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- Abbott, Allan, et al.
(författare)
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Leg pain and psychological variables predict outcome 2-3 years after lumber fusion surgery
- 2011
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Ingår i: European spine journal. - : Springer. - 0940-6719 .- 1432-0932. ; 20:10, s. 1626-1634
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Tidskriftsartikel (refereegranskat)abstract
- Prediction studies testing a thorough range of psychological variables in addition to demographic, work-related and clinical variables are lacking in lumbar fusion surgery research. This prospective cohort study aimed at examining predictions of functional disability, back pain and health-related quality of life (HRQOL) 2-3 years after lumbar fusion by regressing nonlinear relations in a multivariate predictive model of pre-surgical variables. Before and 2-3 years after lumbar fusion surgery, patients completed measures investigating demographics, work-related variables, clinical variables, functional self-efficacy, outcome expectancy, fear of movement/(re)injury, mental health and pain coping. Categorical regression with optimal scaling transformation, elastic net regularization and bootstrapping were used to investigate predictor variables and address predictive model validity. The most parsimonious and stable subset of pre-surgical predictor variables explained 41.6, 36.0 and 25.6% of the variance in functional disability, back pain intensity and HRQOL 2-3 years after lumbar fusion. Pre-surgical control over pain significantly predicted functional disability and HRQOL. Pre-surgical catastrophizing and leg pain intensity significantly predicted functional disability and back pain while the pre-surgical straight leg raise significantly predicted back pain. Post-operative psychomotor therapy also significantly predicted functional disability while pre-surgical outcome expectations significantly predicted HRQOL. For the median dichotomised classification of functional disability, back pain intensity and HRQOL levels 2-3 years post-surgery, the discriminative ability of the prediction models was of good quality. The results demonstrate the importance of pre-surgical psychological factors, leg pain intensity, straight leg raise and post-operative psychomotor therapy in the predictions of functional disability, back pain and HRQOL-related outcomes.
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- Abbott, Allan, et al.
(författare)
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Patient’s experience post-lumbar fusion regarding back problems, recovery and expectations in terms of the international classification of functioning, disability and health.
- 2011
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Ingår i: Disability and Rehabilitation. - : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 33:15-16, s. 1399-1408
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE:To describe within the context of the International Classification of Functioning, Disability and Health (ICF), patient's experiences post-lumber fusion regarding back problems, recovery and expectations of rehabilitation and to contrast with the content of outcome measures and the ICF low back pain (LBP) core sets.METHODS:The study has a cross-sectional and retrospective design and involves 20 lumbar fusion patients. Using the ICF, qualitative content analysis of semi-structured interviews 3-6 months post-surgery was performed. This was compared with the ICF related content of the Oswestry Disability Index (ODI), Medical Outcome Study Short Form 36 (SF-36), European Quality of Life Questionnaire (EQ5D) and the ICF LBP core sets.RESULTS:Patient's experiences were most frequently linked to psychological, sensory, neuromusculoskeletal and movement related body function chapters of the ICF. The most frequently linked categories of activity and participation were mobility, domestic activities, family relationships, work, recreation and leisure. Environmental factors frequently linked were the use of analgesics, walking aids, family support, social security systems, health care systems and labour market employment services.CONCLUSIONS:This study highlights important ICF related aspects of patient's experiences post-lumber fusion. The use of the comprehensive ICF core sets is recommended in conjunction with ODI, SF-36 and the EQ5D for a broader analysis of patient outcomes post-lumbar fusion.
