| 1. |
- Borg, Jorgen, et al.
(författare)
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RATIONALE AND DESIGN OF A MULTICENTRE, DOUBLE-BLIND, PROSPECTIVE, RANDOMIZED, EUROPEAN AND CANADIAN STUDY: EVALUATING PATIENT OUTCOMES AND COSTS OF MANAGING ADULTS WITH POST-STROKE FOCAL SPASTICITY
- 2011
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Ingår i: JOURNAL OF REHABILITATION MEDICINE. - : Foundation for Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 43:1, s. 15-22
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This report describes the design of a study aiming to provide evidence for the extended use of botulinum toxin A (BOTOX(R), Allergan Inc.) in focal post-stroke upper and lower limb spasticity and to evaluate the impact of incorporating botulinum toxin A treatment into the rehabilitation of patients with spasticity. Design: International, prospective, randomized, double-blind, placebo-controlled study with an open-label extension. Methods: Approximately 300 adults with a stroke occurring 23 months before screening, presenting with symptoms and signs of an upper motor neuron syndrome and focal spasticity-related functional impairment, were randomized to botulinum toxin A+standard care or placebo+standard care. Study medication was administered at baseline and again at Week 12 if required, with follow-up to 52 weeks. The primary endpoint was the number of patients who achieved their investigator-rated principal active functional goal (as measured by Goal Attainment Scaling), at 10 weeks after the second injection (Weeks 22-34) or at the 24-week visit if no second injection was administered. Secondary endpoints included changes from baseline in level of goal achievement, health-related quality of life and resource utilization. Conclusion: The BOTOX(R) Economic Spasticity Trial (BEST) will provide information regarding clinical and cost-effectiveness of botulinum toxin+standard care vs standard care alone in patients with upper and/or lower limb post-stroke spasticity typically seen in clinical practice.
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| 2. |
- Ertzgaard, Per, 1958-, et al.
(författare)
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Oculomotor screening and neuro-visual rehabilitation following pediatric brain tumor resection
- 2023
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Ingår i: Journal of Pediatric Rehabilitation Medicine. - : Ios press. - 1874-5393 .- 1875-8894. ; , s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- Visual difficulties are common after brain tumors, despite a lack of visual complaints at diagnosis. These include difficulties with eye movements, visual coordination, vergence, accommodation, and photophobia, in addition to more obvious problems such as visual field defects.This case report presents the results of a thorough neuro-visual evaluation in a boy with sequelae after a brain tumor including intermittent double vision that was not explained by routine visual examination. Subjective complaints included poor reading perseverance, intermittent blurred and double vision, headache around the eyes when performing near activities, less efficient eye movement behavior in reading tasks, and increased sensitivity to visual motion. The patient participated in a multidisciplinary visual rehabilitation program that included reading glasses with prism compensation and tinted glasses, as well as training with the aim of improving eye teaming, near vision functions, and perseverance in eye movements.The patient responded quickly to the vision therapy program, with positive changes after just four weeks. Repeated neuro-visual evaluations over eight months showed remarkable improvements that were stable over time. This encouraging case report supports the notion that neuro-visual evaluation and rehabilitation should be included in the follow-up of patients after brain tumors.
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| 3. |
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| 4. |
- Budh Norrbrink, Cecilia, et al.
(författare)
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Pain in a Swedish spinal cord injury population
- 2003
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Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 17:6, s. 685-690
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe pain and associated variables in a prevalence group of persons with a sustained spinal cord injury (SCI) in the Swedish capital and its surroundings. Setting: Spinalis SCI Unit (outpatient clinic), Stockholm, Sweden. Design: Assessment over a 12-month period in a yearly health control. Subjects: Four hundred and fifty-six SCI patients. Results: Two hundred and ninety-one out of 456 SCI patients (63.7%) suffered from pain, and in 45.7% of these it was classified as being neurogenic. Aching pain was the most used descriptor (38.5%). The onset of pain was commonly within three months (73.5%). In 70.4% of patients pain occurred below the level of the lesion. Most patients identified pain as coming from one (55.0%) or two (28.2%) body regions. Rating of the general pain intensity on a visual analogue scale (VAS) was 46 out of 100 and rating of the worst pain intensity was 78 out of 100. Ninety-four out of 276 patients (32.3%) considered that their quality of life was significantly affected by pain. Conclusion: Pain was most common in patients with incomplete lesions (ASIA impairment grade D) and there was a correlation between pain and higher mean age at injury and between pain and female gender.
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| 5. |
- Ehrmann, Cristina, et al.
(författare)
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IMPACT OF SPASTICITY ON FUNCTIONING IN SPINAL CORD INJURY: AN APPLICATION OF GRAPHICAL MODELLING
- 2020
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Ingår i: Journal of Rehabilitation Medicine. - : FOUNDATION REHABILITATION INFORMATION. - 1650-1977 .- 1651-2081. ; 52:3
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To identify the impact of moderate-to-severe spasticity on functioning in people living with spinal cord injury. Design: Secondary analysis of cross-sectional survey data using graphical modelling. Subjects: Individuals (n= 1,436) with spinal cord injury aged over 16 years with reported spasticity problems. Methods: Spasticity and 13 other impairments in body functions were assessed using the spinal cord injury Secondary Conditions Scale. Impairments in mental functions were assessed using the Mental Health subscale of the 36-item Short Form (SF-36). Independence in activities was measured with the Spinal Cord Injury Independence Measure Self-Report. Restrictions in participation were measured with the Utrecht Scale for Evaluation Rehabilitation - Participation. Results: Fifty-one percent of participants reported moderate-to-severe spasticity. Graphical modelling showed that Chronic pain, Contractures, Tiredness, Doing housework, and Respiratory functions were associated with spasticity and were the top 5 potential targets for interventions to improve the experience of spasticity. The associations and intervention targets were dependent on the level and completeness of the lesion. Conclusion: This is the first application of graphical modelling in studying spasticity in people living with spinal cord injury. The results can be used as a basis for studies aiming to optimize rehabilitation interventions in people with moderate-to-severe spasticity.
