Sensibility remained unaffected. Generally, patients with surgery on multiple fingers had worse scar pliability. The majority of the patients had their expectations met, and at 6 months, 32% considered hand function as fully recovered, and 73% were satisfied with their hand function. Fear of hurting the hand and worry about not trusting the hand function were of greatest concern among safety and social issues. The Disability of the Arm, Shoulder, and Hand score and the Euroqol improved over time.

    CONCLUSIONS:

    After surgery and hand therapy, disability decreased independent of single or multiple operated fingers. The total active finger extension improved enough for the patients to reach a functional range of motion despite an impairment of active finger flexion still present 12 months after treatment.

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

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

  • 24.
    Fältström, Anne
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Patient-Reported Knee Function, Quality of Life, and Activity Level After Bilateral Anterior Cruciate Ligament Injuries2013In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 41, no 12, p. 2805-2813Article in journal (Refereed)
    Abstract [en]

    Background: About 12% of patients who have undergone primary anterior cruciate ligament (ACL) reconstruction sustain a contralateral ACL injury within 5 years. less thanbrgreater than less thanbrgreater thanPurpose: To investigate patient-reported knee function, quality of life, and activity level in patients with bilateral ACL injuries. less thanbrgreater than less thanbrgreater thanStudy Design: Cohort study; Level of evidence, 3. less thanbrgreater than less thanbrgreater thanMethods: A search of hospital records identified 147 patients, aged 18 to 45 years, with bilateral ACL injuries. Of these, 83 met the inclusion criteria, having had their first ACL injury up to 12 years ago with no other major injuries to the knee joint. Sixty-six of these patients (80% of total; 47% female; mean age, 29.1 7.2 years) answered a questionnaire packet. Patients who had undergone unilateral ACL reconstruction (n = 182) were used for comparison. less thanbrgreater than less thanbrgreater thanResults: Patients with bilateral ACL injuries had a median Lysholm knee score of 82 (range, 34-100). The mean EuroQol index (EQ-5D) score of the overall health status was 0.77 +/- 0.22, and the mean EQ-5D visual analog scale score was 75.5 +/- 17.6. The median Tegner activity level was 9 (range, 1-9) before any injuries, 7 (range, 1-9) before the second ACL injury, and 4 (range, 1-9) at the time of follow-up. The activity level before the second injury was higher compared with the follow-up for patients who had undergone unilateral ACL reconstruction. At follow-up, 23% of the patients with bilateral ACL injuries returned to their previous activity, and 12% of patients returned to the same level as before their injuries compared with 43% (P = .004) and 28% (P = .01) in patients who had undergone unilateral ACL reconstruction, respectively. Patients with bilateral ACL injuries had significantly lower values in the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales for pain, function in sports and recreation, and knee-related quality of life as well as the ACL Deficiency Quality of Life (ACL-QOL) score compared with patients who had undergone unilateral ACL reconstruction. less thanbrgreater than less thanbrgreater thanConclusion: Patients with bilateral ACL injuries reported poorer knee function and quality of life compared with those who had undergone unilateral ACL reconstruction. Their activities had changed, and they were dissatisfied with their current activity level. They had a high activity level before their first and second ACL injuries but an impaired activity level after their contralateral injury at follow-up.

  • 25.
    Gajhede-Knudsen, Mariann
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Magnusson, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Maffulli, Nicola
    University of Salerno, Italy .
    Recurrence of Achilles tendon injuries in elite male football players is more common after early return to play: an 11-year follow-up of the UEFA Champions League injury study2013In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 47, no 12, p. 763-768Article in journal (Refereed)
    Abstract [en]

    Background There is limited information about Achilles tendon disorders in professional football. less thanbrgreater than less thanbrgreater thanAims To investigate the incidence, injury circumstances, lay-off times and reinjury rates of Achilles tendon disorders in male professional football. less thanbrgreater than less thanbrgreater thanMethods A total of 27 clubs from 10 countries and 1743 players have been followed prospectively during 11 seasons between 2001 and 2012. The team medical staff recorded individual player exposure and time-loss injuries. less thanbrgreater than less thanbrgreater thanResults A total of 203 (2.5% of all injuries) Achilles tendon disorders were registered. A majority (96%) of the disorders were tendinopathies, and nine were partial or total ruptures. A higher injury rate was found during the preseason compared with the competitive season, 0.25 vs 0.18/1000 h (rate ratio (RR) 1.4, 95% CI 1.1 to 2.0; p=0.027). The mean lay-off time for Achilles tendinopathies was 23 +/- 37 (median=10, Q(1)=4 and Q(3)=24) days, while a rupture of the Achilles tendon, on average, caused 161 +/- 65 (median=169, Q(1)=110 and Q(3)=189) days of absence. Players with Achilles tendon disorders were significantly older than the rest of the cohort, with a mean age of 27.2 +/- 4 years vs 25.6 +/- 4.6 years (pandlt;0.001). 27% of all Achilles tendinopathies were reinjuries. A higher reinjury risk was found after short recovery periods (31%) compared with longer recovery periods (13%) (RR 2.4, 95% CI 2.1 to 2.8; pandlt;0.001). less thanbrgreater than less thanbrgreater thanConclusions Achilles tendon disorders account for 3.8% of the total lay-off time and are more common in older players. Recurrence is common after Achilles tendinopathies and the reinjury risk is higher after short recovery periods.

