| 1. |
- Bornhöft, Lena, et al.
(författare)
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Development and feasibility of a function-based preventive intervention for lifestyle-related disorders
- 2024
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Ingår i: BMC PUBLIC HEALTH. - 1471-2458. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe enormous effect of lifestyle-related disorders on health of the global population warrants the development of preventive interventions. Focusing on musculoskeletal health and physical activity may be a way to encourage necessary lifestyle changes by making them more concrete and understandable. The aims of the current study were to develop a function-based preventive intervention aimed at lifestyle-related disorders in physically inactive 40-year-old people and to investigate the feasibility of the intervention. The feasibility study aimed to solve practical and logistical challenges and to develop the intervention based on the experiences of participants and involved clinical personnel according to defined criteria.MethodsDevelopment of the standardised functional examination was based on literature-validated tests and clinical reasoning. Development of a risk profile was based on the functional examination and similar profiles which have already proved feasible. The feasibility of the functional examination and risk profile, together with function-based lifestyle counselling was tested on 27 participants in a pilot study with two physiotherapist examinations over a four-month period. Practical results and feedback from participants and collaborating personnel were examined.ResultsThe functional examination consists of 20 established tests not requiring specialised equipment or training which were deemed relevant for a middle-aged population and a sub-maximal ergometer test. The risk profile consists of seven functional dimensions: cardiovascular fitness, strength in upper extremity, lower extremity and trunk, mobility, balance and posture, and three non-functional dimensions: weight, self-assessed physical activity and pain. Each dimension contains at least two measures. The participants appreciated the intervention and found it motivating for making lifestyle changes. They found the tests and risk profile understandable and could see them as tools to help achieve concrete goals. The examination required 60-75 min for one physiotherapist. The recruitment rate was low and recruited participants were highly motivated to making lifestyle changes.ConclusionThis project developed a functional test battery and risk profile aimed at inactive 40-year-olds which fulfilled our feasibility criteria. Functional screening and lifestyle counselling were found to be of value to a sub-group of inactive 40-year-olds who were already motivated to improve their health situations.
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| 2. |
- Rindner, Lena, 1959, et al.
(författare)
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Prevalence of somatic and urogenital symptoms as well as psychological health in women aged 45 to 55 attending primary health care: a cross-sectional study.
- 2017
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Ingår i: BMC women's health. - : Springer Science and Business Media LLC. - 1472-6874. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Women's physical and mental ill-health such as stress-related symptoms, depression, pain, hypertension and urogenital health shows a marked increase around the ages 45-55years. These women are an important group for Primary Health Care (PHC) due to their prevalent symptoms and illnesses. The aim of this study was to estimate the prevalence of somatic, psychological and urogenital symptoms in women aged 45-55 attending PHC and evaluate factors associated with severe symptoms.One hundred and thirty-one women were recruited from PHC in southwestern Sweden. Data were obtained from two self-reported questionnaires, the Menopause Rating Scale (MRS) and the Montgomery-Asberg Depression Rating Scale (MADRS).Exhaustion, depressive mood, muscle and joint problems, sleep and sexual problems were the most prevalent reported symptoms. Half of the women reported heart discomfort. Depression and increasing age were correlated to more severe symptoms.We recommend that cardiovascular risk factors, musculoskeletal symptoms, sexual problems, sleeping problems and mental health should be actively asked for when women aged 45 to 55 attend PHC. We propose that preventive counselling of women in PHC before the age 45 should be evaluated in future studies.
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| 3. |
- Bernhardsson, Susanne, 1958, et al.
(författare)
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Digital physiotherapy assessment vs conventional face-to-face physiotherapy assessment of patients with musculoskeletal disorders: A systematic review.
