| 1. |
- Diarbakerli, E., et al.
(author)
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Learning from the past to plan for the future: A scoping review of musculoskeletal clinical research in Sweden 2010-2020
- 2022
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In: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 127:1
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Journal article (peer-reviewed)abstract
- Background: The aims of this study are to 1) determine the scope of musculoskeletal (MSK)-related clinical research in Sweden; 2) collate the amount of first-tier funding received; 3) discuss strategies and infrastructure supporting future MSK clinical trials in Sweden. Methods: A systematic scoping review protocol was applied in PubMed, Scopus, and SweCRIS databases. The articles were examined, and data were extracted in multiple stages by three blinded authors. Results: The search strategy resulted in 3,025 publications from 479 Swedish-affiliated authors. Primary health care was the basis for 14% of the publications, 84% from secondary health care, and 2% from occupational health care with a similar proportional distribution of first-tier research grant financing. Approximately one in six publications were randomized controlled trials (RCTs), while the majority were of observational cohort design. The majority of publications in primary and occupational health care were related to pain disorders (51 and 67%, respectively), especially diagnosis, prognosis, and healthcare organizational-related interventions (34%) and rehabilitation (15%) with similar proportional distribution of first-tier research grant financing. In secondary health care, rheumatic inflammatory disorder-related publications were most prevalent (30%), most frequently concerning diagnosis, prognosis, and healthcare organizational-related interventions (20%), attracting approximately half of all first-tier funding. Publications related to degenerative joint disorders (25%), fractures (16%), and joint, tendon, and muscle injuries (13%) frequently concerned surgical and other orthopedic-related interventions (16, 6, and 8%, respectively). Pain disorder-related publications (10%) as well as bone health and osteoporosis-related publications (4%) most frequently concerned diagnosis, prognosis, and healthcare organizational-related interventions (5 and 3%, respectively). Conclusions: Swedish-affiliated MSK disorder research 2010-2020 was predominantly observational cohort rather than RCT based. There was skewed first-tier funding allocation considering prevalence/incidence and burden of disease. Use of infrastructure supporting register-based RCTs, placebo-controlled RCTs, and hybrid effectiveness-implementation studies on prevention and clinical intervention is important strategies for the future in all healthcare sectors.
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| 2. |
- Diarbakerli, Elias, et al.
(author)
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Swedish musculoskeletal researchers view on a collaborative network and future research priorities in Swedish healthcare
- 2024
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In: Musculoskeletal Care. - : John Wiley & Sons. - 1478-2189 .- 1557-0681. ; 22:1
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Journal article (peer-reviewed)abstract
- Background: Musculoskeletal disorders (MSK) are a global burden causing significant suffering and economic impact. Systematic identification and targeting of research questions of highest interest for stakeholders can aid in improving MSK disorder knowledge and management.Objective: To obtain Swedish MSK researchers' opinions and views on a collaborative Swedish MSK network (SweMSK) and identify future research areas of importance for Swedish MSK research.Methods: A web-based survey was conducted July to September 2021 to collect data from 354 Swedish MSK researchers. The survey focused on the need, objectives, and structure of a SweMSK network and identified prioritised areas for future MSK research.Results: The study included 141 respondents, of which 82 were associate professors or professors. The majority (68%) supported the creation of a new musculoskeletal network. The most supported element was increased collaboration regarding nationwide and multicenter studies. Respondents recommended the creation of a homepage and the establishment of national work groups with different specific interests as the primary elements of a new network.Conclusion: The results demonstrated a need and desire for increased national research collaboration and the creation of a new musculoskeletal network. The high academic experience and active research participation of the respondents suggest the need for MSK disorder knowledge and management improvement in Sweden. Therefore, the SweMSK network may help facilitate effective collaboration and research efforts that can contribute to the advancement of MSK disorder management and care. This study may provide valuable insights for policymakers, clinicians, and researchers to improve MSK disorder care and management in Sweden.
