| 1. |
- Dufvenberg, Marlene, 1961-
(författare)
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Adolescent Idiopathic Scoliosis : Postural Stability, Prognostic factors and Impact of Conservative Treatments on Radiologic, Clinical and Self-Reported Outcomes
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Adolescent idiopathic scoliosis (AIS) is a three-dimensional distortion of spinal curvature of unknown cause that develops during puberty. If the frontal plane curvature exceeds a Cobb angle of 24°, full-time bracing is recommended to prevent curve progression, negative health consequences or need for surgery. However, many patients decline full-time bracing, and limited evidence exists regarding alternative conservative treatments. Increasing knowledge of risk factors enables better identification of high-risk patients, thereby reducing the risk of over- or undertreatment. The overall aim of this thesis was to evaluate evidence of association between scoliosis and postural stability to inform a potential treatment target, to investigate the effectiveness of three alternative conservative treatments for patients who declined full-time bracing, and to develop a prognostic model for future risk of increased curvature in AIS. Methods: Data collection is based on one systematic literature review and meta-analysis, and one randomised controlled trial (RCT) for patients with AIS. In Paper I, literature was reviewed, and utilized posturography data to assess static postural stability to identify potential differences between patients with AIS and the control group (CON). In Papers II and III, patients were randomly assigned to either physical activity combined with hypercorrective Boston scoliosis night brace (NB), scoliosis-specific exercises (SSE), or a control group with physical activity alone (PA). Effects on trunk rotation, Cobb angle, self-reported physical activity, spinal appearance, and health-related quality of life were evaluated. Likewise, adherence, capability, and motivation in performing self-managed treatment were assessed. Follow-up was conducted at 6 months intervals until endpoint. The endpoint was defined as non-progression if the curvature increased by 6° or less at skeletal maturity, i.e., less than 1cm of growth over 6 months, or progression if the curvature increased by more than 6° before skeletal maturity. In Paper IV, data from the RCT were used for a longitudinal cohort analysis, developing and validating a prognostic model using Cox Proportional Hazards survival analysis. Results: Paper I found reduced postural stability in AIS patients compared to CON with increased sway area, mediolateral and anteroposterior range, and a posterior shift in the sagittal plane. The RCT included 135 individuals, mean age of 12.7 years (SD1.4) and Cobb angle of 31° (SD5.3). At 6 months, patients reported high adherence (72-95%) and motivation (65-92%) to the treatment, particularly in the NB group. Both the SSE and PA groups increased physical activity levels compared to the NB group. At endpoint, adherence remained adequate, but better in the NB and PA groups compared with the SSE group (50-89%). Adherence increased with higher capability and motivation, which explained 53% of the variance in adherence at endpoint. The SSE group had higher proportion of moderate problems in mobility and usual activities than the NB and PA groups, with no other clinically relevant between-group differences. The prognostic model (n=127) for curve progression showed acceptable discriminative ability (0.791), with risk factors including skeletal immaturity, larger major curve, and worsening spinal appearance. The model was adjusted for treatment exposure, as NB reduced the risk of curve progression. Conclusions: Patients with AIS have decreased postural stability with a posterior positional shift. Treatment evaluation at endpoint showed few between-group differences. However, the SSE group had higher proportion of moderate problems in mobility and usual activities compared to the other groups. Treatment adherence was adequate, but better in the NB and PA groups. Higher capability and motivation increased long-term adherence to the treatment. The treatment alternatives could be considered as the first option following a clinical decision on treatment. Including self-reported spinal appearance as a risk factor in the prognostic model may be clinically important for predicting which patients are at risk of curve progression.