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| 6. |
- Ertzgaard, Per, et al.
(författare)
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A new way of assessing arm function in activity using kinematic Exposure Variation Analysis and portable inertial sensors - A validity study
- 2016
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Ingår i: Manual Therapy. - : Elsevier BV. - 1356-689X .- 1532-2769. ; 21, s. 241-249
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Tidskriftsartikel (refereegranskat)abstract
- Portable motion systems based on inertial motion sensors are promising methods, with the advantage compared to optoelectronic cameras of not being confined to a laboratory setting. A challenge is to develop relevant outcome measures for clinical use. The aim of this study was to characterize elbow and shoulder motion during functional tasks, using portable motion sensors and a modified Exposure Variation Analysis (EVA) and evaluate system accuracy with optoelectronic cameras. Ten healthy volunteers and one participant with sequel after stroke performed standardised functional arm tasks. Motion was registered simultaneously with a custom developed motion sensor system, including gyroscopes and accelerometers, and an optoelectronic camera system. The EVA was applied on elbow and shoulder joints, and angular and angular velocity EVA plots was calculated. The EVA showed characteristic patterns for each arm task in the healthy controls and a distinct difference between the affected and unaffected arm in the participant with sequel after stroke. The accuracy of the portable system was high with a systematic error ranging between -1.2 degrees and 2.0 degrees. The error was direction specific due to a drift component along the gravity vector. Portable motion sensor systems have high potential as clinical tools for evaluation of arm function. EVA effectively illustrates joint angle and joint angle velocity patterns that may capture deficiencies in arm function and movement quality. Next step will be to manage system drift by including magnetometers, to further develop clinically relevant outcome variables and apply this for relevant patient groups.
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| 7. |
- Ertzgaard, Per, et al.
(författare)
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A review and evaluation of patient-reported outcome measures for spasticity in persons with spinal cord damage: Recommendations from the Ability Network - an international initiative
- 2020
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Ingår i: Journal of Spinal Cord Medicine (JSCM). - : TAYLOR & FRANCIS LTD. - 1079-0268 .- 2045-7723. ; 43:6, s. 813-823
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Forskningsöversikt (refereegranskat)abstract
- Context: Patient-reported outcome measures (PROMs) are valuable for capturing the impact of spasticity on health-related quality of life (HRQoL) in persons with spinal cord damage (SCD) and evaluating the efficacy of interventions. Objective: To provide practical guidance for measuring HRQoL in persons with spasticity following SCD. Methods: Literature reviews identified measures of HRQoL and caregiver burden, utilized in studies addressing spasticity in SCD. Identified measures were evaluated for clinical relevance and practicality for use in clinical practice and research. The PRISM, SCI-SET, EQ-5D and SF-36 instruments were mapped to the International Classification of Functioning, Disability and Health (ICF). The PRISM and SCI-SET were evaluated using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Results: Two spasticity-specific, five generic, and four preference-based measures were identified. ICF mapping and the COSMIN checklist supported the use of the PRISM and SCI-SET in SCD. The SF-36 is considered the most useful generic measure; disability-adapted versions may be more acceptable but further studies on psychometric properties are required. The SF-36 can be converted to a preference-based measure (SF-6D), or alternatively the EQ-5D can be used. While no measures specific to caregivers of people with SCD were identified, the Caregiver Burden Scale and the Zarit Burden Interview are considered suitable. Conclusion: Recommended measures include the PRISM and SCI-SET (condition-specific), SF-36 (generic), and Caregiver Burden Scale and Zarit Burden Interview (caregiver burden). Consideration should be given to using condition-specific and generic measures in combination; the PRISM or SCI-SET combined with SF-36 is recommended.
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| 8. |
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| 9. |
- Ertzgaard, Per, 1958-, et al.
(författare)
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EFFICACY AND SAFETY OF ORAL BACLOFEN IN THE MANAGEMENT OF SPASTICITY: A RATIONALE FOR INTRATHECAL BACLOFEN
- 2017
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Ingår i: Journal of Rehabilitation Medicine. - : FOUNDATION REHABILITATION INFORMATION. - 1650-1977 .- 1651-2081. ; 49:3, s. 193-203
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Forskningsöversikt (refereegranskat)abstract
- Oral baclofen has long been a mainstay in the management of spasticity. This review looks at the clinical evidence for the efficacy and safety of oral baclofen in patients with spasticity of any origin or severity, to determine whether there is a rationale for the use of intrathecal baclofen. Results suggest that oral baclofen may be effective in many patients with spasticity, regardless of the underlying disease or severity, and that it is at least comparable with other antispasmodic agents. However, adverse effects, such as muscle weakness, nausea, somnolence and paraesthesia, are common with oral baclofen, affecting between 25% and 75% of patients, and limiting its usefulness. Intrathecal baclofen may be an effective alternative as the drug is delivered directly into the cerebrospinal fluid, thus bypassing the blood-brain barrier and thereby optimizing the efficacy of baclofen while minimizing drug-related side-effects. Intrathecal baclofen is a viable option in patients who experience intolerable side-effects or who fail to respond to the maximum recommended dose of oral baclofen.
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| 10. |
- Ertzgaard, Per, et al.
(författare)
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Evaluation of a self-administered transcutaneous electrical stimulation concept for the treatment of spasticity: a randomised placebo-controlled trial.
