| 1. |
- Abbott, Allan, 1978-, et al.
(author)
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Understanding the role of diabetes in the osteoarthritis disease and treatment process: a study protocol for the Swedish Osteoarthritis and Diabetes (SOAD) cohort
- 2019
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In: Bmj Open. - : BMJ. - 2044-6055. ; 9:12
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Journal article (peer-reviewed)abstract
- Introduction Osteoarthritis (OA) is the most common form of arthritis and a leading cause of disability worldwide. Metabolic comorbidities such as type II diabetes occur with a higher rate in people with OA than in the general population. Several factors including obesity, hyperglycaemia toxicity and physical inactivity have been suggested as potential links between diabetes and OA, and have been shown to negatively impact patients' health and quality of life. However, little is known on the role of diabetes in determining the outcome of non-surgical and surgical management of OA, and at the same time, how different OA interventions may affect diabetes control. Thus, the overall aim of this project is to explore (1) the impact of diabetes on the outcome of non-surgical and surgical OA treatments and (2) the impact of non-surgical and surgical OA treatments on diabetes control. Methods and analysis The study cohort is based on prospectively ascertained register data on a national level in Sweden. Data from OA patients who received a first-line non-surgical intervention and are registered in the National Quality Register for Better Management of Patients with Osteoarthritis will be merged with data from the Swedish Knee and Hip Arthroplasty Registers and the National Diabetes Register. Additional variables regarding patients' use of prescribed drugs, comorbidities, socioeconomic status and cause of death will be obtained through other national health and population data registers. The linkage will be performed on an individual level using unique personal identity numbers. Ethics and dissemination This study received ethical approval (2019-02570) from the Swedish Ethical Review Authority. Results from this cohort will be submitted to peer-reviewed scientific journals and reported at the leading national and international meetings in the field.
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| 2. |
- Eyles, J.P., et al.
(author)
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Clinical Outcomes Of Osteoarthritis Management Programs: A Project Of The Oa Trial Bank And Oarsi Joint Effort Initiative Using Individual Participant Data
- 2023
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In: Osteoarthritis and Cartilage. - : Elsevier. - 1063-4584 .- 1522-9653. ; 31, s. S385-S386
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Journal article (peer-reviewed)abstract
- Purpose: People living with osteoarthritis (OA) often do not receive best evidence care. Coordinated OA management programs (OAMPs) have been implemented to address this global evidence-practice gap. An OAMP is defined as a package of care with the following: i) a personalized management plan; ii) with reassessment and progression; iii) using a minimum of 2 core treatments (education, exercise, weight control), and; iv) optional adjunctive therapies. Existing OAMP models differ in treatment mode, intensity, duration, the health professionals delivering care, and the healthcare systems and settings they operate within. Randomized trials (RCTs) and cohort studies assess the outcomes of different OAMPs, however, these models are unlikely to ever be compared in RCTs due to the huge expense and complicated logistics required. Prognosis research provides another method of comparing outcomes of different OAMP models. This study aimed to estimate the pain and self-reported function outcomes (at 12-, 26- and 52-weeks) of people with hip and/or knee OA who participated in international OAMPs. It also aimed to describe the characteristics of OAMP participants.Methods: This study was undertaken by members of the OARSI Joint Effort Initiative (JEI), in collaboration with the OA Trial Bank (Erasmus MC, Netherlands). RCTs and clinical cohorts assessing OAMPs were identified through the JEI membership and literature searches. Eligible studies included data from an ongoing OAMP, in any real-world setting, with participants who were diagnosed with hip or knee OA, and longitudinal measures of patient-reported pain and function. The investigators of eligible studies were invited to complete data delivery agreements with the OA Trial Bank, share individual participant data (IPD), contribute to study design and authorship. Investigators ensured they had local ethics review board approval to contribute IPD to the OA Trial bank. Each dataset was converted to a common format to enable merging into one dataset. The IPD were evaluated to convert pain and function variables to standardized scales as appropriate. Pain scores were converted to a 0-100 point scale (100 worst). Function scores were converted to a 0-100 point scale (100 best). A generalized estimating equations (GEE) model analysis was performed to assess the change in pain and function from baseline across weeks 12, 26, and 52. The model specification was based on an unstructured correlation structure and robust standard errors. Pain and function estimates were adjusted by age, sex and body mass index (BMI). Data analyses were carried out using Stata 15 (StataCorp 2015) and SPSS 17.Results: The investigators of 13 international OAMPs were invited to take part. IPD from 9 OAMPs were delivered: the OA Chronic Care Program, Ramsay Health OA Management Program, Joint Health Program, University of Wisconsin Health Knee and Hip Comprehensive Non-Surgical OA Management Clinic, Improved Management of Patients With Hip and Knee OA in Primary Health Care, Joint Academy, Amsterdam OA cohort, Management of OA In Consultations, and Collaborative model of care between Orthopaedics and allied healthcare professionals in knee OA. The characteristics of the OAMPs are summarised in table 1. The OAMPs were conducted in-person except for the Joint Academy that was implemented as an online OAMP. Individual participant data from 9819 participants were analyzed. The cohort studies were missing large amounts of data, as expected in clinical practice. The characteristics of OAMP participants are summarised in Table 2. The majority of OAMP participants reported the knee as their index joint, their mean age ranged between 62- 67 years, 58-74% were female, 25-48% were working and mean BMI indicated they were overweight at baseline. Pain was most commonly assessed using a Numeric Rating Scale or validated questionnaires e.g. the Knee Injury and OA Outcome Scale (KOOS). Function was mostly assessed using validated questionnaires such as the KOOS. The pain and fuction measured in the original datasets are reported in Table 1. The changes in pain and function of the OAMP participants from baseline across weeks 12, 26, and 52 are summarised in Table 3. There were reductions in pain scores and improvements in function scores seen across all programs at the majority of timepoints.Conclusions: We established the first data bank of IPD from different international OAMPs. Analysis of the IPD demonstrated modest improvements in pain and function across the programs at all timepoints. The most rapid improvements were made by week-12, however, these gains were maintained at week-52. In future work this project will use IPD meta-analysis to identify prognostic factors of people with OA who participate in OAMPs.
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| 3. |
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| 4. |
- Abbott, Allan, 1978-, et al.