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| 2. |
- Borg, Sabina, 1982-
(författare)
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Exercise-Based Cardiac Rehabilitation in Patients with Coronary Artery Disease : Attendance, Adherence and the Added Value of a Behavioural Medicine Intervention
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Coronary artery disease (CAD) is the leading global cause of death. After an index event related to CAD, exercise-based cardiac rehabilitation (exCR) is strongly recommended as part of the secondary prevention. Despite the well-established beneficial effects of exCR in patients with CAD, attendance at and adherence to the programme are low, and remain a matter of major concern. One strategy that may increase adherence and rehabilitation outcomes in patients with CAD is to add a behavioural medicine intervention to routine exCR care. The added value of such interventions needs to be further explored. Although several factors associated with non-attendance at exCR appear to be similar between different countries, patterns of attendance may differ due to differences in contextual aspects. The factors that affect attendance at exCR in a Swedish context remain to be explored.Overall aim: To investigate barriers for exCR attendance and to evaluate the added value of a behavioural medicine intervention in physiotherapy on exercise adherence and rehabilitation outcomes in patients with CAD.Methods: The three papers in this thesis are based on two studies of patients with CAD, one registrybased cohort study of 31,297 patients included from the SWEDEHEART registry (Paper I), and one randomised controlled trial of 170 patients included at a Swedish university hospital (Papers II and III). In the first paper, several individual and structural variables were compared for attenders and nonattenders, using multivariable analysis in a logistic regression model. In Papers II and III, patients were randomised 1:1 either to a behavioural medicine intervention in physiotherapy in addition to routine exCR care or to routine exCR care alone for four months. The behaviour change techniques used in the behavioural medicine intervention – specific goal-setting, re-evaluation of the goals, and selfmonitoring and feedback – were based on control theory. Outcome assessment took place at baseline, four and 12 months, and included physical fitness, psychological outcomes and health-related quality of life. Exercise adherence was evaluated at the end of the four-month intervention. An intention-to-treat and a per-protocol analysis were performed.Results: Individual and structural factors associated with non-attendance at exCR in a Swedish context were identified as having a distance greater than 16 km to the hospital, belonging to a county hospital, having a higher burden of comorbidities, being male, and being retired. Exercise adherence was higher for patients who received the behavioural medicine intervention in physiotherapy together with routine exCR (31%) than it was for those who received routine exCR care alone (19%). Rehabilitation outcomes did not differ significantly between the two groups, either between baseline and four months or between four and 12 months. Both groups improved significantly in all measures of physical fitness, and in several measures of health-related quality of life and anxiety at the four-month follow-up. Sufficient enablement remained for patients in both groups at the 12-months follow-up.Conclusions: Distance to the hospital was the strongest predictor for non-attendance at exCR in a Swedish context. The individual factors associated with non-attendance at exCR identified in this thesis confirm previous results, with the exception that female gender was associated with a higher attendance at exCR. The results of this thesis confirm what others have pointed out: it is challenging to achieve behavioural change in patients with the aim to improve rehabilitation outcomes. Even though adherence was higher when a behavioural medicine intervention was added, it was low in both groups. The current behavioural medicine intervention in physiotherapy did not give any improvements over routine exCR care alone in physical fitness, psychological outcomes or health-related quality of life. As such, there is still room for further development and evaluation of behavioural medicine interventions within the context of exCR. A greater tailoring of these interventions to individual needs in a broader population of patients with CAD is suggested.
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| 3. |
- Schröder, Karin, 1966-
(författare)
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Implementing BetterBack – a Best Practice Physiotherapy Healthcare Model for Low Back Pain : Clinician and Patient Evaluation