- 2018
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Ingår i: European Journal of Physical and Rehabilitation Medicine. - : Edizioni Minerva Medica. - 1973-9087 .- 1973-9095. ; 54:4, s. 507-17
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Spasticity is a common consequence of injury to the central nervous system negatively affecting patient’s everyday activities. Treatment mainly consists of training and different drugs, often with side effects. There is a need for treatment options that can be performed by the patient in their home environment.AIM: The objective of this study was to assess the effectiveness of an assistive technology (AT), Mollii®, a garment with integrated electrodes for multifocal transcutaneous electrical stimulation intended for self-treatment of spasticity, in study participants with spasticity due to stroke or CP.DESIGN: The study was a randomized, controlled, double-blind study with a cross-over design.SETTING: Participants were recruited from two rehabilitation clinics. Treatments were performed in participants’ homes and all follow-ups were performed in the two rehabilitation clinics.POPULATION: Thirty-one participants were included in the study and 27 completed the study. Four participants discontinued the study. Two declined participation before baseline and two withdrew due to problems handling the garment.METHODS: Participants used the AT with and without electrical stimulation (active/non-active period) for six weeks each, followed by six weeks without treatment. Goal Attainment Scaling (GAS), change in mobility, arm-hand ability, spasticity and pain were measured at baseline and after 6, 12 and 18 weeks.RESULTS: Fifteen of the 27 participants fulfilled the treatment protocol in terms of recommended use. Deviations were frequent. No statistically significant differences in outcome were found between the active and the non-active treatment periods. During the active period, an improvement was seen in the 10-meter comfortable gait test, time and steps. An improvement was seen in both the active and non-active periods for the GAS.CONCLUSIONS: Compliance was low, partly due to deviations related to the garment, complicating the interpretation of the results. Further research should focus on identifying the target population and concomitant rehabilitation strategies.CLINICAL REHABILITATION IMPACT: The evaluated concept of multifocal transcutaneous electrical stimulation (TES) represents an interesting addition to the existing repertoire of treatments to alleviate muscle spasticity. The evaluated concept allows TES to be self-administered by the patient in the home environment. A more elaborate design of training activities directly related to patient’s own rehabilitation goals is recommended and may increase the value of the evaluated concept.
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| 11. |
- Ertzgaard, Per, et al.
(författare)
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PRACTICAL CONSIDERATIONS FOR GOAL ATTAINMENT SCALING DURING REHABILITATION FOLLOWING ACQUIRED BRAIN INJURY
- 2011
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Ingår i: JOURNAL OF REHABILITATION MEDICINE. - : Foundation for Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 43:1, s. 8-14
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Goal attainment scaling represents a unique approach to identifying and quantifying individualized, meaningful treatment outcomes, and its use in the rehabilitation medicine setting is increasing. The aim of this paper is to discuss the available literature for goal attainment scaling in patients with acquired brain injury, in terms of its advantages, disadvantages and practical application, including examples of goal setting and scaling.
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| 12. |
- Ertzgaard, Per, 1958-, et al.
(författare)
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Regional disparities in botulinum toxin A (BoNT-A) therapy for spasticity in Sweden: budgetary consequences of closing the estimated treatment gap
- 2017
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Ingår i: Acta Neurologica Scandinavica. - : WILEY. - 0001-6314 .- 1600-0404. ; 135:3, s. 366-372
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: As no national treatment guidelines for spasticity have been issued in Sweden, different regional treatment practices may potentially occur. This study examines botulinum toxin A (BoNT-A) treatment for spasticity on a regional level in Sweden and presents budgetary consequences of closing the estimated treatment gap. Materials and Methods: Prevalence of spasticity in Sweden was estimated from published data. Regional sales data for BoNT-A were acquired from IMS Health. A set proportion of hospital BoNT-A use was assumed to represent treatment of spasticity. Total intervention cost of BoNT-A treatment was gathered from healthcare regional tariffs, while costs associated with spasticity were derived from publications on multiple sclerosis and stroke. Results: Results show that the regional variation in treatment of spasticity with BoNT-A is large, with approximately every fourth patient being treated in Southern healthcare region compared to every tenth in the Stockholm-Gotland or Western healthcare regions. The incremental cost of filling the reported treatment gap was also assessed and was estimated at around 9.4 million EUR. However, for the incremental cost to be offset by savings in spasticity-related costs, only a small proportion of treatment responders (defined as patients transitioning to a lower severity grade of spasticity) was required (12%). Conclusions: The study revealed apparent regional disparities of BoNT-A treatment for spasticity in Sweden. The results further suggest that the incremental cost of eliminating the treatment gap has a high probability of being offset by savings in direct costs, even at a low proportion of the patients reaching clinical improvement.
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| 13. |
- Ertzgaard, Per, 1958-, et al.
(författare)
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Ryggmärgsskador och ryggmärgsbråck
- 2006. - 1
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Ingår i: Rehabiliteringsmedicin. - Lund : Studenlitteratur. - 9144045077 - 9789144045078 ; , s. 276-287
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Kapitel om rehabiliteringsmedicinens utveckling och nuvarande plats i sjukvården samt begrepp och metodik inleder boken. I två delar ges därefter rehabiliteringsmedicinska aspekter på de dominerande sjukdomsgrupperna - komplexa smärttillstånd respektive skador och sjukdomar i nervsystemet. Som avslutning beskrivs bland annat stressrelaterade tillstånd. Läroboken är avsedd för grundutbildning av läkare, arbetsterapeuter och sjukgymnaster, logopeder samt för läkare under AT-tjänstgöring. Den är också lämplig som introduktion i specialistutbildningen i rehabiliteringsmedicin, geriatrik, neurologi och smärtlindring. Vidareutbildningar av olika vårdyrkesgrupper kan ha nytta av boken och den kan också användas som referenslitteratur av yrkesverksamma med intresse för rehabiliteringsmedicin.
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| 14. |
- Ertzgaard, Per, et al.
