| 1. |
- Hagell, Peter, et al.
(författare)
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Apomorphine formulation may influence subcutaneous complications from continuous subcutaneous apomorphine infusion in Parkinson's disease
- 2020
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Ingår i: Journal of Neurology. - 0340-5354 .- 1432-1459. ; 267:11, s. 3411-3417
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Tidskriftsartikel (refereegranskat)abstract
- Continuous subcutaneous (s.c.) apomorphine infusion is an effective therapy for Parkinson's disease (PD), but a limitation is the formation of troublesome s.c. nodules. Various chemically non-identical apomorphine formulations are available. Anecdotal experiences have suggested that shifting from one of these (Apo-Go PumpFill®; apoGPF) to another (Apomorphine PharmSwed®; apoPS) may influence the occurrence and severity of s.c. nodules. We, therefore, followed 15 people with advanced PD (median PD-duration, 15 years; median "off"-phase Hoehn and Yahr, IV) on apoGPF and with troublesome s.c. nodules who were switched to apoPS. Data were collected at baseline, at the time of switching, and at a median of 1, 2.5, and 7.3 months post-switch. Total nodule numbers (P < 0.001), size (P < 0.001), consistency (P < 0.001), skin changes (P = 0.058), and pain (P ≤ 0.032) improved over the observation period. PD severity and dyskinesias tended to improve and increase, respectively. Apomorphine doses were stable, but levodopa doses increased by 100 mg/day. Patient-reported apomorphine efficacy tended to increase and all participants remained on apoPS throughout the observation period; with the main patient-reported reason being improved nodules. These observations suggest that patients with s.c. nodules caused by apoGPF may benefit from switching to apoPS in terms of s.c. nodule occurrence and severity. Alternatively, observed benefits may have been due to the switch itself. As nodule formation is a limiting factor in apomorphine treatment, a controlled prospective study comparing local tolerance with different formulations is warranted.
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| 2. |
- Aasa, Björn, et al.
(författare)
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A characterisation of pain, disability, kinesiophobia and physical capacity in patients with predominantly peripherally mediated mechanical low back pain
- 2011
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Ingår i: Physiotherapy. - 0031-9406 .- 1873-1465. ; 97:Suppl. 1, s. eS18-
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The specific objectives were to: 1) describe the level of pain intensity, disability, activity limitation, kinesiophobia and physical capacity in patients with predominantly peripherally mediated mechanical back pain, and 2) investigate whether differences between these patients in physical and psychosocial factors can be distinguished when the patients are further sub-grouped.Relevance: To improve assessment among patients with chronic low back pain (CLBP) it is important to investigate the prevalence of physical and psychosocial features in homogenous sub-groups.Participants: Seventy-one patients with CLBP, 20-60 years old, with peripherally mediated mechanical pain at the the moment for the study, were included and each patient was sub-classified into one of five sub-groups based on their pain behaviour and functional movement pattern (flexion n=20, flexion/lateral shift, n=11, active extension n=23 , passive extension n=8, and multidirectional pattern n=9).Methods: Data on pain intensity (Visual Analogue Scale), disability (the Roland and Morris Questionnaire), activity limitation (the Patient Specific Functional Scale), kinesiophobia (the Tampa Scale of Kinesiophobia) and physical capacity (lifting capacity and trunk extensor endurance) was collected.Analysis: Mean and standard deviation for parametric and median and interquartile range for non-parametric data were used for descriptive statistics. One-way ANOVA for normally distributed data and Kruskal-Wallis for non-normally distributed data were used for analyses of differences between the sub-groups. The subjects were also divided into two age-groups (20-40 and 41-60 years) and measures of physical capacity were compared to women and men at the ages of 34 and 50, respectively, in the general Swedish population using one sample T-test.Results: The patients reported low to moderate pain intensity (3.1/10±2.4), disability (RMDQ (7.27/24 ±4.2) and kinesiophobia (33.4/68 ±7) and these levels were lower than reported levels in other studies including more heterogenous groups of patients with CLBP. The patiens reported activity limitations (PSFS 13/30±23). Lifting capacity and trunk extensor endurance were significantly lower than in the general population in the youngest age-group. No significant differences in pain intensity, disability, kinesiophobia or physical capacity were found between the sub-groups.Conclusions: This research highlights that patients with predominantly peripherally mediated mechanical back pain may differ from other sub-groups of patients with CLBP (e.g., patients with central sensitization as dominating pain mechanism) regarding physical and psychosocial factors. The individual variation in pain intensity, disability, kinesiophbia and physical capacity among the patients indicates the importance to assess these factors in every patient. Due to the fact that there were few patients in the sub-groups, further research is necessary to explore whether there are differences, that we were not able to disingjish, between patients with different movement patterns.
