| 1. |
- Arkel, Elisabeth, et al.
(författare)
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Effects of physiotherapy treatment for patients with obstetric anal sphincter rupture: a systematic review
- 2017
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Ingår i: European Journal of Physiotherapy. - : Informa UK Limited. - 2167-9169 .- 2167-9177. ; 19:2, s. 90-96
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Forskningsöversikt (refereegranskat)abstract
- © 2017 Informa UK Limited, trading as Taylor & Francis Group.Objectives: To evaluate the level of evidence for treatments included in physical therapy practice for patients with Obstetric Anal Sphincter InjurieS (OASIS) and provide treatment recommendations. Methods: Literature search was done in relevant databases of which the last one was performed on 1 November 2016. The randomized controlled trials were evaluated for internal validity and level of evidence for the interventions was set. Results: Eight articles were identified evaluating pelvic floor exercises, biofeedback and electrical stimulation of which six were randomized and controlled. There is a very low level of evidence that pelvic floor exercises with augmented biofeedback (audio-visual feedback and electro stimulation) has better effects compared to sensory biofeedback for women with impaired faecal continence after OASIS and that adjuvant biofeedback has effect on anal incontinence and decreases embarrassment following anal sphincter repair years after OASIS. The studies evaluating solely pelvic floor exercises or electrical stimulation were contradictory or showed no significant effects. Conclusions: There are a limited number of trials evaluating the effect of physical therapy interventions to prevent or treat anal incontinence after OASIS. The studies are diverse and the level of evidence is consequently very low or missing. Until there are enough studies to write evidence-based guidelines, it is still of importance to treat women with leakage and pain in the attempt to increase function and quality of life.
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| 2. |
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| 3. |
- Bergman, Henrik, et al.
(författare)
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Physical performance and physical activity of patients under compulsory forensic psychiatric inpatient care.
- 2020
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Ingår i: Physiotherapy theory and practice. - : Informa UK Limited. - 1532-5040 .- 0959-3985. ; 36:4, s. 507-15
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Tidskriftsartikel (refereegranskat)abstract
- Research stresses the importance of physical activity in general psychiatric care. There is very little research made in the area of forensic psychiatric care. The aim of this exploratory, cross-sectional study was to assess various physical, psychological, and health variables of patients under compulsory forensic psychiatric inpatient care, and to examine correlations among these variables. Maximal oxygen uptake (VO2max), walking ability, running speed, and explosive leg strength were examined in 28 patients. Patients answered questionnaires about physical activity, aggression, stress, character maturity, and health-related quality of life (HRQL). The patients had a mean age of 33.6years, a mean VO2max of 25.3 (8.4) mL 02/min/kg and a mean physical activity level of 268.0 (272.4) min/week. Results from the 6-min walk test were 612.5 (102.8) m. Nine patients had physical activity levels below the international recommendations of 150min/week. Levels of aggression and stress were high and HRQL was low. The results indicate that patients in forensic psychiatric care are in a very poor physical state, which warrants physiotherapeutic interventions, adapted to the unique demands of forensic psychiatric care.
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| 4. |
- Bergman, Henrik, et al.
(författare)
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The use of physical exercise in forensic psychiatric care in Sweden: a nationwide survey.
- 2021
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Ingår i: Journal of mental health (Abingdon, England). - : Informa UK Limited. - 1360-0567 .- 0963-8237. ; , s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Exercise protects against somatic comorbidities and positively affects cognitive function and psychiatric symptoms in patients with severe mental illness. In forensic psychiatry, exercise is a novel concept. Staff at inpatient care facilities may be important resources for successful intervention. Little is known about staff's knowledge, attitudes and behaviors regarding exercise in forensic psychiatric care.To translate, culturally adapt and test the feasibility of the Exercise in Mental Health Questionnaire-Health Professionals Version (EMIQ-HP) in the Swedish context, and to use this EMIQ-HP-Swedish version to describe staff's knowledge, attitudes and behaviors regarding exercise.The EMIQ-HP was translated, culturally adapted, pilot-tested and thereafter used in a cross-sectional nationwide survey.Ten of 25 clinics and 239 health professionals (50.1%) participated. Two parts of the EMIQ-HP-Swedish version showed problems. Most participants considered exercise to be a low-risk treatment (92.4%) that is beneficial (99.2%). Training in exercise prescription was reported by 16.3%. Half of participants (52.7%) prescribed exercise and 50.0% of those undertook formal assessments prior to prescribing.Creation of the EMIQ-HP-Swedish version was successful, despite some clarity problems. Exercise appears to be prescribed informally by non-experts in Swedish forensic psychiatric care and does not address treatment goals.
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| 5. |
- Betten, Carola, et al.
(författare)
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Cross-cultural adaptation and validation of the Swedish STarT Back Screening Tool
- 2015
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Ingår i: European Journal of Physiotherapy. - : Informa UK Limited. - 2167-9169 .- 2167-9177. ; 17:1, s. 29-36
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The STarT Back Screening Tool (SBT) is a newly validated questionnaire that identifies modifiable risk factors of poor prognosis in patients with low back pain (LBP). The aim of this study was to cross-culturally adapt the SBT into Swedish and to test its concurrent validity in patients with LBP in primary healthcare. Methods: The SBT was translated according to established guidelines. Concurrent validity was tested on 62 patients by comparing the SBT with the Örebro Musculoskeletal Pain Screening Questionnaire, short form (ÖMPSQ-short). Analysis of correlations between the instruments' total scores and between psychosocial sub-score of SBT and ÖMPSQ-short was performed using Spearman's rank correlation. Results: A translation of the SBT into Swedish required minor semantic adaptation until the final version was acceptable. Correlation between the SBT and the ÖMPSQ-short was large with r = 0.61 (SBT total with ÖMPSQ-short total score) and r = 0.60 (SBT psychosocial subscale with ÖMPSQ-short total score). Conclusion: The original SBT was successfully translated into Swedish. Correlation between the Swedish SBT and ÖMPSQ-short was large. The present study supports the use of the Swedish SBT for further clinical practice and research.
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| 6. |
- Daremark, Clara, et al.
(författare)
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Women's experiences of the injury, recovery and desire for rehabilitation after a second-degree vaginal tear-a qualitative study
- 2022
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Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 0937-3462 .- 1433-3023. ; 33:6, s. 1521-1527
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and hyposthesis Eighty-five percent of all vaginal deliveries cause some form of obstetric tear injury. To our knowledge, there are no studies exploring experiences after second-degree tear. Therefore, our study aimed to investigate the experiences of a second-degree vaginal tear regarding aspects of the recovery and need for healthcare and rehabilitation. Methods Individual semi-structured interviews were performed and analysed with a qualitative, inductive descriptive approach. Results A group of 18 women with a second-degree vaginal tear after delivery were included. Four main categories with associated subcategories were found: (1) feeling uncertainty, with subcategories: not knowing what is normal, concern, confusion and uncertainty regarding pelvic floor muscle training; (2) feeling of security, with subcategories: I have no/I can handle the symptoms, trust in the healthcare system and I have sufficient knowledge; (3) not prioritizing myself, with the subcategories: I cannot find time and others have bigger problems; (4) lack of trust in healthcare providers, with the subcategories: feeling forgotten, not being taken seriously, distrust of the competence of the healthcare providers and resignation. Conclusion Women who suffer from a second-degree vaginal tear after pregnancy can feel safe when needs are met but uncertainty is also common when available healthcare and information are perceived as insufficient. The women also feel uncertainty about what is normal after the tear and how to perform pelvic floor exercises.
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| 7. |
- Elden, Helen, 1959, et al.
(författare)
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Back pain in relation to pregnancy: A longitudinal 10-year follow-up of 369 women diagnosed with pelvic girdle pain during pregnancy
- 2013
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Ingår i: Advances in multidisciplinary research for better spinal/pelvic care. The 8th Interdiciplinary World Congress on Low Back & Pelvic Pain, Oct, 2013. Dubai.. - 9789081601603
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Konferensbidrag (refereegranskat)abstract
- Introduction PGP have been associated with muscular dysfunction, maternal factors, and pre-pregnancy low back pain, LBP, and/or pelvic girdle pain, PGP. It has also been stated that the pain and functional disturbances in relation to PGP must be reproducible by specific clinical tests. However, physical examinations have not been performed in long-time follow-ups of women with well-defined PGP during pregnancy and knowledge of potential predictors for long-standing LBP/PGP in these women is limited. Aim To describe the long-term development of back pain in women with well-defined PGP during pregnancy and, to identify potential predictors for persistent PGP and/or LBP in a long time perspective. Materials and Methods Women with well-defined PGP according to mechanical assessment of the, lumbar spine, pelvic pain provocation tests, standard history, pain drawings and European Guidelines who completed one of three treatment studies in 2000-2002, 2006-2007 or 2009-2011 answered a questionnaire. Women reporting pain from the pelvic girdle and/or lower back were physically examined. Results Of 534 eligible women, 380 (71%) answered the questionnaire. Data from 37 (9.7%) women were excluded from analysis due to pregnancy (n=15), systemic disease (n=11), participated in two of the studies (=n5) and declined examination (n=6). Forty-five women/343 (13%) had verified back pain. Of these women, 12/343 (3.5%) had LBP; 15/343 (4.4%) had PGP and 18/343 (5.2%) had combined back- and pelvic girdle pain. During pregnancy, predictors for persisting back pain were: Having a back pain history before pregnancy (p=0.0194), high pain intensity in the morning (Visual Analogue Scale, p=0.0097), impaired function (Oswestery Disability Index p=0.0127), low health related quality of life (Euro-qol, p=0.0097), use of an elastic pelvic belt (p=0.031), difficulty to turn over in bed (p=0.001) and early debut of PGP in pregnancy (p=0.029). Relevance of the number of positive pain provocation tests during pregnancy and at follow-up will also be presented. Relevance PGP can be physically compromising during pregnancy and cause anxiousness concerning childcare after delivery and later return to work and future work planning. It is therefore important to present a reliable prognosis to these women as early as possible, preferably during pregnancy. Discussion Considering the long follow up (10 years), the dropout-ratio in this study was acceptable and the results presented were in line with earlier publications about persistent LBP and PGP in a shorter perspective. Furthermore, the women were physically examined by skilled physiotherapists to confirm the diagnoses PGP and LBP in accordance with the European Guidelines. This increases the reliability of our findings, and we therefore believe that general conclusions can be drawn. A well founded prognosis for the later development of PGP and LBP found during pregnancy thus can be presented to the pregnant women covering the time from delivery up to a decade later. Conclusion: Most women (88%) with well-defined PGP during pregnancy recovered. The long time results confirm earlier short time findings that a back pain history before pregnancy, server PGP during pregnancy and early debut of PGP in pregnancy are risk factors for persisting pain several years postpartum. Implications Identification of women at risk for longstanding back pain seems possible in early pregnancy using physical examination and self-reports.