(author)
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Effectiveness of implementing a best practice primary healthcare model for low back pain (BetterBack) compared with current routine care in the Swedish context : an internal pilot study informed protocol for an effectiveness-implementation hybrid type 2 trial
- 2018
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 8:4
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Journal article (peer-reviewed)abstract
- Introduction Low back pain (LBP) is a major health problem commonly requiring healthcare. In Sweden, there is a call from healthcare practitioners (HCPs) for the development, implementation and evaluation of a best practice primary healthcare model for LBP.Aims (1) To improve and understand the mechanisms underlying changes in HCP confidence, attitudes and beliefs for providing best practice coherent primary healthcare for patients with LBP; (2) to improve and understand the mechanisms underlying illness beliefs, self-care enablement, pain, disability and quality of life in patients with LBP; and (3) to evaluate a multifaceted and sustained implementation strategy and the cost-effectiveness of the BetterBack☺ model of care (MOC) for LBP from the perspective of the Swedish primary healthcare context.Methods This study is an effectiveness-implementation hybrid type 2 trial testing the hypothesised superiority of the BetterBack☺ MOC compared with current routine care. The trial involves simultaneous testing of MOC effects at the HCP, patient and implementation process levels. This involves a prospective cohort study investigating implementation at the HCP level and a patient-blinded, pragmatic, cluster, randomised controlled trial with longitudinal follow-up at 3, 6 and 12 months post baseline for effectiveness at the patient level. A parallel process and economic analysis from a healthcare sector perspective will also be performed. Patients will be allocated to routine care (control group) or the BetterBack☺ MOC (intervention group) according to a stepped cluster dogleg structure with two assessments in routine care. Experimental conditions will be compared and causal mediation analysis investigated. Qualitative HCP and patient experiences of the BetterBack☺ MOC will also be investigated.Dissemination The findings will be published in peer-reviewed journals and presented at national and international conferences. Further national dissemination and implementation in Sweden and associated national quality register data collection are potential future developments of the project.
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| 5. |
- Abbott, Allan, 1978-
(author)
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Physiotherapeutic rehabilitation and lumbar fusion surgery
- 2010
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Doctoral thesis (other academic/artistic)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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| 6. |
- Abbott, Allan, 1978-, et al.
(author)
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What biopsychosocial factors are associated with work ability in conservatively managed patients with cervical radiculopathy? : A cross-sectional analysis
- 2020
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In: PM&R. - : John Wiley & Sons. - 1934-1482 .- 1934-1563. ; 12:1, s. 64-72
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Journal article (peer-reviewed)abstract
- BackgroundNo previous studies have investigated what biopsychosocial factors are associated with self‐reported work ability in conservatively managed patients with cervical radiculopathy.ObjectiveTo develop a theoretical model of factors and potential processes associated with variation in work ability based on a thorough assessment of biopsychosocial variables in conservatively managed patients with cervical radiculopathy.DesignCross‐sectional observational study.SettingTertiary neurosurgery clinic.PatientsA total of 144 conservatively managed patients with cervical pain and radiculopathy participated in the study.MethodsFrom 64 biopsychosocial candidate variables, significant (P < .05) bivariate correlators with Work Ability Index (WAI) were entered as independent variables in a categorical regression. Elastic net regularization maintained the most parsimonious set of independent variables significantly associated with variation in WAI as the dependent variable. Process analysis of significant independent variable associations with WAI was performed.Main Outcome MeasurementWAI.ResultsFrom 42 bivariate correlates of WAI, multivariate regression displayed a total of seven variables that were significantly (F [25,98] = 5.74, P < .05) associated with 65.8% of the variation in WAI. The Neck Disability Index (NDI) and Fear‐Avoidance Beliefs Questionnaire Work subscale (FABQ‐W) were significant individual factors within the final regression model. Process analysis displayed FABQ‐W having a significant specific indirect association with the direct association between NDI and WAI, with the model associated with 77% of the variability in WAI (F [2,84] = 141.17, P < .001).ConclusionOf 64 candidate biopsychosocial factors, NDI and FABQ‐W were the most significant multivariate correlates with work ability. FABQ‐W has a significant indirect association with baseline NDI scores and perceived work ability. This warrants future research trialing work‐related fear avoidance interventions in conservatively managed patients with cervical radiculopathy.Level of EvidenceIII
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| 7. |
- Charalampidis, Anastasios, et al.
(author)
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Nighttime Bracing or Exercise in Moderate-Grade Adolescent Idiopathic Scoliosis
- 2024
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In: JAMA Network Open. - : AMER MEDICAL ASSOC. - 2574-3805. ; 7:1
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Journal article (peer-reviewed)abstract
- IMPORTANCE Moderate-grade adolescent idiopathic scoliosis (AIS) may be treated with full-timebracing. For patients who reject full-time bracing, the effects of alternative, conservativeinterventions are unknown.OBJECTIVE To determine whether self-mediated physical activity combined with either nighttimebracing (NB) or scoliosis-specific exercise (SSE) is superior to a control of physical activity alone (PA)in preventing Cobb angle progression in moderate-grade AIS.DESIGN, SETTING, AND PARTICIPANTS The Conservative Treatment for Adolescent IdiopathicScoliosis (CONTRAIS) randomized clinical trial was conducted from January 10, 2013, throughOctober 23, 2018, in 6 public hospitals across Sweden. Male and female children and adolescentsaged 9 to 17 years with an AIS primary curve Cobb angle of 25° to 40°, apex T7 or caudal, and skeletalimmaturity based on estimated remaining growth of at least 1 year were included in the study. Datesof analysis were from October 25, 2021, to January 28, 2023.INTERVENTIONS Interventions included self-mediated physical activity in combination with eitherNB or SSE or PA (control). Patients with treatment failure were given the option to transition to afull-time brace until skeletal maturity.MAIN OUTCOMES AND MEASURES The primary outcome was curve progression of 6° or less(treatment success) or curve progression of more than 6° (treatment failure) seen on 2 consecutiveposteroanterior standing radiographs compared with the inclusion radiograph before skeletalmaturity. A secondary outcome of curve progression was the number of patients undergoing surgeryup until 2 years after the primary outcome.RESULTS The CONTRAIS study included 135 patients (45 in each of the 3 groups) with a mean (SD)age of 12.7 (1.4) years; 111 (82%) were female. Treatment success was seen in 34 of 45 patients (76%)in the NB group and in 24 of 45 patients (53%) in the PA group (odds ratio [OR], 2.7; 95% CI, 1.1-6.6).The number needed to treat to prevent curve progression with NB was 4.5 (95% CI, 2.4-33.5).Treatment success occurred in 26 of 45 patients (58%) in the SSE group (OR for SE vs PA, 1.2; 95% CI,0.5-2.8). Up to 2 years after the primary outcome time point, 9 patients in each of the 3 groupsunderwent surgery.CONCLUSIONS AND RELEVANCE In this randomized clinical trial, treatment with NB preventedcurve progression of more than 6° to a significantly higher extent than did PA, while SSE did not; inaddition, allowing transition to full-time bracing after treatment failure resulted in similar surgicalfrequencies independent of initial treatment. These results suggest that NB may be an effectivealternative intervention in patients rejecting full-time bracing.
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| 8. |
- Diarbakerli, Elias, et al.
