| 1. |
- Grinberg, Adam, 1980-, et al.
(författare)
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An electroencephalography-based approach to evaluate movement-related anxiety in physically-active persons
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Psychological consequences often persist following musculoskeletal trauma and can result in vastly decreased quality of life. Re-injury anxiety is reported to hinder return to sports and can itself be a precursor for secondary injuries. Existing assessments of re-injury anxiety are restricted to subjective questionnaires, which may result in under-reporting and thus poorer injury management. In the current study, we introduced an experimental approach to objectively quantify movement-related anxiety using a threat-conditioning paradigm. We aimed to explore the feasibility of such an approach among non-injured persons.Ten physically-active individuals stood blindfolded on a platform capable of generating high-acceleration translations in eight different directions. Consecutive auditory stimuli were presented (four-second intervals), as either high- (conditioned stimulus; CS+) or low- (neutral stimulus; CS–) tones. Half of the CS+ trials were followed by a perturbation in a pseudo-random order. Event-related potentials were computed for nine electrodes by averaging 100 X CS– and 100 X CS+ trials. Significant latencies for CS– – CS+ comparisons were identified using interval-wise testing. Mean-amplitudes for significant intervals were used to detect a channel effect.Large negative CS+ waveforms were observed from 302-627ms post-stimulus and continuing until the end of the trials, most prominently over frontal and central midline locations (p ≤ 0.025). This effect, inferred as a contingent negative variation wave (CNV), may be reflective of threat-induced arousal response.Our test paradigm was found to be feasible, with a CNV suggested as a potential biomarker for re-injury anxiety. Further validation is needed, as well as exploring the discriminative power of such an approach between individuals with and without previous injury.
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| 2. |
- Stenlund, Tobias, et al.
(författare)
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Double-sided Mechanical Shocks Provoke Larger Seated Postural Reactions Compared to Single-Sided Mechanical Shocks
- 2018
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 43:8, s. E482-E487
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Human volunteers were exposed experimentally to single-sided mechanical shocks (SSMS) and double-sided mechanical shocks (DSMS) while seated.OBJECTIVE: To describe and contrast seated postural reactions due to SSMS or DSMS in healthy male adults.SUMMARY OF BACKGROUND DATA: Mechanical shocks to the body, caused when driving on irregular terrain, are suggested to be hazardous to the spine and may be associated with the reported musculoskeletal pain of the back and neck among professional drivers. However, very little is known about the characteristics of seated postural reactions and the biomechanical effects caused by mechanical shocks.METHODS: Twenty healthy male subjects (18-43 years old) were exposed while seated to 5 SSMS and 15 DSMS in lateral directions. The second acceleration in the DSMS was in the opposite direction to the first acceleration and was either fast, medium or slow depending on the speed of direction change. Surface electromyography (EMG) was recorded in muscles of the upper neck, trapezius, erector spinae and external oblique while kinematics were recorded with inertial sensors placed at the neck, trunk and pelvis. Muscle activity was normalized to maximum voluntary contractions (MVC).RESULTS: The EMG amplitudes were significantly higher (0.6-1%; p < 0.001) for the fast DSMS compared to all other shocks. Range of motion (ROM) of the neck and trunk was greater during the DSMS compared to the SSMS. Evoked muscle activity was less than 2% MVC in the trapezius, less than 10% MVC in the erector spinae and upper neck while the activity exceeded 10% MVC in the external oblique muscles.CONCLUSION: Fast DSMS in lateral directions appear more demanding compared to SSMS, demonstrating augmented seated postural reactions. However, the present mechanical shocks employed did not seem to induce postural reactions with regard to ROM or muscle activity of a magnitude likely to cause musculoskeletal overload.LEVEL OF EVIDENCE: 4.
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| 3. |
- Fjellman-Wiklund, Anncristine, et al.
