| 1. |
- Tegern, Matthias, 1982-
(författare)
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Musculoskeletal disorders in Swedish military aircrew : screening and clinical examination of the cervico-thoracic region
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Musculoskeletal disorders (MSD) are a common and growing occupational problem in military aircrew. Intervention studies attempting to reduce such issues have only showed limited preventive effects. Furthermore, in-depth knowledge of the clinical presentation of aircrew members with painful episodes is lacking. This thesis was conducted to add evidence to the ongoing work of the Swedish Armed Forces (SAF) for the prevention of MSD. The overall aim of this thesis was to estimate the occurrence of MSD in general and specifically cervico-thoracic pain and its associated factors among SAF aircrew and to evaluate clinically relevant tests, prior to the adaptation of a musculoskeletal screening protocol (MSP) for use in the SAF medical health care system. All participants included in the four studies of this thesis were employed in the SAF. Two cross-sectional studies (Study I; n=351, Study III; n=73) aimed to establish the occurrence of MSD in aircrew compared with army deployed soldiers (Study I) and between fighter pilots, helicopter pilots and rear crew (Study I), as well as identify associated factors of cervical, thoracic and shoulder region pain (Study I) and cervico-thoracic pain (Study III). Study II had a test-retest design and aimed to examine inter-rater (n=37) and test-retest (n=45) reliability of movement control tests. In study III, test performance was compared between fighter pilots, helicopter pilots and rear crew. Study IV had a cross-sectional (n=18) and a prospective observational cohort (n=47) design and aimed to explore physical symptoms and functional limitations in aircrew with cervico-thoracic pain, establish 12-month cumulative incidence and to identify risk factors for cervico-thoracic pain.The main findings of this thesis were that when compared to deployed soldiers, military aircrew reported higher prevalence of MSD in the cervical, thoracic, shoulder, and lumbar regions (80% reported at least one painful area during the previous year). Working as aircrew, and a lower rating of one’s physical health, were significantly associated with pain in the cervical, thoracic and shoulder regions (Study I). Two physical therapists could reliably rate movement patterns for the majority of movement control tests in the affected areas. Lower reliability was however seen for test-retest conditions (Study II). Movement control and measures of cervical range of motion (ROM), but not cervical strength and endurance, were associated with cervico-thoracic pain among military aircrew. Specifically, less control of both neck and lumbar flexion movements, and lesser cervical flexion ROM were associated with cervico-thoracic pain. Differences were found between fighter pilots, helicopter pilots and rear crew for lumbar flexion movement control and cervical lateral flexion ROM (Study III). Physical symptoms and functional impairments of aircrew with high (pain) intensity, flight-elicited and work-affecting cervico-thoracic pain showed an individual presentation. Previous pain episodes, lesser cervical flexion ROM, and lesser cervical flexor muscle endurance were identified as risk factors for future cervico-thoracic pain, which had a 12-month cumulative incidence of 23% (Study IV).Findings from this thesis strongly indicate that MSD in SAF aircrew is an occupational problem that need to be solved. The cervico-thoracic region was especially common in SAF aircrew. Movement control can reliably be assessed, but with less stability for repeated measures. While pain history and physical performance can to some degree be used to identify aircrew at risk for further cervico-thoracic pain, the clinical presentation of their physical symptoms showed individual presentation. The effects of implementing the MSP in the SAF as a primary and secondary preventive intervention, as well as rehabilitative strategies, need be systematically evaluated.
