| 1. |
- Dymen, P., et al.
(author)
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Revision Spinal Surgery at a University Hospital : Incidence, Causes, and Microbiological Agents in Infected Patients
- 2022
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In: International Journal of Spine Surgery. - : International Journal of Spine Surgery. - 2211-4599. ; 16:5, s. 928-934
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Journal article (peer-reviewed)abstract
- Background: The number of spinal surgeries performed worldwide have significantly increased over the past decade. However, to the best of our knowledge, there are no national or international studies that report the overall picture of complications following spinal surgery. This article sought to identify the incidence and causes of reoperations in patients undergoing spinal surgery, as well as the average time from index surgery to reoperation. Furthermore, the purpose was to identify the microbiological agents present in cultures from infected patients.Methods: This was a retrospective cohort study that used a university hospital's medical records as the data source. The study population comprised 2110 patients who underwent spinal surgery during a 40 -month period between 2015 and 2018. All suspected reoperations were verified manually. Additional data collected for reoperations included cause, time from index surgery, and laboratory results from cultures. Descriptive analysis was used.Results: The incidence of reoperations during the study period was 11% (n = 232). The most common cause of reoperation was infection (28%, n = 65), followed by implant-related causes (19%, n = 44) and hemorrhage/hematoma (15%, n = 34). The time between index surgery and reoperation varied, but half of all reoperations occurred within 30 days. Coagulase-negative staphylococci were the most common type of bacteria (positive cultures in 39% of infected patients).Conclusion: The number of reoperations in the studied hospital were high during the study period. Infections accounted for a large percentage of reoperations, suggesting that effective preventive measures might significantly reduce the total number of reoperations.Clinical Relevance: Postoperative infection causing reoperations after spinal surgeries is a large problem, and finding effective preventive measures should be a priority for caregivers.Level of Evidence: 3.
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| 2. |
- Witwit, Wisam, et al.
(author)
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Young soccer players have significantly more spinal changes on MRI compared to non-athletes.
- 2020
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In: Translational Sports Medicine. - : Hindawi Limited. - 2573-8488. ; 3:4, s. 288-295
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Journal article (peer-reviewed)abstract
- Purpose Evidence-based facts regarding spinal abnormalities and back pain in young athletes are needed in order to be able to adapt rehabilitation programs and preventive measures accordingly. The aim of this study was therefore to identify MRI changes in the thoracolumbar spine and the lifetime prevalence of back pain in young football players compared to non-athletes. Methods Young elite football players (n = 27) and non-athletes (n = 26) completed MRI examinations of the thoracolumbar spine. MRI images were evaluated for disk signal, height, bulging, herniation, Schmorl's nodes, spondylolisthesis, and vertebral wedging. All participants answered questionnaires regarding training hours and back pain. Results Disk degenerative changes were more commonly displayed by 89% of the football players compared to 54% of the controls (P = .006). Schmorl's nodes (22%), disk herniation (30%), and reduced disk height (37%) were more prevalent in football players compared to controls (0%) (P = .023 and P = .001, respectively). The lifetime prevalence of back pain was reported by 52% of football players and 44% of controls, a difference that was not statistically significant. Conclusion Young male football (soccer) players have more degenerative disk changes compared to non-athletes. Both groups displayed high lifetime prevalence of back pain.
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| 3. |
- Abrahamson, Josefin, et al.
(author)
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Hip pain and its correlation with cam morphology in young skiers-a minimum of 5 years follow-up
- 2020
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In: Journal of Orthopaedic Surgery and Research. - : Springer Science and Business Media LLC. - 1749-799X. ; 15:1
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Journal article (peer-reviewed)abstract
- BackgroundThere is conflicting evidence regarding the association between cam morphological changes and hip pain, and it remains unclear who with cam morphology will develop hip pain and who will not. This study aimed to investigate the correlation between cam morphology, hip pain, and activity level at a 5-year follow-up in young Alpine and Mogul skiers.MethodAll students (n = 76) at angstrom re Ski National Sports High School were invited and accepted participation in this prospective study at baseline. Magnetic resonance imaging (MRI) of both hips was conducted to evaluate the presence of cam morphology (alpha -angle >= 55 degrees) and its size alongside the reporting of hip pain, type, and frequency of training by the Back and hip questionnaire, at baseline. After 5 years, the skiers were invited to complete a shortened version of the same questionnaire.ResultsA total of 60 skiers (80%) completed the follow-up questionnaire, of which 53 had concomitant MRI data. Cam morphology was present in 25 skiers (47.2%, 39 hips). Hip pain at baseline and at follow-up was reported in 17 (28.3%) and 22 (36.7%) skiers, respectively. No correlations were found between the activity level, the frequency, and the size of cam morphology and hip pain, except for the right hip alpha -angle at 1 o'clock and hip pain in skiers with cam morphology at baseline (r(s) = 0.49; P = 0.03) and at follow-up (r(s) = 0.47; P = 0.04). A total of 73.3% skiers had retired, of which 48% reported this was due to injuries.ConclusionHip pain was not shown to be correlated, or had a low correlation, with activity level and the presence and size of cam morphology in young skiers on a 5-year follow-up. Based on these results, cam morphology or activity level did not affect hip pain to develop during 5 years of follow-up in young skiers. Furthermore, this study highlights that almost 75% of young elite skiers had retired from their elite career with almost 50% reporting that this was due to injuries sustained from skiing.