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| 3. |
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| 4. |
- Berglund, Lars, et al.
(författare)
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Which patients with low back pain benefit from deadlift training?
- 2015
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Ingår i: Journal of Strength and Conditioning Research. - 1064-8011 .- 1533-4287. ; 29:7, s. 1803-1811
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Tidskriftsartikel (refereegranskat)abstract
- Recent studies have indicated that the deadlift exercise may be effective in decreasing pain intensity and increasing activity for most, but not all, patients with a dominating mechanical low back pain pattern. This study aimed to evaluate which individual factors measured at baseline could predict activity, disability, and pain intensity in patients with mechanical low back pain after an 8-week training period involving the deadlift as a rehabilitative exercise. Thirty-five participants performed deadlift training under the supervision of a physical therapist with powerlifting experience. Measures of pain-related fear of movement, hip and trunk muscle endurance and lumbopelvic movement control were collected at baseline. Measures of activity, disability and pain intensity were collected at baseline and at follow-up. Linear regression analyses were used to create models to predict activity, disability and pain intensity at follow-up. Results showed that participants with less disability, less pain intensity and higher performance on the Biering-Sørensen test, which tests the endurance of hip and back extensor muscles, at baseline benefit from deadlift training. The Biering-Sørensen test was the strongest predictor since it was included in all predictive models. Pain intensity was the next best predictor as it was included in two predictive models. Thus, for strength and conditioning professionals who use the deadlift as a rehabilitative exercise for individuals with mechanical low back pain, it is important to ensure that clients have sufficient back extensor strength and endurance and a sufficiently low pain intensity level to benefit from training involving the deadlift exercise.
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| 5. |
- Berglund, Lars, et al.
(författare)
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Which patients with persistent mechanical low back pain will respond to high load motor control training?
- 2011
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Ingår i: Physiotherapy. - 0031-9406 .- 1873-1465. ; 97:Suppl. 1, s. eS124-eS125
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of this study was to explore variables influencing success or failure of eight weeks of high load motor control training with the conventional deadlift exercise.Relevance: Researching viable exercises for rehabilitation of specific sub-groups of persistent low back pain is relevant for physical therapists in order to develop tailored treatment regimes for patients with persistent low back pain. This study contributes to this research by exploring which variables characterize the ideal patient for the conventional deadlift exercise.Participants: Thirty-five patients with persistent mechanical low back pain were recruited consecutively from two occupational health care services in Umeå, Sweden . Inclusion and exclusion criteria were designed to include patients with persistent mechanical low back pain.Methods: The study design was a prospective cohort study. The intervention consisted of eight weeks of training with the conventional deadlift exercise. To discriminate between patients with a successful or failed outcome of treatment, change in the patient-specific functional scale was used and a cut-off at 50 % improvement was set. Possible predictive variables collected at baseline included physical activity level, pain intensity (Visual Analogue Scale), activity limitation (the Roland and Morris Disability Questionnaire and the Patient-Specific Functional Scale), kinesiophobia (Tampa Scale of Kinesiophobia), specific anamnestic questions regarding patients' history and symptoms of low back pain, test of active movement control of the low back, trunk muscle endurance(Prone bridge test, Side-bridge test, Biering-Sörensen test) and lift strength (static two-hand lift test), two-point discrimination of the low back and ultrasound imaging of the mm. multifidi.Analysis: Student´s T-test for normally distributed continuous data, Mann Whitney for non-normally distributed continuous data and chi-square tests or Fisher´s Exact tests for categorical variables were used for analyses of differences between the success and the failure group.Results: No significant differences between groups were found in background, anamnestic or physical performance variables. After eight weeks of training, 15 patients (43 %) were categorized as treatment success and 20 patients (57 %) were categorized as treatment failure according to the cut-off set for the PSFS. The patients reported difficulty in performing a wide variation of activities, ranging from not being able to sit for longer than 15 minutes, to stand upright and watch their children play football games, and to not being able to run long distances, play football or perform different lifting tasks.Conclusions: We conclude that the conventional deadlift exercise may be considered a possible exercise to improve patients' activity limitations, if administered by a therapist experienced in resistance training and analyzing movement patterns. However, further research is needed to explore which variables can define patients in the successful and in the failure group, respectively.Implications: The results of this study imply that the conventional deadlift exercise can be used in treatment of patients with mechanical low back pain in order to increase activity limitation. However, it is still unclear on what grounds treatment with the conventional deadlift exercise is indicated to achieve these results.