  • 26.
    Gauffin, Håkan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Tagesson (Sonesson), Sofi
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Meunier, Andreas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Magnusson, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Knee arthroscopic surgery is beneficial to middle-aged patients with meniscal symptoms: a prospective, randomised, single-blinded study2014In: Osteoarthritis and Cartilage, ISSN 1063-4584, E-ISSN 1522-9653, Vol. 22, no 11, p. 1808-1816Article in journal (Refereed)
    Abstract [en]

    Objective: There is no evidence that a knee arthroscopy is more beneficial to middle-aged patients with meniscal symptoms compared to other treatments. This randomised controlled trial aimed to determine whether an arthroscopic intervention combined with a structured exercise programme would provide more benefit than a structured exercise programme alone for middle-aged patients with meniscal symptoms that have undergone physiotherapy. Method: 150 out of 179 eligible patients, aged 45 to 64 (mean: 54 +/- 5), symptom duration more than 3 months and standing X-ray with Ahlback grade 0, were randomised to: (1) a physiotherapy appointment within 2 weeks of inclusion that included instructions for a 3-month exercise programme (non-surgery group); or (2) the same as (1) plus, within 4 weeks of inclusion, knee arthroscopy for resection of any significant meniscal injuries (surgery group). The primary outcome was change in pain at 12 months, assessed with the Knee Injury and Osteoarthritis Outcome Score (KOOSPAIN). Results: In the Intention-To-Treat analysis, pain at 12 months was significantly lower in the surgery than in the non-surgery group. The change in KOOSPAIN was significantly larger in the surgery than in the non-surgery group (between-group difference was 10.6 points of change; 95% CI: 3.4 to 17.7, P = 0.004). The As-Treated analysis results were consistent with the Intention-To-Treat analysis results. Conclusion: Middle-aged patients with meniscal symptoms may benefit from arthroscopic surgery in addition to a structured exercise programme. Patients age or symptom history (i.e., mechanical symptoms or acute onset of symptoms) didnt affect the outcome.

  • 27.
    Gustafsson, Sebastian
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy.
    Svensson (Öberg), Emanuel
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy.
    Effekt av kylbehandling på träningsvärk, muskelflexibilitet, låromfång och styrka i m. quadriceps femoris efter högintensiv, excentrisk träning: En experimentell studie2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background

    Delayed onset muscle soreness (DOMS) is common after unaccustomed, eccentric or high-intensity exercise. Swelling, soreness, impaired muscle function and joint mobility are associated with DOMS. There are several types of treatment strategies to relieve these symptoms. However, there is a discrepancy in the literature regarding the effect of these treatments.

     

    Objective

    The purpose was to investigate how a cold bandage applied on quadriceps femoris immediate after performed high-intensity exercise, affects strength, muscle flexibility and perceived DOMS 48 hours post-exercise.

     

    Methods

    Nineteen subjects were recruited. At the first occasion thigh circumference, Ely’s test and DOMS were evaluated. Peak torque and average peak torque were measured with a training device at 60°/s and 180°/s. The participants underwent a strengthening exercise protocol consisting of concentric/eccentric components. The left quadriceps femoris was then treated with a cold bandage for 60 minutes. All tests were repeated 48 hours post-exercise. Muscle flexibility, thigh circumference, strength and perceived DOMS were evaluated.

     

    Results

    There was significantly less self-estimated DOMS in the treated leg compared to the untreated, during an active extension of the knee. There was a significant increase of the average peak torque in the untreated leg at 180°/s. No significant difference was obtained regarding muscle flexibility, self-estimated DOMS during Ely’s test, peak torque or total work.

     

    Conclusion

    A cold bandage applied on quadriceps femoris after high-intensity exercise may be effective as treatment of self-estimated DOMS, but has no beneficial effect on the loss of function. Further research is required to establish the effect of the treatment strategy.

  • 28.
    Gutke, Annelie
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Olsson, Christina B.
    Stockholm County Council, Sweden Karolinska Institute, Sweden .
    Vollestad, Nina
    Oslo University, Norway.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Nilsson Wikmar, Lena
    Karolinska Institute, Sweden .
    Stendal Robinson, Hilde
    University of Oslo, Norway .
    ASSOCIATION BETWEEN LUMBOPELVIC PAIN, DISABILITY AND SICK LEAVE DURING PREGNANCY - A COMPARISON OF THREE SCANDINAVIAN COHORTS2014In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, no 5, p. 468-474Article in journal (Refereed)
    Abstract [en]

