| 1. |
- Bornhöft, Lena, et al.
(författare)
-
Health effects of direct triaging to physiotherapists in primary care for patients with musculoskeletal disorders: a pragmatic randomized controlled trial
- 2019
-
Ingår i: Therapeutic Advances in Musculoskeletal Disease. - : SAGE Publications. - 1759-720X .- 1759-7218. ; 11
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Physiotherapists and general practitioners (GPs) both act as primary assessors for patients with musculoskeletal disorders in primary care. Previous studies have shown that initial triaging to physiotherapists at primary healthcare centres has advantages regarding efficiency in the work environment and utilization of healthcare. In this study, we aimed primarily to determine whether triaging to physiotherapists affects the progression of health aspects over time differently than traditional management with initial GP assessment. The secondary aim was to determine whether triaging to physiotherapists affects patients' attitudes of responsibility for musculoskeletal disorders. Methods: This was a pragmatic trial where both recruitment and treatment strategies were determined by clinical, not study-related parameters, and was initiated at three primary care centres in Sweden. Working-age patients of both sexes seeking primary care for musculoskeletal disorders and nurse assessed as suitable for triaging to physiotherapists were randomized to initial consultations with either physiotherapists or GPs. They received self-assessment questionnaires before the initial consultation and were followed up at 2, 12, 26 and 52 weeks with the same questionnaires. Outcome measures were current and mean (3 months) pain intensities, functional disability, risk for developing chronic musculoskeletal pain, health-related quality of life and attitudes of responsibility for musculoskeletal conditions. Trends over time were analysed with a regression model for repeated measurements. Results: The physiotherapist-triaged group showed significant improvement for health-related quality of life at 26 weeks and showed consistent but nonsignificant tendencies to greater reductions of current pain, mean pain in the latest 3 months, functional disability and risk for developing chronic pain compared with traditional management. The triage model did not consistently affect patients' attitudes of responsibility for musculoskeletal disorders. Conclusions: Triaging to physiotherapists for primary assessment in primary care leads to at least as positive health effects as primary assessment by GPs and can be recommended as an alternative management pathway for patients with musculoskeletal disorders. ClinicalTrials.gov identifier: NCT148611.
|
|
| 2. |
- Bornhöft, Lena, et al.
(författare)
-
More cost-effective management of patients with musculoskeletal disorders in primary care after direct triaging to physiotherapists for initial assessment compared to initial general practitioner assessment.
- 2019
-
Ingår i: BMC musculoskeletal disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 20:1
-
Tidskriftsartikel (refereegranskat)abstract
- A model for triaging patients in primary care to provide immediate contact with the most appropriate profession to treat the condition in question has been developed and implemented in parts of Sweden. Direct triaging of patients with musculoskeletal disorders (MSD) to physiotherapists at primary healthcare centres has been proposed as an alternative to initial assessment by general practitioners (GPs) and has been shown to have many positive effects. The aim of this study was to evaluate the cost-effectiveness from the societal perspective of this new care-pathway through primary care regarding triaging patients with MSD to initial assessment by physiotherapists compared to standard practice with initial GP assessment.Nurse-assessed patients with MSD (N=55) were randomised to initial assessment and treatment with either physiotherapists or GPs and were followed for 1year regarding health-related quality of life, utilization of healthcare resources and absence from work for MSD. Quality-adjusted life-years (QALYs) were calculated based on EQ5D measured at 5 time-points. Costs for healthcare resources and production loss were compiled. Incremental cost-effectiveness ratios (ICERS) were calculated. Multiple imputation was used to compensate for missing values and bootstrapping to handle uncertainty. A cost-effectiveness plane and a cost-effectiveness acceptability curve were construed to describe the results.The group who were allocated to initial assessment by physiotherapists had slightly larger gains in QALYs at lower total costs. At a willingness-to-pay threshold of 20,000 €, the likelihood that the intervention was cost-effective from a societal perspective including production loss due to MSD was 85% increasing to 93% at higher thresholds. When only healthcare costs were considered, triaging to physiotherapists was still less costly in relation to health improvements than standard praxis.From the societal perspective, this small study indicated that triaging directly to physiotherapists in primary care has a high likelihood of being cost-effective. However, further larger randomised trials will be necessary to corroborate these findings.ClinicalTrials.gov NCT02218749 . Registered August 18, 2014.
|
|
| 3. |
- Nordeman, Lena Margareta, et al.
