| 51. |
- Hermansen, Anna, et al.
(författare)
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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 Techniques
- 2014
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Ingår i: Journal of Manipulative and Physiological Therapeutics. - : Elsevier. - 0161-4754 .- 1532-6586. ; 37:2, s. 87-96
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 52. |
- Hermansen, Anna, et al.
(författare)
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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 article
- 2013
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Ingår i: Journal of Neurosurgery. - : American Association of Neurological Surgeons. - 1547-5654 .- 1547-5646. ; 19:4, s. 403-411
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 53. |
- Hermansen, Anna, et al.
(författare)
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Women’s experiences of daily life after anterior cervical decompression and fusion surgery : A qualitative interview study
- 2016
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Ingår i: Journal of Rehabilitation Medicine. - Uppsala, Sweden : Stiftelsen Rehabiliteringsinformation /Foundation for Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 48:4, s. 352-358
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Tidskriftsartikel (refereegranskat)abstract
- Subjects: Fourteen women aged 39-62 years (median 52 years), were included 1.5 to 3 years after ACDF for cervical degenerative disc disease.Methods: Individual semi-structured interviews were analyzed by qualitative content analysis with an inductive approach.Results: The women described their experiences of daily life in five different ways; Experiences of recovery; Experiences of symptoms in daily life influence feelings and thoughts; Making daily life work; Importance of social and occupational networks; Experiences of the influence of healthcare professionals and interventions on daily life.Conclusion: This interview study provides insight into women’s daily life after ACDF. While improved after surgery, informants also experienced remaining symptoms and limitations in daily life. A variety of mostly active coping strategies were used to manage daily life. Social support from family, friends, occupational networks and healthcare professionals positively influenced daily life. These findings provide knowledge on aspects of daily life that should be considered in individualized postoperative care and rehabilitation in an attempt to provide better outcomes in women after ACDF.
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| 54. |
- Johansson, Maria, et al.
(författare)
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Frail community-dwelling older persons everyday lives and their experiences of rehabilitation - a qualitative study
- 2023
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Ingår i: Scandinavian Journal of Occupational Therapy. - : Taylor & Francis Ltd. - 1103-8128 .- 1651-2014. ; 30:1, s. 65-75
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Tidskriftsartikel (refereegranskat)abstract
- Background The number of older persons with frailty is increasing, and rehabilitation to improve the consequences of frailty are important for both the individual and society. However, the perspective of older persons themselves in research and planning of interventions is scarce. Aim The aim of this study was to describe frail older persons everyday lives and their experiences and views of rehabilitation. Material and methods Twenty older persons were interviewed, and analyses were performed using a qualitative content analysis method. Results The two main categories were Frailty impacts everyday life and Experiences and perceptions of rehabilitation. The participants described that they had to adapt their everyday lives in line with their health conditions. They all used strategies and were dependent on support in their activities of daily living. Their social network had decreased. All participants strived to stay active and independent, and wanted rehabilitation and support from professionals, experiencing decreased access to rehabilitation. Conclusions and significance Frail older persons are a vulnerable group who often need support in everyday life. There is room for improvement when it comes to helping frail older persons to stay active and facilitate participation in both individual and group interventions.
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| 55. |
- Johansson, Maria, et al.
(författare)
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Pain Characteristics and Quality of Life in Older People at High Risk of Future Hospitalization
- 2021
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 18:3
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Tidskriftsartikel (refereegranskat)abstract
- This study deals with how pain characteristics in conjunction with other factors affect quality of life (QoL) in a vulnerable primary care population. We recruited vulnerable older people (75+, n = 825) living in south-eastern Sweden. A postal questionnaire included pain aspects, QoL (EQ-5D-3L, RAND-36 physical functioning, attitudes toward own aging, and life satisfaction), functional status, social networks, and basic demographic information. Pain extent and localization was obtained by digitalization of pain drawings reported on standard body charts. Most respondents were experiencing pain longer than 3 months (88.8%). Pain frequency varied mostly between occasionally (33.8%) and every day (34.8%). A minority reported high pain intensity (13.6%). The lower back and lower legs were the most frequently reported pain locations (>25%). Multiple linear regression model revealed three characteristics of pain (intensity, frequency, and extent) remained inversely associated with the EQ-5D-3L index score (R-2 = 0.57). Individually, each of these pain characteristics showed a negative impact on the other three dimensions of QoL (R-2 = 0.23-0.59). Different features of pain had impact on different dimensions of QoL in this aging population. A global pain assessment is useful to facilitate individual treatment and rehabilitation strategies in primary care.
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| 56. |
- Kammerlind, Ann-Sofi, 1969-, et al.