    Objective: To explore the association between disability and sick leave due to lumbopelvic pain in pregnant women in 3 cohorts in Sweden and Norway and to explore possible factors of importance to sick leave. A further aim was to compare the prevalence of sick leave due to lumbopelvic pain. Design/subjects: Pregnant women (n=898) from two cohorts in Sweden and one in Norway answered to questionnaires in gestational weeks 10-24; two of the cohorts additionally in weeks 28-38. Methods: Logistic regression models were performed with sick leave due to lumbopelvic pain as dependent factor. Disability, pain, age, parity, cohort, civilian status, and occupational classification were independents factors. Results: In gestational weeks 10-24 the regression model included 895 cases; 38 on sick leave due to lumbopelvic pain. Disability, pain and cohort affiliation were associated with sick leave. In weeks 28-38, disability, pain and occupation classification were the significant factors. The prevalence of lumbopelvic pain was higher in Norway than in Sweden (65%, vs 58% and 44%; pless than0.001). Conclusion: Disability, pain intensity and occupation were associated to sick leave due to lumbopelvic pain. Yet, there were significant variations between associated factors among the cohorts, suggesting that other factors than workability and the social security system are also of importance.

  • 29.
    Halvorsen, Marie
    et al.
    Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden .
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden; Bond University, Gold Coast, Australia .
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. University of Queensland, Brisbane, Australia .
    Dedering, Åsa
    Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden .
    Endurance and fatigue characteristics in the neck muscles during sub-maximal isometric test in patients with cervical radiculopathy2014In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 23, no 3, p. 590-598Article in journal (Refereed)
    Abstract [en]

    Purpose

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

    Methods

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

    Results

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

    Conclusion

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

  • 30.
    Halvorsen, Marie
    et al.
    Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
    Abbott, Allan
    Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Stephansson-Dedering, Åsa
    Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
    Endurance and fatigue characteristics of static test of the neck muscles in patients with cervical radiculopathy2012In: Proceedings of the XIXth Congress of the International Society of Electrophysiology and Kinesiology / [ed] Kylie Tucker; Bianca Butler; Paul Hodges, The International Society of Electrophysiology and Kinesiology (ISEK) , 2012, p. 55-55Conference paper (Other academic)
    Abstract [en]

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

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

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

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

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

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

  • 31.
    Hermansen, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Cleland, Joshua A.
    Franklin Pierce University, NH USA .
    Kammerlind, Ann-Sofi
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Peolsson, L.C.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Evaluation of Physical Function in Individuals 11 to 14 Years after AnteriorCervical Decompression and Fusion Surgery: A Comparison betweenPatients and Healthy Reference Samples and Between 2 Surgical Techniques2014In: Journal of Manipulative and Physiological Therapeutics, ISSN 0161-4754, E-ISSN 1532-6586, Vol. 37, no 2, p. 87-96Article in journal (Refereed)
    Abstract [en]

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

  • 32.
    Hermansen, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Hedlund, Rune
    Sahlgrens University Hospital.
    Vavruch, Ludek
    Ryhov Hospital.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    A Comparison Between the Carbon Fiber Cage and the Cloward Procedure in Cervical Spine Surgery A Ten- to Thirteen-Year Follow-Up of a Prospective Randomized Study2011In: SPINE, ISSN 0362-2436, Vol. 36, no 12, p. 919-925Article in journal (Refereed)
    Abstract [en]

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

  • 33.
    Hermansen, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Hedlund, Rune
    Sahlgrens University Hospital, Sweden .
    Vavruch, Ludek
    Ryhov Hospital, Sweden .
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Positive predictive factors and subgroup analysis of clinically relevant improvement after anterior cervical decompression and fusion for cervical disc disease: a 10-to 13-year follow-up of a prospective randomized study Clinical article2013In: Journal of Eurosurgery : Spine, ISSN 1547-5654, E-ISSN 1547-5646, Vol. 19, no 4, p. 403-411Article in journal (Refereed)
    Abstract [en]

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

  • 34.
    Holmgren, Theresa
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Björnsson Hallgren, Hanna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Adolfsson, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Johansson, Kajsa
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Republished research: Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study2014In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 48, no 19, p. 1456-1457Article in journal (Other academic)
    Abstract [en]

    STUDY QUESTION Can a specific exercise strategy improve shoulder function and pain in patients with subacromial impingement syndrome, thereby decreasing the need for arthroscopic subacromial decompression? SUMMARY ANSWER Compared with a control exercise group, patients in the specific exercise group had significantly greater improvements in shoulder function and pain and fewer patients needed surgery at the three month assessment. WHAT IS KNOWN AND WHAT THIS PAPER ADDS Different exercise programmes are used as first line treatment in patients with subacromial impingement syndrome, but conclusive evidence to support the efficacy for these programmes is lacking. This specific exercise strategy proved effective in improving shoulder function and pain in patients in whom earlier conservative treatment had failed.

  • 35.
    Holmgren, Theresa
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Björnsson Hallgren, Hanna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Adolfsson, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Johansson, Kajsa
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Republished research: Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study2013In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 47, no 14, p. 908-908Article in journal (Other academic)
    Abstract [en]

    Study question

    Can a specific exercise strategy improve shoulder function and pain in patients with subacromial impingement syndrome, thereby decreasing the need for arthroscopic subacromial decompression?