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| 8. |
- Elden, Helen, 1959, et al.
(författare)
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Predictors and consequences of long-term pregnancy-related pelvic girdle pain: a longitudinal follow-up study.
- 2016
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Ingår i: BMC musculoskeletal disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 17
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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.
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| 9. |
- Fagevik Olsén, Monika, 1964, et al.
(författare)
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Effects of high-intensity high-frequency transcutaneous electric nerve stimulation in primary dysmenorrhea - a randomised cross-over pilot study
- 2020
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Ingår i: European Journal of Physiotherapy. - : Informa UK Limited. - 2167-9169 .- 2167-9177. ; 22:5, s. 248-252
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many women are affected by primary dysmenorrhoea. Transcutaneous Electric Nerve Stimulation (TENS) can be an alternative to analgesics. In one trial, high-intensity, high-frequency TENS was shown to be effective but there is need for more trials. Objectives: To study the effects of high-intensity, high-frequency TENS for primary dysmenorrhoea. Design: Randomised controlled pilot study with cross over design. Methods: Sixteen women with primary dysmenorrhoea participated. Pain, limitation in physical function, other symptoms related to the menstrual period and use of analgesics were registered at baseline, treatment versus control period followed by a wash-out period. Treatment consisted of high-intensity (40 mA) high-frequency (80 Hz) TENS stimulation in sessions of 60 s. Results: The results revealed no significant difference in pain intensity, limitations in physical function, consumption of analgesics and associated symptoms between the groups but a significant lower limitation in physical function during the wash-out period in comparison to the treatment period within the whole group. Conclusion: No significant effect of TENS was seen in contrast to previous studies. The effect is therefore questionable, but results must be interpreted with care, as this was a pilot study and the use of the equipment was not monitored and therefore unknown.
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| 10. |
- Fagevik Olsén, Monika, 1964, et al.
(författare)
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Evaluation of self-administered tests for pelvic girdle pain in pregnancy
- 2014
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background Different tests are used in order to classify women with pelvic girdle pain (PGP). One limitation of the tests is that they need to be performed by an examiner. Self-administered tests have previously been described and evaluated by women who performed the tests directly before the examiner performed the original tests. Thus, an evaluation of the self-administered tests performed in a more natural setting, such as the women’s home is needed. The purpose of this study was to investigate the agreement between self-administered tests performed at home and tests performed by an examiner on women with suspected PGP. Additionally to compare the classification made by an examiner and classification based on results of the self-administered tests and questionnaire. Methods One hundred and twenty three pregnant women with suspected PGP participated. Before the appointment at the clinic the women performed the self-administered tests and filled in a questionnaire. During the appointment one specialized physiotherapist performed the tests. Result of the two different sets of tests and the classifications made by the examiner and the self-administered tests including questionnaires were compared concerning percentage of agreement (POA), sensitivity and positive predicted value (PPV). Results The P4 and the bridging test had the highest POA (≥74.8%), sensitivity (≥75.5%) and PPV (≥91.2%) for posterior PGP. For anterior PGP the MAT test had highest POA (76.4%), and PPV (69.5%), and the modified Trendelenburg test the highest sensitivity (93.0%). Agreement between the two classifications was 87%. A significantly higher number of positive P4 and bridging tests (p<0.01) and a significantly lower number of positive Trendelenburg tests, Active Straight Leg raise and Straight Leg Raise (p<0.05) were recorded by the examiner compared to the self-administered ones. Conclusions Our results indicate that self-administered test and questionnaires are possible to use for testing and classification of women with suspected PGP.
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| 11. |
- Fagevik Olsén, Monika, 1964, et al.
(författare)
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Self-administered tests as a screening procedure for pregnancy-related pelvic girdle pain
- 2009
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Ingår i: EUROPEAN SPINE JOURNAL. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 18:8, s. 1121-1129
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate sensitivity and specificity of self-administrated tests aimed at pain provocation of posterior and/or anterior pelvis pain and to investigate pain intensity during and after palpation of the symphysis. A total of 175 women participated in the study, 100 pregnant women with and 25 pregnant women without lumbopelvic back pain and 50 non-pregnant women. Standard pain provocation tests were compared with self assessed tests. All women were asked to estimate pain during and after palpation of the symphysis. For posterior pelvic pain, the self-test of P4 and Bridging test had the highest sensitivity of 0.90 versus 0.97 and specificity of 0.92 and 0.87. Highest sensitivity for self-test for anterior pelvic pain was pulling a mat 0.85. Palpation of symphysis was painful and persistency of pain was the longest among women who fulfilled the criteria for symphyseal pain. There were overall significant differences between the groups concerning intensity and persistency of pain (P andlt; 0.001). Our results indicate that pregnant women can perform a screening by provocation of posterior pelvic pain by self-tests with the new P4 self-test and the Bridging test. Palpation of the symphysis is painful and should only be used as a complement to history taking, pain drawing and pulling a MAT-test.
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| 12. |
- Fagevik Olsén, Monika, 1964, et al.
(författare)
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Validation of self-administered tests for screening for chronic pregnancy-related pelvic girdle pain
- 2021
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many women develop pelvic girdle pain (PGP) during pregnancy and about 10% have chronic pain several years after delivery. Self-administered pain provocation tests are one way to diagnose and evaluate this pain. Their validity in post-partum women is not yet studied. The purpose of this study was to evaluate the validity of self-administered test for assessment of chronic pregnancy-related PGP several years after delivery. Methods: Women who previously have had PGP during pregnancy and who participated in one of three RCT studies were invited to a postal follow up of symptoms including performance of self-administered tests after two, 6 or 11 years later, respectively. In total, 289 women returned the questionnaire and the test-results. Of these, a sub-group of 44 women with current PGP underwent an in-person clinical examination. Comparisons were made between test results in women with versus without PGP but also, in the sub-group, between the self-administered tests and those performed during the clinical examination. Results: Fifty-one women reported PGP affecting daily life during the last 4 weeks, and 181 reported pain when performing at least one of the tests at home. Those with chronic PGP reported more positive tests (p < 0.001). There was no significant difference between diagnosis from the self-administered tests compared to tests performed during the in-person clinical examination (p = 0.305), either for anterior or posterior PGP. There were no significant differences of the results between the tests performed self-administered vs. during the clinical examination. Conclusion: A battery of self-administered tests combined with for example additional specific questions or a pain-drawing can be used as a screening tool to diagnose chronic PGP years after delivery. However, the modified SLR test has limitations which makes its use questionable.
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| 13. |
- Gutke, Annelie, 1967-, et al.
(författare)
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Adaptation to a changed body : Experiences of living with long-term pelvic girdle pain after childbirth
- 2018
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 40:25, s. 3054-3060
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To explore how women experience living with long-term pregnancy-related pelvic girdle pain.Materials and methods: Nine women with persistent pregnancy-related pelvic girdle pain of 2–13 years were recruited by means of purposive sampling from long-term follow-up studies. The women were 28–42 years of age and had given birth to 2–3 children. Audio-taped in-depth interview with open-ended questions were used with the guiding question 'How do you experience living with pregnancy-related pelvic girdle pain?'. The Empirical Phenomenological Psychological method was chosen for analysis.Results: The pregnancy-related pelvic girdle pain syndrome has a profound impact on everyday life for many years after pregnancy. Three constituents were identified as central to the experience of living with pregnancy-related pelvic girdle pain: (1) the importance of the body for identity, (2) the understanding of pain, and (3) stages of change. The manner in which the women experienced their pain was interpreted in terms of two typologies: the ongoing struggle against the pain, and adaptation and acceptance.Conclusion: The participants’ narratives highlighted that the pain led to severe functional limitations that threatened their capability to perform meaningful daily activities, and interfered with their sense of identity. It appears essential to meet with each patient individually and to manage long-term pregnancy-related pelvic girdle pain as a pain syndrome.IMPLICATIONS FOR REHABILITATIONChronic pregnancy-related pelvic girdle painPregnancy-related pelvic girdle pain impairs women’s capacity to perform meaningful activities of daily life for many years after pregnancy.The participants’ narratives highlighted that the pain interfered with their sense of identity.It appears essential to meet with each patient individually and to manage long-term pregnancy-related pelvic girdle pain as a pain syndrome.
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| 14. |
- Gutke, Annelie, et al.
