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1.
  • Arkkukangas, Marina, et al. (författare)
  • Evaluation of the electro-dress Mollii (R) to affect spasticity and motor function in children with cerebral palsy : Seven experimental single-case studies with an ABAB design
  • 2022
  • Ingår i: Cogent Engineering. - : TAYLOR & FRANCIS AS. - 2331-1916. ; 9:1
  • Tidskriftsartikel (refereegranskat)abstract
    • There are limited non-invasive treatment options in the home environment for children with cerebral palsy (CP); thus, evaluating such treatment options is needed. We aimed to evaluate the effect of an innovative full-body suit approach for non-invasive surface electrical stimulation ES, the electro-dress Mollii (R). The full-body suit was primarily designed to reduce spasticity and improve motor function through the mechanism of reciprocal inhibition among children with CP. This study involved seven experimental single-case studies with an ABAB design. Seven studies were performed among children aged 4-17 years. The primary outcome (spasticity) was analyzed using graphed data with a visual inspection, and median values were analyzed for secondary outcomes (mobility, sitting, upper limb activity, sleep, pain, and adherence to treatment). The study protocol was recorded at clinicaltrials.gov (NCT04078321). Seven studies were analyzed, and the treatment with the electro-dress had little or no impact on the outcomes: spasticity, mobility, sitting, upper limb activity, sleep, and pain, in any of these seven studies. In conclusion, multiple ES treatment with the innovative electro-dress Mollii (R) revealed little or no observable changes on primary outcome (spasticity) in any of the seven studies. Further the possible impact on motor function is recommended to be further evaluated in future studies
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2.
  • Arkkukangas, Marina, et al. (författare)
  • Risk factors for fall-related injuries among community-dwelling men and women over 70 years of age, based on social cognitive theory : results from a population study
  • 2021
  • Ingår i: European Journal of Physiotherapy. - : Taylor & Francis. - 2167-9169 .- 2167-9177. ; 23:4, s. 221-226
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Healthcare professionals', especially physiotherapists' role as promoters, preventers and rehabilitators play a significant role in prevention of falls. The purpose of this study was to gain knowledge on the risk factors which are associated with fall-related injuries among community dwelling men and women, based on Social Cognitive Theory (SCT) concepts. Patients and methods: The study includes 13,151 people who responded to a postal survey questionnaire in 2017. The random sample consisted of men and women aged 70 years and older. Multivariate regression models were used to explore associations between theory-based risk factors and fall-related injuries. Results: A total of 16% (1951 people) reported a fall-related injury during the past 12 months. For men, a total of seven risk factors were associated with fall-related injury: age, pain (neck/shoulder), incontinence, depression, help in daily living, education and sedentary behaviour. For women, a total of nine risk factors were associated with fall-related injury: age, pain (extremities and neck/shoulder), tiredness, incontinence, appetite, economy, accommodation and participation in social activities. Conclusions: This study identified risk factors from all aspects of the SCT, serving as a clinically useful theory in addition to traditional fall preventive actions. Gender differences should be considered when designing fall prevention strategies.
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3.
  • Berglund, K. M., et al. (författare)
  • Prevalence of pain and dysfunction in the cervical and thoracic spine in persons with and without lateral elbow pain
  • 2008
  • Ingår i: Manual Therapy. - : Elsevier BV. - 1356-689X .- 1532-2769. ; 13:4, s. 295-299
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose of this study was to Survey the prevalence of pain in the cervical and thoracic spine (C2-T7) in persons with and Without lateral elbow pain. Thirty-one subjects with lateral elbow pain and 31 healthy controls participated in the study. The assessment comprised a pain drawing, provocation tests of the cervical and thoracic spine, a neurodynamic test of the radial nerve, and active cervical range of motion. Seventy percent of the subjects with lateral elbow pain indicated pain in the cervical or thoracic spine, as compared to 16% in the control group (p< ;0.001). The frequency of pain responses to the provocation tests of the cervical and thoracic spine was significantly higher (p< ;0.05) in the lateral elbow pain (LEP) group, as was the frequency of pain responses to the neurodynamic test of the radial nerve (p< ;0.001). Cervical flexion and extension range of motion was significantly lower (p< ;0.01) in the LEP group. The results indicate a relation between lateral elbow pain and pain in the vertebral spine (C2-T7). The cervical and thoracic spine should be included in the assessment of patients with lateral elbow pain.
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4.
  • Cederbom, Sara, 1973-, et al. (författare)
  • A behavioral medicine intervention for community-dwelling older adults with chronic musculoskeletal pain : Protocol for a randomized controlled trial
  • 2017
  • Ingår i: Journal of Pain Research. - : Dove Medical Press Ltd.. - 1178-7090. ; 10, s. 845-853
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Chronic musculoskeletal pain is a major health problem among older adults, particularly those who live alone and/or those who are dependent on formal care. Chronic pain is associated with mobility problems, falls, fear of falling, catastrophizing thoughts, and a lower quality of life. Research shows that physical therapy interventions based on behavioral medicine approaches are beneficial for middle-aged adults with chronic pain. However, there appears to be no previous randomized controlled trials (RCTs) based on this theoretical framework that have examined the effect on older adults with chronic musculoskeletal pain who live alone at home and are dependent on formal care to manage their everyday lives. The aim of the planned study is to evaluate the effect of an individually tailored integrated physical therapy intervention based on a behavioral medicine approach compared with the effect of standard care. Methods/design: The planned study is an RCT that will include one intervention and one control group involving a total of 150 adults aged ≥75 years with chronic musculoskeletal pain who live alone at home and are dependent on formal care to manage their everyday lives. The intervention will involve a 12-week home-based individually tailored intervention that will be designed to enhance the participants’ ability to perform everyday activities by improving physical function and reducing pain-related disability and beliefs. The control group will be given standard care, including general advice about physical activity. The participants will be assessed at baseline and at 3 and 6 months after baseline. The primary outcome will be pain-related disability and physical performance. Discussion: The intervention, if effective, will have the potential to be the basis of the first evidence-based guidelines for physical therapists who work with older adults with chronic musculoskeletal pain. 
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5.
  • Cederbom, Sara, et al. (författare)
  • A behavioral medicine intervention for older women living alone with chronic pain - a feasibility study
  • 2014
  • Ingår i: Clinical Interventions in Aging. - 1176-9092 .- 1178-1998. ; 9, s. 1383-1397
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: To be an older woman, live alone, have chronic pain, and be dependent on support are all factors that may have an impact on daily life. One way to promote ability in everyday activities in people with pain-related conditions is to use individualized, integrated behavioral medicine in physical therapy interventions. How this kind of intervention works for older women living alone at home, with chronic pain, and dependent on formal care to manage their everyday lives has not been studied. The aim was to explore the feasibility of a study and to evaluate an individually tailored integrated behavioral medicine in physical therapy intervention for the target group of women. Materials and methods: The study was a 12-week randomized trial with two-group design. Primary effect outcomes were pain-related disability and morale. Secondary effect outcomes focused on pain-related beliefs, self-efficacy for exercise, concerns of falling, physical activity, and physical performance. Results: In total, 23 women agreed to participate in the study and 16 women completed the intervention. The results showed that the behavioral medicine in physical therapy intervention was feasible. No effects were seen on the primary effect outcomes. The experimental intervention seemed to improve the level of physical activity and self-efficacy for exercise. Some of the participants in both groups perceived that they could manage their everyday life in a better way after participation in the study. Conclusion: Results from this study are encouraging, but the study procedure and interventions have to be refined and tested in a larger feasibility study to be able to evaluate the effects of these kinds of interventions on pain-related disability, pain-related beliefs, self-efficacy in everyday activities, and morale in the target group. Further research is also needed to refine and evaluate effects from individualized reminder routines, support to collect self-report data, safety procedures for balance training, and training of personnel to enhance self-efficacy.
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6.
  • Cederbom, Sara, et al. (författare)
  • Chronic pain among older women living alone. A study focusing on disability and morale.
  • 2014
  • Ingår i: European Journal of Physiotherapy. - 2167-9169 .- 2167-9177. ; 16:3, s. 139-150
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To investigate 1)how older women who are living alone perceive chronic musculoskeletal pain,Activities of Daily Living (ADL), physical activity, affective distress,pain-related beliefs, pain management, and rate pain-related disability andmorale,  2) the relationships betweendemographic variables, ADL, physical activity, affective distress, pain-relatedbeliefs, and pain management with pain-related disability and morale.Method: The study had across-sectional and correlational design. Sixty women, living alone with chronicpain and community support aged ≥65 years were included.Results: The women were on average 81 years old and had lived with pain forabout 21.5 years. They reported low scores of affective distress,catastrophizing thoughts and self-efficacy, high scores of fear of movement,low degrees of pain-related disability, and low levels of  morale. The multiple regression analysisshowed that only catastrophizing thoughts significantlyexplained the variation in pain-related disability, and both affective distress and catastrophizing thoughtssignificantly explained the variation in morale. Conclusion: These older women livingalone with chronic pain reported similar prevalence ofchronic pain and pain-related disability but lower morale when comparingthe results with similar studies about older people in the same age group orolder people who are in need of help to manage their daily life. The only variable that was independely associated to bothpain-related disability and morale was catastrophizing. Further researchshould focus on identifying catastrophizing thougts,and also on developing a rehabilitation program based on a biopsychosocialperspective with the goal to decrease catastrophizing, pain-relateddisability, and increase morale for this target group
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7.
