| 1. |
- Aasa, Björn, et al.
(författare)
-
A characterisation of pain, disability, kinesiophobia and physical capacity in patients with predominantly peripherally mediated mechanical low back pain
- 2011
-
Ingår i: Physiotherapy. - 0031-9406 .- 1873-1465. ; 97:Suppl. 1, s. eS18-
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: The specific objectives were to: 1) describe the level of pain intensity, disability, activity limitation, kinesiophobia and physical capacity in patients with predominantly peripherally mediated mechanical back pain, and 2) investigate whether differences between these patients in physical and psychosocial factors can be distinguished when the patients are further sub-grouped.Relevance: To improve assessment among patients with chronic low back pain (CLBP) it is important to investigate the prevalence of physical and psychosocial features in homogenous sub-groups.Participants: Seventy-one patients with CLBP, 20-60 years old, with peripherally mediated mechanical pain at the the moment for the study, were included and each patient was sub-classified into one of five sub-groups based on their pain behaviour and functional movement pattern (flexion n=20, flexion/lateral shift, n=11, active extension n=23 , passive extension n=8, and multidirectional pattern n=9).Methods: Data on pain intensity (Visual Analogue Scale), disability (the Roland and Morris Questionnaire), activity limitation (the Patient Specific Functional Scale), kinesiophobia (the Tampa Scale of Kinesiophobia) and physical capacity (lifting capacity and trunk extensor endurance) was collected.Analysis: Mean and standard deviation for parametric and median and interquartile range for non-parametric data were used for descriptive statistics. One-way ANOVA for normally distributed data and Kruskal-Wallis for non-normally distributed data were used for analyses of differences between the sub-groups. The subjects were also divided into two age-groups (20-40 and 41-60 years) and measures of physical capacity were compared to women and men at the ages of 34 and 50, respectively, in the general Swedish population using one sample T-test.Results: The patients reported low to moderate pain intensity (3.1/10±2.4), disability (RMDQ (7.27/24 ±4.2) and kinesiophobia (33.4/68 ±7) and these levels were lower than reported levels in other studies including more heterogenous groups of patients with CLBP. The patiens reported activity limitations (PSFS 13/30±23). Lifting capacity and trunk extensor endurance were significantly lower than in the general population in the youngest age-group. No significant differences in pain intensity, disability, kinesiophobia or physical capacity were found between the sub-groups.Conclusions: This research highlights that patients with predominantly peripherally mediated mechanical back pain may differ from other sub-groups of patients with CLBP (e.g., patients with central sensitization as dominating pain mechanism) regarding physical and psychosocial factors. The individual variation in pain intensity, disability, kinesiophbia and physical capacity among the patients indicates the importance to assess these factors in every patient. Due to the fact that there were few patients in the sub-groups, further research is necessary to explore whether there are differences, that we were not able to disingjish, between patients with different movement patterns.
|
|
| 2. |
|
|
| 3. |
- Aasa, Björn, et al.
(författare)
-
Acuity of goal-directed arm movements and movement control : evaluation of differences between patients with persistent neck/shoulder pain and healthy controls
- 2022
-
Ingår i: European Journal of Physiotherapy. - : Routledge. - 2167-9169 .- 2167-9177. ; 24:1, s. 47-55
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The main aim was to examine whether patients with persistent upper quadrant pain have higher end-point variability in goal directed pointing movements than pain-free controls when the pointing task is performed in total darkness and under full vision. An additional aim was to study associations between the magnitude of end-point variability and a clinical movement control test battery and self-rated functioning among patients.Methods: Seventeen patients and 17 age- and gender-matched pain-free controls performed a pointing task that evaluated end-point variability of repetitive shoulder movements in horizontal adduction and abduction with full vision, and abduction with no visual information, completed a movement control test battery of neck and shoulder control tests and answered questionnaires.Results: Patients had higher end point variability for horizontal abduction when performed with no visual information. For horizontal adduction the variability was higher, but only when it was controlled for movement time. No significant correlations were found between end-point variability and self-rated functioning, nor between end-point variability and neuromuscular control of the glenohumeral joint.Conclusions: This study provides preliminary evidence that patients with persistent neck/shoulder pain can partly compensate proprioceptive deficits in goal-directed arm movement when visual feedback is present.
|
|
| 4. |
- Aasa, Björn, et al.