    Summary answer

    Compared with a control exercise group, patients in the specific exercise group had significantly greater improvements in shoulder function and pain and fewer patients needed surgery at the three month assessment.

    What is known and what this paper adds

    Different exercise programmes are used as first line treatment in patients with subacromial impingement syndrome, but conclusive evidence to support the efficacy for these programmes is lacking. This specific exercise strategy proved effective in improving shoulder function and pain in patients in whom earlier conservative treatment had failed.

  • 36.
    Holmgren, Theresa
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of 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.
    Adolfsson, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Johansson, Kajsa
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Minimal important changes in the Constant Murley score in patients with subacromial pain2014In: Journal of shoulder and elbow surgery, ISSN 1058-2746, E-ISSN 1532-6500, Vol. 23, no 8, p. 1083-1090Article in journal (Refereed)
    Abstract [en]

    Objective: The purpose of this study was to determine the minimal important change (MIC) of improvement in the Constant‐Murley score (CM score) in patients with longstanding subacromial pain and in subgroups of patients with subacromial pain with and without rotator cuff ruptures.

    Method: The MIC was estimated by using the visual anchor‐based MIC distribution method, which integrates an anchor‐ and distribution‐based approach: the optimal cut‐off point of the receiver operator characteristic curve (MIC ROC) and the 95% limit cut‐ off point (MIC 95%limit). The study population consisted of 93 patients included in a randomized clinical trial evaluating the effect of a specific exercise strategy in patients with longstanding subacromial pain.

    Results: The MIC ROC was found at a mean change of 17 points in the CM score. The MIC 95% limit was found at a mean change of 24 points. In the subgroup analysis the MIC ROC was found at a mean change of 19 points and the MIC 95% limit at 18 points in patients with an intact rotator cuff. In patients with rotator cuff ruptures the MIC ROC was found at a mean change of 15 points and the MIC 95% limit at 30 points.

    Conclusion: The CM score is able to detect the minimal important change in individual patients with long‐standing subacromial pain when the rotator cuff is intact. In all patients with longstanding subacromial pain, the MIC value was dependent on the subgroup as well as the choice of statistical analysis. The estimated MIC values could be used as an indication for relevant changes in the CM score in clinical practice and guide the clinician in how to interpret the results of specific treatments for patients with longstanding subacromial pain.

  • 37.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Atroshi, Isam
    Lund University, Sweden.
    Wagner, Philippe
    Lund University, Sweden.
    Walden, Markus
    Hassleholm Kristianstad Ystad Hospital, Sweden.
    Superior compliance with a neuromuscular training programme is associated with fewer ACL injuries and fewer acute knee injuries in female adolescent football players: secondary analysis of an RCT2013In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 47, no 15, p. 974-979Article in journal (Refereed)
    Abstract [en]

    Background Little is known about the influence of compliance with neuromuscular training (NMT) on the knee injury rate in football.

    Aim To evaluate team and player compliance with an NMT programme in adolescent female football and to study the association between compliance and acute knee injury rates.

    Methods Prospective cohort study based on a cluster randomised controlled trial on players aged 12–17 years with 184 intervention teams (2471 players) and 157 control teams (2085 players). Exposure and acute time loss knee injuries were recorded. Team and player compliance was recorded by the coaches on a player attendance form. The intervention group was divided into tertiles of compliance. Injury rates were compared by calculating rate ratios (RRs) and 95% CIs using exact Poisson tests with the low-compliance tertile as reference. Seasonal compliance trends were analysed using linear regression.

    Results Players in the high-compliance tertile had an 88% reduction in the anterior cruciate ligament (ACL) injury rate (RR 0.12, 95% CI 0.01 to 0.85), whereas the rate in the control group players was not significantly different from those in the low-compliance tertile (RR 0.77, 95% CI 0.27 to 2.21). A significant deterioration occurred in team (b=−3.0% per month, 95% CI −5.2 to −0.8) and player (b=−5.0% per month, 95% CI −7.1 to −2.9) compliance over the season.

    Conclusions Players with high compliance with the NMT programme had significantly reduced ACL injury rate compared with players with low compliance. Significant deterioration in team and player compliance occurred over the season.

  • 38.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Walden, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Magnusson, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Kristenson, Karolina
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Bengtsson, Hakan
    Football Research Group, Linköping University, Linköping, Sweden.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Injuries affect team performance negatively in professional football: an 11-year follow-up of the UEFA Champions League injury study2013In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 47, no 12, p. 738-742Article in journal (Refereed)
    Abstract [en]

    Background The influence of injuries on team performance in football has only been scarcely investigated.

    Aim To study the association between injury rates and team performance in the domestic league play, and in European cups, in male professional football.

    Methods 24 football teams from nine European countries were followed prospectively for 11 seasons (2001–2012), including 155 team-seasons. Individual training and match exposure and time-loss injuries were registered. To analyse the effect of injury rates on performance, a Generalised Estimating Equation was used to fit a linear regression on team-level data. Each team's season injury rate and performance were evaluated using its own preceding season data for comparison in the analyses.

