| 31. |
- Björklund, Martin, et al.
(författare)
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Effects of tailored neck-shoulder pain treatment based on a decision model guided by clinical assessments and standardized functional tests : a study protocol of a randomized controlled trial
- 2012
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Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central. - 1471-2474. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A major problem with rehabilitation interventions for neck pain is that the condition may have multiple causes, thus a single treatment approach is seldom efficient. The present study protocol outlines a single blinded randomised controlled trial evaluating the effect of tailored treatment for neck-shoulder pain. The treatment is based on a decision model guided by standardized clinical assessment and functional tests with cut-off values. Our main hypothesis is that the tailored treatment has better short, intermediate and long-term effects than either non-tailored treatment or treatment-as-usual (TAU) on pain and function. We sub-sequentially hypothesize that tailored and non-tailored treatment both have better effect than TAU.METHODS: 120 working women with minimum six weeks of nonspecific neck-shoulder pain aged 20-65, are allocated by minimisation with the factors age, duration of pain, pain intensity and disability in to the groups tailored treatment (T), non-tailored treatment (NT) or treatment-as-usual (TAU). Treatment is given to the groups T and NT for 11 weeks (27 sessions evenly distributed). An extensive presentation of the tests and treatment decision model is provided. The main treatment components are manual therapy, cranio-cervical flexion exercise and strength training, EMG-biofeedback training, treatment for cervicogenic headache, neck motor control training. A decision algorithm based on the baseline assessment determines the treatment components given to the each participant of T- and NT-groups. Primary outcome measures are physical functioning (Neck Disability Index) and average pain intensity last week (Numeric Rating Scale). Secondary outcomes are general improvement (Patient Global Impression of Change scale), symptoms (Profile Fitness Mapping neck questionnaire), capacity to work in the last 6 weeks (quality and quantity) and pressure pain threshold of m. trapezius. Primary and secondary outcomes will be reported for each group with effect size and its precision.DISCUSSION: We have chosen not to include women with psychological ill-health and focus on biomedical aspects of neck pain. Future studies should aim at including psychosocial aspects in a widened treatment decision model. No important adverse events or side-effects are expected.Trial registration: Current Controlled Trials registration ISRCTN49348025.
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| 32. |
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| 33. |
- Björklund, Martin, et al.
(författare)
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Muscle stretch-induced modulation of noxiously activated dorsal horn neurons of feline spinal cord.
- 2004
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Ingår i: Neuroscience research. - : Elsevier BV. - 0168-0102 .- 1872-8111. ; 48:2, s. 175-184
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Tidskriftsartikel (refereegranskat)abstract
- The present work was designed to check for the possibility of interactions between mechanical innocuous and chemically induced noxious muscle afferent inputs on discharge behavior of nociceptive superficial dorsal horn neurons (SDHNs) of the spinal cord in decerebrated cats. The innocuous and noxious stimuli were applied separately and in combination, so that the effects of the innocuous stimulus on nociceptive processing could be evaluated. The innocuous stimulus consisted of ramp-and-hold stretches of the gastrocnemius muscles, whereas the noxious stimulus consisted of i.a. injections of bradykinin (BK; 0.5-1 ml, 50 microg/ml) into the arterial circulation of same muscles. Only neurons up to approximately 1mm depth and those that responded to noxious pinch of the gastrocnemius muscles were selected for further analysis. The activity of 16 dorsal horn neurons was recorded extracellularly with high-impedance glass microelectrodes, out of which seven responded to stretch, while 12 neurons responded to bradykinin injections. The bradykinin injections induced three types of responses: excitatory, inhibitory and mixed. The majority of the neurons that showed excitatory and mixed responses to bradykinin were also influenced by stretches applied directly after the bradykinin injection. In these neurons, the stretch usually counteracted the bradykinin-induced response, i.e. shortening and reducing bradykinin-induced excitation and re-exciting the cells after bradykinin-induced inhibition. The mechanism of the stretch modulation is proposed to reside in a segmental spinal control of the nociceptive transmission.
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| 34. |
- Björklund, Martin, 1961-, et al.
