| 1. |
- Peolsson, Anneli, et al.
(författare)
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Preliminary evaluation of dorsal muscle activity during resisted cervical extension in patients with longstanding pain and disability following anterior cervical decompression and fusion surgery
- 2015
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Ingår i: Physiotherapy. - : Elsevier BV. - 0031-9406 .- 1873-1465. ; 101:1, s. 69-74
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To compare mechanical activity (deformation and deformation rate) of the dorsal neck muscles between individuals with longstanding symptoms after anterior cervical decompression and fusion (ACDF) surgery and healthy controls.Design Preliminary cross-sectional study.Setting Neurosurgery clinic.Participants Ten individuals {mean age 60 [standard deviation (SD) 7.111 who had undergone ACDF surgery 10 to 13 years previously and 10 healthy age- and sex-matched controls.Main outcomes Mechanical activity of the different layers of dorsal neck muscles, measured at the C4 segment using ultrasonography (speckle tracking analysis) during a standardised, resisted cervical extension task.Results A significant group x muscle interaction was found for muscle deformation (P<0.03) but not for deformation rate (P>0.79). The ACDF group showed significantly less deformation of the semispinalis capitis muscle during the extension task compared with the control group [mean 3.12 (SD 2.06) and 6.64 (SD 4.17), respectively; mean difference 3.34 (95% confidence interval 0.54 to 7.21)].Conclusions As the semispinalis capitis muscle is a powerful neck extensor, the finding of altered activation following ACDF surgery lends support to the inclusion of exercise to train neck muscle performance in the management of these patients.
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| 2. |
- Peterson, Gunnel, et al.
(författare)
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Altered ventral neck muscle deformation for individuals with whiplash associated disorder compared to healthy controls : A case-control ultrasound study
- 2015
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Ingår i: Manual Therapy. - : Elsevier. - 1356-689X .- 1532-2769. ; 20:2, s. 319-327
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Tidskriftsartikel (refereegranskat)abstract
- Previous studies have shown altered neck muscle function in individuals with chronic whiplash associated disorder (WAD). However, we lack real-time investigations with non-invasive methods that can distinguish between the different ventral neck muscle layers. This study investigated deformations and deformation rates in the sternocleidomastoid (SCM), longus capitis (Lcap), and longus colli (Lco) muscles with real-time ultrasonography. Twenty-six individuals with WAD were compared with 26 controls, matched for age and sex. Ultrasound imaging of the SCM, Lcap, and Lco were recorded during 10 repetitive arm elevations. The first and tenth arm elevations were post-process analyzed with speckle tracking. There were few significant differences in the deformations or deformation rates in the SCM, Lcap, and Lco between the WAD and control group. In controls, deformations and deformation rates showed linear positive relationships between SCM/Lcap, SCM/Lco, and Lcap/Lco which increased from the first arm elevation (R-2 = 0.14-0.70); to the tenth arm elevation (R-2 = 0.51-0.71). The WAD group showed similar or weaker linear relationship (R-2 < 0.19) during the tenth compared to the first (R-2 < 0.44) arm elevation except for deformations in Lcap/Lco (R-2 = 0.13-0.57). This result indicated that deformations and deformation rates in one muscle were correlated by similar deformations and deformation rates in other neck muscles in the control group, but this interplay between muscles was not found in the WAD group. (C) 2014 Elsevier Ltd. All rights reserved.
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| 3. |
- Abbott, Rebecca, et al.
