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1.	Borg, Kristian, et al. (författare) Behovet av rehabilitering måste mötas efter svår covid-19 2020 Ingår i: Läkartidningen. - : Xiaolei Hu. - 0023-7205 .- 1652-7518. ; :19-20 Tidskriftsartikel (refereegranskat)
2.	Gerdle, Björn, et al. (författare) Influences of Sex, Education, and Country of Birth on Clinical Presentations and Overall Outcomes of Interdisciplinary Pain Rehabilitation in Chronic Pain Patients : A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP) 2020 Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 9:8 Tidskriftsartikel (refereegranskat)abstract This study investigates the effects of sex, education, and country of birth on clinical presentations and outcomes of interdisciplinary multimodal pain rehabilitation programs (IMMRPs). A multivariate improvement score (MIS) and two retrospective estimations of changes in pain and ability to handle life situations were used as the three overall outcomes of IMMRPs. The study population consisted of chronic pain patients within specialist care in the Swedish Quality Registry for Pain Rehabilitation (SQRP) between 2008 and 2016 at baseline (n = 39,916), and for the subset participating in IMMRPs (n = 14,666). A cluster analysis based on sex, education, and country of origin revealed significant differences in the following aspects: best baseline clinical situation was for European women with university educations and the worst baseline clinical situation was for all patients born outside Europe of both sexes and different educations (i.e., moderate-large effect sizes). In addition, European women with university educations also had the most favorable overall outcomes in response to IMMRPs (small effect sizes). These results raise important questions concerning fairness and equality and need to be considered when optimizing assessments and content and delivery of IMMRPs for patients with chronic pain.
3.	Lindgren, Marie, et al. (författare) Rehabilitering vid traumatisk hjärnskada behöver samordnas 2021 Ingår i: Läkartidningen. - : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 118:36-37 Tidskriftsartikel (refereegranskat)
4.	Lindgren, Marie, 1974-, et al. (författare) Rehabilitering vid traumatisk hjärnskada behöver samordnas : Stora skillnader i Tillgång till hjärnskaderehabilitering ochspecialistkunskap i alla faser i förloppet och över landet 2021 Ingår i: Läkartidningen. - : Sveriges Läkarförbund. - 0023-7205 .- 1652-7518. ; 118 Forskningsöversikt (refereegranskat)abstract Traumatisk hjärnskada är vanligt förekommande i alla åldrar och kan leda till behov av rehabiliteringsinsatser under många år.Kunskap och samarbete mellan flera specialiteter och samordning av insatser är viktiga för patienten genom hela vårdkedjan.Det finns ett behov av mer jämlik vård och stöd i att hantera hjärnskaderelaterade frågor genom hela livet.Vid specialiserad hjärnskaderehabilitering bedöms och behandlas komplexa förlopp med symtom som långvarig svår medvetandestörning, posttraumatisk agitation, kognitiva funktionsnedsättningar, fatigue, motoriska och kommunikativa svårigheter, synsvårigheter, yrsel och stimuluskänslighet efter traumatisk hjärnskada.
5.	Rivano Fischer, Marcelo, et al. (författare) Do quality of life, anxiety, depression and acceptance improve after interdisciplinary pain rehabilitation? A multicentre matched control study of acceptance and commitment therapy-based versus cognitive–behavioural therapy-based programmes 2021 Ingår i: Journal of International Medical Research. - : SAGE Publications. - 0300-0605 .- 1473-2300. ; 49:7 Tidskriftsartikel (refereegranskat)abstract Objective: Interdisciplinary pain rehabilitation (IPR) usually employs a cognitive–behavioural therapeutic (CBT) approach. However, there is growing support for chronic pain treatments based on acceptance and commitment therapy (ACT). Most studies of ACT and CBT for chronic pain have evaluated their effects after psychological interventions, not after IPR. We compared the results of an ACT-based IPR programme with two CBT-based IPR programmes. Methods: We used a retrospective multicentre pretest–posttest design with matched patient groups at three centres. Data were collected from the Swedish Quality Registry for Pain Rehabilitation before and after IPR participation. Participants completed the EQ-5D health-related quality of life questionnaire, the Chronic Pain Acceptance Questionnaire, (CPAQ) and the Hospital Anxiety and Depression Scale (HADS). Analyses were performed to compare the effects of the different interventions. Results: Neither EQ-5D nor HADS depression scores were affected by the psychological approach used. The score changes on both CPAQ subscales (activity engagement and pain willingness) indicated significant improvements between admission and discharge at all centres. Conclusions: These findings indicate the effectiveness of using psychological approaches to manage chronic pain. Both CBT and ACT had a beneficial effect on most of the assessed health-related parameters.