- 2023
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Ingår i: PloS One. - : Public Library of Science (PLoS). - 1932-6203. ; 18:3
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Forskningsöversikt (refereegranskat)abstract
- This systematic review aimed to assess the certainty of evidence for digital versus conventional, face-to-face physiotherapy assessment of musculoskeletal disorders, concerning validity, reliability, feasibility, patient satisfaction, physiotherapist satisfaction, adverse events, clinical management, and cost-effectiveness.Eligibility criteria: Original studies comparing digital physiotherapy assessment with face-to-face physiotherapy assessment of musculoskeletal disorders. Systematic database searches were performed in May 2021, and updated in May 2022, in Medline, Cochrane Library, Cinahl, AMED, and PEDro. Risk of bias and applicability of the included studies were appraised using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the Quality Appraisal of Reliability Studies tool. Included studies were synthesised narratively. Certainty of evidence was evaluated for each assessment component using GRADE.Ten repeated-measures studies were included, involving 193 participants aged 23-62 years. Reported validity of digital physiotherapy assessment ranged from moderate/acceptable to almost perfect/excellent for clinical tests, range of motion, patient-reported outcome measures (PROMs), pain, neck posture, and management decisions. Reported validity for assessing spinal posture varied and was for clinical observations unacceptably low. Reported validity and reliability for digital diagnosis ranged from moderate to almost perfect for exact+similar agreement, but was considerably lower when constrained to exact agreement. Reported reliability was excellent for digital assessment of clinical tests, range of motion, pain, neck posture, and PROMs. Certainty of evidence varied from very low to high, with PROMs and pain assessment obtaining the highest certainty. Patients were satisfied with their digital assessment, but did not perceive it as good as face-to-face assessment.Evidence ranging from very low to high certainty suggests that validity and reliability of digital physiotherapy assessments are acceptable to excellent for several assessment components. Digital physiotherapy assessment may be a viable alternative to face-to-face assessment for patients who are likely to benefit from the accessibility and convenience of remote access.The review was registered in the PROSPERO database, CRD42021277624.
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| 4. |
- Bornhöft, Lena, et al.
(författare)
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Health effects of direct triaging to physiotherapists in primary care for patients with musculoskeletal disorders: a pragmatic randomized controlled trial
- 2019
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Ingår i: Therapeutic Advances in Musculoskeletal Disease. - : SAGE Publications. - 1759-720X .- 1759-7218. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Background: Physiotherapists and general practitioners (GPs) both act as primary assessors for patients with musculoskeletal disorders in primary care. Previous studies have shown that initial triaging to physiotherapists at primary healthcare centres has advantages regarding efficiency in the work environment and utilization of healthcare. In this study, we aimed primarily to determine whether triaging to physiotherapists affects the progression of health aspects over time differently than traditional management with initial GP assessment. The secondary aim was to determine whether triaging to physiotherapists affects patients' attitudes of responsibility for musculoskeletal disorders. Methods: This was a pragmatic trial where both recruitment and treatment strategies were determined by clinical, not study-related parameters, and was initiated at three primary care centres in Sweden. Working-age patients of both sexes seeking primary care for musculoskeletal disorders and nurse assessed as suitable for triaging to physiotherapists were randomized to initial consultations with either physiotherapists or GPs. They received self-assessment questionnaires before the initial consultation and were followed up at 2, 12, 26 and 52 weeks with the same questionnaires. Outcome measures were current and mean (3 months) pain intensities, functional disability, risk for developing chronic musculoskeletal pain, health-related quality of life and attitudes of responsibility for musculoskeletal conditions. Trends over time were analysed with a regression model for repeated measurements. Results: The physiotherapist-triaged group showed significant improvement for health-related quality of life at 26 weeks and showed consistent but nonsignificant tendencies to greater reductions of current pain, mean pain in the latest 3 months, functional disability and risk for developing chronic pain compared with traditional management. The triage model did not consistently affect patients' attitudes of responsibility for musculoskeletal disorders. Conclusions: Triaging to physiotherapists for primary assessment in primary care leads to at least as positive health effects as primary assessment by GPs and can be recommended as an alternative management pathway for patients with musculoskeletal disorders. ClinicalTrials.gov identifier: NCT148611.
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| 5. |
- Bornhöft, Lena, et al.
(författare)
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More cost-effective management of patients with musculoskeletal disorders in primary care after direct triaging to physiotherapists for initial assessment compared to initial general practitioner assessment.
- 2019
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Ingår i: BMC musculoskeletal disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- A model for triaging patients in primary care to provide immediate contact with the most appropriate profession to treat the condition in question has been developed and implemented in parts of Sweden. Direct triaging of patients with musculoskeletal disorders (MSD) to physiotherapists at primary healthcare centres has been proposed as an alternative to initial assessment by general practitioners (GPs) and has been shown to have many positive effects. The aim of this study was to evaluate the cost-effectiveness from the societal perspective of this new care-pathway through primary care regarding triaging patients with MSD to initial assessment by physiotherapists compared to standard practice with initial GP assessment.Nurse-assessed patients with MSD (N=55) were randomised to initial assessment and treatment with either physiotherapists or GPs and were followed for 1year regarding health-related quality of life, utilization of healthcare resources and absence from work for MSD. Quality-adjusted life-years (QALYs) were calculated based on EQ5D measured at 5 time-points. Costs for healthcare resources and production loss were compiled. Incremental cost-effectiveness ratios (ICERS) were calculated. Multiple imputation was used to compensate for missing values and bootstrapping to handle uncertainty. A cost-effectiveness plane and a cost-effectiveness acceptability curve were construed to describe the results.The group who were allocated to initial assessment by physiotherapists had slightly larger gains in QALYs at lower total costs. At a willingness-to-pay threshold of 20,000 €, the likelihood that the intervention was cost-effective from a societal perspective including production loss due to MSD was 85% increasing to 93% at higher thresholds. When only healthcare costs were considered, triaging to physiotherapists was still less costly in relation to health improvements than standard praxis.From the societal perspective, this small study indicated that triaging directly to physiotherapists in primary care has a high likelihood of being cost-effective. However, further larger randomised trials will be necessary to corroborate these findings.ClinicalTrials.gov NCT02218749 . Registered August 18, 2014.
