| 1. |
- Arvidsson, Susann
(författare)
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Health promoting factors in people with chronic musculoskeletal pain or with rheumatic diseases: a descriptive and interventional study
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis with a salutogenic approach was to describe health promoting factors in people with chronic musculoskeletal pain and in people with rheumatic diseases, and to evaluate the effects of an intervention study with a self-care promoting PBL-program for people with rheumatic diseases having chronic musculoskeletal pain, sleep disturbances and/or fatigue. Methods: This thesis is comprised of four samples: a randomly selected sample from a Swedish general population (study I) and three different samples containing people with rheumatic diseases registered at a hospital for rheumatic diseases in the southwest of Sweden (studies II, III and IV). Study I had a longitudinal cohort design with an eight-year follow-up in a general population. There were 1109 participants without chronic pain and 700 participants with chronic musculoskeletal pain. Study II had a longitudinal cohort design with participants with rheumatic diseases (n=185) 12 months after rehabilitation at a hospital for rheumatic diseases. Study III had a descriptive qualitative design with a phenomenological approach based on a reflective life-world perspective. Twelve participants were interviewed about their experiences about health-promoting self-care. Study IV had a randomised controlled design with post-test six months after the one-year self-care promoting problem-based learning (PBL) program for people with rheumatic diseases. The participants were randomly assigned to the experimental group, 54 participants, or to the control group, 148 participants. Data in studies I, II and IV were analysed with statistics. In study III a Husserlian phenomenological approach based on a reflective life-world perspective was used in the data collection and analysis. Results: Study I: Although participants without chronic musculoskeletal pain reported better health-related quality of life (HRQL) than participants with chronic musculoskeletal pain, similar health factors were found to promote a better HRQL in the eight-year follow-up. The most important factors were feeling rested after sleep and having good sleep structure. Study II: The most important factors promoting better outcome in HRQL 12 months after rehabilitation in participants with rheumatic diseases were having a strong sense of coherence (SOC), feeling rested after sleep, having work capacity, and having good sleep structure. Study III: The meaning of health-promoting self-care as experienced by people with rheumatic diseases was that self-care takes place against a background of continual hope and belief to be able to influence health in positive ways. Self-care was a way of life and implied being ready to understand and respond to signals from the body. Three interrelated constituents elucidated the experiences: dialogue, power struggle and choice. Study IV: At the six month follow-up the participants in the experimental group had stronger empowerment after participation in the self-care promoting PBL-program compared with the control group which only got standard care for people with rheumatic diseases. There were no differences in HRQL, self-care ability, SOC, pain, quality of sleep or fatigue between the experimental group and the control group. The participants in the experimental group also stated that they had implemented lifestyle changes which they had not done without the PBL-program. Conclusion: The results of this thesis provide a valuable and useful insight in health promoting factors in people with chronic musculoskeletal pain and in people with rheumatic diseases, but also in that people with rheumatic diseases have benefit from taking part in patient education with a self-care promoting PBL-program. These results contribute to evidence supporting the introduction of a more salutogenic approach in rheumatology care and research.
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| 2. |
- Emilson, Christina, 1969-
(författare)
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Long-term perspectives on musculoskeletal pain : Health care utilization and integration of behavioral medicine treatment into physical therapy
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There are currently no effective methods for treating and preventing chronic pain. The aim of this thesis was to study prognostic factors for health care utilization, and the long-term outcomes of tailored behavioral medicine treatment for patients with musculoskeletal pain. Another aim was to increase knowledge about physical therapists’ assessment and analysis of patients’ pain conditions and to investigate the potential of subgrouping patients based on prognostic factors.Methods: In Study I, a prospective population-based cohort was followed over 21 years. Data from three measure points were analyzed: 1995 (n=2425), 2007 (n=1582) and 2016 (n=1184). Study II was a 10-year follow-up of randomized controlled trial (n=97), comparing tailored behavioral medicine treatment and exercise-based physical therapy. In Study III, a descriptive and explorative design was applied, using data from video-recordings of 12 physical therapists. In study IV, assignment to three subgroups based on the Örebro Musculoskeletal Pain Screening Questionnaire was validated against reference instruments, and the stability between two points of measurement was investigated in patients (n=40) who were seeking primary health care due to musculoskeletal pain.Results: Chronic pain, female gender and high age predict high health care utilization over 21 years, and a trajectory of stable high health care utilization over the entire period. The differences between groups in favor for tailored behavioral medicine treatment reported at post-treatment and after two years, were not maintained at the 10-year follow-up. A majority of the physical therapists assessed factors for poor prognosis. The analyses were mainly based on biomedical assessments and none of the physical therapists included behavioral factors. Subgroup assignment according to the Örebro Musculoskeletal Pain Screening Questionnaire appears to be valid and stable over time.Conclusion: Prognostic factors such as chronic pain and female gender need to be considered when allocating health care resources and planning treatment to improve long-term outcomes. The treatment should also be tailored based on individual functional behavioral analyses of key behaviors and on patient´s biomedical and psychosocial condition, including strategies for maintenance of behavioral changes. Evidence-based methods for integrating behavioral medicine treatment into physical therapy need to be further evaluated and improved.