(författare)
-
Do we see the same movement impairments? : the inter-rater reliability of movement tests for experienced and novice physiotherapists
- 2014
-
Ingår i: European Journal of Physiotherapy. - : Informa UK Limited. - 2167-9169 .- 2167-9177. ; 16:16, s. 173-182
-
Tidskriftsartikel (refereegranskat)abstract
- Study design: Inter-rater reliability study. Background: Physiotherapists (PTs) use clinical tests including movement tests to identify faulty movement patterns. Aims: To investigate the inter-rater-reliability of active movement tests in the cervical spine, shoulder joint and scapulo-thoracic joint, and to describe the reasons for judgment of a positive test. Methodology: Four PTs, two experienced and two recently educated (novice), rated performance of five movement tests for 36 participants. Twenty-one of the participants were patients under treatment because of neck and/or shoulder problems, while 15 participants declared no problem from this region of the body. All tests were video recorded and the ratings were done by observing the video recordings. First, the PTs judged the tests as negative (the movement being ideally performed) or positive (the movement not being ideally performed). Then, the PTs described why the movements that they judged positive were not being ideally performed, using a predefined protocol, which represented different movement quality aspects. The inter-rater reliability was calculated for each test using Kappa statistics between the two experienced and the two novice PTs, respectively, and between each of the experienced and each of the novice PTs. Major findings: The experienced PTs had a higher inter-rater reliability than the novice PTs. The reasons for considering a movement test being positive differed highly between the (novice) PTs. Principal conclusion: This study supports previous studies concluding that the observation of active movement tests is reliable when assessed by experienced PTs. Novice PTs might benefit from further supervision.
|
|
| 5. |
- Aasa, Björn, et al.
(författare)
-
Individualized low-load motor control exercises and education versus a high-load lifting exercise and education to improve activity, pain intensity, and physical performance in patients with low back pain : a randomized controlled trial
- 2015
-
Ingår i: Journal of Orthopaedic and Sports Physical Therapy. - : Journal of Orthopaedic & Sports Physical Therapy (JOSPT). - 0190-6011 .- 1938-1344. ; 45:2, s. 77-85
-
Tidskriftsartikel (refereegranskat)abstract
- Study Design Randomized controlled trial. Background Low back pain is a common disorder. Patients with low back pain frequently have aberrant and pain-provocative movement patterns that often are addressed with motor control exercises. Objective To compare the effects of low-load motor control (LMC) exercise and those of a high-load lifting (HLL) exercise. Methods Seventy participants with recurrent low back pain, who were diagnosed with nociceptive mechanical pain as their dominating pain pattern, were randomized to either LMC or HLL exercise treatments. Participants were offered 12 treatment sessions over an 8-week period. All participants were also provided with education regarding pain mechanisms. Methods Participants were assessed prior to and following treatment. The primary outcome measures were activity (the Patient-Specific Functional Scale) and average pain intensity over the last 7 days (visual analog scale). The secondary outcome measure was a physical performance test battery that included 1 strength, 3 endurance, and 7 movement control tests for the lumbopelvic region. Results Both interventions resulted in significant within-group improvements in pain intensity, strength, and endurance. The LMC group showed significantly greater improvement on the Patient-Specific Functional Scale (4.2 points) compared with the HLL group (2.5 points) (P<.001). There were no significant between-group differences in pain intensity (P = .505), strength, and 1 of the 3 endurance tests. However, the LMC group showed an increase (from 2.9 to 5.9) on the movement control test subscale, whereas the HLL group showed no change (from 3.9 to 3.1) (P<.001). Conclusion An LMC intervention may result in superior outcomes in activity, movement control, and muscle endurance compared to an HLL intervention, but not in pain intensity, strength, or endurance.
|
|
| 6. |
|
|
| 7. |
|
|
| 8. |
- Aasa, Ulrika, et al.
(författare)
-
Krafttag ska stoppa styrkelyftarnas skador
- 2015
-
Ingår i: Svensk idrottsforskning. - : Centrum för idrottsforskning. - 1103-4629 .- 2002-3944. ; :4, s. 29-31
-
Tidskriftsartikel (populärvet., debatt m.m.)
|
|
| 9. |
- Aasa, Ulrika, et al.