6.	Rivano Fischer, Marcelo, et al. (författare) Variability in patient characteristics and service provision of interdisciplinary pain rehabilitation : a study using the Swedish national quality registry for pain rehabilitation 2020 Ingår i: Journal of Rehabilitation Medicine. - : Foundation for Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 52:11 Tidskriftsartikel (refereegranskat)abstract Objective: To describe the organization, content and dosage of interdisciplinary pain rehabilitation, and the differences in degree of severity of problems of patients admitted to clinical units reporting to a Swedish national quality pain registry, grouped according to unit size and possible affiliation with a university hospital.Methods: Reports from 31 out of 39 clinical units in Sweden, on inclusion processes, organization, content and dosage of interdisciplinary pain rehabilitation, and patient-reported data from a Swedish national quality pain registry at assessment for interdisciplinary pain rehabilitation were analysed.Results: the number of patients treated annually at each unit ranged from 3 to 340. In 17 units, teams comprised 5 professionals. Dosage of interdisciplinary pain rehabilitation ranged from 20-180 h per patient in total. Patients at the university-hospital units scored the highest levels of symptoms and lowest levels of health related quality of life. Units used similar sets of inclusion criteria, and several treatments, such as education, self-training and psychological interventions, were used by most units.Conclusion: When interpreting outcome data from registries, aspects other than rehabilitation out-comes must be considered. The interpretation of outcomes from quality registries would be facilitated if data, in addition to assessments and patient reported outcomes, also includes standardized descriptions of the reporting clinical units.
7.	Stenberg, Maud, et al. (författare) Family experiences up to seven years after a severe traumatic brain injury-family interviews 2022 Ingår i: Disability and Rehabilitation. - : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 44:4, s. 608-616 Tidskriftsartikel (refereegranskat)abstract Purpose: To explore the experiences of being a family with one member suffering from severe traumatic brain injury (STBI) up to 7 years earlier through narrative family interviews.Methods: There are few studies where a family as a unit, including persons with STBI, are interviewed together. This study used a family systems research approach following a qualitative interpretative design. Therefore, 21 families with a total of 47 family members were interviewed. Qualitative content analysis was used to reveal categories with sub-categories and a theme.Results: "From surviving STBI towards stability, through the unknown, into a new everyday life and a new future as a family" characterized the implicit message. The results revealed two categories both with three subcategories. The first category characterized the rapid change from a normal everyday life to one of uncertainty and finally to one of stability, and the second category described how it is to adapt as a family after STBI.Conclusions: Long-term experiences of STBI show the importance for the whole family of belonging to a context, having a job, and having something to belong to as a way to achieve stability. Families' feelings of loneliness and lack of treatment and support are challenges for professionals when trying to involve families in care and rehabilitation.IMPLICATIONS FOR REHABILITATIONAsense of belonging, having a purpose and a social network are important within families.Professionals can provide information and can help to eliminate misunderstandings for individuals with severe traumatic brain injury and their families.It is important for rehabilitation professionals to undertake a thorough family assessment.This assessment will support families become involved in the process of rehabilitation.