(författare)
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The qualitative grading of muscle fat infiltration in whiplash using fat and water magnetic resonance imaging
- 2018
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Ingår i: The spine journal. - : ELSEVIER SCIENCE INC. - 1529-9430 .- 1878-1632. ; 18:5, s. 717-725
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND CONTEXT: The development of muscle fat infiltration (MFI) in the neck muscles is associated with poor functional recovery following whiplash injury. Custom software and time-consuming manual segmentation of magnetic resonance imaging (MRI) is required for quantitative analysis and presents as a barrier for clinical translation. PURPOSE: The purpose of this work was to establish a qualitative MRI measure for MFI and evaluate its ability to differentiate between individuals with severe whiplash-associated disorder (WAD), mild or moderate WAD, and healthy controls. STUDY DESIGN/SETTING: This is a cross-sectional study. PATIENT SAMPLE: Thirty-one subjects with WAD and 31 age-and sex-matched controls were recruited from an ongoing randomized controlled trial. OUTCOME MEASURES: The cervical multifidus was visually identified and segmented into eighths in the axial fat/water images (C4-C7). Muscle fat infiltration was assessed on a visual scale: 0 for no or marginal MFI, 1 for light MFI, and 2 for distinct MFI. The participants with WAD were divided in two groups: mild or moderate and severe based on Neck Disability Index % scores. METHODS: The mean regional MFI was compared between the healthy controls and each of the WAD groups using the Mann-Whitney U test. Receiver operator characteristic (ROC) analyses were carried out to evaluate the validity of the qualitative method. RESULTS: Twenty (65%) patients had mild or moderate disability and 11 (35%) were considered severe. Inter- and intra-rater reliability was excellent when grading was averaged by level or when frequency of grade II was considered. Statistically significant differences (pamp;lt;.05) in regional MFI were particularly notable between the severe WAD group and healthy controls. The ROC curve, based on detection of distinct MFI, showed an area-under-the curve of 0.768 (95% confidence interval 0.59-0.94) for discrimination of WAD participants. CONCLUSIONS: These preliminary results suggest a qualitative MRI measure for MFI is reliable and valid, and may prove useful toward the classification of WAD in radiology practice. (C) 2017 Elsevier Inc. All rights reserved.
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| 4. |
- Agnew, Louise, et al.
(författare)
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Factors associated with work ability in patients with chronic whiplash-associated disorder grade II-III : a cross-sectional analysis
- 2015
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Ingår i: Journal of Rehabilitation Medicine. - : FOUNDATION REHABILITATION INFORMATION. - 1650-1977 .- 1651-2081. ; 47:6, s. 546-551
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the factors related to self-perceived work ability in patients with chronic whiplash-associated disorder grades II-III.Design: Cross-sectional analysis.Patients: A total of 166 working age patients with chronic whiplash-associated disorder.Methods: A comprehensive survey collected data on work ability (using the Work Ability Index); demographic, psychosocial, personal, work- and condition-related factors. Forward, stepwise regression modelling was used to assess the factors related to work ability.Results: The proportion of patients in each work ability category were as follows: poor (12.7%); moderate (39.8%); good (38.5%); excellent (9%). Seven factors explained 65% (adjusted R-2 = 0.65, p < 0.01) of the variance in work ability. In descending order of strength of association, these factors are: greater neck disability due to pain; reduced self-rated health status and health-related quality of life; increased frequency of concentration problems; poor workplace satisfaction; lower self-efficacy for performing daily tasks; and greater work-related stress.Conclusion: Condition-specific and psychosocial factors are associated with self-perceived work ability of individuals with chronic whiplash-associated disorder.
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| 5. |
- Amiri Arimi, Somayeh, et al.
