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Sökning: WFRF:(Hedlund Rune)

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1.
  • Abbott, Allan D., et al. (författare)
  • Leg pain and psychological variables predict outcome 2-3 years after lumbar fusion surgery.
  • 2011
  • Ingår i: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. - 1432-0932.
  • Tidskriftsartikel (refereegranskat)abstract
    • Prediction studies testing a thorough range of psychological variables in addition to demographic, work-related and clinical variables are lacking in lumbar fusion surgery research. This prospective cohort study aimed at examining predictions of functional disability, back pain and health-related quality of life (HRQOL) 2-3 years after lumbar fusion by regressing nonlinear relations in a multivariate predictive model of pre-surgical variables. Before and 2-3 years after lumbar fusion surgery, patients completed measures investigating demographics, work-related variables, clinical variables, functional self-efficacy, outcome expectancy, fear of movement/(re)injury, mental health and pain coping. Categorical regression with optimal scaling transformation, elastic net regularization and bootstrapping were used to investigate predictor variables and address predictive model validity. The most parsimonious and stable subset of pre-surgical predictor variables explained 41.6, 36.0 and 25.6% of the variance in functional disability, back pain intensity and HRQOL 2-3 years after lumbar fusion. Pre-surgical control over pain significantly predicted functional disability and HRQOL. Pre-surgical catastrophizing and leg pain intensity significantly predicted functional disability and back pain while the pre-surgical straight leg raise significantly predicted back pain. Post-operative psychomotor therapy also significantly predicted functional disability while pre-surgical outcome expectations significantly predicted HRQOL. For the median dichotomised classification of functional disability, back pain intensity and HRQOL levels 2-3 years post-surgery, the discriminative ability of the prediction models was of good quality. The results demonstrate the importance of pre-surgical psychological factors, leg pain intensity, straight leg raise and post-operative psychomotor therapy in the predictions of functional disability, back pain and HRQOL-related outcomes.
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  • Iderberg, Hanna, et al. (författare)
  • Predicting clinical outcome and length of sick leave after surgery for lumbar spinal stenosis in Sweden : a multi-register evaluation
  • 2019
  • Ingår i: European spine journal. - 0940-6719 .- 1432-0932. ; 28:6, s. 1423-1432
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: Lumbar spinal stenosis (LSS) can be surgically treated, with variable outcome. Studies have linked socioeconomic factors to outcome, but no nation-wide studies have been performed. This register-based study, including all patients surgically treated for LSS during 2008-2012 in Sweden, aimed to determine predictive factors for the outcome of surgery.Methods: Clinical and socioeconomic factors with impact on outcome in LSS surgery were identified in several high-coverage registers, e.g., the national quality registry for spine surgery (Swespine, FU-rate 70-90%). Multivariate regression analyses were conducted to assess their effect on outcome. Two patient-reported outcome measures, Global Assessment of leg pain (GA) and the Oswestry Disability Index (ODI), as well as length of sick leave after surgery were analyzed.Results: Clinical and socioeconomic factors significantly affected health outcome (both GA and ODI). Some predictors of a good outcome (ODI) were: being born in the EU, reporting no back pain at baseline, a high disposable income and a high educational level. Some factors predicting a worse outcome were previous surgery, having had back pain more than 2years, having comorbidities, being a smoker, being on social welfare and being unemployed.Conclusions: The study highlights the relevance of adding socioeconomic factors to clinical factors for analysis of patient-reported outcomes, although the causal pathway of most predictors' impact is unknown. These findings should be further investigated in the perspective of treatment selection for individual LSS patients. The study also presents a foundation of case mix algorithms for predicting outcome of surgery for LSS.