  • Cederbom, Sara, et al. (författare)
  • Home Help Service Staffs' Descriptions of Their Role in Promoting Everyday Activities Among Older People in Sweden Who Are Dependent on Formal Care.
  • 2017
  • Ingår i: Journal of Applied Gerontology. - : SAGE Publications. - 0733-4648 .- 1552-4523. ; 36:8, s. 971-992
  • Tidskriftsartikel (refereegranskat)abstract
    • The study aimed to explore how home help service staff described their role in improving the abilities of older people, in particular, older women with chronic pain who are dependent on formal care, to perform everyday activities. Three focus group interviews were conducted, and a qualitative inductive thematic content analysis was used. The analysis resulted in one theme: struggling to improve the care recipients' opportunities for independence but being inhibited by complex environmental factors. By encouraging the care recipients to perform everyday activities, the staff perceived themselves to both maintain and improve their care recipients' independence and quality of life. An important goal for society and health care professionals is to improve older people's abilities to "age in place" and to enable them to age independently while maintaining their quality of life. A key resource is home help service staff, and this resource should be utilized in the best possible way.
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8.
  • Demmelmaier, Ingrid, 1960- (författare)
  • Behaviours, Beliefs and Back Pain : Prognostic Factors for Disability in the General Population and Implementation of Screening in Primary Care Physiotherapy
  • 2010
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Aim: The overall aim of this thesis was to study prognostic factors for prolonged disability in back pain in the general population and physiotherapists’ screening for prolonged disability, applying a social cognitive learning perspective. Methods and results: Studies I and II were based on a survey in the general population in Sweden. Study I included 1024 individuals aged 20-50 years, reporting non-specific back pain. Four groups (n = 100, 215, 172 and 537) based on duration and recurrence of back pain were formed and compared. After controlling for pain intensity, catastrophising and expectations of future pain were positively correlated to pain duration. Perceived social support was negatively correlated to pain duration. Study II was longitudinal over 12 months and analysed one group reporting first-episode back pain (n = 77), and one group reporting long-term back pain (n = 302). Future pain intensity and disability were predicted by initial levels of pain and disability and pain-related cognitions in both groups. Study III examined the inter-rater reliability of a research protocol for assessment of physiotherapists’ telephone screening for prolonged disability. The results demonstrated sufficient inter-rater reliability. Study IV evaluated the effect of a tailored skills training intervention on physiotherapists’ screening for prolonged disability in back pain. Four physiotherapists in primary care participated in four quasi-experimental single-subject studies. Effects were seen in all participants, with increased screening of prognostic factors and less time spent on detailed discussions about back pain. Conclusions: The identification of mainly cognitive explanatory variables indicates the relevance of a social cognitive perspective of back pain-related disability (studies I and II). Physiotherapists’ telephone screening for prolonged disability in back can be reliably assessed (study III). It is suggested that interventions based on social cognitive theory are effective in producing change in specified clinical behaviours in physiotherapists (study IV).
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9.
  • Demmelmaier, Ingrid, et al. (författare)
  • Biopsychosocial predictors of pain, disability, health care consumption, and sick leave in first-episode and long-term back pain : A longitudinal study in the general population
  • 2010
  • Ingår i: International Journal of Behavioral Medicine. - : Springer Science and Business Media LLC. - 1070-5503 .- 1532-7558. ; 17:2, s. 79-89
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Long-term outcome in back pain is related mainly to cognitive factors such as pain-related beliefs and expectations. Most research has been performed on patient samples. Purpose: This study aimed at investigating changes over time in reported back pain, pain intensity, disability, health care consumption and sick leave as well as biopsychosocial factors over a 12 month-period. A second aim was to identify predictors of reported pain, pain intensity, disability, health care consumption and sick leave. Method: As parts of a large back pain sample from a general population (n = 1024), two groups – one with first-episode pain (n = 77) and one with long-term pain (n = 302) – responded twice to a self-administered questionnaire. Among participants reporting pain at both assessments, changes over time were analysed and predictive models were tested. Results: Generally, the results demonstrated overall stability in the self-reports over time. However, reported pain decreased in both groups, while pain catastrophizing and pain expectations increased in the first-episode group. Pain intensity and disability were predicted in regression models including four cognitive factors and initially reported levels of pain intensity and disability. Conclusion: The significance of pain-related beliefs and expectations both in early and later stages of a back pain condition is pointed out. The results in this study based on a sample from the general population are in line with previous research on patient samples.
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10.
  • Demmelmaier, Ingrid, et al. (författare)
  • Physiotherapists' telephone consultations regarding back pain : a method to analyze screening of risk factors
  • 2010
  • Ingår i: Physiotherapy Theory and Practice. - London : Informa Healthcare. - 0959-3985 .- 1532-5040. ; 26:7, s. 468-475
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and aimsThere is a gap between guidelines and clinical management of risk factors for prolonged disability in back pain. The aims of this study were; 1) to evaluate the inter-rater reliability of a research protocol designed to analyse screening of physical and psychosocial risk factors for prolonged disability in back pain during telephone consultations, and; 2) to describe the overall content and the nature and extent of physical and psychosocial risk factors assessed by physiotherapists in telephone consultations for diagnostic screening of patients with back pain. Method The material consisted of 17 initial telephone consultations regarding back pain recorded by five physiotherapists. A research protocol covering eight evidence-based risk factors was developed. Three raters performed separate analyses according to the protocol.ResultsIntraclass correlation of how many risk factors that were investigated was 0.82 (p<0.001.) Kappa values (pair-wise) of which risk factors that were screened were 0.79, 0.73 and 0.66 (p<0.001). A median of 2 risk factors were screened in each consultation; most frequent was signs of spinal pathology/radiating pain, followed by sick leave, disability, coping with pain and negative beliefs. Rating of pain intensity, depression and expectations of long-term pain were not screened. ConclusionsThe method of analysis appears reliable. It will be used in an intervention study that evaluates to what extent physiotherapists can learn to screen in concordance with guidelines in initial telephone consultations.
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11.
  • Demmelmaier, Ingrid, et al. (författare)
  • Tailored skills training for practitioners to enhance assessment of prognostic factors for persistent and disabling back pain : Four quasi-experimental single subject studies
  • 2012
  • Ingår i: Physiotherapy Theory and Practice. - : Informa UK Limited. - 0959-3985 .- 1532-5040. ; 28:5, s. 359-372
  • Tidskriftsartikel (refereegranskat)abstract
    • The well-known gap between guidelines and behaviour in clinical practice calls for effective behaviour change interventions. One example showing this gap is physiotherapists' insufficient assessment of psychosocial prognostic factors in back pain (i.e., yellow flags). The present study aimed to evaluate an educational model by performing a tailored skills training intervention for caregivers and studying changes over time in physiotherapists' assessment of prognostic factors in telephone consultations. A quasi-experimental single-subject design over 36 weeks was used, with repeated measurements during baseline, intervention, and postintervention phases. Four physiotherapists in primary health care audiorecorded a total of 63 consultations with patients. The tailored intervention included individual goal setting, skills training, and feedback on performance. The primary outcome was the number of assessed prognostic factors (0–10). Changes were seen in all four participants. The amount of assessed prognostic factors increased from between 0 and 2 at baseline to between 6 and 10 at postintervention. Time spent on assessment of psychosocial factors increased, and time spent on discussions about biomedical pain symptoms decreased. Knowledge and biopsychosocial attitudes toward back pain were congruent with guidelines at inclusion and did not change markedly during the intervention. Self-efficacy for assessment of cognitive and emotional prognostic factors increased during the study phases. The results suggest that a tailored skills training intervention using behaviour change techniques, such as individual goal setting, skills training, and feedback on performance, is effective in producing change in specific clinical behaviours in physiotherapists.
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12.
