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  • Aasa, Ulrika, et al. (författare)
  • Physical Activity Might Be of Greater Importance for Good Spinal Control Than If You Have Had Pain or Not : A Longitudinal Study
  • 2015
  • Ingår i: Swedish Physical Activity and Fitness Cohort born in 1958 (SPAF-1958).
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>STUDY DESIGN:</strong> Longitudinal design. A cohort followed in 3 waves of data collection.</p><p><strong>OBJECTIVE:</strong> The aim of the study was to describe the relationships between the performance of 2 tests of spinal control at the age of 52 years and low back pain, physical activity level, and fitness earlier in life, as well as to describe the cross-sectional relationships between these measures.</p><p><strong>SUMMARY OF BACKGROUND DATA:</strong> Altered spinal control has been linked to pain; however, other stimuli may also lead to inability to control the movements of the spine.</p><p><strong>METHODS:</strong> Participants answered questions about physical activity and low back pain, and performed physical fitness tests at the age of 16, 34, and 52 years. The fitness test battery included tests of endurance in the back and abdominal muscles, a submaximal bicycle ergometer test to estimate maximal oxygen uptake, and measurements of hip flexion, thoracic spine flexibility, and anthropometrics. Two tests were aggregated to a physical fitness index. At the age of 52, also 2 tests of spinal control, the standing Waiter's bow (WB) and the supine double leg lower (LL) were performed.</p><p><strong>RESULTS:</strong> Logistic regression analyses showed that higher back muscle endurance at the age of 34 years could positively predict WB performance at 52 years and higher physical fitness at the age of 34 could positively predict LL performance at 52 years. Regarding cross-sectional relationships, an inability to perform the WB correctly was associated with lower physical fitness, flexibility and physical activity, and larger waist circumference. An inability to correctly perform the LL was associated with lower physical fitness. One-year prevalence of pain was not significantly associated with WB or LL test performance.</p><p><strong>CONCLUSION:</strong> An active life resulting in higher physical fitness is related to better spinal control in middle-aged men and women. This further strengthens the importance of physical activity throughout the life span.</p><p><strong>LEVEL OF EVIDENCE:</strong> 3.</p>
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  • Abbott, Allan, et al. (författare)
  • Early rehabilitation targeting cognition, behaviour and motor function after lumbar fusion : A randomized controlled trial
  • 2010
  • Ingår i: Spine. - Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 35:8, s. 848-857
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>Study Design</strong> - Open label randomized controlled trial with 3-, 6-, 12-month, and 2- to 3-year follow-up.</p><p><strong>Objective</strong> - To investigate the effectiveness of a psychomotor therapy focusing on cognition, behavior, and motor relearning compared with exercise therapy applied during the first 3 months after lumbar fusion.</p><p><strong>Summary of Background Data</strong> - Postoperative management after lumbar fusion commonly focuses on analgesic pain control and activities of daily living. After 3 months, exercise therapy is often implemented. No randomized controlled trial has investigated early rehabilitation techniques conducted during the first 3 months after surgery.</p><p><strong>Methods</strong> - The study recruited 107 patients, aged 18 to 65 years, selected for lumbar fusion because of 12 months of symptomatic spinal stenosis, spondylosis, degenerative/isthmic spondylolisthesis, or degenerative disc disease. The exercise therapy group received a home program focusing on pain contingent training of back, abdominal, and leg muscle functional strength and endurance, stretching, and cardiovascular fitness. The psychomotor therapy group received a home program and 3 outpatient sessions focusing on modifying maladaptive pain cognitions, behaviors, and motor control. Rated questionnaires investigating functional disability, pain, health-related quality of life, functional self-efficacy, outcome expectancy, fear of movement/(re)injury, and coping were assessed at 3, 6, 12 months, and 2 to 3 years after surgery.</p><p><strong>Results</strong> - Follow-up rates were 93% at 12 months and 81% at 2 to 3 years after surgery. Psychomotor therapy improved functional disability, self-efficacy, outcome expectancy, and fear of movement/(re)injury significantly more than exercise therapy at respective follow-up occasions. Similar results occurred for pain coping but group differences were nonsignificant at 2 to 3 years follow-up. Potentially clinical relevant higher reoperation rates occurred after psychomotor therapy but rates were within normal ranges.</p><p><strong>Conclusion</strong> - The study shows that postoperative rehabilitation can be safely implemented during the first 3 months after lumbar fusion and should include measures to modify psychological as well as motor functions.</p>
