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1.	Ahmad Kiadaliri, Aliasghar, et al. (författare) Mortality with musculoskeletal disorders as underlying cause in Sweden 1997-2013: a time trend aggregate level study. 2016 Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 17 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: The aim was to assess time trend of mortality with musculoskeletal disorders (MSD) as underlying cause of death in Sweden from 1997 to 2013.METHODS: We obtained data on MSD as underlying cause of death across age and sex groups from the National Board of Health and Welfare's Cause of Death Register. Age-standardized mortality rates per million population for all MSD, its six major subgroups, and all other ICD-10 (International Classification of Disease) chapters were calculated. We computed the average annual percent change (AAPC) in the mortality rates across age/sex groups using joinpoint regression analysis by fitting a regression line to the natural logarithm of the age-standardized mortality rates and calendar year as a predictor.RESULTS: There were a total of 7 976 deaths (0.5 % of all causes deaths) with MSD as the underlying cause of death (32.5 % of these deaths caused by rheumatoid arthritis [RA]). The overall age-standardized mortality rates (95 % CI) were 16.0 (15.4 to 16.7) and 24.9 (24.1 to 25.7) per million among men and women, respectively (women/men rate ratio 1.55; 95%CI 1.47 to 1.63). On average, mortality rate declined by 2.3 % per year and only circulatory system mortality had a more favourable decline than mortality with MSD as underlying cause. Among MSD the highest decline was observed in RA (3.7 % per year) during study period. Across age groups, while there were generally stable or declining trends, spondylopathies and osteoporosis mortality among people ≥ 75 years increased by 2 and 1.5 % per year, respectively.CONCLUSION: In overall, mortality with MSD as underlying cause has declined in Sweden over last two decades, with the highest decline for RA. However, there are variations across MSD subgroups which warrants further investigations.
2.	Ahmad Kiadaliri, Aliasghar, et al. (författare) Musculoskeletal disorders as underlying cause of death in 58 countries, 1986-2011 : trend analysis of WHO mortality database 2017 Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 18 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Due to low mortality rate of musculoskeletal disorders (MSK) less attention has been paid to MSK as underlying cause of death in the general population. The aim was to examine trend in MSK as underlying cause of death in 58 countries across globe during 1986-2011.METHODS: Data on mortality were collected from the WHO mortality database and population data were obtained from the United Nations. Annual sex-specific age-standardized mortality rates (ASMR) were calculated by means of direct standardization using the WHO world standard population. We applied joinpoint regression analysis for trend analysis. Between-country disparities were examined using between-country variance and Gini coefficient. The changes in number of MSK deaths between 1986 and 2011 were decomposed using two counterfactual scenarios.RESULTS: The number of MSK deaths increased by 67% between 1986 and 2011 mainly due to population aging. The mean ASMR changed from 17.2 and 26.6 per million in 1986 to 18.1 and 25.1 in 2011 among men and women, respectively (median: 7.3% increase in men and 9.0% reduction in women). Declines in ASMR of 25% or more were observed for men (women) in 13 (19) countries, while corresponding increases were seen for men (women) in 25 (14) countries. In both sexes, ASMR declined during 1986-1997, then increased during 1997-2001 and again declined over 2001-2011. Despite decline over time, there were substantial between-country disparities in MSK mortality and its temporal trend.CONCLUSIONS: We found substantial variations in MSK mortality and its trends between countries, regions and also between sex and age groups. Promoted awareness and better management of MSK might partly explain reduction in MSK mortality, but variations across countries warrant further investigations.
3.	Aili, Katarina, 1980-, et al. (författare) Sleep problems and fatigue as predictors for the onset of chronic widespread pain over a 5-and 18-year perspective 2018 Ingår i: Bmc Musculoskeletal Disorders. - London : Springer Science and Business Media LLC. - 1471-2474. ; 19 Tidskriftsartikel (refereegranskat)abstract BackgroundPrevious research suggests that sleep problems may be an important predictor for chronic widespread pain (CWP). With this study we investigated both sleep problems and fatigue as predictors for the onset of CWP over a 5-year and an 18-year perspective in a population free from CWP at baseline.MethodsTo get a more stable classification of CWP, we used a wash-out period, including only individuals who had not reported CWP at baseline (1998) and three years prior baseline (1995). In all, data from 1249 individuals entered the analyses for the 5-year follow-up and 791 entered for the 18-year follow-up. Difficulties initiating sleep, maintaining sleep, early morning awakening, non-restorative sleep and fatigue were investigated as predictors separately and simultaneously in binary logistic regression analyses.ResultsThe results showed that problems with initiating sleep, maintaining sleep, early awakening and non-restorative sleep predicted the onset of CWP over a 5-year (OR 1.85 to OR 2.27) and 18-year (OR 1.54 to OR 2.25) perspective irrespective of mental health (assessed by SF-36) at baseline. Also fatigue predicted the onset of CWP over the two-time perspectives (OR 3.70 and OR 2.36 respectively) when adjusting for mental health. Overall the effect of the sleep problems and fatigue on new onset CWP (over a 5-year perspective) was somewhat attenuated when adjusting for pain at baseline but remained significant for problems with early awakening, non-restorative sleep and fatigue. Problems with maintaining sleep predicted CWP 18years later irrespective of mental health and number of pain regions (OR 1.72). Reporting simultaneous problems with all four aspects of sleep was associated with the onset of CWP over a five-year and 18-yearperspective, irrespective of age, gender, socio economy, mental health and pain at baseline. Sleep problems and fatigue predicted the onset of CWP five years later irrespective of each other.ConclusionSleep problems and fatigue were both important predictors for the onset of CWP over a five-year perspective. Sleep problems was a stronger predictor in a longer time-perspective. The results highlight the importance of the assessment of sleep quality and fatigue in the clinic.
4.	Aili, Katarina, et al. (författare) Sleep problems and fatigue as predictors for the onset of chronic widespread pain over a 5- and 18-year perspective 11 Medical and Health Sciences 1117 Public Health and Health Services 2018 Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 19:1 Forskningsöversikt (refereegranskat)abstract Background: Previous research suggests that sleep problems may be an important predictor for chronic widespread pain (CWP). With this study we investigated both sleep problems and fatigue as predictors for the onset of CWP over a 5-year and an 18-year perspective in a population free from CWP at baseline. Methods: To get a more stable classification of CWP, we used a wash-out period, including only individuals who had not reported CWP at baseline (1998) and three years prior baseline (1995). In all, data from 1249 individuals entered the analyses for the 5-year follow-up and 791 entered for the 18-year follow-up. Difficulties initiating sleep, maintaining sleep, early morning awakening, non-restorative sleep and fatigue were investigated as predictors separately and simultaneously in binary logistic regression analyses. Results: The results showed that problems with initiating sleep, maintaining sleep, early awakening and non-restorative sleep predicted the onset of CWP over a 5-year (OR 1.85 to OR 2.27) and 18-year (OR 1.54 to OR 2.25) perspective irrespective of mental health (assessed by SF-36) at baseline. Also fatigue predicted the onset of CWP over the two-time perspectives (OR 3.70 and OR 2.36 respectively) when adjusting for mental health. Overall the effect of the sleep problems and fatigue on new onset CWP (over a 5-year perspective) was somewhat attenuated when adjusting for pain at baseline but remained significant for problems with early awakening, non-restorative sleep and fatigue. Problems with maintaining sleep predicted CWP 18 years later irrespective of mental health and number of pain regions (OR 1.72). Reporting simultaneous problems with all four aspects of sleep was associated with the onset of CWP over a five-year and 18-yearperspective, irrespective of age, gender, socio economy, mental health and pain at baseline. Sleep problems and fatigue predicted the onset of CWP five years later irrespective of each other. Conclusion: Sleep problems and fatigue were both important predictors for the onset of CWP over a five-year perspective. Sleep problems was a stronger predictor in a longer time-perspective. The results highlight the importance of the assessment of sleep quality and fatigue in the clinic.
5.	Ajslev, Jeppe Zielinski Nguyen, et al. (författare) Contradictory individualized self-blaming : a cross-sectional study of associations between expectations to managers, coworkers, one-self and risk factors for musculoskeletal disorders among construction workers 2017 Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 18:1, s. 13-13 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Within work sociology, several studies have addressed construction workers' practices of masculinity, class, economy, safety risks and production. However, few studies have investigated room for agency in relation to bodily pain or musculoskeletal disorders and even fewer have made a quantitative approach. Accordingly, by means of a questionnaire, we examined the association between construction workers' room for agency and physical exertion, bodily and mental fatigue, and lower back pain.METHODS: A total of 481 Danish construction workers who responded to a multifaceted questionnaire were included. Drawing on previous studies and a Foucauldian inspired concept of agency, agency was quantified through specially crafted questions and examined in relation to established measures on physical exertion, physical and mental fatigue and pain in the lower back. Associations were tested using analyses of variance (general linear models) and controlled for age, gender, job group, lifestyle and depression.RESULTS: When asked about options for agency reducing the burden of work, few workers believed themselves to be prime agents of such practices. When asking about their view on performing alternative agency implying caring for the body, 39-49% expected negative reactions from management, and 20-33% expected negative reactions from colleagues. In contrast, only 13-18% of the participants stated that they would give a negative reception to such alternative practices. Using the expected reception outcomes (positive, neutral, negative) to alternative practices as predictors, the statistical regression analyses showed that negative expectations to management were associated with higher levels of physical exertion 0.62 (95% CI = 0.14-1.09) (scale 0-11), bodily fatigue 0.63 (95% CI = 0.22-1.04), mental fatigue 0.60 (95% CI = 0.07-1.12), and low back pain 0.79 (95% CI = 0.13-1.46) (scales 0-10).CONCLUSION: In our study, construction workers answered questions about work and MSD. The answers indicated a contradiction between perceived responsibility and room for agency. Based on the study, a number of target areas could fruitfully be addressed in aiming to reduce MSD among construction workers. To change workers' expectances to the reception of lowering work pace if needed to take care of the body, their expectances to the reception of sickness absence as a result of pain, of discussing physical exertion in work and of demanding appropriate technical assistive devices are such examples. Our results emphasize that management plays an important role in this.