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| 6. |
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| 7. |
- Carina, Hellqvist, et al.
(författare)
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A national Swedish self- management program for people with Parkinson’s disease : patients and relatives view
- 2017
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Ingår i: Movement Disorders. ; , s. 175-176
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Konferensbidrag (refereegranskat)abstract
- Objective: To identify and describe experiences that people with PD and their relatives after participation inthe self-management intervention NPS (National Parkinson School) find valuable for managing daily life.Background: A self-management program called NPS was developed as a collaboration of healthcare providers, researchers and patient organizations. NPS is aiming to provide tools and strategies for people with PD and their relatives to increase ability to manage symptoms and consequences of disease and thereby improving conditions for a good life. Self-monitoring and self-management are central concepts. NPS focuses on life with PD, which via 7 sessions consisting of education/lectures and group discussions are mediated. Home assignments make participants practice the new skills in their own life.Methods: The last session, evaluation of the NPS, was audio recorded in its whole and transcribed verbatim. Data was collected from five separate clinics and analysed both inductively and deductively using Thematic Analysis and by applying the Self-and Family management theory.Results: Through inductive analysis three themes; Exchanging experiences and feeling support, Adjustment and acceptance of PD for managing daily life and Promoting life satisfaction, were identified and described. The themes are capturing the meaning, value and experience of being a participant of NPS. Deductive analysis indicated thatthe Self-and Family management theory was useful and valid for this group of patients and generated a modified framework applicable for patients with PD and their families [figure1].Conclusions: Living with PD affects patients as well as relatives. Meeting others in the same situation gives support and strengthen their self- image. Having the opportunity sharing experiences and practical advices showed that there was a hopeful future to come. Techniques to accept and manage life with PD included seeking information about disease and treatments, self-monitoring in order to adjust to new situations and improve symptoms of disease and having a positive mind-set. Living an active life, participating in enjoyable social, cultural, and physical activities were important to feel happy and satisfied with life. Participation in NPS covered many areas of importance for the ability of self-management in PD. The framework for self-management in chronic disease was found relevant also for the PD population
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| 8. |
- Carina, Hellqvist, et al.