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Low back pain (LBP) occurs in all ages, and first-line treatment by physiotherapists (PTs) is common. However, national evidence-based LBP clinical guidelines are still lacking in Sweden. To facilitate guideline uptake, we developed and with a multifaceted strategy implemented a best practice physiotherapy healthcare model (BetterBack☺ MoC) with the aim of supporting management of LBP in primary care. The overall aim of this thesis was to evaluate a multifaceted implementation strategy and a best practice physiotherapy healthcare model for LBP.Methods: This thesis is based on one methodological study and three experimental trials with PTs and patients with LBP. In Paper I a mixed method design was used to translate, tailor, validate and feasibility-test the Determinants of Implementation Behaviour Questionnaire (DIBQ). This tailored DIBQ Questionnaire (DIBQ-t) was used to evaluate potential barriers/facilitators during the implementation process together with evaluation of PTs’ confidence, attitudes and beliefs in managing LBP. In a stepped cluster randomised controlled trial, PTs and their patients in three clusters were allocated to intervention group (after implementation of BetterBack☺ MoC) or control group (routine physiotherapy care). The proportions of guideline-adherent care were compared between groups (Paper III). This evaluation was based on PTs’ adherence to eight clinical practice recommendations and three clinical practice quality indices (CPQI). The overall CPQI containing the five most prioritised recommendations are: no referral to specialist care; no referral to medical imaging for benign LBP; use of educational interventions; use of exercise interventions; and no use of non-evidence-based physiotherapy. Finally, in Paper IV patient-reported outcome measures (PROMs) were compared between intervention (after the implementation of BetterBack☺ MoC) and routine care. In Paper IV an additional secondary analysis was performed, comparing PROMs based on whether or not PTs had delivered care that met all five criteria of the overall CPQI or not.Results: A tailored, feasible and valid questionnaire was developed, DIBQ-t to be used for evaluation of the implementation of LBP primary care programmes. After implementation workshop, PTs’ (n = 116) confidence increased, and PTs’ attitudes and beliefs shifted towards a more biopsychosocial orientation. PTs had high expectations of the BetterBack☺ MoC, which decreased after using the MoC. When evaluating received treatment for 500 patients with LBP, a more frequent delivery of guideline-adherent care was seen after implementation (n = 278) compared to routine care (n = 222). The overall CPQI containing the five prioritised recommendations was fulfilled in 59% of all patients in intervention versus 26% in routine care group. Analysis of adherence to specific recommendations showed a significantly improved use of stratification of number of PT visits and patient educational interventions, frequent use of exercise was maintained, and use of non-evidence-based treatment and medical imaging decreased after implementation. The primary outcome, i.e. referral to specialist consultation, was low in both groups, with no between-group differences. After implementation of the BetterBack☺ MoC, no between-group differences in PROMs were seen except for greater satisfaction with LBP care, greater improvement in illness perception and better health-related quality of life, compared with routine care. However, when PTs’ care adhered to all five CPQI criteria, a greater improvement of most patient-reported outcomes was seen compared to patient care that did not adhere to all five CPQI criteria. Conclusions: The implementation of a best practice physiotherapy healthcare model (BetterBack☺ MoC) for LBP improved both clinician and patient outcomes. PTs increased use of guideline-adherent care, confidence and biopsychosocial orientation in managing LBP. Patients reported improved satisfaction, illness perception and health-related quality of life. The implementation did not decrease referral to specialist consultation from an initial low level; nor did it improve patients’ disability and pain more than routine care. However, when guideline-adherent care was fulfilled, most PROMs improved. It is therefore important to highlight the importance of guideline-based primary care for improving patient-reported LBP outcomes.
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| 4. |
- Bernhardsson, Susanne, 1958-
(författare)
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Advancing evidence-based practice in primary care physiotherapy : Guideline implementation, clinical practice, and patient preferences
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Research on physiotherapy treatment interventions has increased dramatically in the past 25 years and it is a challenge to transfer research findings into clinical practice, so that patients benefit from effective treatment. Development of clinical practice guidelines is a potentially useful strategy to implement research evidence into practice. However, the impact of guideline implementation in Swedish primary care physiotherapy is unknown. To achieve evidence-based practice (EBP), research evidence should be integrated with clinical expertise and patient preferences, but knowledge is limited about these factors in Swedish primary care physiotherapy.The overall aim of this thesis was to increase understanding of factors of importance for the implementation of EBP in Swedish primary care physiotherapy. Specific aims were: to translate and adapt a questionnaire for the measurement of EBP and guidelines; to investigate physiotherapists’ attitudes, knowledge and behaviour related to EBP and guidelines; to examine clinical practice patterns; to evaluate the effects of a tailored guideline implementation strategy; and to explore patients’ preferences for physiotherapy.The thesis comprises four studies (A-D), reported