6.	Al-Amiry, Bariq, 1976-, et al. (författare) Does body mass index affect restoration of femoral offset, leg length and cup positioning after total hip arthroplasty? : a prospective cohort study 2019 Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central (BMC). - 1471-2474. ; 20 Tidskriftsartikel (refereegranskat)abstract Background: In obese patients, total hip arthroplasty (THA) can be technically demanding with increased perioperative risks. The aim of this prospective cohort study is to evaluate the effect of body mass index (BMI) on radiological restoration of femoral offset (FO) and leg length as well as acetabular cup positioning.Methods: In this prospective study, patients with unilateral primary osteoarthritis (OA) treated with THA between September 2010 and December 2013 were considered for inclusion. The perioperative plain radiographs were standardised and used to measure the preoperative degree of hip osteoarthritis, postoperative FO, leg length discrepancy (LLD), acetabular component inclination and anteversion.Results: We included 213 patients (74.5% of those considered for inclusion) with a mean BMI of 27.7 (SD 4.5) in the final analysis. The postoperative FO was improper in 55% and the LLD in 15%, while the cup inclination and anteversion were improper in 13 and 23% of patients respectively. A multivariable logistic regression model identified BMI as the only factor that affected LLD. Increased BMI increased the risk of LLD (OR 1.14, 95% CI 1.04 to 1.25). No other factors included in the model affected any of the primary or secondary outcomes.Conclusion: Increased BMI showed a negative effect on restoration of post-THA leg length but not on restoration of FO or positioning of the acetabular cup. Age, gender, OA duration or radiological severity and surgeon’s experience showed no relation to post-THA restoration of FO, leg length or cup positioning.
7.	Arponen, H, et al. (författare) Fatigue and disturbances of sleep in patients with osteogenesis imperfecta - a cross-sectional questionnaire study 2018 Ingår i: BMC musculoskeletal disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 19:1, s. 3- Tidskriftsartikel (refereegranskat)
8.	Arvidsson, Inger, et al. (författare) Cross-sectional associations between occupational factors and musculoskeletal pain in women teachers, nurses and sonographers. 2016 Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 17:1 Tidskriftsartikel (refereegranskat)abstract It is usually assumed that musculoskeletal pain is associated with both the physical workload and the psychosocial work environment, as well as with personal and lifestyle factors. This study aims to ascertain the prevalence of musculoskeletal pain in women with varying or different occupational exposures, and to explore the associations between musculoskeletal pain and the occupational and personal factors.
9.	Asker, Martin, et al. (författare) A prospective cohort study identifying risk factors for shoulder injuries in adolescent elite handball players: the Karolinska Handball Study (KHAST) study protocol 2017 Ingår i: BMC Musculoskeletal Disorders. - : BIOMED CENTRAL LTD. - 1471-2474. ; 18 Tidskriftsartikel (refereegranskat)abstract Background: Handball is a physical contact sport that includes frequent overhead throwing, and this combination leads to a high rate of shoulder injuries. Several factors have been associated with shoulder injuries in overhead athletes, but strong scientific evidence is lacking for most suggested risk factors. We therefore designed the Karolinska Handball Study (KHAST) with the aim to identify risk factors for shoulder injuries in adolescent male and female elite handball players studying at handball-profiled secondary schools in Sweden. Secondary objectives are to investigate whether shoulder function changes during the competition season and whether the physical profile of the players changes during their time in secondary school. Methods: Players aged 15 to 19 years were included during the pre-season period of the 2014-2015 and the 2015-2016 seasons. At inclusion, players signed informed consent and filled in a questionnaire regarding playing position, playing level, previous handball experience, history of shoulder problems and athletic identity. Players also completed a detailed test battery at baseline evaluating the shoulder, neck and trunk. Players were then prospectively monitored weekly during the 2014-2015 and/or 2015-2016 competitive seasons regarding injuries and training/match workload. Results from the annual routine physical tests in the secondary school curriculum including bench press, deep squat, hand grip strength, clean lifts, squat jumps, counter movement jumps, amp;lt;30 m sprints, chins, dips and Coopers test will be collected until the end of the competitive season 2017-2018. The primary outcome is the incidence of shoulder injuries and shoulder problems. The secondary outcome is the prevalence of shoulder injuries and shoulder problems. Discussion: Shoulder problems are frequent among handball players and a reduction of these injuries is therefore warranted. However, in order to introduce appropriate preventive measures, a detailed understanding of the underlying risk factors is needed. Our study has a high potential to identify important risk factors for shoulder injuries in adolescent elite handball players owing to a large study sample, a high response rate, data collection during consecutive seasons, and recording of potential confounding factors.
10.	Badawy, Mona, et al. (författare) Hospital volume and the risk of revision in Oxford unicompartmental knee arthroplasty in the Nordic countries -an observational study of 14,496 cases 2017 Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 18:1 Tidskriftsartikel (refereegranskat)abstract Background: High procedure volume and dedication to unicompartmental knee arthroplasty (UKA) has been suggested to improve revision rates. This study aimed to quantify the annual hospital volume effect on revision risk in Oxfordu? nicompartmental knee arthroplasty in the Nordic countries. Methods: 14,496 cases of cemented medial Oxford III UKA were identified in 126 hospitals in the four countries included in the Nordic Arthroplasty Register Association (NARA) database from 2000 to 2012. Hospitals were divided by quartiles into 4 annual procedure volume groups (≤11, 12-23, 24-43 and ≥44). The outcome was revision risk after 2 and 10 years calculated using Kaplan Meier method. Multivariate Cox regression analysis was used to assess the Hazard Ratio (HR) of any revision due to specific reasons with 95% confidence intervals (CI). Results: The implant survival was 80% at 10 years in the volume group ≤11 procedures per year compared to 83% in other volume groups. The HR adjusted for age category, sex, year of surgery and nation was 0.87 (95% CI: 0.76-0.99, p = 0.036) for the group 12-23 procedures per year, 0.78 (95% CI: 0.68-0.91, p = 0.002) for the group 24-43 procedures per year and 0.82 (95% CI: 0.70-0.94, p = 0.006) for the group ≥44 procedures per year compared to the low volume group. Log-rank test was p = 0.003. The risk of revision for unexplained pain was 40-50% higher in the low compared with other volume groups. Conclusion: Low volume hospitals performing ≤11 Oxford III UKAs per year were associated with an increased risk of revision compared to higher volume hospitals, and unexplained pain as revision cause was more common in low volume hospitals.
11.	Balogh, Istvan, et al. (författare) Work-related neck and upper limb disorders - Quantitative exposure-response relationships adjusted for personal characteristics and psychosocial conditions 2019 Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 20:1 Tidskriftsartikel (refereegranskat)abstract Background: We have previously reported quantitative exposure-response relationships between physical exposures recorded by technical methods, and complaints and diagnoses in the neck/shoulders, and the elbows/hands, based on group data. In the present study the number of workers was doubled, and information on individual factors, and psychosocial working conditions was used. Relationships between various kinds of exposure and response have been analysed in this larger and more detailed sample. Methods: The prevalence of complaints (Nordic Questionnaire) and diagnoses (clinical examination) were recorded in a number of occupational groups within which the participants had similar work tasks, 34 groups of female employees (N = 4733 women) and 17 groups of male employees (N = 1107 men). Age and other individual characteristics were recorded, as well as psychosocial work environment factors (job-content questionnaire) for most participants. Postures and velocities (inclinometry) of the head (N = 505) and right upper arm (N = 510), right wrist postures and velocities (electrogoniometry; N = 685), and muscular activity (electromyography; EMG) in the right trapezius muscle (N = 647) and forearm extensors (N = 396) were recorded in representative sub-groups. Exposure-response relationships between physical exposure and musculoskeletal disorders, adjusted for individual factors with Poisson regression were then calculated. The effect of introducing psychosocial conditions into the models was also assessed. Results: Associations were found between head velocity, trapezius activity, upper arm velocity, forearm extensor activity and wrist posture and velocity, and most neck/shoulder and elbow/hand complaints and diagnoses. Adjustment for age, other individual characteristics and psychosocial work conditions had only a limited effect on these associations. For example, the attributable fraction for tension neck syndrome among female workers with the highest quintile of trapezius activity was 58%, for carpal tunnel syndrome versus wrist velocity it was 92% in men in the highest exposure quintile. Conclusions: Based on the findings, we propose threshold limit values for upper arm and wrist velocity.
12.	Bengtsson, Karin, 1980, et al. (författare) Comparisons between comorbid conditions and health care consumption in rheumatoid arthritis patients with or without biological disease-modifying antirheumatic drugs : a register-based study 2016 Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 17:1 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Symptoms and prognosis of patients with rheumatoid arthritis (RA) have improved with more intensive therapy, including the biological disease-modifying anti-rheumatic drugs (bDMARDs). Real life data concerning how comorbidities are distributed among patients treated or not treated with bDMARDs are scarce. Our objective was to investigate differences in comorbidity and health care consumption in RA patients, with and without bDMARDs.METHODS: This cross-sectional study was performed in the Southwestern part of Sweden. Patients, aged ≥ 18 years and diagnosed with RA in secondary health care during 2009-2010, were identified in the regional health care database. Aggregated data of comorbidity and health care consumption were retrieved between 2006 and 2010. RA patients treated with bDMARDs on 31st December 2010 were identified in the Swedish Rheumatology Quality Register (SRQ), which includes the biologics register Anti-Rheumatic Therapy in Sweden (ARTIS). Descriptive, comparative, univariate and multiple logistic regression analyses were used to identify factors associated with bDMARDs.RESULTS: Seven thousand seven hundred and twelve (7712) RA patients were identified (age 64.8 ± 14.9 years, women 74.3%), of whom 1137 (14.7%) were treated with bDMARDs. Overall, the most common comorbidities were infections (69.2%), hypertension (41.1%), chronic respiratory disease (15.3%), ischemic heart disease (14.0%) and malignancy (13.7%). Patients without bDMARDs were older and had more comorbidity. In the multiple logistic regression analysis, older age, cerebrovascular and chronic respiratory disease, heart failure, depression and malignancy were all associated with no present bDMARDs. Infections were associated with bDMARDs. Patients treated with bDMARDs consumed more secondary outpatient care but less visits in primary health care compared to patients without bDMARDs.CONCLUSIONS: Patients treated with bDMARDs versus no bDMARDs were younger and had significantly lower period prevalence for most common comorbidities, with the exception of infections. Differences in comorbidities between RA patients with or without bDMARDs should be taken into consideration when evaluating effectiveness and safety of bDMARDs in ordinary care.