(författare)
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ASSOCIATION BETWEEN LUMBOPELVIC PAIN, DISABILITY AND SICK LEAVE DURING PREGNANCY - A COMPARISON OF THREE SCANDINAVIAN COHORTS
- 2014
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Ingår i: Journal of Rehabilitation Medicine. - : Foundation for Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 46:5, s. 468-474
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore the association between disability and sick leave due to lumbopelvic pain in pregnant women in 3 cohorts in Sweden and Norway and to explore possible factors of importance to sick leave. A further aim was to compare the prevalence of sick leave due to lumbopelvic pain. Design/subjects: Pregnant women (n=898) from two cohorts in Sweden and one in Norway answered to questionnaires in gestational weeks 10-24; two of the cohorts additionally in weeks 28-38. Methods: Logistic regression models were performed with sick leave due to lumbopelvic pain as dependent factor. Disability, pain, age, parity, cohort, civilian status, and occupational classification were independents factors. Results: In gestational weeks 10-24 the regression model included 895 cases; 38 on sick leave due to lumbopelvic pain. Disability, pain and cohort affiliation were associated with sick leave. In weeks 28-38, disability, pain and occupation classification were the significant factors. The prevalence of lumbopelvic pain was higher in Norway than in Sweden (65%, vs 58% and 44%; pless than0.001). Conclusion: Disability, pain intensity and occupation were associated to sick leave due to lumbopelvic pain. Yet, there were significant variations between associated factors among the cohorts, suggesting that other factors than workability and the social security system are also of importance.
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| 15. |
- Gutke, Annelie, et al.
(författare)
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Association between muscle function and low back pain in relation to pregnancy
- 2008
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 40:4, s. 304-311
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the association of muscle function and subgroups of low back pain (no low back pain, pelvic girdle pain, lumbar pain and combined pelvic girdle pain and lumbar pain) in relation to pregnancy. Design: Prospective cohort study. Subjects: Consecutively enrolled pregnant women seen in gestational weeks 12–18 (n = 301) and 3 months postpartum (n = 262). Methods: Classification into subgroups by means of mechanical assessment of the lumbar spine, pelvic pain provocation tests, standard history and a pain drawing. Trunk muscle endurance, hip muscle strength (dynamometer) and gait speed were investigated. Results: In pregnancy 116 women had no low back pain, 33% (n = 99) had pelvic girdle pain, 11% (n = 32) had lumbar pain and 18% (n = 54) had combined pelvic girdle pain and lumbar pain. The prevalence of pelvic girdle pain/combined pelvic girdle pain and lumbar pain decreased postpartum, whereas the prevalence of lumbar pain remained stable. Women with pelvic girdle pain and/or combined pelvic girdle pain and lumbar pain had lower values for trunk muscle endurance, hip extension and gait speed as compared to women without low back pain in pregnancy and postpartum (p < 0.001–0.04). Women with pelvic girdle pain throughout the study had lower values of back flexor endurance compared with women without low back pain. Conclusion: Muscle dysfunction was associated with pelvic girdle pain, which should be taken into consideration when developing treatment strategies and preventive measures.
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| 16. |
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| 17. |
- Gutke, Annelie, et al.
(författare)
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Impact of postpartum lumbopelvic pain on disability, pain intensity, health-related quality of life, activity level, kinesiophobia, and depressive symptoms
- 2011
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Ingår i: EUROPEAN SPINE JOURNAL. - : Springer Science Business Media. - 0940-6719 .- 1432-0932. ; 20:3, s. 440-448
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Tidskriftsartikel (refereegranskat)abstract
- The majority of women recover from pregnancy-related lumbopelvic pain within 3 months of delivery. Since biomechanical and hormonal changes from pregnancy are largely reversed by 3 months postpartum, consequently, it is assumed that other factors might interfere with recovery. Relative to the fear-avoidance model and with reference to previous studies, we chose to investigate some pre-decided factors to understand persistent lumbopelvic pain. The evaluation of lumbopelvic pain postpartum is mostly based on self-administered questionnaires or interviews. Clinical classification of the lumbopelvic pain may increase our knowledge about postpartum subgroups. Two hundred and seventy-two consecutively registered pregnant women evaluated at 3 months postpartum, answered questionnaires concerning disability (Oswestry disability index), pain intensity on visual analog scale, health-related quality of life (HRQL, EQ5D), activity level, depressive symptoms (Edinburgh postnatal Depression Scale) and kinesiophobia (Tampa Scale for Kinesiophobia). Women were classified into lumbopelvic pain subgroups according to mechanical assessment of the lumbar spine, pelvic pain provocation tests, standard history, and pain drawings. Multiple linear regression analysis was performed to explain the variance of disability. Thirty-three percent of postpartum women were classified with lumbopelvic pain; 40% reported moderate to severe disability. The impacts were similar among subgroups. Pain intensity, HRQL and kinesiophobia explained 53% of postpartum disability due to lumbopelvic pain. In conclusion, one of three postpartum women still had some lumbopelvic pain and the impacts were equivalent irrespective of symptoms in lumbar or pelvic areas. The additional explanations of variance in disability by HRQL and kinesiophobia were minor, suggesting that pain intensity was the major contributing factor.
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| 18. |
- Gutke, Annelie, et al.
(författare)
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Lifestyle and Chronic Pain in the Pelvis: State of the Art and Future Directions
- 2021
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Ingår i: Journal of Clinical Medicine. - : MDPI AG. - 2077-0383. ; 10:22
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Tidskriftsartikel (refereegranskat)abstract
- During their lifespan, many women are exposed to pain in the pelvis in relation to menstruation and pregnancy. Such pelvic pain is often considered normal and inherently linked to being a woman, which in turn leads to insufficiently offered treatment for treatable aspects related to their pain experience. Nonetheless, severe dysmenorrhea (pain during menstruation) as seen in endometriosis and pregnancy-related pelvic girdle pain, have a high impact on daily activities, school attendance and work ability. In the context of any type of chronic pain, accumulating evidence shows that an unhealthy lifestyle is associated with pain development and pain severity. Furthermore, unhealthy lifestyle habits are a suggested perpetuating factor of chronic pain. This is of specific relevance during lifespan, since a low physical activity level, poor sleep, or periods of (di)stress are all common in challenging periods of women's lives (e.g., during menstruation, during pregnancy, in the postpartum period). This state-of-the-art paper aims to review the role of lifestyle factors on pain in the pelvis, and the added value of a lifestyle intervention on pain in women with pelvic pain. Based on the current evidence, the benefits of physical activity and exercise for women with pain in the pelvis are supported to some extent. The available evidence on lifestyle factors such as sleep, (di)stress, diet, and tobacco/alcohol use is, however, inconclusive. Very few studies are available, and the studies which are available are of general low quality. Since the role of lifestyle on the development and maintenance of pain in the pelvis, and the value of lifestyle interventions for women with pain in the pelvis are currently poorly studied, a research agenda is presented. There are a number of rationales to study the effect of promoting a healthy lifestyle (early) in a woman's life with regard to the prevention and management of pain in the pelvis. Indeed, lifestyle interventions might have, amongst others, anti-inflammatory, stress-reducing and/or sleep-improving effects, which might positively affect the experience of pain. Research to disentangle the relationship between lifestyle factors, such as physical activity level, sleep, diet, smoking, and psychological distress, and the experience of pain in the pelvis is, therefore, needed. Studies which address the development of management strategies for adapting lifestyles that are specifically tailored to women with pain in the pelvis, and as such take hormonal status, life events and context, into account, are required. Towards clinicians, we suggest making use of the window of opportunity to prevent a potential transition from localized or periodic pain in the pelvis (e.g., dysmenorrhea or pain during pregnancy and after delivery) towards persistent chronic pain, by promoting a healthy lifestyle and applying appropriate pain management.
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| 19. |
- Gutke, Annelie, et al.
(författare)
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Pelvic girdle pain and lumbar pain in pregnancy: a cohort study of the consequences in terms of health and functioning
- 2006
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Ingår i: Spine. - : Ovid Technologies (Wolters Kluwer Health). - 1528-1159 .- 0362-2436. ; 31:5
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: A cohort study in pregnancy. OBJECTIVES: To differentiate between pregnancy-related pelvic girdle pain (PPGP) and lumbar pain, and to study the prevalence of each syndrome and its consequences in terms of pain, functioning, and health. SUMMARY OF BACKGROUND DATA: When studying prevalence, etiology, and consequences, differentiation between PPGP and lumbar pain is important, and, to our knowledge, its consequences for functioning and health during pregnancy have not previously been studied. METHODS: All women answered questionnaires (demographic data, EuroQol). Women with lumbopelvic pain completed the Oswestry Disability Index, pain intensity measures, in addition to undergoing a mechanical assessment of the lumbar spine, pain provocation tests, and active straight leg raising test. RESULTS: Of 313 women, 194 had lumbopelvic pain. The PPGP subgroup comprised 54% of those women with lumbopelvic pain, lumbar pain 17%, and combined PPGP and lumbar pain 29%. Women having both PPGP and lumbar pain reported the highest consequences in terms of health and functioning. CONCLUSIONS: Pain intensity, disability, and health measurements differentiate subgroups of lumbopelvic pain in pregnancy.
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| 20. |
- Gutke, Annelie, et al.