(författare)
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Responsiveness and minimal important change for the ProFitMap-neck questionnaire and the Neck Disability Index in women with neck-shoulder pain
- 2017
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Ingår i: Quality of Life Research. - : Springer Science and Business Media LLC. - 0962-9343 .- 1573-2649. ; 26:1, s. 161-170
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThe aim was to determine the responsiveness and minimal important change (MIC) of the questionnaire ProFitMap-neck that measures symptoms and functional limitations in people with neck pain. The same measurement properties were determined for Neck Disability Index (NDI) for comparison purposes.MethodsLongitudinal data were derived from two randomized controlled trials, including 103 and 120 women with non-specific neck pain, with questionnaire measurements performed before and after interventions. Sensitivity and specificity to discriminate between improved and non-improved participants, based on categorization of a global rating of change scale (GRCS), were determined for the ProFitMap-neck indices and NDI by using area under receiver operator curves (AUC). Correlations between the GRCS anchor and change scores of the questionnaires were also used to assess responsiveness. The change score that showed the highest combination of sensitivity and specificity was set for MIC.ResultsThe ProFitMap-neck indices showed similar responsiveness as NDI with AUC exceeding 0.70 (Range: ProFitMap-neck, 0.74 – 0.83; NDI, 0.75 – 0.86). The MIC in the two samples ranged between 6.6 – 13.6% for ProFitMap-neck indices and 5.2 and 6.3% for NDI. Both questionnaires had significant correlations with GRCS (Spearman’s rho 0.47 – 0.72).ConclusionsValidity of change scores was demonstrated for the ProFitMap-neck indices with adequate ability to discriminate between improved and non-improved participants. Values of minimal important change were presented.
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| 35. |
- Björklund, Martin, et al.
(författare)
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Sensory adaptation after a 2-week stretching regimen of the rectus femoris muscle
- 2001
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Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier BV. - 0003-9993 .- 1532-821X. ; 82:9, s. 1245-1250
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study the effects of a muscle stretching regimen for the rectus femoris muscle on subjective stretch sensation and range of motion (ROM). DESIGN: A 2 x 2 crossover design comprising 2 treatments and 2 intervention periods. SETTING: A military base in Sweden. PARTICIPANTS: A volunteer sample of 29 male military conscripts divided into 2 groups, with each group subjected to both experimental and control treatments at different time periods. INTERVENTION: Two weeks of supervised stretching (4 times/wk) of the rectus femoris muscle (experimental treatment) and the calf muscles (control treatment). MAIN OUTCOME MEASURES: Subjective rating of the stretch sensation for the anterior aspect of the thigh determined on a category ratio scale. Passive knee flexion ROM determined on each test with the same applied torque, specific for each subject. RESULTS: An additive analysis of variance revealed that the stretch sensation after the experimental treatment was decreased, compared with the control treatment (p <.01). The knee flexion, however, remained the same regardless of the treatment. CONCLUSION: Sensory adaptation seems to be an important mechanistic factor in the effect stretching has on ROM changes. The lack of change in knee flexion suggests that the stretching, as performed in this study, did not influence stiffness of the rectus femoris muscle. Sensory adaptation may also be an underlying mechanism in the alleviating effect of stretching when applied to tired, tender, and painful muscles.
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| 36. |
- Björklund, Martin, et al.
(författare)
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The assessment of symptoms and functional limitations in low back pain patients : validity and reliability of a new questionnaire
- 2007
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Ingår i: European spine journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 16:11, s. 1799-1811
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Tidskriftsartikel (refereegranskat)abstract
- Many of the existing low back pain (LBP) questionnaires of function and symptoms have a content of different domains of disability presented as a single sum score, making it difficult to derive changes within a specific domain. The present study describes the development of a clinically derived back-specific questionnaire incorporating both a functional limitation and a symptom scale, with a further subdivision of the symptom scale in separate indices for severity and temporal aspects. The aims of the study were to assess the overall reliability and validity of the new questionnaire, named the Profile Fitness Mapping questionnaire (PFM). A total of 193 chronic LBP patients answered the PFM together with five validated criterion questionnaires. For the internal consistency of the questionnaires, the three indices of the PFM had the highest Cronbach's alpha (0.90-0.95) and all items had item-total correlations above 0.2. The correlation coefficients between the PFM and the back-specific criterion questionnaires ranged between 0.61 and 0.83, indicating good concurrent criterion validity. The best discriminative ability between patients with different pain severities was demonstrated by the functional limitation scale of the PFM. Well centered score distribution with no patient's score at the floor or the ceiling level indicates that the PFM has the potential to detect the improvement or worsening of symptoms and functional limitations in chronic LBP patients. Classification according to the International Classification of Functioning, Disability and health (ICF) of WHO revealed a high degree of homogeneous item content of the symptom scale to the domain of impairments, and of the functional limitation scale to the domain of activity limitations. The present study suggests that the PFM has a high internal consistency and is a valid indicator of symptoms and functional limitations of LBP patients. It offers the combination of a composite total score and the possibility of evaluations within specific domains of disability. Complementary evaluation of test-retest reliability and responsiveness to change is warranted.