(author)
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Bone health in adolescents with idiopathic scoliosis : a comparison with age- and sex-matched controls
- 2020
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In: The Bone & Joint Journal. - London, United Kingdom : British Editorial Society of Bone and Joint Surgery. - 2049-4394 .- 2049-4408. ; 102-B:2, s. 268-272
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Journal article (peer-reviewed)abstract
- AimsIdiopathic scoliosis is the most common spinal deformity in adolescents and children. The aetiology of the disease remains unknown. Previous studies have shown a lower bone mineral density in individuals with idiopathic scoliosis, which may contribute to the causation. The aim of the present study was to compare bone health in adolescents with idiopathic scoliosis with controls.MethodsWe included 78 adolescents with idiopathic scoliosis (57 female patients) at a mean age of 13.7 years (8.5 to 19.6) and 52 age- and sex-matched healthy controls (39 female patients) at a mean age of 13.8 years (9.1 to 17.6). Mean skeletal age, estimated according to the Tanner-Whitehouse 3 system (TW3), was 13.4 years (7.4 to 17.8) for those with idiopathic scoliosis, and 13.1 years (7.4 to 16.5) for the controls. Mean Cobb angle for those with idiopathic scoliosis was 29° (SD 11°). All individuals were scanned with dual energy x-ray absorptiometry (DXA) and peripheral quantitative CT (pQCT) of the left radius and tibia to assess bone density. Statistical analyses were performed with independent-samples t-test, the Mann-Whitney U test, and the chi-squared test.ResultsCompared with controls, adolescents with idiopathic scoliosis had mean lower DXA values in the left femoral neck (0.94 g/cm2 (SD 0.14) vs 1.00 g/cm2 (SD 0.15)), left total hip (0.94 g/cm2 (SD 0.14) vs 1.01 g/cm2 (SD 0.17)), L1 to L4 (0.99 g/cm2 (SD 0.15) vs 1.06 g/cm2 (SD 0.17)) and distal radius (0.35 g/cm2 (SD 0.07) vs 0.39 g/cm2 (SD 0.08; all p ≤ 0.024), but not in the mid-radius (0.72 g/cm2 vs 0.74 g/cm2; p = 0.198, independent t-test) and total body less head (1,559 g (SD 380) vs 1,649 g (SD 492; p = 0.0.247, independent t-test). Compared with controls, adolescents with idiopathic scoliosis had lower trabecular volume bone mineral density (BMD) on pQCT in the distal radius (184.7 mg/cm3 (SD 40.0) vs 201.7 mg/cm3 (SD 46.8); p = 0.029), but not in other parts of the radius or the tibia (p ≥ 0.062, Mann-Whitney U test).ConclusionIn the present study, idiopathic scoliosis patients seemed to have lower BMD at central skeletal sites and less evident differences at peripheral skeletal sites when compared with controls.
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| 9. |
- Diarbakerli, Elias, et al.
(author)
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PReventing Idiopathic SCOliosis PROgression (PRISCOPRO) : A protocol for a quadruple-blinded, randomized controlled trial comparing 3D designed Boston brace to standard Boston brace
- 2021
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In: PLOS ONE. - San Francisco, CA, United States : Public Library of Science. - 1932-6203. ; 16:8
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Journal article (peer-reviewed)abstract
- IntroductionIdiopathic scoliosis is the most common spinal deformity in children. Treatment strategies aim to halt progression of the curve. Patients are treated mainly with thoracolumbosacral orthosis (TLSO) if indicated. This form of brace treatment has been shown to be cumbersome and tough on growing individuals. However, computer aided design and manufactured (CAD/CAM) braces might increase comfortability and ultimately outcome if compliance is improved. In a multicenter, randomized controlled trial, we aim to compare CAD/CAM designed Boston 3D-brace to standard Boston brace.MethodsSubjects: 170 previously untreated and skeletally immature children diagnosed with idiopathic scoliosis, aged 9–17 years of age (curve magnitude Cobb 25–40 degrees) will be included. Interventions: Both groups will receive a physical activity prescription according to the World Health Organization recommendations. Randomization will be performed 1:1 to a 3D CAD/CAM designed Boston 3D-brace or a standard Boston brace, both with prescribed daily wear time of 20 hours. Outcome: The subjects will participate in the study until curve progression or until skeletal maturity. The primary outcome variable is failure of treatment, defined as progression of the Cobb angle more than 6 degrees compared to the baseline x-ray. The progression is confirmed if seen on two consecutive standing spinal x-rays. Radiographs will be taken at each six-month follow-up. Secondary outcome measures include patient and clinical reported outcomes, including number of individuals requiring surgical intervention.DiscussionThis study will show if efficacy in brace treatment can be improved with new brace designs.
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| 10. |
- Diarbakerli, Elias, et al.
(author)
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Quality of life in males and females with idiopathic scoliosis
- 2019
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In: Spine. - : Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 44:6, s. 404-410
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Journal article (peer-reviewed)abstract
- Study Design. Cross-sectional.Objective. To describe quality of life in males and females with idiopathic scoliosis.Summary of Background Data. Idiopathic scoliosis is a three-dimensional deformity affecting the growing spine. The prevalence of larger curves, requiring treatment, is higher in females.Methods. This cross-sectional study comprised 1519 individuals with idiopathic scoliosis (211 males) with a mean (SD) age of 35.3 (14.9) years. They all answered the Scoliosis Research Society 22 revised (SRS-22r) questionnaire and EuroQol 5-dimension-index (EQ-5D). Five hundred twenty eight were surgically treated (78 males), 535 were brace treated (50 males), and 456 were untreated (83 males). The SRS-22r subscore (excluding the satisfaction domain), the SRS-22r domains and the EQ-5D index score were calculated. Subgroup analyses based on treatment and age were performed. Statistical comparisons were performed using analysis of covariance with adjustments for age and treatment. A P-value less than 0.05 was considered as statistical significant.Results. The mean (SD) SRS-22r subscore was 4.19 (0.61) in males and 4.05 (0.61) in females (P = 0.010). The males had higher scores on the SRS-22r domains function (4.56 vs. 4.42), pain (4.20 vs. 4.00), and mental health (4.14 vs. 3.92) (all P < 0.05). The mean (SD) EQ-5D index score was 0.85 (0.22) for males and 0.81 (0.21) for females (P = 0.10). There were minor differences when comparing males and females in treatment and age groups, but both treated and untreated groups had reduced quality of life compared with the national norms.Conclusion. When compared with females, males with idiopathic scoliosis tend to have slightly higher scores in the scoliosis specific SRS-22r but not in the generic quality of life measurement EQ-5D. Quality of life is overall similar between males and females in treatment and age groups, but reduced in comparison with the general population.Level of Evidence: 3
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| 11. |
- Diarbakerli, Elias, et al.