(författare)
-
Predictors for future activity limitation in women with chronic low back pain consulting primary care: a 2-year prospective longitudinal cohort study.
- 2017
-
Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 7:6
-
Tidskriftsartikel (refereegranskat)abstract
- To assess if body function, activity, participation, health-related quality of life and lifestyle behavioural factors can predict activity limitation in women with chronic low back pain (CLBP) in primary healthcare (PHC) 2years later.A 2-year prospective longitudinal cohort study within PHC.PHC in southwestern Sweden.The cohort comprised 130 women with CLBP attending PHC at baseline 2004-2005 and were reassessed after 2years.The dependent outcome variable was self-reported activity limitation (Roland Morris disability questionnaire (RMDQ)) at 2-year follow-up. Independent predictors at baseline were age, body mass index, smoking, alcohol consumption, sleep quantity and quality, leisure time physical activity, a questionnaire of clinical manifestation of stress (Stress and Crises Inventory (SCI-93)), pain localisation, pain intensity, fatigue, anxiety, depression, RMDQ, work status, private social support, health-related quality of life and measures of physical performance specified as 6min walk test (6MWT) and hand grip strength. Relation between baseline predictors and variation in later self-reported activity limitation (RMDQ) was analysed using multivariate linear regression.Ninety-five per cent (n=123/130) were followed up after 2years. The participants were middle-aged (mean 45 (SD 10) years), mostly educated >9 years (88%; 108/123), mainly living with another adult (76%; 93/122) and born in Sweden (90%; 111/123). Seventy-nine per cent (97/123) were categorised as having work ability at baseline. The final prognostic model including 6MWT, SCI-93 and RMDQ at baseline explained 54% of the variance in self-reported activity limitation (RMDQ) at the 2-year follow-up.Lower physical performance, more severe clinical stress symptoms and more severe activity limitation predicted activity limitation after 2years in women with CLBP within PHC. The results can give guidance for interventional trials aiming to improve physical capacity and decrease stress. The impact of the interaction between prognostic factors and interventions on activity limitation needs further investigation.
|
|
| 4. |
- Rindner, Lena, 1959, et al.
(författare)
-
Prevalence of somatic and urogenital symptoms as well as psychological health in women aged 45 to 55 attending primary health care: a cross-sectional study.
- 2017
-
Ingår i: BMC women's health. - : Springer Science and Business Media LLC. - 1472-6874. ; 17:1
-
Tidskriftsartikel (refereegranskat)abstract
- Women's physical and mental ill-health such as stress-related symptoms, depression, pain, hypertension and urogenital health shows a marked increase around the ages 45-55years. These women are an important group for Primary Health Care (PHC) due to their prevalent symptoms and illnesses. The aim of this study was to estimate the prevalence of somatic, psychological and urogenital symptoms in women aged 45-55 attending PHC and evaluate factors associated with severe symptoms.One hundred and thirty-one women were recruited from PHC in southwestern Sweden. Data were obtained from two self-reported questionnaires, the Menopause Rating Scale (MRS) and the Montgomery-Asberg Depression Rating Scale (MADRS).Exhaustion, depressive mood, muscle and joint problems, sleep and sexual problems were the most prevalent reported symptoms. Half of the women reported heart discomfort. Depression and increasing age were correlated to more severe symptoms.We recommend that cardiovascular risk factors, musculoskeletal symptoms, sexual problems, sleeping problems and mental health should be actively asked for when women aged 45 to 55 attend PHC. We propose that preventive counselling of women in PHC before the age 45 should be evaluated in future studies.
|
|
| 5. |
- Rindner, Lena, 1959, et al.