(författare)
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Pelvic girdle pain and lumbar pain in relation to postpartum depressive symptoms
- 2007
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 32:13, s. 1430-1436
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the possible association of lumbopelvic pain and postpartum depression and differences in the prevalence of depressive symptoms among women without lumbopelvic pain and women classified as having pelvic girdle pain (PGP) and/or lumbar pain. Summary of background data: Lumbopelvic pain and depression are common pregnancy complications, but their comorbidity has rarely been evaluated and has not been studied in relation to subgroups of lumbopelvic pain. Methods: In a cohort of consecutively enrolled pregnant women, the Edinburgh Postnatal Depression Scale was used to evaluate depressive symptoms at 3 months postpartum, applying a primary screening cutoff of >=10 and a cutoff of >=13 for probable depression. Women were classified into lumbopelvic pain subgroups by means of mechanical assessment of the lumbar spine, standard history, pelvic pain provocation tests, a pain drawing, and the active straight leg raising test. Results: The postpartum cohort (n = 267) comprised 180 (67%) women without lumbopelvic pain, 44 (16%) with PGP, 29 (11%) with lumbar pain, and 14 (5%) with combined PGP and lumbar pain. Applying a cutoff of >=10, postpartum depressive symptoms were more prevalent in women with lumbopelvic pain (27 of 87, 31%; 95% confidence interval, 26%–36%) than in women without lumbopelvic pain (17 of 180, 9%; 95% confidence interval, 5%–13%; P < 0.001). The comorbidity of lumbopelvic pain and depressive symptoms was 10%. Depressive symptoms were more prevalent in women with lumbar pain versus women without lumbopelvic pain when applying cutoffs of >=10 or >=13 (P <= 0.002); whereas for women with PGP, this comparison was significant only at the screening level of >=10 (P = 0.01). Conclusions: Postpartum depressive symptoms were 3 times more prevalent in women having lumbopelvic pain than in those without. This comorbidity highlights the need to consider both symptoms in treatment strategies.
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| 21. |
- Gutke, Annelie, 1967-
(författare)
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Pelvic Girdle Pain and Lumbar Pain in relation to pregnancy
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The prevalence of low back pain (LBP) is higher in pregnant women compared to women of the same age in a general population. Pregnancy-related LBP persists 6 years after pregnancy in 16% of women. Consequently, pregnancy represents a specific risk for LBP and persistent LBP. Pregnancy-related LBP is usually studied as a single entity, however, only one subgroup of LBP, i.e. pelvic girdle pain (PGP), seems to be associated with pregnancy. Accordingly, possible differences in subgroups of patients with LBP are unknown.The aims of this thesis were the following: 1) to describe the prevalence of clinically classified subgroups of women with LBP in a cohort (no LBP, lumbar pain, PGP, and combined pain (PGP and lumbar pain)) during pregnancy and postpartum, and 2) to determine if there was a disparity in the course, health-related quality of life (HRQL), pain intensity, disability, depressive symptoms, or muscle function in subgroups of the cohort, and 3) to identify predictors for having persistent pregnancy-related PGP postpartum.Consecutively-enrolled pregnant women were classified into LBP subgroups by mechanical assessment of the lumbar spine, pelvic pain provocation tests, standard history, and pain drawings. All women answered questionnaires (background data, EQ-5D). Women with LBP completed the Oswestry Disability Index and pain measures. The Edinburgh Postnatal Depression Scale was used to evaluate depressive symptoms at 3 months postpartum (cut-off ≥10). Trunk muscle endurance, hip muscle strength, and gait speed were investigated. Multiple logistic regression was used to identify predictors from self-reports and clinical examination.At the 12-18 gestational week evaluation, 118/308 (38%) women had no LBP, 33 (11%) had lumbar pain, 101 (33%) had PGP, and 56 (18%) had combined pain. Three months postpartum, 183/272 (67%) women had no LBP, 29 (11%) had lumbar pain, 46 (17%) had PGP, and 14 (5%) had combined pain. Pregnant women with combined pain were most affected in terms of HRQL, pain intensity, and disability. Depressive symptoms were three times more prevalent in women with LBP (27/87, 31%) than in women without LBP (17/180, 9%). Women with PGP and/or combined pain had lower values for trunk muscle endurance, hip extensor strength and gait speed compared to women without LBP. Postpartum, 16-20% of the women had persistent combined pain or PGP, whereas 1/29 had lumbar pain. Predictors for persistent PGP or combined pain were work dissatisfaction, older age, combined pain in early pregnancy, and low endurance of the back flexors.In conclusion, women with combined pain were identified to be a target group since they had the lowest recovery rate and since the classification of combined pain was found to be a predictor for persistent PGP or combined pain postpartum. The hypothesis of an association between muscle dysfunction and PGP was strengthened. Based on the finding of high comorbidity of postpartum depressive symptoms and LBP, it seems important to screen for and consider treatment strategies for both symptoms.
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| 22. |
- Gutke, Annelie, et al.
(författare)
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Posterior pelvic pain provocation test is negative in patients with lumbar herniated discs
- 2009
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Ingår i: EUROPEAN SPINE JOURNAL. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 18:7, s. 1008-1012
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Tidskriftsartikel (refereegranskat)abstract
- The classification of pelvic girdle pain can only be reached after lumbar causes have been excluded by a clinical examination. During clinical examination, the posterior pelvic pain provocation test is a well-established method for verifying pelvic girdle pain. However, a criticism of pelvic pain provocation tests is that they may have an effect on lumbar structures, thus yielding false-positive results. The posterior pelvic pain provocation test was performed with four groups of patients: patients with computed tomography-verified disc herniations (1) on the waiting list for surgery (14 women; 9 men); (2) 6 weeks after disc surgery (18 women, 12 men); (3) pregnant women seeking care for pelvic girdle pain (n = 25); and (4) women with persistent pelvic girdle pain after delivery (n = 32). The sensitivity of the posterior pelvic pain provocation test was 0.88 and the specificity was 0.89. The positive predictive value was 0.89 and the negative predictive value was 0.87. Analysis of only women showed similar results. In our study, the posterior pelvic pain provocation test was negative in patients with a well-defined lumbar diagnosis of lumbar disc herniation, both before and after disc surgery. Our results are an important step toward the more accurate classification of lumbopelvic pain.
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| 23. |
- Gutke, Annelie, et al.
(författare)
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Predicting persistent pregnancy-related low back pain
- 2008
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 33:12, s. E386-E393
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine the course of subtypes of low back pain (LBP) experienced [no LBP, pelvic girdle pain (PGP), lumbar pain, and combined PGP and lumbar pain (combined pain)] during gestational weeks 12 to 18 and 3 months postpartum, and to explore potential predictors for persistent PGP or combined pain postpartum. Summary of background data: LBP is more prevalent in pregnant women (25%) than in the general population (6.3%). Persistent LBP postpartum (16%) is usually studied as a single entity. However, only one subgroup of LBP, pelvic girdle pain (PGP), is associated with pregnancy. Several studies have suggested an association between muscular dysfunction and pregnancy-related LBP, however, muscle dysfunction has not been evaluated as potential predictor of persistent LBP postpartum. Possible subgroup differences in the course and predictors of persistent LBP are unknown. Methods: Pregnant women (n = 308) were classified into LBP subgroups by mechanical assessment of the lumbar spine, pelvic pain provocation tests, standard history, and pain drawings. Trunk muscle endurance, hip muscle strength (dynamometer) and gait speed were evaluated. Multiple logistic regression was used to identify predictors from self-reports and clinical examination. Results: Women with combined pain recovered to a lower degree 33% (17 of 51) than those with PGP 66% (56 of 85) or lumbar pain 72% (21 of 29). Predictors for having persistent PGP or combined pain after delivery were low endurance of back flexors, older age, combined pain in early pregnancy and work dissatisfaction (explained variance 30%). Conclusion: Women with combined pain were identified to be a target group since they had the most unfavorable course and since the classification of combined pain was found to be a predictor for persistent pain postpartum. Identification of women at risk for persistent pain postpartum seems possible in early pregnancy and requires physical examination and self-reports. Pregnancy had low impact on the course of lumbar pain.
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| 24. |
- Gutke, Annelie, et al.
(författare)
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Specific muscle stabilizing as home exercises for persistent pelvic girdle pain after pregnancy : a randomized, controlled clinical trial
- 2010
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Ingår i: Journal of Rehabilitation Medicine. - : Foundation for Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 42:10, s. 929-935
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the efficacy of home-based specific stabilizing exercises focusing on the local stabilizing muscles as the only intervention in the treatment of persistent postpartum pelvic girdle pain (PGP). Design: A prospective, randomized, single-blinded, clinically controlled study. Subjects: Eighty-eight women with PGP were recruited 3 months after delivery. Methods: The treatment consisted of specific stabilizing exercises targeting the local trunk muscles. The reference group had one telephone contact with a physiotherapist. Primary outcome was disability measured with Oswestry Disability Index. Secondary outcomes were pain, health-related quality of life (EQ-5D), symptom satisfaction, and muscle function. Results: No significant differences between groups could be found at 3- or 6-month follow-up regarding primary outcome in disability. Within-group comparisons showed some improvement in both groups in terms of disability, pain, symptom satisfaction and muscle function compared to baseline although the majority still experienced PGP. Conclusion: Treatment with this home-training concept of specific stabilizing exercises targeting the local muscles was no more effective in improving consequences of persistent postpartum PGP than the clinically natural course. Regardless of treatment with specific stabilizing exercises or not, the majority still experiences some back pain almost a year after pregnancy.
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| 25. |
- Gutke, Annelie, et al.