13.	Berglund, Britta, et al. (författare) Self-reported quality of life, anxiety and depression in individuals with Ehlers-Danlos syndrome (EDS) : a questionnaire study 2015 Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 16 Tidskriftsartikel (refereegranskat)abstract Background: Many individuals with Ehlers-Danlos Syndrome (EDS) are hypermobile, suffer from long term pain, and have complex health problems. Since these sometimes have no objective physical signs, individuals with EDS sometimes are referred for psychiatric evaluation. The aim was therefore to identify the level of anxiety and quality of life in a Swedish group of individuals with EDS. Methods: A postal survey in 2008 was distributed to 365 members over 18 years of the Swedish National EDS Association and 250 with EDS diagnosis responded. Two questionnaires, the Hospital Anxiety and Depression Scale (HADS) and SF-36, were used. A Swedish population study was used to compare results from SF-36. Independent Student's t-test was used to compare differences between groups, possible relationships were tested using Spearman's correlation coefficient and the General Linear Model was used for regression analyses. Higher scores on HADS represent higher levels of anxiety and depression and higher scores on SF-36 represent higher quality of health. Results: Of the respondents 74.8% scored high on anxiety and 22.4% scored high on depression on the HADS. Age, tiredness and back pain was independently associated with the HAD anxiety score in a multiple regression analysis, When comparing the SF-36 scores from the EDS group and a Swedish population group, the EDS group scored significantly lower, indicating lower health-related quality of health than the general population (p < 0.001). Conclusions: In comparison with a Swedish population group, a lower health-related quality of life was found in the EDS group. Also, higher levels of anxiety and depression were detected in individuals with EDS. The importance to explore the factors behind these results and what initiatives can be taken to alleviate the situation for this group is emphasized.
14.	Bergman, Stefan, et al. (författare) Chronic widespread pain and its associations with quality of life and function at a 20-year follow-up of individuals with chronic knee pain at inclusion 2019 Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 20:1 Tidskriftsartikel (refereegranskat)abstract Objective: To study the prevalence of chronic widespread pain (CWP) and chronic regional pain (CRP), and their association to quality of life, pain, physical function at a 20-year follow-up in a population based cohort with chronic knee pain at inclusion. Methods: 121 individuals (45% women, mean age 64 years, range 54-73) with chronic knee pain from a population-based cohort study, answered a questionnaire and had radiographic knee examination at a 20-year follow-up. The responders were divided into three groups according to reported pain; individuals having no chronic pain (NCP), chronic widespread pain (CWP) and chronic regional pain (CRP). Pain and physical function were assessed using Knee injury and Osteoarthritis Outcome Score (KOOS). Health related quality of life (HRQL) was assessed with Euroqol-5D-3 L (EQ5D) and Short form 36 (SF36). The associations between pain groups and KOOS, EQ5D, and SF36 were analysed by multiple logistic regression, controlled for age, gender and radiographic changes indicating knee osteoarthritis (OA). Results: The prevalence of CWP was 30%, and CWP was associated to worse scores in all KOOS subscales, controlled for age, gender and radiographic changes. CWP was also associated to worse scores in EQ-5D and in seven of the SF-36 subgroups, controlled for age, gender and radiographic changes. Conclusion: One third of individuals with chronic knee pain met the criteria for CWP. CWP was associated with patient reported pain, function and HRQL. This suggest that it is important to assess CWP in the evaluation of patients with chronic knee pain, with and without radiographic knee OA.
15.	Bergström, Cecilia, et al. (författare) Prevalence and predictors of persistent pelvic girdle pain 12 years postpartum 2017 Ingår i: BMC Musculoskeletal Disorders. - : BIOMED CENTRAL LTD. - 1471-2474. ; 18 Tidskriftsartikel (refereegranskat)abstract Background: Pelvic girdle pain (PGP) is not always a self-limiting condition. Women with more pronounced persistent PGP (PPGP) report poorer health status compared to women with less pronounced symptoms. The knowledge concerning the long-term consequences of PPGP is limited, thus more knowledge in this area is needed. The overall aim was to study the prevalence and predictors of PPGP 12 years after delivery. Methods: This is a long-term follow-up study based on a previous cohort study that commenced in 2002. New questionnaire data 12 years postpartum were collected in 2014 and early 2015. The questionnaire was distributed to a total of 624 women from the initial cohort. Results: In total, 295 women (47.3%) responded to the questionnaire where 40.3% (n = 119) reported pain to a various degree and 59% (n = 174) reported no pain. Increased duration and/or persistency of pain, self-rated health, sciatica, neck and/or thoracic spinal pain, sick leave the past 12 months, treatment sought, and prescription and/or non-prescription drugs used were all associated with an statistically significant increase in the odds of reporting pain 12 years postpartum. Widespread pain was common and median expectation of improvement score was 5 on an 11-point numeric scale (interquartile range 2-7.50). More than one of five women (21.8%) reporting pain stated that they had been on sick leave the past 12 months and nearly 11% had been granted disability pension due to PPGP. No statistically significant differences were found between respondents and non-respondents regarding most background variables. Conclusions: This study is unique as it is one of few long-term follow-up studies following women with PPGP of more than 11 years. The results show that spontaneous recovery with no recurrences is an unlikely scenario for a subgroup of women with PPGP. Persistency and/or duration of pain symptoms as well as widespread pain appear to be the strongest predictors of poor long-term outcome. Moreover, widespread pain is commonly associated with PPGP and may thus contribute to long-term sick leave and disability pension. A screening tool needs to be developed for the identification of women at risk of developing PPGP to enable early intervention.
16.	Bjersing, Jan, 1966, et al. (författare) Benefits of resistance exercise in lean women with fibromyalgia: involvement of IGF-1 and leptin 2017 Ingår i: Bmc Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 18:106 Tidskriftsartikel (refereegranskat)abstract Background: Chronic pain and fatigue improves by exercise in fibromyalgia (FM) but underlying mechanisms are not known. Obesity is increased among FM patients and associates with higher levels of pain. Symptom improvement after aerobic exercise is affected by body mass index (BMI) in FM. Metabolic factors such as insulin-like growth factor 1 (IGF1) and leptin may be involved. In this study, the aim was to evaluate the role of metabolic factors in lean, overweight and obese women during resistance exercise, in relation to symptom severity and muscle strength in women with FM. Methods: Forty-three women participated in supervised progressive resistance exercise, twice weekly for 15-weeks. Serum free and total IGF-1, IGF-binding protein 3 (IGFBP3), adiponectin, leptin and resistin were determined at baseline and after 15-weeks. Level of current pain was rated on a visual analogue scale (0-100 mm). Level of fatigue was rated by multidimensional fatigue inventory (MFI-20) subscale general fatigue (MFIGF). Knee extension force, elbow flexion force and handgrip force were assessed by dynamometers. Results: Free IGF-1 (p = 0.047), IGFBP3 (p = 0.025) and leptin (p = 0.008) were significantly decreased in lean women (n = 18), but not in the overweight (n = 17) and the obese (n = 8). Lean women with FM benefited from resistance exercise with improvements in current pain (p= 0.039, n = 18), general fatigue (MFIGF, p = 0.022, n = 18) and improved elbow-flexion force (p = 0.017, n = 18). In overweight and obese women with FM there was no significant improvement in pain or fatigue but an improvement in elbow flexion (p = 0.049; p = 0.012) after 15 weeks of resistance exercise. Conclusion: The clearest clinical response to resistance exercise was found in lean patients with FM. In these individuals, individualized resistance exercise was followed by changes in IGF-1 and leptin, reduced pain, fatigue and improved muscular strength. In overweight and obese women FM markers of metabolic signaling and clinical symptoms were unchanged, but strength was improved in the upper limb. Resistance exercise combined with dietary interventions might benefit patients with FM and overweight.
17.	Björk, Mathilda, et al. (författare) Quality of life and acquired organ damage are intimately related to activity limitations in patients with systemic lupus erythematosus 2015 Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central / Springer Verlag (Germany). - 1471-2474. ; 16:188 Tidskriftsartikel (refereegranskat)abstract Background: Systemic lupus erythematosus (SLE) is an autoimmune multi-organ disease, characterized by episodes of disease flares and remissions over time, which may restrain affected patients ability to perform daily activities. The purpose of the present study was to characterize variation in activity limitations among well-defined SLE patients, and to describe disease phenotypes, acquired organ damage and their relations to activity limitation and self-reported health, respectively. Methods: The disease phenotypes were organized into 4 different clinical groups and logistic regression analyses were used to identify how an elevated health assessment questionnaire (HAQ) score was related to disease variables such as phenotypes, disease activity and damage accrual. Correlation and multiple linear regression analyses were used to examine the association between each group of variables - background variables, disease variables and self-reported measurements - and the degree of elevated HAQ. Results: We found a higher proportion of activity limitation in patients with skin and joint involvement compared to others. The presence of activity limitation, as detected by the HAQ instrument, was significantly associated with quality of life (EuroQol-5D) and accrual of organ damage using the Systemic Lupus International Collaborative Clinics/ACR damage index. Conclusions: The findings highlight the differing requirements of the multi-professional rehabilitation interventions for the various SLE phenotypes in order to optimize the clinical care of the patients.
