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Träfflista för sökning "WFRF:(Adolfsson Lars 1955 ) srt2:(2020-2021)"

Sökning: WFRF:(Adolfsson Lars 1955 ) > (2020-2021)

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1.
  • Husdal, R., et al. (författare)
  • Organisation of primary diabetes care in people with type 2 diabetes in relation to all-cause mortality: A nationwide register-based cohort study
  • 2020
  • Ingår i: Diabetes Research and Clinical Practice. - : Elsevier. - 0168-8227 .- 1872-8227. ; 167
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: To examine if personnel resources and organisational features in Swedish primary health-care centres (PHCCs) are associated to all-cause mortality (ACM) in people with type 2 diabetes mellitus (T2DM). Methods: A total of 187,570 people with T2DM registered in the Swedish National Diabetes Register (NDR) during 2013 were included in this nationwide cohort study. Individual NDR data were linked to data from a questionnaire addressing personnel resources and organisational features for 787 (68%) PHCCs as well as to individual data on socio-economic status and comorbidities. Furthermore, data on ACM were obtained and followed up until 30 January 2018. Hierarchical Cox regression analyses were applied. Results: After a median follow-up of 4.2 years, 27,136 (14.5%) participants had died. An association was found between number of whole-time-equivalent (WTE) general practitioner's (GP's) devoted to diabetes care/500 people with T2DM and lower risk of early death (hazard ratio 0.919 [95% confidence interval 0.895–0.945] per additional WTE GP; p = 0.002). No other personnel resources or organisational features were significantly associated with ACM. Conclusions: This nationwide register-based cohort study suggests that the number of WTE GPs devoted to diabetes care have an impact on the risk of early death in people with T2DM. © 2020 Elsevier B.V.
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2.
  • Nordqvist, Jenny, 1976-, et al. (författare)
  • Heterogeneity among patients with subacromial pain – variabilities within clinical presentation and its impact on daily life
  • 2020
  • Ingår i: Physiotherapy. - 0031-9406 .- 1873-1465.
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: The primary aim was to describe the variability within clinical presentation of patients with subacromial pain in primary care, secondly to investigate associations between clinical presentation and self-reported pain intensity, shoulder function, level of anxiety and depression, and health-related quality of life. Design and setting A cross-sectional study based on data from two clinical studies in primary care, one randomized controlled trial and one implementation study. Three components: active range of motion (AROM), rotator cuff function and scapular kinematics were analyzed to describe variability within clinical presentation and patient-reported measurements were used to investigate the impact on daily life. Participants Patients aged 30-67 years, describing pain for more than two weeks, and positive signs for a minimum of three out of the following five clinical tests: impingement sign according to Neer, impingement test according to Hawkins-Kennedy, Pattes maneuver, Jobe’s test, and painful arc. Results Among the 164 patients included, 24% displayed dysfunction in one, 50% two and 24% in all three components. Limited AROM was seen in 46%, rotator cuff dysfunction in 91% and scapular dyskinesia in 57% of the patients. Conclusions These results reveal a heterogeneity among primary care patients with subacromial pain confirming a large variability regarding the components AROM, rotator cuff function and scapular kinematics. All three components appear unique (not significantly correlated) where a rotator cuff dysfunction is very frequent while limited AROM and scapular dyskinesia are more inconsistent. There are significant, but rather weak, associations between clinical presentation and impact on daily life.
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3.