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| 2. |
- Åström, Charlotte, 1979-
(författare)
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Effects of vibration on muscles in the neck and upper limbs : with focus on occupational terrain vehicle drivers
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Occupational drivers of terrain vehicles are exposed to several risk factors associated with musculoskeletal symptoms in the lower back as well as in the neck and upper limbs. Vibration has been suggested to be a main risk factor. These drivers are exposed to both whole-body vibration (WBV) and hand-arm vibration (HAV). Aim: This study establishes the association between driving terrain vehicles and musculoskeletal disorders (MSDs) in the neck and upper limbs as well as hand-arm vibration syndrome (HAVS). In addition, this study examines the effect on muscles in the neck and upper limbs of the type of vibration exposure that occurs in occupational driving of terrain vehicles. Methods and results: In Paper I, a cross-sectional questionnaire study on occupational drivers of terrain vehicles, increased Prevalence Odds Ratios (POR) were found for numbness, sensation of cold and white fingers (POR 1.5-3.9) and for MSDs in the neck (POR 2.1-3.9), shoulder (POR 1.8-2.6) and wrist (POR 1.7-2.6). For the shoulders, neck and elbow, there appears to be a pattern of increased odds with increasing exposure time. In Paper II, an experimental study on the trapezius muscle, which included 20 men and 17 women, the mean frequency of the electromyography signal (EMGMNF) decreased significantly more in a three minute sub-maximal contraction without vibration (-3.71Hz and -4.37Hz) compared to with induced vibration (-3.54Hz and -1.48Hz). In Paper III, a higher initial increase of the mean of the root-mean-square of the electromyography signal (EMGRMS) was seen in a three minute sub-maximal contraction with vibration exposure compared to without vibration (0.096% vs. 0.045%). There was a larger mean EMGMNF decrease for NV compared to V in the total three minutes, and a larger decrease also in the first time period was seen for the NV compared to V. A small gender effect was also noticed. In Paper IV, the combination of HAV and WBV was studied in laboratory settings and resulted in a higher trapezius EMGRMS compared to the HAV and WBV separately. Conclusion: Occupational drivers of terrain vehicles are likely to experience symptoms related to HAVS and musculoskeletal symptoms in the neck and upper limbs. Local vibration does not seem to have any negative acute effects on trapezius muscle fatigue. Vibration exposure seems to cause an initial increase in muscle activity in the trapezius that could be related to recruitment on new motor-units. A combination of HAV and WBV causes a larger muscular demand on the trapezius muscle.
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| 3. |
- 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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| 4. |
- Enberg, Birgit, 1956-
(författare)
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Work experiences among healthcare professionals in the beginning of their professional careers : a gender perspective
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Swedish healthcare organizations have undergone substantial organizational and economic restructuring during the 1990s due to financial cutbacks. Little is known about recently graduated healthcare professionals´ work experience in healthcare and their future career preferences. The overall aims of this thesis was, to increase knowledge about how recently graduated healthcare professionals in Sweden perceive their work in healthcare organizations. A gender perspective is adopted. In this national cross-sectional study, four stratified random samples were separately drawn from the 1999 Swedish university graduates who were nurses (NS), occupational therapists (OT), physical therapists (PT) and (registered) physicians (PN) and who at the time of the sampling procedure were living in Sweden. Stratification was performed by sex. A total of 3989 were eligible and of those, 1434 were selected: 535 NS, 250 OT, 250 PT and 399 PN. A questionnaire was constructed containing questions about socio-demographic factors, working conditions, career preferences, work satisfaction and questions about the responsibility for and actual work with home and family, the so called unpaid household work. The questionnaires also contained questions measuring psychosocial working conditions: the effort-reward imbalance questionnaire (ERI-Q) and the demand-control questionnaire (DCQ). Collection of the data for NS, OT and PT was completed in March 2002 and for PN in May 2003. The response rate was 81% and 76% respectively. The total sample thus consists of 1145 participants; 423 nurses, 212 occupational therapists, 205 physiotherapists and 305 physicians. Most of the respondents were employed in the public sector, but many desired privately employment within the coming five year period, men more often than women. Career preferences for future work differed between women and men. A majority indicated that they did not have the opportunity to pursue knowledge development in the professional field during working hours and nearly one half could not work as independently as they wished. Satisfaction with work in general was high, but many were dissatisfied with management at work and a majority was