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| 2. |
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| 3. |
- Gerdle, Björn, et al.
(författare)
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The importance of emotional distress, cognitive behavioural factors and pain for life impact at baseline and for outcomes after rehabilitation - a SQRP study of more than 20,000 chronic pain patients
- 2019
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Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter GmbH. - 1877-8860 .- 1877-8879. ; 19:4, s. 693-711
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims Although literature concerning chronic pain patients indicates that cognitive behavioural variables, specifically acceptance and fear of movement/(re)injury, are related to life impact, the relative roles of these factors in relation to pain characteristics (e.g. intensity and spreading) and emotional distress are unclear. Moreover, how these variables affect rehabilitation outcomes in different subgroups is insufficiently understood. This study has two aims: (1) to investigate how pain, cognitive behavioural, and emotional distress variables intercorrelate and whether these variables can regress aspects of life impact and (2) to analyse whether these variables can be used to identify clinically meaningful subgroups at baseline and which subgroups benefit most from multimodal rehabilitation programs (MMRP) immediately after and at 12-month follow-up. Methods Pain aspects, background variables, psychological distress, cognitive behavioural variables, and two life impact variables were obtained from the Swedish Quality Registry for Pain Rehabilitation (SQRP) for chronic pain patients. These data were analysed mainly using advanced multivariate methods. Results The study includes 22,406 chronic pain patients. Many variables, including acceptance variables, showed important contributions to the variation in clinical presentations and in life impacts. Based on the statistically important variables considering the clinical presentation, three clusters/subgroups of patients were identified at baseline; from the worst clinical situation to the relatively good situation. These clusters showed significant differences in outcomes after participating in MMRP; the subgroup with the worst situation at baseline showed the most significant improvements. Conclusions Pain intensity/severity, emotional distress, acceptance, and life impacts were important for the clinical presentation and were used to identify three clusters with marked differences at baseline (i.e. before MMRP). Life impacts showed complex relationships with acceptance, pain intensity/severity, and emotional distress. The most significant improvements after MMRP were seen in the subgroup with the lowest level of functioning before treatment, indicating that patients with complex problems should be offered MMRP. Implications This study emphasizes the need to adopt a biopsychosocial perspective when assessing patients with chronic pain. Patients with chronic pain referred to specialist clinics are not homogenous in their clinical presentation. Instead we identified three distinct subgroups of patients. The outcomes of MMRP appears to be related to the clinical presentation. Thus, patients with the most severe clinical presentation show the most prominent improvements. However, even though this group of patients improve they still after MMRP show a complex situation and there is thus a need for optimizing the content of MMRP for these patients. The subgroup of patients with a relatively good situation with respect to pain, psychological distress, coping and life impact only showed minor improvements after MMRP. Hence, there is a need to develop other complex interventions for them.
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| 4. |
- Gerdle, Björn, et al.
(författare)
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Who benefits from multimodal rehabilitation - an exploration of pain, psychological distress, and life impacts in over 35,000 chronic pain patients identified in the Swedish Quality Registry for Pain Rehabilitation
- 2019
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Ingår i: Journal of Pain Research. - : DOVE Medical Press Ltd.. - 1178-7090. ; 12, s. 891-908
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic pain patients frequently suffer from psychological symptoms. There is no consensus concerning the prevalence of severe anxiety and depressive symptoms and the strength of the associations between pain intensity and psychological distress. Although an important aspect of the clinical picture is understanding how the pain condition impacts life, little is known about the relative importance of pain and psychological symptoms for individual's life impact. The aims of this study were to identify subgroups of pain patients; to analyze if pain, psychological distress, and life impact variables influence subgrouping; and to investigate how patients in the subgroups benefit from treatments.Methods: Background variables, pain aspects (intensity/severity and spreading), psychological distress (depressive and anxiety symptoms), and two life impact variables (pain interference and perceived life control) were obtained from the Swedish Quality Registry for Pain Rehabilitation for chronic pain patients and analyzed mainly using advanced multivariate methods.Results: Based on >35,000 patients, 35%-40% had severe anxiety or depressive symptoms. Severe psychological distress was associated with being born outside Europe (21%-24% vs 6%-8% in the category without psychological distress) and low education level (20.7%-20.8% vs 26%-27% in the category without psychological distress). Dose relationships existed between the two psychological distress variables and pain aspects, but the explained variances were generally low. Pain intensity/severity and the two psychological distress variables were significantly associated (R2=0.40-0.48; P>0.001) with the two life impact variables (pain interference and life control). Two subgroups of patients were identified at baseline (subgroup 1: n=15,901-16,119; subgroup 2: n=20,690-20,981) and the subgroup with the worst situation regarding all variables participated less in an MMRP (51% vs 58%, P<0.001) but showed the largest improvements in outcomes.Conclusion: The results emphasize the need to assess both pain and psychological distress and not take for granted that pain involves high psychological stress in the individual case. Not all patients benefit from MMRP. A better matching between common clinical pictures and the content of MMRPs may help improve results. We only partly found support for treatment resistance in patients with psychological distress burden.
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| 5. |
- Grooten, Wilhelmus Johannes Andreas, et al.
(författare)
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Elaborating on the assessment of the risk of bias in prognostic studies in pain rehabilitation using QUIPS-aspects of interrater agreement
- 2019
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Ingår i: Diagnostic and Prognostic Research. - : Springer Science and Business Media LLC. - 2397-7523. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many studies have been performed to identify important prognostic factors for outcomes after rehabilitation of patients with chronic pain, and there is a need to synthesize them through systematic review. In this process, it is important to assess the study quality and risk of bias. The "Quality In Prognosis Studies" (QUIPS) tool has been developed for this purpose and consists of several prompting items categorized into six domains, and each domain is judged on a three-grade scale (low, moderate or high risk of bias). The aim of the present study was to determine the interrater agreement of the risk of bias assessment in prognostic studies of patients with chronic pain using QUIPS and to elaborate on the use of this instrument.Methods: We performed a systematic review and a meta-analysis of prognostic factors for long-term outcomes after multidisciplinary rehabilitation in patients with chronic pain. Two researchers rated the risk of bias in 43 published papers in two rounds (15 and 28 papers, respectively). The interrater agreement and Cohen's quadratic weighted kappa coefficient (κ) and 95% confidence interval (95%CI) were calculated in all domains and separately for the first and second rounds.Results: The raters agreed in 61% of the domains (157 out of 258), with similar interrater agreement in the first (59%, 53/90) and second rounds (62%, 104/168). The overall weighted kappa coefficient (kappa for all domains and all papers) was weak: κ = 0.475 (95%CI = 0.358-0.601). A "minimal agreement" between the raters was found in the first round, κ = 0.323 (95%CI = 0.129-0.517), but increased to "weak agreement" in the second round, κ = 0.536 (95%CI = 0.390-0.682).Conclusion: Despite a relatively low interrater agreement, QUIPS proved to be a useful tool in assessing the risk of bias when performing a meta-analysis of prognostic studies in pain rehabilitation, since it demands of raters to discuss and investigate important aspects of study quality. Some items were particularly hard to differentiate in-between, and a learning phase was required to increase the interrater agreement. This paper highlights several aspects of the tool that should be kept in mind when rating the risk of bias in prognostic studies, and provides some suggestions on common pitfalls to avoid during this process.Trial registration: PROSPERO CRD42016025339; registered 05 February 2016.