in five papers. In Study A, a questionnaire for the measurement of EBP and guidelines was translated, cross-culturally adapted, and tested for validity (n=10) and reliability (n=42). Study B was a cross-sectional study in which this questionnaire was used to survey primary care physiotherapists in the county council Region Västra Götaland (n=271). In Study C, a strategy for the implementation of guidelines was developed and evaluated, using the same questionnaire (n=271 at baseline, n=256 at follow-up), in a prospective controlled trial. The strategy was based on an implementation model, was tailored to address the determinants of guideline use identified in Study B, and comprised several components including an educational seminar. Study D was an exploratory qualitative study of patients with musculoskeletal disorders (n=20), using qualitative content analysis.The validity and reliability of the questionnaire was found to be satisfactory. Most physiotherapists have a positive regard for EBP and guidelines, although these attitudes are not fully reflected in the reported use of guidelines. The most important determinants of guideline use were considering guidelines important to facilitate practice and knowing how to integrate patient preferences with guidelines. The tailored, multi-component guideline implementation significantly affected awareness of, knowledge of, and access to guidelines. Use of guidelines was significantly affected among those who attended an implementation seminar. Clinical practice for common musculoskeletal conditions included interventions supported by evidence of various strengths as well as interventions with insufficient research evidence. The most frequently reported interventions were advice and exercise therapy. The interviewed patients expressed trust and confidence in the professionalism of physiotherapists and in the therapists’ ability to choose appropriate treatment, rendering treatment preferences subordinate. This trust seemed to foster active engagement in their physiotherapy.In conclusion: The adapted questionnaire can be used to reliably measure EBP in physiotherapy. The positive attitudes found do not necessarily translate to guideline use, due to several perceived barriers. The tailored guideline implementation strategy used can be effective to reduce barriers and contribute to increased use of guidelines. The clinical practice patterns identified suggest that physiotherapists rely both on research evidence and their clinical expertise when choosing treatment methods. Patients’ trust in their physiotherapist’s competence and preference for active engagement in their therapy need to be embraced by the clinician and, together with the therapist’s clinical expertise, integrated with guideline use in the clinical decision making. Further research is needed on how the EBP components and different knowledge sources can be integrated in physiotherapy practice, as well as on implementation effects on patient outcomes.
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| 5. |
- Crommert, Martin Eriksson, 1974-
(författare)
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On the role of transversus abdominis in trunk motor control
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- All trunk muscles are important contributors to spine stability. However, the deepest abdominal muscle, transversus abdominis (TrA), with its characteristically horizontal fibre orientation seems to serve a unique function in trunk motor control. The main mechanical role of TrA is believed to be to contribute to vertebral alignment during imposed moments on the trunk, executed mainly via either regulating the pressure level within the abdominal cavity and/or transmit forces to the spine via the thoracolumbar fascia. However, the complete function of TrA and what factors affect its activation are still not fully understood. The purpose of the present thesis was to investigate the role of TrA in trunk motor control, specifically in relation to the presence or absence of postural demand on the trunk.The timing and magnitude of TrA activation were investigated, in relation to other trunk muscles, with intramuscular fine-wire electrodes in different loading situations and body positions with varying postural demand.In a side-lying position, with no postural demand of keeping the trunk upright, the activation of TrA was delayed relative the superficial abdominal muscles compared to previous experiments performed in a standing position. The timing and magnitude of activation of TrA did not depend upon the direction of perturbation. In the standing position, different static arm positions revealed that the activation of TrA co-varied with variations in the degree of postural demand on the trunk and also the imposed moments, regardless of moment direction. Finally, a study on rapid arm flexion movements confirmed that TrA is part of the pre-programmed anticipatory response in advance of known perturbations. The activation magnitude of TrA was the same regardless if the arm movement induced flexion or extension moments on the trunk.In conclusion, the activation of TrA is associated with the upright postural demand on the trunk and with balancing imposed moments acting on the spine, regardless their direction. The findings are in support of the beliefs that TrA act as a general, direction non specific, stabilizer of the lumbar spine.