  • Demmelmaier, Ingrid, et al. (författare)
  • The associations between pain intensity, psychosocial variables, and pain duration/recurrence in a large sample of persons with nonspecific spinal pain
  • 2008
  • Ingår i: The Clinical Journal of Pain. - 0749-8047 .- 1536-5409. ; 24:7, s. 611-619
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: The aims of this study were: (1) to describe and compare pain intensity, disability, cognitive, physical, behavioral, and environmental variables in 4 predefined categories, on the basis of duration and recurrence of nonspecific spinal pain; and (2) to compare disability, cognitive, physical, behavioral, and environmental variables in these 4 predefined categories, after controlling for pain intensity. Methods: Postal questionnaires were sent to a random sample of 5000 persons, aged 20 to 50 years, in Sweden. The response rate was 39%. One thousand and twenty-four participants reporting spinal pain were divided into 4 predefined categories (n=100, 215, 172, and 537) based on duration and recurrence of pain. Multivariate analyses of variance and covariance were performed to investigate differences between the 4 pain duration/recurrence groups. Results: The first analyses revealed that the 4 pain duration/recurrence groups differed in pain intensity, disability, 7 cognitive variables, and perceived social support. After controlling for pain intensity, small but significant group differences were identified in depression, catastrophizing, pain expectations, and perceived social support. Higher levels of catastrophizing and pain expectations and lower levels of perceived social support were seen in groups with longer duration of pain. Discussion: After controlling for pain intensity, categories based on pain duration/recurrence differed in 3 cognitive variables and perceived social support. Pain expectations, catastrophizing and perceived social support were related to longer duration of pain. Between-group differences were small and pain duration/recurrence was not an important explanatory factor.
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13.
  • Denison, Eva, et al. (författare)
  • Musculoskeletal pain in primary health care : subgroups based on pain intensity, disability, self-efficacy, and fear-avoidance variables
  • 2007
  • Ingår i: Journal of Pain. - : Elsevier BV. - 1526-5900 .- 1528-8447. ; 8:1, s. 67-74
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose of this study was to identify and describe subgroup profiles based on self-reported pain intensity, disability, self-efficacy, fear of movement/(re)injury, and catastrophizing in patients with musculoskeletal pain. Two primary health care samples (n = 215 and n = 161) were used. Self-report questionnaires were completed at the start of physical therapy treatment. Cluster analysis was used to generate subgroups. Three subgroups were identified in sample 1 and replicated in sample 2. These were labeled "High self-efficacy-Low fear-avoidance," "Low self-efficacy-Low fear-avoidance," and "Low self-efficacy-High fear-avoidance." The subgroups differed significantly in work-status in both samples (P < .001), but not in age, gender, or duration of pain. The results show the presence of subgroups based on pain intensity, disability, self-efficacy, fear of movement/(re)injury, and catastrophizing. The profile patterns suggest that different management strategies may be relevant in each subgroup. Perspective  This article presents subgroups of patients with musculoskeletal pain with different profiles in pain intensity, disability, and psychosocial variables possible to modify by physical therapy management. The results could potentially aid clinicians in tailoring assessment and treatment approaches to each subgroup.
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14.
  • Denison, Eva, et al. (författare)
  • Self-efficacy, fear avoidance, and pain intensity as predictors of disability in subacute and chronic musculoskeletal pain patients in primary health care
  • 2004
  • Ingår i: Pain. - : Ovid Technologies (Wolters Kluwer Health). - 0304-3959 .- 1872-6623. ; 111:3, s. 245-252
  • Tidskriftsartikel (refereegranskat)abstract
    • This study examined the relations between disability, as measured by the Pain Disability Index (PDI) and self-efficacy, fear avoidance variables (kinesiophobia and catastrophizing), and pain intensity, using a prospective design. Two primary health care samples (n1=210; n2=161) of patients with subacute, chronic or recurring musculoskeletal pain completed sets of questionnaires at the beginning of a physiotherapy treatment period. Multiple hierarchial regression analyses showed that self-efficacy explained a considerably larger proportion of the variance in disability scores than the fear avoidance variables in the first sample. This finding was replicated in the second sample. Pain intensity explained a small, but significant proportion of the variance in disability scores in one sample only. Gender, age, and pain duration were not related to disability. These findings suggest that self-efficacy beliefs are more important determinants of disability than fear avoidance beliefs in primary health care patients with musculoskeletal pain. The findings also suggest that pain-related beliefs, such as self-efficacy and fear avoidance, in turn, are more important determinants of disability than pain intensity and pain duration in these patients.
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15.
  • Emilson, Christina, et al. (författare)
  • A 10-year follow-up of tailored behavioural medicine treatment and exercise-based physiotherapy in persistent musculoskeletal pain
  • 2017
  • Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 31:2, s. 186-196
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To study the long-term outcomes of two interventions targeting patients with sub-acute and persistent pain in a primary care physiotherapy setting.Design: A 10-year follow-up of a two-armed randomised controlled trial, initially including 97 participants.Interventions: Tailored behavioural medicine treatment, applied in a physiotherapy context (experimental condition), and exercise-based physiotherapy (control condition). Main measures: Pain-related disability was the primary outcome. The maximum pain intensity, pain control, fear of movement, sickness-related absence (register data) and perceived benefit and confidence in coping with future pain problems were the secondary outcomes.Results: Forty-three (44%) participants responded to the follow-up survey, 20 in the tailored behavioural medicine treatment group and 23 in the exercise-based physiotherapy group. The groups did not differ in terms of the change in the scores for the primary outcome (p=0.17) of pain-related disability between the experimental group (median: 2.5, Q1-Q3: -2.5-14.25), and the control group (median: 0, Q1-Q3: -5-6). Further, there were also no significant differences found for the secondary outcomes except for sickness-related absence, where the exercise-based physiotherapy group had more days of sickness-related absence three months before treatment (p= 0.02), and at the 10-year follow-up (p=0.03).Discussion: The beneficial effects favouring tailored behavioural medicine treatment that observed post-treatment and at the two-year follow-up were not maintained 10 years after treatment.
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16.
  • Emilson, Christina, et al. (författare)
  • A 10-year follow-up of tailored behavioural treatment and exercise-based physiotherapy for persistent musculoskeletal pain
  • 2017
  • Ingår i: Clinical Rehabilitation. - London : Sage Publications. - 0269-2155 .- 1477-0873. ; 31:2, s. 186-196
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To study the long-term outcomes of two interventions targeting patients with sub-acute and persistent pain in a primary care physiotherapy setting.DESIGN: A 10-year follow-up of a two-armed randomised controlled trial, initially including 97 participants.INTERVENTIONS: Tailored behavioural medicine treatment, applied in a physiotherapy context (experimental condition), and exercise-based physiotherapy (control condition).MAIN MEASURES: Pain-related disability was the primary outcome. The maximum pain intensity, pain control, fear of movement, sickness-related absence (register data) and perceived benefit and confidence in coping with future pain problems were the secondary outcomes.RESULTS: Forty-three (44%) participants responded to the follow-up survey, 20 in the tailored behavioural medicine treatment group and 23 in the exercise-based physiotherapy group. The groups did not differ in terms of the change in the scores for the primary outcome (p=0.17) of pain-related disability between the experimental group (median: 2.5, Q1-Q3: -2.5-14.25), and the control group (median: 0, Q1-Q3: -5-6). Further, there were also no significant differences found for the secondary outcomes except for sickness-related absence, where the exercise-based physiotherapy group had more days of sickness-related absence three months before treatment (p= 0.02), and at the 10-year follow-up (p=0.03).DISCUSSION: The beneficial effects favouring tailored behavioural medicine treatment that observed post-treatment and at the two-year follow-up were not maintained 10 years after treatment. © The Author(s) 2016
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17.
  • Eriksson, Lisbeth (författare)
  • Effects and patients' experiences of interactive video-based physiotherapy at home after shoulder joint replacement
  • 2009
  • Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Physiotherapy is essential to optimize the results of shoulder joint replacement, but requires a close monitoring and co-operation between patient and physiotherapist. The development of telerehabilitation brings opportunities for distance-spanning and home-based physiotherapy interventions. The aim of this thesis is to explore effects and to describe experiences among patients participating in interactive video-based physiotherapy at home after shoulder joint replacement. A series of 22 patients underwent shoulder joint replacement and initial physiotherapy at the hospital. After discharge, 12 patients were referred to conventional out-patient physiotherapy (control), while 10 patients participated in a telerehabilitation intervention in the form of interactive video-based physiotherapy at home. Shoulder function, activity limitations and health-related quality of life were assessed before surgery and two months after surgery. The experiences of participating in the telerehabilitation were described using open interviews and qualitative content analysis. Two months post surgery, members of the telerehabilitation group had participated in more physiotherapy sessions (p<.001) and showed significantly better recovery regarding shoulder pain (p<.001), shoulder joint external rotation (p=.002), shoulder function and activity limitations (p<.001) and in two dimensions of health-related quality of life (p=.004 and p=.001) compared to the control group. All telerehabilitation group participants expressed that they were satisfied with the rehabilitation and that they had experienced technique and exercise as safe. In the interviews seven categories of the participants' experiences were revealed: An odd reinforced communication; Pain-free exercising as an effective routine; The home as an exercising arena; Closeness at a distance; From a dependent patient to a strengthened person; Facilitated daily living; Continuous rehabilitation process. The identified theme was: Achieving prerequisites for recovery competence. In conclusion, interactive video-based physiotherapy at home after shoulder joint replacement was experienced positively by the participating patients and seemed more effective than conventional post-discharge rehabilitation procedures concerning short-time recovery. This could be explained by the fact that the telerehabilitation group participated in more patient-physiotherapy sessions compared to the control group, but the interviews also indicate that the modality might have promoted continuity and patient participation and competence.