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| 3. |
- Schlager, Angela
(författare)
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Defining generalised joint hypermobility : Aspects of reliability, validity and the association to pregnancy induced pain
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to evaluate the definition of joint hypermobility and generalised joint hypermobility with aspects of reliability, validity and the association between generalised joint hypermobility and pregnancy-induced pain. Generalised joint hypermobility is used to reflect hereditary systematic connective tissue fragility. In study I, the inter-rater and intra-rater reliability, were evaluated in 49 women and men through 12 joint mobility tests included in three instruments for defining generalised joint hypermobility. In study II, the criterion validity was evaluated in 339 women in early pregnancy between the self-reported five-part questionnaire to identify generalised joint hypermobility, with the Beighton score. In study III, 255 women in early pregnancy were included to evaluate if a subset of joint mobility tests could define generalised joint hypermobility and establish limits for joint hypermobility. In study IV, 99 women pain-free before pregnancy were included to investigate the first onset of self-reported pain during pregnancy comparing women with and without generalised joint hypermobility, by parity and pain location. The reliability was good-to-excellent for both inter- and intra-rater reliability, for the majority of the joint mobility tests. The five-part questionnaire to identify generalised joint hypermobility with a cut-off level of ≥ 2 entailed the highest clinimetric values. However, the odds of having generalised joint hypermobility with a positive self-reported five-part questionnaire were low and yielding a false positive rate of 38%. No subset of joint mobility tests could define generalised joint hypermobility. Different combinations of joint mobility tests in upper- and lower limbs and the axial skeleton were compiled and evaluated for different standard deviation levels, where plus two standard deviations were most difficult to achieve. Women with generalised joint hypermobility and multiparous women experienced substantial earlier onset of self-reported pain during pregnancy, mainly in the lower back region. Thoroughly measured joint mobility and defining generalised joint hypermobility through different combinations of joint mobility tests, probably increased the precision of defining generalised joint hypermobility. Generalised joint hypermobility seems to be important for early development of pain during pregnancy. To identify women with generalised joint hypermobility in early pregnancy might be important in order to offer proper information, advice and rehabilitation.
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| 4. |
- Filipsson, Karl, 1991-
(författare)
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From behaviour to genes: anti-predator responses of brown trout (Salmo trutta) under winter conditions
- 2020
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Temperature has major effects on the performance of poikilotherms. In encounters with predators, low winter temperatures constrain predator detection and escape capabilities in prey fishes. Most studies of the anti-predator responses of fish under winter conditions focus on endothermic terrestrial predators, whereas effects of piscivorous fish are generally overlooked. The studies presented in this thesis explore behavioural and physiological responses of juvenile brown trout (Salmo trutta) at winter temperatures of 3 and 8 °C in the presence and absence of a winter-active piscivorous fish (burbot, Lota lota). In Paper I, I report behavioural responses of trout in relation to the time of day. At the lower temperature and in the presence of burbot, trout reduced their activity. Trout used overhead shelter the most during the day and in the presence of burbot. Trout also spatially avoided burbot at night and at dawn but not during the day. In Paper II, I examined plasma cortisol and mRNA expression of stress-related genes. A redundancy analysis showed that both temperature and the presence of burbot explained a significant amount of the observed variation. Trout had higher cortisol levels when exposed to the burbot. Analyses of individual gene expressions revealed that trout had higher mRNA expression at 3 than at 8 °C for 11 of the 16 examined genes. Only one gene, RBP1, was expressed to a higher degree in the presence of burbot, but there were also interaction effects between temperature and burbot presence for two genes coding for serotonin and glucocorticoid receptors. My studies show that piscivorous fish shape anti-predator responses of juvenile brown trout, both behaviourally and at the gene level, under winter conditions. The observed thermal effects on mRNA levels underscore the importance of temperature in fish stress responses, with implications for stream salmonids in a warmer climate.
