| 1. |
- Sernert, Ninni, 1954, et al.
(författare)
-
Similar cost-utility for double- and single-bundle techniques in ACL reconstruction
- 2018
-
Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 26:2, s. 634-647
-
Tidskriftsartikel (refereegranskat)abstract
- © 2017 The Author(s) Purpose: The aim was to estimate the cost-utility of the DB technique (n = 53) compared with the SB (n = 50) technique 2 years after ACL reconstruction. Methods: One hundred and five patients with an ACL injury were randomised to either the Double-bundle (DB) or the Single-bundle (SB) technique. One hundred and three patients (SBG n = 50, DBG n = 53) attended the 2-year follow-up examination. The mean age was 27.5 (8.4) years in the SBG and 30.1 (9.1) years in the DBG. The cost per quality-adjusted life years (QALYs) was used as the primary outcome. Direct costs were the cost of health care, in this case outpatient procedures. Indirect costs are costs related to reduce work ability for health reasons. The cost-utility analysis was measured in terms of QALY gained. Results: The groups were comparable in terms of clinical outcome. Operating room time was statistically significantly longer in the DBG (p = 0.001), making the direct costs statistically significantly higher in the DBG (p = 0.005). There was no significant difference in QALYs between groups. In the cost-effectiveness plane, the mean difference in costs and QALYs from the trial data using 1000 bootstrap replicates in order to visualise the uncertainty associated with the mean incremental cost-effectiveness ratio (ICER) estimate showed that the ICERs were spread out over all quadrants. The cost-effectiveness acceptability curve showed that there was a 50% probability of the DB being cost-effective at a threshold of Euro 50,000. Conclusion: The principal findings are that the DB is more expensive from a health-care perspective. This suggests that the physician may choose individualised treatment to match the patients’ expectations and requirements.
|
|
| 2. |
- Ahldén, Mattias, et al.
(författare)
-
A Prospective Randomized Study Comparing Double- and Single-Bundle Techniques for Anterior Cruciate Ligament Reconstruction.
- 2013
-
Ingår i: American Journal of Sports Medicine. - : SAGE Publications. - 0363-5465 .- 1552-3365. ; 41:11, s. 2484-2491
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:The aim of the study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using either the double-bundle or single-bundle technique with hamstring tendon autografts in an unselected group of patients. HYPOTHESIS:Double-bundle ACL reconstruction will render a better outcome on the pivot-shift test. STUDY DESIGN:Randomized controlled trial; Level of evidence, 1. METHODS:A randomized series of 103 patients (33 women, 70 men; median age, 27 years; range, 18-52 years) with a unilateral ACL rupture underwent anatomic ACL reconstruction. The double-bundle technique was used in 53 patients, and the single-bundle technique was used in 50 patients. The ACL footprint was visualized, and the femoral tunnel was drilled through the anteromedial portal; interference screw fixation was used at both ends. The patients were examined preoperatively and at a median of 26 months (range, 22-42 months) after the reconstruction by a blinded observer. The primary variable was the pivot-shift test. RESULTS:At 2-year follow-up, 98 patients (93%) were examined. Clinical assessments at follow-up revealed no significant differences between the double-bundle and single-bundle groups in terms of the pivot-shift test, KT-1000 arthrometer laxity measurements, manual Lachman test, range of motion, Lysholm knee scoring scale, Tegner activity scale, Knee Injury and Osteoarthritis and Outcome Score (KOOS), 1-legged hop test, and square hop test. A significant improvement was seen in both groups compared with the preoperative values in terms of most clinical assessments. CONCLUSION:In this prospective randomized study, the primary variable, the pivot-shift test, and other subjective and objective outcome variables revealed no significant differences between the double-bundle and single-bundle techniques at 2 years after ACL reconstruction in an unselected group of patients.
|
|
| 3. |
- Ahldén, Mattias, et al.