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18.
  • Flank, Peter, 1972- (författare)
  • Spinal cord injuries in Sweden : studies on clinical follow-ups
  • 2016
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • A spinal cord injury is a serious medical condition, often caused by a physical trauma. An injury to the spinal cord affects the neurotransmission between the brain and spinal cord segments below the level of injury. The SCI causes a loss of motor function, sensory function and autonomic regulation of the body, temporary or permanent. Significantly improved acute care, primary comprehensive rehabilitation and life-long structured follow-up has led to persons with spinal cord injury (SCI) living longer than ever before. However, increased long-time survival has allowed secondary conditions to emerge, like diabetes mellitus and where cardiovascular disease (CVD) now is the most common cause of death among SCI patients. Other possible CVD-related comorbidities in this patient group have been reported to be pain and mood disturbances. There is still lack of, and need for more knowledge in the field of CVD-related screening and prevention after SCI.The overall aim of this thesis was to contribute to a scientific ground regarding the need for CVD-related screening and prevention after SCI.In Paper I and Paper II, patients with wheelchair-dependent post-traumatic SCI (paraplegia) were assessed. The results in paper I showed that 80% of the examined patients had at least one cardiovascular disease risk marker irrespective of body mass index (BMI). Dyslipidemia was common for both men and women at all BMI categories. The study also showed a high prevalence of hypertension, especially in men. Paper II showed a low frequency of self-reported physical activity, where only one out of 5 persons reported undertaking physical activity >30 min/day. The physically active had lower diastolic blood pressure but no significant difference in blood lipids.In paper III and IV, patients with SCI (tetraplegia and paraplegia) participated in the studies. Eighty-one percent of the patients had dyslipidemia, where also a majority of the patients with normal abdominal clinical measures had dyslipidemia. Self-reported physical activity >30min/day was reported by one third of the patients. No differences were found between physically active and not physically active patients when it came to blood glucose, serum lipid values and clinical measures (paper III). Pain was common in the patient group, however, most often on a mild to moderate level. Anxiety and depression was less common than reported in other studies (paper IV).
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19.
  • Gustavsson, Catharina, et al. (författare)
  • Predictive factors for disability outcome at 20 weeks and 2 years following a pain self-management group intervention in patients with persistent neck pain in primary health care
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Study design. An explorative, longitudinal, prospective study, with measurement at baseline, 20 weeks and 2 years. Objective. To explore plausible predictors associated with short-term (20 weeks) and long-term (2 years) treatment success in terms of pain-related disability for patients with persistent tension-type neck pain following a multi-component pain and stress self-management group intervention (PASS). Summary of Background Data. In previously reported short-term and long-term follow-up, PASS had better effect on pain control, pain-related self-efficacy, disability and catastrophizing than a control treatment; individually administered physical therapy (IAPT). Identification of patients who are likely to benefit from particular interventions is required. Methods. Data collected from 77 participants assigned to PASS in a randomized controlled trial were explored in order to identify plausible predictors of favorable outcome regarding pain-related disability as measured by the Neck Disability Index (NDI), by use of Pearson correlation analysis, factor analysis (FA) and partial least squares (PLS) and ordinary least squares (OLS) regression analyses. Data from self-assessment questionnaires completed by the participants before intervention, post-treatment (20 weeks) and at 2 years after the intervention, were used. The questionnaire comprised: the Self-Efficacy Scale (SES), the NDI, the Coping Strategies Questionnaire(CSQ), the Hospital Anxiety and Depression Scale (HADS) and questions regarding neck pain and analgesics. Results. Multivariate PLS regression analysis showed that baseline scores in NDI, SES and pain intensity explained only 31% of the variance in disability (NDI) immediately post-treatment (20-week follow-up). PLS regression analysis showed that post-treatment scores in NDI, SES and pain intensity explained 68% of the variance in disability (NDI) at 2 years. Univariate OLS linear regression analyses indicated that each variable contributed significantly to the latter PLS regression model (NDI p<0.001, SES p<0.001, pain intensity p<0.001). Conclusions. Treatment gains, as measured by immediate post-treatment scores at 20-week follow-up, in disability, self-efficacy and pain intensity were associated with long-term outcome in pain-related disability two years post-treatment, in patients with persistent neck pain participating in a self-management group intervention in PHC. Pre-treatment characteristics explained only a small proportion of variance in disability post-treatment. Thus, the intervention appears to be feasible for the majority of persons seeking PHC due to persistent tension-type neck pain.
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20.
  • Gustavsson, Catharina, et al. (författare)
  • Predictive factors for disability outcome at twenty weeks AND two years following a pain self-management group intervention in patients with persistent neck pain in primary health care
  • 2013
  • Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 45:2, s. 170-176
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To explore possible predictors associated with short-term (post-treatment) and long-term (2 years) treatment success in terms of pain-related disability for patients with persistent neck pain following a pain and stress self-management intervention (PASS). Methods: Data from 77 participants assigned to PASS in a randomized controlled trial were explored to identify possible predictors of favourable outcome regarding pain-related disability as measured by the Neck Disability Index (NDI), by use of Pearson correlation analysis, partial least squares (PLS) and ordinary least squares (OLS) regression analyses. Data from self-assessment questionnaires completed by the participants before, post-treatment (i.e. 20 weeks after inclusion) and 2 years after inclusion in the study, were used. Results: Multivariate PLS regression analysis showed that baseline scores in NDI, the Self-Efficacy Scale. (SES) and pain intensity explained 31% of the variance in disability (NDI) post-treatment. Multivariate PLS regression analysis showed that post-treatment scores in NDI, SES and pain intensity explained 68% of the variance in disability (NDI) at 2 years. Conclusion: Treatment gains, as measured by post-treatment scores at 20-week follow-up, in disability, self-efficacy and pain intensity were associated with long-term outcome in pain-related disability at 2 years, in patients with persistent neck pain participating in a self-management group intervention in primary health care.
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21.
  • Gustavsson, Catharina, 1961- (författare)
  • Self-management of Persistent Neck Pain : A Multi-component Group Intervention in Primary Health Care
  • 2011
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The overall aim of this thesis was to evaluate effects of a multi-component pain and stress self-management group intervention (PASS) and to explore plausible predictors associated with short-term and long-term treatment effects among patients with persistent tension-type neck pain in primary health care (PHC). Study I was a pilot study in order to explore feasibility of the study design and methods. It included 37 participants randomly assigned to the intervention (n=18) or treatment-as-usual (n=19). Study II-III was a pragmatic randomized controlled trial that compared effects of the PASS and individually administered physiotherapy (IAPT) on patients with persistent tension-type neck pain in PHC. Study II evaluated short-term effects over a 20-week follow-up. Study III evaluated long-term effects on maintenance over a follow-up period of 2 years. Studies included 156 participants randomly assigned to PASS (n=77) or IAPT (n=79). Study IV explored predictive factors for favorable outcome in disability regarding participants assigned to PASS. The results showed that PASS had better effects than IAPT regarding coping with pain, in terms of patients’ ability to control pain, self-efficacy regarding activities interfered with by pain, disability and catastrophizing, over the 20-week follow-up, and treatment effects were largely maintained over a 2-year follow-up. Post-treatment scores in disability, self-efficacy and pain intensity were associated with long-term outcome in pain-related disability 2 years post-treatment following PASS. Pre-treatment characteristics explained only a minor proportion of variance in disability, and were assumed weakly associated with treatment success and long-term outcome. Key components for enhancement of long-term efficacy in pain self-management coping efforts were adequately targeted by PASS. It is suggested important to strengthen self-efficacy beliefs in regard to pain coping, to reduce disability and enhance pain self-management in the treatment of persistent neck pain, and to induce long-term maintenance of treatment gains on disability following a pain self-management intervention.
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22.
  • Gustavsson, Catharina, et al. (författare)
  • Self-management of persistent neck pain : a randomized controlled trial of a multi-component group intervention in primary health care
  • 2010
  • Ingår i: European Journal of Pain. - : Wiley. - 1090-3801 .- 1532-2149. ; 14:6, s. 630.e1-630.e11
  • Tidskriftsartikel (refereegranskat)abstract
    • Studies regarding self-management of persistent neck pain are infrequent. Objective: to compare treatment effects of (a) a multi-component pain and stress self-management group intervention (PASS) and (b) individually administered physical therapy (IAPT) for patients with persistent musculoskeletal tension-type neck pain. Methods: Persons seeking physical therapy treatment due to persistent tension-type neck pain at nine primary health care centers in Sweden were randomly assigned to either PASS or IAPT. Before treatment (baseline) and at 10- and 20-weeks the participants completed a self-assessment questionnaire comprising: the Self-Efficacy Scale, the Neck Disability Index, the Coping Strategies Questionnaire, the Hospital Anxiety and Depression Scale, the Fear-Avoidance Beliefs Questionnaire and questions regarding neck pain, analgesics and utilization of health care. Intention-to-treat analyses were performed using repeated measures analysis of variance between baseline, 10-week and 20-week follow-up. Results: One hundred and fifty six participants were included (PASS n=77, IAPT n=79). On average participants receiving PASS attended seven treatment sessions and participants receiving IAPT 11 sessions over the 20-week follow-up period. Repeated measures ANCOVA showed significant time x group interaction effects for ability to control pain (p<0.001), self-efficacy regarding pain-interfering activities (p=0.005), disability due to neck pain (p=0.001) and levels of catastrophic thinking (p<0.001) in favour of PASS. Conclusion: PASS had a better effect than IAPT in the treatment of persistent musculoskeletal tension-type neck pain regarding coping with pain, in terms of patients' self-reported pain control, self-efficacy, disability and catastrophizing, over the 20-week follow-up.