    Results 7792 injuries were reported during 1 026 104 exposure hours. The total injury incidence was 7.7 injuries/1000 h, injury burden 130 injury days lost/1000 h and player match availability 86%. Lower injury burden (p=0.011) and higher match availability (p=0.031) were associated with higher final league ranking. Similarly, lower injury incidence (p=0.035), lower injury burden (p<0.001) and higher match availability (p<0.001) were associated with increased points per league match. Finally, lower injury burden (p=0.043) and higher match availability (p=0.048) were associated with an increase in the Union of European Football Association (UEFA) Season Club Coefficient, reflecting success in the UEFA Champions League or Europa League.

    Conclusions Injuries had a significant influence on performance in the league play and in European cups in male professional football. The findings stress the importance of injury prevention to increase a team's chances of success.

  • 39.
    Kammerlind, Ann-Sofi
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Fristedt, Sofi
    Jonköping University, Sweden .
    Ernsth Bravell, Marie
    Jonköping University, Sweden .
    Fransson, Eleonor I.
    Jonköping University, Sweden Karolinska Institute, Sweden .
    Test-retest reliability of the Swedish version of the Life-Space Assessment Questionnaire among community-dwelling older adults2014In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 28, no 8, p. 817-823Article in journal (Refereed)
    Abstract [en]

    Objective: To examine the test-retest reliability of the Swedish version of the Life-Space Assessment Questionnaire. Design: Test-retest reliability study. Subjects: A total of 298 community-dwelling subjects between 75 and 90 years of age. Methods: The Life-Space Assessment Questionnaire was translated into Swedish. By personal interviews during home visits and two weeks later by telephone interviews the subjects were asked about their life-space mobility during the past four weeks, and how often and whether they were independent or needed assistance from another person or equipment to reach different life-space levels. Results: None of the four scoring methods showed significant difference between test sessions. The mean (SD) total scores were 65 (22) and 65 (23) out of the maximum possible score of 120 at the two sessions. High levels were found for independent, assisted, and maximal life-space at both sessions. Intraclass correlation coefficients and weighted Kappa-values between 0.84-0.94 were found for the total score, the independent, and the assisted life-space levels, indicating good to excellent reliability. A lower Kappa-value was observed for the maximal life-space level, mainly owing to skewed distributions. The method error values showed that a change of 10 in the total score and a change of one level in any of the three life-space levels can be considered to indicate a real change in clinical practice. Conclusion: The Swedish version of the Life-Space Assessment Questionnaire can be reliably used among community-dwelling older adults.

  • 40.
    Kristenson, Karolina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Bjørneboe, John
    Norwegian School Sport Science, Norway.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Andersen, Thor Einar
    Norwegian School Sport Science, Norway.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    The Nordic Football Injury Audit: higher injury rates for professional football clubs with third-generation artificial turf at their home venue2013In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 47, no 12, p. 775-781Article in journal (Refereed)
    Abstract [en]

    Background Previously, no difference in acute injury rate has been found when playing football on artificial turf (AT) compared with natural grass (NG).

    Aim To compare acute injury rates in professional football played on AT and NG at the individual player level; and to compare, at club level, acute and overuse injury rates between clubs that have AT at their home venue (AT clubs) and clubs that have NG (NG clubs).

    Methods 32 clubs (AT, n=11; NG, n=21) in the male Swedish and Norwegian premier leagues were followed prospectively during the 2010 and 2011 seasons. Injury rate was expressed as the number of time loss injuries/1000 h and compared with rate ratio (RR) and 99% CI.

    Results No statistically significant differences were found in acute injury rates on AT compared with NG during match play (RR 0.98, 99% CI 0.79 to 1.22) or training (RR 1.14, 99% CI 0.86 to 1.50) when analysing at the individual player level. When analysing at the club level, however, AT clubs had a significantly higher acute training injury rate (RR 1.31, 99% CI 1.04 to 1.63) and overuse injury rate (RR 1.38, 99% CI 1.14 to 1.65) compared with NG clubs.

    Conclusions At the individual player level, no significant differences were found in acute injury rates when playing on AT compared with NG. However, clubs with AT at their home venue had higher rates of acute training injuries and overuse injuries compared with clubs that played home matches on NG.

  • 41.
    Kristenson, Karolina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Lower Injury Rates for Newcomers to Professional Soccer: a Prospective Cohort Study over Nine Consecutive Seasons2013In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 41, no 6, p. 1419-1425Article in journal (Refereed)
    Abstract [en]

    Background: No study has investigated whether newcomers to professional soccer have a different injury rate than established players.                     

    Purpose: The primary objective was to investigate whether being a newcomer to professional soccer influences injury rates. The secondary objective was to evaluate whether playing position and player age influence injury rates.                     

    Study Design: Cohort study; Level of evidence, 2.                     

    Methods: Twenty-six soccer clubs, with 1401 players, were followed prospectively over 9 consecutive seasons between 2001 and 2010. Club medical staff recorded time-loss injuries and soccer exposure on an individual level. Cox regression analyses were used to evaluate associations between time-loss injuries and time in professional soccer, playing position, and age.                     