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| 6. |
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| 7. |
- Lo Martire, Riccardo, et al.
(författare)
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Predictors of Sickness Absence in a Clinical Population With Chronic Pain
- 2021
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Ingår i: Journal of Pain. - Philadelphia, PA, United States : Churchill Livingstone. - 1526-5900 .- 1528-8447. ; 22:10, s. 1180-1194
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Tidskriftsartikel (refereegranskat)abstract
- Chronic pain-related sickness absence is an enormous socioeconomic burden globally. Optimized interventions are reliant on a lucid understanding of the distribution of social insurance benefits and their predictors. This register-based observational study analyzed data for a 7-year period from a population-based sample of 44,241 chronic pain patients eligible for interdisciplinary treatment (IDT) at specialist clinics. Sequence analysis was used to describe the sickness absence over the complete period and to separate the patients into subgroups based on their social insurance benefits over the final 2 years. The predictive performance of features from various domains was then explored with machine learning-based modeling in a nested cross-validation procedure. Our results showed that patients on sickness absence increased from 17% 5 years before to 48% at the time of the IDT assessment, and then decreased to 38% at the end of follow-up. Patients were divided into 3 classes characterized by low sickness absence, sick leave, and disability pension, with eight predictors of class membership being identified. Sickness absence history was the strongest predictor of future sickness absence, while other predictors included a 2008 policy, age, confidence in recovery, and geographical location. Information on these features could guide personalized intervention in the specialized healthcare. PERSPECTIVE: This study describes sickness absence in patients who visited a Swedish pain specialist interdisciplinary treatment clinic during the period 2005 to 2016. Predictors of future sickness absence are also identified that should be considered when adapting IDT programs to the patient's needs.
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| 8. |
- Lo Martire, Riccardo, et al.
(författare)
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Psychometric properties of Short Form-36 Health Survey, EuroQol 5-dimensions, and Hospital Anxiety and Depression Scale in patients with chronic pain
- 2020
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Ingår i: Pain. - : Ovid Technologies (Wolters Kluwer Health). - 0304-3959 .- 1872-6623. ; 161:1, s. 83-95
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Tidskriftsartikel (refereegranskat)abstract
- Recent research has highlighted a need for the psychometric evaluation of instruments targeting core domains of the pain experience in chronic pain populations. In this study, the measurement properties of Short Form-36 Health Survey (SF-36),EuroQol 5-dimensions (EQ-5D) and Hospital Anxiety and Depression Scale (HADS) were analyzed within the item response-theory framework based on data from 35,908 patients. To assess the structural validity of these instruments, the empirical representations of several conceptually substantiated latent structures were compared in a cross-validation procedure. The most structurally sound representations were selected from each questionnaire and their internal consistency reliability computed as a summary of their precision. Finally, questionnaire scores were correlated with each other to evaluate their convergent and discriminant validity. Our results supported that SF-36 is an acceptable measure of 2 independent constructs of physical and mental health. By contrast, although the approach to summarize the health-related quality of life construct of EQ-5D as a unidimensional score was valid, its low reliability rendered practical model implementation of doubtful utility. Finally, rather than being separated into 2 subscales of anxiety and depression, HADS was a valid and reliable measure of overall emotional distress. In support of convergent and discriminant validity, correlations between questionnaires showed that theoretically similar traits were highly associated, whereas unrelated traits were not. Our models can be applied to score SF-36 and HADS in chronic pain patients, but we recommend against using the EQ-5D model due to its low reliability. These results are useful for researchers and clinicians involved in chronic pain populations because questionnaires' properties determine their discriminating ability in patient status assessment.
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| 9. |
- LoMartire, Riccardo, et al.
(författare)
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The value of interdisciplinary treatment for sickness absence in chronic pain : A nationwide register-based cohort study
- 2021
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Ingår i: European Journal of Pain. - : Wiley. - 1090-3801 .- 1532-2149. ; 25:10, s. 2190-2201
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Tidskriftsartikel (refereegranskat)abstract
- Background Interdisciplinary treatment (IDT) is an internationally recommended intervention for chronic pain, despite inconclusive evidence of its effects on sickness absence. Methods With data from 25,613 patients in Swedish specialist healthcare, we compared sickness absence, in the form of both sick leave and disability pensions, over a 5-year period between patients either allocated to an IDT programme or to other/no interventions (controls). To obtain population-average estimates, a Markov multistate model with theory-based inverse probability weights was used to compute both the proportion of patients on sickness absence and the total sickness absence duration. Results IDT patients were more likely than controls to receive sickness absence benefits at any given time (baseline: 49% vs. 46%; 5-year follow-up: 36% vs. 35%), and thereby also had a higher total duration, with a mean (95% CI) of 67 (87, 48) more days than controls over the 5-year period. Intriguingly, sick leave was higher in IDT patients (563 [552, 573] vs. 478 [466, 490] days), whereas disability pension was higher in controls (152 [144, 160] vs. 169 [161, 178] days). Conclusion Although sickness absence decreased over the study period in both IDT patients and controls, we found no support for IDT decreasing sickness absence more than other/no interventions in chronic pain patients. Significance In this large study of chronic pain patients in specialist healthcare, sickness absence is compared over a 5-year period between patients in an interdisciplinary treatment programme and other/no interventions. Sickness absence decreased over the study period in bothgroups; however, there was no support forthat it decreased more with interdisciplinary treatment than alternative interventions.
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| 10. |
- Molander, Peter, et al.
(författare)
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The role of pain in chronic pain patients' perception of health-related quality of life : A cross-sectional SQRP study of 40,000 patients
- 2018
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Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter GmbH. - 1877-8860 .- 1877-8879. ; 18:3
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Tidskriftsartikel (refereegranskat)abstract
- Health-related quality of life (Hr-QoL) reflects the burden of a condition on an overarching level. Pain intensity, disability and other factors influence how patients with chronic pain perceive their condition, e.g. Hr-QoL. However, the relative importance of these factors is unclear and there is an ongoing debate as to what importance pain measures have in this group. We investigated the importance of current pain level and mood on aspects of Hr-QoL in patients with chronic pain and investigated whether such relationships are influenced by demographics. Data was obtained from the Swedish Quality Registry for Pain Rehabilitation (SQRP), between 2008 and 2016 on patients ≥18 years old who suffered from chronic pain and were referred to participating specialist clinics. Dependent variables were general Hr-QoL [using two scales from European Quality of Life instrument: EQ5D Index and the European Quality of Life instrument health scale (EQ thermometer)] and specific Hr-QoL [from the Short Form Health Survey (SF36) the physical component summary (SF36-PCS) and the mental (psychological) component summary (SF36-MCS)]. Independent variables were sociodemographic variables, pain variables, psychological distress and pain attitudes. Principal component analysis (PCA) was used for multivariate correlation analyses of all investigated variables and Orthogonal Partial Least Square Regression (OPLS) for multivariate regressions on health aspects. There was 40,518 patients (72% women). Pain intensity and interference showed the strongest multivariate correlations with EQ5D Index, EQ thermometer and SF36-PCS. Psychological distress variables displayed the strongest multivariate correlations with SF36-MCS. Demographic properties did not significantly influence variations in the investigated Hr-QoL variables. Pain, mood and pain attitudes were significantly correlated with Hr-QoL variables, but these variables cannot explain most of variations in Hr-QoL variables. The results pinpoint that broad assessments (including pain intensity aspects) are needed to capture the clinical presentation of patients with complex chronic pain conditions.