dissatisfied with the work organization. This dissatisfaction was associated with the opportunity to work as independently as they wished and the opportunity to pursue knowledge development in the professional field. Significantly more women than men had the main responsibility for home and family and did most of the unpaid household work. Among the OT and PT working for county councils and municipalities, the results revealed that those working for municipalities, experienced low control at work compared with those working for county councils. No differences were found between OT and PT or between men and women in the two professions regarding the DCQ and the ERI-Q except for the WOC scale. Women had significantly higher scores on the WOC scale compared with men. Logistic regression analyses revealed a significant association between WOC and ERI, effort, reward and sex. One fourth of the OT and PT working for county councils and municipalities was dissatisfied with their job and this dissatisfaction was significantly associated with type of employer, reward and effort-reward imbalance (in the ERI-Q) and control (in the DCQ). Differences regarding scoring on the ERI-Q were found between nurses and physicians working in county councils but not between women and men in the same group, with the exception of the scores on overcommitment. Significantly more nurses were defined as having high effort, low reward and effort-reward imbalance compared with the physicians. More women in the NS and PN group were defined as experiencing WOC compared to men. Logistic regression analyses revealed significant associations between experiences of WOC and ERI, effort and reward. Nearly one fifth in the NS and PN group were dissatisfied with work and this dissatisfaction was particularly high among those with high effort, low reward, those with the greatest imbalance between effort and reward and those who experienced high overcommitment. In conclusion, in order to limit future work related problems and to be able to retain well educated professionals in healthcare work, dissatisfaction among the recently graduated must be taken seriously. Healthcare employers should better utilize the knowledge that recently graduated possess, regarding for example how to be a part of the development of the profession and the job. It is also important that healthcare employers address gender (in) equality at work and that work environments allow both women and men to combine careers with family duties.
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| 5. |
- Glimskär, Bo, 1954-
(författare)
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The Adoption of Ergonomic Innovations for Injury Prevention : Examples from the building construction and health care industries
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A good work environment is important for the individual, for industry and for society. The work environment research has, predominantly, targeted identification of problems and the measurement of the size of these problems.Innovations to reduce the incidence of musculoskeletal disorder, MSD, have been introduced in different branches of industry, but with limited success.Few of the ergonomic innovations developed for the building and construction industry have reached a sufficient level of adoption. Ergonomic innovations in the health care sector are of an incremental character and seem to have similar problems of adoption as the ones in the building and construction industry.Three examples of ergonomic innovation are examined in the thesis:a glue spreader for floor layersa four-wheel walker with a lifting devicea sonographer’s scanning support deviceThe studies show that an ergonomic innovation is not adopted for prevention of occupational injury unless the innovation also has other relative advantages apart from the ergonomic ones. For the group who already has sustained an injury, it is enough that the ergonomic problems are solved, while the other, symptom-free group, requires other advantages in order to adopt the innovation; increased production economy seems to be the most prominent potential advantage.
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| 6. |
- Grönblom-Lundström, Lena, 1951-
(författare)
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Rehabilitation in light of different theories of health : Outcome for patients with low-back complaints - a theoretical discussion
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to investigate if the outcome of rehabilitation efforts is depending on what view health care has in relation to what need of care people have and if the outcome for different groups of patients with low-back complaints (specific versus non-specific complaints) is various successful. The outcome is measured in length of sick leave, number of spells and granted sickness and disability pensions.This thesis combines a theoretical analysis of different theories of health with studies of two empirical materials. One material comprises a group of individuals with low-back complaints (specific versus non-specific complaints) from a nation-wide survey of Living Conditions conducted by Statistics Sweden in 1981. The other material comprises a sample of individuals on sick leave either due to low-back complaints or other kinds of complaints than low-back complaints. The outcome of these studies are measured as to what extent people with low-back complaints are granted a disability pension (Paper