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- Abbott, Allan, 1978-
(författare)
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Physiotherapeutic rehabilitation and lumbar fusion surgery
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Over the last two decades, the economic costs and rates of lumbar fusion surgery for chronic low back pain has risen dramatically in western industrialized countries. Data from the Swedish National Spine Register suggest that 25% of patients experience unimproved pain and up to 40% are not satisfied with the outcome of lumbar fusion surgery. Thus, there is a definite need to optimize the selection and management of patients to improve lumbar fusion outcomes. Aim: To investigate the role of biopsychosocial factors in explaining disability and health related quality of life in chronic low back pain patients before and after lumbar fusion surgery and to evaluate the effectiveness of post-operative rehabilitation regimes. Methods: At total of 107 patients were recruited, aged 18 to 65 years, selected for lumbar fusion due to 12 months of symptomatic back and/or leg pain due to spinal stenosis, degenerative/isthmic spondylolisthesis or degenerative disc disease. Measures of disability, health related quality of life, pain, mental health, fear of movement/(re)injury, self-efficacy, outcome expectancy, pain coping styles, work status, health care use, analgesic use and sickness leave were collected with self-rated questionnaires at baseline (Studies I-IV), 3, 6, 12 months (Study II) and 2-3 years after surgery (Studies II-III). In Studies II-IV, patients were randomised to psychomotor therapy (N=53) or exercise therapy (N=54) implemented during the first 3 post-operative months. Semi-structured interviews were conducted 3-6 months after surgery on 20 patients including 10 from each rehabilitation group to investigate experiences of back problems before and after surgery, post-operative recovery and expectations of rehabilitation analysed in terms of the International Classification of Functioning, Disability and Health (Study IV). Results: Approximately 50% of the variability in baseline disability and 40% of the variability in baseline health related quality of life could be explained by psychological variables. In particular, catastrophizing, control over pain, self-efficacy and outcome expectancy had significant mediation roles (Study I). For the short and long term outcome of lumbar fusion surgery, post-operative psychomotor therapy is significantly more effective than exercise therapy with approximately 10-20% better outcome in measures of disability, fear of movement/(re)injury, pain catastrophizing, self-efficacy, outcome expectancy sickness leave, health care utilization and return to work (Study II). A model with good outcome predictive performance which significantly predicts disability, back pain and health related quality of life outcomes 2-3 year after lumbar fusion surgery, was shown to involve pre-operative screening of disability, leg pain intensity, mental health, fear of movement/(re)injury, outcome expectations, catastrophizing, control over pain and the implementation of post-operative psychomotor therapy (Study III). Lumbar fusion patient s experiences of back problems before and after the operation as well as experiences of recovery and outcome expectations correspond well with the content of outcomes measures used in the study suggesting good content validity (Study IV). Conclusion: Psychological factors strongly influence levels of disability and health related quality of life in lumbar fusion candidates as well as predicts post-operative outcomes. Early post-operative rehabilitation focusing on cognition, behaviour and motor control is recommended for improved lumbar fusion outcomes.
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- Abbott, Allan, et al.
(författare)
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The influence of psychological factors on pre-operative levels of pain intensity, disability and HRQOL in lumbar spinal fusion surgery patients
- 2010
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Ingår i: Physiotherapy. - : Elsevier. - 0031-9406 .- 1873-1465. ; 96:3, s. 213-221
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES:To assess the extent to which perceived pain and psychological factors explain levels of disability and health-related quality of life (HRQOL) in patients scheduled for lumbar fusion surgery, and to test the hypothesis that relationships between pain intensity, mental health, fear of movement/(re)injury, disability and HRQOL are mediated by cognitive beliefs and appraisals.DESIGN:Cross-sectional, correlation study.SETTING:Orthopaedic outpatient setting in a tertiary hospital.PARTICIPANTS:One hundred and seven chronic back pain patients scheduled for lumbar fusion surgery.MEASURES:Visual analogue scale for pain intensity, Short Form 36 mental health subscale, Tampa Scale for Kinesiophobia, Back Beliefs Questionnaire, Self-efficacy Scale, Coping Strategy Questionnaire, Oswestry Disability Index and European Quality of Life Questionnaire.RESULTS:The group effect of multiple mediators significantly influenced the relationships between pain intensity and mental health, fear of movement/(re)injury, functional disability and HRQOL. Pain catastrophising significantly mediated the relationship between pain intensity and mental health, control over pain significantly mediated the relationship between mental health and functional disability, self-efficacy and pain outcome expectancy significantly mediated the relationship between mental health and HRQOL, and self-efficacy also significantly mediated the relationship between pain intensity, fear of movement/(re)jury and functional disability. The model explained 28, 30, 52 and 42% of the variation in mental health, fear of movement/(re)injury, functional disability and HRQOL, respectively.CONCLUSIONS:This study highlights the strong influence and mediation roles of psychological factors on pain, mental health, fear of movement/(re)injury, disability and HRQOL in patients scheduled for lumber fusion. Future research should focus on screening as well as pre- and post-operative interventions based on these psychological factors for the potential improvement of lumber fusion surgery outcomes.Copyright 2010 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
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- Europe, Eeva, et al.
(författare)
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Om upplevelse av sjukdom och livssituation hos kvinnor med kronisk hjärtsvikt
- 2001
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Ingår i: Nordisk fysioterapi. - 1402-3024. ; 5:2, s. 50-7
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this study was to describe how women with chronic heart failure (CHF) experience becoming ill, being ill and how they adjust to their new life situation. Qualitative interviews were carried out with 16 women with CHF (aged 4172 years). Interviews were analysed using qualitative content analysis as a method. The content was sorted in three categories: To become ill, To be ill and To be a carrier of a chronic heart disease. To become ill was described by bodily discomfort, emotional experiences and contact with health care. To be ill was described through having troubles, to be in need of help and support, adaptation to the illness and to be scared. To be a carrier of a chronic heart disease was described by attitudes towards physical activity, attitudes towards cigarette smoking and a lifelong medication. These women describe their illness experience in various ways. Their descriptions confirm the earlier knowledge of consequences of CHF and also reveal new knowledge. This may increase our understanding of how it is to live with a chronic heart failure and this understanding can be used in planning the rehabilitation
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- Heiwe, Susanne, et al.