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| 11. |
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| 12. |
- Tseli, Elena, et al.
(författare)
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Predictors of multidisciplinary rehabilitation outcomes in patients with chronic musculoskeletal pain : protocol for a systematic review and meta-analysis
- 2017
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Ingår i: Systematic Reviews. - : BioMed Central (BMC). - 2046-4053. ; 6:1
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: Chronic musculoskeletal pain is a major public health problem. Early prediction for optimal treatment results has received growing attention, but there is presently a lack of evidence regarding what information such proactive management should be based on. This study protocol, therefore, presents our planned systematic review and meta-analysis on important predictive factors for health and work-related outcomes following multidisciplinary rehabilitation (MDR) in patients with chronic musculoskeletal pain.METHODS: We aim to perform a synthesis of the available evidence together with a meta-analysis of published peer-reviewed original research that includes predictive factors preceding MDR. Included are prospective studies of adults with benign, chronic (> 3 months) musculoskeletal pain diagnoses who have taken part in MDR. In the studies, associations between personal and rehabilitation-based factors and the outcomes of interest are reported. Outcome domains are pain, physical functioning including health-related quality of life, and work ability with follow-ups of 6 months or more. We will use a broad, explorative approach to any presented predictive factors (demographic, symptoms-related, physical, psychosocial, work-related, and MDR-related) and these will be analyzed through (a) narrative synthesis for each outcome domain and (b) if sufficient studies are available, a quantitative synthesis in which variance-weighted pooled proportions will be computed using a random effects model for each outcome domain. The strength of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation.DISCUSSION: The strength of this systematic review is that it aims for a meta-analysis of prospective cohort or randomized controlled studies by performing an extensive search of multiple databases, using an explorative study approach to predictive factors, rather than building on single predictor impact on the outcome or on predefined hypotheses. In this way, an overview of factors central to MDR outcome can be made and will help strengthen the evidence base and inform a wide readership including health care practitioners and policymakers.SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016025339.
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| 13. |
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| 14. |
- Tseli, Elena, et al.
(författare)
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Prognostic factors for improved physical and emotional functioning one year after interdisciplinary rehabilitation in patients with chronic pain : Results from a national quality registry in Sweden
- 2020
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 52:2
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate prognostic factors for physical and emotional functioning following interdisciplinary multimodal pain rehabilitation, by targeting patients' baseline characteristics and health measures.METHODS: A prospective cohort of 2,876 patients from 38 specialist clinics across Sweden, who were completing interdisciplinary multimodal pain rehabilitation programmes, was followed through the Swedish Quality Registry for Pain Rehabilitation, from initial assessment to 12-month follow-up. Using logistic regression, baseline data were regressed to predict improvement in Physical functioning and Emotional functioning, fused by principal component analyses using the 36-item Short Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS).RESULTS: Employment status emerged as having the largest effect sizes in both Physical functioning and Emotional functioning; Working: odds ratio (OR) 2.05 (95% confidence interval (95% CI) 1.64-2.56) and OR 1.59 (95% CI 1.27-1.98), respectively. Strong beliefs in restored health, better initial emotional health, lower levels of pain and pain interference, and younger age all predicted Physical functioning. European origin, higher levels of general activity, and sense of life control all predicted Emotional functioning. Worse initial physical and emotional health predicted the corresponding dependent outcomes.CONCLUSION: Employment was consistently found to be an important prognostic factor, suggesting the significance of avoiding delay in interdisciplinary multimodal pain rehabilitation. A positive treatment expectancy was of importance. In general, multidimensional measures indicated that better initial status was more favourable; however, inconsistency implies a complex prognostic picture.
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| 15. |
- Tseli, Elena, et al.
(författare)
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Prognostic Factors for Physical Functioning After Multidisciplinary Rehabilitation in Patients With Chronic Musculoskeletal Pain : A Systematic Review and Meta-Analysis
- 2019
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Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 35:2, s. 148-173
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVES: This systematic review aimed to identify and evaluate prognostic factors for long-term (≥6 mo) physical functioning in patients with chronic musculoskeletal pain following multidisciplinary rehabilitation (MDR).MATERIALS AND METHODS: Electronic searches conducted in MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, and Cochrane CENTRAL revealed 25 original research reports, published 1983-2016, (n=9436). Potential prognostic factors relating to initial pain and physical and psychological functioning were synthesized qualitatively and quantitatively in random effects meta-analyses. The level of evidence (LoE) was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE).RESULTS: Pain-related factors (intensity and chronicity) were not associated with function/disability at long-term follow-up, odds ratio (OR)=0.84; 95% confidence interval (CI), 0.65-1.07 and OR=0.97; 95% CI, 0.93-1.00, respectively (moderate LoE). A better function at follow-up was predicted by Physical factors; higher levels of initial self-reported functioning, OR=1.07; 95% CI, 1.02-1.13 (low LoE), and Psychological factors; low initial levels of emotional distress, OR=0.77; 95% CI, 0.65-0.92, low levels of cognitive and behavioral risk factors, OR=0.85; 95% CI, 0.77-0.93 and high levels of protective cognitive and behavioral factors, OR=1.49; 95% CI, 1.17-1.90 (moderate LoE).DISCUSSION: While pain intensity and long-term chronicity did not predict physical functioning in chronic pain patients after MDR, poor pretreatment physical and psychological functioning influenced the prognosis negatively. Thus, treatment should further target and optimize these modifiable factors and an increased focus on positive, psychological protective factors may perhaps provide an opening for yet untapped clinical gains.
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| 16. |
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| 17. |
- Tseli, Elena, et al.
(författare)
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What Is the Effectiveness of Different Duration Interdisciplinary Treatment Programs in Patients with Chronic Pain? A Large-Scale Longitudinal Register Study
- 2020
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Ingår i: Journal of Clinical Medicine. - : MDPI AG. - 2077-0383. ; 9:9
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Tidskriftsartikel (refereegranskat)abstract
- Chronic pain is a leading cause of disability globally. Interdisciplinary multimodal pain rehabilitation (IMPR) targets pain with a bio-psycho-social approach, often delivered as composite programs. However, evidence of optimal program duration for the rehabilitation to succeed remains scarce. This study evaluated the effectiveness of different duration IMPR-programs-using within- and between-effects analyses in a pragmatic multicenter register-based controlled design. Using the Swedish Quality Registry for Pain Rehabilitation, data from fifteen clinics specialized in chronic pain rehabilitation across Sweden were retrieved. Participants were patients with chronic musculoskeletal pain who had taken part in short (4-9 weeks; n = 924), moderate (10 weeks; n = 1379), or long (11-18 weeks; n = 395) IMPR programs. Longitudinal patient-reported outcome data were assessed at baseline, post-intervention, and at a 12-month follow-up. Primary outcomes were health-related quality of life, presented as perceived physical and mental health (SF-36). Secondary outcomes included the Hospital Anxiety and Depression Scale (HADS), pain intensity (NRS 0-10), the Multidimensional Pain Inventory (MPI), and perceived health (EQ-5D). Overall, all groups showed improvements. No clinically important effect emerged for different duration IMPR. In conclusion, while our results showed that patients following IMPR report improvement across a bio-psycho-social specter, a longer program duration was no more effective than a shorter one.
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| 18. |
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| 19. |
- Bruvoll, Mona, et al.