8.	Stenberg, Maud, et al. (författare) Health and Well-Being of Persons of Working Age up to Seven Years after Severe Traumatic Brain Injury in Northern Sweden : A Mixed Method Study 2022 Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 11:5 Tidskriftsartikel (refereegranskat)abstract Purpose: To explore the health and well-being of persons seven years after severe traumatic brain injury (STBI).Material and methods: Follow-up of 21 persons 1 and 7 years after STBI using surveys for functional outcome, anxiety/depression, health and mental fatigue. Interviews were conducted and analysed using qualitative content analysis. Convergent parallel mixed method then merged and analysed the results into an overall interpretation.Results: Good recovery, high functional outcome and overall good health were relatively unchanged between 1 and 7 years. Well-being was a result of adaptation to a recovered or changed life situation. Persons with good recovery had moved on in life. Persons with moderate disability self-estimated their health as good recovery but reported poorer well-being. For persons with severe disability, adaptation was an ongoing process and health and well-being were low. Only a few persons reported anxiety and depression. They had poorer health but nevertheless reported well-being. Persons with moderate and severe mental fatigue had low functional outcomes and overall health and none of them reported well-being.Conclusions: The life of a person who has suffered STBI is still affected to a lesser or greater degree several years after injury due to acceptance of a recovered or changed life situation. Further studies are needed on how health and well-being can be improved after STBI in the long-term perspective.
9.	Andersson, Jenni, et al. (författare) Long-term perceived disabilities up to 10 years after transient ischaemic attack 2021 Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 53:3 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: The long-term impact of transient ischaemic attack is largely unknown.OBJECTIVES: To assess the long-term perceived impact of transient ischaemic attack and explore the influence of sex and age on these perceptions; and to evaluate the relationships between activities of daily living, participation and overall recovery, and the other domains of the Stroke Impact Scale 3.0 (SIS).METHODS: A retrospective study among adult community-dwelling individuals from 6 months up to 10 years after onset of transient ischaemic attack. A total of 299 survivors of transient ischaemic attack responded to the SIS.RESULTS: Most self-reported disabilities involved emotion, strength, and participation domains of SIS and remained stable until 10 years post-transient ischaemic attack. Women reported significantly more disabilities for emotion and hand function. Elderly subjects (age > 65 years) reported more disabilities for strength, mobility, hand function, activities of daily living/instrumental activities of daily living, and participation. The activities of daily living/instrumental activities of daily living, participation, and overall recovery demonstrated significant, although low-to-moderate, associations with other SIS domains after transient ischaemic attack.CONCLUSION: The broadly perceived disabilities were demonstrated consistently and played a significant meaningful role in everyday life and recovery among community-dwelling individuals up to 10 years after a transient ischaemic attack. These findings indicate the need for long-term multi-professional follow-up with holistic rehabilitation to improve overall recovery among survivors of transient ischaemic attack.
10.	Beer, Torfinn, 1992- (författare) An epidemiological perspective on heart and lung weight in cardiac and intoxication deaths 2022 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract The main purpose of a medico-legal autopsy is to determine the cause and manner of death. A forensic pathologist makes assessments of this using several sources of information, one of which is the discrepancy between measured organ weight and reference values. Of particular interest is the heart weight in heart disease and the weight of the lungs in fatal intoxications. In this thesis, a linear model of lung weight was created, but the model could at best explain only 13% of the variation in combined lung weight (Paper I). Unsurprisingly, this meant that the model was a poor definition of “normal” lung weight and could not be used to identify intoxication cases (Paper II). A ratio of lung weight to heart weight (LWHW ratio) also failed to differentiate intoxication cases from controls. The poor performance of these methods could plausibly have been due to fatal intoxications with only some substances being associated with increased lung weight, but an analysis showed that many common intoxicants were associated with heavier lungs than hanging deaths (Paper III). To establish heart weight references more applicable in a medico-legal autopsy population, a model of heart weight accounting for undiagnosed cardiac hypertrophy was created (Paper IV). The model showed that for a decedent of average the evidence that a was hypertrophic reached, substantial support at around 470 g.In conclusion, a definition of “heavy lungs” remains elusive. However, it seems to be a finding compatible with fatal intoxications with many substances and the low predictive value found may be due to study design. The heart weight model presented allows pathologists to assess the evidence of cardiac hypertrophy more easily than previously published models.