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23.
  • Gustavsson, Catharina, et al. (författare)
  • Self-management of persistent neck pain : 2-year follow-up of a randomized controlled trial of a multi-component group intervention in primary health care
  • 2011
  • Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 36:25, s. 2105-2115
  • Tidskriftsartikel (refereegranskat)abstract
    • Study design A 2-year follow-up of a randomized controlled trial. Objective To compare long-term effects of a) a multi-component pain and stress self-management group intervention (PASS) and b) individually administered physical therapy (IAPT) on patients with persistent tension-type neck pain in a primary health care (PHC) setting. Summary of Background Data In a previously reported short-term follow-up, PASS had better effects on pain control, pain-related self-efficacy, disability and catastrophizing than IAPT. Long-term effects of self-management interventions for persistent neck pain, e.g. maintenance of improvement and adherence to coping skills are sparsely investigated. Methods Persons with persistent tension-type neck pain seeking physical therapy treatment at nine PHC centers in Sweden were randomly assigned to either PASS or IAPT. Before intervention, at 10 and 20 weeks and at 1 and 2 years after the intervention, the participants completed a self-assessment questionnaire comprising: the Self-Efficacy Scale, the Neck Disability Index, the Coping Strategies Questionnaire, the Hospital Anxiety and Depression Scale and questions regarding neck pain and analgesics. Analyses were performed using linear mixed models for repeated measures. Results The study included 156 participants (PASS n=77, IAPT n=79). Between baseline, 10-week, 20-week, 1-year and 2-year follow-up, significant time by group interaction effects were found in favor of PASS regarding the primary outcomes ability to control pain (p<0.001) and self-efficacy for performing activities in spite of pain (p=0.002), and the secondary outcome catastrophic thinking (p<0.001) but not in neck pain related disability. Conclusions The initial treatment effects of a self-management group intervention were largely maintained over a 2 year follow-up period and with a tendency to have superior long-term effects as compared to individually administered physical therapy, in the treatment of persistent tension-type neck pain with regard to coping with pain, in terms of pain control, self-efficacy and catastrophizing.
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24.
  • Hammer, C., et al. (författare)
  • Mechanical diagnosis and therapy in back pain : Compliance and social cognitive theory
  • 2007
  • Ingår i: Advances in Physiotherapy. - : Informa UK Limited. - 1403-8196 .- 1651-1948. ; 9:4, s. 190-197
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to describe social cognitive theory (SCT) constructs and exercise compliance, and to explore relations between SCT variables and exercise compliance in patients with lumbar derangement syndrome during mechanical diagnosis and therapy (MDT) treatment. Fifty-eight subjects completed the study. The data collection included measures relevant to SCT constructs and compliance: outcome expectations and expectancies, self-efficacy expectations, behavioural capability, and self-reported frequency of exercise occasions, as well as treatment outcomes regarding pain intensity and disability. Data were collected at five occasions during treatment and during a 2-month follow-up period. The subjects received a mean of three movements (range one to five) as home exercises. The mean number of weeks with these exercises was 4 (range 1-6). High median scores were found in all variables related to SCT. The median compliance rates varied between 79% (week 1) and 91% (week 3) during treatment. During the first follow-up month, the compliance rate was 79% and during the second month of follow-up 62%. Pain intensity and disability decreased during treatment. Although there were no significant correlations between the SCT variables and exercise compliance, the descriptive data are in line with SCT.
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25.
  • Nilsagård, Ylva, et al. (författare)
  • Clinical relevance using timed walk tests and 'timed up and go' testing in persons with multiple sclerosis
  • 2007
  • Ingår i: Physiotherapy Research International. - London : Whurr Publishers. - 1358-2267 .- 1471-2865. ; 12:2, s. 105-14
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND AND PURPOSE: One must understand the potentials and limitations of all tests used to evaluate interventions. The aim of the present study was to clarify the reproducibility, smallest percentage difference needed to be able to detect a genuine change and correlation regarding the 10-m and 30-m timed walks (10TW 30TW) and the 'timed up and go' (TUG) test in people with moderate multiple sclerosis (MS).METHOD: A repeated-measures design was used, with randomization into two groups and different time intervals used for testing. The 10TW and 30TW were performed three times and TUG twice at each testing. Self-selected speed was used for 10TW and forced speed (quickly but safely) for 30TW and TUG. Forty-three people were tested on three occasions within one week. Each person was tested at approximately the same time of the day and by the same physiotherapist on each occasion.RESULTS: The reproducibility was very high. For a single testing occasion, the intraclass correlation was 0.97 for the 10TW and 0.98 for the 30TW and TUG. The smallest percentage difference needed to be able to detect a genuine change in the entire study group was approximately -23% or +31% for either the 1OTW or TUG. It was evident from the 30TW testing results that lower values applied to those with less (-14% to +17%) rather than more (-38% or +60%) disability. The correlation between all tests for the entire study group was 0.85 (0.76-0.91).CONCLUSION: It is sufficient to use only one attempt and to choose only one of the tests when evaluating people with moderate MS. In the case of the 30TW greater attention must be paid to the degree of disability when determining the smallest percentage difference needed to establish a genuine change, than
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26.
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27.
  • Nilsagård, Ylva, et al. (författare)
  • Evaluation of a single session with cooling garment for persons with multiple sclerosis-a randomized trial
  • 2006
  • Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 1748-3107 .- 1748-3115. ; 1:4, s. 225-233
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose. This research investigates the objective and subjective effects of wearing the Rehband® cooling garment. Method. A multi-centre, randomized crossover study was conducted regarding 43 heat-sensitive persons with multiple sclerosis (MS), comparing active treatment with placebo. Subjects were tested immediately before and after intervention. Ten- (10TW) and 30-metre timed walk (30TW), oral temperature, spasticity, standing balance and timed up and go (TUG) and nine-hole peg test (NHPT) performance were measured. A study-specific questionnaire was used to evaluate subjective experiences. Results. Active treatment produced statistically significant objective improvement in 10TW, 30TW, one-legged stance, tandem stance (right) and TUG; statistically significant subjective improvement was also found in fatigue, spasticity, weakness, balance, gait, transfers, ability to think clearly and time to recover. The coherence between the objective and subjective results indicates clinical relevance from the subjects' perspective. There were no statistically significant differences between treatments in terms of oral temperature, spasticity (measured by the modified Ashworth scale), tandem stance (left), step test or NHPT, or subjective signs such as difficulty in dressing, dysarthria or pain. Conclusions. Active cooling with a Rehband® vest is likely to have a positive effect on everyday life in heat-sensitive persons with MS.
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28.
  • Nilsagård, Ylva, 1964-, et al. (författare)
  • Factors perceived as being related to accidental falls by persons with multiple sclerosis
  • 2009
  • Ingår i: Disability and Rehabilitation. - London : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 31:16, s. 1301-1310
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose. This study explores and describes factors that persons with multiple sclerosis (MS) perceive as being related to accidental falls. Method. A qualitative content analysis with primarily deductive approach was conducted using the International Classification of Functioning, Disability and Health. Twelve persons with MS, and identified as fallers, were interviewed. Results. Factors perceived to cause accidental falls that had not previously been targeted in MS populations in relation to falls were identified as divided attention, reduced muscular endurance, fatigue and heat sensitivity. Previously reported risk factors such as changed gait pattern, limited walking ability, impaired proprioception, vision and spasticity were supported. Activities involving walking, recreation and leisure, maintaining and changing body position, lifting or carrying, taking care of the home, washing the body, moving around, preparing meals and housekeeping were limited and considered to be risk activities. Supportive persons and assistive device reduced falls, and unsuitable physical environments and climate conditions induced falls. Several preventative strategies were described as partially compensating for the impairments, limitations and restrictions. Conclusions. Investigating accidental falls using the perspective of the patient gave important information about variables not earlier targeted in MS research.
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29.