(författare)
-
Reducing menopausal symptoms for women during the menopause transition using group education in a primary health care setting a randomized controlled trial
- 2017
-
Ingår i: Maturitas. - : Elsevier BV. - 0378-5122. ; 98, s. 14-19
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: Women's physical and mental ill-health shows a marked increase during menopause, which usually occurs between 45 and 55 years of age. Mental illness and somatic symptoms are common causes of long-term sick leave. Women suffer from a lack of knowledge about the menopause transition and its associated symptoms. The aim of the study was to investigate whether group education for women in primary health care (PHC) about the menopause transition can improve their physical and mental ill-health. Study design: This randomized controlled study was conducted in PHC and aimed to evaluate a group education programme for women aged 45-55 years, around the menopause transition. A total of 131 women were randomized to group education or no intervention. The group intervention included two education sessions with topics related to menopause. They answered two questionnaires at baseline and at four-month follow-up: the Menopause Rating Scale (MRS) and the Montgomery-Asberg Depression Rating Scale (MADRS). Main outcome measure: Change in MRS and MADRS scores over the four months. Results: The intervention group experienced a slight reduction in symptoms while the control group mostly experienced the opposite. Conclusion: This study showed that it was feasible to implement group education on menopause for women aged 45-55 years. The clinical trial registration number: NTCO2852811 (C) 2017 Elsevier B.V. All rights reserved.
|
|
| 6. |
- Bergenheim, Anna, et al.
(författare)
-
Stress levels predict substantial improvement in pain intensity after 10 to 12years in women with fibromyalgia and chronic widespread pain: a cohort study.
- 2019
-
Ingår i: BMC rheumatology. - : Springer Science and Business Media LLC. - 2520-1026. ; 3
-
Tidskriftsartikel (refereegranskat)abstract
- Previous studies of prognosis for women with Fibromyalgia (FM) or chronic widespread pain (CWP) show contradictory results. However, some women appear to improve in pain and other core symptoms over time. There is limited knowledge about predictors of substantial improvement in pain intensity over a longer period of time. The primary objective of this study was to investigate the natural course of pain intensity and distribution of pain over 10 to 12years in a cohort of 166 women with FM or CWP. Secondarily we wanted to investigate predictors of substantial improvement (≥50%) in pain intensity after 10 to 12years.The study is a longitudinal prospective cohort study. 166 women with FM or CWP were followed up after 10 to 12years. 126 women (76%) participated in the follow-up and completed a battery of questionnaires concerning pain intensity, pain distribution and other physical and mental aspects of health. Differences in symptoms within the cohort over 10 to 12years and predictors of substantial improvement (≥50%) in pain intensity were calculated.Pain had improved at the 10 to 12year follow-up (p<0.001) with a mean change of -9.2mm (SD 23.3, 95% CI: -13.3; -5.0) for pain intensity and-2.0 sites (SD 4.2, 95% CI: -2.7; -1.2) for pain distribution. Nine percent of the 126 women showed an individual moderate improvement in pain intensity while 16% showed a substantial improvement at the follow-up as compared to baseline. Lower symptoms of stress and higher pain intensity at baseline predicted higher probability of reporting at least 50% less pain intensity after 10 to 12years as compared to baseline.A majority of women with FM and CWP appear to have a positive course of pain over time, which should be communicated to these patients in health care. Reducing stress levels might contribute to better chances of improvement over time.Clinicaltrials.gov NCT02872129, registered 06/30/2016.
|
|
| 7. |
- Gustafsson, T., et al.