(author)
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Swedish musculoskeletal researchers view on a collaborative network and future research priorities in Swedish healthcare
- 2024
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In: Musculoskeletal Care. - : John Wiley & Sons. - 1478-2189 .- 1557-0681. ; 22:1
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Journal article (peer-reviewed)abstract
- Background: Musculoskeletal disorders (MSK) are a global burden causing significant suffering and economic impact. Systematic identification and targeting of research questions of highest interest for stakeholders can aid in improving MSK disorder knowledge and management.Objective: To obtain Swedish MSK researchers' opinions and views on a collaborative Swedish MSK network (SweMSK) and identify future research areas of importance for Swedish MSK research.Methods: A web-based survey was conducted July to September 2021 to collect data from 354 Swedish MSK researchers. The survey focused on the need, objectives, and structure of a SweMSK network and identified prioritised areas for future MSK research.Results: The study included 141 respondents, of which 82 were associate professors or professors. The majority (68%) supported the creation of a new musculoskeletal network. The most supported element was increased collaboration regarding nationwide and multicenter studies. Respondents recommended the creation of a homepage and the establishment of national work groups with different specific interests as the primary elements of a new network.Conclusion: The results demonstrated a need and desire for increased national research collaboration and the creation of a new musculoskeletal network. The high academic experience and active research participation of the respondents suggest the need for MSK disorder knowledge and management improvement in Sweden. Therefore, the SweMSK network may help facilitate effective collaboration and research efforts that can contribute to the advancement of MSK disorder management and care. This study may provide valuable insights for policymakers, clinicians, and researchers to improve MSK disorder care and management in Sweden.
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| 12. |
- Dufvenberg, Marlene, 1961-
(author)
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Adolescent Idiopathic Scoliosis : Postural Stability, Prognostic factors and Impact of Conservative Treatments on Radiologic, Clinical and Self-Reported Outcomes
- 2024
-
Doctoral thesis (other academic/artistic)abstract
- Background: Adolescent idiopathic scoliosis (AIS) is a three-dimensional distortion of spinal curvature of unknown cause that develops during puberty. If the frontal plane curvature exceeds a Cobb angle of 24°, full-time bracing is recommended to prevent curve progression, negative health consequences or need for surgery. However, many patients decline full-time bracing, and limited evidence exists regarding alternative conservative treatments. Increasing knowledge of risk factors enables better identification of high-risk patients, thereby reducing the risk of over- or undertreatment. The overall aim of this thesis was to evaluate evidence of association between scoliosis and postural stability to inform a potential treatment target, to investigate the effectiveness of three alternative conservative treatments for patients who declined full-time bracing, and to develop a prognostic model for future risk of increased curvature in AIS. Methods: Data collection is based on one systematic literature review and meta-analysis, and one randomised controlled trial (RCT) for patients with AIS. In Paper I, literature was reviewed, and utilized posturography data to assess static postural stability to identify potential differences between patients with AIS and the control group (CON). In Papers II and III, patients were randomly assigned to either physical activity combined with hypercorrective Boston scoliosis night brace (NB), scoliosis-specific exercises (SSE), or a control group with physical activity alone (PA). Effects on trunk rotation, Cobb angle, self-reported physical activity, spinal appearance, and health-related quality of life were evaluated. Likewise, adherence, capability, and motivation in performing self-managed treatment were assessed. Follow-up was conducted at 6 months intervals until endpoint. The endpoint was defined as non-progression if the curvature increased by 6° or less at skeletal maturity, i.e., less than 1cm of growth over 6 months, or progression if the curvature increased by more than 6° before skeletal maturity. In Paper IV, data from the RCT were used for a longitudinal cohort analysis, developing and validating a prognostic model using Cox Proportional Hazards survival analysis. Results: Paper I found reduced postural stability in AIS patients compared to CON with increased sway area, mediolateral and anteroposterior range, and a posterior shift in the sagittal plane. The RCT included 135 individuals, mean age of 12.7 years (SD1.4) and Cobb angle of 31° (SD5.3). At 6 months, patients reported high adherence (72-95%) and motivation (65-92%) to the treatment, particularly in the NB group. Both the SSE and PA groups increased physical activity levels compared to the NB group. At endpoint, adherence remained adequate, but better in the NB and PA groups compared with the SSE group (50-89%). Adherence increased with higher capability and motivation, which explained 53% of the variance in adherence at endpoint. The SSE group had higher proportion of moderate problems in mobility and usual activities than the NB and PA groups, with no other clinically relevant between-group differences. The prognostic model (n=127) for curve progression showed acceptable discriminative ability (0.791), with risk factors including skeletal immaturity, larger major curve, and worsening spinal appearance. The model was adjusted for treatment exposure, as NB reduced the risk of curve progression. Conclusions: Patients with AIS have decreased postural stability with a posterior positional shift. Treatment evaluation at endpoint showed few between-group differences. However, the SSE group had higher proportion of moderate problems in mobility and usual activities compared to the other groups. Treatment adherence was adequate, but better in the NB and PA groups. Higher capability and motivation increased long-term adherence to the treatment. The treatment alternatives could be considered as the first option following a clinical decision on treatment. Including self-reported spinal appearance as a risk factor in the prognostic model may be clinically important for predicting which patients are at risk of curve progression.
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| 13. |
- Dufvenberg, Marlene, 1961-, et al.
(author)
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Does postural stability differ between adolescents with idiopathic scoliosis and typically developed? : A systematic literature review and meta-analysis
- 2018
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In: Scoliosis and Spinal Disorders. - : BioMed Central (BMC). - 2397-1789. ; 13:1
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Research review (peer-reviewed)abstract
- BackgroundPostural stability deficits have been proposed to influence the onset and progression of adolescent idiopathic scoliosis (AIS). This study aimed to systematically identify, critically evaluate and meta-analyse studies assessing postural stability during unperturbed stance with posturography in AIS compared to typically developed adolescents.MethodsStudies from four electronic databases (PubMed, Scopus, CINAHL, PEDro) were searched and case-control methodological quality assessed using a risk-of-bias assessment tool and a posturography methodological quality checklist. Pooled data regarding centre of pressure (COP) parameters such as sway area, Mediolateral (ML) and Anteroposterior (AP) position and range were compared for AIS and typically developed adolescents using Cohen’s d effect size (ES) and homogeneity estimates.ResultsEighteen studies for quality analysis and 9 of these for meta-analysis were identified from 971 records. Risk-of-bias assessment identified 6 high, 10 moderate and 2 low risk-of-bias studies. The posturography methodological quality checklist identified 4 low, 7 moderate and 7 high-quality studies. Meta-analysis was performed for sway area whereas ML and AP are presented in three different meta-analyses due to divergent measurement units used in the studies: ML position 1 (MLP1), ML position 2 (MLP2) and ML range (MLR); AP position 1 (APP1), AP position 2 (APP2) and AP range (APR). Cohen’s d showed a medium ES difference in sway area 0.65, 95% CI (0.49–0.63), whereas ML showed no (MLP1, MLP2) and large (MLR) ES differences; MLP1 0.15, 95% CI (0.08–0.22); MLP2 0.14, 95% CI (0.08–0.19); and MLR 0.94, 95% CI (0.83–1.04). Cohen’s d for AP showed small ES (APP1) and large ES difference (APP2 and APR); APP1 0.43, 95% CI (0.31–0.54); APP2 0.85, 95% CI (0.72–0.97); and APR 0.98, 95% CI (0.87–1.09). Cochran’s Q and Higgins I2 showed homogeneity between studies.ConclusionsThere is moderate quality evidence for decreased postural stability in AIS measured as COP parameters sway area, ML and AP range with a positional shift posteriorly in the sagittal plane. The findings support studying postural stability in early stage AIS and also prospectively identify cause and effect of the curvature as well as effectiveness of postural control interventions in the prevention of scoliosis progression.