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| 3. |
- Bohman, Tony, et al.
(author)
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Predictive models for short-term and long-term improvement in women under physiotherapy for chronic disabling neck pain : a longitudinal cohort study.
- 2019
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In: BMJ Open. - : BMJ. - 2044-6055. ; 9:4
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To develop predictive models for short-term and long-term clinically important improvement in women with non-specific chronic disabling neck pain during the clinical course of physiotherapy.DESIGN: Longitudinal cohort study based on data from a randomised controlled trial evaluating short-term and long-term effects on sensorimotor function over 11 weeks of physiotherapy.PARTICIPANTS AND SETTINGS: Eighty-nine women aged 31-65 years with non-specific chronic disabling neck pain from Gävle, Sweden.MEASURES: The outcome, clinically important improvement, was measured with the Patient Global Impression of Change Scale (PGICS) and the Neck Disability Index (NDI), assessed by self-administered questionnaires at 3, 9 and 15 months from the start of the interventions (baseline). Twelve baseline prognostic factors were considered in the analyses. The predictive models were built using random-effects logistic regression. The predictive ability of the models was measured by the area under the receiver operating characteristic curve (AUC). Internal validity was assessed with cross-validation using the bootstrap resampling technique.RESULTS: Factors included in the final PGICS model were neck disability and age, and in the NDI model, neck disability, depression and catastrophising. In both models, the odds for short-term and long-term improvement increased with higher baseline neck disability, while the odds decreased with increasing age (PGICS model), and with increasing level of depression (NDI model). In the NDI model, higher baseline levels of catastrophising indicated increased odds for short-term improvement and decreased odds for long-term improvement. Both models showed acceptable predictive validity with an AUC of 0.64 (95% CI 0.55 to 0.73) and 0.67 (95% CI 0.59 to 0.75), respectively.CONCLUSION: Age, neck disability and psychological factors seem to be important predictors of improvement, and may inform clinical decisions about physiotherapy in women with chronic neck pain. Before using the developed predictive models in clinical practice, however, they should be validated in other populations and tested in clinical settings.
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| 4. |
- Hadrévi, Jenny, et al.
(author)
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Systemic differences in serum metabolome : a cross sectional comparison of women with localised and widespread pain and controls
- 2015
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In: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 5
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Journal article (peer-reviewed)abstract
- Chronic musculoskeletal pain exists either as localised to a single region or as widespread to multiple sites in several quadrants of the body. Prospective studies indicate that widespread pain could act as a far end of a continuum of musculoskeletal pain that started with chronic localised pain. The mechanism by which the transition from localised pain to widespread occurs is not clear, although many studies suggest it to be an altered metabolism. In this study, systemic metabolic differences between women with chronic localised neck-shoulder pain (NP), women with chronic widespread pain (CWP) and women who were healthy (CON) were assessed. Blood samples were analysed taking a metabolomics approach using gas chromatography mass spectrometry (GC-MS) and orthogonal partial least square discriminant analysis (OPLS-DA). The metabolomics analysis showed a clear systematic difference in the metabolic profiles between the subjects with NP and the CON but only a weak systematic difference between the subjects with CWP and the CON. This most likely reflects a difference in the portion of the metabolome influenced by the two pain conditions. In the NP group, the overall metabolic profile suggests that processes related to energy utilisation and lipid metabolism could be central aspects of mechanisms maintaining disorder.
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| 5. |
- Röijezon, Ulrik, 1970-, et al.