11.	Björsenius, Viktor, et al. (författare) One-Year Follow-Up after Multimodal Rehabilitation for Patients with Whiplash-Associated Disorders 2020 Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 17:13 Tidskriftsartikel (refereegranskat)abstract Long-term symptoms after whiplash injury often comprise neck pain, headache, anxiety, depression, functional impairment and low quality of life. In an observational cohort study, we examined physical and mental health effects in patients with subacute to chronic whiplash-associated disorders (WAD) after participation in a multimodal rehabilitation (MMR) program. MMR is a team-based multi-professional method based on a bio-psycho-social model with a cognitive focus to reach an individualized and common goal for the team and patient together. Standardized self-report questionnaires were filled in three times: before MMR, after MMR, and one year after MMR. A total of 322 participants completed the program, 161 of whom responded in full and were further analyzed. At one-year follow-up after MMR, a significant improvement was seen in the evaluation of the primary outcomes (physical and mental health) and secondary outcomes (anxiety, depression, pain intensity and interference with life). Women improved on all outcomes while men did not improve on the psychological measures (mental health, depression and anxiety). This study indicates that a MMR program could be beneficial for patients with subacute to chronic WAD, at least for women, since the outcomes at one-year follow-up were positive.
12.	Böthun, Alicia, et al. (författare) Clinical signs in the jaw and neck region following whiplash trauma : A 2-year follow-up 2023 Ingår i: European Journal of Pain. - : John Wiley & Sons. - 1090-3801 .- 1532-2149. ; 27:6, s. 699-709 Tidskriftsartikel (refereegranskat)abstract Background: Pain in the orofacial region is often reported after whiplash trauma. However, prospective studies evaluating clinical signs related to orofacial pain and disability in whiplash populations are rare. The aim of the present study was to evaluate clinical signs related to pain and dysfunction in orofacial and neck regions after whiplash trauma, in a short- and long-term perspective.Methods: In total, 84 cases (48 women) diagnosed with neck distortion after a car accident and 116 controls (68 women) were examined within 1 month, and 49 cases (27 women) and 71 controls (41 women) were re-examined 2 years later. Outcome measures were pain on palpation of jaw and neck muscles and maximal jaw opening. Analysis was performed using mixed-models.Results: Cases and women were at higher risk for pain on palpation of jaw muscles (OR:7.7; p < 0.001 and OR:3.2; p = 0.010 respectively) and neck muscles (OR:12.7; p < 0.001 and OR:2.9; p = 0.020 respectively) but with no significant effect of time. Cases and women also had lower maximal jaw opening (−3.1; p = 0.001 and −3.3; p = 0.001 respectively). There was no significant time effect, but a significant interaction between cases and time (2.2; p = 0.004).Conclusion: Individuals with a whiplash trauma present a higher risk for pain on palpation in jaw and neck muscles both in a short- and long-term perspective, but show normal jaw movements. No time effect suggests that cases do not spontaneously improve nor get worse. Investigating pain on palpation in the jaw and neck muscles after whiplash trauma can identify individuals at risk for developing long-term orofacial pain and dysfunction.Significance: Orofacial pain is often reported after whiplash trauma but most previous studies concerning orofacial pain in whiplash populations have been questionnaire studies. Cases with a previous whiplash trauma and women, in general, had higher risk for pain on palpation in the jaw and neck region. Investigating pain on palpation after a whiplash trauma can help to identify individuals at risk of developing long-lasting pain in the orofacial region.