(författare)
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Feasibility of high dose medical exercise therapy in patients with long-term symptomatic knee osteoarthritis
- 2022
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Ingår i: Physiotherapy Theory and Practice. - : Informa UK Limited. - 0959-3985 .- 1532-5040. ; 38:11, s. 1615-1623
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: High repetition high dose medical exercise therapy (MET) is a promising treatment for patients with musculoskeletal pain. However, little is known regarding the feasibility of MET in patients with symptomatic knee osteoarthritis (OA). The aim of this study was to investigate the feasibility of MET in patients with symptomatic knee pain with radiographic verified OA. Methods: Patients with symptomatic knee osteoarthritis were recruited to a group-based high repetitive high dose MET intervention for 12 weeks in a primary health care setting. Indicators of feasibility included processes (recruitment, program adherence, and exercise compliance), and scientific feasibility (safety and pain evaluated by using the Visual Analogue Scale (VAS)). Results: Out of 31 individuals with symptomatic knee OA, 29 (93%) were included in this study. A total of 26 patients (90%) completed the intervention and 83% reached an attendance rate of >= 30 treatments. No adverse events were reported, and a majority of the patients reported a pain intensity <30 mm (VAS) throughout the intervention period. The results showed a 70% reduction of median pain intensity between baseline (33 mm, IQR: 39), and post-assessment (10 mm, IQR: 25, P = .003). Conclusion: These findings support an overall positive feasibility of MET for patients with symptomatic knee OA. The results also demonstrated that achieving a high dose of exercises might be challenging for this population. Thus, individual variations in exercise dose may be a confounding factor when evaluating high dose MET in future clinical studies.
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| 20. |
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| 21. |
- de Alwis, M.P., et al.
(författare)
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Crew acceleration exposure, health and performance in high-speed operations at sea
- 2017
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Konferensbidrag (refereegranskat)abstract
- The presented research program investigates the association between working conditions aboard High-Speed Craft (HSC) and its outcomes in terms of acceleration exposure and crew health and systems performance respectively. The aim is to identify the related risk factors and further, to use them to improve the assessment criteria in a simulation-based-design framework. The investigation initially document a seaborne population by a web-based questionnaire tailored for High-Performance Marine Craft Personnel (HPMCP) and similar populations. Then data is collected during regular service by measuring craft acceleration and through another questionnaire especially resolute on perceived work-exposure, health and performance. Exposure and performance data is collected daily and health data weekly, depending on seaborne frequency. The population repeats the prevalence questionnaire about a year later enabling a longitudinal follow-up for identifying long-term effects of exposure. The paper reports the two questionnaires´ development and pilot test as well as the first application for baseline data collection in the target group. The results indicate health and performance characteristics of the study population and data shows a promising correlation between the self-reported subjective exposure and the measured objective acceleration. Data indicates a comparatively higher prevalence of musculoskeletal pain in the study population than that of the general population.
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| 22. |
- de Alwis, Manudul Pahansen, et al.
(författare)
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Development and validation of a web-based questionnaire for surveying the health and working conditions of high-performance marine craft populations
- 2016
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 6:6
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Tidskriftsartikel (refereegranskat)abstract
- Background High-performance marine craft crews are susceptible to various adverse health conditions caused by multiple interactive factors. However, there are limited epidemiological data available for assessment of working conditions at sea. Although questionnaire surveys are widely used for identifying exposures, outcomes and associated risks with high accuracy levels, until now, no validated epidemiological tool exists for surveying occupational health and performance in these populations. Aim To develop and validate a web-based questionnaire for epidemiological assessment of occupational and individual risk exposure pertinent to the musculoskeletal health conditions and performance in high-performance marine craft populations. Method A questionnaire for investigating the association between work-related exposure, performance and health was initially developed by a consensus panel under four subdomains, viz. demography, lifestyle, work exposure and health and systematically validated by expert raters for content relevance and simplicity in three consecutive stages, each iteratively followed by a consensus panel revision. The item content validity index (I-CVI) was determined as the proportion of experts giving a rating of 3 or 4. The scale content validity index (S-CVI/Ave) was computed by averaging the I-CVIs for the assessment of the questionnaire as a tool. Finally, the questionnaire was pilot tested. Results The S-CVI/Ave increased from 0.89 to 0.96 for relevance and from 0.76 to 0.94 for simplicity, resulting in 36 items in the final questionnaire. The pilot test confirmed the feasibility of the questionnaire. Conclusions The present study shows that the web-based questionnaire fulfils previously published validity acceptance criteria and is therefore considered valid and feasible for the empirical surveying of epidemiological aspects among high-performance marine craft crews and similar populations.
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| 23. |
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| 24. |
- de Alwis, Pahansen, 1980-, et al.
(författare)
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Exposure aboard high-performance Marine craft increases musculoskeletal pain and lowers contemporary work capacity of the occupants
- 2021
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Ingår i: Journal of Engineering for the Maritime Environment (Part M). - : SAGE Publications. - 1475-0902 .- 2041-3084. ; 235:3, s. 750-762
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Tidskriftsartikel (refereegranskat)abstract
- High-Performance Marine Craft (HPMC) occupants are currently being investigated for various psychophysical impairments degrading work performance postulating that these deteriorations are related to their occupational exposures. However, scientific evidence for this is lacking and the association of exposure conditions aboard HPMC with adverse health and performance effects is unknown. Therefore, the study estimates the prevalence of musculoskeletal pain (MSP) among HPMC occupants and the association of their work exposure with MSP and performance degradation. It also presents a criterion for evaluating the self-reported exposure severity aboard three different types of mono-hull HPMC; displacement, semi-displacement and planing, on a par with the available standard criteria for objectively measurable exposures. Furthermore, another criterion is proposed to assess the performance-degradation of HPMC occupants based on self-reported fatigue symptoms and MSP. Swedish Coast Guard HPMC occupants were surveyed for MSP, fatigue symptoms as well as for work-related and individual risk indicators using a validated web-based questionnaire. Prevalence of MSP and performance-degradation during the past 12 months were assessed and presented as a percentage of the sample. Associations of exposure conditions aboard HPMC with MSP and performance-capacity were systematically evaluated using multiple logistic regression models and expressed as odds ratio (OR). Prevalence of MSP was 72% among which lower back pain was the most prevalent (46%) followed by neck pain (29%) and shoulder pain (23%) while 29% with degraded performance. Exposure to severe conditions aboard semi-displacement craft was associated with lower back (OR = 2.3) and shoulder (OR = 2.6) pain while severe conditions aboard planing craft with neck pain (OR = 2.3) and performance-degradation (OR = 2.6). MSP is common among Swedish coast guards. Severe exposure conditions aboard HPMC are significantly associated with both MSP and performance-degradation. The spine and shoulders are the most susceptible to work-related MSP among HPMC occupants which should be targeted in work-related preventive and corrective measures.
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| 25. |
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| 26. |
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| 27. |
- Granström, Hannah, et al.
(författare)
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Movement control tests for the lumbopelvic complex. Are these tests reliable and valid?