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| 4. |
- Abrahamson, Josefin, et al.
(author)
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Horseback riding is common among female athletes who had arthroscopic treatment for femoroacetabular impingement syndrome
- 2021
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In: Translational Sports Medicine. - : Hindawi Limited. - 2573-8488. ; 4:4, s. 500-507
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Journal article (peer-reviewed)abstract
- The purpose was to investigate pre-operative symptoms and types of sport in competitive athletes undergoing arthroscopic treatment for femoroacetabular impingement syndrome (FAIS), and to compare between genders. Competitive athletes planned for arthroscopic treatment for FAIS were included prospectively in a hip arthroscopy registry. A total of 1548 athletes were identified and 919 were included. Sporting activity and patient-reported outcome measures (PROMs), including HSAS, iHOT-12, and HAGOS, were recorded, pre-operatively. The study comprised 738 male and 181 female athletes (median age 25; interquartile range 20-32 years) who had undergone arthroscopic treatment for FAIS. The most common sports type performed by males were football (48%) and ice hockey (19%) and in females, football (25%) and horseback riding (22%). Females reported a significantly longer duration of symptoms (median 36 vs 24 months) and lower pre-operative scores for the iHOT-12 and all the HAGOS subscales, except for physical activity. In conclusion, horseback riding and football are almost equally common in female athletes, while football is by far the most common in male athletes, who underwent arthroscopic treatment for FAIS. Females had a longer duration of symptoms and a higher degree of self-reported symptoms and dysfunction prior to the hip arthroscopy.
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| 5. |
- Abrahamson, Josefin, et al.
(author)
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Low rate of high-level athletes maintained a return to pre-injury sports two years after arthroscopic treatment for femoroacetabular impingement syndrome
- 2020
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In: Journal of Experimental Orthopaedics. - : Springer Science and Business Media LLC. - 2197-1153. ; 7:1
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Journal article (peer-reviewed)abstract
- Purpose: The aim was to investigate the rate of athletes still active at their pre-injury sports level two years after arthroscopic treatment for femoroacetabular impingement syndrome (FAIS), and examine this between different sports and gender, and its correlation to patient-reported outcome measures (PROMs). Method: High-level athletes planned for arthroscopic treatment for FAIS were included prospectively in a Swedish hip arthroscopy registry between 2011 and 2017, and 717 met the inclusion criteria. Self-reported sporting activity was recorded preoperatively. The subjects answered PROMs, including the HSAS, iHOT-12 and HAGOS pre- and postoperatively. Results: A total of 551 athletes (median age 26, interquartile range 20–34 years; 23% women) had completed follow-up PROMs, at mean 23.4 ± 7.2 months postoperatively. In total, 135 (24.5%) were active at their pre-injury level of sports at follow-up (RTSpre). Athletes ≤30 years at time of surgery (n = 366; median age 22 years) had higher rate of RTSpre (31.4%) compared with athletes > 30 years (n = 185; median age 40 years) (10.8%; p < 0.001). All athletes had improvements in iHOT-12 and HAGOS, two years postoperatively (p < 0.001), while RTSpre athletes reported significantly better PROMs, pre- and postoperatively, and had greater improvements two years postoperatively, compared with athletes not active at pre-injury level. Conclusion: Only 25% of all high-level athletes and 31% of athletes ≤30 years were still active at their pre-injury sports level two years after arthroscopic treatment for FAIS. Athletes still active had significantly and clinically greater improvement regarding hip symptoms, function and quality of life, as compared with athletes not active at pre-injury level, two years postoperatively. © 2020, The Author(s).