    Results: In total, 6140 injuries and 797,389 hours of exposure were registered. A decreased general injury rate was observed for newcomers (n = 116) compared with established players (n = 3091) (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.61-0.99). In contrast, newcomers had a higher rate of fractures (rate ratio [RR], 1.77; 95% CI, 1.05-2.97), especially stress-related bone injuries (RR, 2.68; 95% CI, 1.08-6.69). Using goalkeepers as a reference, all outfield playing positions had significantly higher adjusted injury rates: defenders with an HR of 1.91 (95% CI, 1.64-2.24), midfielders with an HR of 1.78 (95% CI, 1.53-2.07), and forwards with an HR of 1.82 (95% CI, 1.55-2.14). Using players aged ≤21 years as a reference, the overall adjusted injury rate increased with age, with a peak injury rate among players aged 29 to 30 years (HR, 1.44; 95% CI, 1.24-1.68).                     

    Conclusion: Newcomers to professional soccer had a lower general injury rate than established players but a higher rate of stress-related bone injuries. Being a goalkeeper was associated with lower injury rates than all outfield playing positions. Injury rates increased with age, a pattern that persisted after adjusting for playing position and match exposure.

  • 42.
    Kvist, Joanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Kartus, Juri
    NU Hospital Group, Trollhättan/Uddevalla, Sweden.
    Karlsson, Jon
    University of Gothenburg, Sweden .
    Forssblad, Magnus
    Karolinska Institutet, and Capio Artro Clinic AB, Sophiahemmet, Stockholm, Sweden .
    Results From the Swedish National Anterior Cruciate Ligament Register2014In: Arthroscopy: The Journal of Arthroscopy And Related, ISSN 0749-8063, E-ISSN 1526-3231, Vol. 30, no 7, p. 803-810Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    The purpose of the study was to analyze the baseline variables and clinical outcomes for almost 24,000 patients entered into the Swedish National ACL Register between January 2005 and December 2012.

    METHODS:

    The register consists of 2 parts: 1 section in which surgeons report baseline and surgical data and 1 section in which patients report the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the EQ-5D score before and 1, 2, and 5 years after surgery.

    RESULTS:

    By December 2012, 23,744 patients had been entered into the surgeons' part of the register. The female-male ratio in the register is 42:58. The mean age at primary anterior cruciate ligament (ACL) reconstruction was 26 years (SD, 11 years) and 28 years (SD, 9 years) for the female and male patients, respectively. The ACL injury occurred during soccer in 36% of the female patients and 49% of the male patients. In 2012, 95% of the primary ACL reconstructions were performed using hamstring tendon autografts. For patients who had a minimum of 5 years' follow-up, the revision rate was 3.3% and the contralateral reconstruction rate was 3.8%. On all follow-up occasions up to 5 years, patients who had undergone revision had a significantly (P < .001) poorer outcome than those who had undergone primary unilateral ACL reconstructions in all KOOS and EQ-5D dimensions. On all follow-up occasions, smokers obtained significantly poorer scores than nonsmokers in terms of both the KOOS (P < .008) and the EQ-5D (P < .024).

    CONCLUSIONS:

    Soccer is the most common cause of injury in both female and male patients, and patients undergoing revisions fare less well than those undergoing primary unilateral ACL reconstructions, as well as bilateral reconstructions. Furthermore, smokers fare less well than nonsmokers. The cumulative risk of an ACL revision or contralateral ACL reconstruction during a 5-year period is approximately 7%. For patients aged younger than 19 years, the cumulative risk is significantly higher.

    LEVEL OF EVIDENCE:

    Level II, retrospective prognostic study.

  • 43.
    Kvist, Joanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Österberg, Annika
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Gauffin, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Tagesson (Sonesson), Sofi
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Webster, K
    La Trobe University, Australia .
    Ardern, C
    La Trobe University, Australia .
    Translation and measurement properties of the Swedish version of ACL-Return to Sports after Injury questionnaire2013In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 23, no 5, p. 568-575Article in journal (Refereed)
    Abstract [en]

    Psychological factors may be a hindrance for returning to sport after an anterior cruciate ligament (ACL) reconstruction. The ACL-Return to Sport after Injury scale (ACL-RSI) measures athletes emotions, confidence in performance, and risk appraisal in relation to return to sport. The aim of this study was to translate the ACL-RSI scale from English to Swedish and to examine some of the measurement properties of the Swedish version. The ACL-RSI was translated and culturally adapted. A professional expert group and five patients evaluated face validity. One hundred and eighty-two patients completed the translated ACL-RSI, a project-specific questionnaire, the Tampa Scale of Kinesiophobia (TSK), the Knee-Self-Efficacy Scale (K-SES), the Multidimensional Health Locus of Control (MHLC-C), the Knee injury and Osteoarthritis Outcome Score (KOOS), and the Anterior Cruciate Ligament-Quality of Life (ACL-QoL) questionnaires. Fifty-three patients answered the ACL-RSI twice to examine reproducibility. The ACL-RSI showed good face validity, internal consistency (Cronbachs alpha=0.948), low floor and ceiling effects and high construct validity when evaluated against the TSK, K-SES, MHLC-C, KOOS, and ACL-QoL scales. The reproducibility was also high (intra-class correlation=0.893). Therefore, the ACL-RSI can be used to evaluate psychological factors relevant to returning to sport after ACL reconstruction surgery.