(författare)
-
Physical Activity Might Be of Greater Importance for Good Spinal Control Than If You Have Had Pain or Not : A Longitudinal Study
- 2015
-
Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 40:24, s. 1926-1933
-
Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Longitudinal design. A cohort followed in 3 waves of data collection.OBJECTIVE: The aim of the study was to describe the relationships between the performance of 2 tests of spinal control at the age of 52 years and low back pain, physical activity level, and fitness earlier in life, as well as to describe the cross-sectional relationships between these measures.SUMMARY OF BACKGROUND DATA: Altered spinal control has been linked to pain; however, other stimuli may also lead to inability to control the movements of the spine.METHODS: Participants answered questions about physical activity and low back pain, and performed physical fitness tests at the age of 16, 34, and 52 years. The fitness test battery included tests of endurance in the back and abdominal muscles, a submaximal bicycle ergometer test to estimate maximal oxygen uptake, and measurements of hip flexion, thoracic spine flexibility, and anthropometrics. Two tests were aggregated to a physical fitness index. At the age of 52, also 2 tests of spinal control, the standing Waiter's bow (WB) and the supine double leg lower (LL) were performed.RESULTS: Logistic regression analyses showed that higher back muscle endurance at the age of 34 years could positively predict WB performance at 52 years and higher physical fitness at the age of 34 could positively predict LL performance at 52 years. Regarding cross-sectional relationships, an inability to perform the WB correctly was associated with lower physical fitness, flexibility and physical activity, and larger waist circumference. An inability to correctly perform the LL was associated with lower physical fitness. One-year prevalence of pain was not significantly associated with WB or LL test performance.CONCLUSION: An active life resulting in higher physical fitness is related to better spinal control in middle-aged men and women. This further strengthens the importance of physical activity throughout the life span.LEVEL OF EVIDENCE: 3.
|
|
| 10. |
- Berglund, Lars, et al.
(författare)
-
Effects of low-load motor control exercises and a high-load lifting exercise on lumbar multifidus thickness : a randomized controlled trial
- 2017
-
Ingår i: Spine. - : Wolters Kluwer. - 0362-2436 .- 1528-1159. ; 42:15, s. E876-E882
-
Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN:Randomized controlled trial.OBJECTIVE:The aim of this study was to compare the effects of low-load motor control (LMC) exercises and a high-load lifting (HLL) exercise, on lumbar multifidus (LM) thickness on either side of the spine and whether the effects were affected by pain intensity or change in pain intensity.SUMMARY OF BACKGROUND DATA:There is evidence that patients with low back pain (LBP) may have a decreased size of the LM muscles with an asymmetry between sides in the lower back. It has also been shown that LMC training can affect this asymmetry. It is, however, not known whether a high-load exercise has the same effect.METHODS:Sixty-five participants diagnosed with nociceptive mechanical LBP were included and randomized into LMC exercises or a HLL exercise, the deadlift. The LM thickness was measured using rehabilitative ultrasound imaging (RUSI), at baseline and after a 2-month training period.RESULTS:There were no differences between interventions regarding effect on LM muscle thickness. However, the analysis showed a significant effect for asymmetry. The thickness of the LM muscle on the small side increased significantly compared with the large side in both intervention groups, without influence of pain at baseline, or change in pain intensity.CONCLUSION:At baseline, there was a difference in thickness of the LM muscles between sides. It seems that exercises focusing on spinal alignment may increase the thickness of the LM muscles on the small side, irrespective of exercise load. The increase in LM thickness does not appear to be mediated by either current pain intensity or the magnitude of change in pain intensity.
|
|
| 11. |
- Berglund, Lars, et al.
(författare)
-
Effects of low-load motor control exercises and a high-load lifting exercise on lumbar multifidus thickness : a randomized controlled trial
- 2017
-
Ingår i: Spine. - : Wolters Kluwer. - 0362-2436 .- 1528-1159. ; 42:15, s. E876-E882
-
Tidskriftsartikel (refereegranskat)abstract
- Study Design: Randomized controlled trialObjective: The aim of this study was to compare the effects of low-load motor control exercises and a high-load lifting exercise on lumbar multifidus thickness among patients with nociceptive mechanical low back pain.Summary of Background Data: There is evidence that patients with low back pain may have a decreased size of the lumbar multifidus muscles with an asymmetry between left/right sides in the lower back. It has also been shown that low-load motor control training can affect this asymmetry; essentially, it is effective in equalizing side differences in lumbar multifidus muscle size. It is, however, not known whether a high-load exercise has the same effect.Methods: Sixty-five participants diagnosed with nociceptive mechanical low back pain were included and randomized into low-load motor control exercises or a high-load lifting exercise, the deadlift. The lumbar multifidus thickness at the fifth lumbar vertebra was measured, using rehabilitative ultrasound imaging, at baseline and after a 2-month training period.Results: There were no differences between interventions regarding effect on lumbar multifidus muscle thickness. However, the linear mixed model analysis showed a significant effect for asymmetry. The thickness of the lumbar multifidus muscle on the small side increased significantly compared to the large side in both intervention groups.Conclusions: There was a difference in thickness of the lumbar multifidus muscles between sides. It seems that exercises focusing on spinal alignment may increase the thickness of the lumbar multifidus muscles on the small side, irrespective of exercise load.