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| 14. |
- Dufvenberg, Marlene, 1961-, et al.
(author)
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Six-Month Results on Treatment Adherence, Physical Activity, Spinal Appearance, Spinal Deformity, and Quality of Life in an Ongoing Randomised Trial on Conservative Treatment for Adolescent Idiopathic Scoliosis (CONTRAIS)
- 2021
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In: Journal of Clinical Medicine. - Basel, Switzerland : MDPI. - 2077-0383. ; 10:21
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Journal article (peer-reviewed)abstract
- Adolescents with idiopathic scoliosis (AIS) often receive conservative treatments aiming to prevent progression of the spinal deformity during puberty. This study aimed to explore patient adherence and secondary outcomes during the first 6 months in an ongoing randomised controlled trial of three treatment interventions. Interventions consisted of physical activity combined with either hypercorrective Boston scoliosis night brace (NB), scoliosis-specific exercise (SSE), or physical activity alone (PA). Measures at baseline and 6 months included angle of trunk rotation (ATR), Cobb angle, International Physical Activity Questionnaire short form (IPAQ-SF), pictorial Spinal Appearance Questionnaire (pSAQ), Scoliosis Research Society (SRS-22r), EuroQol 5-Dimensions Youth (EQ-5D-Y) and Visual Analogue Scale (EQ-VAS). Patient adherence, motivation, and capability in performing the intervention were reported at 6 months. The study included 135 patients (111 females) with AIS and >1-year estimated remaining growth, mean age 12.7 (1.4) years, and mean Cobb angle 31 (±5.3). At 6 months, the proportion of patients in the groups reporting high to very high adherence ranged between 72 and 95%, while motivation ranged between 65 and 92%, with the highest proportion seen in the NB group (p = 0.014, p= 0.002). IPAQ-SF displayed significant between group main effects regarding moderate activity (F = 5.7; p = 0.004; ηp2 = 0.10), with a medium-sized increase favouring the SSE group compared to NB. Walking showed significant between group main effects, as did metabolic equivalent (MET-min/week), with medium (F = 6.8, p = 0.002; ηp2 = 0.11, and large (F = 8.3, p = < 0.001, ηp2 = 0.14) increases, respectively, for the SSE and PA groups compared to NB. From baseline to 6 months, ATR showed significant between group medium-sized main effects (F = 1.2, p = 0.019, ηp2 = 0.007) favouring the NB group compared to PA, but not reaching a clinically relevant level. In conclusion, patients reported high adherence and motivation to treatment, especially in the NB group. Patients in the SSE and PA groups increased their physical activity levels without other clinically relevant differences between groups in other clinical measures or patient-reported outcomes. The results suggest that the prescribed treatments are viable first-step options during the first 6 months.
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| 15. |
- Folmli, Brookes, et al.
(author)
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Dose-response of somatosensory cortex repeated anodal transcranial direct current stimulation on vibrotactile detection : A randomized sham controlled trial
- 2018
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In: Journal of Neurophysiology. - Bethesda, United States : American Physiological Society. - 0022-3077 .- 1522-1598.
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Journal article (peer-reviewed)abstract
- This randomized sham-controlled trial investigated anodal transcranial direct current stimulation (tDCS) over the somatosensory cortex contralateral to hand dominance for dose-response (1mA-20 minutes x 5 days) effects on vibrotactile detection thresholds (VDT). VDT was measured before and after tDCS on days 1,3&5 for low (30hz) and high (200hz) frequency vibrations on the dominant and non-dominant hands in 29 healthy adults (mean age = 22.86; 15 males, 14 females). Only the dominant hand 200Hz VDT displayed statistically significant medium effect size improvement for mixed model analysis of variance time x group interaction for active tDCS compared to sham. Post Hoc contrasts were statistically significant for dominant hand 200Hz VDT on day 5 after tDCS compared to day 1 before tDCS , day 1 after tDCS and day 3 before tDCS. There was a linear dose-response improvement with dominant hand 200Hz VDT mean difference decreasing from day 1 before tDCS peaking at -15.5% (SD=34.9%) on day 5 after tDCS. Both groups showed learning effect trends over time for all VDT test conditions but only the non-dominant hand 30Hz VDT was statistically significant (p=0.03) though Post Hoc contrasts were non-significant after Sidak adjustment. No adverse effects for tDCS were reported. In conclusion, anodal tDCS 1mA-20 minutes x 5 days on the dominant sensory cortex can modulate a linear improvement of dominant hand high frequency VDT but not for low frequency or non-dominant hand VDT.
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| 16. |
- Fors, Maria, 1987-
(author)
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Best Practice Physiotherapy for Patients with Low Back Pain in Primary Care : Clinical Outcomes and Explanatory Factors
- 2023
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Doctoral thesis (other academic/artistic)abstract
- Background: Clinical practice guidelines provide general recommendations informing best practice physiotherapy for low back pain (LBP). Despite increased research on LBP, the recommendations have barely changed over the last few decades and the burden of LBP remains. New research strategies have been suggested to further understand the complexity of factors influencing recovery of LBP. Several mechanisms are expected to underpin the benefits of physiotherapy care. How different factors influence and explain treatment outcome in patients in different phases of primary care pathway needs to be better understood for the development of better targeted LBP interventions.The overall aim of this thesis was to investigate if and how best practice physiotherapy primary care for patients with LBP can improve clinical outcome.Methods: The four papers in the thesis are based on two randomised controlled trials (RCT) evaluating best practice physiotherapy for patients with LBP in different phases of the primary care pathway reflecting the variation of patients’ needs. Two papers investigated pre-surgery physiotherapy compared to being on a waiting-list in patients with degenerative lumbar spine disorders who are surgical candidates (n = 197). Effects on walking ability and quadriceps femoris strength were evaluated. Associations between the pre-surgery physical factors with 1-year post-surgery physical activity (PA) level were analysed using multiple linear regression. The dose-response relationship was investigated comparing the effects of attending ≤11 treatment sessions with ≥12 treatment sessions. Multiple mediation analyses and conditional process analyses were used to explore physical and psychosocial factors as mediators and patients’ treatment expectations as a moderator of the treatment’s effects on disability, back pain intensity, health-related quality of life (HRQoL), and self-rated health.Two papers were based on a stepped cluster RCT, where a physiotherapy primary healthcare model for LBP (the BetterBack MoC) was regionally implemented. Patients seeking care for LBP were allocated to either the BetterBack MoC (after implementation) or to routine care (before implementation) (n = 467). In a prospective cohort study within the RCT, the associations between patients’ initial illness perceptions and outcomes in disability, back pain intensity, HRQoL, and self-care enablement (i.e., perceived ability to understand and cope with LBP) after 3 and 12 months were explored using stepwise linear regression. Single mediation analyses were used to test whether a priori hypothesised patients’ illness perceptions and self-care enablement at 3 months mediated effects in disability and pain at 6 months of care according to the BetterBack MoC compared to routine care. Exploratory mediation analyses were also used to compare guideline-adherent care with non-adherent care. Guideline-adherent care was defined as care that included