  • 44.
    Kyhlbäck, Maria
    et al.
    Sjukgymnastikavdelningen, Akademiska sjukhuset, Uppsala.
    Kjellby Wendt, Gunilla
    Sjukgymnastik och Arbetsterapiverksamheten, Sahlgrenska Universitetssjukhuset, Göteborg.
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Sjukgymnastikkliniken, Karolinska Universitetssjukhuset, Huddinge.
    Millisdotter, Monica
    VO Rehabiliteringsmedicin, Universitetssjukhuset i Lund.
    Grönlund, Per
    Ortopedens ryggkirurgiska mottagning, Östersund.
    Johansson, Mia
    Ortopedkliniken, Norrlands Universitets Sjukhus, Umeå.
    Johansson, Ann -Christin
    Mälardalens Högskola/Centrum för klinisk forskning, Centrallasarettet, Västerås.
    Postoperativ rehabilitering vid ländryggsdiskbråck2011In: Fysioterapi, ISSN 1653-5804, no 1, p. 32-37Article in journal (Refereed)
    Abstract [en]

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

  • 45.
    Landén Ludvigsson, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Primary Health Care in Motala.
    Enthoven, Paul
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Evaluation of physiotherapists as primary assessors of patients with musculoskeletal disorders seeking primary health care2012In: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 98, no 2, p. 131-137Article in journal (Refereed)
    Abstract [en]

    Objectives To evaluate primary physiotherapist assessment and management of patients with musculoskeletal disorders in primary care, and to compare patient satisfaction with primary assessment by a physiotherapist or a general practitioner (GP). less thanbrgreater than less thanbrgreater thanDesign An observational, retrospective cohort study reviewing medical records, and a separate consecutive non-randomised study of patient satisfaction. less thanbrgreater than less thanbrgreater thanSetting Primary healthcare centre. less thanbrgreater than less thanbrgreater thanParticipants Four hundred and thirty-two patients with musculoskeletal disorders, primarily assessed by a physiotherapist. Fifty-one of these patients primarily assessed by a physiotherapist and 42 patients assessed by a GP answered a patient satisfaction questionnaire. less thanbrgreater than less thanbrgreater thanInterventions Primary assessment and management of patients with musculoskeletal disorders. less thanbrgreater than less thanbrgreater thanMain outcome measures Data from medical records within 3-month after the visit, and patient satisfaction questionnaire. less thanbrgreater than less thanbrgreater thanResults Eighty-five percent (367/432) of patients did not need to see a GP. Serious pathologies were found among the 6% (26/432) of patients who were referred to a GP by a physiotherapist, but no serious pathologies were found among the 9% (39/432) of patients who subsequently returned for a GP appointment for the same disorder. Patients assessed by a physiotherapist were more satisfied with the information received about their disorder and self-care than patients assessed by a GP. Patients also had higher confidence in the ability of physiotherapists to assess their disorder (P andlt; 0.002). less thanbrgreater than less thanbrgreater thanConclusion Physiotherapists can be considered primary assessors of patients with musculoskeletal disorders in primary care as few patients needed additional assessment by a GP, patients with confirmed serious pathologies were identified by the physiotherapists, and patients were satisfied with assessment by a physiotherapist.

  • 46.
    Linde, Elin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Gustafsson, Lina
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Sjukgymnasters upplevelser av arbete på särskilt boende för äldre: En intervjustudie2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: The conditions for the physiotherapists’ work in housing for the elderly vary depending on number of care recipients, the availability of the physiotherapists and the resources provided at the county level in Sweden. Previous studies have shown that the lack of resources makes the work difficult for the physiotherapists. Moreover, it is hard to meet the needs of individual care recipients when physiotherapists have the medical rehabilitation responsibility for a large number of care recipients. Rehabilitation is carried out on a specific level and a general level and often delegated to care assistants. Purpose: The aim of this study was to examine physiotherapists’ perceptions of their work in housing for the elderly. Method: Seven physiotherapists working in houses for the elderly were interviewed with the help of a semi-structured interview guide. The interviews were analyzed with qualitative content analysis. Results: The analysis revealed five categories: controlling factors, priorities, cooperation around the care recipient, the breadth of the work and self-image and status. Conclusion: The participants’ perceptions of work in housing for the elderly were that the job was fun and varied but influenced by stress and lack of resources. The work was perceived as consisting of a lot of prioritizing; however, the grounds on which the decisions were made varied as did the perception of support from guidelines. The participants reported that they desired a well-functioning working relationship with the care assistants because the physiotherapy inputs were often delegated to them.