18.	Blomgren, Johannes, et al. (författare) Effects of deep cervical flexor training on impaired physiological functions associated with chronic neck pain: a systematic review 2018 Ingår i: BMC Musculoskeletal Disorders. - London : BMC. - 1471-2474. ; 19 Tidskriftsartikel (refereegranskat)abstract Background:Neck pain is a major health issue with high rates of recurrence. It presents with a variety ofaltered sensorimotor functions. Exercise is a cornerstone of rehabilitation and many training methods areused. Exercise is evaluated in most randomized controlled trials on its pain relieving effects. No review hasassessed the effect of exercise on the altered physiological functions or determined if there are differentialeffects of particular training methods. This review investigated the effects of deep cervical flexor (DCF)training, a training method commonly used for patients with neck pain, and compared it to other trainingmethodsornotrainingonoutcomesofcervicalneuromuscular function, muscle size, kinematics and kinetics.Methods:Web of Science, Scopus, CINAHL, PubMed were searched from inception until January 2018. Twelverandomized controlled trials were included that compared DCF training as sole intervention to other trainingor no interventions in persons with neck pain. The Cochrane Risk of Bias tool was used to assess the methodquality. All outcome measures were analysed descriptively and meta-analyses were performed for measuresevaluated in three or more studies.Results:DCF training was compared to cervical endurance, strength, proprioception and mobility training,muscle stretching, and no intervention control groups. Physiological outcome measures includedneuromuscular co-ordination (craniocervical flexion test), functional tasks, muscle fatigability, muscle size,kinematics (joint position sense, posture and range of motion) and kinetics (strength, endurance andcontraction accuracy). Strong evidence was found for effectiveness of DCF training on neuromuscularcoordination, but it had no or small effects on strength and endurance at higher loads. DCF trainingimproved head and cervical posture, while evidence was limited or contradictory for other measures.Conclusions:DCF training can successfully address impaired neuromuscular coordination, but not cervicalflexor strength and endurance at higher contraction intensities. A multimodal training regime is proposedwhen the aim is to specifically address various impaired physiological functions associated with neck pain
19.	Blomkvist, AW, et al. (författare) Handgrip force steadiness in young and older adults: a reproducibility study 2018 Ingår i: BMC musculoskeletal disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 19:1, s. 96- Tidskriftsartikel (refereegranskat)
20.	Blomkvist, AW, et al. (författare) Isometric hand grip strength measured by the Nintendo Wii Balance Board - a reliable new method 2016 Ingår i: BMC musculoskeletal disorders. - 1471-2474. ; 17, s. 56- Tidskriftsartikel (refereegranskat)
21.	Bornhöft, Lena, et al. (författare) More cost-effective management of patients with musculoskeletal disorders in primary care after direct triaging to physiotherapists for initial assessment compared to initial general practitioner assessment. 2019 Ingår i: BMC musculoskeletal disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 20:1 Tidskriftsartikel (refereegranskat)abstract A model for triaging patients in primary care to provide immediate contact with the most appropriate profession to treat the condition in question has been developed and implemented in parts of Sweden. Direct triaging of patients with musculoskeletal disorders (MSD) to physiotherapists at primary healthcare centres has been proposed as an alternative to initial assessment by general practitioners (GPs) and has been shown to have many positive effects. The aim of this study was to evaluate the cost-effectiveness from the societal perspective of this new care-pathway through primary care regarding triaging patients with MSD to initial assessment by physiotherapists compared to standard practice with initial GP assessment.Nurse-assessed patients with MSD (N=55) were randomised to initial assessment and treatment with either physiotherapists or GPs and were followed for 1year regarding health-related quality of life, utilization of healthcare resources and absence from work for MSD. Quality-adjusted life-years (QALYs) were calculated based on EQ5D measured at 5 time-points. Costs for healthcare resources and production loss were compiled. Incremental cost-effectiveness ratios (ICERS) were calculated. Multiple imputation was used to compensate for missing values and bootstrapping to handle uncertainty. A cost-effectiveness plane and a cost-effectiveness acceptability curve were construed to describe the results.The group who were allocated to initial assessment by physiotherapists had slightly larger gains in QALYs at lower total costs. At a willingness-to-pay threshold of 20,000 €, the likelihood that the intervention was cost-effective from a societal perspective including production loss due to MSD was 85% increasing to 93% at higher thresholds. When only healthcare costs were considered, triaging to physiotherapists was still less costly in relation to health improvements than standard praxis.From the societal perspective, this small study indicated that triaging directly to physiotherapists in primary care has a high likelihood of being cost-effective. However, further larger randomised trials will be necessary to corroborate these findings.ClinicalTrials.gov NCT02218749 . Registered August 18, 2014.
22.	Bramberg, EB, et al. (författare) Effects of yoga, strength training and advice on back pain: a randomized controlled trial 2017 Ingår i: BMC musculoskeletal disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 18:1, s. 132- Tidskriftsartikel (refereegranskat)
23.	Brandt Knutsson, Sara, et al. (författare) Femoral fracture classification in the Swedish Fracture Register - A validity study 2019 Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 20 Tidskriftsartikel (refereegranskat)abstract © 2019 The Author(s). Background: A total of more than 270,000 fractures are registered in the Swedish Fracture Register (SFR), a national quality register. Fractures are classified following the AO/OTA classification, commonly by a junior doctor. As a step in the process of validating the data in the SFR, several studies of the accuracy of the fracture classification have already been published. The aim of this study was to evaluate the accuracy of femoral fracture classification in the SFR. Methods: One hundred and eighteen femur fractures were randomly selected from the SFR. Three experienced orthopaedic surgeons individually classified these fractures on two separate occasions and a gold standard classification was established. This classification was compared with the original classification in the SFR. Inter- and intraobserver agreement was calculated. Results: The agreement between the classification in the SFR and the gold standard classification was kappa = 0.65 for the AO/OTA group and kappa = 0.83 for the AO/OTA type. This corresponds to substantial and almost perfect agreement, according to Landis and Koch. The kappa values for interobserver agreement ranged from 0.64-0.76 for the AO/OTA group and 0.76-0.85 for the AO/OTA type. The kappa values for intraobserver agreement ranged from 0.79-0.81 for the AO/OTA group and 0.91-0.93 for the AO/OTA type. Conclusions: The classification of femoral fractures in the Swedish Fracture Register is substantial (AO/OTA group) to almost perfect (AO/OTA type) and as accurate as in previous studies. The present study also shows that the agreement between the SFR classification and a gold standard classification is in the same range of agreement as between experienced raters. In contrast to previous studies, the classifications in the SFR are made by an unselected group of mostly inexperienced classifiers. The results indicate that the fracture classification in a national quality register can be accurate enough to permit the evaluation of fracture treatment in specific groups of fractures.
24.	Castell, MV, et al. (författare) Osteoarthritis and frailty in elderly individuals across six European countries: results from the European Project on OSteoArthritis (EPOSA) 2015 Ingår i: BMC musculoskeletal disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 16, s. 359- Tidskriftsartikel (refereegranskat)
25.	Chammout, G, et al. (författare) Cemented compared to uncemented femoral stems in total hip replacement for displaced femoral neck fractures in the elderly: study protocol for a single-blinded, randomized controlled trial (CHANCE-trial) 2016 Ingår i: BMC musculoskeletal disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 17:1, s. 398- Tidskriftsartikel (refereegranskat)
26.	Charlesworth, Jonathon, et al. (författare) Osteoarthritis- a systematic review of long-term safety implications for osteoarthritis of the knee 2019 Ingår i: BMC Musculoskeletal Disorders. - : BMC. - 1471-2474. ; 20 Forskningsöversikt (refereegranskat)abstract Background: There is no cure for knee osteoarthritis (KOA) and typically patients live approximately 30-years with the disease. Most common medical treatments result in short-term palliation of symptoms with little consideration of long-term risk. This systematic review aims to appraise the current evidence for the long-term (amp;gt;= 12 months) safety of common treatments for knee osteoarthritis (KOA). Methods: Cochrane Database of Systematic Reviews, Medline and PubMed were systematically searched from 1990 to July 2017, inclusive. Inclusion criteria were 1) peer-reviewed publications investigating treatments for KOA referred to in the Australian Clinical Care Standard and/or Therapeutic Guidelines: Rheumatology 2) specifically addressing safety of the treatments 3) with amp;gt;= 12 months of follow-up and 4) Downs and Black quality score amp;gt;= 13. Results: Thirty-four studies fulfilled the inclusion criteria. Lifestyle modifications (moderate exercise and weight loss), paracetamol, glucosamine, Intraarticular Hyaluronic Acid (IAHA) and platelet-rich-plasma (PRP) injections have a low risk of harm and beneficial amp;gt;= 12 month outcomes. Although Nonsteroidal Anti-inflammatory Drugs (NSAIDs) provide pain relief, they are associated with increased risk of medical complications. Cortisone injections are associated with radiological cartilage degeneration at amp;gt; 12 months. Arthroscopy for degenerative meniscal tears in KOA leads to a 3-fold increase in total knee arthroplasty (TKA). TKA improves primary outcomes of KOA but has a low rate of significant medical complications. Conclusions: Given the safety and effectiveness of lifestyle interventions such as weight loss and exercise, these should be advocated in all patients due to the low risk of harm. The use of NSAIDs should be minimized to avoid gastrointestinal complications. Treatment with opioids has a lack of evidence for use and a high risk of long-term harm. The use of IAHA and PRP may provide additional symptomatic benefit without the risk of harm. TKA is associated with significant medical complications but is justified by the efficacy of joint replacement in late-stage disease.
27.	Cnudde, Peter, 1970, et al. (författare) Linking Swedish health data registers to establish a research database and a shared decision-making tool in hip replacement 2016 Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 17:1 Tidskriftsartikel (refereegranskat)abstract Background: Sweden offers a unique opportunity to researchers to construct comprehensive databases that encompass a wide variety of healthcare related data. Statistics Sweden and the National Board of Health and Welfare collect individual level data for all Swedish residents that ranges from medical diagnoses to socioeconomic information. In addition to the information collected by governmental agencies the medical profession has initiated nationwide Quality Registers that collect data on specific diagnoses and interventions. The Quality Registers analyze activity within healthcare institutions, with the aims of improving clinical care and fostering clinical research. Main body: The Swedish Hip Arthroplasty Register (SHAR) has been collecting data since 1979. Joint replacement in general and hip replacement in particular is considered a success story with low mortality and complication rate. It is credited to the pioneering work of the SHAR that the revision rate following hip replacement surgery in Sweden is amongst the lowest in the world. This has been accomplished by the diligent follow-up of patients with feedback of outcomes to the providers of the healthcare along with post market surveillance of individual implant performance. During its existence SHAR has experienced a constant organic growth. One major development was the introduction of the Patient Reported Outcome Measures program, giving a voice to the patients in healthcare performance evaluation. The next aim for SHAR is to integrate patients' wishes and expectations with the surgeons' expertise in the form of a Shared Decision-Making (SDM) instrument. The first step in building such an instrument is to assemble the necessary data. This involves linking the SHARs database with the two aforementioned governmental agencies. The linkage is done by the 10-digit personal identity number assigned at birth (or immigration) for every Swedish resident. The anonymized data is stored on encrypted serves and can only be accessed after double identification. Conclusion: This data will serve as starting point for several research projects and clinical improvement work.
28.	Dahlqvist, Camilla, et al. (författare) Self-recordings of upper arm elevation during cleaning - comparison between analyses using a simplified reference posture and a standard reference posture 2018 Ingår i: BMC Musculoskeletal Disorders. - : BMC. - 1471-2474. ; 19 Tidskriftsartikel (refereegranskat)abstract Background To reduce ergonomic risk factors in terms of awkward and constrained postures and high velocities, it is important to perform adequate risk assessments. Technical methods provide objective measures of physical workload. These methods have so far mainly been used by researchers. However, if written instructions how to apply the sensors and how to adopt the reference posture are provided, together with triaxial accelerometers, it may be possible for employees to record their own physical workload. The exposure in terms of e.g. upper arm elevations could then easily be assessed for all workers in a workplace. The main aims of this study were: 1) to compare analyses for self-recording of upper arm elevation during work using a simplified reference posture versus using a standard reference posture, and 2) to compare the two reference postures.MethodsTwenty-eight cleaners attached an accelerometer to their dominant upper arm and adopted a simplified reference according to a written instruction. They were thereafter instructed by a researcher to adopt a standard reference. Upper arm elevations were recorded for 2 or 3 days. Each recording was analysed twice; relative to the simplified reference posture and relative to the standard reference posture. The group means of the differences in recorded upper arm elevations between simplified and standard reference analyses were assessed using Wilcoxon signed ranks test. Furthermore, we calculated the group mean of the differences between the simplified reference posture and the standard reference posture.ResultsFor arm elevation during work (50(th) percentile), the group mean of the differences between the two analyses was 0.2 degrees (range-7 - 10 degrees). The group mean of the differences between the two references was 9 degrees (range 1-21 degrees). The subjects were able to follow the instructions in the protocol and performed self-recording of upper arm elevation and velocity.ConclusionsThe small difference between the two analyses indicates that recordings performed by employees themselves are comparable, on a group level, with those performed by researchers. Self-recordings in combination with action levels would provide employers with a method for risk assessment as a solid basis for prevention of work-related musculoskeletal disorders.