(författare)
-
The nurses challenge of caring for patients with chronic obstructive pulmonary disease in primary health care
- 2018
-
Ingår i: Nursing Open. - : Wiley. - 2054-1058. ; 5:3, s. 292-299
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim was to describe asthma and chronic obstructive pulmonary disease nurses' experiences of caring for patients with chronic obstructive pulmonary disease in primary health care. Methods: Ten asthma and chronic obstructive pulmonary disease specialized nurses were interviewed. Systematic Text Condensation by Malterud was used to analyse the data. Results: Two main categories were found: the patient-nurse relationship and available resources. Several challenges emerged when connecting with patients and the nurses found it difficult to individualize care. They struggled with a lack of time and support from other professionals. Being responsible for asthma and chronic obstructive pulmonary disease practice was experienced as positive, but could become overwhelming. The asthma and chronic obstructive pulmonary disease nurses described several challenges and the need for support and resources to provide the best possible care for patients with chronic obstructive pulmonary disease.
|
|
| 8. |
- Ho, Chan-Mei, et al.
(författare)
-
Physiotherapist as primary assessor for patients with suspected knee osteoarthritis in primary care-a randomised controlled pragmatic study
- 2019
-
Ingår i: Bmc Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 20
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundIn Swedish primary care, the healthcare process for patients with knee osteoarthritis (KOA) can be initiated by a physician or physiotherapist assessment. However, it is unclear how the different assessments affect the healthcare processes and patient reported outcomes over time. The purpose of this study was to examine the differences in health-related quality of life (HrQoL), adjusted for pain and physical function, for patients with KOA when the healthcare process is initiated by a physiotherapist assessment compared to a physician assessment in primary care.MethodsAn assessor-blinded randomised controlled pragmatic trial. Using a computer-generated list of random numbers, patients seeking primary care during 2013-2017 with suspected KOA were randomised to either a physiotherapist or physician for primary assessment and treatment. Data was collected before randomisation and at 3, 6, and 12-month follow-ups. Primary outcome was HrQoL using EuroQol 5 dimensions 3 levels questionnaire, index (EQ-5D-3L index) and a visual analogue scale (VAS) (EQ-5D-3L VAS); pain intensity was measured with VAS (0-100) and physical function measured with the 30-s chair stand test. Mixed effect model analyses compared repeated measures of HrQoL between groups. The significance level was p<0.05 and data was applied with intention-to-treat.ResultsPatients were randomised to either a physiotherapist (n=35) or physician (n=34) for primary assessment. All 69 patients were included in the analyses. There were no significant differences in HrQoL for patients assessed by a physiotherapist or a physician as primary assessor (EQ-5D-3L index, p=0.18; EQ-5D-3L VAS, p=0.49). We found that HrQoL changed significantly 12months after baseline assessment for all patients regardless of assessor (EQ-5D-3L index, p<0.001; EQ-5D-3L VAS, p=0.0049). No adverse events or side effects were reported.ConclusionsThere were no differences in HrQoL, when adjusted for pain and physical function, for patients with KOA when the healthcare process was initiated with physiotherapist assessment compared to physician assessment in primary care. Both assessments resulted in significantly higher HrQoL at the 12-month follow-up. The results imply that physiotherapists and physicians in primary care are equally qualified as primary assessors.Trial registrationRetrospectively registered at http://clinicaltrial.gov, ID: NCT03715764.
|
|
| 9. |
|
|
| 10. |
- Larsson, Robin, et al.