(författare)
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Ryggmärgsskador och ryggmärgsbråck
- 2006
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Ingår i: Rehabiliteringsmedicin. - : Studentlitteratur. - 9144045077
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 15. |
- Ertzgaard, Per, 1958-
(författare)
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Studies on Spasticity from an Interventional Perspective
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis focuses on interventional aspects of spasticity, but has a very holistic approach, grounded in the specialty of Rehabilitation medicine. This means capturing the effects of spasticity, on such a complex biological system as the human being, living in a psychosocial context affecting the situation. When evaluating spasticity there are a number of levels of evidence. The first of course, understanding what we mean with spasticity, where there unfortunately is no consensus. The second level is to study if our treatments affect spasticity in a positive direction. The third is to grasp if a decrease in spasticity improve or normalize patient’s movement patterns. The fourth level investigates if improvement in movement patterns improve patient’s ability to perform activities; and the fifth level, comprising whether this intervention improves life satisfaction. Finally, on a societal level, we wish to investigate whether the improvement in life satisfaction or health related quality of life would motivate society to fund the intervention.Paper I on Goal Attainment Scaling pointed out necessary aspects to consider when using this instrument. This relates, among other things, to the need of learning (“the art of”) goal setting and deciding the purpose of the measurements. Research and clinical use puts different demands on the instrument, for the latter time-efficiency and simplicity to use being most important. For research, it is important to be able to register deterioration, and this can be achieved using the 6-step version.In paper II, concerning validation of the portable motion system, we showed this system to be valid for short-term measurements and that the use of Exposure Variation Analysis (EVA) seems to be a valuable tool for graphically elucidating different movements. The equipment needs further development in handling long-term measurements (which is effectuated), and norms for normal movements in different activities has to be produced. The discriminative value of EVA needs confirmation in coming studies. For the future, there is the intriguing possibility of long-term measurements in patients’ every-day life, thereby getting objective measures on how our patients use their abilities, thus capturing the difference between what you can do and what you actually do.The results from paper III demonstrated a large inequality in Sweden regarding the accessibility of BoNT-A treatment for spasticity. We could also show that treatment with BoNT-A is sound from a health-economic perspective, accounting for the uncertainty of data via the sensitivity analysis. For the future, we need to explore if this inequality also exists for other modes of spasticity treatments, e.g. multidisciplinary spasticity treatment and ITB pumps, and in other countries.In paper IV evaluating multifocal TES, the results could not confirm efficacy with the treatment according to the protocol of the manufacturer. The results have to be interpreted with care, as low compliance and frequent adverse events made deduction not captured in the RCT study. Further studies are needed in a number of areas, e.g. what is the optimal stimulation frequency, what patients can gain from the treatment and how should adjunct treatment be organized.In this thesis, I have had the privilege to explore different methods of evaluating spasticity interventions from a multimodal perspective as a starting point in an effort to understand more of this intriguing phenomenon. Some of the research questions above are already in the “pipeline” for coming studies; others are to be planned by our research group and others.
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| 16. |
- Falci, S, et al.
(författare)
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Obliteration of a posttraumatic spinal cord cyst with solid human embryonic spinal cord grafts : first clinical attempt.
- 1997
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Ingår i: Journal of Neurotrauma. - : Mary Ann Liebert Inc. - 0897-7151 .- 1557-9042. ; 14, s. 875-
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Tidskriftsartikel (refereegranskat)abstract
- Cystic lesions of the spinal cord (syringomyelia) may occur after spinal cord injury. Posttraumatic syringomyelia may result in a myelopathy causing symptoms of sensory and motor loss, as well as worsening spasticity, pain, hyperhidrosis, and autonomic dysreflexia. Shunting of the cyst cavity along with untethering of the scarred spinal cord is widely accepted as the treatment of choice. However, the long-term stabilization of the progressive myelopathy caused by a posttraumatic cyst is suboptimal because of arachnoidal rescarring, shunt tube blockage, and cyst reexpansion. A new neurosurgical strategy to overcome the complication of cyst reexpansion was designed. Experimental studies have shown the successful use of embryonic spinal cord grafts, including human grafts, to obliterate induced spinal cord cavities in rats. The authors report the first use of solid human embryonic spinal cord grafts to successfully obliterate 6 cm of a large cyst cavity in a patient becoming myelopathic from a posttraumatic cyst. The grafts are well visualized by MRI to the 7-month postoperative follow-up and cyst obliteration is seen in the region where the grafts were placed.
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| 17. |
- Forsmark, Annabelle, et al.
(författare)
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Inequalities in pharmacologic treatment of spasticity in Sweden : health economic consequences of closing the treatment gap
- 2020
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Ingår i: Health Economics Review. - : BioMed Central (BMC). - 2191-1991. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe Swedish Healthcare Act states that patients should have equal access to healthcare. This study addresses at how this translates to pharmacological treatment of adult spasticity, including injections with botulinum toxin A (BoNT-A) and pumps for intrathecal baclofen (ITB). To address potential economic incentives for treatment differences, the results are also set into a health economic perspective.Thus, the current study provides a detailed and comprehensive overview for informed decision- and policymaking.MethodsBotulinum toxin use was retrieved from sales data. Clinical practice regarding mean BoNT-A treatment dose and proportion used for spasticity indication were validated in five county councils, while the number of ITB pumps were mapped for all county councils. Published costs and quality of life data was used for estimating required responder rates for cost-balance or cost-effectiveness.ResultsThe proportion of patients treated with BoNT-A varied between 5.8% and 13.6% across healthcare regions, with a mean of 9.2% on a national level. The reported number of ITB pumps per 100,000 inhabitants varied between 3.6 and 14.1 across healthcare regions, with a national mean of 6/100,000.The estimated incremental cost for reaching treatment equity was EUR 1,976,773 per year for BoNT-A and EUR 3,326,692 for ITB pumps. Based on expected cost-savings, responder rates ranging between 4% and 15% cancelled out the incremental cost for BoNT-A. Assuming no cost-savings, responder rates of 14% or 36% was required for cost-effectiveness.ConclusionsThere is a marked variation in pharmacologic treatment of adult spasticity in Sweden. Overall, the results indicate an underuse of treatment and need for harmonisation of clinical practice. Furthermore, the incremental cost for reaching treatment equity is likely to be offset by spasticity-associated cost-savings.
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| 18. |
- Gunnarsson, Stina, et al.
(författare)
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Dosing Patterns In Treatment of Disabling Spasticity With Intrathecal Baclofen
- 2021
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Ingår i: REHABILITATION NURSING. - : Wolters Kluwer. - 0278-4807 .- 2048-7940. ; 46:6, s. 315-322
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of this study was to describe and analyze dosing patterns for patients with ITB treatment over time and to identify possible subgroups demonstrating diversity in patterns.Design: A retrospective design.Methods: For 81 patients from six different hospitals, baclofen doses from the first 2 years of treatment were identified using medical records. Line graphs of each patient's doses were analyzed and grouped based on similarities in dosing pattern.Findings: The analyses of the dosing patterns resulted in four different subgroups classified as stable, slow increase, rapid increase, and fluctuating.Conclusion: The results highlight the clinical challenge of predicting dose development over time.