29.	Dean, E., et al. (författare) What is the role of lifestyle behaviour change associated with non-communicable disease risk in managing musculoskeletal health conditions with special reference to chronic pain? 2015 Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 16:1 Tidskriftsartikel (refereegranskat)abstract Background: Other than activity and exercise, lifestyle practices such as not smoking and healthy nutrition, well established for preventing and managing lifestyle-related non-communicable diseases (i.e., heart disease, cancer, hypertension, stroke, obstructive lung disease, diabetes, and obesity), are less emphasized in the physical therapy guidelines for addressing chronic pain, e.g., back pain. This state-of-the-art review examines the relationships between lifestyle behaviours and musculoskeletal health, with special reference to chronic pain, and their clinical and research implications. Discussion: A state-of-the-art review was conducted to synthesize evidence related to lifestyle factors (not smoking, healthy diet, healthy weight, optimal sleep and manageable stress, as well as physical activity) and musculoskeletal health, with special reference to chronic pain. The findings support that health behaviour change competencies (examination/assessment and intervention/treatment) may warrant being included in first-line management of chronic pain, either independently or in conjunction with conventional physical therapy interventions. To address knowledge gaps in the literature however three lines of clinical trial research are indicated: 1) to establish the degree to which traditional physical therapy interventions prescribed for chronic pain augment the benefits of lifestyle behaviour change; 2) to establish the degree to which adopting healthier lifestyle practices, avoids or reduces the need for conventional physical therapy; and 3) to establish whether patients/clients with healthier lifestyles and who have chronic pain, respond more favourably to conventional physical therapy interventions than those who have less healthy lifestyles. Summary: Lifestyle behaviour change is well accepted in addressing lifestyle-related non-communicable diseases. Compelling evidence exists however supporting the need for elucidation of the role of negative lifestyle behaviours on the incidence of chronic pain, and the role of positive lifestyle behaviours on its incidence and effective management. Addressing lifestyle behaviour change in patients/clients with chronic pain, e.g., back pain, as a first-line intervention might not only constitute a novel approach, but also reduce the socioeconomic burden related to chronic pain as well as non-communicable diseases.
30.	Dehlin, Mats, 1968, et al. (författare) Validity of gout diagnosis in Swedish primary and secondary care - a validation study 2015 Ingår i: Bmc Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 16:149 Tidskriftsartikel (refereegranskat)abstract Background: The diagnostic golden standard for gout is to detect monosodium urate (MSU) crystals in synovial fluid. While some gout classification criteria include this variable, most gout diagnoses are based on clinical features. This discrepancy between clinical practice and classification criteria can hinder gout epidemiological studies. Here, the objective was to validate gout diagnoses (International Classification of Diseases (ICD)-10 gout codes) in primary and secondary care relative to five classification criteria (Rome, New York, ARA, Mexico, and Netherlands). The frequency with which MSU crystal identification was used to establish gout diagnosis was also determined. Methods: In total, 394 patients with >= 1 ICD-10 gout diagnosis between 2009 and 2013 were identified from the medical records of two primary care centers (n = 262) and one secondary care center (n = 132) in Gothenburg, Sweden. Medical records were assessed for all classification criteria. Results: Primary care patients met criteria cutoffs more frequently when >= 2 gout diagnoses were made. Even then, few primary care patients met the Rome and New York cutoffs (19 % and 8 %, respectively). The ARA, Mexico, and Netherlands cutoffs were met more frequently by primary care patients with >= 2 gout diagnoses (54 %, 81 %, and 80 %, respectively). Mexico and Netherlands cutoffs were met more frequently by the rheumatology department patients (80 % and 71 %, respectively), even when patients with only 1 gout diagnosis were included. Analysis of MSU crystals served to establish gout diagnoses in only 27 % of rheumatology department and 2 % of primary care cases. Conclusions: If a patient was deemed to have gout at >= 2 primary care center or >= 1 rheumatology-center visits according to an ICD-10 gout code, the positive predictive value of this variable in relation with the Mexico and Netherlands classification criteria was >= 80 % for both primary care and rheumatology care settings in Sweden. MSU crystal identification was rarely used to establish gout diagnosis.
31.	Ebbevi, David, et al. (författare) Persons with rheumatoid arthritis challenge the relevance of the health assessment questionnaire: a qualitative study of patient perception 2017 Ingår i: BMC Musculoskeletal Disorders. - : BMC (part of Springer Nature). - 1471-2474. ; 18:1 Tidskriftsartikel (refereegranskat)abstract Background: The Stanford Health Assessment Questionnaire-Disability Index (HAQ) is widely used to measure functional ability in persons with Rheumatoid Arthritis (RA). The instrument was developed with limited involvement from persons with RA, and their perception of the instrument has not been studied in depth. The aim of this study was to explore how persons with RA experience the use of the HAQ in care. Methods: The study used secondary data analysis. Persons with RA participated in semi-structured interviews in previous research projects. Thirty-nine interviews were included based on data fit, and thematic analysis applied. Results: The participants questioned the relevance of the HAQ but nevertheless experienced that the instrument had a profound effect on their understanding of health and how care is delivered. The analysis resulted in three themes: Problems with individual items, meaning of the summative score, and effects on care and health perceptions. Conclusions: To make the HAQ relevant to persons with RA, it needs to be revised or to include an option to select items most meaningful to the respondent. To ensure relevance, the HAQ update should preferably be co-created by researchers, clinicians and persons with RA. © 2017 The Author(s).Author keywords
32.	Eiriksdottir, Asa, et al. (författare) A new finger-preserving procedure as an alternative to amputation in recurrent severe Dupuytren contracture of the small finger 2019 Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 20:1 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Background: Recurrent severe Dupuytren contracture of the small finger's proximal interphalangeal (PIP) joint is a difficult problem. Further surgery carries high risk of complications and poor outcome. Patients are often offered finger amputation. We have devised a novel surgical procedure consisting of middle phalanx monoblock resection and ligament reconstruction to create a new functioning interphalangeal joint. Methods: Two patients requesting small-finger amputation because of severe PIP joint contracture after multiple treatments for Dupuytren contracture were offered and accepted this new procedure. Through a dorsal incision the extensor tendon is incised longitudinally exposing the middle phalanx and interphalangeal joints. The collateral ligaments of both interphalangeal joints are detached from the middle phalanx. The middle phalanx is dissected from soft tissues (including the flexor digitorum superficialis tendon) and removed. The distal phalanx is brought proximally and the ends of the collateral ligaments are sutured with non-absorbable sutures with the joint held in full extension and congruency. The two patients were evaluated at 18 months and 15 months after surgery, respectively. Results: Both patients regained good finger posture with almost full extension and had normal sensation and no pain. Active flexion in the new interphalangeal joint was 60 degrees and 35 degrees, respectively. Both patients had full metacarpophalangeal joint flexion and extension, normal 2-point discrimination in the small finger and higher grip strength in the treated than the contralateral hand. Radiographs showed a congruent new interphalangeal joint. Both patients were very satisfied with the outcome. Conclusions: In patients with Dupuytren disease and severe PIP joint contracture after multiple treatments, this novel procedure consisting of middle-phalanx excision and ligament reconstruction creating a new functioning interphalangeal joint has good short-term outcomes and is a favorable alternative to finger amputation. Longer follow-up will show whether these results are durable.
33.	Eklund, Andreas, et al. (författare) Do psychological and behavioral factors classified by the West Haven-Yale Multidimensional Pain Inventory (Swedish version) predict the early clinical course of low back pain in patients receiving chiropractic care? 2016 Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central. - 1471-2474. ; 17:1 Tidskriftsartikel (refereegranskat)abstract Background: To investigate if psychological and behavioral factors (as determined by the Swedish version of the West Haven-Yale Multidimensional Pain Inventory, MPI-S) can predict the early clinical course of Low Back Pain (LBP).Methods: MPI-S data from patients (18–65 years of age) seeking chiropractic care for recurrent and persistent LBP were collected at the 1st visit. A follow-up questionnaire was administered at the 4th visit. The predictive value of the MPI-S subgroups Adaptive Copers (AC), Interpersonally Distressed (ID) and Dysfunctional (DYS) was calculated against the subjective improvement at the 4th visit and clinically relevant difference in pain intensity between the 1st and 4th visit.Results: Of the 666 subjects who were included at the 1st visit, 329 completed the questionnaire at the 4th visit. A total of 64.7 % (AC), 68.0 % (ID) and 71.3 % (DYS) reported a definite improvement. The chance of “definite improvement”, expressed as relative risk (95 % CI) with the AC group as reference, was 1.05 (.87–1.27) for the ID and 1.10 (.93–1.31) for the DYS groups, respectively. The DYS and ID groups reported higher values in pain intensity both at the 1st and the 4th visit. The proportion of subjects who reported an improvement in pain intensity of 30 % or more (clinically relevant) were 63.5 % AC, 72.0 % ID and 63.2 % DYS. Expressed as relative risk (95 % CI) with the AC group as reference, this corresponded to 1.26 (.91–1.76) for the ID and 1.09 (.78–1.51) for the DYS groups, respectively.Conclusions: The MPI-S instrument could not predict the early clinical course of recurrent and persistent LBP in this sample of chiropractic patients.