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| 6. |
- Aminoff, Anna Swärd, et al.
(author)
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Young elite Alpine and Mogul skiers have a higher prevalence of cam morphology than non-athletes
- 2020
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In: Knee Surgery Sports Traumatology Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 28:4, s. 1262-1269
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Journal article (peer-reviewed)abstract
- Purpose To investigate the prevalence of cam morphology in (1) a group of young elite Mogul and Alpine skiers compared with non-athletes and (2) between the sexes. Method The hip joints of 87 subjects [n = 61 young elite skiers (29 females and 32 males) and n = 26 non-athletes (17 females and 9 males)] were examined using MRI, for measurements of the presence of cam morphology (alpha-angle >= 55). Results The skiers had a significantly higher prevalence of cam morphology compared with the non-athletes (49% vs 19%, p = 0.009). A significant difference (p < 0.001) was also found between females and males, where 22% of the females and 61% of the males had cam morphology. Among the skiers, there was also a significant difference (p < 0.001) between the sexes, where 28% of the females and 68% of the males had cam morphology. This difference between the sexes was not found in the non-athletic group. No significant differences were found between Mogul and Alpine skiers. Conclusion Young male elite skiers have a higher prevalence of cam morphology of the hips compared with non-athletes.
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| 7. |
- Angelini, Eva, 1964, et al.
(author)
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Evaluating a targeted person-centred pain management intervention programme in lumbar spine surgery - a controlled segment-specific before-and-after interventional design
- 2024
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In: BMC Health Services Research. - 1472-6963. ; 24:1
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Journal article (peer-reviewed)abstract
- Background: Postoperative pain management in lumbar spine surgery care remains a challenge. The aim of this study was to evaluate the impact of a person-centred postoperative pain management intervention programme on lumbar spine surgery patients on postoperative pain, shared decision-making, and satisfaction with postoperative pain management. Methods: The study was performed with a controlled before-and-after interventional design in an orthopaedic unit at a university hospital. Person-centred pain management for patients undergoing spine surgery was developed in co-creation by a multi-professional team and implemented throughout the care pathway. The usual care group (pre-intervention) served as a comparison to the intervention group. Pain intensity, shared decision-making in pain management, and patient satisfaction with results of pain management, served as patient-reported measures, collected using the International Pain Outcomes questionnaire and analysed using descriptive statistics. Results: The intervention showed no benefit for patients’ pain and satisfaction, while shared decision-making in pain management was significant lower in the intervention group than in the conventional group. The per-protocol analysis showed no significant differences between groups. Conclusion: The initial assumption of the study, that the implementation of a co-created structured person-centred care pathway would improve patient-reported outcomes, was not confirmed. The periodically low fidelity to the intervention due to organizational constraints (due to sub-optimal organizational conditions and managerial support) may have affected the results.
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| 8. |
- Angelini, Eva, 1964, et al.
(author)
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Healthcare practitioners’ experiences of postoperative pain management in lumbar spine surgery care—A qualitative study
- 2020
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In: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 29, s. 1662-1672
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Journal article (peer-reviewed)abstract
- © 2020 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd Aims and objective: To explore and describe healthcare practitioners’ experiences of postoperative pain management to patients undergoing planned lumbar spine surgery by identifying the healthcare practitioners’ behaviours, attitudes and strategies. Background: Poorly managed postoperative pain continues to cause suffering and prolong hospital care and may affect individual and team practitioners’ strategies and attitudes. The impact of these strategies and attitudes needs greater understanding. Design: Descriptive qualitative study. Methods: In-depth interviews were conducted at a university hospital in Sweden during January–March 2016 with 9 healthcare practitioners (ages: 29–61years; gender: male 3 and female 6; professions: medical doctor 3, registered nurse 3 and physiotherapist 3; professional experience: 1.5months to 25years). The interviews were analysed using Braun and Clarke's thematic analysis. The study adhered to the Consolidated Criteria for Reporting Qualitative Research COREQ. Results: The interviews revealed healthcare practitioners’ attitudes and strategies. Three themes were identified: (a) Connecting with the person was recognised as the key component in postoperative pain management; (b) Professionalism: a balancing act, accentuated health care practitioners’ duality in being both vulnerable and strong in delicate care situations; and (c) Collaboration: being constantly responsive, the necessity for healthcare practitioners to be constantly responsive to their environment. Conclusions: The findings pinpoint the need for healthcare organisations to build structures enabling practitioners to deliver adequate pain management in acknowledging the practitioners’ delicate situation when facing patients in pain. Relevance to clinical practice: Given the global need for postoperative pain management, our findings have international relevance. Preconceived expectations on specific pain need to be depicted and postoperative pain taken seriously to protect the patient as well as the healthcare practitioners.