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| 6. |
- Holmgren, Theresa, 1974-
(författare)
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Exercise treatment of patients with long-standing subacromial pain
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Subacromial pain is the most common problem among patients with shoulder complaints seeking primary care. The recommended treatment for these patients is primarily non-surgical with a focus on exercise treatment. If this treatment fails arthroscopic subacromial decompression (ASD) followed by exercise treatment is recommended. Surgical treatment with ASD has increased substantially in Sweden in recent years even though studies comparing exercise treatment with surgery report equally positive results. Still, there is a need of evidence based preand postoperative exercise treatments, standardised and described in detail, to guide treatment of these patients in clinical practice.The overall aim of this thesis was to evaluate the efficacy of pre- and postoperative exercise strategies on shoulder function and how the preoperative strategy affects the need for surgery in patients with long-standing subacromial pain.This thesis comprises four papers which are based on two randomised controlled trials. In study A, patients were randomised after ASD surgery to either physical therapist (PT) supervised strength-endurance exercises for the rotator cuff and scapula stabilisers or to home-based movement exercises for a period of three months. Shoulder function and pain, health related quality of life and return to work was evaluated for 6 months (paper I). In study B, patients on the waiting list for surgery were randomised to either specific exercise strategy with strengthendurance exercises for the rotator cuff and the scapula stabilisers or to control exercises with movement exercises for the neck and shoulders for a period of three months. After completing the exercise program and also after 12 months, shoulder function and pain, need for surgery and health related quality of life was evaluated. Baseline shoulder function, rotator cuff status and radiological findings were analysed in relation to the choice of surgery (paper II, III). The minimal important clinical change (MIC) of the Constant-Murley (CM) score, used as primary outcome in this thesis, was determined by using a visual anchor-based MIC distribution method (paper IV).Six months after ASD surgery, patients who performed PT-supervised strength-endurance exercises improved significantly more in shoulder function and pain compared to patients who had performed home-based movement exercises (paper I). Patients on the waiting list for surgery who performed specific strength-endurance exercises had significantly greater improvements in shoulder function and pain compared to patients performing movement exercises (paper II). A significantly lower proportion of those performing specific strength-endurance exercises chose surgery at the three- and 12 months follow-ups (paper II, paper III). Low baseline values in shoulder function and pain measured with the CM score and/or having a full thickness rotator cuff rupture were associated with an increased risk of choosing surgery (paper III). Regarding the CM score, a change between 17-24 points seems to be clinically important for patients with long-standing subacromial pain (paper IV).Supervised strength-endurance exercises seem to be more effective than home-based movement exercises after ASD surgery. For patients on the waiting list for surgery, the specific strategy of strength-endurance exercises was effective in improving shoulder function and pain and the need for surgery was reduced at 12 months. Low baseline values for shoulder function and pain measured with the CM score and/or having a full thickness rotator cuff tear seem to be predictors for choosing surgery. The CM score is able to detect the MIC in individual patients with long-standing subacromial pain when the rotator cuff is intact. In all patients with longstanding subacromial pain, the MIC value was dependent on the subgroup as well as the choice of statistical analysis.
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| 7. |
- Sjödahl, Jenny, 1979-
(författare)
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Pregnancy-related pelvic girdle pain and its relation to muscle function
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Pregnancy-related lumbopelvic pain affects approximately 50% of all pregnant women. For the majority the pain disappears during the first months after delivery; however, for a significant number of women, the pain is persistent, with little improvement for more than three months after delivery. Moreover, women who experience persistent lumbopelvic pain three months postpartum are at substantial risk for new episodes or for chronic lumbopelvic pain later in life. Hence, pregnancy-related lumbopelvic pain should be considered a major public health issue. In order to develop and offer specific treatment strategies, it is important to identify different subgroups of lumbopelvic pain based on different clinical presentations. Pelvic girdle pain (PGP) is one of the major subgroups of pain related to pregnancy. There is no consensus regarding the underlying mechanisms although instability in the pelvis has been proposed as one of the possible mechanism; thus, further studies are necessary to determine how to treat these women. The local lumbopelvic muscle system, including the pelvic floor muscles (PFM) is thought to contribute to the stabilization of the pelvis and they are also the target for many treatment strategies for lumbopelvic pain.The overall aim of this thesis was to improve rehabilitation for women with persistent postpartum PGP by investigating three areas, including: 1) the postural response of the PFM, 2) the effect of home-based specific stabilizing exercises (SSE) that target the local lumbopelvic muscle system and, 3) predictors for disability at 15 months postpartum.The thesis comprises three studies: A) a methodological study, B) an experimental study, and C) a clinical randomized controlled trial (RCT). The data is mainly based on muscle function, including recordings of electromyographic (EMG) activation, muscle endurance, and muscle strength. We also collected subjective ratings of disability, healthrelated quality of life, and pain.The methodological study showed that the designed protocol, which included limb movements performed at a comfortable speed in both standing and supine positions, was useful for detecting a postural response in the PFM. The experimental study demonstrated that women with persistent postpartum PGP and those free of pain exhibited a feed-forward mechanism in the PFM that responded in anticipation to leg lifts performed in a supine position. However, we cannot rule out the possibility that women with difficulties in transferring load between the trunk and legs (i.e., those with functional pelvic instability) might have a different postural response in the PFM. In the present study, one woman with persistent postpartum PGP failed to present a feed-forward mechanism in the PFM, in agreement with previous studies on other parameters of the PFM from other similar groups.The clinical RCT demonstrated that the concept of home-based SSE with visits every second week with the treating physiotherapist was not more effective than the clinical natural course for improving subjective ratings or muscle function in women with persistent postpartum PGP.A linear regression analysis revealed a complex picture that suggests that disability 15 months postpartum in women with persistent PGP could be partially predicted by two interaction effects comprising factors from different dimensions: biological, physical functioning, and self-rated function. The proposed association between muscle function and PGP was strengthen. New approaches are most likely needed to further identify subgroups of patients with persistent postpartum PGP that can be considered homogeneous for treatment.