- 2017
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Ingår i: Physiotherapy Theory and Practice. - : Informa UK Limited. - 0959-3985 .- 1532-5040. ; 33:5, s. 386-397
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Tidskriftsartikel (refereegranskat)abstract
- This study evaluated inter- and intra-observer reliability and discriminative validity of three movement control tests: 1) standing knee-lift test; 2) static lunge test; and 3) dynamic lunge test. Thirty-eight subjects, 21 with low-back pain and 17 healthy, were video-recorded while performing the tests. Four physical therapists scored the tests according to a standardized protocol and calculated a composite score for each test based on the number of incorrect test components. Inter-observer reliability for the composite scores ranged between 0.68 and 0.80 (ICC 2,k) and intra-observer reliability between 0.54 and0.82 (ICC 2,1). The separate test components ranged between 0.32 and 0.91 (κfree) for inter-observer reliability and 0.42 and1.00 for intra-observer reliability. Test components showing the highest values were: back extension; arm lowering; and shoulders moving backwards. Components hip hitch, trunk lateral flexion, knee not lifted straight up and hips moving backwards did not reach accepted thresholds. Discriminative validity ranged between 0.47 and 0.56 (AUC). As our results showed an overall good agreement for the composite, scores and for the majority of the included test components the tests can be considered reliable enough. As the tests' discriminative ability was close to "none", they should, however, not be used for diagnostic purposes but should be further evaluated toward predicted validity.
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| 28. |
- Grooten, W.J.A., et al.
(författare)
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Does a dynamic chair increase office workers' movements? – Results from a combined laboratory and field study
- 2017
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Ingår i: Applied Ergonomics. - : Elsevier BV. - 0003-6870 .- 1872-9126. ; 60, s. 1-11
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE:Dynamic chairs have the potential to facilitate movements that could counteract health problems associated with sedentary office work. This study aimed to evaluate whether a dynamic chair can increase movements during desk-based office work.METHODS:Fifteen healthy subjects performed desk-based office work using a dynamic office chair and compared to three other conditions in a movement laboratory. In a field study, the dynamic office chair was studied during three working days using accelerometry.RESULTS:Equivocal results showed that the dynamic chair increased upper body and chair movements as compared to the conventional chair, but lesser movements were found compared to standing. No differences were found between the conditions in the field study.CONCLUSIONS:A dynamic chair may facilitate movements in static desk-based office tasks, but the results were not consistent for all outcome measures. Validation of measuring protocols for assessing movements during desk-based office work is warranted.
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| 29. |
- Grooten, Wilhelmus Johannes Andreas, et al.
(författare)
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Health risk appraisals in Swedish occupational health services
- 2016
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Ingår i: Work. - : IOS Press. - 1051-9815 .- 1875-9270. ; 55:4, s. 849-859
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Tidskriftsartikel (refereegranskat)abstract
- Background: Health risk appraisals (HRAs) in occupational health services (OHS) in Sweden are very commonly used for health promotion issues, but not much research has explored the extent and nature of individual feedback that is provided.Objectives: This study aimed to describe and explore HRAs in OHS regarding the content of the feedback in relation to the individual status and overall employee satisfaction.Methods: Feedback (evaluation and advice) and employee satisfaction with HRA were studied in employees that participated in health risk appraisals with a specific feedback session (HRA-F) (n = 272) and employees that participated in a single session (HRA-S) (n = 104). Associations between feedback and individual status concerning life style were assessed with Cohen's kappa (k).Results: The employees received mainly information and advice for improvement on health and lifestyle issues (89-100%), while advice for improvement of working conditions was less common (15-59%). The feedback provided on life style was not based on individual status (k < 0.4), except for smoking and risky alcohol consumption (k > 0.55). A great majority of employees reported good overall satisfaction with their HRAs.Conclusions: The evaluation and feedback given to employees after HRAs should be based more on HRA-results and advice could be focused more on work-related factors.
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| 30. |
- Grooten, Wilhelmus Johannes Andreas, et al.
(författare)
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Non-participation in initial and repeated health risk appraisals : a drop-out analysis based on a health project
- 2019
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Health risk assessment (HRAs) are commonly used by occupational health services (OHS) to aid workplaces in keeping their employees healthy, but for unknown reasons, many employees choose not to participate in the HRAs. The aim of the study was to explore whether demographic, lifestyle and health-related factors in employees are associated with non-participation in initial and repeated HRAs.METHODS: In an OHS-based health project, 2022 municipal employees were asked to participate in three repeated HRAs. Multiple logistic regression analyses were used so as to determine associations between non-participating and demographic, lifestyle and health-related factors (e.g. biomarkers).RESULTS: Among the employees who were asked to participate in the health project, more than half did not participate in any HRA and among those who did, more than one third did not participate in repeated HRAs. Young age, male sex and being employed in the Technical department or Health and Social Care department in comparison with being employed in the department for Childcare and Education were factors significantly associated with non-participation in the initial HRA. These factors, together with being on sick leave and having unhealthy dietary habits, were factors associated with non-participation in repeated HRAs.CONCLUSIONS: Among the non-participators in initial HRAs and in repeated HRAs younger men and those already related to ill-health were overrepresented. This implicates that health care providers to a higher extent should focus on "those most needed" and that employers should be more engaged in results of repeated HRA's. Future studies should focus on modifiable variables that could make the HRAs more attractive and inclusive.
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| 31. |
- Grooten, W. J., et al.
(författare)
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Is active sitting as active as we think?
- 2013
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Ingår i: Ergonomics. - : Informa UK Limited. - 0014-0139 .- 1366-5847. ; 56:8, s. 1304-14
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Tidskriftsartikel (refereegranskat)
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| 32. |
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| 33. |
- Grönkvist, Rode, et al.
(författare)
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Measurement error, minimal detectable change, and minimal clinically important difference of the Short Form-36 Health Survey, Hospital Anxiety and Depression Scale, and Pain Numeric Rating Scale in patients with chronic pain
- 2024
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Ingår i: Journal of Pain. - 1526-5900 .- 1528-8447.
-
Tidskriftsartikel (refereegranskat)abstract
- In both pain research and clinical practice, patient-reported outcome measures are used to assess dimensions of health. Interpreting these instruments requires understanding their measurement error and what magnitude of change has subjective importance for patients. This study estimated the standard error of measurement (SEM), one-year minimal detectable change, and one-year minimal clinically important difference (MCID) for the Short Form-36 Health Survey physical component summary (SF-36 PCS) and mental (SF36 MCS), the Hospital Anxiety and Depression Scale anxiety symptoms (HADS-A) and depression symptoms (HADS-D) subscales, and the Numeric Rating Scale (NRS) for past-week average pain intensity. MCIDs for these instruments have not previously been estimated in a large sample of chronic pain patients participating in interdisciplinary pain rehabilitation. Data were drawn from the Swedish Quality Registry for Pain Rehabilitation (n=8854 patients). MCID was estimated as average change and change difference, based on three different anchors. MCID estimates were 2.62-4.69 for SF-36 PCS, 4.46-6.79 for SF-36 MCS, 0.895-1.48 for NRS, 1.17-2.13 for HADS-A, and 1.48-2.54 for HADS-D. The common assumption of an identical SEM for pre- and post-treatment measurements was not always applicable. When estimating MCID, researchers should select an estimation method and anchor aligned with the study's context and objectives.PERSPECTIVE: This article presents estimates of minimal clinically important difference and minimal detectable change for several commonly used patient-reported outcome measures among patients with chronic pain. These estimates can help clinicians and researchers to determine when a measured health improvement is subjectively important to the patient and greater than measurement error.DATA AVAILABILITY: Data Availability Statement: The data utilized in this study are not available due to ethical considerations and the need for appropriate ethical approval.