  • Nilsagård, Ylva, 1964-, et al. (författare)
  • Predicting accidental falls in people with multiple sclerosis : a longitudinal study
  • 2009
  • Ingår i: Clinical Rehabilitation. - London : Sage Publications. - 0269-2155 .- 1477-0873. ; 23:3, s. 259-269
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To investigate accidental falls and near fall incidents in people with multiple sclerosis with respect to clinical variables and the predictive values of four tests. Design: A longitudinal, multi-centred cohort study with prospectively collected falls. Procedures: Self-reported incidents during the three months following a standardized test procedure. Subjects: Seventy-six people with multiple sclerosis and an Expanded Disability Status Scale score between 3.5 and 6.0. Main outcome measures: Berg Balance Scale, Timed Up and Go cognitive, Four Square Step Test (FSST) and 12-item Multiple Sclerosis Walking Scale. Results: Forty-eight people (63%) registered 270 falls. Most falls occurred indoors during activities of daily life. We found a correlation of rs=0.57 between near falls and falls, and of rs = 0.82 between registered and retrospectively recalled falls. Fallers and non-fallers differed significantly regarding Expanded Disability Status Score (odds ratio (OR) 1.99, 95% confidence interval (CI) 1.22; 3.40), spasticity (OR 1.14, CI 1.02; 1.31), proprioception (OR 2.50, CI 1.36; 5.12) and use of walking aids (OR 2.27, CI 1.23; 4.37). Reported use of walking aids both indoors and outdoors increased the odds of falling fivefold while disturbed proprioception increased the odds 2.5—15.6 times depending on severity. The odds of falling were doubled for each degree of increased Expanded Disability Status Score and more than doubled for each degree of increased spasticity. The Berg Balance Scale, use of walking aids and Timed Up and Go cognitive best identified fallers (73—94%) and proprioception, Expanded Disability Status Score, 12-item Multiple Sclerosis Walking Scale and Four Square Step Test best identified non-fallers (75—93%). Conclusions: In clinical practice, looking at the use of walking aids, investigating proprioception and spasticity, rating Expanded Disability Status Score and using Berg Balance Scale or Timed Up and Go cognitive all contribute when identifying fallers.
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30.
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31.
  • Nilsagård, Ylva, et al. (författare)
  • Self-perceived limitations of gait in persons with multiple sclerosis
  • 2007
  • Ingår i: Advances in Physiotherapy. - London : Informa UK Limited. - 1403-8196 .- 1651-1948. ; 9:3, s. 136-143
  • Tidskriftsartikel (refereegranskat)abstract
    • This study aimed to describe the self-perceived walking limitations of those with multiple sclerosis (MS) using the Swedish translation of the 12-item MS Walking Scale [MSWS-12 (S)], and to investigate it for concurrent validity and internal consistency. Eighty-one persons, recruited from five centres in Sweden, were tested using the Four Square Step Test (FSST), the Timed Up and Go cognitive (TUGcog) and the Berg Balance Scale (BBS) in randomized order, besides filling in the MSWS-12 (S). Perceived limitations were reported in 89-96% of the sample, i.e. performance of activities related to standing or walking, decreased speed and distance, and qualitative aspects; and self-perception regarding the ability to run being most extremely affected. Correlations between the MSWS-12 (S) and the objective tests were low, as were correlations between items in the MSWS-12 (S) and the BBS or time taken to complete the TUGcog or the FSST. The internal consistency was acceptable for nine of the 12 items (0.7-0.84). The majority of the sample experienced limitations in several aspects of their walking ability. Concurrent validity was not established between the MSWS-12 (S) and the other tests. There may be a discrepancy in self- perception of disability and objective measures. The use of subjective, as well as objective measures is recommended.
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32.
  • Nilsagård, Ylva, 1964- (författare)
  • Walking ability, balance and accidental falls in persons with Multiple Sclerosis
  • 2008
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • By using a pragmatic paradigm, different research methodologies were employed in this thesis. MS-related symptoms may be exaggerated due to heatsensitivity and it is supposed that cooling garments relieve the symptoms. The effects of wearing a Rehband® vest were evaluated in a sample of 42 persons with MS in a randomised controlled crossover study. Both objective and subjective statistically significant improvements were found when a cooled Rehband® vest was worn compared to the wearing of a room-tempered vest. Using a repeated-measures design, 10m and 30m timed walks and Timed Up and Go were studied in 42 persons with MS. Reproducibility was investigated within and between test points. High reproducibility was found both within (r=0.97–0.98) and between measure points (r=0.91–0.93). The correlation between the three tests was high (r=0.85). Differences at –23% to +40% were established as being needed to detect genuine changes. Severity of MS infl uenced the size of the differences, especially for the 30m timed walk test. The 12-item MS Walking Scale was translated and used in a cross-sectional study. Out of 81 persons with MS, 89–96% perceived limitations in standing or walking. The internal consistency of the scale was acceptable for nine items (0.69–0.84). The concurrent validity between the 12-item MS Walking Scale and the investigated objective tests was low: Berg Balance Scale (r=–0.368**), Four Square Step Test (r=0.338**) and Timed Up and Gocognitive (r=0.319*). A prevalence of falling was found at 63% in a longitudinal cohort study with prospectively registered falls including 76 persons with MS. The odds of falling were fi ve fold when there was a reported need of using a walking aid indoors and outdoors and by 2.5 to 15.6 times while there was disturbed proprioception, depending on severity. The highest sensitivity was found for the Berg Balance Scale (94%) and the highest specifi city was found for the 12-item MS Walking Scale (82%). Positive predictive values at 70–83% were found for the Berg Balance Scale, Timed Up and Gocognitive, the Four Square Step Test and the 12-item MS Walking Scale. Finally, we explored and described factors that persons with MS perceive as related to accidental falls. A content analysis with a deductive approach was chosen. By conducting interviews, we found previously untargeted factors: divided attention, reduced muscular endurance, fatigue and heat-sensitivity. The content of the interviews also gave support to previously reported risk factors such as changes in gait pattern, walking disability, impaired proprioception and vision, and spasticity.
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33.
  • Nilsson, Annika, et al. (författare)
  • Factors related to long-duration pain and sick leave among Swedish staff working in the public health service
  • 2005
  • Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 19 (4):19, s. 7-
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of the present study was to provide information about factors related to long-duration pain (LDP) (>3 months), sick leave (SL) and long sick leave (LSL) (>3 months) among staff in the community health services. The specific research question was: To what extent do data on activity, physical function, pain severity, psychological/cognitive factors, expectations of LDP, expectations to be working within 6 months and work satisfaction predict LDP, SL and LSL respectively? Logistic regression analyses were used to test predicted membership in the groups LDP, SL and LSL. In this context prediction refers to statistical prediction only, due to the cross-sectional design. Staff (n = 914) in the public health services in a medium-sized Swedish city completed a questionnaire during the spring of 2000. The results show that musculoskeletal pain and SL for this occupational group are common. Pain severity, expectations of LDP and fear-avoidance increased the odds of being in the LDP group, while kinesiophobia decreased the odds. Pain severity and kinesiophobia increased the odds of being in the SL group, while expectations to be working in 6 months decreased the odds. Only expectations to be working in 6 months predicted membership in the LSL group, decreasing the odds. Although some caution is warranted concerning the representativity of the sample, the results indicate that expectations about pain duration and ability to work are important psychosocial factors in LDP and LSL.
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34.
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35.
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36.
  • Nilsson, Annika, et al. (författare)
  • Life values as predictors of pain, disability and sick leave among Swedish registered nurses : a longitudinal study
  • 2011
  • Ingår i: BMC Nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 10, s. 17-
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Prospective studies on high-risk populations, such as subgroups of health care staff, are limited, especially prospective studies among staff not on sick-leave. This paper is a report of a longitudinal study conducted to describe and compare the importance and consistency of life domains among registered nurses (RNs) working in a Swedish hospital and evaluate a model based on the consistency of valued life domains for prediction of pain, disability and sick leave.METHOD: Importance and consistency ratings of life values, in 9 domains, were collected during 2003 and 2006 from 196 RNs using the Valued Living Questionnaire (VLQ). Logistic regression analyses were used for prediction of pain, disability and sick leave at the three-year follow-up. The predictors family relations, marriage couples/intimate relations, parenting, friends/social life, work, education, leisure time, psychological well-being, and physical self-care were used at baseline.RESULTS: RNs rated life values regarding parenting as most important and with the highest consistency both at baseline and at follow-up. No significant differences were found between RNs' ratings of importance and consistency over the three-year period, except for friends/social relations that revealed a significant decrease in importance at follow-up. The explanatory models for pain, disability and sick leave significantly predicted pain and disability at follow-up. The odds of having pain were significantly increased by one consistency rating (psychological well-being), while the odds were significantly decreased by physical self-care. In the model predicting disability, consistency in psychological well-being and education significantly increased the odds of being disabled, while consistency in physical self-care significantly decreased the odds.CONCLUSION: The results suggest that there might be a link between intra-individual factors reflecting different aspects of appraised life values and musculoskeletal pain (MSP).
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37.