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| 8. |
- Wåhlin, Charlotte, 1961-
(författare)
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The Rehabilitation Process for Individuals with Musculoskeletal and Mental Disorders : Evaluation of Health, Functioning, Work Ability and Return to Work
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Musculoskeletal disorders (MSD) and mental disorders (MD) are common among working-age individuals, and reduced work ability is often a problem that influences functioning in working life. Having MSD and MD is also a common cause of seeking health care and these conditions account for the majority of sick leave in most western countries. The overall aims of the thesis were to increase knowledge about biopsychosocial assessment of health, functioning and work ability for individuals with MSD and MD seeking care. A further aim was to gain better understanding of praxis behaviour in the rehabilitation process for sick-listed patients by evaluating patient-reported work ability, type of interventions given, usefulness of interventions, and return to work.This thesis comprises four studies based on two different cohorts. A cross-sectional design was used for studies I and II, which included 210 individuals diagnosed with MSD and MD seeking occupational health services. Data collection consisted of questionnaires to patients on self-reported health, functioning, work conditions, work ability and reports of professional assessment of diagnosis, main clinical problem, recommended intervention and sick leave. Studies III (n=699) and IV (n=810) were based on a longitudinal cohort study, ReWESS, with a 3-month follow-up comprising individuals who sought primary health care or occupational health services for MSD or MD and were sick-listed. The data collection included repeated questionnaires to the patients on self-reported health, functioning, work conditions, work ability, type and usefulness of intervention and return to work.There was an association between the professional biopsychosocial assessment and patients’ self-reported measures of health, functioning and work ability in clinical reasoning. Self-reported health and work measures can complement the expert-based diagnosis. Patients who had MSD and MD with co-morbid conditions reported more problems with mental functioning, had higher psychological demands at work and reported poorer work ability compared with those with MSD only. Patients with co-morbid conditions also had worse outcome compared to having mental disorders only. Psychosocial problems and activity limitations concerning social interaction skills were a frequent problem. This can be identified in clinical screening by physiotherapists in dialogue with the patient using the Patient-Specific Functional Scale. Three-quarters of sick-listed individuals with MSD or MD returned to work within 90 days. The treatment approach to sick-listed persons is still very medical and clinically oriented. Access to work-related interventions seems to be limited in the early rehabilitation process and may not be equal in practice. Those who were younger, had higher educational level and reported stronger health resources were favoured. There is a need to strive for access to work-related interventions.Return to work was associated with receiving combined clinical- and work-related interventions for patients with MD, and with better health-related quality of life, positive return to work expectations and better work ability for patients with MSD. Factors associated with return to work can be identified using self-reported measures. Patients with MD who received a combination of work-related and clinical interventions perceived best usefulness and best effect of health care contacts on work ability. Patients with MSD did not report as good usefulness. There seems to be a gap between scientific evidence and praxis behaviour in the early rehabilitation process; unimodal rehabilitation was widely applied, use of a multimodal treatment approach was limited and only one-third received work-related interventions. For patients with MSD, behavioural treatment seems to be underutilized in clinical practice considering the effect it may have on developing coping strategies and reducing symptoms. In order to meet recommendations in guidelines, physical activity needs to increase as a treatment strategy for patients with MD. A clinical implication is that the rehabilitation process needs to adopt a broader perspective for patients with MSD and MD to include patients’ individual health-related needs, aspects of employment and work conditions. Still, it remains a challenge to understand who needs what type of intervention.