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| 34. |
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| 35. |
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| 36. |
- Landén Ludvigsson, Maria, 1967-
(författare)
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Neck-specific exercise with or without a behavioural approach, or prescription of physical activity in chronic whiplash associated disorders
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Although 50% of those who suffer a whiplash injury still report neck pain after one year, there is a lack of knowledge about effective treatment for chronic whiplash associated disorders (WAD). Exercise is potentially useful, but the response to exercise in chronic WAD is highly variable between individuals and factors associated with good outcomes as well as the cost-effectiveness are unknown.Aim: The general aim of this thesis was to evaluate the effect on self-reported disability/ functioning, pain and selfefficacy of three different exercise interventions in chronic WAD grade 2 and 3, and to determine the cost-effectiveness of these interventions.Material and methods: A total of 216 participants with chronic WAD took part in this randomized, assessor blinded, controlled, clinical trial. Participants were randomized to either neck-specific exercise without (NSE), or with a behavioural approach (NSEB), or prescription of physical activity (PPA) for 12 weeks. Evaluations of change scores and proportion of clinically relevantly improved participants regarding disability/functioning (Neck Disability Index (NDI)/Patient Specific Functional Scale (PSFS)), pain (Visual Analogue Scale of current neck pain (VAS-P), pain bothersomeness (VAS-B)) and Self-efficacy (Self-Efficacy Scale (SES)) were made after 3, 6, 12 and 24 months. Secondary analyses were made, regarding factors associated with clinically relevant improvements in disability, pain and regarding cost-effectiveness.Results: Disability was more improved in the NSE/NSEB groups (NDI, P=0.02) than the PPA group, which reported no improvement, at 3 and 6 months, results remaining at 12 and 24 months (p ≤ 0.02). Functioning (PSFS) was also more improved in the NSE/NSEB groups than the PPA group at 3 months, in the NSEB compared to the PPA group at 6 months, and the NSE compared to the PPA groups at 12 and 24 months. The proportion of participants reaching clinically relevant improvement regarding NDI and PSFS was also larger in the NSE/NSEB groups at all time points (P<0.05), except NDI at 3 months and PSFS at 24 months. There were no differences between groups in VAS-P, VASB or SES change scores. The proportion of participants with clinically relevant reduction in VAS-P and VAS-B was however higher (P<0.02) in the NSE/NSEB groups compared with the PPA group at 3 and 12 months. Self-efficacy was only improved in the NSE group but without any between-group differences. There were no significant differences in any outcomes between the NSE/NSEB groups.The only significant factor associated with both clinically relevant improvements in disability and neck pain both at 3 and 12 months was participation in the NSE group, with odds up to 5.3 times higher than in the PPA group. Different baseline features were associated with the improvements depending on the outcome and time point examined. From a societal perspective, NSE was the cost-effective option.Conclusion: Physiotherapist-led neck-specific exercise resulted in better outcomes than prescription of physical activity regarding disability, functioning, and pain. The observed benefits of adding a behavioural approach to neck-specific exercise were inconclusive, and NSE was the cost-effective option from a societal perspective. Factors associated with clinically relevant improvements after exercise interventions in chronic WAD differed whether disability or neck pain was the outcome, but also differed in the short and long term. Participation in the NSE group was the only factor associated with both outcomes after both 3 and 12 months.
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| 37. |
- Lo Martire, Riccardo, et al.
(författare)
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Construction of a web-based questionnaire for longitudinal investigation of work exposure, musculoskeletal pain and performance impairments in high-performance marine craft populations
- 2017
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 7:7
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: High-performance marine craft personnel (HPMCP) are regularly exposed to vibration and repeated shock (VRS) levels exceeding maximum limitations stated by international legislation. Whereas such exposure reportedly is detrimental to health and performance, the epidemiological data necessary to link these adverse effects causally to VRS are not available in the scientific literature, and no suitable tools for acquiring such data exist. This study therefore constructed a questionnaire for longitudinal investigations in HPMCP.METHODS: A consensus panel defined content domains, identified relevant items and outlined a questionnaire. The relevance and simplicity of the questionnaire's content were then systematically assessed by expert raters in three consecutive stages, each followed by revisions. An item-level content validity index (I-CVI) was computed as the proportion of experts rating an item as relevant and simple, and a scale-level content validity index (S-CVI/Ave) as the average I-CVI across items. The thresholds for acceptable content validity were 0.78 and 0.90, respectively. Finally, a dynamic web version of the questionnaire was constructed and pilot tested over a 1-month period during a marine exercise in a study population sample of eight subjects, while accelerometers simultaneously quantified VRS exposure.RESULTS: Content domains were defined as work exposure, musculoskeletal pain and human performance, and items were selected to reflect these constructs. Ratings from nine experts yielded S-CVI/Ave of 0.97 and 1.00 for relevance and simplicity, respectively, and the pilot test suggested that responses were sensitive to change in acceleration and that the questionnaire, following some adjustments, was feasible for its intended purpose.CONCLUSIONS: A dynamic web-based questionnaire for longitudinal survey of key variables in HPMCP was constructed. Expert ratings supported that the questionnaire content is relevant, simple and sufficiently comprehensive, and the pilot test suggested that the questionnaire is feasible for longitudinal measurements in the study population.
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| 38. |
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| 39. |
- Lo Martire, Riccardo, et al.
(författare)
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Neck muscle EMG-force relationship and its reliability during isometric contractions
- 2017
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Ingår i: Sports medicine - open. - : Springer. - 2199-1170 .- 2198-9761. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Susceptible to injury, the neck is subject to scientific investigations, frequently aiming to elucidate possible injury mechanisms via surface electromyography (EMG) by indirectly estimating cervical loads. Accurate estimation requires that the EMG-force relationship is known and that its measurement error is quantified. Hence, this study examined the relationship between EMG and isometric force amplitude of the anterior neck (AN), the upper posterior neck (UPN), and the lower posterior neck (LPN) and then assessed the relationships' test-retest reliability across force-percentiles within and between days.METHODS: EMG and force data were sampled from 18 participants conducting randomly ordered muscle contractions at 5-90% of maximal voluntary force during three trials over 2 days. EMG-force relationships were modeled with general linear mixed-effects regression. Overall fitted lines' between-trial discrepancies were evaluated. Finally, the reliability of participants' fitted regression lines was quantified by an intraclass correlation coefficient (ICC) and the standard error of measurement (SEM).RESULTS: A rectilinear model had the best fit for AN while positively oriented quadratic models had the best fit for UPN and LPN, with mean adjusted conditional coefficients of determination and root mean square errors of 0.97-0.98 and 4-5%, respectively. Overall EMG-force relationships displayed a maximum 6% between-trial discrepancy and over 20% of maximal force, and mean ICC was above 0.79 within day and 0.27-0.61 between days across areas. Corresponding SEM was below 12% both within and between days across areas, excluding UPN between days, for which SEM was higher.CONCLUSIONS: EMG-force relationships were elucidated for three neck areas, and provided models allow inferences to be drawn from EMG to force on a group level. Reliability of EMG-force relationship models was higher within than between days, but typically acceptable for all but the lowest contraction intensities, and enables adjustment for measurement imprecision in future studies.
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| 40. |
- Monnier, Andreas, et al.