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| 6. |
- Nordeman, Lena Margareta, et al.
(författare)
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Early access to physical therapy treatment for subacute low back pain in primary health care: a prospective randomized clinical trial.
- 2006
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Ingår i: The Clinical journal of pain. - : Ovid Technologies (Wolters Kluwer Health). - 0749-8047. ; 22:6, s. 505-11
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To evaluate the effects of early access (EA) to physical therapy treatment for patients with subacute low back pain compared to access with a 4-week waiting list. DESIGN: A prospective, randomized clinical trial. SETTING: Primary health care. PATIENTS: Sixty consecutive patients with subacute low back pain. INTERVENTIONS: Patients were randomized either to EA within 2 days for physical examination and individualized physical therapy treatment (n=32) or a control group with a 4-week waiting list (n=28). OUTCOME MEASURES: Self-administrated questionnaires were used for assessment at inclusion, at discharge, and at 6 months. Primary outcome measure was pain intensity assessed by Borg category scale for ratings of perceived pain. Secondary outcomes included the Orebro musculoskeletal pain screening questionnaire, the Roland and Morris disability questionnaire, sick-leave, visits to health care, and physical therapy. RESULTS: The results showed no significant differences in pain between the groups at discharge. At 6 months, the reduction of pain was significantly greater in the EA group compared to the control group (P=0.025). Changes in secondary outcome measures were not significantly different between groups. CONCLUSIONS: This study indicated that EA to physical therapy resulted in greater improvement in perceived pain at 6 months compared to later access. In this study, EA to physical therapy could be introduced by reorganization without additional resources.
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| 7. |
- Nordeman, Lena Margareta, et al.
(författare)
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Predictors for future activity limitation in women with chronic low back pain consulting primary care: a 2-year prospective longitudinal cohort study.
- 2017
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 7:6
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Tidskriftsartikel (refereegranskat)abstract
- To assess if body function, activity, participation, health-related quality of life and lifestyle behavioural factors can predict activity limitation in women with chronic low back pain (CLBP) in primary healthcare (PHC) 2years later.A 2-year prospective longitudinal cohort study within PHC.PHC in southwestern Sweden.The cohort comprised 130 women with CLBP attending PHC at baseline 2004-2005 and were reassessed after 2years.The dependent outcome variable was self-reported activity limitation (Roland Morris disability questionnaire (RMDQ)) at 2-year follow-up. Independent predictors at baseline were age, body mass index, smoking, alcohol consumption, sleep quantity and quality, leisure time physical activity, a questionnaire of clinical manifestation of stress (Stress and Crises Inventory (SCI-93)), pain localisation, pain intensity, fatigue, anxiety, depression, RMDQ, work status, private social support, health-related quality of life and measures of physical performance specified as 6min walk test (6MWT) and hand grip strength. Relation between baseline predictors and variation in later self-reported activity limitation (RMDQ) was analysed using multivariate linear regression.Ninety-five per cent (n=123/130) were followed up after 2years. The participants were middle-aged (mean 45 (SD 10) years), mostly educated >9 years (88%; 108/123), mainly living with another adult (76%; 93/122) and born in Sweden (90%; 111/123). Seventy-nine per cent (97/123) were categorised as having work ability at baseline. The final prognostic model including 6MWT, SCI-93 and RMDQ at baseline explained 54% of the variance in self-reported activity limitation (RMDQ) at the 2-year follow-up.Lower physical performance, more severe clinical stress symptoms and more severe activity limitation predicted activity limitation after 2years in women with CLBP within PHC. The results can give guidance for interventional trials aiming to improve physical capacity and decrease stress. The impact of the interaction between prognostic factors and interventions on activity limitation needs further investigation.
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| 8. |
- Rindner, Lena, 1959, et al.
(författare)
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Effect of group education and person-centered support in primary health care on mental health and quality of life in women aged 45-60years with symptoms commonly associated with stress: a randomized controlled trial.