III) and which the characteristics are of those on sick leave due to low-back complaints compared to those with other kinds of complaints (Paper IV). The results from Paper III revealed a difference concerning socio-economic group and granted disability pension between those with specific, non-specific and frequent low-back complaints. Those with non-specific and frequent low-back complaints were to higher extent manual workers and disability pensioners. The results of Paper IV reveals also a socio-economic difference besides that those with low-back complaints had longer sick leave periods and more spells. What does these results indicate? Are non-specific and frequent low-back complaints not successfully treated within the health care system? Is this due to how these matters have been identified? Are these individuals truly disabled due to their low-back complaints, if so how are they assessed and treated? I believe that the notions of health and disease as well as the social context in which people act influence the outcome of rehabilitation. If people judge their health as bad (here due to low-back troubles) and in need of health care and the health care system do not recognise their need when not identified as diseased a problem arises. These individuals claim that their ability to work is hampered due to the low-back complaint and the society has an obligation and needs a legitimate solution for those individuals that cannot support themselves due to ill health. This obligation makes a demand on the health care system.If non-specific complaints are assessed as non-medical problems, from a biomedical point of view, health care lacks measures to take care of these people if they ought to be taken care of within the health care system at all. But this outcome (a disability pension) may also indicate that people suffer from a “true” illness although not defined by objective findings. If that is the state one may ask if there is a lack of sufficient diagnostic procedures and measures as well. A rehabilitation approach stemming from a humanistic social perspective might lead to a more favourable outcome for people with low-back complaints, whether or not these complaints have been identified in a biomedical sense, as this perspective take into account both the goals, the resources and the social context of that individual. This thesis has paid attention to the matter that conceptual notions, which seldom are considered within clinical praxis, are of vital importance for the outcome of rehabilitation. Health care falls short especially when it comes to non-specific and frequent low-back complaints and this may be due to the biomedical model being used too strictly within a domain where other models, here exemplified as Pörn’s Theory of Health, might result in a more favourable rehabilitation outcome for the individual.
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| 7. |
- Johansson, Ann-Christin
(författare)
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Psychosocial factors in patients with lumbar disc herniation : enhancing postoperative outcome by the identifiction of predictive factors and optimised physiotherapy
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Psychosocial factors have been advanced as an explanation for the development of chronic disability in 20 to 30% of patients treated by lumbar disc surgery. Aims: The overall aim of this thesis was to study the role of psychosocial factors in patients undergoing first-time lumbar disc surgery in relation to the outcome of both surgery and subsequent physiotherapy. Methods: Sixty-nine patients with lumbar disc herniation undergoing first-time disc surgery participated in the studies; in addition, Study I included 162 knee patients for comparison. Psychosocial factors were assessed preoperatively, as was the activation of the physiological stress response system. Pain, disabil-ity and quality of life were assessed before, and 3 and 12 months after surgery. Coping and kinesiophobia were analysed before and one year after surgery. The results of two different postoperative training programmes were compared. Results: There were no differences between disc and knee patients regarding the presence of psychosocial stress factors preoperatively (Study I). Disc patients with low diurnal cortisol variability had lower physical function, perceived fewer possibilities to influence their pain and were more prone to catastrophise than patients with high diurnal cortisol variability (Study II). The results of clinic-based physiotherapy and home training did not differ regarding postoperative disability and pain 3 months after surgery. The home-based group had less pain and higher quality of life in comparison to the clinic-based group 12 months after surgery (Study III). Patients’ expectations of returning to work could best predict pain, disability, quality of life and sick leave one year after surgery (Study IV). Psychosocial factors were only weakly asso-ciated to pain, disability, quality of life and sick leave preoperatively. However, these associations were stronger in patients with residual pain one year after surgery. Conclusion: Psychosocial factors and, in particular, patients’ expectations regarding outcome are associated with the results of lumbar disc surgery. Assessing psychosocial factors preoperatively and developing an active home training programme after surgery could create options leading to better results for these patients.