  • Nordqvist, Jenny, 1976- (författare)
  • Patients with subacromial pain in primary care : Assessment and efficacy of physiotherapy-guided exercise treatment
  • 2021
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • Background: Shoulder pain is a common musculoskeletal disorder and 40-74% of the patients attending primary healthcare with a shoulder disorder are diagnosed with subacromial pain. Subacromial pain is characterized by restricted and painful movement of the arm that leads to difficulties in performing arm-related activities and often affects the quality of life profoundly, with respect to everyday function, work capacity, sleep quality and mental health. It is crucial that the measurements used to evaluate shoulder function and treatment response have acceptable psychometric properties and also that they are patients-specific and time-efficient to administer. For patients with subacromial pain, exercises are recommended as first-line treatment but consensus about which exercises and dosage to recommend has not been reached. The lack of evidence for one specific exercise model may be partly due to heterogeneity among this group of patients. The overall aim of this thesis were to evaluate the efficacy of a previously tested exercise strategy for patients with subacromial pain in a primary care setting, to describe the heterogeneity with possible subcategories among patients with subacromial pain, and finally to validate and adjust the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire for more diagnosis-specific clinical assessment. Methods: The four papers in this thesis are based on two clinical studies, one randomized controlled trial (RCT) and one clinical cohort. The participants in both studies were patients with subacromial pain attending physiotherapist (PT) in a primary care setting. Two of the papers are based on psychometric analyses, with evaluation of construct validity and responsiveness for the DASH when used to evaluate shoulder function in patients with subacromial pain, and also calculation of minimal important change (MIC) for a diagnosis-specific short version of DASH (DASH 7). A third paper describe clinical presentation in patients with subacromial pain, based on the components active range of motion (AROM), rotator cuff function and scapular kinematics and the fourth paper evaluated the efficacy of a 3-month specific exercise strategy in comparison to an active control strategy. Results: Seven items from the original DASH were identified as being the most important in evaluating patients with subacromial pain (resulting in the DASH 7 questionnaire). The DASH 7 shows good responsiveness, can discriminate between patients who perceive themselves as improved and those who do not, and maintain a high level of internal consistency for the assessment of shoulder function in patients with subacromial pain, using only a quarter of the items of the original DASH. Based on clinical presentation, patients with subacromial pain in the primary care setting comprise a heterogeneous group. Rotator cuff dysfunction, defined as pain during resisted isometric muscle-testing, is very frequently present while limitation in active range of motion and scapular dyskinesia are less common. After three months of exercise, both groups in the RCT had significantly improved with no between group difference as measured with the primary CM-score. However, as measured with the DASH and the DASH 7, the patients in the specific exercise group was significantly more improved compared to those in the active control group. Conclusions: The DASH 7 questionnaire is a short patient-reported outcome measurement (PROM) with good responsiveness, specific for patients with subacromial pain. Heterogeneity was confirmed with identified variability in AROM, rotator cuff function and scapular kinematics in clinical presentation which confirms that these components are important in the clinical examination of patients with subacromial pain. Shoulder function evaluated with the CM score did not improve to a significantly different degree between the two groups studied. The specific exercises might not be necessary for all patients in the primary care setting to achieve a clinically relevant improvement. However, the specific exercise strategy was significantly better when improvement was assessed by DASH and DASH 7, and this leads us to recommend this strategy, with its progressive loading of the rotator cuff muscles and scapula stabilizers, as first choice, provided that it is tolerated by the patient. 
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4.
  • Ranebo, Mats, 1970- (författare)
  • Rotator Cuff Tears : Short- and long-term aspects on treatment outcome
  • 2020