(författare)
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The inter-rater reliability of a standardised classification system for pregnancy-related lumbopelvic pain
- 2010
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Ingår i: MANUAL THERAPY. - : Elsevier BV. - 1356-689X .- 1532-2769. ; 15:1, s. 13-18
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Tidskriftsartikel (refereegranskat)abstract
- Pregnancy-related lumbopelvic pain has varying clinical presentations and effects among subgroups. Different lumbopelvic pain subgroups require different specific management approaches which require the differentiation between lumbar and pelvic girdle pain (PGP). Thirty-one consecutive pregnant women with non-specific lumbopelvic pain were evaluated by two examiners and classified into lumbar pain, PGP, or combined pelvic girdle and lumbar pain. A standard history about different positions/activities of daily life such as bending, sitting, standing, walking, and lying, was followed by a standardised mechanical assessment of the lumbar spine (Mechanical Diagnosis and Therapy), including tests of repeated end-range movements to standing and lying, pelvic pain provocation tests (distraction test, posterior pelvic pain provocation test, Gaenslens test, compression test, and sacral thrust) a hip-rotation range-of-motion test, the active straight-leg-raising test, and a neurological examination. Agreement for the three syndromes (lumbar pain, PGP, or combined pelvic girdle and lumbar pain) was 87% (27/31), with a kappa coefficient of 0.79 (95% CI 0.60-0.98). It was possible to perform the classification procedure throughout pregnancy. There was substantial agreement between the two examiners for the classification of non-specific lUrnbopelvic pain into lumbar pain and PGP in pregnant women.
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| 26. |
- Gutke, Annelie, et al.
(författare)
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The Severity and Impact of Pelvic Girdle Pain and Low-Back Pain in Pregnancy: A Multinational Study.
- 2018
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Ingår i: Journal of Women's Health. - : Mary Ann Liebert Inc. - 1931-843X .- 1540-9996. ; 27:4
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Tidskriftsartikel (refereegranskat)abstract
- Pelvic girdle pain (PGP) and low-back pain (LBP) are the most common musculoskeletal disorders experienced during pregnancy, yet they are not familiar to healthcare providers in some countries. The objective was to compare prevalence, severity, and impact of PGP and LBP among pregnant women in the United States, the United Kingdom, Norway, and Sweden. Women's desires for, access to, and experience of treatment were also examined.This is a cross-sectional self-reported questionnaire study of pregnant women, recruited at maternity care units in gestational weeks 30-38. Main outcome measures were presence and impact of PGP and/or LBP.A total of 869 pregnant women from the United States (n=214), the United Kingdom (n=220), Norway (n=220), and Sweden (n=215) were included. PGP and/or LBP were reported by 70%-86%, with lowest prevalence in Scandinavia. Severity and impact differed significantly across countries (p<0.001), with U.K. women reporting the highest pain intensity (Numeric Rating Scale [NRS] 7/10) and highest mean total score on the Pelvic Girdle Questionnaire (PGQ) (46/100). U.S. women were significantly less afflicted, with mean PGQ total score 35/100 (p≤0.001). The countries differed regarding concern about PGP and/or LBP (p<0.001), with U.K. women being most affected (NRS 5/10). Norwegian women were most likely to receive treatment (53%) and U.S. women least likely (24%) (p<0.001). Among women receiving treatment, 68%-87% reported a positive effect.PGP and/or LBP during pregnancy are common in the United States, the United Kingdom, Norway, and Sweden. Severity, concern, and treatment experiences differed across countries. The majority of women who received treatment reported a positive effect.
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| 27. |
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| 28. |
- Gutke, Annelie, et al.
(författare)
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Treatments for pregnancy-related lumbopelvic pain: a systematic review of physiotherapy modalities
- 2015
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Ingår i: Acta Obstetricia Et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 94:11, s. 1156-1167
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Forskningsöversikt (refereegranskat)abstract
- ObjectiveTo explore the effect of physiotherapeutic interventions on pregnancy-related lumbopelvic pain. Material and methodsData sources: MEDLINE, Cochrane Central Register of Controlled Trials, PEDro, CINAHL, AMED, and SCOPUS databases were searched up to December 2014 for studies written in English, French, German or Scandinavian languages that evaluated physiotherapeutic modalities for preventing and treating pregnancy-related lumbopelvic pain. ResultsFor lumbopelvic pain during pregnancy, the evidence was strong for positive effects of acupuncture and pelvic belts. The evidence was low for exercise in general and for specific stabilizing exercises. The evidence was very limited for efficacy of water gymnastics, progressive muscle relaxation, a specific pelvic tilt exercise, osteopathic manual therapy, craniosacral therapy, electrotherapy and yoga. For postpartum lumbopelvic pain, the evidence was very limited for clinic-based treatment concepts, including specific stabilizing exercises, and for self-management interventions for women with severe disabilities. No specific adverse events were reported for any intervention. No meta-analysis could be performed because of study heterogeneity. ConclusionsThe levels of evidence were strong for a positive effect of acupuncture and pelvic belts, but weak for an effect of specific exercises. Caution should prevail in choosing other interventions for pregnancy-related lumbopelvic pain.
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| 29. |
- Gutke, Annelie, et al.
(författare)
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Untitled - Response
- 2006
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Ingår i: Spine. - : Ovid Technologies (Wolters Kluwer Health). - 0362-2436 .- 1528-1159. ; 31:20, s. 2406-2407
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 30. |
- Hodges, P. W., et al.
(författare)
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Building a Collaborative Model of Sacroiliac Joint Dysfunction and Pelvic Girdle Pain to Understand the Diverse Perspectives of Experts
- 2019
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Ingår i: PM&R. - : Wiley. - 1934-1482 .- 1934-1563. ; 11:Suppl. 1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pelvic girdle pain (PGP) and sacroiliac joint (SIJ) dysfunction/pain are considered frequent contributors to low back pain (LBP). Like other persistent pain conditions, PGP is increasingly recognized as a multifactorial problem involving biological, psychological, and social factors. Perspectives differ between experts and a diversity of treatments (with variable degrees of evidence) have been utilized. Objective: To develop a collaborative model of PGP that represents the collective view of a group of experts. Specific goals were to analyze structure and composition of conceptual models contributed by participants, to aggregate them into a metamodel, to analyze the metamodel's composition, and to consider predicted efficacy of treatments. Design: To develop a collaborative model of PGP, models were generated by invited individuals to represent their understanding of PGP using fuzzy cognitive mapping (FCM). FCMs involved proposal of components related to causes, outcomes, and treatments for pain, disability, and quality of life, and their connections. Components were classified into thematic categories. Weighting of connections was summed for components to judge their relative importance. FCMs were aggregated into a metamodel for analysis of the collective opinion it represented and to evaluate expected efficacy of treatments. Results: From 21 potential contributors, 14 (67%) agreed to participate (representing six disciplines and seven countries). Participants' models included a mean (SD) of 22 (5) components each. FCMs were refined to combine similar terms, leaving 89 components in 10 categories. Biomechanical factors were the most important in individual FCMs. The collective opinion from the metamodel predicted greatest efficacy for injection, exercise therapy, and surgery for pain relief. Conclusions: The collaborative model of PGP showed a bias toward biomechanical factors. Most efficacious treatments predicted by the model have modest to no evidence from clinical trials, suggesting a mismatch between opinion and evidence. The model enables integration and communication of the collection of opinions on PGP.
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| 31. |
- Huseth, Kari, et al.
(författare)
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Assessment of neuromuscular activity during maximal isometric contraction in supine vs standing body positions
- 2020
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Ingår i: Journal of Electromyography and Kinesiology. - : Elsevier BV. - 1050-6411. ; 50
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Tidskriftsartikel (refereegranskat)abstract
- Background: When comparing neuromuscular activity between different individuals or different conditions by use of surface electromyography (sEMG) it is necessary to apply standardized assessment protocol. Most frequently used method is the maximum voluntary isometric contraction (MVIC). However, the influence of body posture on sEMG activity during MVIC testing remains largely unknown. Aim: To evaluate the MVIC method for sEMG normalization in supine versus standing positions for selected muscles of the lower extremity and trunk. Methods: Twelve healthy individuals participated; five females and seven males (age 22–51 yrs). sEMG signals were recorded bilaterally from mm tibialis anterior, gluteus medius, adductor longus, rectus abdominus, external oblique and internal oblique/transversus abdominus according to standardized test protocol. Two different body positions were used: supine and standing position. Results: MVIC peak sEMG signal amplitudes did not differ systematically between supine and standing test positions. Pronounced inter-subject variability in MVIC reference sEMG activity were observed between participants, during both supine and standing test positions. Conclusion: Present data demonstrate that MVIC EMG normalization is a biomechanically stable procedure that can be performed in a reproducible manner for the major leg and trunk muscles when comparing supine vs. standing test positions. © 2019 Elsevier Ltd
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| 32. |
- Jakobsson, Max, et al.
(författare)
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Level of Evidence for Reliability, Validity, and Responsiveness of Physical Capacity Tasks Designed to Assess Functioning in Patients With Low Back Pain: A Systematic Review Using the COSMIN Standards.
- 2019
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Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 1538-6724 .- 0031-9023. ; 99:4, s. 457-477
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Physical capacity tasks (ie, observer-administered outcome measures that comprise a standardized activity) are useful for assessing functioning in patients with low back pain. PURPOSE: The purpose of this study was to systematically review the level of evidence for the reliability, validity, and responsiveness of physical capacity tasks. DATA SOURCES: MEDLINE, CINAHL, PsycINFO, Scopus, the Cochrane Library, and relevant reference lists were used as data sources. STUDY SELECTION: Two authors independently selected articles addressing the reliability, validity, and responsiveness of physical capacity tasks, and a third author resolved discrepancies. DATA EXTRACTION AND QUALITY ASSESSMENT: One author performed data extraction, and a second author independently checked the data extraction for accuracy. Two authors independently assessed the methodological quality with the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) 4-point checklist, and a third author resolved discrepancies. DATA SYNTHESIS AND ANALYSIS: Data synthesis was performed by all authors to determine the level of evidence per measurement property per physical capacity task. The 5-repetition sit-to-stand, 5-minute walk, 50-ft (∼15.3-m) walk, Progressive Isoinertial Lifting Evaluation, and Timed "Up & Go" tasks displayed moderate to strong evidence for positive ratings of both reliability and construct validity. The 1-minute stair-climbing, 5-repetition sit-to-stand, shuttle walking, and Timed "Up & Go" tasks showed limited evidence for positive ratings of responsiveness. LIMITATIONS: The COSMIN 4-point checklist was originally developed for patient-reported outcome measures and not physical capacity tasks. CONCLUSIONS: The 5-repetition sit-to-stand, 50-ft walk, 5-minute walk, Progressive Isoinertial Lifting Evaluation, Timed "Up & Go," and 1-minute stair-climbing tasks are promising tests for the measurement of functioning in patients with chronic low back pain. However, more research on the measurement error and responsiveness of these tasks is needed to be able to fully recommend them as outcome measures in research and clinical practice.
