| 1. |
|
|
| 2. |
- Bernhardsson, Susanne, 1958, et al.
(författare)
-
Clinical practice in line with evidence? A survey among primary care physiotherapists in western Sweden
- 2015
-
Ingår i: Journal of Evaluation in Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 21:6, s. 1169-1177
-
Tidskriftsartikel (refereegranskat)abstract
- Rationale, aims and objectives Evidence-based practice is becoming increasingly important in primary care physiotherapy. Clinical practice needs to reflect current best evidence and be concordant with evidence-based clinical guidelines. There is limited knowledge about therapeutic interventions used in primary care physiotherapy in Sweden. The objectives were to examine preferred treatment interventions reported by publicly employed physiotherapists in primary care for three common musculoskeletal disorders (low back pain, neck pain and subacromial pain), the extent to which these interventions were supported by evidence, and associations with demographic variables. Methods 419 physiotherapists in primary care in western Sweden were surveyed using a validated web-based questionnaire. Results The survey was completed by 271 respondents (65%). Median number of interventions reported was 7 (range 1-16). The most common treatment interventions across the three conditions were advice on posture (reported by 82-94%), advice to stay active (86-92%), and different types of exercise (65-92%). Most of these interventions were supported by evidence. However, interventions with insufficient evidence, such as advice on posture, TENS and aquatic exercise, were also used by 29-96%. Modalities such as laser therapy and ultrasound were sparingly used (< 5%), which is in line with evidence. For neck pain, use of evidence-based interventions was associated with gender and for subacromial pain, with work experience. Conclusions Advice and exercise therapy were the interventions most frequently reported across the three diagnoses, illustrating an active treatment strategy. While most reported interventions are supported by evidence, interventions with unclear or no evidence of effect were also used to a high extent.
|
|
| 3. |
- Lundqvist, Stefan, et al.
(författare)
-
Long-term physical activity on prescription intervention for patients with insufficient physical activity level-a randomized controlled trial
- 2020
-
Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 21:1
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundPhysical activity (PA) can be used to prevent and treat diseases. In Sweden, licensed healthcare professionals use PA on prescription (PAP) to support patients to increase their PA level. The aim of this randomized controlled trial was to evaluate a 2-year intervention of two different strategies of PAP treatment for patients with insufficient PA level, after a previous 6-month period of ordinary PAP treatment in a primary health care setting.MethodsWe included 190 patients, 27-77years, physically inactive with metabolic risk factors where the patients were not responding to a previous 6-month PAP treatment with increased PA. The patients were randomized to either enhanced support from a physiotherapist (PT group) or continued ordinary PAP treatment at the health care centre (HCC group). The PAP treatment included an individualized dialogue; an individually dosed PA recommendation, including a written prescription; and a structured follow-up. In addition to PAP, the PT group received aerobic fitness tests and more frequent scheduled follow-ups. The patient PA level, metabolic health, and health-related quality of life (HRQOL) were measured at baseline and at 1- and 2-year follow-ups.ResultsAt the 2-year follow-up, 62.9% of the PT group and 50.8% of the HCC group had increased their PA level and 31.4% vs. 38.5% achieved >= 150min of moderate-intensity PA/week (difference between groups n.s.). Over 2 years, both groups displayed increased high-density lipoproteins (HDL) (p=0.004 vs. baseline), increased mental health status (MCS) (p=0.036), and reduced body mass index (BMI) (p=0.001), with no difference between groups.ConclusionDuring long-term PAP interventions, the PA level, metabolic health, and HRQOL increased in patients at metabolic risk without significant differences between groups. The results indicate to be independent of any changes in pharmacological treatment. We demonstrated that the PAP treatment was feasible in ordinary primary care. Both the patients and the healthcare system benefitted from the improvement in metabolic risk factors. Future studies should elucidate effective long-term PAP-treatment strategies.Trial registrationClinicalTrials.gov NCT03012516. Registered on 30 December 2016-retrospectively registered.
|
|
| 4. |
- Bernhardsson, Susanne, 1958, et al.
(författare)
-
Determinants of Guideline Use in Primary Care Physical Therapy: A Cross-Sectional Survey of Attitudes, Knowledge, and Behavior
- 2014
-
Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 94:3, s. 343-354
-
Tidskriftsartikel (refereegranskat)abstract
- 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. 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.
|
|
| 5. |
- Joelsson, M., et al.