34.	Eklund, Andreas, et al. (författare) Psychological and behavioral differences between low back pain populations : a comparative analysis of chiropractic, primary and secondary care patients 2015 Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central. - 1471-2474. ; 16 Tidskriftsartikel (refereegranskat)abstract Background: Psychological, behavioral and social factors have long been considered important in the development of persistent pain. Little is known about how chiropractic low back pain (LBP) patients compare to other LBP patients in terms of psychological/behavioral characteristics.Methods: In this cross-sectional study, the aim was to investigate patients with LBP as regards to psychosocial/behavioral characteristics by describing a chiropractic primary care population and comparing this sample to three other populations using the MPI-S instrument. Thus, four different samples were compared. A: Four hundred eighty subjects from chiropractic primary care clinics. B: One hundred twenty-eight subjects from a gainfully employed population (sick listed with high risk of developing chronicity). C: Two hundred seventy-three subjects from a secondary care rehabilitation clinic. D: Two hundred thirty-five subjects from secondary care clinics. The Swedish version of the Multidimensional Pain Inventory (MPI-S) was used to collect data. Subjects were classified using a cluster analytic strategy into three pre-defined subgroups (named adaptive copers, dysfunctional and interpersonally distressed).Results: The data show statistically significant overall differences across samples for the subgroups based on psychological and behavioral characteristics. The cluster classifications placed (in terms of the proportions of the adaptive copers and dysfunctional subgroups) sample A between B and the two secondary care samples C and D.Conclusions: The chiropractic primary care sample was more affected by pain and worse off with regards to psychological and behavioral characteristics compared to the other primary care sample. Based on our findings from the MPI-S instrument the 4 samples may be considered statistically and clinically different.
35.	El-Habta, Roine, et al. (författare) Tendinosis-like changes in denervated rat Achilles tendon 2018 Ingår i: BMC Musculoskeletal Disorders. - : BMC. - 1471-2474. ; 19 Tidskriftsartikel (refereegranskat)abstract Background: Tendon disorders are common and lead to significant disability and pain. Our knowledge of the ‘tennis elbow’, the ‘jumpers knee’, and Achilles tendinosis has increased over the years, but changes in denervated tendons is yet to be described in detail. The aim of the present study was to investigate the morphological and biochemical changes in tendon tissue following two weeks of denervation using a unilateral sciatic nerve transection model in rat Achilles tendons.Methods: Tendons were compared with respect to cell number, nuclear roundness, and fiber structure. The non-denervated contralateral tendon served as a control. Also, the expression of neuromodulators such as substance P and its preferred receptor neurokinin-1 receptor, NK-1R, was evaluated using real-time qRT-PCR.Results: Our results showed that denervated tendons expressed morphological changes such as hypercellularity; disfigured cells; disorganization of the collagen network; increased production of type III collagen; and increased expression of NK-1R.Conclusion: Taken together these data provide new insights into the histopathology of denervated tendons showing that denervation causes somewhat similar changes in the Achilles tendon as does tendinosis in rats.
36.	Elden, Helen, 1959, et al. (författare) Predictors and consequences of long-term pregnancy-related pelvic girdle pain: a longitudinal follow-up study. 2016 Ingår i: BMC musculoskeletal disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 17 Tidskriftsartikel (refereegranskat)abstract Pelvic girdle pain (PGP) is a multifactorial condition, which can be mentally and physically compromising both during and after pregnancy. However, long-term pregnancy-related PGP has been poorly investigated. This longitudinal follow-up study uniquely aimed to describe prevalence and predictors of PGP and its consequences on women's health and function up to 11years after pregnancy.A postal questionnaire was sent to 530 women who participated in 1 of 3 randomized controlled studies for PGP in pregnancy. Women who reported experiencing lumbopelvic pain were offered a clinical examination. Main outcome measure was the presence of long term PGP as assessed by an independent examiner. Secondary outcomes were: working hours/week, function (the Disability Rating Index, and Oswestry Disability Index), self-efficacy (the General Self-Efficacy Scale), HRQL (Euro-Qol 5D and EQ-Visual scale), anxiety and depression, (Hospital anxiety and depression scale,) and pain-catastrophizing (Pain Catastrophizing Scale), in women with PGP compared to women with no PGP.A total of 371/530 (70%) women responded and 37/ 371 (10%) were classified with long-term PGP. Pregnancy-related predictors for long-term PGP were number of positive pain provocation tests (OR=1.79), history of low back pain (LBP) (OR=2.28), positive symphysis pressure test (OR=2.01), positive Faber (Patrick's) test (OR=2.22), and positive modified Trendelenburg test (OR=2.20). Women with PGP had significantly decreased ability to perform daily activities (p<.001), lower self-efficacy (p=0.046), decreased HRQL (p<.001), higher levels of anxiety and depression (p<.001), were more prone to pain catastrophizing, and worked significantly fewer hours/week (p=0.032) compared to women with no PGP.This unique long-term follow up of PGP highlights the importance of assessment of pain in the lumbopelvic area early in pregnancy and postpartum in order to identify women with risk of long term pain. One of 10 women with PGP in pregnancy has severe consequences up to 11years later. They could be identified by number of positive pain provocation tests and experience of previous LBP. Access to evidence based treatments are important for individual and socioeconomic reasons.
37.	Emilson, Christina, et al. (författare) Physical therapists' assessments, analyses and use of behavior change techniques in initial consultations on musculoskeletal pain : direct observations in primary health care 2016 Ingår i: BMC Musculoskeletal Disorders. - London : BIOMED CENTRAL LTD. - 1471-2474. ; 23, s. S187-S187 Tidskriftsartikel (refereegranskat)abstract Background: Behavioral medicine (BM) treatment is recommended to be implemented for pain management in physical therapy. Its implementation requires physical therapists (PTs), who are skilled at performing functional behavioral analyses based on physical, psychological and behavioral assessments. The purpose of the current study was to explore and describe PTs' assessments, analyses and their use of behavioral change techniques (BCTs) in initial consultations with patients who seek primary health care due to musculoskeletal pain. Methods: A descriptive and explorative research design was applied, using data from video recordings of 12 primary health care PTs. A deductive analysis was performed, based on a specific protocol with definitions of PTs' assessment of physical and psychological prognostic factors (red and yellow flags, respectively), analysis of the clinical problem, and use of BCTs. An additional inductive analysis was performed to identify and describe the variation in the PTs' clinical practice. Results: Red and yellow flags were assessed in a majority of the cases. Analyses were mainly based on biomedical assessments and none of the PTs performed functional behavioral analyses. All of the PTs used BCTs, mainly instruction and information, to facilitate physical activity and improved posture. The four most clinically relevant cases were selected to illustrate the variation in the PTs' clinical practice. The results are based on 12 experienced primary health care PTs in Sweden, limiting the generalizability to similar populations and settings. Conclusion: Red and yellow flags were assessed by PTs in the current study, but their interpretation and integration of the findings in analyses and treatment were incomplete, indicating a need of further strategies to implement behavioral medicine in Swedish primary health care physical therapy.
38.	Ericsson, Ylva B., et al. (författare) Association between thigh muscle strength four years after partial meniscectomy and radiographic features of osteoarthritis 11 years later 2019 Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 20:1 Tidskriftsartikel (refereegranskat)abstract Background: Meniscus injury and meniscectomy both entail increased risk of knee osteoarthritis (OA). Thigh muscle weakness is a suggested mediator of OA but there is little evidence of its importance for knee OA development after meniscectomy. This study aimed to examine the association between thigh muscle strength after partial meniscectomy in middle-aged subjects with a non-traumatic meniscal tear and later radiographic knee OA changes. Methods: Thirty-four out of 45 participants in an exercise-trial underwent testing for isokinetic thigh muscle strength 4 years after arthroscopic partial meniscectomy and had radiographic examination 11 years later (15 years post-surgery, mean age at follow-up of 57 years (range 50-61)). Outcomes were grade of joint space narrowing and osteophyte score in the medial tibiofemoral compartment of the operated knee and the contralateral knee. We tested the association between muscle strength at baseline and the radiographic outcomes at follow-up using logistic regression analyses adjusted for sex and overweight. Results: At follow-up, 33/34 subjects had joint space narrowing and 27/34 subjects had osteophytes in the operated knee, in the contralateral knee joint space narrowing was found in 23 subjects. In the operated knee baseline knee extensor and flexor strength were negatively associated with grade of joint space narrowing at follow-up (OR 0.972 and 0.956, p = 0.028 and 0.026, respectively) and also with osteophyte score (OR 0.968 and 0.931, p = 0.017 and 0.011, respectively). In the contralateral knee longitudinal associations between strength and radiographic OA features were similar, OR 0.949-0.972, p < 0.05. Conclusion: The finding that stronger thigh muscles 4 years after meniscectomy were associated with less severe osteoarthritic changes in the medial tibiofemoral compartment of both the operated and contralateral knee 11 years later, may suggest that strong thigh muscles can help to preserve joint integrity in middle-aged subjects at risk of knee OA.
39.	Eriksson, Marie, et al. (författare) Gait dynamics in the wide spectrum of children with arthrogryposis : a descriptive study 2015 Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central. - 1471-2474. ; 16 Tidskriftsartikel (refereegranskat)abstract Background: Arthrogryposis Multiplex Congenita (AMC) is a heterogeneous condition characterized by multiple joint contractures at birth. Greater movements in the trunk and pelvis during walking have been observed in children with AMC using orthoses compared to those wearing only shoes. This study investigated gait dynamics in children with AMC and identified compensatory mechanisms that accommodate walking. Methods: Twenty-six children with AMC who walked with orthoses or shoes and a control group consisting of 37 typically-developing children were evaluated in 3D gait analysis. Children with AMC were divided into subgroups based on which joints needed to be stabilized in the sagittal plane; AMC1 used knee-ankle-foot orthoses (KAFOs) with locked knee joints, AMC2 used KAFOs with open knee joints or ankle-foot orthoses, and AMC3 used shoes. Results: The Gait Deviation Index was lower in AMC groups than in the control group, with the lowest in AMC1. Excessive trunk movements in frontal and transverse planes were observed in AMC2 and especially in AMC1. Lower hip flexion moment was found in AMC1, while AMC2 and AMC3 showed similar hip flexion moments as the control group. Knee extension moments were similar between the groups. In the frontal plane there were only small differences between the groups in hip abduction moment. A joint work analysis indicated greater contribution from the hip muscles to overall positive work in AMC groups, particularly in AMC1, than in the control group. Conclusion: All AMC groups showed less hip extension than the control group, but hip flexion moment was significantly lower only in AMC1, which can be attributed to their gait strategy with bilateral locked KAFOs. AMC1, who had weak knee extensors, were helped by their locked KAFOs and therefore showed similar knee extension moment as the other groups. This finding, together with their gait patterns, demonstrates the children's high reliance on hip muscles and presumably trunk muscles to provide propulsion. Our study shows that with adequate orthotic support, children with AMC and even with severe weakness and contractures can achieve walking.