(författare)
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Retrospective experiences of individuals two decades after anterior cruciate ligament injury : a process of re-orientation towards acceptance
- 2022
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Ingår i: Disability and Rehabilitation. - : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 44:21, s. 6267-6276
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Individual perspectives of long-term consequences decades after anterior cruciate ligament (ACL) injury are unexplored. We addressed experiences and the impact on life of former athletes >20 years post-ACL injury.Methods: Individual interviews, analysed using Grounded Theory, were conducted with 18 persons injured mainly during soccer 20–29 years ago.Results: A theoretical model was developed with the core category Re-orientation towards acceptance, overarching three categories illustrating the long-term process post-injury. Initially the persons felt like disaster had struck; their main recall was strong pain followed by reduced physical ability and fear of movement and re-injury. In the aftermaths of injury, no participant reached the pre-injury level of physical activity. Over the years, they struggled with difficult decisions, such as whether to partake or refrain from different physical activities, often ending-up being less physically active and thereby gaining body weight. Fear of pain and re-injury was however perceived mainly as psychological rather than resulting from physical limitations. Despite negative consequences and adjustments over the years, participants still found their present life situation manageable or even satisfying.Conclusion: ACL injury rehabilitation should support coping strategies e.g., also related to fear of re-injury and desirable physical activity levels, also with increasing age.IMPLICATIONS FOR REHABILITATIONMore than 20 years after the ACL injury, the individuals despite re-orientation towards acceptance and a settlement with their life situation, still had fear of both pain and re-injury of the knee, with concerns about physical activity and gaining of body weight. Patients with ACL injury may need better individual guidance and health advice on how to remain physically active, to find suitable exercises and to maintain a healthy body weight. Education related to pain, treatment choices, physical activity, injury mechanisms in participatory discussions with the patient about the ACL injury may be beneficial early in the rehabilitation process to avoid catastrophizing and avoidance behaviour. ACL injury rehabilitation needs to address coping strategies incorporating the psychological aspects of suffering an ACL injury, including fear of movement/secondary injury, in order to support return-to-sport and/or re-orientation over time.
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| 4. |
- Markström, Jonas, 1985-, et al.
(författare)
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Side-hops challenge knee control in the frontal and transversal plane more than hops for distance or height among ACL-reconstructed individuals
- 2023
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Ingår i: Sports Biomechanics. - : Taylor & Francis Group. - 1476-3141 .- 1752-6116. ; 22:1, s. 142-159
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Tidskriftsartikel (refereegranskat)abstract
- We compared knee landing mechanics with presumed relation to risk of anterior cruciate ligament (ACL) injury among three single-leg hop tests and between legs in individuals with unilateral ACL reconstruction. Thirty-four participants (>10 months' post-surgery, 23 females) performed the standardised rebound side hop (SRSH), maximal hop for distance (OLHD) and maximal vertical hop (OLVH). We calculated the following knee outcomes from motion capture and force plate data: finite helical axis inclination angles (approximates knee robustness), frontal and transversal plane angles at initial contact, peak angles of abduction and internal rotation during landing, and peak external moments of flexion, abduction and internal rotation during landing. Repeated-measures MANOVA analysis ('sex' as covariate) confirmed that SRSH induced greater angles and moments, particularly in the frontal plane, compared to OLHD and OLVH. There was between-leg asymmetry for peak knee flexion moment for males during OLHD and OLVH, and for females during SRSH. Our results advocate the SRSH over OLHD and OLVH for assessment of knee landing control to screen for movement patterns potentially related to ACL injury risk. However, clear differences in both knee kinematics and kinetics between OLHD and SRSH motivate the use of both tests to evaluate different aspects of landing control.
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| 5. |
- Naili, Josefine, et al.
(författare)
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The impact of symptomatic knee osteoarthritis on gait pattern and its association with performance-based measures and patient-reported outcomes
- 2017
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Ingår i: Knee (Oxford). - : Elsevier. - 0968-0160 .- 1873-5800. ; 24:3, s. 536-546
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Tidskriftsartikel (refereegranskat)abstract
- Background: Limited knowledge exists regarding the impact of symptomatic knee osteoarthritis (OA) on the overall gait pattern; and whether gait deviations are associated with performance based measures (PBMs) and patient-reported outcomes (PROs). This cross-sectional study evaluated overall gait patterns in patients with knee OA using the Gait Deviation Index for kinematics (GDI) and kinetics (GDI-kinetic), and explored associations between gait deviations, PBMs, and PROs. Methods: Forty patients with knee OA and 25 age and gender-matched controls underwent three-dimensional gait analysis. Participants performed the Timed Up and Go (TUG), Five Times Sit-to-Stand (5STS), and Single Limb Mini Squat (SLMS) tests and completed a disease specific PRO. Associations between gait deviations, PBMs, and PROs were assessed by Pearson's correlation and multiple linear regression. Results: Patients with OA demonstrated significantly lower GDI and GDI-kinetic scores of the OA and contralateral limbs compared to controls; with GDI-kinetic scores on the contralateral limb more impacted than the OA limb. On the contralateral limb, GDI-kinetic score significantly correlated with TUG (r = -0.42) and 5STS (r = -033), while on the OA limb with TUG (r = -0.68), 5STS (r = -0.38), SLMS (r = -0.38), activities of daily living (r = -0.35) and Knee-related Quality of Life (r = -035). No significant associations existed between kinematic GDI scores, PBMs and PROs. Conclusion: The overall gait pattern, as represented by GDI and GDI-kinetic scores, in patients with symptomatic knee OA is affected both on the painful OA limb and the contralateral limb. The GDI and GDI-kinetic scores provide different information regarding function that is not revealed by PBMs or PROs.