(author)
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A novel method for neck coordination exercise : a pilot study on persons with chronic non-specific neck pain
- 2008
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In: Journal of NeuroEngineering and Rehabilitation. - : BioMed Central (BMC). - 1743-0003. ; 5, s. 36-
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Journal article (peer-reviewed)abstract
- BACKGROUND: Chronic neck pain is a common problem and is often associated with changes in sensorimotor functions, such as reduced proprioceptive acuity of the neck, altered coordination of the cervical muscles, and increased postural sway. In line with these findings there are studies supporting the efficacy of exercises targeting different aspects of sensorimotor function, for example training aimed at improving proprioception and muscle coordination. To further develop this type of exercises we have designed a novel device and method for neck coordination training. The aim of the study was to investigate the clinical applicability of the method and to obtain indications of preliminary effects on sensorimotor functions, symptoms and self-rated characteristics in non-specific chronic neck painMETHODS: The study was designed as an uncontrolled clinical trial including fourteen subjects with chronic non-specific neck pain. A new device was designed to allow for an open skills task with adjustable difficulty. With visual feedback, subjects had to control the movement of a metal ball on a flat surface with a rim strapped on the subjects' head. Eight training sessions were performed over a four week period. Skill acquisition was measured throughout the intervention period. After intervention subjects were interviewed about their experience of the exercise and pain and sensorimotor functions, including the fast and slow components of postural sway and jerkiness-, range-, position sense-, movement time- and velocity of cervical rotation, were measured. At six-month follow up, self-rated pain, health and functioning was collected.RESULTS: The subjects improved their skill to perform the exercise and were overall positive to the method. No residual negative side-effects due to the exercise were reported. After intervention the fast component of postural sway (p = 0.019) and jerkiness of cervical rotation (p = 0.032) were reduced. The follow up showed decreased disability (one out of three indices) and fear of movement, and increased general health (three out of eight dimensions).CONCLUSION: The results support the clinical applicability of the method. The improvements in sensorimotor functions may suggest transfer from the exercise to other, non-task specific motor functions and justifies a future randomized controlled trial.
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| 6. |
- Richter, Hans O., et al.
(author)
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Long-term adaptation to neck/shoulder pain and perceptual performance in a hand laterality motor imagery test
- 2010
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In: Perception. - : Sage Publications. - 0301-0066 .- 1468-4233. ; 39:1, s. 119-130
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Journal article (peer-reviewed)abstract
- The effect of neck/shoulder pain on the performance in a hand laterality motor imagery test was studied. Responses to the Cooper and Shepard (1975, Journal of Experimental Psychology: Human Perception and Performance 104 48–56) hand laterality test were explored in twenty-four individuals with chronic non-specific neck pain and twenty-one subjects with chronic neck pain of traumatic origin (whiplash-associated disorder). Twenty-two controls were also included in the study. Digitalised right- or left-hand stimuli were presented at five different stimulus angles (0°, 45° laterally, 90° laterally, 135° laterally, and 180°). The experimental task was to decide the laterality as fast and accurately as possible. The performance, both reaction time (RT) and accuracy, of the two experimental groups was contrasted with that of the control group. The main results revealed that the subjects afflicted with whiplash injury on the average exhibited a faster response pattern than symptom-free healthy controls. Despite their musculoskeletal deficits and experience of pain these volunteers also exhibited a preserved speed–accuracy tradeoff. Longer duration of time with symptoms of neck pain was, moreover, associated with progressively faster RTs. These results point to perceptual learning and may reflect different stages of adaptation to neck pain.
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| 7. |
- Röijezon, Ulrik, 1970-, et al.