(författare)
-
Knee laxity measurements after anterior cruciate ligament reconstruction, using either bone-patellar-tendon-bone or hamstring tendon autografts, with special emphasis on comparison over time
- 2009
-
Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 1433-7347 .- 0942-2056. ; 17:9, s. 1117-24
-
Tidskriftsartikel (refereegranskat)abstract
- The aims of the study were to analyse the change in knee laxity over time after anterior cruciate ligament (ACL) reconstruction, using either bone-patellar-tendon-bone (BPTB) or hamstring (HS) tendon autografts, and to compare the knee laxity measurements between the study groups both pre-operatively and on multiple follow-up occasions. Another aim was to compare the radiographic findings in terms of degenerative changes between the study groups. A randomised series of 71 patients, who underwent ACL reconstruction using BPTB or HS tendon autografts and interference screw fixation, were included in the study. Of these patients, 47/71 (66%) attended a clinical examination, including laxity measurements using the KT-1000 arthrometer, pre-operatively and on four post-operative occasions; 6 months, 1 year, 2 years and 7 years after the reconstruction. The BPTB group consisted of 22 patients, while there were 25 patients in the HS group. There were no significant differences in the mean side-to-side knee laxity between the BPTB and the HS group pre-operatively or at the follow-up examinations. There was a tendency towards a reduction in side-to-side knee laxity over time in both groups, measured with the KT-1000 arthrometer. The decrease was significant when analysing the injured and uninjured knee separately (injured side p < 0.001 (BPTB) and p = 0.005 (HS), uninjured side p = 0.008 and p = 0.042, respectively). Forty-four patients (BPTB 21, ST 23) underwent a radiographic assessment at the 7-year follow-up, which revealed no significant differences between the study groups in terms of osteoarthritic findings classified according to the Fairbank and Ahlback rating systems. In overall terms, osteoarthritis was identified in 16% (BPTB 19%; ST 13%; n.s.) according to the Ahlback rating system and 68% (BPTB 67%; ST 70%; n.s.) according to the Fairbank rating system. There were no significant differences in knee laxity measurements between the two study groups pre-operatively or at 7 years. A decrease in knee laxity over time was seen in both groups. There were no significant differences between the BPTB and ST groups in terms of osteoarthritic findings at 7 years.
|
|
| 4. |
- Ahldén, Mattias, et al.
(författare)
-
Outcome of anterior cruciate ligament reconstruction with emphasis on sex-related differences.
- 2012
-
Ingår i: Scandinavian journal of medicine & science in sports. - : Wiley. - 1600-0838 .- 0905-7188. ; 22:5, s. 618-626
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this retrospective study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using the four-strand semitendinosus-gracilis (ST/G) autograft in male (n=141) vs female (n=103) patients. The patients were operated on between 1996 and 2005, using interference screw fixation and drilling the femoral tunnel through the anteromedial portal. The pre-operative assessments and demographics, apart from age (males 29 years, females 26 years; P=0.02), were comparable at the time of surgery. At 25 (23-36) months post-operatively, no significant differences were found between the study groups in terms of anterior side-to-side knee laxity, manual Lachman test, Tegner activity level, Lysholm knee score, range of motion or donor-site morbidity. Both study groups improved significantly in most clinical assessments and functional scores compared with their pre-operative values. Two years after ACL reconstruction using ST/G autografts, there were no significant differences between male and female patients in terms of clinical outcome or functional scores.
|
|
| 5. |
- Ahldén, Mattias, et al.
(författare)
-
The Swedish National Anterior Cruciate Ligament Register A Report on Baseline Variables and Outcomes of Surgery for Almost 18,000 Patients
- 2012
-
Ingår i: American Journal of Sports Medicine. - : SAGE Publications. - 0363-5465 .- 1552-3365. ; 40:10, s. 2230-2235
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The Swedish National Anterior Cruciate Ligament Register provides an opportunity for quality surveillance and research. Purpose: The primary objective was to recognize factors associated with a poorer outcome at an early stage. Study Design: Case series; Level of evidence, 4. Methods: Registrations are made using a web-based protocol with 2 parts: a patient-based section with self-reported outcome scores and a surgeon-based section, where factors such as cause of injury, previous surgery, time between injury and reconstruction, graft selection, fixation technique, and concomitant injuries are reported. The self-reported outcome scores are registered preoperatively and at 1, 2, and 5 years. Results: Approximately 90% of all anterior cruciate ligament (ACL) reconstructions performed annually in Sweden are reported in the register. Registrations during the period 2005-2010 were included (n = 17,794). After excluding multiligament reconstructions and reoperations, the male: female ratio was 57.5: 42.5 for both primary (n = 15,387) and revision (n = 964) surgery. The cause of injury was soccer in approximately half the male patients and in one third of the female patients. All subscales of the Knee injury and Osteoarthritis Outcome Score (KOOS) were significantly improved 1, 2, and 5 years postoperatively in patients undergoing primary reconstructions. In terms of the KOOS, revisions did significantly less well than primary reconstructions on all follow-up occasions, and smokers fared significantly less well than nonsmokers both preoperatively and at 2 years. Patients who had concomitant meniscal or chondral injuries at reconstruction did significantly less well preoperatively and at 1 year in terms of most KOOS subscales compared with patients with no such injuries. At 5 years, a significant difference was only found in terms of the sport/recreation subscale. Double-bundle reconstructions revealed no significant differences in terms of all the KOOS subscales at 2 years compared with single-bundle reconstructions (114 double-bundle vs 5109 single-bundle). During a 5-year period, 9.1% (contralateral, 5.0%; revision, 4.1%) of the patients underwent a contralateral ACL reconstruction or revision reconstruction of the index knee. The corresponding figure for 15- to 18-year-old female soccer players was 22.0%. Conclusion: Primary ACL reconstruction significantly improves all the subscales of the KOOS. Young female soccer players run a major risk of reinjuring their ACL or injuring the contralateral ACL; revision ACL reconstructions do less well than primary reconstructions, and smokers do less well than nonsmokers.