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| 6. |
- Strong, Andrew, et al.
(författare)
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Asymmetric loading strategies during squats following anterior cruciate ligament reconstruction : a longitudinal investigation throughout rehabilitation with curve analyses
- 2022
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Ingår i: 27th annual congress of the European college of sport science. - : European College of Sport Science. - 9783981841459 ; , s. 483-483
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Konferensbidrag (refereegranskat)abstract
- INTRODUCTION: Kinetic loading asymmetries during bilateral squats have been reported following anterior cruciate ligament reconstruction (ACLR). Evidence is however limited to discrete value data extracted at specific knee angles from cross-sectional studies where side-toside strategies are presented only at group level. It is therefore unclear whether loading asymmetries occur throughout the entire squat, whether they change during rehabilitation and how they are distributed between sides.METHODS: Bilateral bodyweight squats were performed by 24 individuals (13 females) post-ACLR on three occasions: 1) Early rehab - 2.9(1.1) months; 2) Mid-rehab - 8.8 (3.1) months; 3) Return to sport (RTS) - 13.1 (3.6) months; and 29 asymptomatic controls (22 females) on one occasion. Motion capture and two force plates were used to calculate time-normalized curves of vertical ground reaction forces andhip, knee, and ankle moments. Outcomes were compared between sides and groups, and over time, using functional t-tests with p-values adjusted by the interval-wise testing procedure. Individual knee loading strategies, i.e., under-/overloading of the ACLR side, were classified when asymmetry in favour of the respective side exceeded the 95% pointwise confidence interval of controls during at least 50% of the squat.RESULTS: At Early rehab, ACLR had significantly greater (adjusted P < .05) asymmetry in knee flexion moment than controls during thetime-normalized interval of 15-100% of the eccentric phase and the entire concentric phase, as well as ankle flexion moment during 56-65% of the concentric phase. At Mid-rehab, ACLR had significantly greater asymmetry than controls for knee flexion moment during 41-72% of the eccentric phase and for ankle flexion moment during 56-69% of the concentric phase. No significant between-group differences were found at RTS. At RTS compared with Early rehab, ACLR significantly reduced asymmetry for hip (21-46%, eccentric phase), knee (27-58%, concentric phase), and ankle flexion moment (21-57%, eccentric phase). Individual asymmetry strategies for knee flexion moment atEarly rehab were mainly due to individuals underloading the ACLR side (46%) rather than overloading (4%). At RTS, however, more individuals overloaded (25%) than underloaded (17%) the ACLR side.CONCLUSION: Curve analyses revealed significant kinetic loading asymmetries throughout bilateral bodyweight squats for our ACLR group compared with controls at Early rehab and Mid-rehab, but not at RTS. Significant reductions in hip, knee and ankle flexion moment asymmetry from Early rehab to RTS showed modifications during rehabilitation. An expected underloading strategy was evident for almost half of the ACLR participants at Early rehab, but an overloading strategy was the main reason for knee flexion moment asymmetry at RTS.Loading asymmetries during bilateral tasks should thus not be assumed due to underloading of the ACLR side, but may depend on anoverloading strategy, particularly late in rehabilitation.
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| 7. |
- Strong, Andrew, et al.