(författare)
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Multifidus muscle size changes at different directions of head and neck movements in females with unilateral chronic non-specific neck pain and healthy subjects using ultrasonography
- 2018
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Ingår i: Journal of Bodywork & Movement Therapies. - : Churchill Livingstone. - 1360-8592 .- 1532-9283. ; 22:3, s. 560-565
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of the study was to compare the dimensions of cervical multifidus muscle (CMM) in different conditions.METHODS: Twenty five women with neck pain and 25 healthy subjects participated in this study. The dimensions of the CMM were measured at rest, 50% and 100% maximum isometric voluntary contraction (MIVC) at six directions of neck movements, using ultrasonography.RESULTS: The size of multifidus was smaller in patients than healthy individuals at rest state (P < 0.05). A significant smaller CMM dimension was found in the affected side compared with unaffected side in patients group (P < 0.05). The result of ANOVA for MLD showed a significant difference for contraction levels (P < 0.001) and neck movements (P < 0.001) in both groups. The MLD of the CMM was significantly different between CMM at rest and 50%, and 100% MIVC (P < 0.001). No significant differences were found between the groups at 50% and 100% MIVC (P > 0.05 in both instances). The most prominent CMM size change was observed during neck extension, flexion, ipsilateral lateral-flexion, and ipsilateral rotation, respectively (P < 0.05).CONCLUSIONS: Results of the present study indicate that the size of CMM was decreased in patients with neck pain in rest state. The size of CMM changes in all directions of neck movements, although the most prominent was during neck extension. This points out CMM stabilization role's in different directions of neck movements.
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| 6. |
- Ardern, Clare, et al.
(författare)
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Satisfaction With the Outcome of Physical Therapist-Prescribed Exercise in Chronic Whiplash-Associated Disorders : Secondary Analysis of a Randomized Clinical Trial
- 2016
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Ingår i: Journal of Orthopaedic and Sports Physical Therapy. - : Journal of Orthopaedic & Sports Physical Therapy (JOSPT). - 0190-6011 .- 1938-1344. ; 46:8, s. 640-649
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Secondary analysis of a randomized clinical trial.BACKGROUND: Patient perception of the benefits gained from treatment is important, yet satisfaction with the outcome of treatment for chronic whiplash-associated disorders (WADs) has not been investigated.OBJECTIVES: To investigate whether satisfaction with the outcome of treatment for chronic WAD changed over time, and whether there were group differences.METHODS: Two hundred sixteen people with chronic WAD (66% women; mean age, 40.4 years) participated in a 3-month program of physical therapist-led neck-specific exercises with or without a behavioral approach, or received a prescription of general physical activity. The main outcome was satisfaction with the outcome of treatment, assessed at baseline and 3, 6, and 12 months later. Additional outcomes were enablement and expectation fulfillment.RESULTS: Satisfaction improved over time in the 3 groups (odds ratio = 1.15; 95% confidence interval: 1.10, 1.20; P < .001). There was a significant group-by-time interaction (P < 001), with increased odds of being satisfied in the groups receiving neck-specific exercises compared to general physical activity. Enablement increased after completion of the intervention in all groups (P < .001). People who received neck-specific exercises reported greater enablement and expectation fulfillment than people prescribed general physical activity (P < .01).CONCLUSION: Exercise interventions for chronic WAD led to increased satisfaction for 12 months following treatment that was unrelated to the type of exercise intervention received.
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| 7. |
- Bernhoff, Gabriella, et al.
(författare)
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The pain drawing as an instrument for identifying cervical spine nerve involvement in chronic whiplash-associated disorders
- 2016
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Ingår i: Journal of Pain Research. - : DOVE MEDICAL PRESS LTD. - 1178-7090. ; 9, s. 397-404
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of the study was to investigate the psychometric properties of a standardized assessment of pain drawing with regard to clinical signs of cervical spine nerve root involvement. Design: This cross-sectional study included data collected in a randomized controlled study. Patients: Two hundred and sixteen patients with chronic (amp;gt;= 6 months) whiplash-associated disorders, grade 2 or 3, were included in this study. Methods: The validity, sensitivity, and specificity of a standardized pain drawing assessment for determining nerve root involvement were analyzed, compared to the clinical assessment. In addition, we analyzed the interrater reliability with 50 pain drawings. Results: Agreement was poor between the standardized pain drawing assessment and the clinical assessment (kappa = 0.11, 95% CI: -0.03 to 0.20). Sensitivity was high (93%), but specificity was low (19%). Interrater reliability was good (kappa = 0.64, 95% CI: 0.53 to 0.76). Conclusion: The standardized pain drawing assessment of nerve root involvement in chronic whiplash-associated disorders was not in agreement with the clinical assessment. Further research is warranted to optimize the utilization of a pain/discomfort drawing as a supportive instrument for identifying nerve involvement in cervical spinal injuries.