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| 19. |
- Gunnarsson, Stina, et al.
(författare)
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Experiences from intrathecal baclofen treatment based on medical records and patient- and proxy-reported outcome : a multicentre study
- 2019
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 41:9, s. 1037-1043
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Tidskriftsartikel (refereegranskat)abstract
- Purpose:To investigate patient satisfaction with intrathecal baclofen treatment, complications from the treatment, and the impact of general expectations on treatment outcome in relation to satisfaction.Methods:A multicentre study with cross-sectional design. Data were collected through questionnaires and patient records. Patients were recruited from six outpatient intrathecal baclofen clinics in Sweden. Eighty-three patients who had been treated with intrathecal baclofen for 1-4 years were included. For patients unable to communicate, data were collected through a proxy. The Patient Global Impression of Change was used to measure patients' general satisfaction with change from intrathecal baclofen treatment. The Life Orientation Test - revised, was used to measure general expectations/optimism.Results:General satisfaction with intrathecal baclofen treatment was high; 51/77 patients reported "much improved" or "very much improved." There was no relationship between the two main outcomes (general satisfaction and general expectations/optimism) (r(s) = 0.12, p = 0.382). The two groups; those who could and those who could not communicate, did differ regarding personal characteristics and should be evaluated as such.Conclusions:Most patients/proxies reported a high level of satisfaction with intrathecal baclofen treatment. The reported satisfaction with intrathecal baclofen treatment was not dependent on general expectations.
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| 20. |
- Hofers, Wiebke, et al.
(författare)
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Organisation of services and systems of care in paediatric spinal cord injury rehabilitation in seven countries: a survey with a descriptive cross-sectional design
- 2022
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Ingår i: Spinal Cord. - : SPRINGERNATURE. - 1362-4393 .- 1476-5624. ; 60:4, s. 339-347
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Tidskriftsartikel (refereegranskat)abstract
- Study design International multicentre cross-sectional study. Objectives To describe the organisation and systems of paediatric spinal cord injury (SCI) rehabilitation services in seven countries and compare them with available recommendations and key features of paediatric SCI. Setting Ten SCI rehabilitation units in seven countries admitting children and adolescents with SCI < 18 years of age. Methods An online survey reporting data from 2017. Descriptive and qualitative analysis were used to describe the data. Results The units reported large variations in catchment area, paediatric population and referrals, but similar challenges in discharge policy. Nine of the units were publicly funded. Three units had a paediatric SCI unit. The most frequent causes of traumatic injury were motor vehicle accidents, falls, and sports accidents. Unlike the other units, the Chinese units reported acrobatic dancing as a major cause. Mean length of stay in primary rehabilitation ranged between 18 and 203 days. Seven units offered life-long follow-up. There was a notable variation in staffing between the units; some of the teams were not optimal regarding the interdisciplinary and multiprofessional nature of the field. Eight units followed acknowledged standards and recommendations for specialised paediatric SCI rehabilitation and focused on family-centred care and rehabilitation as a dynamic process adapting to the child and the family. Conclusions As anticipated, we found differences in the organisation and administration of rehabilitation services for paediatric SCI in the ten rehabilitation units in seven countries. This might indicate a need for internationally approved, evidence-based guidelines for specialised paediatric SCI rehabilitation.
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| 21. |
- Jonasson, Lise-Lotte, 1956-, et al.
(författare)
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Patients’ Experiences of Self-Administered Electrotherapy for Spasticity in Stroke and Cerebral Palsy: A Qualitative Study
- 2022
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 54, s. jrm00263-jrm00263
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore patients’ experiences of a self-administered electrotherapy treatment for muscle spasticity in cerebral palsy and stroke; the Exopulse Mollii Suit®. Design: Qualitative design with an inductive approach Subjects: Fifteen patients with spasticity due to stroke or cerebral palsy, participating in a previous randomized controlled trial evaluating the treatment concept.Methods: Information letters were sent to all potential participants (n = 27) in the previous study. Semi-structured interviews (21–57 min) were carried out with all subjects who volunteered (n = 15), administered by an experienced interviewer who was not involved in the previous study. Transcribed interviews were subject to content analysis. Results: The 5 categories that emerged from the content analysis were “New method gives hope”, experiences related to “Using the assistive technology”, “Outcome from training with the assistive technology”, “The assistive technology” and “Taking part in the study”. Respondents felt hopeful when included in the previous study, motivated when experiencing a treatment effect, and disappointed when not. Conclusion: The qualitative approach used in this study elicited complementary information that was not evident from the previous randomized controlled trial. This included statements regarding increased mobility, reduced spasticity, reduced use of medication, and problems related to using the treatment concept.
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| 22. |
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| 23. |
- Levi, Richard, et al.
(författare)
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Förvärvade ryggmärgsskador
- 2015. - 1
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Ingår i: Rehabiliteringsmedicin. - Lund : Studentlitteratur AB. - 9789144101965 ; , s. 375-388
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Rehabiliteringsmedicinsk kunskap är relevant vid alla sjukdomar och skador som medför långvariga, komplexa funktionshinder och är därför relevant inom stora delar av sjukvården. Inom den rehabiliteringsmedicinska specialiteten handläggs idag främst patienter med skador och sjukdomar i nervsystemet respektive med långvariga smärttillstånd.Denna reviderade upplaga inleds med en sektion som avhandlar rehabiliteringsmedicinens utveckling och nuvarande plats i sjukvården, centrala rehabiliteringsmedicinska koncept, mät- och arbetsmetoder. Följande sektioner omfattar rehabiliteringsmedicinsk funktionsdiagnostik, läkningsmekanismer och behandling vid långvariga smärttillstånd respektive vid skador och kroniska sjukdomar i nervsystemet. Bokens omfång har ökat något. Några kapitel har fått större utrymme och nya kapitel om beteendestörning och medicinska komplikationer efter svår hjärnskada liksom om anoxisk hjärnskada har tillkommit. Andra kapitel, som inte rör dagens kärnverksamhet inom praktisk rehabiliteringsmedicin, har utgått.Rehabiliteringsmedicin är avsedd för grundutbildning av läkare, arbetsterapeuter och sjukgymnaster, logopeder samt för läkare under ATtjänstgöring. Den är också lämplig som introduktion i specialistutbildningen i rehabiliteringsmedicin, geriatrik, neurologi och smärtlindring, i vidareutbildningar av olika vårdyrkesgrupper och som referenslitteratur av yrkesverksamma med intresse för rehabiliteringsmedicin.