|
|
| 6. |
- Augustsson Ryman, Sofia, 1975, et al.
(författare)
-
Clinical evaluation of muscle function, quality of life and functional capacity after shoulder surgery
- 2012
-
Ingår i: Advances in Physiotherapy. - : Informa UK Limited. - 1403-8196 .- 1651-1948. ; 14:1, s. 29-37
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to analyse and describe muscle function, quality of life and functional capacity before and after shoulder instability surgery. Twenty-six women aged 34 (±14) years and 95 men aged 32 (±10) years participated in this study. All patients were on the waiting list or had undergone shoulder instability surgery. The study was performed with a cross-sectional design and patients were examined pre-operatively, 6-month post-operatively or 7-year post-operatively. Handgrip strength measurement, active range of motion (AROM), isometric shoulder muscle strength measurement, health-related quality of life measured by Western Ontario Shoulder Instability Index (WOSI © ) and shoulder function using the Constant Score were evaluated. The mean AROM in fl exion for women in all groups ranged from 162 ° (±16) to 169 ° (±12), and for men from 157 ° (±19) to 162 ° (±12). The mean AROM in abduction ranged from 170 ° (±25) to 177 ° (±5) for women and from 177 ° (±8) to 179 ° (±24) for men. The mean AROM in external rotation ranged from 89 ° (±14) to 95 ° (±14) for women and from 83 ° (±21) to 85 ° (±12) for men. Men were signifi cantly stronger and had a larger AROM on the non-injured side compared with the injured side, whereas differences were found between non-injured and injured side for women only in AROM. The scores from the WOSI © for all the patients were far from normative values suggesting that the patient ’ s subjective experience does not fully refl ect the physical examination. The results from the present study can guide the physiotherapist to give patients realistic expectations of shoulder function concerning AROM and muscle strength.
|
|
| 7. |
- Björnsson, Haukur, et al.
(författare)
-
A Randomized Controlled Trial With Mean 16-Year Follow-up Comparing Hamstring and Patellar Tendon Autografts in Anterior Cruciate Ligament Reconstruction
- 2016
-
Ingår i: American Journal of Sports Medicine. - : SAGE Publications. - 0363-5465 .- 1552-3365. ; 44:9, s. 2304-2313
-
Tidskriftsartikel (refereegranskat)abstract
- Background: There is no consensus in the current literature on which surgical options render the best long-term results after anterior cruciate ligament (ACL) reconstruction in terms of clinical outcomes and the development of radiographic osteoarthritis (OA). Purpose: To investigate the long-term clinical and radiographic results after ACL reconstruction using either a patellar tendon (PT) autograft or a hamstring tendon (HT) autograft. Methods: This multicenter study was based on 2 previous randomized cohorts consisting of 193 patients who underwent unilateral primary ACL reconstruction using either a PT autograft or an HT autograft. The index surgical procedure was performed between September 1995 and January 2000. Clinical assessments, including knee laxity measurements, functional outcomes, patient-reported outcomes, and bilateral standing radiographs, were performed at the final follow-up examination. Results: At the long-term follow-up, 147 (76%) patients were examined: 61 in the PT group and 86 in the HT group. The mean (SD) follow-up time was 191.9 +/- 15.1 months for the HT group and 202.6 +/- 10.4 months for the PT group. Knee laxity measurements revealed significantly more patients with a normal pivot-shift test finding in the HT group compared with the PT group (71% vs 51%, respectively; P = .048); however, no significant differences were found in terms of the manual Lachman test or the KT-1000 arthrometer manual maximum test. The patients in the PT group had significantly more difficulty knee walking (P = .049). There were no significant differences between the study groups in terms of patient-reported outcomes or range of motion in the reconstructed knee. In both groups, significantly more signs of radiographic OA were found in the reconstructed knee than in the contralateral healthy knee. However, there were no significant differences between the groups in terms of radiographic OA. Conclusion: Only minor and mostly insignificant differences were found between the PT and HT autograft groups in this long-term randomized controlled trial. In both groups, significantly more signs of radiographic OA were found in the reconstructed knee than in the contralateral knee.
|
|
| 8. |
- Brink, Peter, et al.