(författare)
-
Tailored physical activity on prescription with follow-ups improved motivation and physical activity levels. A qualitative study of a 5-year Swedish primary care intervention
- 2020
-
Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 38:4, s. 399-410
-
Tidskriftsartikel (refereegranskat)abstract
- Objective To explore how physically inactive patients, with metabolic risk factors, experienced long term treatment with physical activity on prescription. Design Qualitative content analysis of individual interviews after strategical sampling of respondents. Setting Fifteen primary health care centres in Gothenburg, Sweden. Subjects Twenty physically inactive patients, with one or more metabolic syndrome components, 9 women, 11 men, mean age 58 years (25-73); 10 patients were responders and 10 non-responders to the intervention. Main outcome measures Categories describing treatment effect and successful intervention Results The interviews revealed three categories of effect. First, individual adjustments contributed to increased physical activity. Second, follow-up and support were valuable aids for prioritising and maintaining lifestyle changes. Third, motivation could be higher if patients make their own choices and experienced positive health effects. The overarching emerging theme was 'tailored physical activity on prescription with regular follow-ups can contribute to increased and maintained motivation and physical activity levels.' Conclusion Physical activity on prescription in a Swedish primary care setting was successful when the recommended physical activity and follow up was individually adapted.
|
|
| 6. |
- Lundqvist, Stefan, et al.
(författare)
-
Physical Activity on Prescription (PAP), in patients with metabolic risk factors. A 6-month follow-up study in primary health care
- 2017
-
Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 12:4
-
Tidskriftsartikel (refereegranskat)abstract
- There is strong evidence that inadequate physical activity (PA) leads to an increased risk of lifestyle-related diseases and premature mortality. Physical activity on prescription (PAP) is a method to increase the level of PA of patients in primary care, but needs further evaluation. The aim of this observational study was to explore the association between PAP-treatment and the PA level of patients with metabolic risk factors and the relationship between changes in the PA level and health outcomes at the 6 month follow-up. This study included 444 patients in primary care, aged 27-85 years (56% females), who were physically inactive with at least one component of metabolic syndrome. The PAP-treatment model included: individualized dialogue concerning PA, prescribed PA, and a structured follow-up. A total of 368 patients (83%) completed the 6 months of follow-up. Of these patients, 73% increased their PA level and 42% moved from an inadequate PA level to sufficient, according to public health recommendations. There were significant improvements (p <= 0.05) in the following metabolic risk factors: body mass index, waist circumference, systolic blood pressure, fasting plasma glucose, cholesterol, and low density lipoprotein. There were also significant improvements regarding health-related quality of life, assessed by the Short Form 36, in: general health, vitality, social function, mental health, role limitation-physical/emotional, mental component summary, and physical component summary. Regression analysis showed a significant association between changes in the PA level and health outcomes. During the first 6-month period, the caregiver provided PAP support 1-2 times. This study indicates that an individual-based model of PAP-treatment has the potential to change people's PA behavior with improved metabolic risk factors and self-reported quality of life at the 6 month follow-up. Thus, PAP seems to be feasible in a clinical primary care practice, with minimum effort from healthcare professionals.
|
|
| 7. |
- Bernhardsson, Susanne, et al.
(författare)
-
"In the physio we trust": A qualitative study on patients' preferences for physiotherapy
- 2017
-
Ingår i: Physiotherapy Theory and Practice. - : Informa UK Limited. - 0959-3985 .- 1532-5040. ; 33:7, s. 535-549
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Patients' preferences should be integrated in evidence-based practice. This study aimed to explore patients' preferences for physiotherapy treatment and participation in decision making. Methods: A qualitative study set in an urban physiotherapy clinic in Gothenburg, Sweden. Individual, semi-structured interviews were conducted with 20 individuals who sought physiotherapy for musculoskeletal disorders. The interviews were recorded, transcribed, and analyzed with qualitative content analysis. Results: An overarching theme, embracing six categories, was conceptualized: Trust in the physiotherapist fosters active engagement in therapy. The participants preferred active treatment strategies such as exercise and advice for self-management, allowing them to actively engage in their therapy. Some preferred passive treatments. Key influencers on treatment preferences were previous experiences and media. All participants wanted to be involved in the clinical decision making, but to varying extents. Some expressed a preference for an active role and wanting to share decisions while others were content with a passive role. Expectations for a professional management were reflected in trust and confidence in physiotherapists' skills and competence, expectations for good outcomes, and believing that treatment methods should be evidence-based. Conclusion: Trust in the physiotherapist's competence, as well as a desire to participate in clinical decision making, fosters active engagement in physiotherapy.