(författare)
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A longitudinal observational study of back pain incidence, risk factors and occupational physical activity in Swedish marine trainees
- 2019
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 9:5
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To evaluate the occurrence of low back pain (LBP) and LBP that limits work ability, to identify their potential early risks and to quantify occupational physical activity in Swedish Armed Forces (SwAF) marines during their basic 4 month marine training course.DESIGN: Prospective observational cohort study with weekly follow-ups.PARTICIPANTS: Fifty-three SwAF marines entering the training course.OUTCOMES: Incident of LBP and its related effect on work-ability and associated early risks. Occupational physical activity, as monitored using accelerometers and self-reports.RESULTS: During the training course, 68% of the marines experienced at least one episode of LBP. This yielded a LBP and LBP limiting work ability incidence rate of 13.5 (95% CI 10.4 to 17.8) and 6.3 (95% CI 4.2 to 10.0) episodes per 1000 person-days, respectively. Previous back pain and shorter body height (≤1.80 m) emerged as independent risks for LBP (HR 2.5, 95% CI 1.4 to 4.3; HR 2.0, 95% CI 1.2 to 3.3, respectively), as well as for LBP that limited work ability (HR 3.6, 95% CI 1.4 to 8.9; HR 4.5, 95% CI 2.0 to 10.0, respectively). Furthermore, managing fewer than four pull-ups emerged as a risk for LBP (HR 1.9, 95% CI 1.2 to 3.0), while physical training of fewer than three sessions per week emerged as a risk for LBP that limited work ability (HR 3.0, 95% CI 1.2 to 7.4). More than 80% of the work time measured was spent performing low levels of ambulation, however, combat equipment (≥17.5 kg) was carried for more than half of the work time.CONCLUSIONS: Incidents of LBP are common in SwAF marines' early careers. The link between LBP and previous pain as well as low levels of exercise highlights the need for preventive actions early on in a marine's career. The role of body height on LBP needs further investigation, including its relationship with body-worn equipment, before it can effectively contribute to LBP prevention.
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| 41. |
- Monnier, A., et al.
(författare)
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Inter- and intra-observer reliability of clinical movement-control tests for marines
- 2012
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 13, s. 263-
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundMusculoskeletal disorders particularly in the back and lower extremities are common among marines. Here, movement-control tests are considered clinically useful for screening and follow-up evaluation. However, few studies have addressed the reliability of clinical tests, and no such published data exists for marines. The present aim was therefore to determine the inter- and intra-observer reliability of clinically convenient tests emphasizing movement control of the back and hip among marines. A secondary aim was to investigate the sensitivity and specificity of these clinical tests for discriminating musculoskeletal pain disorders in this group of military personnel.MethodsThis inter- and intra-observer reliability study used a test-retest approach with six standardized clinical tests focusing on movement control for back and hip. Thirty-three marines (age 28.7 yrs, SD 5.9) on active duty volunteered and were recruited. They followed anin-vivoobservation test procedure that covered both low- and high-load (threshold) tasks relevant for marines on operational duty. Two independent observers simultaneously rated performance as “correct” or “incorrect” following a standardized assessment protocol. Re-testing followed 7–10 days thereafter. Reliability was analysed using kappa (κ) coefficients, while discriminative power of the best-fitting tests for back- and lower-extremity pain was assessed using a multiple-variable regression model.ResultsInter-observer reliability for the six tests was moderate to almost perfect with κ-coefficients ranging between 0.56-0.95. Three tests reached almost perfect inter-observer reliability with mean κ-coefficients > 0.81. However, intra-observer reliability was fair-to-moderate with mean κ-coefficients between 0.22-0.58. Three tests achieved moderate intra-observer reliability with κ-coefficients > 0.41. Combinations of one low- and one high-threshold test best discriminated prior back pain, but results were inconsistent for lower-extremity pain.ConclusionsOur results suggest that clinical tests of movement control of back and hip are reliable for use in screening protocols using several observers with marines. However, test-retest reproducibility was less accurate, which should be considered in follow-up evaluations. The results also indicate that combinations of low- and high-threshold tests have discriminative validity for prior back pain, but were inconclusive for lower-extremity pain.
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| 42. |
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| 43. |
- Monnier, Andreas, et al.
(författare)
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Risk factors for back pain in marines; A prospective cohort study
- 2016
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: It is recognised that back pain (BP) is a debilitating medical problem in the soldier community, which limits operational readiness as well as work ability. As such, identification of risk factors is a necessity for effective preventive actions, but also regarded as important from a safety perspective. The aim of this prospective cohort study was therefore to identify risk factors for back pain and BP limiting work ability in active duty marines within a 6 and 12-month period. Methods: Demographic characteristics, health-related factors and occupational exposure information, as gathered from questionnaires, as well as clinical test of movement control among 137 Swedish marines were regressed with multivariable logistic regressions, and strength of associations was presented as odds ratio (OR) with 95 % confidence intervals (CI). BP within 6 and 12 months were used as primary outcomes, whereas BP limiting work ability within 6 and 12 months served as secondary outcomes. Results: Previous BP and tall body height (≥1.86 m) emerged as risk factors for back pain within 6 months (OR 2.99, 95 % CI 1.22-7.30; OR 2.81, 95 % CI 1.16- 6.84, respectively), and 12 months (OR 6.75, 95 % CI 2.30-19.80; 2.75, 95 % CI 1.21-6.29, respectively). Previous BP was also identified as risk factor for BP limiting work ability within 12 months (OR 6.64, 95 % CI 1.78-24.78), and tall body height emerged as a risk within both six (OR 4.30, 95 % CI 1.31-14.13) and 12 months (OR 4.55, 95 % CI 1.53-13.57) from baseline. Conclusions: Marines with a history of BP are at risk of further BP episodes, which, thus, emphasise the importance of early BP preventive actions. Tall body height also emerged as an important risk which may reflect that personal equipment and work tasks are not adapted for the tallest marines. While this should be considered when introducing new work equipment, further studies are warranted to clarify the underlying mechanism of this association.
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| 44. |
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| 45. |
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| 46. |
- Owiredua, Christiana, 1989-, et al.
(författare)
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The Context Matters : A Retrospective Analysis of Life Stage at Chronic Pain Onset in Relation to Pain Characteristics and Psychosocial Outcomes
- 2020
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Ingår i: Journal of Pain Research. - : Dove Medical Press Ltd.. - 1178-7090. ; 13, s. 2685-2695
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Tidskriftsartikel (refereegranskat)abstract
- Background: Developmental life stage at chronic pain onset differs among chronic pain patients. Although pain affects multiple life domains, it is unknown whether the timing of chronic pain onset relates to pain characteristics and psychosocial outcomes. The purpose of this retrospective study was to investigate differences in pain characteristics and psychosocial outcomes in patients at different developmental life stages at chronic pain onset.Methods: Cross-sectional baseline data from the Swedish Quality Registry for Pain Rehabilitation (2009 to 2016) were used, selecting the middle-aged patients (45-65 years, n=6225) reporting chronic nonmalignant pain. Patients were categorized into three groups, depending on their developmental life stage at chronic pain onset: early onset (age ≤30 years), intermediate onset (age 31-45 years), and late onset (age ≥46 years). Pain characteristics and psychosocial outcomes were assessed with validated self-reported measures.Results: One-way MANCOVA indicated differences in number of pain locations and psychosocial outcomes among the groups. Post hoc analysis showed differences in the trends for how groups differed on outcome domains. Overall, patients with earlier chronic pain onset showed significantly poorer psychosocial outcomes and more spreading of pain.Conclusion: Developmental life stage at chronic pain onset is associated with different pain outcomes. Pain onset early in life is linked to worse outcomes in multiple domains, pointing to a need for identifying these patients early.