(författare)
-
Effects of eccentric exercise in patients with subacromial impingement syndrome: a systematic review and meta-analysis
- 2019
-
Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 20:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Subacromial impingement syndrome is a common problem in primary healthcare. It often include tendinopathy. While exercise therapy is effective for this condition, it is not clear which type of exercise is the most effective. Eccentric exercises has proven effective for treating similar tendinopathies in the lower extremities. The aim of this systematic review was therefore to investigate the effects of eccentric exercise on pain and function in patients with subacromial impingement syndrome compared with other exercise regimens or interventions. A secondary aim was to describe the included components of the various eccentric exercise regimens that have been studied. Methods: Systematic searches of PubMed, Cochrane Library and PEDro by two independent authors. Included studies were assessed using the PEDro scale for quality and the Cochrane scale for clinical relevance by two independent authors. Data were combined in meta-analyses. GRADE was applied to assess the certainty of evidence. Results: Sixty-eight records were identified. Seven studies (eight articles) were included, six were meta-analysed (n = 281). Included studies were of moderate quality (median PEDro score 7, range 5-8). Post-treatment pain was significantly lower after eccentric exercise compared with other exercise: MD -12.3 (95% CI - 17.8 to - 6.8, I-2 = 7%, p < 0.001), but this difference was not clinically important. Eccentric exercise provided no significant post-treatment improvement in function compared with other exercise: SMD -0.10 (95% CI - 0.79 to 0.58, I-2 = 85%, p = 0.76). Painful eccentric exercise showed no significant difference compared to pain-free eccentric exercise. Eccentric training regimes showed both similarities and diversity. Intervention duration of 6-8 weeks was almost as effective as 12 weeks. Conclusions: Evidence of low certainty suggests that eccentric exercise may provide a small but likely not clinically important reduction in pain compared with other types of exercise in patients with subacromial impingement syndrome. It is uncertain whether eccentric exercise improves function more than other types of exercise (very low certainty of evidence). Methodological limitations of existing studies make these findings susceptible to change in the future.
|
|
| 11. |
- Lindstrom, J., et al.
(författare)
-
What a difference a CRP makes. A prospective observational study on how point-of-care C-reactive protein testing influences antibiotic prescription for respiratory tract infections in Swedish primary health care
- 2015
-
Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 33:4, s. 275-282
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore how C-reactive protein (CRP) tests serve to support physicians in decisions concerning antibiotic prescription to patients with respiratory tract infections (RTI). Design. Prospective observational study. Setting: Primary health care centres in western Sweden. Subjects. Physicians in primary health care. Patients with acute RTI. Main outcome measures: Physician willingness to measure CRP, their ability to estimate CRP, and changes in decision-making concerning antibiotic treatment based on error estimate and the physician's opinion of whether CRP measurement was crucial. Results: Data from 340 consultations were gathered. CRP testing was found to be crucial in 130 cases. In 86% of visits decisions regarding antibiotic prescription were unchanged. Physicians considering CRP crucial and physicians making an error estimate of CRP altered their decisions concerning antibiotic prescription after CRP testing more often than those who considered CRP unnecessary, and those making a more accurate estimate. Physicians changed their decision on antibiotic prescription in 49 cases. In the majority of these 49 cases physicians underestimated CRP levels, and the majority of changes were from no to yes as to whether to prescribe antibiotics. Conclusion: CRP is an important factor in the decision on whether to prescribe antibiotics for RTIs. Error estimates of CRP and willingness to measure CRP are important factors leading to physicians changing decisions on antibiotic treatment.
|
|
| 12. |
- Marczak, J., et al.
(författare)
-
Patient experiences of living with chronic leg ulcers and making the decision to seek professional health-care
- 2019
-
Ingår i: Journal of Wound Care. - 0969-0700. ; 28:1
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of the study was to elucidate how patients experience living with chronic leg ulcers before consulting a health professional, and to determine the reasons behind the decision to visit a health-care centre. Method: A qualitative interview study was carried out. There were 11 participants, five men and six women (age range: 27-83 years old). All participants in the study were patients visiting the public primary medical centre in western Sweden for the first time for a chronic leg ulcer. The data was obtained by recorded interviews. Systematic text condensation (STC) by Malterud was applied to the analysis. Results: The analysis identified five main categories of the issues relating to ulcers to their ulcers: convictions, pain, emotions,strategies, and health-care treatment. At first, patients accepted the inconvenience of a leg ulcer. Gradually, they focused more on strategies dealing with the ulcer, and withdrew from their social context, while their fears increased. Many needed support in the decision to seek professional care. Conclusion: Despite pain, anxiety, emotional lability, and disappointment, they had strategies to cope with ulcers on their own. A social network seems crucial for the decision to seek professional health care and greater knowledge of leg ulcers, particularly in the elderly population, is needed.
|
|
| 13. |
- Sundvall, Pär-Daniel, et al.