|
|
| 8. |
- Bernhardsson, Susanne, 1958, et al.
(författare)
-
Does a tailored guideline implementation strategy have an impact on clinical physiotherapy practice? A nonrandomized controlled study
- 2019
-
Ingår i: J Eval Clin Pract. - : Wiley. - 1356-1294. ; 25:4, s. 575-584
-
Tidskriftsartikel (refereegranskat)abstract
- Rationale, aims, and objectives Clinical practice guidelines are a common strategy for implementing research findings into practice and facilitating evidence-based practice in health care settings. There is a paucity of knowledge about the impact of different guideline implementation strategies on clinical practice in a physiotherapy context. The study aimed to assess the impact of a guideline implementation intervention on clinical physiotherapy practice. Methods A tailored, multicomponent guideline implementation was compared with usual practice. Clinical practice was evaluated in physiotherapy treatment methods used for 3 common musculoskeletal disorders. Data were collected with a validated web-based questionnaire. Results Postimplementation data were collected from 168 physiotherapists in the intervention group and 88 in the control group. The most frequently reported treatment methods for low back pain were advice on posture (reported by 95% in the intervention group vs 90% in the control group), advice to stay active (93% vs 90%), and stabilization exercise (88% vs 80%). Differences between groups were not significant. Reported use of body awareness training (23% vs 6%, P = .023) and spinal manipulation (9% vs 23%, P = .044) differed between the groups. The most frequently used treatment methods for neck pain were advice on posture (95% vs 92%), advice to stay active (89% vs 87%), and ROM exercise (85% vs 71%) (no significant differences between groups). Reported use of body awareness training (24% vs 7%, P = .023) differed between the groups. The most frequently used treatment methods for subacromial pain were range of motion exercises (reported by 93% in both groups), advice on posture (90% vs 87%), home exercise (77% vs 74%), and stabilization exercise (69% vs 66%) (no significant difference between groups). Conclusions Treatment methods used were largely in line with evidence already before the guideline implementation, which may explain why the guideline implementation had only little impact on clinical practice.
|
|
| 9. |
- Beales, D., et al.
(författare)
-
The Predictive Ability of the Full and Short Versions of the Orebro Questionnaire for Absenteeism and Presenteeism Over the Subsequent 12 Months, in a Cohort of Young Community-Based Adult Workers
- 2021
-
Ingår i: Journal of Occupational and Environmental Medicine. - : Ovid Technologies (Wolters Kluwer Health). - 1076-2752 .- 1536-5948. ; 63:12, s. 1058-1064
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: The primary purpose of this study was to investigate the predictive ability of the orebro Musculoskeletal Pain Screening Questionnaire (oMPSQ) in regard to work productivity (absenteeism and presenteeism) in early adulthood. Methods: A prospective study was performed using data from the Raine Study Generation 2 (Gen2) 22-year follow-up. The oMPSQ was completed at baseline, and absenteeism and presenteeism assessed at four intervals over the following 12 months. Results: In early adulthood, the full and short versions of the oMPSQ showed some predictive ability for work absenteeism but the Receiver Operator Characteristic demonstrated poor discrimination. There was no evidence of predictive ability for presenteeism. Conclusion: Further work is required to increase the fidelity of screening for risk of reduced work productivity at the population level.
|
|
| 10. |
- Bernhardsson, Susanne, 1958, et al.
(författare)
-
Digital physiotherapy assessment vs conventional face-to-face physiotherapy assessment of patients with musculoskeletal disorders: A systematic review.
- 2023
-
Ingår i: PloS One. - : Public Library of Science (PLoS). - 1932-6203. ; 18:3
-
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.
|
|