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  • Joelson, Anders, 1970-, et al. (författare)
  • Self-Image and Health-Related Quality of Life Three Decades After Fusion In Situ for High-Grade Isthmic Spondylolisthesis
  • 2019
  • Ingår i: Spine deformity. - : Elsevier. - 2212-134X .- 2212-1358. ; 7:2, s. 293-297
  • Tidskriftsartikel (refereegranskat)abstract
    • STUDY DESIGN: Observational study.OBJECTIVES: To evaluate self-image after in situ fusion for high-grade isthmic spondylolisthesis.SUMMARY OF BACKGROUND DATA: Certain clinical findings such as short trunk or waistline skin folds are often seen in high-grade spondylolisthesis. Since treatment with spinal fusion in situ does not address appearance, self-image and also health-related quality of life might be negatively affected in the short-term as well as the long-term perspective. This observational study evaluated health-related quality of life outcome including self-image three decades after in situ fusion for high-grade isthmic spondylolisthesis in relation to healthy controls.METHODS: Thirty-eight of 39 consecutive patients, fused in situ for high-grade isthmic spondylolisthesis at a young age, completed the Scoliosis Research Society (SRS)-22r questionnaire 28-41 years after surgery. The results were compared with the results of an age- and gender-matched control group.RESULTS: We found that the SRS-22r self-image domain scores were statistically significantly lower in patients than in controls whereas the pain and mental health scores were similar in patients and controls. Also, the SRS-22r function domain scores were statistically significantly lower in patients but the difference in means was small. We found no correlation between severity of slip and SRS-22r outcome.CONCLUSIONS: In situ fusion for high-grade isthmic spondylolisthesis is a safe treatment option in the long term from a function and pain perspective, but the results of our study suggest that self-image is negatively affected long into adult life.LEVEL OF EVIDENCE: Level IV.
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  • Abbott, Allan, et al. (författare)
  • Early physiotherapeutic rehabilitation following lumbar spinal fusion surgery
  • 2009
  • Ingår i: Oral Presentations. - : Springer. ; , s. S409-S410
  • Konferensbidrag (övrigt vetenskapligt)abstract
    • Background: Physiotherapy after lumbar spinal fusion surgery is traditionally focused on physical exercise. Too few studies have investigatedthe efficacy of modern lumbar stabilization exercise regimes. Benefits have been shown for combining traditional physical exercise with a psychosocial intervention. No randomised controlled study has evaluated thecombined biopsychosocial effect of modern lumbar stabilization exercisesand cognitive behavioural intervention compared to traditional physical exercise starting immediately after lumbar spinal fusion.Purpose: To investigate the effectiveness of modern physiotherapy(MPT) compared to a traditional physiotherapy (TPT) starting immediately after lumber spinal fusion.Study design/setting: Randomized controlled clinical trial.Patient sample, inclusion period and follow-up: Patients between 18 and 65 years, selected for lumbar spinal fusion due to at least 12 months of CLBP symptoms caused by spinal stenosis, spondylosis, spondylolisthesis or degenerative disc disease were included in the study between 2005 and 2007. A total of 107 patients were randomly allocated to the MPT group (n = 53) and TPT group (n = 54). The TPT group was prescribed daily home based pain contingent training of traditional physical exercises for back, abdominal and leg muscles. The MPT group was prescribed daily home based training of lumbar stabilization exercises combined with 90 min of cognitive behavioural intervention at 3, 6 and 9 weeks after the operation. The patients outcomes were followed up at 3, 6, 12 months and 2–3 yearsOutcome measures: Oswestry disability index (ODI), pain intensity, HRQOL, kinesiophobia, anxiety/depression, self-efficacy, outcome expectancy, use of coping strategies, work status, sickness leave and health care use.Methods: Analysis of mean differences between groups.Results: 2–3 year follow-up showed that the MPT group had significantly lower percentage scores in ODI = 18.2 (P = 0.008), kinesiophobia= 30.0 (P = 0.001), catastrophizing = 21.8 (P = 0.006) and higher self-efficacy = 64.6 (P = 0.019) compared to TPT group’s ODI = 28.1, kinesiophobia = 41.9, catastrophizing = 31.3 and self-efficacy = 55.5. The MPT group had significantly more employment, less health care use (P = 0.035) and less long-term sickness leave (P = 0.040).Conclusions: This study provides evidence for the benefits of combining lumbar stabilization exercise and cognitive behavioural intervention starting immediately after lumbar fusion.
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10.
  • 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
    • Study Design - Open label randomized controlled trial with 3-, 6-, 12-month, and 2- to 3-year follow-up.Objective - 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.Summary of Background Data - 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.Methods - 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.Results - 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.Conclusion - 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.
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