(författare)
-
Diagnostic methods for acute otitis media in 1 to 12 year old children: A cross sectional study in primary health care
- 2019
-
Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 20
-
Tidskriftsartikel (refereegranskat)abstract
- © 2019 The Author(s). Background: Otoscopy alone has low sensitivity and specificity for acute otitis media (AOM). Otomicroscopy and pneumatic methods are superior to otoscopy. However, these methods require clinical skills. The use of different diagnostic methods for AOM differs between countries and has not been evaluated in Sweden since new guidelines were introduced in 2010. This study aimed to describe the extent of which diagnostic methods and written advice were used for AOM in children 1 to 12 years old. Methods: In this cross-sectional study all general practitioners (GPs) and specialist trainees in primary care (STs) at 27 primary health care centres in Sweden were asked to complete a self-administrated questionnaire including diagnostic approach and the management of AOM; 75% (111/148) responded to the questionnaire. Outcome Measures: GPs versus STs and their gender, the use of otoscopy, pneumatic otoscopy, otomicroscopy, tympanometry and written advice. Logistic regressions were used to evaluate the association between GPs versus STs and their gender and the use of diagnostic methods and written advice. Results: To diagnose AOM, 98% of the GPs and STs often or always used otoscopy, in addition to this 17% often or always used otomicroscopy, 18% pneumatic otoscopy and 11% tympanometry. Written advice to parents was provided often or always by 19% of the GPs and STs. The GPs used otomicroscopy more often than STs, adjusted OR 4.9 (95% CI 1.5-17; p = 0.011). For the other diagnostic methods, no differences were found. Female GPs and STs provided written advice more often than male GPs and STs, OR 5.2 (95% CI, 1.6-17; p = 0.0061), adjusted for GP versus ST. Conclusions: Otoscopy was by far the most commonly used method for the diagnosis of AOM. Female GPs and STs provided written advice more frequently than did their male colleagues. GPs used the significantly better method otomicroscopy more often than STs, therefore, it is important to emphasise teaching of practical skills in otomicroscopy in the specialist training programme for general practice. A correct diagnosis is important for avoiding potentially harmful antibiotic treatments, antimicrobial resistance and possible delay of other diagnoses.
|
|
| 14. |
- Tenenbaum, Artur, 1957, et al.
(författare)
-
A risk stratification tool for prehospital triage of patients exposed to a whiplash trauma
- 2019
-
Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 14:5
-
Tidskriftsartikel (refereegranskat)abstract
- Objective Our aim was to develop a risk stratification model to predict the presence of a potentially more sinister injury in patients exposed to a whiplash trauma. The study base comprised of 3,115 residents who first sought healthcare contact within one week after being exposed to a whiplash trauma between 1999-2008, from within a defined geographical area, Skaraborg County in south-western Sweden. Information about gender, age, time elapsed prior to seeking care, type of health care contact, and hospitalisation was retrieved. Seventeen potential risk factors were identified and evaluated using multivariable logistic regression. Of 3,115 patients, 215 (6.9%) required hospital admission so theoretically 93% could have been initially assessed by primary health care. However, only 46% had their first contact in primary health care. All patients had symptoms resulting in a diagnosis of whiplash injury. Four risk factors were found to be associated with hospital admission: commotio cerebri (OR 31, 19-51), fracture/ luxation (OR 11, 5.1-22), serious injury (OR 41, 8.0-210), and the patient sought care during the same day as the trauma (OR 5.9, 3.7-9.5). These four risk factors explained 27% of the variation for hospital admission and the area under curve (AUC) was 0.77 (0.74-0.80). Ninety-six percent of patients (2,985) had only a whiplash injury with no other injury. These could be split into those attending health care the same day as the trauma, 1,737 (56%) with a 7.1% risk for hospital admission, and those attending health care later, 1,248 (40%) with a 1.3% risk for hospital admission. Patients with no signs of commotio cerebri, no fracture/luxation injury, no serious injury, comprising 96% of all patients exposed to a whiplash trauma can initially be referred to primary health care for initial assessment. However, those contacting the health care the same day as the trauma should be referred to a hospital for evaluation if they can't get an appointment with a general practitioner the same day.