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| 47. |
- Peterson, Gunnel, 1959-
(författare)
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Neck muscle function in individuals with persistent pain and disability after whiplash injury
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Neck pain and disability are common after whiplash injury. One year after the accident up to 50 % still have symptoms called whiplash associated disorders (WAD). Despite decades of research the cause of persistent pain and disability are largely unknown and effective treatment and diagnostic tools are lacking. Altered neck muscle function may cause pain and disability, and real-time non-invasive methods that investigate both superficial and deep neck muscle function need to be evaluated.Aim: The general aim of the work presented in this thesis was to investigate mechanical neck muscle function and evaluate effects of three different exercise interventions related to neck muscle function in individuals with persistent pain and disability after whiplash injury.Method: The thesis comprised two studies, reported in four papers. Study A was a prospective randomized controlled trail with 216 participants. The effects of three exercise interventions; neck-specific exercises, neck-specific exercises with behavioral approach and prescription of physical activity were evaluated. Neck muscle endurance, perceived pain following testing, kinesiophobia and satisfaction with treatment were compared between the three groups (paper I). Study B was an experimental case-control study with participants consecutively recruited from the randomized controlled trial. Deformation and deformation rates in the neck muscles were investigated with real-time ultrasound imaging during ten repetitive arm elevations (paper II-IV). To investigate ventral neck muscles, 26 individuals with WAD were compared with 26 healthy controls (paper II). The dorsal neck muscles were investigated in paper III, including 40 individuals with WAD and 40 controls. In total 46 individuals, 23 with WAD and 23 healthy controls were included in paper IV to develop ventral neck muscle interaction models.Results: Paper I: Participants in the two neck-specific exercise groups (with and without behavioral approach) showed increased dorsal neck muscle endurance (p = 0.003), decreased pain intensity following testing (p = 0.04) and were more satisfied with treatment (p < 0.001) than participants in the prescribed physical activity group. Kinesiophobia did not significantly differ between groups (p > 0.12).Paper II: Deformation and deformation rate showed linear positive relationship between ventral muscle pairs in healthy controls, especially between superficial and deep neck muscles. This relationship was weaker or absent in the WAD group.Paper III: The WAD group had higher deformation rates in the deepest dorsal neck muscles during the first and tenth (only women) arm elevations compared to the control group (p < 0.04). Women in the WAD group showed a weaker linear relationship between the two deepest dorsal neck muscles compared to women in the control group.Paper IV: The results revealed two different ventral neck muscle models in individuals with WAD and healthy controls (R2Y = 0.72, Q2Y = 0.59). The models were capable to detect different neck muscle interplay in people with WAD.Conclusion: Neck-specific exercise intervention with or without a behavioral approach appears to improve neck muscle endurance in individuals with persistent WAD. Decreased pain after the neck muscle endurance test also suggests improved tolerance of load in these two groups. Altered mechanical neck muscle function was revealed in individuals with WAD indicating decreased muscular support for maintain a stable cervical spine during repetitive arm elevations. The results show great promise for improved diagnosis of neck muscle function in WAD.
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| 48. |
- Posch, Markus, et al.
(författare)
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Prevalence and potential risk factors of flight-related neck, shoulder and low back pain among helicopter pilots and crewmembers : a questionnaire-based study
- 2019
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 20:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Flight-related neck, shoulder and low back pain are the most common musculoskeletal disorders among helicopter pilots and their crewmembers, thus becoming a growing concern. Information on the combined prevalence of these types of pain and related risks are scarce. The aim of this study was therefore to estimate pain prevalence and to evaluate potential risk factors for neck pain among helicopter pilots and crewmembers within the armed forces, the airborne police and airborne rescue organizations in Austria.METHODS: Among a cohort of 104 helicopter pilots and 117 crewmembers (69.8% compliance), demographics, flying experience, use of Night Vision Goggles (NVG), helicopter type flown, prevalence and intensity of musculoskeletal symptoms (pain was defined as any reported pain experience, ache or discomfort) were collected by an online-based questionnaire.RESULTS: For helicopter pilots the 12-month prevalence of neck pain was 67.3%, followed by low back (48.1%) and shoulder pain (43.3%). Among crewmembers, the 12-month pain prevalence were 45.3, 36.8 and 30.8% among the neck, lower back and shoulder, respectively. During this period, 41.8% of these helicopter pilots had experienced 8-30 pain days in the areas of neck (45.7%), shoulder (37.8%) and lower back (42.0%) whereas 47.8% of crewmembers self-reported 1-7 days of neck (54.7%), low back (44.2%) and shoulder (44.4%) pain in the previous year. The 3-month prevalence of neck pain was 64.4% followed by low back (42.3%) and shoulder pain (38.5%) for helicopter pilots. Among crewmembers, 41.9% suffered from neck, 29.9% from low back and 29.1% from shoulder pain the previous 3 months. Multivariate regression analysis revealed NVG use (OR 1.9, 95% CI, 1.06-3.50, p = 0.032), shoulder pain (OR 4.9, 95% CI, 2.48-9.55, p < 0.001) and low back pain (OR 2.3, 95% CI, 1.21-4.31, p = 0.011) to be significantly associated with neck pain.CONCLUSIONS: The 12- and 3-month prevalence of neck, shoulder and low back is considerably high among both, helicopter pilots and crewmembers confirming the existence of this growing concern. The use of NVG devices, shoulder and low back pain in the previous 12 months represent independent risk factors for neck pain. These findings highlight the need for longitudinal studies.
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| 49. |
- Pousette, Magnus Wallquist, et al.
(författare)
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Neck Muscle Strain in Air Force Pilots Wearing Night Vision Goggles
- 2016
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Ingår i: Aerospace Medicine and Human Performance. - : Aerospace Medical Association. - 2375-6314 .- 2375-6322. ; 87:11, s. 928-932
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Flight-induced neck pain is common in high performance jet pilots, with incidents frequently attributed to high G, flight maneuvers. The additional load of helmet-mounted night vision goggles (NVG) is believed to increase the risk, possibly from neck muscle strain in counteracting muscles. Hence, the aim was to investigate the effect of NVG on neck muscle strain as well as on the activity level distribution through a simulated flight session in air force pilots. METHODS: In this post hoc randomized crossover trial, four senior air force pilots each completed two identical 1.5-h dynamic flight simulations in a human centrifuge: one with a standard helmet and NVG, and one with a standard helmet only. Simulations included repeated exposure to 3-7 G(z), during which neck muscle activity was recorded bilaterally from the anterior neck, the upper and lower posterior neck, and the upper shoulders. The number of muscle activities surpassing 50% of maximum voluntary electrical activity (MVE) and total time of activity at each MVE percentile were compared between NVG and control flights. RESULTS: There was no overall effect in number of neck strain activities between NVG and control flights; however, significantly more activities emerged in the anterior neck. In addition, MVE percentile data showed a tendency of higher activity in the lower posterior neck during NVG flights. CONCLUSIONS: The results showed that the additional load of helmet-mounted NVG increases neck muscle strain in anterior stabilizing muscles, indicating that the inertia of head-worn NVG elevates the risk of flight-related neck pain.
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