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| 5. |
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| 6. |
- Malmborg, Julia, 1988-, et al.
(författare)
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Risk Factors for Persistence and Development of Frequent Musculoskeletal Pain in Adolescent Athletes
- 2020
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 79:Suppl 1, s. 206-206
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Tidskriftsartikel (refereegranskat)abstract
- Physical activity has a positive impact on health, but adolescent athletes often report musculoskeletal pain (MP) which is negative in the aspect of sustaining physical activity over time. There is a lack of longitudinal assessments of MP and potential risk factors, such as timing of physical maturation, in adolescent athletes.Objectives:To identify risk factors associated with the persistence or development of frequent MP at a 2-year follow-up in adolescent sport school students.Methods:Fourteen-year-old sport school students (n=233) were invited to participate in this 2-year longitudinal study. Self-reports of MP was assessed as frequency, distribution, and intensity, and health status by EQ-5D. Physical maturation was calculated by the Mirwald equation (height, weight, and sitting height) (1), and categorized as early (>1 year), average (±1 year), or late (<–1 year). Students were grouped at baseline and follow-up into infrequent (never to monthly) or frequent (weekly to daily) MP groups. Logistic regression analysis was used to study associations between frequent MP at follow-up and baseline variables.Results:131 students (79 boys and 52 girls) were included in the study. Development or persistence of frequent MP at follow-up (n=61) was associated with being a girl, late physical maturation (only boys were categorized as late), non-contact sports participation, frequent MP at baseline, and reporting ≥2 MP sites at baseline. Students with a better health status at baseline were less likely to belong to the frequent MP group at follow-up (Table).Conclusion:Frequent MP is common in sport school students. MP in young athletes may become a future health problem and there is a need for recognition and interventions by coaches and health services to prevent MP from becoming persistent.References:[1]Mirwald, R. L., Baxter-Jones, A. D., Bailey, D. A., & Beunen, G. P. (2002). An assessment of maturity from anthropometric measurements.Med Sci Sports Exerc, 34(4), 689-694.Table.Associations between background variables at baseline and frequent MP at follow-up based on crude logistic regression analysis controlling each variable for sex.Baseline variablesModelInfrequent MP vs. Frequent MPOR(95% CI; p-value)SexBoys1.00Girls2.76(1.34–5.68; p<0.01)Physical maturationAverage (±1 year)1.00Early (>1 year)0.41(0.05–3.65; p=0.42)Late (<–1 year)3.83(1.13–12.95; p=0.03)Sport categoriesContact1.00Non-contact5.16(2.07–12.88; p<0.001)MP groupsInfrequent1.00Frequent2.74(1.31–5.72; p<0.01)MP intensity last week (NRS 0–10, best to worst)1.15(0.98–1.35; p=0.10)Number of MP sites01.0012.32(0.71–7.58; p=0.16)≥22.87(1.32–6.25; p<0.01)EQ-5D (0.00–1.00, worst to best)0.03(0.001–0.58; p=0.02)Disclosure of Interests:None declared
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| 7. |
- Malmborg, Julia S., 1988-, et al.