  • 47.
    Lundblad, Matilda
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Walden, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Magnusson, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Karlsson, Jon
    Sahlgrenska University, Sweden .
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    The UEFA injury study: 11-year data concerning 346 MCL injuries and time to return to play2013In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 47, no 12, p. 759-+Article in journal (Refereed)
    Abstract [en]

    Background Medial collateral ligament (MCL) injury is the most common knee ligament injury in professional football. less thanbrgreater than less thanbrgreater thanAim To investigate the rate and circumstances of MCL injuries and development over the past decade. less thanbrgreater than less thanbrgreater thanMethods Prospective cohort study, in which 27 professional European teams were followed over 11 seasons (2001/2002 to 2011/2012). Team medical staffs recorded player exposure and time loss injuries. MCL injuries were classified into four severity categories. Injury rate was defined as the number of injuries per 1000 player-hours. less thanbrgreater than less thanbrgreater thanResults 346 MCL injuries occurred during 1057 201 h (rate 0.33/1000 h). The match injury rate was nine times higher than the training injury rate (1.31 vs 0.14/1000 h, rate ratio 9.3, 95% CI 7.5 to 11.6, pandlt;0.001). There was a significant average annual decrease of approximately 7% (p=0.023). The average lay-off was 23 days, and there was no difference in median lay-off between index injuries and reinjuries (18 vs 13, p=0.20). Almost 70% of all MCL injuries were contact-related, and there was no difference in median lay-off between contact and non-contact injuries (16 vs 16, p=0.74). less thanbrgreater than less thanbrgreater thanConclusions This largest series of MCL injuries in professional football suggests that the time loss from football for MCL injury is 23 days. Also, the MCL injury rate decreased significantly during the 11-year study period.

  • 48.
    McAllister, Anita
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Aanstoot, Janna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences.
    Lundeborg Hammarström, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences.
    Samuelsson, Christina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences.
    Johannesson, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Sandström, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Berglind, Ulrika
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Learning in the tutorial group: A balance between individual freedom and institutional control2014In: Clinical Linguistics & Phonetics, ISSN 0269-9206, E-ISSN 1464-5076, Vol. 28, no 1-2, p. 47-59Article in journal (Refereed)
    Abstract [en]

    The study investigates factors in problem-based learning tutorial groups which promote or inhibit learning. The informants were tutors and students from speech-language pathology and physiotherapy programmes. Semi-structured focus-group interviews and individual interviews were used. Results revealed three themes: Responsibility, Time and Support. Under responsibility, the delicate balance between individual and institutional responsibility and control was shown. Time included short and long-term perspectives on learning. Under support, supporting documents, activities and personnel resources were mentioned. In summary, an increased control by the program and tutors decreases students motivation to assume responsibility for learning. Support in tutorial groups needs to adapt to student progression and to be well aligned to tutorial work to have the intended effect. A lifelong learning perspective may help students develop a meta-awareness regarding learning that could make tutorial work more meaningful.

  • 49.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Bernhardsson, Susanne
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Towards evidence-based physiotherapy - research challenges and needs2013In: Journal of Physiotherapy, ISSN 1836-9553, E-ISSN 1836-9561, Vol. 59, no 3, p. 143-144Article in journal (Other academic)
    Abstract [en]

    The evidence-based practice (EBP) movement has gained ground steadily in physiotherapy over the past decade. Influential researchers and clinicians have argued that physiotherapists have a moral and professional obligation to move away from assessment and treatment methods based on anecdotal testimonies or opinion (Grimmer-Somers 2007). However, the growing volume of high-quality clinical research makes it difficult for clinicians to keep pace with the latest evidence. Simultaneously, the practice of physiotherapy has become increasingly complex due to changes in health care systems that entail higher demands on physiotherapists to provide effective and efficient management of patients amidst high patient turnover.

  • 50.
    Nilsing Strid, Emma
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Söderberg, Elsy
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. 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.
    Sickness certificates: what information do they provide about rehabilitation?2014In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 36, no 15, p. 1299-1304Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate whether patients are prescribed rehabilitation early in a new sick leave period, and whether this prescription is associated with age, sex, diagnosis, description of functioning, and affiliation of certifying physician.

    Methods: A cross-sectional study using data from sickness certificates issued during a total sick leave period, collected consecutively during 2 weeks in 2007 in Östergötland County, Sweden. Rehabilitation prescribed in the first certificate or within 28 days after the start of sick leave was defined as early rehabilitation.

    Results: Musculoskeletal diseases (MSD) were the largest diagnostic group, followed by mental disorders (MD). The mean certified duration of sick leave was 94 days (SD 139), longest for MD patients. Early rehabilitation was prescribed in 27% of all certificates and in 45% of certificates for MSD and MD diagnoses. Logistic regression analysis indicated that prescription of early rehabilitation was associated with certificates issued for MSD and MD, youngest patients, and certificates issued by primary health care physicians. The final model explained 29% of variation in the prescription of early rehabilitation.

    Conclusion: There is a modest prescription of early rehabilitation in sickness certificates, based on younger age and MSD or MD diagnosis. This indicates that patients’ rehabilitation needs may not have been identified.

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