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| 33. |
- Jakobsson, Max, et al.
(författare)
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One-minute stair climbing, 50-foot walk, and timed up-and-go were responsive measures for patients with chronic low back pain undergoing lumbar fusion surgery
- 2019
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Ingår i: Bmc Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPhysical capacity tasks are useful tools to assess functioning in patients with low back pain (LBP), but evidence is scarce regarding the responsiveness (ability to detect change over time) and minimal important change (MIC). The aim was to investigate the responsiveness and MIC of 5-min walk, 1-min stair climbing, 50-ft walk, and timed up-and-go in patients with chronic LBP undergoing lumbar fusion surgery.MethodsIn this clinimetric study, 118 patients scheduled for lumbar fusion surgery for motion-elicited chronic LBP with degenerative changes were included. All patients performed the physical capacity tasks 5-min walk, 1-min stair climbing, 50-ft walk, and timed up-and-go 8-12weeks before and six months after surgery. Responsiveness was evaluated by testing five a priori responsiveness hypotheses. The hypotheses concerned the area under the receiver operating characteristics (ROC) curve and correlations (Spearman's rho) between the change scores of the physical capacity tasks, the Oswestry Disability Index 2.0 (ODI), and back pain intensity measured with visual analog scale (VAS). At least 80% of the hypotheses would have to be confirmed for adequate responsiveness. Absolute and relative MICs for improvement were determined by the optimal cut-off point of the ROC curve based on the classification of improved and unchanged patients according to construct-specific global perceived effect (GPE) scales.ResultsOne-minute stair climbing, 50-ft walk and timed up-and-go displayed adequate responsiveness ( 80% of hypotheses confirmed), while 5-min walk did not (40% of hypotheses confirmed). The absolute MICs for improvement were 45.5m for 5-min walk, 20.0 steps for 1-min stair climbing, -0.6s for 50-ft walk, and-1.3s for timed up-and-go.ConclusionsThe results of responsiveness for 1-min stair climbing, 50-ft walk, and timed up-and-go implies that these have the ability to detect changes in physical capacity over time in patients with chronic LBP who have undergone lumbar fusion surgery.
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| 34. |
- Jakobsson, Max, et al.
(författare)
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Prediction of Objectively Measured Physical Activity and Self-Reported Disability Following Lumbar Fusion Surgery.
- 2019
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Ingår i: World neurosurgery. - : Elsevier BV. - 1878-8769 .- 1878-8750. ; 121
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the predictive value of preoperative fear-avoidance factors (self-efficacy for exercise, pain catastrophizing, kinesiophobia, and depression), walking capacity, and traditional predictor variables for predicting postoperative changes in physical activity level and disability 6 months after lumbar fusion surgery in patients with chronic low back pain (LBP). METHODS: We prospectively enrolled 118 patients scheduled for lumbar fusion surgery for motion-elicited chronic LBP with degenerative changes in 1-3 segments of the lumbar spine. Associations between the predictors and the dependent variables were investigated with multiple linear regression analysis. Dependent variables were physical activity level as objectively measured with a triaxial accelerometer and disability as measured with the Oswestry Disability Index. RESULTS: Preoperative physical activity level (β=-0.349; P < 0.001) and self-efficacy for exercise (β= 0.176; P= 0.021) were significant predictors of the postoperative change in physical activity. Preoperative disability (β=-0.790; P < 0.001), self-efficacy for exercise (β= 0.152; P= 0.024), and pain catastrophizing (β= 0.383; P= 0.033) were significant predictors for the change in the Oswestry Disability Index. CONCLUSIONS: Patients with low levels of preoperative physical activity were more likely to increase their level of physical activity after lumbar fusion surgery, especially when their self-efficacy for exercise was high. However, most of these patients still had low levels of physical activity after surgery, and they may therefore need extra support in increasing their postoperative physical activity levels.
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| 35. |
- Jesberg, U., et al.
(författare)
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Swedish validation of the Pelvic Floor Questionnaire for pregnant and postpartum women
- 2022
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Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 0937-3462 .- 1433-3023. ; 33, s. 3013-3024
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and hypothesis The German "Pelvic Floor Questionnaire for pregnant and postpartum women" is a self-administered questionnaire customized for pregnancy and the postpartum period that assesses four domains of pelvic floor function regarding perceived symptoms, suffering, and impact on quality of life: bladder, bowel, prolapse, and sexual function. No similar questionnaire is available in Swedish, despite a high prevalence of pregnancy and postpartum pelvic floor dysfunction. Thus, we aimed to translate the validated German questionnaire into Swedish and test its validity and reliability in a Swedish population. Methods Translation and cultural adaptation were performed according to guidelines. Of the 248 women who answered the Swedish questionnaire, 57 filled out the questionnaire twice to evaluate test-retest reliability. We also assessed internal consistency and discriminant validity. Results The Swedish version of the questionnaire showed good face and content validity. Cronbach's alpha was in the acceptable to excellent range (bladder 0.82, bowel 0.78, prolapse 0.91, and sexual 0.83), showing adequate internal consistency. A comparison of means (>= 1 point) showed that the questionnaire significantly (p < 0.05) distinguished between women who reported suffering and those who did not. Cohen's kappa for all individual items showed fair to almost perfect agreement (0.24-0.87) between test and retest scores. The intraclass correlation coefficients for domain scores (0.92-0.97) were all in an optimal range. Conclusions The Swedish version of the questionnaire is a reliable and valid instrument for assessing pelvic floor disorders, symptom severity, and impact on quality of life during pregnancy and the postpartum period.
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| 36. |
- Johannesson, E., et al.
(författare)
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Women's experiences of obstetric anal sphincter injury and physical therapy interventions - A qualitative study: Experiences after anal sphincter injury
- 2022
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Ingår i: Brazilian Journal of Physical Therapy. - : Elsevier BV. - 1413-3555. ; 26:2
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Tidskriftsartikel (refereegranskat)abstract
- Background: During childbirth, women may suffer perineal injuries that can lead to persistent disorders. No interview study has investigated women's experience of obstetric anal sphincter injuries (OASIS) and physical therapy rehabilitation process after the injury. Objective: To describe women's experiences of OASIS and the physical therapy rehabilitation process. Methods: A qualitative study with an inductive approach based on semi-structured interviews was performed with 14 primi- and multi-parous women affected by OASIS. They had been sutured within 24 h and were recruited from a university hospital in Sweden. The interviews lasted between 35 and 66 min. Data were processed and analyzed using qualitative content analysis. Results: Three main categories emerged from the analysis: The categories described experiences of a difficult time after the injury and physical therapy rehabilitation but also experiences of a safe follow-up. Moreover, experiences of that it wasn´t that bad after all when looking back. Conclusion: Regardless of the extent of the injury, some women experienced a long and troublesome recovery with intense physical therapy rehabilitation, while other women felt that they fortunately got away lightly. Factors that can influence a woman's confidence in safely beginning pelvic floor muscle training at an early stage include individualizing when and how information about OASIS is provided. Meeting each woman's needs and wishes is emphasized by this study. © 2022 The Author(s)
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| 37. |
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| 38. |
- Lotzke, Hanna, et al.
(författare)
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A Person-Centered Prehabilitation Program Based on Cognitive-Behavioral Physical Therapy for Patients Scheduled for Lumbar Fusion Surgery: A Randomized Controlled Trial
- 2019
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Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 99:8, s. 1069-1088
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Tidskriftsartikel (refereegranskat)abstract
- Background Prehabilitation programs have led to improved postoperative outcomes in several surgical contexts, but there are presently no guidelines for the prehabilitation phase before lumbar fusion surgery. Objective The objective was to investigate whether a person-centered physical therapy prehabilitation program, based on a cognitive-behavioral approach, is more effective than conventional care in reducing disability and improving functioning after lumbar fusion surgery in patients with degenerative disk disease. Setting The study took place at 2 private spine clinics and 1 university hospital. Patients We prospectively enrolled 118 patients scheduled for lumbar fusion surgery. Intervention The active intervention used a person-centered perspective and focused on promoting physical activity and targeting psychological risk factors before surgery. The control group received conventional preoperative care. Measurements The primary outcome was the Oswestry Disability Index score. Secondary outcomes were back and leg pain intensity, catastrophizing, kinesiophobia, self-efficacy, anxiety, depression, health-related quality of life, and patient-specific functioning, physical activity, and physical capacity. Data were collected on 6 occasions up to 6 months postoperatively. A linear mixed model was used to analyze the change scores of each outcome. Results No statistically significant between-group difference was found on the primary outcome (disability) over time (baseline to 6 months). Among secondary outcome measures, a statistically significant interaction effect (Group x Time) was seen for the European Quality of Life 5 Dimensions Questionnaire. The largest between-group difference on the European Quality of Life 5 Dimensions Questionnaire index was seen 1 week prior to surgery and favored the active intervention. The largest between-group effect sizes at the 6-month follow-up favored the active intervention, and were seen for physical activity intensity, steps per day, and the One Leg Stand Test. Both groups reached the minimal important change for the primary outcome and, in several secondary outcomes (pain intensity, back and leg; pain catastrophizing; anxiety; health-related quality of life [EQ5D VAS]), already at 8-week follow-up. Limitations The participants' preoperative level of disability was lower than normative values, which suggests selection bias. Conclusions Both interventions led to clinically important changes, but it is not clear what kind of prehabilitation program is the most effective.