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| 8. |
- Björk, Mathilda, 1977-
(författare)
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Aspects of Disability in Rheumatoid Arthritis : a five-year follow-up in the Swedish TIRA project
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Rheumatoid arthritis (RA) is a progressive disease, often leading to disability. Because the disease course develops rapidly during the first years after diagnosis, more knowledge is needed about the early disease course to minimize later disability. This thesis describes the course of disability in early RA such as hand function, pain intensity, activity limitation and sick leave. In addition, this thesis compares disability between women and men and compares disability between RA patients and referents.This thesis is primarily based on data from the 320 patients that were included in the multi-centre project in Sweden called ‘Early interventions in rheumatoid arthritis’ (TIRA). A wide range of outcome variables was registered between 1996 and 2006 during regular follow-ups from time for diagnosis through the eight-year follow-up. Outcome regarding disease activity and disability of RA patients still remaining in TIRA at the three and five year follow-up respectively are used in this thesis. Data concerning sick leave were obtained for the patients during six years (1993-2001) – three years before and three years after diagnosis. Referents were included in two of the studies. Data regarding disability in referents were obtained according to hand function and activity limitation using the Health Assessment Questionnaire (HAQ). Data for sick leave were obtained for six years in referents, for the same period as the RA patients.For most variables, disability in RA was most pronounced at time of diagnosis but before intervention started. Disability was then reduced already at the 3-month follow-up and thereafter affected but stable during the following five years. The exception was participation, reflected by sick leave, a variable that was stable from inclusion to three years from diagnosis. Activity limitation, pain intensity and sick leave in RA that represents different aspects of disability were explained by other aspects of disability and contextual factors rather than by disease activity. RA affects women and men differently in some aspects. Women had more severe course of activity limitations than men according to HAQ. Men were more affected than women in range of motion, although the differences were small in a clinical perspective. However, pain intensity and frequency of sick leave did not differ between women and men. Patients with RA have pronounced disability in relation to referents although several variables improve soon after diagnosis. This discrepancy refers to hand function as well as activity limitations and sick leave. The frequency of sick leave increased during the year before diagnosis in relation to referents and was thereafter high compared to sick leave in referents.
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| 9. |
- Eriksson, Lisbeth
(författare)
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Telerehabilitering : sjukgymnastik på distans
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to study physiotherapy at a distance in the home after surgery on the shoulder joint as well as conditions for (physical examination) palpation at a distance. Technical developments have contributed to shorter hospital stays and more care and rehabilitation outside the hospital and in the patient’s home. Distance-spanning technology can be a tool to this development to take place while providing the same or better quality. Study I was a controlled quantitative study. A series of 25 patients underwent shoulder joint replacement and initial physiotherapy at the hospital. After discharge, 12 patients were referred to conventional out-patient physiotherapy (control), while 10 patients participated in a telerehabilitationintervention of interactive video-based physiotherapy at home with the physiotherapist situated at the hospital. Shoulder function, activity limitations and health-related quality of life were assessed before surgery and two months after surgery. The telerehabilitation intervention group was also interviewed twomonths after the surgery and physiotherapy at distance at home.Study I showed that the telerehabilitation group members had participated in more physiotherapy sessions and showed significantly better recovery regarding shoulder pain, shoulder joint external rotation, shoulder function and activity limitations in two dimensions of health-related quality of life, compared to the control group.In study II the content analysis of interviews with the telerehabilitation group members showed that all participants expressed that they were satisfied with the rehabilitation and that they had experienced the videocommunication technique and the exercise as safe. The analysis of the interviews showed that participants experienced accessibility to specific frequent physiotherapy at a distance at home as a prerequisites for recovery competence. Participantsexperienced closeness to the physiotherapist at distant. The analysis revealed a process from dependent patients to strengthened responsible persons.In study III and IV seven experienced physiotherapists and one technical engineer with experience of video communication technique participated in qualitative focus group interviews. The aim was to describe the concept palpation (study III) and to describe conception of palpation at a distance (study IV). Qualitative content analysis showed that palpation was an important part of the physiotherapy assessment and examination. The study points to an intrinsic relationship between “manual and technical skills”, and “the relationship between the physiotherapist and the patient”. The analysis of the focus group interviews showed an important aspect of palpation where the physiotherapist and the patient communicate and interact with each other. In the focus group interviews, participants view on robotic palpation was developed, revealing a change from doubts and skepticism to interest and fascination. The physiotherapists saw a potential for palpation at a distance to meet their needs and their conceptions of their patients’ needs. The interviews revealed thoughts of technical demands on design of the robot. A future with robotic palpation as the “physiotherapists extended arm” should change the physiotherapists’ professional role.Furthermore, in study IV, these descriptions of palpation and conceptions of robotic palpation were used when developing a prototype for robotic palpation, which, in turn, was the subject of a field trial among four participants of the focus groups. A prototype master-slave system was built using budget haptic robots. It included a palpation force measurement system and a force/position controller using open-source software. The field trial of the prototype developed revealed accordance in the palpation force used between manual and robotic palpation. Despite the technical shortcomings and lack of sensory feedback appeared a feeling similar to manual palpation of and to during the test. In conclusion, a novel working prototype for robotic palpation was produced, and focus group interviews as well as field trial experiences resulted in a description of the potential of distance palpation and needs for further development.In summary, this thesis shows that physical therapy at a distance after surgery with shoulder prosthesis is feasible and may have particular advantages. The explanation for this may be several: more physiotherapy sessions, access to physiotherapist with specialized skills and an involved patient. Palpation at a distance is a challenging development, which can stimulate and enhance distance-spanning technologies in physiotherapy and provide an additional complement in contact with the patient. The technology needs to be further developed adjusted to patient´s and physiotherapist´s needs and benefits. Furthermore ethical and safety issues need to be addressed in more recent studies.