(författare)
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Properties of knee joint position sense tests after anterior cruciate ligament injury : A systematic review and meta-analysis
- 2021
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Ingår i: The Orthopaedic Journal of Sports Medicine. - : Sage Publications. - 2325-9671. ; 9:8
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Forskningsöversikt (refereegranskat)abstract
- Background: Knee proprioception is believed to be deficient after anterior cruciate ligament (ACL) injury. Tests of joint position sense (JPS) are commonly used to assess knee proprioception, but their psychometric properties (PMPs) are largely unknown.Purpose: To evaluate the PMPs (reliability, validity, and responsiveness) of existing knee JPS tests targeting individuals with ACL injury.Study design: Systematic review; Level of evidence, 4.Methods: PubMed, Allied and Complementary Medicine, CINAHL, SPORTDiscus, Web of Science, Scopus, CENTRAL, and ProQuest databases were searched to identify studies that assessed PMPs of knee JPS tests in individuals with ACL injury. The risk of bias for each included study was assessed and rated at the outcome level for each knee JPS test. Overall quality and levels of evidence for each PMP were rated according to established criteria. Meta-analyses with mean differences were conducted using random effects models when adequate data were available.Results: Included were 80 studies covering 119 versions of knee JPS tests. Meta-analyses indicated sufficient quality for known-groups and discriminative validity (ACL-injured knees vs knees of asymptomatic controls and contralateral noninjured knees, respectively), owing to significantly greater absolute errors for ACL-injured knees based on a strong level of evidence. A meta-analysis showed insufficient quality for responsiveness, which was attributed to a lack of significant change over time after diverse interventions with a moderate level of evidence. Statistical heterogeneity (I 2 > 40%) was evident in the majority of meta-analyses. All remaining PMPs (reliability, measurement error, criterion validity, convergent validity, and other PMPs related to responsiveness) were assessed qualitatively, and they failed to achieve a sufficient quality rating. This was a result of either the study outcomes not agreeing with the statistical cutoff values/hypotheses or the level of evidence being rated as conflicting/unknown or based on only a single study.Conclusion: Knee JPS tests appear to have sufficient validity in differentiating ACL-injured knees from asymptomatic knees. Further evidence of high methodologic quality is required to ascertain the reliability, responsiveness, and other types of validity assessed here. We recommend investigations that compare the modifiable methodologic components of knee JPS tests on their PMPs to develop standardized evidence-based tests.
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| 8. |
- Svedmark, Åsa, 1961-, et al.
(författare)
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Is tailored treatment superior to non-tailored treatment for pain and disability in women with non-specific neck pain? : A randomized controlled trial
- 2016
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 17
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The evidence for the effect of treatments of neck pain is modest. In the absence of causal treatments, a possibility is to tailor the treatment to the individuals' functional limitations and symptoms. The aim was to evaluate treatment effects of a tailored treatment versus a non-tailored treatment. Our hypothesis was that tailored treatment (TT) would have better effect on pain intensity and disability than either non-tailored treatment (NTT) (same treatment components but applied quasi-randomly) or treatment-as-usual (TAU) (no treatment from the study, no restrictions). We further hypothesized that TT and NTT would both have better effect than TAU.METHOD: One hundred twenty working women with subacute and chronic non-specific neck pain were allocated to 11 weeks of either TT, NTT or TAU in a randomized controlled trial with follow-ups at 3, 9 and 15 months. The TT was designed from a decision model based on assessment of function and symptoms with defined cut-off levels for the following categories: reduced cervical mobility, impaired neck-shoulder strength and motor control, impaired eye-head-neck control, trapezius myalgia and cervicogenic headache. Primary outcomes were pain and disability. Secondary outcomes were symptoms, general improvement, work productivity, and pressure pain threshold of m. trapezius.RESULTS: Linear mixed models analysis showed no differences between TT and NTT besides work productivity favoring TT at 9- and 15-months follow-ups. TT and NTT improved significantly more than TAU on pain, disability and symptoms at 3-month follow-up. General improvement also favored TT and NTT over TAU at all follow-ups.CONCLUSION: Tailored treatment according to our proposed decision model was not more effective than non-tailored treatment in women with subacute and chronic neck pain. Both tailored and non-tailored treatments had better short-term effects than treatment-as-usual, supporting active and specific exercise therapy, although therapist-patient interaction was not controlled for. Better understanding of the importance of functional impairments for pain and disability, in combination with a more precise tailoring of specific treatment components, is needed to progress.TRIAL REGISTRATION: Current Controlled Trials ISRCTN 49348025. Registered 2 August 2011.
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| 9. |
- Tronarp, Rebecca, et al.