education and exercise interventions and did not include non-evidence-based interventions, referral to specialist care, or imaging.Results: Small positive effects from pre-surgery physiotherapy were seen in walking ability and quadriceps femoris strength. No clear dose-response relationship could be demonstrated when comparing the effects of ≤11 treatment sessions with ≥12. Pre-surgery physical outcome measures together explained 27.5% of the variation in PA level 1-year post-surgery, mainly explained by the pre-surgery PA level. The effect of the pre-surgery physiotherapy on patients’ PA level partly explained the treatment’s effect on self-rated health. Furthermore, among biopsychosocial factors, self-efficacy related to activities of daily living (ADL) partly explained the effect on all outcomes. PA related fear avoidance beliefs partly explained the effects on pain and self-rated health. Patients’ treatment expectations moderated the effect in all outcomes. High expectations had a positive moderating effect, while expectation of full recovery had a suppressive effect. In patients seeking physiotherapy for LBP, negative initial prognosis and treatment expectations were associated with worse scores in several outcomes at 3- and 12-month follow-ups. Patients’ illness perceptions and self-care enablement did not explain the effects of care after implementing the BetterBack MoC. This was mainly due to the BetterBack MoC not having superior effects over routine care on the hypothesised mediators. Illness perceptions and self-care enablement at 3 months were associated with disability and pain at 6 months. Further, these factors partly explained the effects of guideline-adherent care in disability and pain.Conclusions: Patients’ illness perceptions, self-care enablement, ADL self-efficacy, and PA related fear-avoidance beliefs were supported to be potential factors explaining the effect on clinical outcomes of best practice physiotherapy for LBP in primary care. Patients’ initial expectations regarding the prognosis and treatment may influence prospective outcomes including patients’ self-care enablement. More specifically, pain and disability outcomes of best practice physiotherapy for patients seeking care for LBP may improve by targeting patients’ illness perceptions and self-care enablement. Patients who are surgical candidates can increase their physical capacity and walking related performance through best practice physiotherapy. In this pre-surgery phase, the treatment should include targeting patients’ ADL self-efficacy, PA related fear-avoidance beliefs, and PA level for improved disability, pain, and HRQoL.
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| 17. |
- Fors, Maria, 1987-, et al.
(author)
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Effects of pre-surgery physiotherapy on walking ability and lower extremity strength in patients with degenerative lumbar spine disorder : Secondary outcomes of the PREPARE randomised controlled trial
- 2019
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In: BMC Musculoskeletal Disorders. - : BioMed Central. - 1471-2474. ; 20:1
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Journal article (peer-reviewed)abstract
- BackgroundDegenerative lumbar spine disorders are common among musculoskeletal disorders. When disabling pain and radiculopathy persists after adequate course of rehabilitation and imaging confirms compressive pathology, surgical decompression is indicated. Prehabilitation aiming to augment functional capacity pre-surgery may improve physical function and activity levels pre and post-surgery. This study aims to evaluate the effect and dose-response of pre-surgery physiotherapy on quadriceps femoris strength and walking ability in patients with degenerative lumbar spine disorders compared to waiting-list controls and their association with postoperative physical activity level.MethodIn this single blinded, 2-arm randomised controlled trial, 197 patients were consecutively recruited. Inclusion criteria were: MRI confirmed diagnosis and scheduled for surgery due to disc herniation, lumbar spinal stenosis, degenerative disc disease or spondylolisthesis, ages 25-80 years. Patients were randomised to 9 weeks of pre-surgery physiotherapy or to waiting-list. Patient reported physical activity level, walking ability according to Oswestry Disability Index item 4, walking distance according to the SWESPINE national register and physical outcome measures including the timed ten-meter walk test, maximum voluntary isometric quadriceps femoris muscle strength, patient-rated were collected at baseline and follow-up. Parametric or non-parametric within and between group comparisons as well as multivariate regression was performed.ResultsPatients who received pre-surgery physiotherapy significantly improved in all variables from baseline to follow-up (p < 0.001 – p < 0.05) and in comparison to waiting-list controls (p < 0.001 – p < 0.028). Patients adhering to ≥12 treatment sessions significantly improved in all variables (p < 0.001 – p < 0.032) and those receiving 0-11 treatment session in only normal walking speed (p0.035) but there were no significant differences when comparing dosages. Physical outcome measures after pre-surgery physiotherapy together significantly explain 27.5% of the variation in physical activity level 1 year after surgery with pre-surgery physical activity level having a significant multivariate association.ConclusionPre-surgery physiotherapy increased walking ability and lower extremity strength in patients with degenerative lumbar spine disorders compared to waiting-list controls. A clear treatment dose-response response relationship was not found. These results implicate that pre-surgery physiotherapy can influence functional capacity before surgical treatment and has moderate associations with maintained postoperative physical activity levels mostly explained by physical activity level pre-surgery.Trial registrationNCT02454400. Trial registration date: August 31st 2015, retrospectively registered.
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| 18. |
- Fors, Maria, 1987-, et al.
(author)
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The association between patients' illness perceptions and longitudinal clinical outcome in patients with low back pain
- 2022
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In: PAIN Reports. - Philadelphia, PA, United States : Lippincott Williams & Wilkins. - 2471-2531. ; 7:3
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Journal article (peer-reviewed)abstract
- Introduction: Illness perception is suggested to influence outcome in patients with low back pain (LBP). It is unknown if specific illness perceptions are of more importance for longitudinal outcomes, including development of self-management strategies.Objectives: This study explores whether patients' initial illness perceptions were associated with disability, pain, health-related quality of life, and self-care enablement outcomes in patients with LBP after 3 and 12 months.Methods: Four hundred sixty-seven consecutive patients seeking physiotherapeutic primary care for LBP were eligible to participate in this prospective cohort study, providing data at baseline and after 3 and 12 months (mean age 45 years, 56% women). Multiple linear regression analysis was used to explore whether patients' illness perceptions at baseline were associated with outcome in the Oswestry Disability Index (ODI), Numeric Rating Scale–LBP (NRS-LBP), EuroQol Five Dimensions, and Patient Enablement Instrument (PEI).Results: Stronger beliefs that the back problem will last a long time at baseline were associated with worse outcome in ODI, NRS-LBP, and PEI at 3 and 12 months and in EuroQol Five Dimensions at 12 months. Negative beliefs regarding treatment's ability to improve LBP were associated with worse outcome in NRS-LBP and PEI at 3 and 12 months and in ODI at 12 months.Conclusions: Illness perceptions regarding prognosis and treatment's ability to improve symptoms were the most prominent perceptions explaining several longitudinal clinical outcomes. These expectations should be addressed in an early stage in the delivery of interventions for LBP. These expectations were also important for patients' development of coping and self-management strategies.