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| 37. |
- Björklund, Martin, et al.
(författare)
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The ProFitMap-neck - reliability and validity of a questionnaire for measuring symptoms and functional limitations in neck pain
- 2012
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Ingår i: Disability and Rehabilitation. - London : Informa Healthcare. - 0963-8288 .- 1464-5165. ; 34:13, s. 1096-1107
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To assess overall reliability and validity of a neck-specific questionnaire, the Profile Fitness Mapping neck questionnaire (ProFitMap-neck), on three chronic neck pain groups. Method: Participating groups were as follows: whiplash associated disorders, inpatient care (IP-WAD, n = 127); nonspecific neck pain, inpatient care (IP-NS, n = 83) and nonspecific neck pain subjects (non-IP-NS, n = 104). All groups answered the ProFitMap-neck and the SF-36, whereas non-IP-NS also answered the Neck Disability Index (NDI) and the Functional Self-Efficacy Scale (SES). Internal consistency, test-retest reliability and components of convergent construct, face and content validity were determined for the ProFitMap-neck. Results: The ProFitMap-neck showed good internal consistency in all three groups, and ICC test-retest reliability (0.80-0.91). Good correlation (0.66-0.78) and highest agreement was reached with NDI. According to the International Classification of Functioning, Disability and Health, the symptom scale of the ProFitMap-neck was mainly classified to the domain of impairments-body functions, and the functional limitation scale to the activity limitation domain. Conclusion: The results indicate that the ProFitMap-neck is valid for measuring symptoms and functional limitations in people with chronic neck pain. The combination of a composite total score of symptoms and function as well as separate scores of each domain makes ProFitMap-neck suitable for research as well as in clinical practice.
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| 38. |
- Blomqvist, Sven, et al.
(författare)
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Adolescents with intellectual disability have reduced postural balance and muscle performance in trunk and lower limbs compared to peers without intellectual disability
- 2013
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Ingår i: Research in Developmental Disabilities. - : Elsevier BV. - 0891-4222 .- 1873-3379. ; 34:1, s. 198-206
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Tidskriftsartikel (refereegranskat)abstract
- For adolescent people with ID, falls are more common compared to peers without ID. However, postural balance among this group is not thoroughly investigated. The aim of this study was to compare balance and muscle performance among adolescents aged between 16 and 20 years with a mild to moderate intellectual disability (ID) to age-matched adolescents without ID. A secondary purpose was to investigate the influence of vision, strength, height and Body Mass Index (BMI) on balance. A group of 100 adolescents with ID and a control group of 155 adolescents without ID were investigated with five balance tests and three strength tests: timed up and go test, one leg stance, dynamic one leg stance, modified functional reach test, force platform test, counter movement jump, sit-ups, and Biering-Sorensen trunk extensor endurance test. The results showed that adolescents with an ID in general had significantly lower scores in the balance and muscle performance tests. The group with ID did not have a more visually dominated postural control compared to the group without ID. Height, BMI or muscle performance had no strong correlations with balance performance. It appears as if measures to improve balance and strength are required already at a young age for people with an ID.
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| 39. |
- Blomqvist, Sven, 1964-, et al.
(författare)
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Physical exercise frequency seem not to influence postural balance but trunk muscle endurance in young persons with intellectual disability
- 2017
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Ingår i: Journal of Physical Education and Sports Management. - : American Research Institute for Policy Development. - 2373-2156 .- 2373-2164. ; 4:2, s. 38-47
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Tidskriftsartikel (refereegranskat)abstract
- Background The influence of various physical exercise frequencies on postural balance and muscle performance among young persons with intellectual disability (ID) is not well understood.Method Cross-sectional data from 26 elite athletes were compared with 37 students at a sports school and to 57 students at a special school, all diagnosed with mild to moderate ID and with different exercise frequencies. Data were also compared with a group of 149 age-matched participants without ID.Results There were no significant differences in postural balance between young ID groups regardless of physical exercise frequency, all of them had however impaired postural balance compared to the non-ID group. The group with high exercise performed better than the other ID groups in the trunk muscle endurance test.Conclusions It appears as if physical exercise frequency don’t improve postural balance but endurance in the trunk muscles for young persons with ID.