(författare)
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Dizziness in older persons at high risk of future hospitalization : prevalence, differences between those with and without dizziness, and effect of a proactive primary care intervention
- 2022
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Ingår i: BMC Geriatrics. - London, United Kingdom : BioMed Central. - 1471-2318. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Dizziness is a common reason for seeking care, and frequently affects older persons. The aims were to determine the prevalence of dizziness in older persons at high risk of hospitalization, to compare subjects with and without dizziness, and to examine the effects on dizziness of a proactive primary care intervention in comparison with conventional care after one year.Methods: Data were derived from a prospective multicentre clinical trial in persons aged 75 and older and at high risk of hospitalization. A baseline questionnaire included demographic data, use of aids, questions about everyday physical activity and exercise, pain (intensity, frequency, and duration), activities of daily living measured using the ADL Staircase, and health-related quality of life measured using the EQ-5D-3L vertical visual analogue scale. Both at baseline and after one year, subjects were asked about dizziness, and those with dizziness answered the Dizziness Handicap Inventory - Screening version. Subjects in the intervention group were evaluated by a primary care team and when needed proactive care plans were established. Groups were compared using the Mann Whitney U-test or chi-squared test.Results: Of the 779 subjects, 493 (63%) experienced dizziness. Persons with dizziness differed regarding sex, homecare service, aids, activities of daily living, health-related quality of life, physical activity, and pain. The intervention did not significantly reduce the level of dizziness.Conclusions: Dizziness is common in vulnerable older persons, and individuals with dizziness differ in several respects. Further studies are needed employing more dizziness-specific assessment and individually tailored interventions.
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| 57. |
- Karlsson, Anette, et al.
(författare)
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An Investigation of Fat Infiltration of the Multifidus Muscle in Patients With Severe Neck Symptoms Associated With Chronic Whiplash-Associated Disorder
- 2016
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Ingår i: Journal of Orthopaedic and Sports Physical Therapy. - : Journal of Orthopaedic & Sports Physical Therapy (JOSPT). - 0190-6011 .- 1938-1344. ; 46:10, s. 886-893
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Cross-sectional study. BACKGROUND: Findings of fat infiltration in cervical spine multifidus, as a sign of degenerative morphometric changes due to whiplash injury, need to be verified. OBJECTIVES: To develop a method using water/fat magnetic resonance imaging (MRI) to investigate fat infiltration and cross-sectional area of multifidus muscle in individuals with whiplash associated disorders (WADS) compared to healthy controls. METHODS: Fat infiltration and cross-sectional area in the multifidus muscles spanning the C4 to C7 segmental levels were investigated by manual segmentation using water/fat-separated MRI in 31 participants with WAD and 31 controls, matched for age and sex. RESULTS: Based on average values for data spanning C4 to C7, participants with severe disability related to WAD had 38% greater muscular fat infiltration compared to healthy controls (P = .03) and 45% greater fat infiltration compared to those with mild to moderate disability related to WAD (P = .02). There were no significant differences between those with mild to moderate disability and healthy controls. No significant differences between groups were found for multifidus cross-sectional area. Significant differences were observed for both cross-sectional area and fat infiltration between segmental levels. CONCLUSION: Participants with severe disability after a whiplash injury had higher fat infiltration in the multifidus compared to controls and to those with mild/moderate disability secondary to WAD. Earlier reported findings using T1-weighted MRI were reproduced using refined imaging technology. The results of the study also indicate a risk when segmenting single cross-sectional slices, as both cross-sectional area and fat infiltration differ between cervical levels.
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| 58. |
- Karlsson, Anette, 1986-
(författare)
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Quantitative Muscle Composition Analysis Using Magnetic Resonance Imaging
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Changes in muscle tissue composition, e.g. decrease in volume and/or increase of fat infiltration, are related to adverse health conditions such as sarcopenia, inflammation, muscular dystrophy, and chronic pain. However, the onset and progression of disease and the effect of potential intervention effects are not fully understood, partly due to insufficient measurement tools. For advanced knowledge regarding these diseases, an accurate and precise measurement tool for detecting changes in muscle composition is needed. The tool must be able to detect both local changes on specific muscles for investigating local injuries and generalized muscle composition changes on a whole-body level. Magnetic resonance imaging is an excellent tool due to its superior soft tissue contrast but is normally not quantitative, making it challenging to produce reproducible results. Furthermore, manual analysis of the vast amount of images produced is extremely time consuming and therefore expensive. The aim of this thesis was to develop and validate a new magnetic resonance imaging method for muscle volume quantification and fat infiltration estimation that would have the potential to be used in both large-scale studies and for analyzing small individual muscles.The method development was divided into four main steps: 1) Rapid acquisition and reconstruction of data with sufficient resolution and calibration giving quantitative images where the relative fat content of each voxel (related to pure fat voxels) is attainable; 2) Automated muscle tissue classification based on non-rigid multi-atlas segmentation followed by probability voting to acquire the region of interest for each muscle; 3) Quantification of muscle tissue volume and fat infiltration from the classification step and the local fat signal; 4) Evaluation of the potential of the method in clinical studies.In Paper I, a method for automatic muscle volume quantification of both whole-body and regional muscles, i.e. involving steps 1–3, is presented. The automated method showed good agreement compared to manual segmentation. It was robust to an 8-fold resolution difference using two different scanner field strengths. Papers II and III evaluated the clinical relevance and the need for developing methods with high-resolution images to answer the research questions regarding the effect of a whiplash trauma on the multifidus muscles. This involved steps 1–4. The method enabled acquisition of high-resolution data to distinguish the small multifidus muscles (Paper II). The paper also showed a higher fat infiltration in the multifidus muscles in individuals with severe self-reported disability compared to individuals with milder symptoms and to healthy controls. Furthermore, the local fat infiltration was also related to widespread muscle fat infiltration (Paper III). However, the difference in widespread muscle fat infiltration could not alone distinguish between the three different groups. Paper IV showed the robustness of fat infiltration estimation when changing flip angle, and thereby the T1 weighting, of the acquired images (steps 1–3). The higher flip angle also provided better noise characteristics. Therefore, this quantitative method can be used with higher flip angle, and thus a potentially better anatomical contrast, without losing accuracy or precision.To conclude, this thesis presents a method that quantifies muscle volume and estimates fat infiltration robustly and reproducibly. The versatility of the method allows for both high-resolution images of small muscles and rapid acquisition of whole-body data. The method can be a useful tool in clinical studies regarding small individual muscles. Furthermore, the combination of being quantitative and automatic means that the method has potential to be used in longitudinal, multi-center, and large-scale studies for advanced understanding of muscular diseases.