40.	Ernstgård, Anna, et al. (författare) Health enhancing physical activity in patients with hip or knee osteoarthritis - an observational intervention study 2017 Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central. - 1471-2474. ; 18 Tidskriftsartikel (refereegranskat)abstract Background: Osteoarthritis is one of the leading causes of inactivity worldwide. The recommended level of health enhancing physical activity (HEPA) is at least 150 min of moderate intensity physical activity per week. The purpose of this study was to explore how the proportion of patients, who reached the recommended level of HEPA, changed following a supported osteoarthritis self-management programme in primary care, and to explore how reaching the level of HEPA was influenced by body mass index (BMI), gender, age and comorbidity. Methods: An observational study was conducted using data from a National Quality Registry in which 6810 patients in primary care with clinically verified hip or knee osteoarthritis with complete data at baseline, 3 and 12 months follow-up before December 31st 2013 were included. HEPA was defined as self-reported physical activity of at least moderate intensity either a) at least 30 min per day on four days or more per week, or b) at least 150 min per week. HEPA was assessed at baseline, and again at 3 and 12 months follow-up. Cochran's Q test was used to determine change in physical activity over time. The association between reaching the level of HEPA and time, age, BMI, gender, and Charnley classification was investigated using the generalized estimation equation (GEE) model. Results: The proportion of patients who reached the level of HEPA increased by 345 patients, from 77 to 82%, from baseline to 3 months follow-up. At 12 months, the proportion of patients who reached the level of HEPA decreased to 76%. Not reaching the level of HEPA was associated with overweight, obesity, male gender and Charnley category C, i.e. osteoarthritis in multiple joint sites (hip and knee), or presence of any other disease that affects walking ability. Conclusions: Following the supported osteoarthritis self-management programme there was a significant increase in the proportion of patients who reached the recommended level of HEPA after 3 months. Improvements were lost after 12 months. To increase physical activity and reach long-lasting changes in levels of physical activity, more follow-up sessions might be needed.
41.	Farhang, Mehdy, et al. (författare) The trend of radiological severity of hip fractures over a 30 years period : a cohort study 2019 Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 20:1 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Despite advances in operative techniques and preoperative care, proximal femur fractures (PFF) still represent a great public health problem. Displacement and fracture stability have been assumed as important determinants of treatment modality and outcome in such fractures. Purpose of this study was to determine whether the radiological severity of PFF fractures has increased over time.METHODS: In a cohort study, the plain radiographs of all patients with PFF aged over 50 years who were admitted to Umeå University Hospital in 1981/82, 2002 and 2012 were recruited to examine the types of fractures.RESULTS: The ratio of undisplaced to displaced femoral neck (FN) fractures was 30 to 70% in 1981/82, 28 to 72% in 2002 and 25 to 75% in 2012. The ratio of stable to unstable intertrochanteric (IT) fractures was 64 to 36% in 1981/82, 68 to 32% in 2002 and 75 to 25% in 2012. The ratio of simple to comminute subtrochanteric fractures was 35 to 65% in 1981/82, 16 to 84% in 2002 and 12 to 88% in 2012. In both FN and IT fractures we found no statistical difference among these 3 study periods, p = 0.67 and p = 0.40. In subtrochanteric fractures we saw a tendency towards more comminute subtrochanteric fractures (1981/82 to 2012), p = 0.09.CONCLUSIONS: We found no significant increment in the radiological severity of FN and IT over a 30 years' period. However, there was tendency towards an increase in comminute subtrochanteric fractures.
42.	Feldthusen, Caroline, 1977, et al. (författare) Seasonal variations in fatigue in persons with rheumatoid arthritis: a longitudinal study 2016 Ingår i: Bmc Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 17 Tidskriftsartikel (refereegranskat)abstract Background: Fatigue is a prominent symptom in persons with rheumatoid arthritis (RA). Although this symptom has been described to vary in duration and frequency little is known about fluctuations in fatigue over time and season. The aim of this study was to describe monthly and seasonal variations in fatigue, in persons with RA of working age. Methods: Sixty-five participants diagnosed with RA and aged 20-65 years were recruited from a rheumatology clinic in Sweden. The participants provided self-assessments of their fatigue at seven time points during the four seasons using a 0-100 mm visual analogue scale (VAS) and the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ). Multiple regression analysis using mixed models was used to analyze changes in fatigue over time. Results: The mean +/- SD of fatigue rated on the VAS was 51 +/- 13, indicating substantial fatigue. Analysis of monthly variation showed statistically significant variation in fatigue ratings concerning VAS fatigue score (p < 0.01) as well as the BRAF-MDQ total score and Living, Cognition (p < 0.001), and Physical (p < 0.05) sub-scores, but not the BRAF-MDQ Emotional sub-score. The greatest variations were seen from January to September, with higher fatigue ratings in January. The changes in VAS fatigue scores over time were considered to be of clinical importance. Analysis of seasonal variation revealed a statistically significant seasonal variation in fatigue levels, with higher fatigue values during the winter as measured by VAS fatigue score (p < 0.01) as well as BRAF-MDQ total score (p < 0.01) and Physical and Living sub-scores (both p < 0.01). The greatest variation was seen between winter and autumn for VAS fatigue and between winter and summer for BRAF-MDQ total score and Physical and Living sub-scores. There were no statistical differences in fatigue levels, monthly or seasonal, between sexes or age groups. Conclusions: The majority of rating scales used in this study showed fluctuations in fatigue, general and physical fatigue being significantly greater during the winter. As fatigue is a substantial symptom in many persons with RA, this information is important for rheumatology professionals when dealing with persons with RA in routine care.
43.	Finlayson, L., et al. (författare) The head shaft angle is associated with hip displacement in children at GMFCS levels III-V - A population based study 2018 Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 19:1 Tidskriftsartikel (refereegranskat)abstract Background: An increased Head Shaft Angle (HSA) has been reported as a risk factor for hip displacement in children with cerebral palsy (CP) but opinions differ in the literature. The purpose of this study was to re-evaluate the relationship between HSA and hip displacement in a different population of children with CP. Methods: The Cerebral Palsy Integrated Pathway Scotland surveillance programme includes 95% of all children with CP in Scotland. The pelvic radiographs from 640 children in GMFCS levels III-V were chosen. The most displaced hip was analysed and the radiographs used were those taken at the child's first registration in the database to avoid the potential effects of surveillance on subsequent hip centration. A logistic regression model was used with hip displacement (migration percentage [MP] ≥40%) as outcome and HSA, GMFCS, age and sex as covariates. Results: The MP was ≥40% in 118 hips with a mean HSA of 164° (range 121-180°) and < 40% in 522 hips with a mean HSA of 160° (range 111-180°). The logistic regression analysis showed no significant influence of age and sex on MP in this population but a high GMFCS level was strongly associated with hip displacement. An increased HSA was also associated with hip displacement, a 10° difference in HSA for children adjusted for age, sex, and GMFCS gave an odds ratio of 1.26 for hip displacement equal or above 40% (p = 0.009) and hips with HSA above 164.5 degrees had an odds ratio of 1.96 compared with hips with HSA below 164.5 degrees (p = 0.002). Conclusion: These findings confirm that HSA is associated with hip displacement in children in GMFCS levels III-V.
44.	Flodin, Ulf, et al. (författare) Risk factors for neck pain among forklift truck operators : a retrospective cohort study 2018 Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central. - 1471-2474. ; 19:44, s. 1-10 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: No previous research has been performed into neck pain among forklift operators. This is a common complaint among these workers, who number around 150,000 in Sweden and six million in Europe. The aim of the study was to examine long-term exposure to unnatural neck positions among forklift operators as a risk factor for neck pain.METHODS: A retrospective cohort study was conducted of all eligible employees at a high-level warehouse. Forklift operators and office workers answered an 18-page questionnaire comprising questions about joint pain, work tasks, work postures and year of start for all items. By using person years in the exposed and less-exposed groups before start of neck pain we were able to calculate Incident Rate ratios for various exposures.RESULTS: Forty nine percent of the forklift operators reported having experienced neck pain compared to 30 % of office workers. Being a forklift operator was associated with an increased risk of neck pain (OR = 5.1, 95% CI 1.4-18.2). Holding the head in an unnatural position resulted in significantly increased risks for neck pain, irrespective of type of position. The risks for neck pain remained after taking other ergonomic exposures and psychosocial aspects into consideration.CONCLUSIONS: This is the first published study showing that forklift operators have an increased risk of neck pain. The results are therefore of significance for improving work schedules, the adjustment of work tasks for these workers and the design of the vehicles.
45.	Flosadottir, Vala, et al. (författare) Impact of treatment strategy and physical performance on future knee-related self-efficacy in individuals with ACL injury 2018 Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 19:1, s. 1-9 Tidskriftsartikel (refereegranskat)abstract Background: In people with anterior cruciate ligament (ACL) injury, high self-efficacy facilitates recovery, indicated by improved muscle function, reduced knee symptoms and increased physical activity. Impact of treatment on future self-efficacy is however not well investigated. The aims of the study were to 1) investigate knee-related self-efficacy 6 years after acute ACL injury in patients treated with exercise therapy alone or in combination with either early or the option of delayed ACL reconstruction (ACLR), and 2) to investigate associations between single-leg physical performance at various time points after ACL injury and knee self-efficacy at 6 years after injury. Methods: Participants (n = 121) originated from the KANON-study (ISRCTN84752559), a treatment RCT including active adults with acute ACL injury treated with structured exercise therapy combined with early or the option of delayed ACLR. In this ancillary study, participants with knee self-efficacy data at 6 years (n = 89) were analyzed as treated; exercise therapy alone (n = 20), exercise therapy plus early ACLR (n = 46), and exercise therapy plus delayed ACLR (n = 23). The participants performed physical performance tests (hop, strength and balance) at the end the of exercise therapy (mean 10 (SD 6) months), and at 5 years, and rated their knee self-efficacy using Knee Self-Efficacy Scale (K-SES) questionnaire (0 to 10, worst to best) at 6 years. Results: Median K-SES score for the total group (n = 89) was 7.8 (IQR 5.9-9.0). There were no differences between treatment groups in K-SES scores at 6 years nor in physical performance at any time point (p ≥ 0.097). Worse knee flexion strength LSI (rsp = 0.341, p = 0.042) at the end of the exercise therapy, and worse LSI for single-leg hop test (rsp = 0.310, p = 0.005) at the end of the exercise therapy and at 5 years, correlated moderately with worse knee-related self-efficacy at 6 years. Low associations were observed between the remaining physical performance tests and K-SES scores (rsp ≤ 0.265, p ≥ 0.045). Conclusion: Knee-related self-efficacy at 6 years after ACL injury did not differ between those treated with ACLR, performed early or as a delayed procedure, or exercise therapy alone. Good physical performance at the end of the exercise therapy, and at 5 years, appears to have a positive, yet small, impact on future knee-related self-efficacy.