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| 19. |
- Fors, Maria, 1987-, et al.
(author)
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What mediates treatment effects in a pre-surgery physiotherapy treatment in surgical candidates with degenerative lumbar spine disorders? : A mediation and conditional process analysis of the PREPARE randomized controlled trial
- 2021
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In: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 3, s. 168-176
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Journal article (peer-reviewed)abstract
- Objectives: Treatment guidelines recommend targeting both physical and psychological factors in interventions for degenerative lumbar spine disorders. Studying treatment mechanisms gives information on key factors explaining outcome improvement which can refine treatments for future research. This study explores treatment mediators in a physiotherapy treatment on disability, pain intensity and health related quality of life (HRQoL) in surgical candidates with degenerative lumbar spine disorders compared to waiting-list controls. An additional aim was to evaluate patients´ expectation as a moderator of treatment outcome.Methods: Data collected from 197 patients in a single blinded randomized controlled trial comparing 9 weeks of multifaceted physiotherapy to waiting-list were used in this conditional process analysis. Analysis was carried out on group differences for change in Oswestry Disability Index (ODI), Pain Visual Analog Scale (VAS) back pain, EuroQol-5D (EQ-5D) and EQ-VAS. The putative moderation role of expectations and mediation role of change in physical variables and psychosocial variables were tested.Results: Change in self-efficacy mediated improvement in all outcomes. Improvement in ODI was also mediated by change in depression, VAS was mediated by change in fear avoidance beliefs and EQ-VAS was mediated by change in activity level and fear avoidance beliefs. Improvements were moderated by patients´ treatment expectations.Discussion: Self-efficacy, fear avoidance beliefs, physical activity level and patients´ treatment expectations were found to be important factors explaining treatment effects. Self-efficacy was the consistent mediator for effects of the pre-surgical physiotherapy on disability, back pain intensity and HRQoL.
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| 20. |
- Hörder, Helena, et al.
(author)
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Digitally Delivered Exercise and Education Treatment Program for Low Back Pain: Longitudinal Observational Cohort Study
- 2022
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In: JMIR Rehabilitation and Assistive Technologies. - : JMIR Publications Inc.. - 2369-2529. ; 9:2, s. e38084-e38084
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Journal article (peer-reviewed)abstract
- Background: Exercise and education is recommended as first-line treatment by evidence-based, international guidelines for low back pain (LBP). Despite consensus regarding the treatment, there is a gap between guidelines and what is offered to patients. Digital LBP treatments are an emerging way of delivering first-line treatment.Objective: The aim of this study is to evaluate outcomes after participation in a 3-month digitally delivered treatment program for individuals with subacute or chronic LBP.Methods: We analyzed data from 2593 consecutively recruited participants in a digitally delivered treatment program, available via the national health care system in Sweden. The program consists of video-instructed and progressive adaptable exercises, education through text lessons, and a chat and video function connecting participants with a personal physiotherapist. The primary outcome was mean change and proportion reaching a minimal clinically important change (MCIC) for LBP (2 points or 30% decrease) assessed with the numerical rating scale (average pain during the past week, discrete boxes, 0-10, best to worst). Secondary outcomes were mean change and proportion reaching MCIC (10 points or 30%) in disability, assessed with the Oswestry Disability Index (ODI; 0-100, best to worst) and a question on patient acceptable symptom state (PASS).Results: The mean participant age was 63 years, 73.85% (1915/2593) were female, 54.72% (1419/2593) had higher education, 50.56% (1311/2593) were retired, and the mean BMI was 26.5 kg/m2. Participants completed on average 84% of the prescribed exercises and lessons, with an adherence of ≥80% in 69.26% (1796/2593) and ≥90% in 50.13% (1300/2593) of the participants. Mean reduction in pain from baseline to 3 months was 1.7 (95% CI –1.8 to –1.6), corresponding to a 35% relative change. MCIC was reached by 58.50% (1517/2593) of participants. ODI decreased 4 points (95% CI –4.5 to –3.7), and 36.48% (946/2593) reached an MCIC. A change from no to yes in PASS was seen in 30.35% (787/2593) of participants. Multivariable analysis showed positive associations between reaching an MCIC in pain and high baseline pain (odds ratio [OR] 1.9, 95% CI 1.6-2.1), adherence (OR 1.5, 95% CI 1.3-1.8), and motivation (OR 1.2, 95% CI 1.0-1.5), while we found negative associations for wish for surgery (OR 0.6, 95% CI 0.5-0.9) and pain in other joints (OR 0.9, 95% CI 0.7-0.9). We found no associations between sociodemographic characteristics and pain reduction.Conclusions: Participants in this digitally delivered treatment for LBP had reduced pain at 3-month follow-up, and 58.50% (1517/2593) reported an MCIC in pain. Our findings suggest that digital treatment programs can reduce pain at clinically important levels for people with high adherence to treatment but that those with such severe LBP problems that they wish to undergo surgery may benefit from additional support.
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| 21. |
- Karppinen, Jaro, et al.
(author)
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Evaluation of training in guideline‐oriented biopsychosocial management of low back pain in occupational health services : Protocol of a cluster randomized trial
- 2021
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In: Health Science Reports. - : John Wiley & Sons. - 2398-8835. ; 4:1
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Journal article (peer-reviewed)abstract
- BackgroundTo prevent low back pain (LBP) from developing into a prolonged disabling condition, clinical guidelines advocate early stage assessment, risk‐screening, and tailored interventions. Occupational health services recommend guideline‐oriented biopsychosocial screening and individualized assessment and management. However, it is not known whether training a limited number of health care professionals improves the management process. The primary objective of this study is to investigate whether training in the biopsychosocial practice model is effective in reducing disability. Furthermore, we aim to evaluate health‐economic impacts of the training intervention in comparison to usual medical care.MethodsThe occupational health service units will be allocated into a training or control arm in a two‐arm cluster randomized controlled design. The training of occupational physiotherapists and physicians will include the assessment of pain‐related psychosocial factors using the STarT Back Tool and the short version of the Örebro Musculoskeletal Pain Screening Questionnaire, the use of an evidence‐based patient education booklet as part of the management of LBP, and tailored individualized management of LBP according to risk stratification. The control units will receive no training. The study population will include patients aged 18–65 with nonspecific LBP. The primary outcome is a patient‐reported Oswestry Disability Index from baseline to 12 months. By estimating group differences over time, we aim to evaluate the effectiveness of the training intervention in comparison to usual medical care, and to undertake an economic evaluation using individual patients' health care records (participant‐level data) and the participating units' registries (cluster‐level data). In addition, through interviews and questionnaires, we will explore the health care professionals' conceptions of the adoption of, the barriers to, and the facilitators of the implementation of the practice model.DiscussionThe evaluation of training in the guideline‐oriented biopsychosocial management of LBP in occupational health services is justified because LBP represents an enormous burden in terms of work disability.