(author)
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Kinematics of fast cervical rotations in persons with chronic neck pain : a cross-sectional and reliability study
- 2010
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In: BMC Musculoskeletal Disorders. - : BioMed Central. - 1471-2474. ; 11, s. 222-
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Journal article (other academic/artistic)abstract
- BackgroundAssessment of sensorimotor function is useful for classification and treatment evaluation of neck pain disorders. Several studies have investigated various aspects of cervical motor functions. Most of these have involved slow or self-paced movements, while few have investigated fast cervical movements. Moreover, the reliability of assessment of fast cervical axial rotation has, to our knowledge, not been evaluated before.MethodsCervical kinematics was assessed during fast axial head rotations in 118 women with chronic nonspecific neck pain (NS) and compared to 49 healthy controls (CON). The relationship between cervical kinematics and symptoms, self-rated functioning and fear of movement was evaluated in the NS group. A sub-sample of 16 NS and 16 CON was re-tested after one week to assess the reliability of kinematic variables. Six cervical kinematic variables were calculated: peak speed, range of movement, conjunct movements and three variables related to the shape of the speed profile.ResultsTogether, peak speed and conjunct movements had a sensitivity of 76% and a specificity of 78% in discriminating between NS and CON, of which the major part could be attributed to peak speed (NS: 226 ± 88 °/s and CON: 348 ± 92 °/s, p < 0.01). Peak speed was slower in NS compared to healthy controls and even slower in NS with comorbidity of low-back pain. Associations were found between reduced peak speed and self-rated difficulties with running, performing head movements, car driving, sleeping and pain. Peak speed showed reasonably high reliability, while the reliability for conjunct movements was poor.ConclusionsPeak speed of fast cervical axial rotations is reduced in people with chronic neck pain, and even further reduced in subjects with concomitant low back pain. Fast cervical rotation test seems to be a reliable and valid tool for assessment of neck pain disorders on group level, while a rather large between subject variation and overlap between groups calls for caution in the interpretation of individual assessments.
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| 8. |
- Röijezon, Ulrik, 1970-
(author)
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Sensorimotor function in chronic neck pain : objective assessments and a novel method for neck coordination exercise
- 2009
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Doctoral thesis (other academic/artistic)abstract
- Chronic neck pain is a widespread problem that causes individual suffering as well as large costs for the society. The knowledge about the pathophysiology is poor and therefore specific diagnosis and causal treatment are rare. Important knowledge for characterization of the disorders has been gained from research on sensorimotor functions in people with neck pain. Moreover, rehabilitation regimes including sensorimotor exercises indicate promising results.The main objectives of this thesis were to extend the knowledge on sensorimotor dysfunctions in chronic neck pain, and to develop a new exercise method for improving sensorimotor functions of the neck. The studies focused on aspects of postural control and movements of the arm and neck. These are vital functions for many activities of daily living. People with chronic (>3 months) neck pain were compared to healthy controls (CON). Neck pain related to trauma was referred to as whiplash associated disorders (WAD), while neck pain without association to trauma was referred to as non-specific (NS).Arm-functioning was assessed in a pointing task. WAD and NS had reduced pointing precision compared to CON. The reduced precision was associated with self-rated difficulties performing neck movements, physical functioning, and in WAD, also pain and balance disturbances.Postural control was assessed in quiet standing on a force platform without vision. The center of pressure signal was decomposed into it’s slow and fast components. WAD and NS were compared to CON. The results revealed an effect of age on the magnitude of the fast sway component, but no effect of group. The magnitude of the slow component was elevated in both WAD and NS. This increase was associated with self-rated balance disturbance, arm-functioning, difficulties to run and sensory alterations in WAD, while in NS, the increase in the slow sway component was associated with concurrent low back pain.Neck movements were assessed in a cervical axial rotation test with maximal speed. In total 8 variables representing basic kinematics, including variables reflecting movement smoothness and conjunct motions were calculated. NS were compared to CON. Linear discriminant modelling indicated Peak Speed and conjunct motions as significant classification variables that together had a sensitivity of 76.3% and specificity of 77.6%. Retest reliability was good for Peak Speed but poor for the measure of conjunct motions. Peak Speed was slower in NS compared to CON, and even slower in a sub-group of NS with concurrent low back pain. Reduced Peak Speed was associated with self-rated difficulties performing neck movements, car driving, running, sleeping disturbances and pain.The clinical applicability of a novel method for neck coordination exercise was assessed in a pilot study on persons with NS. The results supported the applicability and indicated positive effects of the exercise: reduced postural sway in quiet standing and increased smoothness in cervical rotations. Indications on improvement in self-rated disability and fear of movement were seen at six months follow up.In conclusion, sensorimotor functions can be altered in chronic neck pain, particularly in neck disorders with concurrent low back pain and WAD. The discriminative ability and clinical validity displayed in pointing precision, postural sway and cervical axial rotation speed imply that such tests can be valuable tools in the assessment of chronic neck pain patients, and for selecting and evaluating treatment interventions. Indications of improvements seen in the pilot-study support a future RCT.