|
|
| 15. |
- Tenenbaum, Artur, 1957, et al.
(författare)
-
Gender differences in care-seeking behavior and healthcare consumption immediately after whiplash trauma.
- 2017
-
Ingår i: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 12:4
-
Tidskriftsartikel (refereegranskat)abstract
- The aim was to study gender differences in care-seeking behavior and treatment provided immediately after whiplash trauma.Participants were residents from a defined geographical area, Skaraborg County in the southwestern part of Sweden. A cohort of 3,368 persons exposed to whiplash trauma and attending a healthcare facility immediately after the trauma between 1999 and 2008 were identified in a database. Information about gender, age, time elapsed prior to seeking care, type of healthcare contact, initial treatment provided and eventual hospitalization time was retrieved.Women sought care later than men (p = 0.00074). Women consulted primary healthcare first more often than men, who more often first sought hospital care (p = 0.0060). There were no gender differences regarding the type of treatment after trauma. Women had longer hospital admission than men (p = 0.022), indicating their injuries were at least similar to or worse than men's.Women sought healthcare later than men after whiplash trauma. Although not directly investigated in this study, it raises the question if this may reduce their probability of getting financial compensation compared to men.
|
|
| 16. |
- Thorneby, A., et al.
(författare)
-
No association between level of vitamin D and chronic low back pain in Swedish primary care: a cross-sectional case-control study
- 2016
-
Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 34:2, s. 196-204
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: Assessment of vitamin D levels and deficiency status in individuals with chronic low back pain (CLBP) in a Swedish general population, compared with controls matched for sex and age.Design: Cross-sectional case-control study.Setting: Primary care, southern Sweden.Subjects: Participants (n=44) with self-reported low back pain for at least 3 months and individually sex- and age-matched controls without a chronic pain condition (n=44), recruited from the general population by random letter of invitation.Main outcome measure: Association between vitamin D level and CLBP when adjusting for possible confounders in a multivariate forward conditional logistic regression model.Results: Mean S-25-hydroxyvitamin D levels were 81 and 80nmol/L in the CLBP and control group, respectively. The prevalence of vitamin D deficiency was low and similar in the CLBP group and the control group. Vitamin D level was not associated with CLBP when potential confounders were taken into account.Conclusions: No difference in vitamin D levels between participants with CLBP and matched controls could be demonstrated in the present sample. Assessment of vitamin D level and deficiency status may be of questionable value in the management of CLBP in primary care settings at similar latitudes, unless there are additional risk factors for deficiency or specific indicators of osteomalacia. Key pointsVitamin D deficiency is common and reported in many chronic pain conditions, including chronic low back pain (CLBP), but evidence for an association and causality is insufficient.center dot The present study found no association between vitamin D levels and CLBP in a case-control sample of 44+44 individuals from the Swedish general population.center dot Prevalence of vitamin D deficiency was low and comparable in individuals with CLBP and controls without chronic pain, matched for sex and age.center dot Assessment of vitamin D status, for the purpose of finding and treating an underlying cause of pain, may be of limited value in the management of CLBP in primary care settings at similar latitudes.
|
|