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| 22. |
- Limbäck Svensson, Gunilla, et al.
(author)
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BOA - Better manangement of patients with arthritis - National quality registry annual report 2018
- 2019
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Reports (other academic/artistic)abstract
- This is the ninth annual report of the BOA register and the ninth year of BOA as a national quality registry. The BOA registry collects clinician reported process measures and patient-reported outcomes. This to monitor the quality of primary health care for knee, hip and hand osteoarthritis according to Swedish national guideline recommendations. The annual report for 2018 provides a summary of these health quality indicators on a national and regional level. The annual report is available on the website, boa.registercentrum.se. The website also provides open online aggregate statistics for health care quality indicator on a national, regional and clinic level.Thank you to everyone who has worked in the past year to collect data, support patients and contribute to the use of the BOA register as a tool in improving health care. Thanks also to the Steering Group and regional contact persons for your invaluable work in managing the register.
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| 23. |
- Limbäck-Svensson, Gunilla, et al.
(author)
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BOA - Bättre omhändertagande av patienter med artros. Årsrapport 2018
- 2019
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Reports (other academic/artistic)abstract
- Detta är den nionde årsrapporten för BOA-registret och det nionde året för BOA som nationellt kvalitetsregister. Vi har glädjen att meddela att BOA-registret har höjts från certifieringsnivå 3 till 2 av Ledningsfunktionen för Nationella Kvalitetsregister. Detta visar att BOA kontinuerligt förbättras och anses hålla god kvalitet.BOA-registret syftar främst till att patienter som har artros ska få optimal grundbehandling. Registret ska mäta vårdkvalitet, patientrapporterat utfall och serva verksamheter med relevant information som hjälper dem att uppfylla målet om optimal grundbehandling. Patienter med artros erbjuds grundbehandling av fysioterapeuter och arbetsterapeuter inom primärvård.Data från BOA-registret påvisar variationer i omhändertagande och resultat av behandling av patienter med artros i höft, knä eller hand. Registret utvecklas hela tiden för att bättre kunna användas som ett värdefullt verktyg för utvärdering och förbättring av det kliniska arbetet.Årsrapporten 2018 kommer att finnas tillgänglig på hemsidan, boa.registercentrum.se, men den kommer inte att tryckas och distribueras. Läsarundersökningar har visat att årsrapporten läses av få, medan vår statistikportal med realtidsdata på enhetsnivå är frekvent besökt med runt 1000 sidvisningar per månad. Vi fortsätter med att lägga resurser på att utveckla statistikportalen och underlätta administrationen kring registreringen.Årsrapporten vänder sig i första hand till vårdpersonal som möter personer med artros, men även till övriga intresserade som vill fördjupa sig i statistiken från registret.Tack till alla er som under det gångna året arbetat med att samla in data, utbildat patienter och bidragit till att BOA-registret kan användas som ett verktyg i vården. Tack även till styrgrupp och kontaktpersoner för ert ovärderliga arbete med att driva registret.
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| 24. |
- Lindbäck, Yvonne, 1967-, et al.
(author)
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Altered somatosensory profile according to quantitative sensory testing in patients with degenerative lumbar spine disorders scheduled for surgery
- 2017
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In: BMC Musculoskeletal Disorders. - : BIOMED CENTRAL LTD. - 1471-2474. ; 18
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Journal article (peer-reviewed)abstract
- Background: Somatosensory profiling in affected and non-affected body regions can strengthen our insight regarding the underlying pain mechanisms, which can be valuable in treatment decision making and to improve outcomes, in patients with degenerative lumbar spine disorders pre-surgery. The aim was to describe somatosensory profiles in patients with degenerative lumbar spine disorders, to identify the proportion with altered somatosensory profile, and to analyze demographic characteristics, self-reported function, pain, and health pre- and 3 months post-surgery. Methods: In this prospective cohort study in a Spine Clinic, 105 patients scheduled for surgery for spinal stenosis, disc herniation, degenerative disc disease, or spondylolisthesis were consecutively recruited. Exclusion criteria were; indication for acute surgery or previous surgery at the same spinal level or severe grade of pathology. Quantitative sensory testing (QST) and self-reported function, pain, and health was measured pre- and 3 months post-surgery. The somatosensory profile included cold detection threshold, warmth detection threshold, cold pain threshold, heat pain threshold and pressure pain threshold in affected and non-affected body regions. Results: On a group level, the patients somatosensory profiles were within the 95% confidence interval (CI) from normative reference data means. On an individual level, an altered somatosensory profile was defined as having two or more body regions (including a non-affected region) with QST values outside of normal ranges for reference data. The 23 patients (22%) with altered somatosensory profiles, with mostly loss of function, were older (P = 0.031), more often female (P = 0.005), had higher back and leg pain (P = 0.016, 0.020), lower mental health component summary score (SF 36 MCS) (P = 0.004) and larger pain distribution (P = 0.047), compared to others in the cohort. Post-surgery there was a tendency to worse pain, function and health in the group with altered somatosensory profile pre-surgery. Conclusions: On a group level, patients with degenerative lumbar spine disorders scheduled for surgery were within normal range for the QST measurements compared to reference values. On an individual level, an altered somatosensory profile outside of normal range in both affected and non-affected body regions occurred in 22% of patients, which may indicate disturbed somatosensory function. Those patients had mostly loss of sensory function and had worse self-reported outcome pre-surgery, compared to the rest of the cohort. Future prospective studies are needed to further examine whether these dimensions can be useful in predicting post-surgery outcome and guide need of additional treatments.
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| 25. |
- Lindbäck, Yvonne, 1967-, et al.
(author)
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Association between pain sensitivity in the hand and outcomes after surgery in patients with lumbar disc herniation or spinal stenosis.
- 2017
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In: European spine journal. - : Springer. - 0940-6719 .- 1432-0932. ; 26:10, s. 2581-2588
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Journal article (peer-reviewed)abstract
- PURPOSE: To investigate the association between pain sensitivity in the hand pre-surgery, and patient-reported outcomes (PROs) in function, pain and health pre- and post-surgery in patients with disc herniation or spinal stenosis.METHODS: This is a prospective cohort study with 82 patients. Associations between pressure-, cold- and heat pain threshold (PPT, CPT, HPT) in the hand pre-surgery and Oswestry, VAS pain, EQ-5D, HADS, and Self-Efficacy Scale, pre- and three months post-surgery; were investigated with linear regression.RESULTS: Patients with disc herniation more sensitive to pressure pain pre-surgery showed lower function and self-efficacy, and higher anxiety and depression pre-surgery, and lower function, and self-efficacy, and higher pain post-surgery. Results for cold pain were similar. In patients with spinal stenosis few associations with PROs were found and none for HPT and PROs.CONCLUSIONS: Altered pain response in pressure- and cold pain in the hand, as a sign of widespread pain pre-surgery had associations with higher pain, lower function and self-efficacy post-surgery in patients with disc herniation.
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