(författare)
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Office-cycling : a promising way to raise pain thresholds and increase metabolism with minimal compromising of work performance
- 2018
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Ingår i: BioMed Research International. - : Hindawi Publishing Corporation. - 2314-6133 .- 2314-6141. ; 2018
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Tidskriftsartikel (refereegranskat)abstract
- Sedentary behaviour constitutes a risk for lifestyle related diseases and musculoskeletal pain which does not seem to be compensated for by shorter bouts of high intensity physical activity. A way of tackling this may be long term light intensity physical activity while performing office work.Aim: Establish the effects of low intensity cycling (LC), moderate intensity cycling (MC) and standing at a simulated office workstation on pain modulation, metabolic expenditure and work performance.Methods: 36 healthy adults (21 females), mean age 26.8 (SD 7.6) years, partook in this randomized 3x3 cross-over trial with 75 minutes of LC on 20% of maximum aerobic power output (MAP), 30 minutes of MC on 50% of MAP and standing 30 minutes with 48 hours wash-out periods. Outcome measures were pain modulation (pressure- and thermal pain thresholds, (PPT and TPT)), work performance (transcription, mouse pointing and cognitive performance) and metabolic expenditure.Results: PPTs increased in all conditions. Median increase in PPT trapezius was highest after LC; 39.3 kilopascal (kPa) (15.6;78.6) compared to MC; 17.0 kPa (2.8;49.9) and standing; 16.8 kPa (-5.6;39.4), p=0.015. TPT showed no change. Work performance; compared to standing, transcription was reduced during LC and MC, mouse pointing was faster in LC but had more errors while slower with more errors in MC. Performance in the cognitive task did not differ between conditions. Metabolic expenditure rates differed between all conditions (p<0.001) and were 1.4 (1.3;1.7), 3.3 (2.3;3.7) and 7.5 (5.8;8.7) kilocalories per minute during standing, LC and MC, respectively.Conclusions: LC seem to be the preferred option since it raised PPTs, more than doubled metabolic expenditure, while minimally influencing work performance when compared to standing. Thus, LC is promising but requires corroboration in field studies.
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| 10. |
- Grinberg, Adam, 1980-, et al.
(författare)
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An electroencephalography-based approach to evaluate movement-related anxiety in physically active adults and following anterior cruciate ligament injury
- 2022
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Konferensbidrag (refereegranskat)abstract
- Background: Psychophysiological consequences often persist following musculoskeletal trauma and can result in vastly decreased quality of life. Re-injury anxiety is particularly common among individuals following anterior cruciate ligament (ACL) injury. Existing assessments of re-injury anxiety are, however, restricted to subjective suboptimal questionnaires, which may result in under-reporting and thus poorer injury management. We propose a novel approach to objectively quantify arousal response to movement-related anxiety. A new experimental paradigm was implemented to induce and record a conditioned electrophysiological response to a sudden perturbation, experienced to be potentially injurious.Objective: To explore the feasibility of detecting anxiety-associated electrocortical response and to evaluate its discriminative ability between asymptomatic individuals and those who had experienced an ACL injury.Methods: Physically-active asymptomatic persons and individuals post-ACL reconstruction stood blindfolded on a perturbation platform capable of generating high-acceleration translations (1.5 m/s2). Auditory stimuli were repeatedly presented in four-second intervals, as either low- or high-frequency tones. Half of the high-frequency tones were followed 1.5 seconds later by a destabilizing perturbation in one of eight randomized directions. The two tone conditions were thus termed ‘Neutral’ and ‘Anxiety’, as the high-frequency tone was intended to invoke an arousal response in anticipation of a potential perturbation. Event-related potentials (ERP) were computed for nine electrodes by averaging 100 Neutral and 100 Anxiety trials. Significant ERP components were identified using functional data analysis. Paired difference-waves’ amplitudes (Neutral - Anxiety) were compared between groups.Results: ERP correlates of anxiety were detected for both groups in frontal and central midline locations, with an observable contingent negative variation (CNV) from 500 ms post-stimulus in Anxiety compared with Neutral trials. This ERP component is reflective of a threat-induced arousal response, associated with attention and expectancy of an anxiety-relevant event. Preliminary data indicate no group differences in CNV amplitudes.Conclusions: Objective evaluation of an arousal response to movement-related anxiety was found to be feasible, resulting in a threat-induced CNV. Further investigation will elucidate the discriminative power of such an approach to differentiate between individuals with high and low re-injury anxiety, as well as potential associations with existing patient-reported outcome measures.
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