  • Nilsson, Annika (författare)
  • Musculoskeletal Pain among Health Care Staff : Riskfactors for Pain, Disability and Sick leave
  • 2008
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The present thesis is based on four empirical studies concerning risk factors related to musculoskeletal pain (MSP), disability, and sick leave among three non-clinical samples of health care staff. Initially, in Study I, cognitive, behavioural and environmental factors related to MSP of nurses' aides were explored. An experimental design including baseline, intervention and follow-ups among 29 nurses' aides working in a home for the elderly was used to evaluate effects of a workplace intervention based on cognitive behaviour (CB)- and conventional, symptom reduction principles. In Study II, a cross-sectional and correlational design was applied. A self-administered questionnaire was used to describe and investigate the relationship between risk factors and development of persistent pain, sick leave and long sick leave among 914 municipal health care staff. In Study III and IV, a longitudinal design was used among 200 registered nurses (RN) working in a county hospital to describe and predict pain, disability and sick leave. Data collection involved two self-administered questionnaires covering: 1) work and personal factors, pain, disability and sick leave at baseline and 2) valued life dimensions at baseline. The results showed that MSP was common among the staff. Study I showed positive effects among nurses' aides receiving the CB principles related to MSP compared with nurses' aides receiving the conventional principles. In Study II, pain severity and expectations to be working in 6 months were associated with persistent MSP and sick leave, respectively. In Study III, pain, disability and sick leave at baseline were the strongest predictors of pain, disability and sick leave at the three-year follow-up. In Study IV, the findings support the notion that individual values in different life domains are possible predictors of pain and disability.
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38.
  • Nilsson, Annika, et al. (författare)
  • Predicting of pain, disability, and sick leave regarding a non-clinical sample among Swedish nurses
  • 2010
  • Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter GmbH. - 1877-8860 .- 1877-8879. ; 1:3, s. 160-166
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Health care providers, especially registered nurses (RNs), are a professional group with a high risk of musculoskeletal pain (MSP). This longitudinal study contributes to the literature by describing the prevalence and change in MSP, work-related factors, personal factors, self-reported pain, disability and sick leave (>7 days) among RNs working in a Swedish hospital over a 3-year period. Further, results concerning prediction of pain, disability and sick leave from baseline to a 3-year follow-up are reported. Method: In 2003, a convenience sample of 278 RNs (97.5% women, mean age 43 years) completed a questionnaire. In 2006, 244 RNs (88% of the original sample) were located, and 200 (82%) of these completed a second questionnaire. Results: Logistic regression analyses revealed that pain, disability and sick leave at baseline best predicted pain, disability, and sick leave at follow-up. The personal factors self-rated health and sleep quality during the last week predicted pain at follow-up, while age, self-rated health, and considering yourself as optimist or pessimist predicted disability at follow-up, however weakly. None of the work-related factors contributed significantly to the regression solution. Conclusions: The results support earlier studies showing that a history of pain and disability is predictive of future pain and disability. Attention to individual factors such as personal values may be needed in further research. 
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39.
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40.
  • Overmeer, Thomas, 1960-, et al. (författare)
  • Does teaching physical therapists to deliver a biopsychosocial treatment program result in better patient outcomes? : A randomized controlled trial
  • 2011
  • Ingår i: Physical Therapy. - 0031-9023 .- 1538-6724. ; 91:5, s. 804-819
  • Tidskriftsartikel (refereegranskat)abstract
    • Background. Psychosocial prognostic factors are important in the development of chronic pain, but treatment providers often lack knowledge and skills to assess and address these risk factors. Objective. The aim of this study was to examine the effects on outcomes (pain and disability) in patients of a course about psychosocial prognostic factors for physical therapists. Design. This study was a randomized, controlled trial. Setting. The setting was primary care practice. Participants. Forty-two primary care physical therapists attended an 8-day university course (over 8 weeks) aimed at identifying and addressing psychosocial risk factors. Intervention. The physical therapists were randomly assigned to either the course or a waiting list. They treated consecutive patients with acute and subacute musculoskeletal pain both before and after the course. Measurements. We measured physical therapists' attitudes and beliefs about psychosocial factors, knowledge, and skills before and after the course. We measured patients' pain, disability, catastrophizing, and mood at the start of treatment and at a 6-month follow-up. Methods. The physical therapists were randomly assigned to either the course or a waiting list. They treated consecutive patients with acute and subacute musculoskeletal pain both before and after the course. Results. Pain and disability outcomes in all patients of physical therapists who had participated in the course or in patients at risk of developing long-term disability who had higher levels of catastrophizing or depression were not significantly different from those outcomes in patients of physical therapists who had not participated in the course. Pain and disability outcomes in patients with a low risk of developing long-term disability-and pain outcomes in patients with a high risk of developing long-term disability-were not dependent upon whether the attitudes and beliefs of their physical therapists changed during the course. However, disability outcomes in patients with a high risk of developing long-term disability may have been influenced by whether the attitudes and beliefs of their physical therapists changed. Limitations. A limitation of this study was that actual practice behavior was not measured. Conclusions. An 8-day university course for physical therapists did not improve outcomes in a group of patients as a whole or in patients with a risk of developing long-term disability. However, patients who had a risk of developing long-term disability and had higher levels of catastrophizing or depression may have shown greater reductions in disability if the attitudes and beliefs of their physical therapists changed during the course.
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41.
  • Overmeer, Thomas, 1960-, et al. (författare)
  • Does teaching physical therapists to deliver a biopsychosocial treatment program result in better patient outcomes? : A randomized controlled trial
  • 2011
  • Ingår i: Physical Therapy. - : Oxford University Press. - 0031-9023 .- 1538-6724. ; 91:5, s. 804-819
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Psychosocial risk factors are important in the development of chronic pain but treatment providers often lack knowledge and skills to assess and address these risk factors.Objectives: We examined the effects of a course on psychosocial factors for physical therapists on patient outcome in terms of pain and disability. Design: A randomised controlled trail.Participants: Forty-two primary care physical therapists attended an eight-day university course over eight weeks aimed at identifying and addressing psychosocial risk factors.Methods: They were randomised to either the course or a waiting list. The physical therapists collected consecutive acute and sub-acute patients with musculoskeletal pain both before and after the course.Results: There were no significant differences in outcome for pain or disability for allpatients of physical therapists who had participated in the course or for risk patients with higher levels of catastrophizing or depression compared to patients of physical therapists who had not participated in the course. Outcome for low risk patients on pain and disability and for high risk patients on pain was not dependent on if their physical therapists changed their attitudes and beliefs during the course. Yet, outcome on disability for high risk patients may have been influenced if their physical therapists change their attitudes and beliefs.Limitations: no measure of actual practice behaviour.Conclusions: An eight-day university course for physiotherapists did not improve outcome for the group of patients as a whole or patients at risk of developing long term disability. Yet, risk patients with higher levels of catastrophizing or depression may have had a greater improvement in disability if their physical therapist changed attitudes and beliefs during the course.
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42.
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43.
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44.
  • Sandborgh, Maria, 1955-, et al. (författare)
  • Implementing behavioural medicine in physiotherapy treatment : Part I: Clinical trial
  • 2010
  • Ingår i: Advances in Physiotherapy. - : Informa UK Limited. - 1403-8196 .- 1651-1948. ; 12:1, s. 2-12
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective  To investigate the capacity of the Pain Belief Screening Instrument (PBSI) to discriminate between subgroups for targeting of treatment, investigate effects of treatment tailored to patients' individual and functional goals, and identify a suitable treatment dosage for patients with low risk of disability. Explorative study, Part I. Design  Randomized, controlled clinical trial with four treatment conditions.  Methods  Patients in primary healthcare (n=45) with musculoskeletal pain for ≥4 weeks were included. PBSI-identified subgroups were validated by comparing scores on four established instruments. Measures of disability and patients' ratings of global outcome were used to examine treatment effect.  Results  PBSI data adequately defined patients with either high or low risk of disability. Patients in the tailored treatment rated global outcome as better than in the non-tailored treatment. No differences were found on disability measures. For the low-risk group, the brief tailored treatment was as effective as the non-targeted control treatment. Conclusion  The PBSI adequately defined subgroups. Tailored treatment was partially superior to physical exercise treatment. Targeting by treatment dosage was effective for low-risk patients but remains to be investigated for high-risk patients. Treatment integrity for tailored treatments was compromised and is to be further explored in the following study. Read More: http://informahealthcare.com/doi/abs/10.3109/14038190903480664
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45.