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| 24. |
- McIntyre, Amanda, et al.
(författare)
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A Systematic Review of the Scientific Literature for Rehabilitation/Habilitation Among Individuals With Pediatric-Onset Spinal Cord Injury
- 2022
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Ingår i: Topics in Spinal Cord Injury Rehabilitation. - : AMER SPINAL INJURY ASSOC. - 1082-0744 .- 1945-5763. ; 28:2, s. 13-90
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Forskningsöversikt (refereegranskat)abstract
- Objectives: To conduct a systematic review to examine the scientific literature for rehabilitation/habilitation among individuals with pediatric-onset spinal cord injury (SCI). Methods: A literature search of multiple databases (i.e., PubMed/MEDLINE, CINAHL, EMBASE, PsychINFO) was conducted and was filtered to include studies involving humans, published as full-length articles up to December 2020, and in English. Included studies met the following inclusion criteria: (1) >= 50% of the study sample had experienced a traumatic, acquired, nonprogressive spinal cord injury (SCI) or a nontraumatic, acquired, noncongenital SCI; (2) SCI onset occurred at <= 21 years of age; and (3) sample was assessed for a rehabilitation/habilitationrelated topic. Studies were assigned a level of evidence using an adapted Sackett scale modified down to five levels. Data extracted from each study included author(s), year of publication, country of origin, study design, subject characteristics, rehabilitation/habilitation topic area, intervention (if applicable), and outcome measures. Results: One hundred seventy-six studies were included for review (1974-2020) with the majority originating from the United States (81.3%). Most studies were noninterventional observational studies (n = 100; 56.8%) or noninterventional case report studies (n = 5; 2.8%). Sample sizes ranged from 1 to 3172 with a median of 26 (interquartile range [IQR], 116.5). Rehabilitation/habilitation topics were categorized by the International Classification of Functioning, Disability and Health (ICF); most studies evaluated ICF Body Function. There were 69 unique clinical health outcome measures reported. Conclusion: The evidence for rehabilitation/habilitation of pediatric-onset SCI is extremely limited; nearly all studies (98%) are level 4-5 evidence. Future studies across several domains should be conducted with novel approaches to research design to alleviate issues related to sample sizes and heterogeneity.
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| 25. |
- Necking, Erik, et al.
(författare)
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Complications of intrathecal drug delivery therapy (ITDD) : A retrospective study of 231 implantations between 1999 and 2014
- 2021
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Ingår i: Clinical neurology and neurosurgery. - : ELSEVIER. - 0303-8467 .- 1872-6968. ; 205
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Determination of types and frequencies of complications related to ITDD therapy, and assessment of possible risk factors for such complications. Methods: Retrospective study (1999-2014) including all ITDD-implantations at one regional center in Sweden. Descriptors comprised: sex; age; medical condition; body weight index; preoperative ASA-grade; presence of indwelling urinary catheters, feeding tubes, and/or daily urinary or anal incontinence; primary or reimplantation; type of pump and catheter; drug delivered; weekday of surgery; surgical procedure time; surgeon; experience of surgeon; surgical theater; and type of antibiotic prophylaxis. All deaths during the study period were assessed as regards possible relation to ITDD. Data were analyzed with SPSS 25, using Chi(2) test for correlations between descriptors and complications. Results: 231 ITDD pump implantations/re-implantations occurred in 159 patients. Seventy-eight (34%) instances of complications were found: 33 catheter-associated; 6 pump-associated; and 29 infection-associated, where 16 were surgical site infections. A higher infection rate occurred in pump re-implantations, as compared to primary implantations (p = 0.002), and in patients with traumatic spinal cord injury (TSCI) as compared to other diagnoses (p = 0.02). Cloxacillin as antibiotic prophylaxis correlated with a higher infection risk (p = 0.005) relative to other antibiotic prophylaxis. Prolonged surgical procedure time in re-implantations correlated positively with increased catheter-associated complications (p = 0.006). Conclusion: Complications in ITDD therapy were common, comprising catheter-, infection-, and pump-associated mishaps. A comprehensive system of care needs to be present for managing complications. Future studies may show less complications due to improved protocols and equipment.
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| 26. |
- Nilsson, Sofie, et al.
(författare)
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Test‐Retest Reliability of Kinematic and Temporal Outcome Measures for Clinical Gait and Stair Walking Tests, Based on Wearable Inertial Sensors
- 2022
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Ingår i: Sensors. - : MDPI. - 1424-8220. ; 22:3
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Tidskriftsartikel (refereegranskat)abstract
- It is important to assess gait function in neurological disorders. A common outcome meas-ure from clinical walking tests is average speed, which is reliable but does not capture important kinematical and temporal aspects of gait function. An extended gait analysis must be time efficient and reliable to be included in the clinical routine. The aim of this study was to add an inertial sensor system to a gait test battery and analyze the test‐retest reliability of kinematic and temporal outcome measures. Measurements and analyses were performed in the hospital environment by physiother-apists using customized software. In total, 22 healthy persons performed comfortable gait, fast gait, and stair walking, with 12 inertial sensors attached to the feet, shank, thigh, pelvis, thorax, and arms. Each person participated in 2 test sessions, with about 3–6 days between the sessions. Kinematics were calculated based on a sensor fusion algorithm. Sagittal peak angles, sagittal range of motion, and stride frequency were derived. Intraclass‐correlation coefficients were determined to analyze the test‐retest reliability, which was good to excellent for comfortable and fast gait, with exceptions for hip, knee, and ankle peak angles during fast gait, which showed moderate reliability, and fast gait stride frequency, which showed poor reliability. In stair walking, all outcome measures except shoulder extension showed good to excellent reliability. Inertial sensors have the potential to improve the clinical evaluation of gait function in neurological patients, but this must be verified in patient groups.