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  • Abul-Kasim, Kasim, et al. (författare)
  • Reliability of Low-Radiation Dose CT in the Assessment of Screw Placement After Posterior Scoliosis Surgery, Evaluated With a New Grading System
  • 2009
  • Ingår i: Spine. - Lippincott Williams & Wilkins. - 0362-2436. ; 34:9, s. 941-948
  • Tidskriftsartikel (refereegranskat)abstract
    • Study Design. A retrospective study. Objective. To evaluate the reliability of computed tomography (CT) with low radiation dose in the assessment of implant status in patients with adolescent idiopathic scoliosis (AIS). Summary of Background Data. The use of all-pedicle screw construct in scoliosis corrective surgery continues to gain increasing popularity since their introduction 1994 although their use in the thoracic spine carries a potential risk for neurovascular complications. CT is the method widely used to evaluate screw placement. Methods. Retrospective analysis of 46 consecutive low-dose spine CT in patients with AIS after posterior corrective surgery. Status of 809 titanium screws (642 thoracic) was evaluated. The degree of interobserver and intraobserver agreements about implant status was used as an indicator of the reliability of the low-dose spine CT in the assessment of accuracy of pedicle screw insertion. A new grading system has been developed for this purpose. Five types of misplacement have been evaluated: lateral, medial, and anterior cortical perforations; end-plate perforation; and foraminal perforation. Results. The analysis has shown a substantial interobserver and intraobserver agreements (kappa: 0.69 and 0.76, respectively) in differentiating pedicle screws with acceptable placement from screws with partial or total cortical perforation. None of the examinations was subjectively classified as unreliable. Conclusion. The study has shown that low-dose spine CT is a reliable method in evaluating screw placement in patients with AIS after posterior scoliosis surgery with titanium implants, using the here proposed grading system. The new grading system of screw misplacement was feasible and in line with the general agreement about the harmlessness of misplacement with minor pedicle breach. The reliability of low-dose spine CT in evaluation of lateral and medial cortical perforations was substantial. To reduce the radiation load, the postoperative assessment of titanium implants should be performed with low-dose CT.
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  • Albeck, Michael J, et al. (författare)
  • A controlled comparison of myelography, computed tomography, and magnetic resonance imaging in clinically suspected lumbar disc herniation
  • 1995
  • Ingår i: Spine. - Lippincott Williams & Wilkins. - 0362-2436. ; 20:4, s. 443-448
  • Tidskriftsartikel (refereegranskat)abstract
    • STUDY DESIGN. A controlled prospective blinded study. OBJECTIVES. To compare the diagnostic power of myelography, computed tomography and magnetic resonance imaging in the diagnosis of low lumbar disc herniation. METHODS. Eighty patients with monoradicular sciatica were examined by myelography, computed tomography, and magnetic resonance imaging, and all underwent subsequent surgery. The images were evaluated twice in a blinded fashion, and the diagnostic power of the modalities was expressed by a decision-analytic regret function. RESULTS. In 57 patients (71%) a disc herniation at the expected level was disclosed at surgery. The largest amount of diagnostic information was gained from computed tomography, followed by magnetic resonance imaging and myelography. Both computed tomography and magnetic resonance imaging were significantly informative, whereas this was not the case for myelography. CONCLUSION. The results indicate that computed tomography or magnetic resonance imaging should be the first choice for imaging in patients with suspected lumbar disc herniation.