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| 9. |
- Röijezon, Ulrik, et al.
(author)
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The slow and fast components of postural sway in chronic neck pain
- 2011
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In: Manual Therapy. - : Elsevier BV. - 1356-689X .- 1532-2769. ; 16:3, s. 273-278
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Journal article (peer-reviewed)abstract
- Objective: To evaluate the slow and fast components of postural control in quiet stance in subjects with chronic neck pain, associations between postural sway and self-rated characteristics and to study the impact of anthropometrics on postural sway.Design: A single-blinded cross-sectional study including two separate data collections.Subjects: Sample 1: Persons with chronic non-specific neck pain (NS, n=24), whiplash associated disorders (WAD, n=21). Healthy subjects were controls (CON, n=21). Sample 2: Women only, 98 NS and 32 CON subjects.Methods: Subject performed a quiet stance test with eyes closed on a force platform while the center of pressure (CoP) trajectory was measured. Sample 1 was tested on a firm surface for 30 seconds, while sample 2 was tested on both firm and foam surfaces for 190 seconds. The CoP signal was decomposed into the slow and fast components and the magnitude of these signals were calculated. Anthropometrics were included as covariate in the analysis of group differences if correlated with postural sway variables. Group differences in the sway variables were evaluated, as well as association between postural sway and self-ratings of symptoms, functioning and kinesiophobia.Results: Increased magnitude of the slow sway component was found for both neck pain groups. Increasing age was associated with increased magnitude of the fast component. Surface conditions had no effect on group difference. For WAD, associations were found between the magnitude of the slow component and self-rated characteristics related to physical functioning, sensory alterations and psychosocial functioning. For NS, concurrent low back pain was associated with increased postural sway.Conclusion: Postural control can be altered in chronic neck pain. This effect was present only for the slow sway component, which implies aberration in sensory feedback or processing of sensory information. Associations between postural sway and self-rated characteristics in WAD support the clinical validity of postural control assessment in this group. Increased postural sway found in NS with concurrent low back pain suggests an important role of generalised spinal pain on postural control alterations.
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| 10. |
- Sandlund, Jonas, et al.
(author)
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Acuity of goal-directed arm movements to visible targets in chronic neck pain
- 2008
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In: Journal of Rehabilitation Medicine. - : Foundation of Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 40:5, s. 366-374
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Journal article (peer-reviewed)abstract
- Objective: To evaluate end-point acuity in goal-directed arm movements in subjects with chronic neck pain, while taking the trade-off between speed and accuracy into account, and to evaluate associations between reduced acuity and self-rated characteristics.Design: Single-blinded, controlled, comparative group study.Subjects: Forty-five subjects with chronic non-traumatic, non-specific neck pain (n = 24) and whiplash-associated disorders (n = 21). Healthy subjects served as controls (n = 22). The groups were age- and sex-matched.Methods: Subjects performed fast and accurate pointing movements to a visual target. Group differences in end-point variability, controlled for peak velocity, were evaluated. Associations between end-point variability and self-rated symptoms, functioning, self-efficacy and kinesiophobia were analysed.Results: End-point acuity, controlled for peak velocity, was reduced for both neck-pain groups. Similar spatial error patterns across all groups indicated no direction-specific reduction. For both neck-pain groups, associations were found between end-point acuity and neck movement deficits, physical functioning and, in whiplash, also balance and pain.Conclusion: Acuity of goal-directed arm movements can be reduced in chronic neck pain. Associations between acuity and self-rated characteristics support the clinical validity of the results and indicate that impaired neck function contributes to reduced end-point acuity. The results can be of importance for characterization and rehabilitation of neck disorders.
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