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| 9. |
- Diarbakerli, Elias, et al.
(författare)
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Swedish musculoskeletal researchers view on a collaborative network and future research priorities in Swedish healthcare
- 2024
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Ingår i: Musculoskeletal Care. - : John Wiley & Sons. - 1478-2189 .- 1557-0681. ; 22:1
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Tidskriftsartikel (refereegranskat)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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| 10. |
- Lindbäck, Yvonne, 1967-
(författare)
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Pre-surgery physiotherapy and pain thresholds in patients with degenerative lumbar spine disorders
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Patients scheduled for spinal surgery often experience long duration of pain, which may influence the pain-regulation system, function and health and have an impact on post-surgery outcome. Prehabilitation potentially augments functional capacity before surgery, which may have beneficial effects after surgery.Aim: The overall aim of the thesis is to study pre-surgery physiotherapy and somatosensory function in patients with degenerative lumbar spine disorders and to explore the patients’ experiences of pre-surgery physiotherapy.Methods: Somatosensory function was measured with quantitative sensory testing (QST). Pre-surgery physiotherapy was evaluated with patient-reported outcome measures (n = 197). Patients’ experiences of how symptoms are explained and their experiences of the influences on back-related health after pre-surgery physiotherapy were explored.Results: Half of the patients reported back or leg pain for more than 2 years. On a group level, the somatosensory profiles were within the reference range. On an individual level, an altered somatosensory profile was found in 23/105 patients, these were older, more often women, and reported higher pain, larger pain distribution and worse SF-36 MCS (mental health component summary). Patients with disc herniation, more sensitive to pressure pain in the hand presurgery, was associated with poorer function, self-efficacy, anxiety and depression score pre-surgery, worse function, self-efficacy and leg pain 3 months post-surgery and worse health related quality of life, self-efficacy, depression score 1 year postsurgery. The results for sensitivity for cold pain were similar, except that it even was associated with poorer function and pain 1 year post-surgery. The pre-surgery physiotherapy group had less back pain, better function, health, self-efficacy, fear avoidance score, depression score and physical activity level than the waiting-list group after the pre-surgery intervention. The effects were small. Both groups improved significantly after surgery, with no differences between groups, except that the higher physical activity level in the physiotherapy group remained at the 1-year follow-up. Only 58% of the patients reported a minimum of one visit for rehabilitation during the 1 year preceding the decision to undergo surgery. Patients experienced that pre-surgery physiotherapy had influenced symptoms, physical function, coping, well-being and social functioning to various degrees. Pre-surgery physiotherapy was experienced as a tool for reassurance and an opportunity to reflect about treatment and lifestyle. The patients mainly used biomedical explanatory models based on image reports to explain their backrelated symptoms. Both broader and more narrow, as well as lack of explanations of symptoms emerged. Further, wanting and sometimes struggling to be wellinformed about symptoms and interventions were described.Conclusions: Being more sensitive to pressure- and cold pain in the hand, as a sign of widespread pain pre-surgery, was associated with poorer function, pain and health at post-surgery in patients with disc herniation. Pre-surgery physiotherapy decreased pain, fear avoidance, improved health related quality of life; and it decreased the risk of a worsening in psychological well-being before surgery. The improvements were small, and improvements after surgery were similar for both groups. At the 1-year follow-up, the physiotherapy group still had a higher activity level than the waiting list group. The pre-surgery physiotherapy was well tolerated. Patients’ reported experiences also illustrates the influence on function, pain and health. Patients experienced that pre-surgery physiotherapy provided reassurance and gave time to reflect on treatments and lifestyle. Symptoms were mainly described in line with a biomedical explanatory model. Those using a broader explanation were confident that physiotherapy and self-management could influence their back-related symptoms.
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