|
|
| 12. |
- Berglund, Lars, et al.
(författare)
-
Sagittal lumbopelvic alignment in patients with low back pain and the effects of a high-load lifting exercise and individualized low-load motor control exercises : a randomized controlled trial
- 2018
-
Ingår i: The spine journal. - : Elsevier. - 1529-9430 .- 1878-1632. ; 18:3, s. 399-406
-
Tidskriftsartikel (refereegranskat)abstract
- Background Context Assessment of posture and lumbopelvic alignment is often the main focus in the classification and treatment of patients with low back pain (LBP). However, little is known regarding the effects of motor control interventions on objective measures of lumbopelvic alignment.Purpose The primary aim of this study was to describe the variation of sagittal lumbopelvic alignment in patients with nociceptive mechanical LBP. The secondary aim was to compare the effects of a high-load lifting exercise (HLL) and low-load motor control exercises (LMC) on the change in lumbopelvic alignment with a special emphasis on patients with high and low degrees of lumbar lordosis (lu) and sacral angle (sa).Study Design This study is a secondary analysis of a randomized controlled trial evaluating the effects of HLL and LMC.Patient Sample Patients from the primary study, that is, patients categorized with nociceptive mechanical LBP, who agreed to participate in the radiographic examination were included (n=66).Outcome Measures Lateral plain radiographic images were used to evaluate lumbopelvic alignment regarding the lumbar lordosis and the sacral angle as outcomes, with posterior bend as an explanatory variable.Materials and Methods The participants were recruited to the study from two occupational health-care facilities. They were randomized to either the HLL or the LMC intervention group and offered 12 supervised exercise sessions. Outcome measures were collected at baseline and following the end of intervention period 2 months after baseline. Between- and within-group analyses of intervention groups and subgroups based on the distribution of the baseline values for the lumbar lordosis and the sacral angle, respectively (LOW, MID, and HIGH), were performed using both parametric and non-parametric statistics.Results The ranges of values for the present sample were 26.9–91.6° (M=59.0°, standard deviation [SD]=11.5°) for the lumbar lordosis and 18.2–72.1° (M=42.0°, SD=9.6°) for the sacral angle. There were no significant differences between the intervention groups in the percent change of eitheroutcome measure. Neither did any outcome change significantly over time within the intervention groups. In the subgroups, based on the distribution of respective baseline values, LOWlu showed a significantly increased lumbar lordosis, whereas HIGHsa showed a significantly decreased sacral angle following intervention.Conclusions This study describes the wide distribution of values for lumbopelvic alignment for patients with nociceptive mechanical LBP. Further research is needed to investigate subgroups of other types of LBP and contrast findings to those presented in this study. Our results also suggest that retraining of the lumbopelvic alignment could be possible for patients with LBP.
|
|
| 13. |
- Berglund, Lars, et al.
(författare)
-
Styrketräning som behandling vid långvariga ländryggsbesvär
- 2017
-
Ingår i: Fysioterapi. - Stockholm : Fysioterapeuterna. - 1653-5804. ; :4, s. 28-33
-
Forskningsöversikt (övrigt vetenskapligt/konstnärligt)abstract
- Fysisk träning är viktigt för en god hälsa och fungerar även som behandlingsform vid många sjukdomar, så även ländryggsbesvär. Styrketräning har visat sig vara en mer effektiv träningsform än till exempel aerob träning vid behandling av långvariga ländryggsbesvär. I dagsläget finns det ingen konsensus kring vilket det mest effektiva styrketräningsupplägget kan vara. Den vanligaste designen av styrketräningsprogram vid ländryggsbesvär tycks vara ett upplägg med syftet att förbättra styrkan/uthålligheten av ryggsträckarmuskulaturen och därigenom uppnå smärtlindring och funktionsförbättring. I en studie från Umeå universitet och Luleå tekniska universitet har träning av marklyft för patienter med långvariga ländryggsbesvär utvärderats. Marklyftsträningen förväntades öka deltagarnas bålstyrka samtidigt som den fokuserade på förbättring av rörelsekontroll kring såväl höft som ländrygg. När den åtta veckor långa träningsperioden var slut, visade det sig att gruppen som tränat marklyft hade ökat sin bålstyrka, minskat smärta, ökat funktionsförmåga och hälsorelaterad livskvalitet i samma omfattning som gruppen som tränade individanpassad träning av rörelsekontroll. Men de hade inte förbättrats lika mycket gällande rörelsekontroll eller vardagsfunktion. Vidare forskning pågår vid Umeå universitet om skador i samband med tung styrketräning samt lyftteknikens betydelse för skador och besvär vid tung styrketräning.