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| 8. |
- Calner, Tommy
(författare)
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Persistent musculoskeletal pain : A web-based activity programme for behaviour change, does it work? Expectations and experiences of the physiotherapy treatment process
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis concerned persons with persistent musculoskeletal pain in primary health care and had three aims. The first aim was to evaluate the effects of a web-based programme for behaviour change. The second aim was to create and evaluate a multimodal intervention. The third aim was to explore and describe expectations andexperiences of the physiotherapy treatment process.In Study I, we evaluated the effects of a web-based activity programme for behaviour change added to multidisciplinary rehabilitation (MDR) in primary health care. Ninety-nine participants were randomized to 1) MDR with an additional web-based programme, and 2) MDR. Outcome measures were work ability, pain intensity, pain-relate disability and health-related quality of life. There were no significant effects of the web-based programme for any outcome measure at 4 or 12 months. In conclusion, this study provides no support for adding a self-guided web-based programme to MDR in primary health care.In Study II, we evaluated first the web-based programme from Study I compared to the waiting list. Effect measures were workability, pain intensity, disability and self-efficacy. Thereafter, we evaluated the effects and process of a novel multimodal intervention consisting of the web-based programme with additional individual counselling, and individually tailored physiotherapy treatment. Ten participants were included in the study. Effects were evaluated using a Single Subject Experimental Design (SSED) and the process was evaluated by interviews with the participants and log data of usage of the modalities. There were no conclusive effects of the self-managed web-based programme as compared to the waiting list. The SSED analyses of the multimodal intervention showed promising short-term results regarding disability and pain intensity, but no conclusive results for work ability or self-efficacy. The multi-modal intervention process seemed successfully implemented, and the importance of physiotherapy and, to some extent counselling, was emphasized by the participants. In conclusion, the newly designed multimodal intervention in primary health care seemed feasible and showed some promising short-term effects, while the implementation of a self-managed web-based programme as a single intervention seemed without effect.In Study III, qualitative interviews were conducted with ten participants to explore their expectations of physiotherapy. Data were analysed with qualitative content analysis and the findings described a multi-faceted picture of the participants’ expectations, encompassing several aspects regarding the treatment process and outcome. Regarding the treatment process, participants expected a good dialogue, to be confirmed as individuals, and to get an explanation for their pain. The participants expected tailored training with frequent follow-ups and their expectations of outcome ranged from hope of the best possible results to being realistic or resigned.In Study IV, qualitative interviews were conducted with 11 participants to explore their experiences in physiotherapy treatment. Data were analysed with qualitative content analysis. The findings show how the participants described how they used knowledge, awareness, movements and exercises learned from the physiotherapy treatment to develop strategies to manage pain and the process of acceptance. There were experiences involving the importance of establishing an alliance with the physiotherapist, based on trust and with a continuous dialogue. When exercises, activities and other treatment modalities were individualized, participants were actively involved in the process. This was rewarding but was also considered an effort and a challenge. The physiotherapist’s initiatives and actions were considered important for incentive and support.In conclusion, we found no effects of the web-based activity programme on behaviour change for persons with persistent musculoskeletal pain. The newly designed multi-modal intervention in primary health care seemed feasible and showed some promising short-term effects. Expectations of physiotherapy treatment were multi-faceted, encompassing both process and outcome. After finishing physiotherapy, the participants described how they used knowledge, awareness, movements and exercises learned from the physiotherapy treatment to develop strategies to manage pain and the process of acceptance. The importance of alliance and incentives for activities throughout the physiotherapy treatment process were also described.