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| 39. |
- Lotzke, Hanna, et al.
(författare)
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Developing an evidence-based prehabilitation programme designed to improve functional outcomes after lumbar fusion surgery-A feasibility study using the Medical Research Council framework
- 2020
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Ingår i: European Journal of Physiotherapy. - : Informa UK Limited. - 2167-9169 .- 2167-9177. ; 22:1, s. 51-61
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: A prehabilitation phase is suggested as the ideal way to prepare patients for optimal outcomes from surgery. Our aim was to describe the lessons we learned from developing PREPARE, an evidence-based prehabilitation programme based on a cognitive behavioural approach designed to improve functional outcomes after lumbar fusion surgery. Methods: We used the Medical Research Council (MRC) framework approach for developing and designing a complex intervention, specifically the two phases; 'Development' and 'Feasibility and Piloting'. Various aspects of treatment fidelity were evaluated during the phase 'Feasibility and Piloting'. As part of the feasibility element, a pilot Single Subject Research Design study was performed. Eleven patients awaiting lumbar fusion surgery participated in the study. We evaluated in particular the use and application of outcome measures. Results: Significant lessons were learned which we used to adjust the prehabilitation programme to better fit a surgical context. The original treatment manual was elaborated on, the outcome measures adjusted, and the content of the intervention altered. Finally, the PREPARE programme was published in the form of a study protocol. Conclusions: There are significant lessons to be learned from testing a study protocol before it is implemented in a large-scale randomised controlled trial (RCT).
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| 40. |
- Lotzke, Hanna, et al.
(författare)
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Patients with severe low back pain exhibit a low level of physical activity before lumbar fusion surgery: a cross-sectional study
- 2018
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: People with severe low back pain are at higher risk of poor health. Patients scheduled for lumbar fusion surgery are assumed to have low levels of physical activity, but few data exist. The aim of the study was firstly to investigate preoperative levels of objectively measured physical activity in patients with severe low back pain waiting for lumbar fusion surgery, and secondly to investigate whether factors in the fear-avoidance model were associated with these levels. METHODS: We included 118 patients waiting for lumbar fusion surgery (63 women and 55 men; mean age 46 years). Physical activity expressed as steps per day and total time spent in at least moderate-intensity physical activity was assessed with ActiGraph GT3X+ accelerometers. The data were compared to the WHO recommendations on physical activity for health. Whether factors in the fear-avoidance model were associated with physical activity was evaluated by two different multiple linear regression models. RESULTS: Ninety-six patients (83%) did not reach the WHO recommendations on physical activity for health, and 19 (16%) patients took fewer than 5000 steps per day, which indicates a sedentary lifestyle. On a group level, higher scores for fear of movement and disability were associated with lower numbers of steps per day. CONCLUSION: A high proportion of the patients did not reach the WHO recommendations on physical activity and are therefore at risk of poor health due to insufficient physical activity. We also found a negative association between both fear of movement and disability, and the number of steps per day. Action needs to be taken to motivate patients to be more physically active before surgery, to improve health postoperatively. There is a need for interventions aimed at increasing physical activity levels and reducing barriers to physical activity in the prehabilitation phase of this patient group. TRIAL REGISTRATION: Current Controlled Trials ISCRTN 17115599 , retrospectively Registered 18 may 2015.
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| 41. |
- Lotzke, Hanna, et al.
(författare)
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Use of the PREPARE (PREhabilitation, Physical Activity and exeRcisE) program to improve outcomes after lumbar fusion surgery for severe low back pain: A study protocol of a person-centred randomised controlled trial
- 2016
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Following lumbar fusion surgery, a successful outcome is empirically linked to effective rehabilitation. While rehabilitation is typically postoperative, the phase before surgery - termed prehabilitation - is reportedly an ideal time to prepare the patient. There are presently no guidelines for prehabilitation before lumbar fusion surgery. Physical activity has well-known health benefits, and staying physically active despite pain is a major principle in non-pharmacological chronic low back pain treatment. Psychological factors such as fear of movement, pain catastrophizing and low self-efficacy are known to be barriers to staying active. No studies have investigated prehabilitation protocols that promote physical activity and target psychological risk factors before lumbar fusion surgery. The aim of our proposed randomised controlled trial is to investigate whether patients who undergo lumbar fusion surgery for degenerative disc disease experience better functioning with a physiotherapeutic prehabilitation program (PREPARE) based on a cognitive behavioural approach compared to conventional care. Methods/Design: We will recruit 110 patients between 18-70 years of age with degenerative disc disease who are waiting for lumbar fusion surgery. These patients will be randomly assigned to receive either PREPARE or conventional care. PREPARE uses a person-centred perspective and focuses on promoting physical activity and targeting psychological risk factors before surgery. The primary outcome will be disability measured using the Oswestry Disability Index 2.0. Secondary outcomes will include functioning (patient-reported and performance-based), physical activity (accelerometer), health-related quality of life, back and leg pain intensity, pain catastrophizing, kinesiophobia, self-efficacy, depression, anxiety, satisfaction with treatment results and health economic factors. Data will be collected at baseline (preoperatively) after the intervention (preoperatively), 3 and 8 weeks, 3, 6, 12, 24 and 60 months postoperatively. Discussion: We hypothesise that the focus on promoting physical activity and targeting psychological risk factors before surgery will decrease disability and help the patients to be more active despite pain both before and after surgery. We will use a combination of outcome measures both patient-reported and performance-based, as well as accelerometer data. This will provide a more comprehensive picture of the patient's functioning than just patient-reported outcomes alone. Trial registration: Current Controlled Trials ISCRTN17115599, Retrospectively Registered 18 May 2015. © 2016 The Author(s).
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| 42. |
- Nijs, Jo, et al.
(författare)
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Nociceptive, neuropathic, or nociplastic low back pain? : The low back pain phenotyping (BACPAP) consortium's international and multidisciplinary consensus recommendations
- 2024
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Ingår i: The Lancet Rheumatology. - : Elsevier. - 2665-9913. ; 6:3, s. e178-e188
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Tidskriftsartikel (refereegranskat)abstract
- The potential to classify low back pain as being characterised by dominant nociceptive, neuropathic, or nociplastic mechanisms is a clinically relevant issue. Preliminary evidence suggests that these low back pain phenotypes might respond differently to treatments; however, more research must be done before making specific recommendations. Accordingly, the low back pain phenotyping (BACPAP) consortium was established as a group of 36 clinicians and researchers from 13 countries (five continents) and 29 institutions, to apply a modified Nominal Group Technique methodology to develop international and multidisciplinary consensus recommendations to provide guidance for identifying the dominant pain phenotype in patients with low back pain, and potentially adapt pain management strategies. The BACPAP consortium's recommendations are also intended to provide direction for future clinical research by building on the established clinical criteria for neuropathic and nociplastic pain. The BACPAP consortium's consensus recommendations are a necessary early step in the process to determine if personalised pain medicine based on pain phenotypes is feasible for low back pain management. Therefore, these recommendations are not ready to be implemented in clinical practice until additional evidence is generated that is specific to these low back pain phenotypes.
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| 43. |
- Remus, A., et al.
(författare)
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A core outcome set for research and clinical practice in women with pelvic girdle pain: PGP-COS
- 2021
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 16:2
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Tidskriftsartikel (refereegranskat)abstract
- Background Inconsistent reporting of outcomes in clinical trials of women with Pelvic Girdle Pain (PGP) hinders comparison of findings and the reliability of evidence synthesis. A core outcome set (COS) can address this issue as it defines a minimum set of outcomes that should be reported in all clinical trials on the condition. The aim of this study was to develop a consensus-based COS for evaluating the effectiveness of interventions in PGP during pregnancy and postpartum for use in research and clinical practice. Methods A systematic review of previous studies on PGP and semi-structured interviews with women were undertaken to identify all outcomes that were reported in prior studies and that are relevant to those experiencing the condition. Key stakeholders (clinicians, researchers, service providers/policy makers and individuals with PGP) then rated the importance of these outcomes for including in a preliminary PGP-COS using a 3-round Delphi study. The final COS was agreed at a face-to-face consensus meeting. Results Consensus was achieved on five outcomes for inclusion in the final PGP-COS. All outcomes are grouped under the "life impact" domain and include: pain frequency, pain intensity/severity, function/disability/activity limitation, health-related quality of life and fear avoidance. Conclusion This study identified a COS for evaluating the effectiveness of interventions in pregnancy-related and postpartum-related PGP in research and clinical settings. It is advocated that all trials, other non-randomised studies and clinicians in this area use this COS by reporting these outcomes as a minimum. This will ensure the reporting of meaningful outcomes and will enable the findings of future studies to be compared and combined. Future work will determine how to measure the outcomes of the PGP-COS. Core outcome set registration This PGP-COS was registered with COMET (Core Outcome Measures for Effectiveness Trials) in January 2017 (http://www.comet-initiative.org/studies/details/958).
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| 44. |
- Sjödahl, Jenny, 1979-, et al.