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| 27. |
- Norrbrink Budh, C, et al.
(författare)
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Gender related differences in pain in spinal cord injured individuals.
- 2003
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 41:2, s. 122-8
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Out of a population of 456 patients with spinal cord injuries (SCI), 130 having pain were selected after matching, based on gender, age, American Spinal Injury Association (ASIA) impairment grade and level of lesion.OBJECTIVE: To investigate whether gender differences with regard to pain perception and prevalence exist in a population of patients following spinal cord injury.SETTING: Spinalis SCI Unit (out-patient clinic), Stockholm, Sweden.METHOD: 130 patients suffering from pain were assessed over a 12-month period in a yearly health control.RESULTS: SCI women had a higher prevalence of nociceptive pain than men and their use of analgesics was greater. However, no differences between the sexes could be seen regarding pain and localization, onset, distribution, factors affecting pain, number of painful body regions, pain descriptors, ratings of pain intensities or in pain and life satisfaction.CONCLUSION: This study showed that SCI men and women describe their pain very similarly. However, SCI women had a higher prevalence of nociceptive pain than men and their use of opiates and non-steroid anti-inflammatory drugs (NSAIDs) was greater.
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| 28. |
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| 29. |
- Roaldsen, Kirsti Skavberg, et al.
(författare)
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Pediatric spinal cord injury rehabilitation : A protocol for an international multicenter project (SINpedSCI)
- 2022
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Ingår i: Journal of Pediatric Rehabilitation Medicine. - : IOS Press. - 1874-5393 .- 1875-8894. ; 15:2, s. 395-403
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Children and adolescents (<18 years old) who sustain a spinal cord injury (SCI) should ideally be managed in specialized rehabilitation services. This project aims to describe the organization of pediatric SCI in ten rehabilitation units in seven countries and to qualitatively explore psychosocial aspects of adolescents living with SCI. METHODS: A multicenter cross-sectional project is planned, using quantitative (web survey) and qualitative (interview) methods in ten rehabilitation units from Norway, Sweden, United States, Israel, PR China, Russia and Palestine. Individual interviews will be conducted with >= 20 adolescents aged 13-17 years at least 6 months post rehabilitation. RESULTS: Units involved will be described and compared, according to funding, attachment to an acute SCI unit, catchment area, number of beds, admittance and discharge procedures, availability of services, staff/patient ratio, content and intensity of rehabilitation programs, length of stay, measurement methods, follow-up services, health promotion services, and pediatric SCI prevention acts. The semi-structured interview guide will include experiences from acute care and primary rehabilitation, daily life, school, contact with friends, leisure time activities, peers, physical and psychological health, and the adolescents plans for the future. CONCLUSION: Based on the present protocol, this project is likely to provide new insight and knowledge on pediatric SCI rehabilitation and increase the understanding of pediatric SCI in adolescents and their families internationally.
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| 30. |
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| 31. |
- Scott Burns, Anthony, et al.
(författare)
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Optimizing the Management of Disabling Spasticity Following Spinal Cord Damage: The Ability Network-An International Initiative
- 2016
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Ingår i: Archives of Physical Medicine and Rehabilitation. - : W B SAUNDERS CO-ELSEVIER INC. - 0003-9993 .- 1532-821X. ; 97:12, s. 2222-2228
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Tidskriftsartikel (refereegranskat)abstract
- Optimizing the treatment of disabling spasticity in persons with spinal cord damage is hampered by a lack of consensus regarding the use of acceptable definitions of spasticity and disabling spasticity, and the relative absence of decision tools such as clinical guidelines and concise algorithms to support decision-making within the broader clinical community. Many people with spinal cord damage are managed outside specialist centers, and variations in practice result in unequal access to best practice despite equal`need. In order to address these issues, the Ability Network an international panel of clinical experts was initiated to develop management algorithms to guide and standardize the assessment, treatment, and evaluation of outcomes of persons with spinal cord damage and disabling spasticity. To achieve this, consensus was sought on common definitions through facilitated, in-person meetings. To guide patient selection, an in-depth review of the available tools was performed and expert consensus sought to develop an appropriate instrument. Literature reviews are guiding the selection and development of tools to evaluate treatment outcomes (body functions, activity, participation, quality of life) as perceived by people with spinal cord damage and disabling spasticity, and their caregivers and clinicians. Using this approach, the Ability Network aims to facilitate treatment decisions that take into account the following: the impact of disabling spasticity on health status, patient preferences, treatment goals, tolerance for adverse events, and in cases of totally dependent persons, caregiver burden. (C) 2016 by the American Congress of Rehabilitation Medicine
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| 32. |
- Skogberg, Olof, et al.