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| 10. |
- Gutke, Annelie, 1967-
(författare)
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Pelvic Girdle Pain and Lumbar Pain in relation to pregnancy
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The prevalence of low back pain (LBP) is higher in pregnant women compared to women of the same age in a general population. Pregnancy-related LBP persists 6 years after pregnancy in 16% of women. Consequently, pregnancy represents a specific risk for LBP and persistent LBP. Pregnancy-related LBP is usually studied as a single entity, however, only one subgroup of LBP, i.e. pelvic girdle pain (PGP), seems to be associated with pregnancy. Accordingly, possible differences in subgroups of patients with LBP are unknown.The aims of this thesis were the following: 1) to describe the prevalence of clinically classified subgroups of women with LBP in a cohort (no LBP, lumbar pain, PGP, and combined pain (PGP and lumbar pain)) during pregnancy and postpartum, and 2) to determine if there was a disparity in the course, health-related quality of life (HRQL), pain intensity, disability, depressive symptoms, or muscle function in subgroups of the cohort, and 3) to identify predictors for having persistent pregnancy-related PGP postpartum.Consecutively-enrolled pregnant women were classified into LBP subgroups by mechanical assessment of the lumbar spine, pelvic pain provocation tests, standard history, and pain drawings. All women answered questionnaires (background data, EQ-5D). Women with LBP completed the Oswestry Disability Index and pain measures. The Edinburgh Postnatal Depression Scale was used to evaluate depressive symptoms at 3 months postpartum (cut-off ≥10). Trunk muscle endurance, hip muscle strength, and gait speed were investigated. Multiple logistic regression was used to identify predictors from self-reports and clinical examination.At the 12-18 gestational week evaluation, 118/308 (38%) women had no LBP, 33 (11%) had lumbar pain, 101 (33%) had PGP, and 56 (18%) had combined pain. Three months postpartum, 183/272 (67%) women had no LBP, 29 (11%) had lumbar pain, 46 (17%) had PGP, and 14 (5%) had combined pain. Pregnant women with combined pain were most affected in terms of HRQL, pain intensity, and disability. Depressive symptoms were three times more prevalent in women with LBP (27/87, 31%) than in women without LBP (17/180, 9%). Women with PGP and/or combined pain had lower values for trunk muscle endurance, hip extensor strength and gait speed compared to women without LBP. Postpartum, 16-20% of the women had persistent combined pain or PGP, whereas 1/29 had lumbar pain. Predictors for persistent PGP or combined pain were work dissatisfaction, older age, combined pain in early pregnancy, and low endurance of the back flexors.In conclusion, women with combined pain were identified to be a target group since they had the lowest recovery rate and since the classification of combined pain was found to be a predictor for persistent PGP or combined pain postpartum. The hypothesis of an association between muscle dysfunction and PGP was strengthened. Based on the finding of high comorbidity of postpartum depressive symptoms and LBP, it seems important to screen for and consider treatment strategies for both symptoms.
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