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| 9. |
- Dannapfel, Petra, 1978-
(författare)
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Evidence-Based Practice in Practice : Exploring Conditions for Using Research in Physiotherapy
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Research developments have led to increased opportunities for the use of improved diagnostic and treatment methods in physiotherapy and other areas of health care. The emergence of the evidence-based practice (EBP) movement has led to higher expectations for a more research-informed health care practice that integrates the best available research evidence with clinical experience and patient priorities and values. Physiotherapy research has grown exponentially, contributing to an increased interest in achieving a more evidence-based physiotherapy practice. However, implementation research has identified many individual and contextual barriers to research use. Strategies to achieve a more EBP tend to narrowly target individual practitioners to influence their knowledge, skills and attitudes concerning research use. However, there is an emerging recognition that contextual conditions such as leadership and culture are critical to successfully implementing EBP.Against this background, the overall aim of this thesis was to explore conditions at different levels, from the individual level to the organizational level and beyond, for the use of research and implementation of an evidence-based physiotherapy practice. The thesis consists of four interrelated papers that address various aspects of the aim. Individual and focus group interviews were conducted with physiotherapists and managers within physiotherapy in various county councils in Sweden between 2011 and 2014. Data were analysed using qualitative content analysis, direct content analysis and hermeneutics.It was found that many different types of motivation underlie physiotherapists’ use of research in their clinical practice, from amotivation (i.e. a lack of intention to engage in research use) to intrinsic motivation (research use is perceived as interesting and satisfying in itself). Most physiotherapists tend to view research use in favourable terms. Physiotherapists’ participation in a research project can yield many individual learning experiences that might contribute to a more research-informed physiotherapy practice. However, organizational learning was more limited. Numerous conditions at different levels (individual, workplace and extra-organizational levels) provide support for physiotherapists’ use of research in their clinical practice. However, physiotherapy leaders appear to contribute to a modest degree to establishing a culture that is conducive to implementing EBP in physiotherapy practice. Instead, EBP issues largely seem to depend on committed individual physiotherapists who keep to up to date with research in physiotherapy and inform colleagues about the latest research findings.
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| 10. |
- Dedering, Asa, et al.
(författare)
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The Effects of Neck-Specific Training Versus Prescribed Physical Activity on Pain and Disability in Patients With Cervical Radiculopathy: A Randomized Controlled Trial
- 2018
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Ingår i: Archives of Physical Medicine and Rehabilitation. - : W B SAUNDERS CO-ELSEVIER INC. - 0003-9993 .- 1532-821X. ; 99:12, s. 2447-2456
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare the effects of a neck-specific training program to prescribed physical activity with both groups receiving a cognitive behavioral approach, on pain and disability in patients with cervical radiculopathy (CR). Design: Parallel-group randomized clinical trial with follow-up at 3, 6, 12, and 24 months. Setting: Recruitment and assessments of participants were performed at a university hospital. Interventions were performed in primary care setting at outpatient physiotherapy clinics. Participants: Patients (N=144) with CR were recruited to participate in this clinical trial. Interventions: Patients were randomly assigned to 3 months of either of a neck-specific training program or prescribed physical activity. Main Outcome Measures: Primary outcomes included self-rated neck and arm pain as collected by the visual analog scale (VAS). Secondary outcomes were self-rated headache measured with the VAS, the Neck Disability Index, the EuroQol 5D, the Fear Avoidance Beliefs Questionnaire, and the Hospital Anxiety and Depression Scale. Assessments were performed at baseline and at 3-, 6-, 12-, and 24-month follow-up periods. Results: Intention-to-treat and per-protocol analyses showed no significant interaction (group x time) or group effects. There were, however, significant time effects indicating improvement over time for both groups for all outcomes except for levels of depression. Conclusions: The study revealed that neck-specific training as well as prescribed physical activity both including additional cognitive behavioral approach decreased the pain in patients with CR, that is, participants improved regardless of the intervention received. There is a lack of consensus of how to best manage individuals with CR. However, our findings suggest that CR has a natural favorable long-term outcome when patients are prescribed neck-specific training and exercise in combination with a behavioral approach. (C) 2018 by the American Congress of Rehabilitation Medicine
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