(författare)
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Predictors for disability in women with persistent postpartum pelvic girdle pain
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- The majority of studies on postpartum lumbopelvic pain have investigated predictors for women experiencing lumbopelvic pain during pregnancy. Since the majority of women recover within the first months of delivery it is unknown if the same predictors are valid for disability in women with persistent postpartum pelvic girdle pain (PGP). The aim of this study was to identify predictors for disability in women with persistent PGP 15 months postpartum. Factors were obtained by clinical tests and questionnaires 3 months postpartum. Outcome 15 months postpartum was disability measured with Oswestry Disability Index. A multiple linear regression analysis identified two significant two-way interaction effects that predicted for disability in women with persistent PGP at 15 months postpartum: a) age + trunk flexor endurance, b) disability + hip extensor strength.
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| 45. |
- Sjödahl, Jenny, et al.
(författare)
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Predictors for long-term disability in women with persistent postpartum pelvic girdle pain
- 2013
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Ingår i: European spine journal. - : Springer Verlag (Germany). - 0940-6719 .- 1432-0932. ; 22:7, s. 1665-1673
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThe majority of prognostic studies on postpartum lumbopelvic pain have investigated factors during pregnancy. Since the majority of women recover within the first few months of delivery, it is unknown if the same predictors are valid for long-term consequences. It is also important to investigate predictors within subgroups of patients with pregnancy-related lumbopelvic pain due to their different clinical courses. The aim of this study was to identify predictors for disability 15 months postpartum in women with persistent postpartum pelvic girdle pain (PGP).MethodsData were obtained by clinical tests and questionnaires 3 months postpartum. The outcome 15 months postpartum was disability measured with the Oswestry Disability Index.ResultsA multiple linear regression analysis identified two significant two-way interaction effects that were predictive of disability 15 months postpartum: (a) age + trunk flexor endurance, and (b) disability + hip extensor strength.ConclusionsAge, muscle function and disability seem to influence the long-term outcome on disability in women with persistent postpartum PGP. It may be important to consider the possibility of different variables impact on each other when predicting long-term disability. In addition, further studies are needed to investigate the impact of interaction effects on long-term consequences in women with persistent postpartum PGP.
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| 46. |
- Sjödahl, Jenny, 1979-
(författare)
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Pregnancy-related pelvic girdle pain and its relation to muscle function
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Pregnancy-related lumbopelvic pain affects approximately 50% of all pregnant women. For the majority the pain disappears during the first months after delivery; however, for a significant number of women, the pain is persistent, with little improvement for more than three months after delivery. Moreover, women who experience persistent lumbopelvic pain three months postpartum are at substantial risk for new episodes or for chronic lumbopelvic pain later in life. Hence, pregnancy-related lumbopelvic pain should be considered a major public health issue. In order to develop and offer specific treatment strategies, it is important to identify different subgroups of lumbopelvic pain based on different clinical presentations. Pelvic girdle pain (PGP) is one of the major subgroups of pain related to pregnancy. There is no consensus regarding the underlying mechanisms although instability in the pelvis has been proposed as one of the possible mechanism; thus, further studies are necessary to determine how to treat these women. The local lumbopelvic muscle system, including the pelvic floor muscles (PFM) is thought to contribute to the stabilization of the pelvis and they are also the target for many treatment strategies for lumbopelvic pain.The overall aim of this thesis was to improve rehabilitation for women with persistent postpartum PGP by investigating three areas, including: 1) the postural response of the PFM, 2) the effect of home-based specific stabilizing exercises (SSE) that target the local lumbopelvic muscle system and, 3) predictors for disability at 15 months postpartum.The thesis comprises three studies: A) a methodological study, B) an experimental study, and C) a clinical randomized controlled trial (RCT). The data is mainly based on muscle function, including recordings of electromyographic (EMG) activation, muscle endurance, and muscle strength. We also collected subjective ratings of disability, healthrelated quality of life, and pain.The methodological study showed that the designed protocol, which included limb movements performed at a comfortable speed in both standing and supine positions, was useful for detecting a postural response in the PFM. The experimental study demonstrated that women with persistent postpartum PGP and those free of pain exhibited a feed-forward mechanism in the PFM that responded in anticipation to leg lifts performed in a supine position. However, we cannot rule out the possibility that women with difficulties in transferring load between the trunk and legs (i.e., those with functional pelvic instability) might have a different postural response in the PFM. In the present study, one woman with persistent postpartum PGP failed to present a feed-forward mechanism in the PFM, in agreement with previous studies on other parameters of the PFM from other similar groups.The clinical RCT demonstrated that the concept of home-based SSE with visits every second week with the treating physiotherapist was not more effective than the clinical natural course for improving subjective ratings or muscle function in women with persistent postpartum PGP.A linear regression analysis revealed a complex picture that suggests that disability 15 months postpartum in women with persistent PGP could be partially predicted by two interaction effects comprising factors from different dimensions: biological, physical functioning, and self-rated function. The proposed association between muscle function and PGP was strengthen. New approaches are most likely needed to further identify subgroups of patients with persistent postpartum PGP that can be considered homogeneous for treatment.
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| 47. |
- Sjödahl, Jenny, et al.
(författare)
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Response of the muscles in the pelvic floor and the lower lateral abdominal wall during the Active Straight Leg Raise in women with and without pelvic girdle pain: An experimental study
- 2016
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Ingår i: Clinical Biomechanics. - : Elsevier BV. - 0268-0033 .- 1879-1271. ; 35, s. 49-55
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Tidskriftsartikel (refereegranskat)abstract
- Background The relationship between activation of the stabilizing muscles of the lumbopelvic region during the Active Straight Leg Raise test and pelvic girdle pain remains unknown. Therefore, the aim was to examine automatic contractions in relation to pre-activation in the muscles of the pelvic floor and the lower lateral abdominal wall during leg lifts, performed as the Active Straight Leg Raise test, in women with and without persistent postpartum pelvic girdle pain. Methods Sixteen women with pelvic girdle pain and eleven pain-free women performed contralateral and ipsilateral leg lifts, while surface electromyographic activity was recorded from the pelvic floor and unilaterally from the lower lateral abdominal wall. As participants performed leg lifts onset time was calculated as the time from increased muscle activity to leg lift initiation. Findings No significant differences were observed between the groups during the contralateral leg lift. During the subsequent ipsilateral leg lift, pre-activation in the pelvic floor muscles was observed in 36% of women with pelvic girdle pain and in 91% of pain-free women (P = 0.01). Compared to pain-free women, women with pelvic girdle pain also showed significantly later onset time in both the pelvic floor muscles (P = 0.01) and the muscles of the lower lateral abdominal wall (P < 0.01). Interpretation We suggest that disturbed motor activation patterns influence women's ability to stabilize the pelvis during leg lifts. This could be linked to provocation of pain during repeated movements. © 2016 Elsevier Ltd. All rights reserved.
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| 48. |
- Sjödahl, Jenny, et al.
(författare)
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The postural response of the pelvic floor muscles during limb movements : A methodological electromyography study in parous women without lumbopelvic pain
- 2009
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Ingår i: CLINICAL BIOMECHANICS. - : Elsevier BV. - 0268-0033. ; 24:2, s. 183-189
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pregnancy-related lumbopelvic pain is common. More than 30% of women have persistent pain 3 months after giving birth. There is no consensus regarding the pathology. However, coordination of muscle activity by appropriate timing and amplitude is necessary for maintaining adequate stability in the lumbopelvic area. The aim was to develop a method using surface electromyography to detect a feed-forward response in the pelvic floor muscles during limb movements performed at a comfortable speed applicable in future studies for women with lumbopelvic pain. Methods: Ten parous women with no lumbopelvic pain in the past 12 months were included. Surface electromyographic activity was recorded from the pelvic floor muscles and unilaterally from transversus abdominis/internal oblique, rectus abdominis, erector spinae, hip adductors, rectus femoris and deltoid. The subjects performed leg lift in supine and arm lift from standing. The electromyographic onset was related to the initiation of the movement. Findings: In the majority of the women the electromyographic onsets of the pelvic floor muscles occurred before the movement was initiated, regardless of whether it was a leg or an arm lift. In addition. electromyographic onsets for the other muscles, except the rectus abdominis during the arm lift, also occurred prior to the movements. Interpretation: The findings suggest a feed-forward response in the pelvic floor muscles during leg and arm lifts in women who had previously given birth and were without lumbopelvic pain. Movements performed at a comfortable speed seem to be useful in order to detect such a response.
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| 49. |
- Sjödahl, Jenny, 1979-, et al.
(författare)
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The Postural response of the pelvic floor muscles during the active straight leg raise test in women with and without persistent postpartum pelvic girdle pain : an experimental study
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- The hypothesis was that women with pelvic girdle pain (PGP) would lack a feedforward mechanism in the pelvic floor muscles (PFM) in relation to a functional instability problem. Eight women with PGP and 10 pain-free women were included. A clinical examination was performed to verify that participants with PGP fulfilled the diagnostic criteria used in this study. Surface electromyographic activity was recorded from the PFM and unilaterally from abdominal muscles and the rectus femoris muscle. Participants performed leg lifts (performed as Active Straight Leg Raise (ASLR) tests), first with one leg and then with the other. The lift was also performed with an extra weight strapped on one leg. Median onset of PFM activity occurred before the initiation of the lifts in both groups. One woman experienced more severe PGP/dysfunction demonstrated by a higher score on the ASLR test during the clinical examination. This woman presented onset of PFM activity after the initiation of the lifts. The findings suggest that a feed-forward response of the PFM is present during leg lifts in women with and without postpartum PGP. However, one can speculate that a lack of feed-forward in the PFM may be associated with a load transfer problem.
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