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| 59. |
- Karlsson, Anette, 1986-, et al.
(författare)
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The effect on precision and T1 bias comparing two flip angles when estimating muscle fat infiltration using fat-referenced chemical shift-encoded imaging
- 2021
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Ingår i: NMR in Biomedicine. - : John Wiley & Sons. - 0952-3480 .- 1099-1492. ; 34:11
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Tidskriftsartikel (refereegranskat)abstract
- Investigation of the effect on accuracy and precision of different parameter settings is important for quantitative Magnetic Resonance Imaging. The purpose of this study was to investigate T1-bias and precision for muscle fat infiltration (MFI) using fat-referenced chemical shift magnetic resonance imaging at 5° and 10° flip angle. This [MB1] experimental study was done on forty postmenopausal women using 3T MRI test and retest images using 4-point 3D spoiled gradient multi-echo acquisition including real and imaginary images for reconstruction acquired at Flip angles 5° and 10°. Post-processing included T2* correction and fat-referenced calibration of the fat signal. The mean MFI was calculated in six different automatically segmented muscle regions using both the fat-referenced fat signal and the fat fraction calculated from the fat and water image pair for each acquisition. The variance of the difference between mean MFI from test and retest was used as measure of precision. The SNR characteristics were analyzed by measuring difference of the full width half maximum of the fat signal distribution using Student’s t-test.There was no difference in the mean fat-referenced MFI at different flip angles with the fat-referenced technique, which was the case using the fat fraction. No significant difference in the precision was found in any of the muscles analyzed. However, the full width half maximum of the fat signal distribution was significantly lower at 10° flip angle compared to 5°. Fat-referenced MFI is insensitive to T1 bias in chemical shift magnetic resonance imaging enabling usage of a higher and more SNR effective flip angle. The lower full-width-at half-maximum in fat-referenced MFI at 10° indicates that high flip angle acquisition is advantageous although no significant differences in precision was observed comparing 5° and 10°.
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| 60. |
- Karlsson, Anette, 1986-, et al.
(författare)
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The relation between local and distal muscle fat infiltration in chronic whiplash using magnetic resonance imaging.
- 2019
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Ingår i: PLOS ONE. - San Francisco, CA, United States : Public Library of Science. - 1932-6203. ; 14:12
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to investigate the relationship between fat infiltration in the cervical multifidi and fat infiltration measured in the lower extremities to move further into understanding the complex signs and symptoms arising from a whiplash trauma. Thirty-one individuals with chronic whiplash associated disorders, stratified into a mild/moderate group and a severe group, together with 31 age- and gender matched controls were enrolled in this study. Magnetic resonance imaging was used to acquire a 3D volume of the neck and of the whole-body. Cervical multifidi was used to represent muscles local to the whiplash trauma and all muscles below the hip joint, the lower extremities, were representing widespread muscles distal to the site of the trauma. The fat infiltration was determined by fat fraction in the segmented images. There was a linear correlation between local and distal muscle fat infiltration (p<0.001, r2 = 0.28). The correlation remained significant when adjusting for age and WAD group (p = 0.009) as well as when correcting for age, WAD group and BMI (p = 0.002). There was a correlation between local and distal muscle fat infiltration within the severe WAD group (p = 0.0016, r2 = 0.69) and in the healthy group (p = 0.022, r2 = 0.17) but not in the mild/moderate group (p = 0.29, r2 = 0.06). No significant differences (p = 0.11) in the lower extremities' MFI between the different groups were found. The absence of differences between the groups in terms of lower extremities' muscle fat infiltration indicates that, in this particular population, the whiplash trauma has a local effect on muscle fat infiltration rather than a generalized.
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