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| 9. |
- Angelini, Eva, 1964, et al.
(author)
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The impact of implementing a person-centred pain management intervention on resistance to change and organizational culture
- 2021
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In: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 21:1
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Journal article (peer-reviewed)abstract
- Background: Resistance to change and organizational culture are essential factors to consider in change management in health care settings. Implementation of structural change remains a challenge. There is a lack of studies providing information on the impact of implementation processes on the organization. The aim of this study was to describe the impact of implementing a systematic change process concerning postoperative person-centred pain management on resistance to change and organizational culture in an orthopaedic spine surgery unit. Methods: The study was set in an orthopaedic spine surgery unit at a university hospital. Person-centred bundles of care for postoperative pain management of spine surgery patients were developed in co-creation by a multi-professional expert group and implemented throughout the care pathway. The intervention was underpinned by theories on organizational culture and inspired by principles of person-centred care. Quantitative data were collected using the Resistance to Change Scale and the Organizational Culture Assessment Instrument and analysed using descriptive statistics. Results: The findings showed a low resistance to change decreasing during the study. The organizational culture shifted from a result-oriented to a formalized and structured culture after the implementation. The culture preferred by the staff was team-oriented and participation-focused throughout the study. The discrepancy between the current and preferred cultures remained extensive over time. Conclusion: It is challenging to describe the influence of the development and implementation of a postoperative pain management program on organizational culture as well as in terms of resistance to change, in a complex health care setting. In the current study the unit was under organizational strain during the implementation. Albeit, the important discrepancy between the current and preferred organizational culture could imply that structural changes aren’t enough when implementing person-centred pain management structures and needs to be combined with relational aspects of change.
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| 10. |
- Beck, Joel, et al.
(author)
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Association of extended duration of sciatic leg pain with worse outcome after lumbar disc herniation surgery: a register study in 6216 patients
- 2021
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In: Journal of Neurosurgery-Spine. - 1547-5654. ; 34, s. 759-767
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Journal article (peer-reviewed)abstract
- OBJECTIVE Sciatica is the hallmark symptom of a lumbar disc herniation (LDH). Up to 90% of LDH patients recover within 12 weeks regardless of treatment. With continued deteriorating symptoms and low patient quality of life, most surgeons recommend surgical discectomy. However, there is not yet a clear consensus regarding the proper timing of surgery. The aim of this study was to evaluate how the duration of preoperative leg pain (sciatic neuralgia) is associated with patient-reported levels of postoperative leg pain reduction and other patient-reported outcome measures (PROMs) in a prospectively collected data set from a large national cohort. METHODS All patients aged 18?65 years undergoing a lumbar discectomy during 2013?2016 and registered in Swespine (the Swedish national spine registry) with 1 year of postoperative follow-up data were included in the study (n = 6216). The patients were stratified into 4 groups according to preoperative pain duration: < 3, 3?12, 12?24, or > 24 months. Patient results assessed with the numeric rating scale (NRS) for leg pain (rated from 0 to 10), global assessment of leg pain, EQ-5D, Oswestry Disability Index (ODI), and patient satisfaction with the final surgical outcome were analyzed and compared with preoperative values and between groups. RESULTS A significant improvement was seen 1 year postoperatively regardless of preoperative pain duration (change in NRS score: mean ?4.83, 95% CI ?4.73 to ?4.93 in the entire cohort). The largest decrease in leg pain NRS score (mean ?5.59, 95% CI ?5.85 to ?5.33) was seen in the operated group with the shortest sciatica duration (< 3 months). The patients with a leg pain duration in excess of 12 months had a significantly higher risk of having unchanged radiating leg pain 1 year postoperatively compared with those with < 12-month leg pain duration at the time of surgery (OR 2.41, 95% CI 1.81?3.21, p < 0.0001). CONCLUSIONS Patients with the shortest leg pain duration (< 3 months) reported superior outcomes in all measured parameters. More significantly, using a 12-month pain duration as a cutoff, patients who had a lumbar discectomy with a preoperative symptom duration < 12 months experienced a larger reduction in leg pain and were more satisfied with their surgical outcome and perception of postoperative leg pain than those with > 12 months of sciatic leg pain.
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