- 2023
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Ingår i: BMC women's health. - : Springer Science and Business Media LLC. - 1472-6874. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Mental illness and somatic symptoms are common causes of long-term sick leave for women during menopause, which usually occurs between the ages of 45 and 55. Many women experience a lack of knowledge about menopause and its associated symptoms. This study evaluates the effect of group education and person-centeredindividual support in primary health care (PHC) on mental health and quality of life forwomen in menopause with symptoms that are usually associated with stress.The randomized controlled clinical trial (RCT) with a two-factor design was conducted in PHC in southwestern Sweden, from2018 to 2019. A total of 370 women aged 45-60 were allocated in four groups: 1, group education (GE) 2, GE and person-centered individual support (PCS) 3, PCS and 4, control group. GE comprised four weekly sessions and PCS included five sessions with topics related to menopause. The effect of the interventions were followed up at 6 and 12months.Linear and ordinal regression were used to analyse the effect of the intervention, either group education or person-centred individual support.The main findings: Improved quality of life and physical, psychological, and urogenital symptoms. GE and PCS resulted in improvement of the quality of life at six months. At the 12-month follow-up these results were significantly strengthened for PCS and improved health-related quality of life, and reduced mental, urogenital, and stress-related symptoms with an effect lasting at least 12months. These results suggest that this intervention could be an effective intervention in PHC for improving women's health in menopause.PCS can be an effective intervention in PHC for improving women's health in menopause and possibly also prevent the development of exhaustion syndrome.Universal trial number is U1111-1219-6542 and the registration number in ClinicalTrials.gov is NCT03663075, date of registration 10/09/2018.
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| 9. |
- Rindner, Lena, 1959, et al.
(författare)
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Prognostic factors for future mental, physical and urogenital health and work ability in women, 45-55 years: a six-year prospective longitudinal cohort study.
- 2020
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Ingår i: BMC women's health. - : Springer Science and Business Media LLC. - 1472-6874. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Impaired health due to stress is a common cause of long-term illness in women aged 45-55years. It is a common cause for visits to primary health care (PHC) and may influence work-ability. The aim of this study was to investigate prognostic factors for future mental, physical and urogenital health as well as work-ability in a population of average women aged 45-55years.This longitudinal cohort study initially assessed 142 women from PHC centers in southwestern Sweden. One houndred and ten accepted participation and were followed for 6years. They were assessed using the self-reported questionnaires: the Menopause Rating Scale (MRS), the Montgomery-Asberg Depression Rating Scale (MADRS-S), the Short-Form Health Survey (SF-36). Descriptive data are presented of health, education, relationships and if they are working. Multicollinearity testing and logistic regression were used to test the explanatory variables.Severity of symptoms in the MRS somatic and urogenital domains decreased while they increased in the psychological and depressive domains. Having tertiary education was associated with decreased overall mental health, vitality and social role functioning. Living with a partner was associated with increased physical role functioning, social role functioning and emotional role functioning.Quality of life seems to be enhanced by a good relationship with the partner, social support and work/life balance. Therefore, to improve women health women should early discuss ways in which these issues can be incorporated as they pursue their academic or career goals. Hence, we emphasize the importance of supporting women to gain increased awareness about a healthy life balance and to have realistic goals in work as well as in their social life.
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| 10. |
- Rindner, Lena, 1959, et al.
(författare)
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Reducing menopausal symptoms for women during the menopause transition using group education in a primary health care setting a randomized controlled trial
- 2017
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Ingår i: Maturitas. - : Elsevier BV. - 0378-5122. ; 98, s. 14-19
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Women's physical and mental ill-health shows a marked increase during menopause, which usually occurs between 45 and 55 years of age. Mental illness and somatic symptoms are common causes of long-term sick leave. Women suffer from a lack of knowledge about the menopause transition and its associated symptoms. The aim of the study was to investigate whether group education for women in primary health care (PHC) about the menopause transition can improve their physical and mental ill-health. Study design: This randomized controlled study was conducted in PHC and aimed to evaluate a group education programme for women aged 45-55 years, around the menopause transition. A total of 131 women were randomized to group education or no intervention. The group intervention included two education sessions with topics related to menopause. They answered two questionnaires at baseline and at four-month follow-up: the Menopause Rating Scale (MRS) and the Montgomery-Asberg Depression Rating Scale (MADRS). Main outcome measure: Change in MRS and MADRS scores over the four months. Results: The intervention group experienced a slight reduction in symptoms while the control group mostly experienced the opposite. Conclusion: This study showed that it was feasible to implement group education on menopause for women aged 45-55 years. The clinical trial registration number: NTCO2852811 (C) 2017 Elsevier B.V. All rights reserved.
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