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| 40. |
- Blomqvist, Sven
(författare)
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Postural balance, physical activity and capacity among young people with intellectual disability
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to investigate postural balance, physical activity, physical capacity and their associations in young people (16-20 years) with intellectual disability (ID), mild to moderate. The aim was also to study the reliability and concurrent validity of postural balance tests.To evaluate postural balance, one assessor used five common postural balance tests and one new test. The tests were performed twice for 89 young people with ID (one to twelve days apart). Intraclass correlation coefficients greater than 0.80 were achieved for four of the common balance tests: Extended Timed Up and Go Test (ETUGT), Modified Forward Reach Test (MFRT), One-Leg Stance Test (OLS), and a Force Platform Test (FPT). The smallest real difference ranged from 12% to 40%; less than 20% is considered to be low. For the six balance tests, the concurrent validity varied between none to low.Falls are more common for young people with ID compared to young people without ID. One reason could be impaired postural balance. The postural balance for young people with ID has not been thoroughly investigated. Therefore, five balance tests and three muscle strength tests were used to compare young people with ID with an age-matched control group without ID (n=255). The young people with ID had significantly lower scores on most of the postural balance tests and muscle strength tests of the trunk and lower limbs. Muscle strength, height, and body mass index had no strong association with postural balance. The results also illustrated that young people with ID did not rely more on vision for their balance ability compared to peers without ID.It seems that postural balance is impaired for young people with ID when evaluated with common tests. An everyday situation is to react to unexpected balance disturbances to avoid falls by using different postural responses. Since young people with ID seem to fall more often than peers without ID, it is valuable to investigate if those postural responses are different between the groups. Therefore, young people with and without ID (n=99) were exposed to six backward surface translations and several postural muscle responses were evaluated: muscle synergies and strategies, muscle onset latency, time-to-peak amplitude, and adaptation. The responses of the investigated muscles – the gastrocnemius, the biceps femoris, and the erector spinae L4 level – were measured using electromyography. The results showed that there were no differences between the two groups with respect to synergies or strategies, muscle onset latency, and time-to-peak amplitude. An overall pattern was seen, that young people with ID adapted their muscle response slower in all three muscles than peers without ID, but this pattern was not statistically significant.Studies have shown that people with ID have impaired postural balance, a lower level of physical activity, and lower aerobic capacity compared to people without ID. The association is however not investigated. Therefore, postural balance (postural sway indirectly measured with the subjects standing on a force platform), physical activity (measured with a pedometer), and aerobic capacity (measured with a sub-maximal ergometer cycle test) were used to assess young people with and without ID (n=106). To investigate the subjects’ view of their own health, the subjects completed an adapted questionnaire that addressed their perceived health. The analysis showed no significant associations between postural balance, level of physical activity, and aerobic capacity. The subjects in the ID group, both men and women, had significantly lower aerobic capacity compared to subjects without ID. The answers from the health questionnaire did not correspond to the measured outcomes from the physical tests for young people with ID.In conclusion, ETUGT and MFRT can be used to evaluate change in postural balance over time in young people with mild to moderate ID. The low concurrent validity suggests that the postural balance tests probably challenge various subsystems. Young people with ID have impaired postural balance and perform lower on muscle strength tests than age-matched controls. Postural muscle responses after external perturbations seem to be similar for young people with and without ID, but the ability to adapt muscle responses after repeated perturbations appears to be slower for young people with ID. The studies in the thesis also indicate that young people with ID have reduced level of physical activity and lower aerobic capacity. The lack of association between the different physical functions indicates that they should be evaluated and exercised separately. Young persons with ID might have more difficulty realising the health advantage of being physically active, as they do not seem to make this connection. Because of this, it is important that parents/guardians, school staff, physiotherapists, and others encourage them to participate in physical activity.
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