(författare)
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Evidence-based practice : attitudes, knowledge and behaviour among allied health care professionals
- 2011
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press. - 1353-4505 .- 1464-3677. ; 23:2, s. 198-209
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore dieticians', occupational therapists' and physical therapists' attitudes, beliefs, knowledge and behaviour concerning evidence-based practice within a university hospital setting. Design: Cross-sectional survey. Setting. University hospital. Participants: All dieticians, occupational therapists and physical therapists employed at a Swedish university hospital (n = 306) of whom 227 (74%) responded. Main Outcome Measures: Attitudes towards, perceived benefits and limitations of evidence-based practice, use and understanding of clinical practice guidelines, availability of resources to access information and skills in using these resources. Results: Findings showed positive attitudes towards evidence-based practice and the use of evidence to support clinical decision-making. It was seen as necessary. Literature and research findings were perceived as useful in clinical practice. The majority indicated having the necessary skills to be able to interpret and understand the evidence, and that clinical practice guidelines were available and used. Evidence-based practice was not perceived as taking into account the patient preferences. Lack of time was perceived as the major barrier to evidence-based practice. Conclusions: The prerequisites for evidence-based practice were assessed as good, but ways to make evidence-based practice time efficient, easy to access and relevant to clinical practice need to be continuously supported at the management level, so that research evidence becomes linked to work-flow in a way that does not adversely affect productivity and the flow of patients. © The Author 2011. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.
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- Tyni-Lenné, Raija
(författare)
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Efficiency of aerobic exercise training in women and men with chronic heart failure
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The syndrome of heart failure is one of the major public health problems in many countries. Despite advances in pharmacological therapy, patients with chronic heart failure (CHF) are characterized by exercise intolerance and a reduced health-related quality of life. Beneficial effects of physical training have been reported in men with CHF, mainly due to peripheral adaptations. Data on women is lacking, as well as studies comparing efficiency of different training modes. The aims of this thesis were to compare the phenotype of women with moderate CHF with that of men; to compare the efficiency of aerobic exercise training between the genders; and to investigate whether the quantity of muscle mass activated simultaneously affects training out comes in order to acquire the knowledge needed for planning efficient exercise-based rehabilitation for women and men with CHF. A total of 16 women and 27 men (age 41-73 years) with CHF in NYHA functional classes II-III (LVEF < 40%) participated in the trials and performed different modes of aerobic training: conventional cycle ergometer training; training of a restricted muscle mass in both knee extensors; and training of one knee-extensor muscle group at a time. Skeletal muscle biopsies and isokinetic muscle strength tests were performed. Peak work rate, peak oxygen uptake, and blood lactate and norepinephrine responses to exercise were measured. The 6-minute walking test was done and the health-related quality of life was assessed by means of several questionnaires. Contrary to men with CHF, the proportion of type I (slow-twitch) muscle fibers was normal in women, but also women, like men showed atrophy of muscle fibers. Muscle oxidative capacity was similar in both genders, while strength was lower in women. Women with CHF showed skeletal muscle trainability, as previously reported in male patients. Aerobic power was lower in women than in men, just as in a healthy population. The walking performance did not differ between the genders, nor did metabolic and hormonal responses to exercise. Both women and men reported a reduced health-related quality of life and men reported a lower psychosocial quality of life than women. Aerobic exercise training with two-leg knee extensions increased muscular oxidative capacity, peak exercise performance and strength, and decreased metabolic and hormonal responses, and improved the health-related quality of life similarly in women and men. However, in the group studied, aerobic power increased only in the women. When training with one-leg knee-extensions and on the cycle ergometer were compared, aerobic exercise training involving a minor muscle mass showed signs of being more efficient with regard to aerobic power, the plasma norepinephrine concentration during submaximal exercise and the health-related quality of life. Neither one of the exercise modes produced adverse effects. Since aerobic training with an intensive activation of a minor muscle mass appears to be more efficient than training involving one large muscle mass at a time, comprehensive aerobic training involving one minor muscle mass at a time is suggested as a mode in the exercise based rehabilitation of patients with CHF. Exercise training should be complemented with a physically active daily life.
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