|
|
| 14. |
- Berglund, Lars, et al.
(författare)
-
Which patients with low back pain benefit from deadlift training?
- 2015
-
Ingår i: Journal of Strength and Conditioning Research. - 1064-8011 .- 1533-4287. ; 29:7, s. 1803-1811
-
Tidskriftsartikel (refereegranskat)abstract
- Recent studies have indicated that the deadlift exercise may be effective in decreasing pain intensity and increasing activity for most, but not all, patients with a dominating mechanical low back pain pattern. This study aimed to evaluate which individual factors measured at baseline could predict activity, disability, and pain intensity in patients with mechanical low back pain after an 8-week training period involving the deadlift as a rehabilitative exercise. Thirty-five participants performed deadlift training under the supervision of a physical therapist with powerlifting experience. Measures of pain-related fear of movement, hip and trunk muscle endurance and lumbopelvic movement control were collected at baseline. Measures of activity, disability and pain intensity were collected at baseline and at follow-up. Linear regression analyses were used to create models to predict activity, disability and pain intensity at follow-up. Results showed that participants with less disability, less pain intensity and higher performance on the Biering-Sørensen test, which tests the endurance of hip and back extensor muscles, at baseline benefit from deadlift training. The Biering-Sørensen test was the strongest predictor since it was included in all predictive models. Pain intensity was the next best predictor as it was included in two predictive models. Thus, for strength and conditioning professionals who use the deadlift as a rehabilitative exercise for individuals with mechanical low back pain, it is important to ensure that clients have sufficient back extensor strength and endurance and a sufficiently low pain intensity level to benefit from training involving the deadlift exercise.
|
|
| 15. |
- Berglund, Lars, et al.
(författare)
-
Which patients with persistent mechanical low back pain will respond to high load motor control training?
- 2011
-
Ingår i: Physiotherapy. - 0031-9406 .- 1873-1465. ; 97:Suppl. 1, s. eS124-eS125
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of this study was to explore variables influencing success or failure of eight weeks of high load motor control training with the conventional deadlift exercise.Relevance: Researching viable exercises for rehabilitation of specific sub-groups of persistent low back pain is relevant for physical therapists in order to develop tailored treatment regimes for patients with persistent low back pain. This study contributes to this research by exploring which variables characterize the ideal patient for the conventional deadlift exercise.Participants: Thirty-five patients with persistent mechanical low back pain were recruited consecutively from two occupational health care services in Umeå, Sweden . Inclusion and exclusion criteria were designed to include patients with persistent mechanical low back pain.Methods: The study design was a prospective cohort study. The intervention consisted of eight weeks of training with the conventional deadlift exercise. To discriminate between patients with a successful or failed outcome of treatment, change in the patient-specific functional scale was used and a cut-off at 50 % improvement was set. Possible predictive variables collected at baseline included physical activity level, pain intensity (Visual Analogue Scale), activity limitation (the Roland and Morris Disability Questionnaire and the Patient-Specific Functional Scale), kinesiophobia (Tampa Scale of Kinesiophobia), specific anamnestic questions regarding patients' history and symptoms of low back pain, test of active movement control of the low back, trunk muscle endurance(Prone bridge test, Side-bridge test, Biering-Sörensen test) and lift strength (static two-hand lift test), two-point discrimination of the low back and ultrasound imaging of the mm. multifidi.Analysis: Student´s T-test for normally distributed continuous data, Mann Whitney for non-normally distributed continuous data and chi-square tests or Fisher´s Exact tests for categorical variables were used for analyses of differences between the success and the failure group.Results: No significant differences between groups were found in background, anamnestic or physical performance variables. After eight weeks of training, 15 patients (43 %) were categorized as treatment success and 20 patients (57 %) were categorized as treatment failure according to the cut-off set for the PSFS. The patients reported difficulty in performing a wide variation of activities, ranging from not being able to sit for longer than 15 minutes, to stand upright and watch their children play football games, and to not being able to run long distances, play football or perform different lifting tasks.Conclusions: We conclude that the conventional deadlift exercise may be considered a possible exercise to improve patients' activity limitations, if administered by a therapist experienced in resistance training and analyzing movement patterns. However, further research is needed to explore which variables can define patients in the successful and in the failure group, respectively.Implications: The results of this study imply that the conventional deadlift exercise can be used in treatment of patients with mechanical low back pain in order to increase activity limitation. However, it is still unclear on what grounds treatment with the conventional deadlift exercise is indicated to achieve these results.