(författare)
-
Group supervision as a means of developing professional competence within pre-hospital care.
- 2012
-
Ingår i: International emergency nursing. - : Elsevier BV. - 1878-013X .- 1755-599X. ; 20:2, s. 76-82
-
Tidskriftsartikel (refereegranskat)abstract
- Ambulance care has its foundations in experience-based knowledge relating to the care provider's flexibility and humility in the encounter with patients. The group supervision model used in this study is retrospective and experience orientated and it is designed to promote and develop the group's overall competence by facilitating the group process, as well as extending and improving levels of professional knowledge.The aim was to evaluate the experience of group supervision and to explore its impact on the participants' personal and professional development.This study uses an inductive qualitative approach where data collection was performed in the form of a focus group interview and analysed by a model of content analysis.Group supervision appears to have had a positive impact on the participants' personal and professional development. The structure of the model appears to make it easier for the inexperienced co-worker more rapidly to develop expertise within his/her working area, which can be seen as an important tool in today's financially focused and time-pressurised health-care service. It is to be hoped that the results of this study will interest health managers and encourage them to consider group supervision as a tool for professional development not only within the area of the ambulance service.
|
|
| 9. |
- Bäck-Pettersson, Siv, 1946, et al.
(författare)
-
FOU-kompetensförsörjningsprogram för sjuksköterskor i Fyrbodal
- 2012
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Sammanfattning Betydelsen av FoU-kompetensförsörjningsprogrammet som varit en medveten och strategisk satsning inom FoU-området kan sammanfattas på följande sätt: Deltagarnas behållning och föreskriven akademisk utveckling har haft en närmast hundraprocentig måluppfyllelse och gett kliniskt verksamma sjuksköterskor en bra start på sin akademiska karriär. Programmet illustrerar ett effektivt sätt att stimulera sjuksköterskors livslånga lärande genom att bygga upp förmågan att genomföra och tillämpa omvårdnadsforskning i klinisk praktik. Programmet har också bidragit till utvecklingen av kompetenta handledare för studenter under utbildning. Flertalet av deltagarna har utvecklat både en önskan om och kompetens för att ta på sig ledande uppdrag såväl inom den egna verksamheten som i gränsöverskridande projekt både inom Fyrbodal och nationellt. Programmet har medverkat till att bryta revirtänkande och kan bidra till en mer öppen och gränsöverskridande kultur inom Fyrbodalområdets hälso- och sjukvård. Det har även medverkat till att deltagarna skaffat sig en helhetssyn på och förståelse för olika vårdverksamheter. Programmets design kan användas för att utveckla såväl professionell som vetenskaplig kompetens och kan med fördel användas inom andra yrkesgrupper med medellång vårdutbildning, eller för en tvärprofessionell grupp.
|
|
| 10. |
- Bäck-Pettersson, Siv, 1946, et al.
(författare)
-
Nurses´Experiences of participation in a research and development programme
- 2013
-
Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 22:7-8, s. 1103-1111
-
Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives. To describe clinical nurses’ experience of participating in a Research and Development (R&D) programme and its influence on their research interest and ability to conduct and apply nursing research. Background. To stimulate nurses’ research interest and to overcome barriers for building research capacity in nursing, there is a need for sustainable research programmes. A two-year programme was designed for nurses, to take part in both an academic education for master and research seminars and workshops to conduct a research project from idea to publication. Design. A qualitative approach using using focus group interviews. Methods. Registered nurses (n = 12) with a bachelor’s degree in nursing, participated. Data were collected in focus group interviews, after one year and when the programme ended. Content analysis was used to analyse the data. Results. The findings consist of two themes: being a traveller in the world of nursing research, which included three categories, and experiencing professional growth as a result of nursing research training, in both cases focusing on the experience of students involved in a cohesive programme which included four categories: discovering new dimensions of clinical nursing practice; selected and confirmed; supported by professional others; development of professional self-concept. Conclusions. To support early career researchers, there is a need for strong leadership, an organisational and supportive infrastructure underpinning research capability building in nurses. In this context, research strategies, programmes and collaboration between leaders of academia and clinical institutions appear to be essential. Relevance to clinical practice. The R&D programme illustrates an effective way of stimulating nurses’ lifelong learning by building the capacity to conduct and apply nursing research in clinical practice. The structure of the programme can be used as a model in other contexts.
|
|