(författare)
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CHANGES IN BODY COMPOSITION AFTER SPASTICITY TREATMENT WITH INTRATHECAL BACLOFEN
- 2017
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Ingår i: Journal of Rehabilitation Medicine. - : FOUNDATION REHABILITATION INFORMATION. - 1650-1977 .- 1651-2081. ; 49:1, s. 36-39
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess changes in body composition, body weight and resting metabolic rate in patients who received intrathecal baclofen therapy for spasticity. Design: Prospective, longitudinal, quasi-experimental, with a pre/post design. Patients: Twelve patients with spasticity, fulfilling study criteria, and due for pump implantation for intrathecal baclofen therapy, completed the study. Methods: Data were obtained before, 6 months and 12 months after commencement of intrathecal baclofen therapy as regards body composition (by skinfold calliper), body weight, and resting metabolic rate (by resting oxygen consumption). Spasticity was assessed according to the Modified Ashworth Scale (MAS) and Penn Spasm Frequency Scale (PSFS). Results: A reduction in spasticity according to MAS occurred. Mean fat body mass increased and mean lean body mass decreased. Mean body weight showed a non-significant increase and resting metabolic rate a non-significant decrease. Conclusion: This explorative study indicates that unfavourable changes in body composition might occur after intrathecal baclofen therapy. Since obesity and increased fat body mass contribute to an increased cardiovascular risk, these findings may indicate a need for initiation of countermeasures, e.g. increased physical activity and/or dietary measures, in conjunction with intrathecal baclofen therapy. Further studies, including larger study samples and control groups, are needed to corroborate these findings.
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| 33. |
- Svensson, Erik, 1959-, et al.
(författare)
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Bacteriuria in spinal cord injured patients with neurogenic bladder dysfunction
- 2004
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Ingår i: Upsala Journal of Medical Sciences. - 0300-9734 .- 2000-1967. ; 109:1, s. 25-32
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Tidskriftsartikel (refereegranskat)abstract
- The occurrence of bacteriuria in spinal cord injured patients with neurogenic bladder dysfunction who used clean intermittent catheterisation to empty their bladders was studied in order to examine cut-off concentration breakpoints for significant bacteriuria in this group of patients using procedures of the European Urinanalysis Guideline. 344 samples were cultured, yielding 285 isolates. Coagulase-negative staphylococci (27 %), Enterococci (25 %), Klebsiella spp (19 %), and Escherichia coli (12 %) were the most common findings. Bacteria grew at concentrations of 105-108 cfu/L, but only a few at 104 cfu/L. It is concluded that low bacterial concentrations in the urine (105 cfu/L) of patients with neurogenic bladder dysfunction who are on intermittent catheterisation might be as significant for bladder contamination with bacteria as a high bacterial concentration and can possibly be responsible for bladder infections.
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| 34. |
- Ward, Anthony B., et al.
(författare)
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Functional goal achievement in post-stroke spasticity patients : The BOTOX® Economic Spasticity Trial (BEST)
- 2014
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Ingår i: Journal of Rehabilitation Medicine. - : Foundation for Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 46:6, s. 504-513
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:Evaluate changes in active and passive function with onabotulinumtoxinA + standard of care within goal-oriented rehabilitation programmes in adults with focal post-stroke spasticity.METHODS:Prospective, 24-week double-blind study with an open-label extension. Subjects were randomized to onabotulinumtoxinA + standard of care or placebo + standard of care, at baseline and at 12 weeks, if judged appropriate, with follow-up to 52 weeks. The primary endpoint was the number of patients achieving their principal active functional goal at 24 weeks (or 10 weeks after an optional second injection). Secondary endpoints included achievement of a different active or a passive goal at this timepoint.RESULTS:The intent-to-treat population comprised 273 patients. The proportion of patients achieving their principal active functional goal and secondary active functional goal with onabotulinumtoxinA + standard of care was not statistically different from placebo + standard of care. Significantly more patients achieved their secondary passive goal with onabotulinumtoxinA + standard of care (60.0%) vs. placebo + standard of care (38.6%) (odds ratio, 2.46; 95% confidence interval, 1.18-5.14) as well as higher Goal Attainment Scaling levels for upper limb and ankle flexor subgroups.CONCLUSIONS:Addition of onabotulinumtoxinA to standard of care as part of goal-oriented rehabilitation in post-stroke spasticity patients significantly increased passive goal achievement and was associated with higher levels of active function.
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| 35. |
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| 36. |
- Wissel, Joerg, et al.
(författare)
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OnabotulinumtoxinA Improves Pain in Patients With Post-Stroke Spasticity: Findings From a Randomized, Double-Blind, Placebo-Controlled Trial
- 2016
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Ingår i: Journal of Pain and Symptom Management. - : ELSEVIER SCIENCE INC. - 0885-3924 .- 1873-6513. ; 52:1, s. 17-26
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Tidskriftsartikel (refereegranskat)abstract
- Context. Patients with post-stroke spasticity (PSS) commonly experience pain in affected limbs, which may impact quality of life. Objectives. To assess onabotulinumtoxinA for pain in patients with PSS from the BOTOX (R) Economic Spasticity Trial, a multicenter, randomized, double-blind, placebo-controlled trial. Methods. Patients with PSS (N = 273) were randomized to 22- to 34-week double-blind treatment with onabotulinumtoxinA + standard care (SC) or placebo injection + SC and were eligible to receive open-label onabotulinumtoxinA up to 52 weeks. Assessments included change from baseline on the 11-point pain numeric rating scale, proportion of patients with baseline pain amp;gt;= 4 achieving amp;gt;= 30% and amp;gt;= 50% improvement in pain, and pain interference with work at Week 12, end of double-blind treatment, and Week 52. Results. At baseline, most patients (74.3%) experienced pain and 47.4% had pain amp;gt;= 4 (pain subgroup). Mean pain reduction from baseline at Week 12 was significantly greater with onabotulinumtoxinA + SC (-0.77, 95% CI -1.14 to -0.40) than placebo + SC (-0.13, 95% CI -0.51 to 0.24; P amp;lt; 0.05). Higher proportions of patients in the pain subgroup achieved amp;gt;= 30% and amp;gt;= 50% reductions in pain at Week 12 with onabotulinumtoxinA + SC (53.7% and 37.0%, respectively) compared with placebo (28.8% and 18.6%, respectively; P amp;lt; 0.05). Reductions in pain were sustained through Week 52. Compared with placebo + SC, onabotulinumtoxinA consistently reduced pain interference with work. Conclusion. This is the first randomized, placebo-controlled trial demonstrating statistically significant and clinically meaningful reductions in pain and pain interference with work with onabotulinumtoxinA in patients with PSS. (C) 2016 The Authors. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine. This is an open access article under the CC BY-NC-ND license.
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