|
|
| 16. |
|
|
| 17. |
|
|
| 18. |
- Michaelson, Peter, et al.
(författare)
-
High load lifting exercise and low load motor control exercises as interventions for patients with mechanical low back pain : a randomized controlled trial with 24-month follow-up
- 2016
-
Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 48:5, s. 456-463
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to compare the effects of a high load lifting exercise with low load motor control exercises on pain intensity, disability and health-related quality of life for patients with mechanical low back pain. Design: A randomized controlled trial. Subjects: Patients with mechanical low back pain as their dominating pain mechanism. Methods: The intervention programme consisted of a high load lifting exercise, while the control group received low load motor control exercises over 8 weeks (12 sessions) with pain education included in both intervention arms. The primary outcome was pain intensity and disability, and the secondary outcome was health-related quality of life. Results: Each intervention arm included 35 participants, analysed following 2-, 12- and 24-month follow-up. There was no significant difference between the high load lifting and low load motor control interventions for the primary or secondary outcome measures. Between 50% and 80% of participants reported a decrease in perceived pain intensity and disability for both short-and long-term follow-up. Conclusion: No difference was observed between the high low load lifting and low load motor control interventions. Both interventions included retraining of movement patterns and pain education, which might explain the positive results over time.
|
|
| 19. |
- Sandlund, Jonas, et al.
(författare)
-
Classification accuracy of motor control tests of the lumbar spine for subgroups of mechanical low back pain
- 2012
-
Ingår i: Journal of Orthopaedic and Sports Physical Therapy. - : Journal of Orthopaedic & Sports Physical Therapy (JOSPT). - 0190-6011 .- 1938-1344. ; 42:10, s. A57-A57
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To investigate the classification accuracy of motor control testsof the lumbar spine in discriminating 5 subgroups of peripherally mediated mechanical low back pain (LBP) suggested in the classification system developed by Peter O’Sullivan.RELEVANCE: Identifying clinically relevant subgroups is considered a prioritized area of LBP research. The current study addresses the issue of using accurate, reliable, and standardized tests to guide such classifications.METHODS: Seventy subjects with nonspecific LBP were classified by anexpert clinician into 5 subgroups based on the direction of motor control impairment and the assumed mechanism underlying the pain disorder (ie, flexion, lateral shift, active extension, passive extension, andmultidirectional pattern). Thereafter, 5 standardized tests of motor control were performed under the supervision of 2 therapists blinded tothe subgroup classification: “waiters bow,” bilateral and unilateral sitting knee extension, and bilateral and unilateral prone knee flexion. Alack of ability to prevent a compensatory movement (motion give) when instructed to maintain neutral lumbar posture was judged as test failure. Multinomial logistic regression was used to analyze the association between tests and subgroups and to determine the tests’ joint classification accuracy.RESULTS: The motor control tests showed significant associations to thedifferent subgroups (χ2 = 37.08, P = .002, Nagelkerke pseudo R2 = 0.431)and displayed significant discriminative ability, increasing the classification accuracy substantially, 95% above chance level overall, and for allsubgroups except for the multidirectional pattern. The different subgroups were characterized by different association patterns, indicating different tests to be important for different subgroups.CONCLUSIONS AND CLINICAL IMPLICATIONS: The results indicate a clinical utility of the motor control tests and suggest them to be useful to supplement in subgroup classification of what traditionally have been considered nonspecific mechanical LBP. The findings also support the clinical validity of the approach to subgroup patients according to the direction of motorcontrol impairment.
|
|
| 20. |
- Berg, Johanna, et al.