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • Rotator cuff tear is a common disorder and there is a lack of knowledge of appropriate treatment and consequences of different treatment modalities. The overall aim of this thesis was to examine short- and long-term results of rotator cuff tear treatment.In Paper I we did a retrospective 21 to 25-year follow-up of a consecutive series of patients with partial and full-thickness rotator cuff tears, treated with acromioplasty without cuff repair. The cuff status had been documented in a specific perioperative protocol in all patients at the index operation. We did x-ray, ultrasonography and clinical scores with Constant score and Western Ontario Rotator Cuff index (WORC) at follow-up. We identified 111 patients with either a partial or a full-thickness tear, but at follow-up 21 were deceased and 11 were too ill from medical conditions unrelated to their shoulder. Out of the remaining 78 eligible patients, 69 were examined (follow-up rate 88 %) and they had a mean age at the index operation of 49 years (range 19-69 years). Forty-five had a partial tear and 24 a full-thickness tear at the index operation. At follow-up, 74% of patients with full-thickness tear had cuff tear arthropathy grade 2 or more according to the arthropathy classification of Hamada (grade 1 to 5) and 87% had developed tear progression (i.e. a larger tear). Corresponding numbers in those with a partial tear was 7 % arthropathy and 42 % tear progression, and the differences between the full-thickness group and the partial tear group was significant for both outcome measures (P<0.001 for both analyses). In those with arthropathy, the mean Constant score was 47 (standard deviation [SD], 23), the mean age and gender-adjusted Constant score 62 (SD, 27) and the mean WORC 58 % (SD, 26). Patients with a partial tear at follow-up had mean Constant score and WORC within the normal range. In multivariable analysis with logistic regression, having a full-thickness tear at the index operation was a risk factor for arthropathy (odds ratio [OR] 37.8; 95% confidence interval [CI], 8.2-175.0) and for tear progression (OR 6.09; 95% CI, 1.41-26.29).In Paper II we examined the contralateral shoulder in the same patients as in paper I and with the same methodology. Sixty-one patients were examined and 38 had had a partial tear at the index operation 21-25 years ago and 23 a full-thickness tear. The overall rate of contralateral full-thickness tears was 50.8 %, which is higher than the 16-35 % rate found in previous studies of newly diagnosed cuff patients. The rate of contralateral full-thickness tear ranged from 13.6 % in patients with a partial tear in the index shoulder at follow-up, to 90 % in patients with a full-thickness tear and arthropathy in the index shoulder. There was a significant correlation regarding conditions between shoulders in the same patient, with a Spearman coefficient of 0.72 for the number of ten-dons with a full-thickness tear, 0.31 for Hamada grade of arthropathy and 0.65 for Constant score. The number of tendons with a full-thickness tear in the index shoulder at follow-up was a risk factor for a contralateral full-thickness tear (OR 3.28; 95% CI, 1.67-6.44) in a multi-variable logistic regression model. We also found that cuff tear arthropathy was significantly more common in patients who had undergone an acromioplasty (P<0.001), a finding which is not confirmatory but may generate a hypothesis.Paper III addressed 17 to 20-year results after operation with a synthetic interposition graft for irreparable cuff tears. We used X-ray, ultrasonography and clinical scores at follow-up. We identified a consecutive series of 13 patients, one of whom was deceased at follow-up. Ten of the remaining 12 participated in a complete follow-up and 2 did only x-ray examination. Nine out of 12 (75 %; 95% CI, 43-95 %) had cuff tear arthropathy Hamada grade 2 or more in the index shoulder at follow-up. The mean Constant score was 46 (SD, 26) and the mean WORC 59 % (SD, 20). Seven out of 12 had contralateral cuff tear arthropathy, and the difference in frequency of arthropathy between shoulders was not statistically significant (P=0.667).In Paper IV we tested whether early repair of small cuff tears, involving mainly supraspinatus, would give a superior clinical result com-pared to physiotherapy without repair in a prospective randomised trial with 12 months follow-up. We used Constant score as the primary out-come, and WORC, EQ-VAS and Numerical Rating Scale for pain (NRS) as secondary outcomes. We also aimed at assessing the rate of tear progression in unrepaired shoulders and the healing rate in repaired shoulders by Magnetic Resonance Imaging (MRI) performed at 12 months. With a high grade of follow-up (100 % for 12 months Constant score and 95 % for 12 months MRI), the repair group had a 12 months median Constant score of 83 (Quartile range [QR], 25) and the conservative group 78 (QR, 22). This between-group difference in medians of 4.5 (95% CI,-5 to 9; P=0.68) was not statistically significant and we did not detect any significant differences in the secondary outcomes at 12 months. The retear rate was 6.5 % in repaired patients and 29 % of unrepaired patients had a tear enlargement >5 mm.The results in this thesis indicate that patients with small, traumatic, full-thickness tears of mainly supraspinatus have no clinical benefit of early surgical repair compared to physiotherapy alone, but in the long-term, patients with full-thickness tears have an increased risk of tear progression, cuff tear arthropathy and low clinical scores. These results are especially important in the treatment decision of repair or not in younger patients. Having a full-thickness tear is also a risk factor for having a contralateral cuff tear, a phenomenon that underlines the importance of endogenous factors in the development of rotator cuff tears. If a cuff tear is not repairable to bone, the addition of a synthetic inter-position graft does not seem to prevent cuff tear arthropathy.
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