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  • Alipour, Akbar, et al. (författare)
  • Four-year incidence of sick leave because of neck and shoulder pain and its association with work and lifestyle
  • 2009
  • Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 34:4, s. 413-418
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>STUDY DESIGN: Four-year prospective cohort study. OBJECTIVE: To find the incidence of sick leave because of neck and shoulder pain (NSP) in industrial workers, and its association with work and lifestyle risk factors. SUMMARY OF BACKGROUND DATA: Longitudinal studies to investigate NSP incidence and risk factors are rare, and even fewer have been conducted in middle- and low-income countries. METHODS: After inviting all full-time employees of an Iranian car manufacturing company with 18,031 employees to participate in a baseline study, they were followed for 4 years. New episodes of sick leave because of NSP have been calculated based on sickness absence registration between the years 2003 and 2007. The incidence was compared for participants and nonparticipants. The association between sick leave, physical, and psychosocial risk factors at work, and previous self-reported NSP, was calculated for the remaining population of baseline participants (12,184 employees) during a 4-year follow-up. RESULTS: During a 4-year follow-up of study subjects for the remaining participants of the baseline study, the incidence of sick leave was 0.8% (98 sick leave cases in 12,184 employees). For nonparticipants this incidence was 4.2% (130 cases in 3127 employees). In the final regression model for sick leave cases, the remaining factors for potential physical risk factors were repetitive work and sitting positions at work; for psychosocial factors unattractive work was the only significant remaining factor. CONCLUSION: The incidence of NSP based on sick leave is definitely very low compared with previous studies in high-income countries. This incidence varies between participants and nonparticipants. Risk factors for sick leave differ from risk factors for self-reported pain. A young population, job security, the insurance system, different health behaviors, and healthy worker bias, are all factors that may affect the results, and sick-leave as an outcome must be interpreted with more caution in middle- and low-income countries.</p>
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  • Andersson, Eleonor I., et al. (författare)
  • Performance Tests in People With Chronic Low Back Pain Responsiveness and Minimal Clinically Important Change
  • 2010
  • Ingår i: Spine. - J B Lippincott Co. - 0362-2436 .- 1528-1159. ; 35:26, s. E1559-E1563
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Study Design. Cohort study. Objective. To assess the responsiveness and minimal clinically important change (MCIC) of 6 commonly-used performance tests (5-minute walking, 50-ft walking, sit-to-stand, 1 minute stair climbing, loaded forward reach, Progressive Isoinertial Lifting Evaluation). Summary of Background Data. Performance tests are used to evaluate physical function in people with low back pain. Little is known about their clinimetric properties. Methods. Performance tests were administered in people with chronic nonspecific low back pain (n = 198) before and after 10 weeks of treatment. At 10 weeks, the global perceived effect scale was used to determine if participants judged themselves as worsened, unchanged, or improved. The mean change scores for each performance test were calculated. A performance test was considered responsive if the area under the receiver operating characteristic curve (AUC) was equal to or greater than 0.70. We used 2 methods to evaluate MCIC: the optimal cut-off point based on the receiver operating characteristic curve, which takes into account both sensitivity and specificity, and the minimal detectable change for improvement, which considers test specificity only. Results. In general, the mean change scores were the smallest in participants who judged themselves worsened and largest in those reporting to be improved. Sit-to-stand (AUC = 0.75) and stair climbing (AUC = 0.72) were the only performance tests that showed adequate responsiveness. For sit-to-stand, the MCIC ranged from 4.1 to 9.8 seconds (19%-45% of the mean baseline score). For stair climbing, the MCIC ranged from 14.5 to 23.9 steps (19%-31% of the mean baseline score). Conclusion. Only 2 of the 6 performance tests were responsive. Both had acceptable MCIC values. Developing individualized performance tests might partly overcome the general lack of responsiveness of performance tests. Future research should focus on the clinimetric testing of performance tests in subgroups.</p>
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