(författare)
-
OpenChart-SE: A corpus of artificial Swedish electronic health records for imagined emergency care patients written by physicians in a crowd-sourcing project
- 2023
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Electronic health records (EHRs) are a rich source of information for medical research and public health monitoring. Information systems based on EHR data could also assist in patient care and hospital management. However, much of the data in EHRs is in the form of unstructured text, which is difficult to process for analysis. Natural language processing (NLP), a form of artificial intelligence, has the potential to enable automatic extraction of information from EHRs and several NLP tools adapted to the style of clinical writing have been developed for English and other major languages. In contrast, the development of NLP tools for less widely spoken languages such as Swedish has lagged behind. A major bottleneck in the development of NLP tools is the restricted access to EHRs due to legitimate patient privacy concerns. To overcome this issue we have generated a citizen science platform for collecting artificial Swedish EHRs with the help of Swedish physicians and medical students. These artificial EHRs describe imagined but plausible emergency care patients in a style that closely resembles EHRs used in emergency departments in Sweden. In the pilot phase, we collected a first batch of 50 artificial EHRs, which has passed review by an experienced Swedish emergency care physician. We make this dataset publicly available as OpenChart-SE corpus (version 1) under an open-source license for the NLP research community. The project is now open for general participation and Swedish physicians and medical students are invited to submit EHRs on the project website (https://github.com/Aitslab/openchart-se). Additional batches of quality-controlled EHRs will be released periodically.
|
|
| 21. |
|
|
| 22. |
- Tegern, Matthias, et al.
(författare)
-
Inter-rater and test-retest reliability of movement control tests for the neck, shoulder, thoracic, lumbar, and hip regions in military personnel
- 2018
-
Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:9
-
Tidskriftsartikel (refereegranskat)abstract
- Strategies are needed to mitigate the high rates and related risks of musculoskeletal complaints and injuries (MSCI) in the military aviator community. Previous work on Swedish Armed Forces (SwAF) soldiers have shown that proper screening methods have been successful in reducing early discharge from military training. Research has pointed at the importance of optimal spinal movement control in military aviators. The aim of this work was to investigate the inter-rater and test-retest reliability of a battery of clinical tests for evaluating movement control in the neck, shoulders, thoracic, lumbar, and hip regions in a population of SwAF military personnel. Inter-rater and test-retest reliability of 15 movement control tests were assessed by crude and prevalence-adjusted kappa coefficient. The study included 37 (inter-rater) and 45 (test-retest) SwAF personnel and was performed with two physiotherapists simultaneously observing and rating the movements on the first occasion and repeated with one physiotherapist on the second occasion. For inter-rater reliability, the kappa coefficient ranged from .19 to .95. Seven tests showed substantial to almost perfect agreement (kappa > .60). With the adjusted kappa, three more tests reached the level of substantial agreement. The corresponding values for test-retest reliability ranged from .26 to .65. Substantial agreement was attained for two tests, three with adjusted kappa. The following tests can reliably be used when screening for biomechanically less advantageous movement patters in military aviators: Shoulder flexion, and rotation, Neck flexion in sitting and supine, Neck extension and rotation in sitting, Pelvic tilt, Forward lean and Single and Double knee extension tests. Grading criteria for tests in supine and quadruped positions need to be further elaborated.
|
|
| 23. |
- Tegern, Matthias, et al.
(författare)
-
Musculoskeletal disorders and their associations with health- and work-related factors : a cross-sectional comparison between Swedish air force personnel and army soldiers
- 2020
-
Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 21:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The high numbers of musculoskeletal disorders (MSD) among soldiers in the Swedish Armed Forces has led to the implementation of an effective prevention program, the musculoskeletal screening protocol (MSP), including questionnaires, physical tests and individual intervention of their MSD. A corresponding MSP for the Swedish Air Force is also needed due to earlier reported high prevalence of MSD. We therefore investigated the prevalence of MSD in Swedish Air Force personnel (AF) and compared this to Swedish Army deployed soldiers (DS). Individual, health- and work-related factors associated with MSD were also investigated.METHODS: Cross-sectional questionnaire-based study on 166 male AF and 185 DS. AF consisted of fighter pilots, helicopter pilots and rear crew from one Swedish air base.RESULTS: The one-year and point prevalence, respectively, of MSD were significantly higher for AF compared to DS with regard to both the upper quarter of the body (i.e. neck, shoulder and thoracic regions) (AF = 54.8 and 31.3%, DS = 26.1 and 13.6%, p = 0.01) and the lumbar region (AF = 38.0 and 18.7%, DS = 22.2 and 7.1%, p = 0.00). No significant differences were present between fighter pilots, helicopter pilots and rear crew regarding MSD prevalence. Factors significantly associated with having both upper quarter and lumbar regions MSD were group (i.e. greater odds for AF than DS) and self-reported physical health as less than excellent. Additionally, being older and taller were also factors associated with lumbar region MSD.DISCUSSION: Despite a generally healthy lifestyle, MSD were commonly reported by AF and DS, with generally higher prevalence in AF who mainly reported MSD in the upper quarter of the body. The results from this study indicate that the MSP can be a meaningful tool to prevent MSD in air force personnel and that questions regarding general health and MSD in specific body regions should be included in screening protocols. The development of the preventive program MSP is therefore recommended for the Swedish Air Force.