(författare)
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A national Swedish self- management program for people with Parkinson’s disease : patients and relatives view
- 2017
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To identify and describe experiences that people with PD and their relatives after participation inthe self-management intervention NPS (National Parkinson School) find valuable for managing daily life. Background: A self-management program called NPS was developed as a collaboration of healthcare providers, researchers and patient organizations. NPS is aiming to provide tools and strategies for people with PD and their relatives to increase ability to manage symptoms and consequences of disease and thereby improving conditions for a good life. Self-monitoring and self-management are central concepts. NPS focuses on life with PD, which via 7 sessions consisting of education/lectures and group discussions are mediated. Home assignments make participants practice the new skills in their own life. Methods: The last session, evaluation of the NPS, was audio recorded in its whole and transcribed verbatim. Data was collected from five separate clinics and analysed both inductively and deductively usingThematic Analysis and by applying the Self-and Family management theory. Results: Through inductive analysis three themes; Exchanging experiences and feeling support, Adjustment and acceptance of PD for managing daily life and Promoting life satisfaction, were identified and described. The themes are capturing the meaning, value and experience of being a participant of NPS. Deductive analysis indicated thatthe Self-and Family management theory was useful and valid for this group of patients and generated a modified framework applicable for patients with PD and their families [figure1]. Conclusions: Living with PD affects patients as well as relatives. Meeting others in the same situation gives support and strengthen their self- image. Having the opportunity sharing experiences and practical advices showed that there was a hopeful future to come. Techniques to accept and manage life with PD included seeking information about disease and treatments, self-monitoring in order to adjust to new situations and improve symptoms of disease and having a positive mind-set. Living an active life, participating in enjoyable social, cultural, and physical activities were important to feel happy and satisfied with life. Participation in NPS covered many areas of importance for the ability of self-management in PD. The framework for self-management in chronic disease was found relevant also for the PD population
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| 9. |
- Fräjdin-Hellqvist, Ulla-Britt, et al.
(författare)
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Missa inte chansen med ESS
- 2005
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Ingår i: Ny teknik. - 0550-8754. ; :24
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Tidskriftsartikel (populärvet., debatt m.m.)
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| 10. |
- Hagell, Peter, et al.
(författare)
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Apomorphine formulation influences subcutaneous complications in continuous apomorphine pump therapy for Parkinson’s disease
- 2017
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Ingår i: Movement Disorders.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To explore if the occurrence and severity of subcutaneous (sc) nodules is influenced by the pharmaceutical formulation of apomorphine used for sc infusion in advanced Parkinson’s disease (PD).Background: Apomorphine infusion is an effective therapy in advanced PD, but a limitation is troublesome sc nodules. Various chemically non-identical apomorphine formulations are available. Anecdotal clinical experience has suggested that shifting from one of these (Apo-Go PumpFill; apoGPF) to another (Apomorphine PharmSwed; apoPS, developed in Sweden) may influence the occurrence and severity of sc nodules.Methods: In this multicenter open-label prospective observational study, 15 people with advanced PD (mean PD- duration, 13.4 years; median Hoehn & Yahr, IV) on apoGPF since a mean of 2.1 years and with troublesome sc nodules were switched to apoPS. Ongoing interventions to treat existing nodules (ultrasound, massage, Hirudoid cream) continued, and apomorphine as well as other drugs was managed according to clinical routines. Data were collected between May 2015 and March 2017; at baseline, at the time of switching (about 2 weeks later), and up to 1.7-4.2 (mean, 2.5) months post-switch follow-up. Primary outcomes were total nodule numbers, size (mm diameter for the 5 worst nodules), consistency (scored 0-3 for the 5 worst nodules), and associated skin changes (scored 0-4 for the 5 worst nodules) and pain (scored 0-5). Patients also rated their perceived PD severity and motor complications (UPDRS IV). Patient preferences 5-12 months post-switch (2-9 months after follow-up) were also recorded.Results: Apomorphine and L-dopa doses did not change over the observation period (P≥0.400). Baseline nodule numbers (7.4 vs. 4.6; P<0.003), size (92.9 vs. 54.1 mm; P=0.016), consistency (11 vs. 5; P=0.003), skin changes (3 vs. 1.5; P=0.205), and average pain (1 vs. 0; P=0.020) improved 11 weeks post-switch. Patient-reported PD severity (P=0.020) and motor fluctuations improved (P=0.051), whereas dyskinesias tended to increase (P=0.205). At 5-12 months post-switch, 13 patients had decided to remain on apoPS; mainly due to improved nodules.Conclusions: These observations suggest that apoPS may have a better safety profile compared to apoGPF in terms of sc nodule occurrence and severity. There is a need for larger, randomized controlled studies for firmer conclusions.
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