(författare)
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Musculoskeletal pain and its association with health status, maturity, and sports performance in adolescent sport school students: a 2-year follow-up
- 2022
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Ingår i: Bmc Sports Science Medicine and Rehabilitation. - London : Springer Science and Business Media LLC. - 2052-1847. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Musculoskeletal pain and its risk factors are rarely assessed in studies on adolescent athletes. The aim was to identify risk factors at baseline that were associated with the persistence or development of musculoskeletal pain at a two-year follow-up in adolescent sport school students, and to study cross-sectional associations at follow-up between musculoskeletal pain and sports performance. Methods Sport school students (79 boys and 52 girls, aged 14 years at baseline) were divided into infrequent (never-monthly) or frequent (weekly-almost daily) pain groups, based on frequency of pain using a pain mannequin. Logistic regression analyses were performed to study longitudinal associations between frequent pain at follow-up and baseline variables: pain group, number of regions with frequent pain, health status by EQ-5D, maturity offset (pre, average, or post peak height velocity), and sports (contact or non-contact). Linear regression analyses were used to study cross-sectional associations between pain groups and 20-m sprint, agility T-test, counter-movement jump, and grip strength at follow-up. Results were stratified by sex. Results A higher percentage of girls than boys reported frequent pain at follow-up (62% vs. 37%; p = 0.005). In boys, frequent pain at follow-up was associated with being pre peak height velocity at baseline (OR 3.884, CI 1.146-13.171; p = 0.029) and participating in non-contact sports (OR 3.429, CI 1.001-11.748; p = 0.050). In girls, frequent pain at follow-up was associated with having frequent pain in two or more body regions at baseline (OR 3.600, CI 1.033-12.542; p = 0.044), having a worse health status at baseline (OR 3.571, CI 1.026-12.434; p = 0.045), and participating in non-contact sports (OR 8.282, CI 2.011-34.116; p = 0.003). In boys, frequent pain was associated with worse performances in 20-m sprint and counter-movement jump, but not in agility T-test and grip strength. Conclusions Baseline risk factors for having frequent pain at follow-up were late maturation in boys, frequent pain and worse health status in girls, and participation in non-contact sports in both sexes. Boys with pain performed worse in sports tests. Coaches and school health-care services should pay attention to the risk factors and work towards preventing pain from becoming persistent.
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| 8. |
- Söderström Malmborg, Julia, 1988-
(författare)
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Pain and health in adolescents and young adults – pieces of a puzzle
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Musculoskeletal pain is a burden for the individual and for society, and it has a negative impact on overall health. The biological, psychological, and social factors that govern pain and health form a complex puzzle to put together. Musculoskeletal pain conditions may be alleviated by physical activity, but a too high level of physical activity may also increase the risk of pain. Youth athletes may be especially vulnerable to developing pain due to factors related to training load and physical maturity. Being physically active and maintaining a healthy diet is associated with better health, but if carried out to excess these health behaviours may become unhealthy. Our understanding of musculoskeletal pain and health in adolescents and young adults needs to be developed, both in individuals involved in sports and exercise and in the general population.Aim: The overall aim was to study musculoskeletal pain and its relationship to various health-related factors in adolescents and young adults enrolled in sport or general education programmes.Methods: Study I was a cross-sectional study on university students (aged 19–29) from an exercise science programme (n = 118) and a business programme (n = 89), assessing health status, physical activity, and orthorexia nervosa (an exaggerated fixation on healthy food). Study II was a cross-sectional study (n = 178), and Study III a 2-year longitudinal (n = 131) study on sport school students (aged 14 at baseline), assessing musculoskeletal pain, health status, physical maturity, and sports performance. Study IV was a 3-year longitudinal study on students from a general upper secondary school (n = 256, aged 16 at baseline), assessing chronic musculoskeletal pain, health status, physical activity, sleep, stress, anxiety, and depression.Results: In Study I, compared to business students, exercise science students reported more pain, but better general health. A high level of physical activity in combination with orthorexia nervosa was most prevalent in men from the exercise science programme. In Studies II and III, pain was common in sport school students. At baseline, boys with constant pain were not as physically mature as boys with infrequent pain. Students with constant pain reported a worse health status than students with infrequent pain. At follow-up, frequent pain, frequent pain in two or more body regions, and a worse health status at baseline were identified as risk factors for having frequent pain at follow-up in girls. For boys, late physical maturation at baseline was a risk factor. Involvement in non-contact sports was also an identified risk factor over time in both sexes. Pain was associated with a worse sports performance in boys at both baseline and follow-up. In Study IV, chronic musculoskeletal pain was common in students from a general upper secondary school. A worse health status, severe sleeping problems, anxiety, and chronic musculoskeletal pain at baseline were associated with reporting chronic musculoskeletal pain at follow-up.Conclusions: Pain was prevalent, and also persistent, in adolescents and young adults, irrespective of attending sport or general education programmes. Pain is a biopsychosocial phenomenon and must be treated as such. Pain should be frequently monitored, and treatment should be introduced early on to prevent pain from becoming persistent.
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