|
|
| 24. |
- Tegern, Matthias, 1982-
(författare)
-
Musculoskeletal disorders in Swedish military aircrew : screening and clinical examination of the cervico-thoracic region
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Musculoskeletal disorders (MSD) are a common and growing occupational problem in military aircrew. Intervention studies attempting to reduce such issues have only showed limited preventive effects. Furthermore, in-depth knowledge of the clinical presentation of aircrew members with painful episodes is lacking. This thesis was conducted to add evidence to the ongoing work of the Swedish Armed Forces (SAF) for the prevention of MSD. The overall aim of this thesis was to estimate the occurrence of MSD in general and specifically cervico-thoracic pain and its associated factors among SAF aircrew and to evaluate clinically relevant tests, prior to the adaptation of a musculoskeletal screening protocol (MSP) for use in the SAF medical health care system. All participants included in the four studies of this thesis were employed in the SAF. Two cross-sectional studies (Study I; n=351, Study III; n=73) aimed to establish the occurrence of MSD in aircrew compared with army deployed soldiers (Study I) and between fighter pilots, helicopter pilots and rear crew (Study I), as well as identify associated factors of cervical, thoracic and shoulder region pain (Study I) and cervico-thoracic pain (Study III). Study II had a test-retest design and aimed to examine inter-rater (n=37) and test-retest (n=45) reliability of movement control tests. In study III, test performance was compared between fighter pilots, helicopter pilots and rear crew. Study IV had a cross-sectional (n=18) and a prospective observational cohort (n=47) design and aimed to explore physical symptoms and functional limitations in aircrew with cervico-thoracic pain, establish 12-month cumulative incidence and to identify risk factors for cervico-thoracic pain.The main findings of this thesis were that when compared to deployed soldiers, military aircrew reported higher prevalence of MSD in the cervical, thoracic, shoulder, and lumbar regions (80% reported at least one painful area during the previous year). Working as aircrew, and a lower rating of one’s physical health, were significantly associated with pain in the cervical, thoracic and shoulder regions (Study I). Two physical therapists could reliably rate movement patterns for the majority of movement control tests in the affected areas. Lower reliability was however seen for test-retest conditions (Study II). Movement control and measures of cervical range of motion (ROM), but not cervical strength and endurance, were associated with cervico-thoracic pain among military aircrew. Specifically, less control of both neck and lumbar flexion movements, and lesser cervical flexion ROM were associated with cervico-thoracic pain. Differences were found between fighter pilots, helicopter pilots and rear crew for lumbar flexion movement control and cervical lateral flexion ROM (Study III). Physical symptoms and functional impairments of aircrew with high (pain) intensity, flight-elicited and work-affecting cervico-thoracic pain showed an individual presentation. Previous pain episodes, lesser cervical flexion ROM, and lesser cervical flexor muscle endurance were identified as risk factors for future cervico-thoracic pain, which had a 12-month cumulative incidence of 23% (Study IV).Findings from this thesis strongly indicate that MSD in SAF aircrew is an occupational problem that need to be solved. The cervico-thoracic region was especially common in SAF aircrew. Movement control can reliably be assessed, but with less stability for repeated measures. While pain history and physical performance can to some degree be used to identify aircrew at risk for further cervico-thoracic pain, the clinical presentation of their physical symptoms showed individual presentation. The effects of implementing the MSP in the SAF as a primary and secondary preventive intervention, as well as rehabilitative strategies, need be systematically evaluated.
|
|