46.	Folkesson, Elin, et al. (författare) Differential protein expression in human knee articular cartilage and medial meniscus using two different proteomic methods : A pilot analysis 2018 Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 19:1 Tidskriftsartikel (refereegranskat)abstract Background: Proteomics is an emerging field in the study of joint disease. Our two aims with this pilot analysis were to compare healthy human knee articular cartilage with meniscus, two tissues both known to become affected in the osteoarthritic disease process, and to compare two mass spectrometry (MS)-based methods: data-dependent acquisition (DDA) and data-independent acquisition (DIA). Methods: Healthy knee articular cartilage taken from the medial tibial condyle and medial meniscus samples taken from the body region were obtained from three adult forensic medicine cases. Proteins were extracted from tissue pieces and prepared for MS analysis. Each sample was subjected to liquid chromatography (LC)-MS/MS analysis using an Orbitrap mass spectrometer, and run in both DDA and DIA mode. Linear mixed effects models were used for statistical analysis. Results: A total of 653 proteins were identified in the DDA analysis, of which the majority was present in both tissue types. Only proteins with quantitation information in both tissues (n = 90) were selected for more detailed analysis, of which the majority did not statistically significantly differ in abundance between the two tissue types, in either of the MS analyses. However, 21 proteins were statistically significantly different (p < 0.05) between meniscus and cartilage in the DIA analysis. Out of these, 11 proteins were also significantly different in the DDA analysis. Aggrecan core protein was the most abundant protein in articular cartilage and significantly differed between the two tissues in both methods. The corresponding protein in meniscus was serum albumin. Dermatopontin exhibited the highest meniscus vs articular cartilage ratio among the statistically significant proteins. The DIA method led to narrower confidence intervals for the abundance differences between the two tissue types than DDA. Conclusions: Although articular cartilage and meniscus had similar proteomic composition, we detected several differences by MS. Between the two analyses, DIA yielded more precise estimates and more statistically significant different proteins than DDA, and had no missing values, which makes it preferable for future LC-MS/MS analyses.
47.	Fors, Maria, 1987-, et al. (författare) Effects of pre-surgery physiotherapy on walking ability and lower extremity strength in patients with degenerative lumbar spine disorder : Secondary outcomes of the PREPARE randomised controlled trial 2019 Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central. - 1471-2474. ; 20:1 Tidskriftsartikel (refereegranskat)abstract BackgroundDegenerative lumbar spine disorders are common among musculoskeletal disorders. When disabling pain and radiculopathy persists after adequate course of rehabilitation and imaging confirms compressive pathology, surgical decompression is indicated. Prehabilitation aiming to augment functional capacity pre-surgery may improve physical function and activity levels pre and post-surgery. This study aims to evaluate the effect and dose-response of pre-surgery physiotherapy on quadriceps femoris strength and walking ability in patients with degenerative lumbar spine disorders compared to waiting-list controls and their association with postoperative physical activity level.MethodIn this single blinded, 2-arm randomised controlled trial, 197 patients were consecutively recruited. Inclusion criteria were: MRI confirmed diagnosis and scheduled for surgery due to disc herniation, lumbar spinal stenosis, degenerative disc disease or spondylolisthesis, ages 25-80 years. Patients were randomised to 9 weeks of pre-surgery physiotherapy or to waiting-list. Patient reported physical activity level, walking ability according to Oswestry Disability Index item 4, walking distance according to the SWESPINE national register and physical outcome measures including the timed ten-meter walk test, maximum voluntary isometric quadriceps femoris muscle strength, patient-rated were collected at baseline and follow-up. Parametric or non-parametric within and between group comparisons as well as multivariate regression was performed.ResultsPatients who received pre-surgery physiotherapy significantly improved in all variables from baseline to follow-up (p < 0.001 – p < 0.05) and in comparison to waiting-list controls (p < 0.001 – p < 0.028). Patients adhering to ≥12 treatment sessions significantly improved in all variables (p < 0.001 – p < 0.032) and those receiving 0-11 treatment session in only normal walking speed (p0.035) but there were no significant differences when comparing dosages. Physical outcome measures after pre-surgery physiotherapy together significantly explain 27.5% of the variation in physical activity level 1 year after surgery with pre-surgery physical activity level having a significant multivariate association.ConclusionPre-surgery physiotherapy increased walking ability and lower extremity strength in patients with degenerative lumbar spine disorders compared to waiting-list controls. A clear treatment dose-response response relationship was not found. These results implicate that pre-surgery physiotherapy can influence functional capacity before surgical treatment and has moderate associations with maintained postoperative physical activity levels mostly explained by physical activity level pre-surgery.Trial registrationNCT02454400. Trial registration date: August 31st 2015, retrospectively registered.
48.	Forsbrand, Malin, et al. (författare) Comparison of the Swedish STarT Back Screening Tool and the Short Form of the Örebro Musculoskeletal Pain Screening Questionnaire in patients with acute or subacute back and neck pain 2017 Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 18:1 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Patients with back and neck pain are often seen in primary care and it is important to provide them with tailored interventions based on risk stratification/triage. The STarT Back Screening Tool (SBT) is a widely used screening questionnaire which has not yet been validated for a population with back and/or neck pain with short duration. Our aim was to compare the concurrent validity of the SBT and the short form of the ÖMPSQ including psychometric properties and clinical utility in a primary care setting.METHODS: Patients who applied for physiotherapy by direct access (January 2013 to January 2014) at 35 primary care centers in south Sweden, with acute or subacute back and/or neck pain, aged 18-67 years, who were not currently on sick leave or had been on sick leave less than 60 days were asked to complete the SBT and ÖMPSQ-short questionnaire (n = 329). We used the Spearman's rank correlations to study correlations, cross tabulation and Cohen's kappa to analyze agreement of patient classification. Clinical utility was described as clinician scoring miscalculations and misclassifications of total and/or subscale scores.RESULTS: Completed SBT (9-items) and ÖMPSQ-short (10-items) data were available for 315/329 patients respectively. The statistical correlation for SBT and ÖMPSQ-short total scores was moderately strong (0.62, p < 0.01). In subgroup analyses, the correlations were 0.69 (p < 0.01) for males and 0.57 (p < 0.01) for females. The correlations were lower among older age groups, especially females over 50 years (0.21, p = 0.11). Classification to high or low risk for long-term pain and disability had moderate agreement (κ = 0.42). Observed classification agreement was 70.2%. The SBT had fewer miscalculations (13/315) than the ÖMPSQ-short (54/315).CONCLUSIONS: The correlation between the SBT and the ÖMPSQ-short scores were moderately strong for individuals with acute or subacute back and/or neck pain. SBT seemed to be clinically feasible to use in clinical practice. We therefore suggest that SBT can be used for individuals with both BP and/or NP in primary care settings but it is important to be aware of that SBT's agreement with the ÖMPSQ-short was poor among females aged over 50 years.TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02609750 Registered: November 18, 2015.
49.	Franzén, Maria, et al. (författare) Treatment with Botulinum toxin A in a total population of children with cerebral palsy - A retrospective cohort registry study 2017 Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 18:1 Tidskriftsartikel (refereegranskat)abstract Background: Botulinum toxin A (BTX-A) has been used to reduce spasticity in children with cerebral palsy (CP) for decades. The purpose of this study was to analyze to what extent BTX-A treatment was used to treat spasticity in a total population of children with CP. We investigated 1) the use of BTX-A in relation to age, sex, and Gross Motor Function Classification System (GMFCS) level, 2) the most common muscle groups treated with BTX-A in relation to the same variables, and 3) changes in the proportions of children treated with BTX-A between two time points (2010 and 2015). Methods: The study was based on data from CPUP, a combined Swedish follow-up program and national healthcare registry, comprising >95% of all children with CP in Sweden. The participants (N = 3028) were born in 2000 or later. Potential BTX-A treatment and treated muscle groups were included from all CPUP assessments recorded in the registry in 2014-2015. In Aim 3, BTX-A administration in 3-5 year-olds at two time points was assessed. Crosstabs and 95% confidence intervals (CIs) for binominal proportions were calculated and logistic regression was used to regress age, sex, and GMFCS level on BTX-A treatment. Muscle groups treated with BTX-A were assessed using crosstabs and 95% CIs. Proportional change in BTX-A treatment over a 5-year period was analyzed using chi-square. Results: We included 3028 children (57% boys; median age 7 years) of whom 26% received BTX-A. Significantly more boys (28%) than girls (23%) received BTX-A (OR = 1.25, [95% CI 1.05-1.48]). Significant differences were found for age and GMFCS levels; 4-6 year-olds and those at GMFCS III-IV were more likely to receive BTX-A. BTX-A treatment in the gastrocnemius muscle was most common in the 4-6 year-olds and at GMFCS I-III, whereas treatment of the hamstring and adductor muscles was more common in older children and at GMFCS IV-V. No significant change in the proportion of BTX-A administered in 2010 and 2015 was demonstrated. Conclusions: BTX-A treatment differed based on age, sex, and GMFCS level. Proportion of BTX-A treatment in Sweden has remained stable during the past five years.
50.	Friberger Pajalic, Katarina, et al. (författare) Update on the risks of complications after knee arthroscopy 2018 Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 19:1 Tidskriftsartikel (refereegranskat)abstract Background: Knee arthroscopy is one of the most common surgical procedures worldwide and the number of arthroscopies has substantially increased in the last 30 years. Thus, our aim was to provide updated estimates on the risk of complications and compare it with the background risk in the general population. Methods: We identified patients aged 15-84 years with knee arthroscopy in the years 2005-2016 in southern Sweden. We calculated the risk of pyogenic arthritis, venous thromboembolism, and other typical complications within 30 days. As a reference cohort we included the regional population in the corresponding age interval. We estimated the relative and absolute risks of complications compared to the reference cohort using logistic regression adjusted for age, sex, and level of education. We also estimated the proportion of complications in the population explained by knee arthroscopy (population attributable fraction). Results: We identified 18,735 knee arthroscopy patients (mean age 39 years) and 1,171,084 reference subjects (mean age 46 years). The absolute risk of one or more complications was 1.1% after knee arthroscopy and 0.16% in references. The odds ratio of any complication after knee arthroscopy vs. the reference cohort was 9.4 (95% confidence interval [CI] 8.1, 10.9) with an absolute risk difference of 1.4% (1.1, 1.6%). The relative risk (95% CI) for pyogenic arthritis was 115 (75, 174), venous thromboembolism 6.8 (5.1, 9.1), and other complications 7.7 (6.3, 9.5). The population attributable fraction for pyogenic arthritis was 5%. Conclusions: The absolute risks of complications associated with knee arthroscopy remain small at about 1%. Still, 5% of all pyogenic knee arthritis cases in adults are attributable to knee arthroscopy, thus risks with knee arthroscopy should be carefully considered in the choice of treatment.

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