  • Sandborgh, Maria, 1955-, et al. (författare)
  • Implementing behavioural medicine in physiotherapy treatment : Part II: Adherence to treatment protocol
  • 2010
  • Ingår i: Advances in Physiotherapy. - : Informa UK Limited. - 1403-8196 .- 1651-1948. ; 12:1, s. 13-23
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives  In a controlled clinical trial, targeted and tailored treatment strategies, based on cognitive–behavioural treatment principles were investigated. The intervention was aimed at patients with persistent musculoskeletal pain in primary healthcare. A preliminary examination indicated low treatment integrity for the tailored treatment. Therefore, the aim in this study was to evaluate physiotherapists' treatment adherence to a treatment tailored to physical, cognitive and behavioural factors of importance for the performance of patients' prioritized activities. Explorative study, Part II. Materials and Methods  Treatment documents for 18 patients, treated by four specially trained physiotherapists, were utilized for assessment of treatment adherence. A treatment integrity measure was developed, tested and used for evaluation of adherence to the treatment protocol. Results  Physiotherapists' adherence to the treatment manual was low concerning treatment components and the overall sequencing of the treatment. Intrapersonal physical and cognitive factors, and situational variations tied to the performance of prioritized activities targeted in treatment, were rarely found or specified in treatment documents. Statements about functional and causal relationships between determinants for activity performance were not documented or unspecified. Conclusion  The physiotherapists' adherence to the treatment protocol was low despite the pre-intervention training programme and supervision during the intervention period.
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46.
  • Sandborgh, Maria, 1955-, et al. (författare)
  • Integration of Behavioral Medicine Competencies into Physical Therapy Curriculum in an Exemplary Swedish Program : Rationale, Process and Ten-year Review
  • 2020
  • Ingår i: Physiotherapy Theory and Practice. - Philadelphia : Taylor & Francis. - 0959-3985 .- 1532-5040. ; 36:3, s. 365-377
  • Forskningsöversikt (refereegranskat)abstract
    • In 2004, Mälardalen University, Sweden, introduced a new undergraduate entry-level physiotherapy program. Program developers constructed the curriculum with behavioral medicine content that reflected the contemporary definition and values of the physiotherapy profession aligning it with current best practices, evidence, and the International Classification of Functioning, Disability, and Health (ICF). The new curriculum conceptualized movement and function as modifiable behaviors in that they reflect behavioral contingencies, perceptions, beliefs, and lifestyle factors as well as pathophysiology and environmental factors. The purpose of this article is to describe how one university accordingly structured its new curriculum and its review. We describe the rationale for the curriculum's behavioral medicinecontent and competencies, its development and implementation, challenges, long-term outcomes, and its related research enterprise. We conclude that physiotherapy practiced by our graduates augments that taught in other programs based on accreditation reviews. With their expanded practice scope, graduates are systematically practicing within the constructs of health and function conceptualized within the ICF. Our intent in sharing our experience is to exemplify one university's initiative to best prepare students with respect to maximizing physiotherapy outcomes as well as establish a dialogue regarding minimum standards of behavioral medicine competencies in physiotherapy education and practice.
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47.
  • Sandborgh, Maria, et al. (författare)
  • Pain belief screening instrument : development and preliminary validation of a screening instrument for disabling persistent pain
  • 2007
  • Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081 .- 0001-5555. ; 39:6, s. 461-466
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To develop and test the ability of a screening instrument to identify subgroups among primary healthcare patients with musculoskeletal pain. The Pain Belief Screening Instrument covers pain intensity, disability, self-efficacy, fear avoidance and catastrophizing. DESIGN: Cross-sectional, correlational and comparative study. SUBJECTS: Patients in primary healthcare (n1 = 215; n2 = 93) with a pain duration of 4 weeks or more were included. METHODS: Items for the Pain Belief Screening Instrument were derived from principal component analyses of: the Self-efficacy Scale, the Tampa Scale of Kinesiophobia and the Catastrophizing subscale in the Coping Strategies Questionnaire. Cluster solutions of scores on the screening instrument and the original instruments were cross-tabulated. The reliability of items in the Pain Belief Screening Instrument was examined. RESULTS: The screening instrument identified 2 groups: high- or low-risk profile for pain-related disability. Validity was in-between moderate and substantial (kappa = 0.61, p < 0.001). The reliability of each item in the Pain Belief Screening Instrument in relation to the corresponding item in the original instruments was moderate to high (rs 0.50-0.80, p < 0.01). CONCLUSION: The screening instrument fairly well replicated subgroups identified by the original instruments. The reliability of items in the screening instrument was acceptable. Further testing of predictive validity for a primary healthcare population is needed.
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48.
  • Sandborgh, Maria, 1955- (författare)
  • Screening, Targeting, Tailoring, and Implementation in Primary Health Care : An integrated physical therapy and behavioural medicine approach to persons with persistent musculoskeletal pain
  • 2008
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • This thesis deals with a behavioural medicine approach to the management of patients with persistent musculoskeletal pain in primary health care physical therapy. The main aims of the thesis were; to develop, and evaluate the psychometric properties of, a screening instrument for risk of disability and; to evaluate the implementation and effects of a targeted and tailored treatment.The studies comprise four samples of patients with musculoskeletal pain exceeding one month. All subjects were recruited when consulting physical therapists in Swedish primary health care settings. For development and evaluation of the Pain Belief Screening Instrument (PBSI) four samples were used; two samples (n1 = 215 and n2 = 93) in Study I, one sample (n = 168) in Study II, and one sample (n = 45) in Study III. For evaluation of implementation and effects of targeted and tailored treatment the 32 patients who completed treatment in Study III were used. In Study IV treatment documents of 18 patient cases from Study III were studied to evaluate treatment integrity.The concurrent and predictive validity of the PBSI was good, and the instrument was therefore used to define subgroups with either a high or low risk for disability. A low treatment dosage of a tailored treatment for low risk patients was tried and found equally efficient as a longer treatment focusing physical exercise. Subjects who received a treatment tailored to individual patient characteristics perceived a better global outcome of treatment compared to subjects in the control group. However, no between-group differences in the disability measures were found. The evaluation of treatment integrity displayed low therapist adherence to the treatment rationale for the tailored treatment.The studies demonstrate ways to systematically integrate a behavioural medicine approach and physical therapy. The results indicate efficiency in managing patients with persistent musculoskeletal pain in primary health care.
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49.
  • Sandborgh, Maria, et al. (författare)
  • The Pain Belief Screening Instrument (PBSI) : Predictive validity for disability status in persistent musculoskeletal pain
  • 2008
  • Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 30:15, s. 1123-1130
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose. To evaluate the predictive validity of a screening instrument measuring disability, self-efficacy, fear of movement and catastrophizing, for disability status in patients with musculoskeletal pain in primary health care physical therapy. Development over time of pain-related disability, pain intensity, self-reported work capacity and overall daily function for subgroups of patients was also investigated. Method. Prospective and correlational study, where patients (n = 168) with a pain-duration of 4 weeks or more completed the questionnaires and their cases were followed for 8 months to assess the variables of interest. For predictive validity of the screening instrument discriminant analyses were conducted. The development over time for subgroups was analysed by comparing scores at the first and second measurement. Results. The PBSI correctly classified 72% of the subjects as High-disabled (n = 33) or Low-disabled (n = 110), as measured with the Pain Disability Index (Wilks' lambda = 0.848, p < 0.005). For pain intensity, self-reported changes in work capacity and overall daily function the discriminant analyses were not significant. The High-disability group had increased disability, unchanged pain intensity and decreased work capacity and daily function after 8 months. Conclusion. The predictive validity of the PBSI for disability was confirmed. In clinical use the PBSI could serve as a mean to obtain supplementary and clinically useful information.
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50.
  • Söderlund, Anne, et al. (författare)
  • Classification of patients with whiplash associated disorders (WAD) : reliable and valid subgroups based on the Multidimensional Pain Inventory (MPI-S).
  • 2006
  • Ingår i: European Journal of Pain. - : Wiley. - 1090-3801 .- 1532-2149. ; 10:2, s. 113-119
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Classification of patients with chronic whiplash associated disorders (WAD) into homogenous subgroups is an important objective in order to tailor interventions and to control for subgroup differences when evaluating treatment outcome. AIMS: The aims of this study were to investigate if it was possible to replicate and describe the three cluster solution and profiles found in other pain groups and describe cluster profiles based on self-reported Multidimensional Pain Inventory-scores for patients with WAD three months after the injury, describe characteristics of the clusters in relation to disability, self-efficacy and coping at the same point in time and to validate the cluster solution by comparing clusters in disability, self-efficacy and coping over time. METHODS: Ninety-one WAD-patients three months after the accident took part in the study. The measures used were the Multidimensional Pain Inventory-Swedish version (MPI-S), The Self-Efficacy Scale, The Coping Strategies Questionnaire and The Pain Disability Index. Cluster analysis was conducted for the total sample MPI-S subscale scores. RESULTS: The adaptive copers cluster represented 42% of the sample, dysfunctional 34% of the sample, and interpersonally distressed 24% of the sample. The external validation of cluster solution showed that there were several significant differences between clusters in self-efficacy, disability and coping measures. There was also a significant interaction effect (clusterxtime) in disability (PDI). Patients in dysfunctional cluster reported a decreased disability over time. CONCLUSIONS: These results support the presence of different subgroups among patients with whiplash associated disorders. This classification can be seen as a complement to a classification based on medical condition.
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