13.	Böthun, Alicia, et al. (författare) Whiplash trauma did not predict jaw pain after 2 years : an explorative study 2024 Ingår i: Clinical Oral Investigations. - : Springer Nature. - 1432-6981 .- 1436-3771. ; 28 Tidskriftsartikel (refereegranskat)abstract Objectives: To explore predictive factors for the development and maintenance of jaw pain over a 2-year period.Methods: One hundred nineteen cases (73 women) and 104 controls (59 women), mean age 34.9 years (SD 13.9), attended baseline and 2-year follow-up examinations. The whiplash cases visited the emergency department at Umeå University Hospital, Sweden, with neck pain within 72 h following a car accident, and baseline questionnaires were answered within a month after trauma. Controls were recruited via advertising. Inclusion criteria were age 18–70 years, living in Umeå municipality and Swedish speaking. The exclusion criterion was neck fracture for cases and a previous neck trauma for controls. Validated questionnaires recommended in the standardized Research Diagnostic Criteria for temporomandibular disorders were used. Jaw pain was assessed by two validated screening questions answered with “yes” or “no.” A logistic regression analysis was used to predict the outcome variable jaw pain (yes/no) after 2 years.Results: Whiplash trauma did not increase the odds of development of jaw pain over a 2-year period (OR 1.97, 95% CI 0.53–7.38). However, non-specific physical symptoms (OR 8.56, 95% CI 1.08–67.67) and female gender (OR 4.89, 95% CI 1.09–22.02) did increase the odds for jaw pain after 2 years.Conclusion: The development and maintenance of jaw pain after whiplash trauma are primarily not related to the trauma itself, but more associated with physical symptoms.Clinical relevance: The development of jaw pain in connection with a whiplash trauma needs to be seen in a biopsychosocial perspective, and early assessment is recommended.
14.	Ekdahl, Natascha, et al. (författare) Cognitive Reserve, Early Cognitive Screening, and Relationship to Long-Term Outcome after Severe Traumatic Brain Injury 2022 Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 11:7 Tidskriftsartikel (refereegranskat)abstract The objective was to investigate the relationship between early global cognitive functioning using the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) and cognitive flexibility (Trail Making Test (TMT), TMT B-A), with long-term outcome assessed by the Mayo-Portland Adaptability Index (MPAI-4) in severe traumatic brain injury (sTBI) controlling for the influence of cognitive reserve, age, and injury severity. Of 114 patients aged 18–65 with acute Glasgow Coma Scale 3–8, 41 patients were able to complete (BNIS) at 3 months after injury and MPAI-4 5–8 years after injury. Of these, 33 patients also completed TMT at 3 months. Global cognition and cognitive flexibility correlated significantly with long-term outcome measured with MPAI-4 total score (rBNIS = 0.315; rTMT = 0.355). Global cognition correlated significantly with the participation subscale (r = 0.388), while cognitive flexibility correlated with the adjustment (r = 0.364) and ability (r = 0.364) subscales. Adjusting for cognitive reserve and acute injury severity did not alter these relationships. The effect size for education on BNIS and TMT scores was large (d ≈ 0.85). Early screenings with BNIS and TMT are related to long-term outcome after sTBI and seem to measure complementary aspects of outcome. As early as 3 months after sTBI, educational level influences the scores on neuropsychological screening instruments.
15.	Ekdahl, Natascha, et al. (författare) Investigating cognitive reserve, symptom resolution and brain connectivity in mild traumatic brain injury 2023 Ingår i: BMC Neurology. - : BioMed Central (BMC). - 1471-2377. ; 23:1 Tidskriftsartikel (refereegranskat)abstract BackgroundA proportion of patients with mild traumatic brain injury (mTBI) suffer long-term consequences, and the reasons behind this are still poorly understood. One factor that may affect outcomes is cognitive reserve, which is the brain's ability to maintain cognitive function despite injury. It is often assessed through educational level or premorbid IQ tests. This study aimed to explore whether there were differences in post-concussion symptoms and symptom resolution between patients with mTBI and minor orthopedic injuries one week and three months after injury. Additional aims were to explore the relationship between cognitive reserve and outcome, as well as functional connectivity according to resting state functional magnetic resonance imaging (rs-fMRI).MethodFifteen patients with mTBI and 15 controls with minor orthopedic injuries were recruited from the emergency department. Assessments, including Rivermead Post-Concussion Questionnaire (RPQ), neuropsychological testing, and rs-fMRI scans, were conducted on average 7 days (SD = 2) and 122 days (SD = 51) after injury.ResultsAt the first time point, significantly higher rates of post-concussion symptoms (U = 40.0, p = 0.003), state fatigue (U = 56.5, p = 0.014), and fatigability (U = 58.5, p = 0.025) were observed among the mTBI group than among the controls. However, after three months, only the difference in post-concussion symptoms remained significant (U = 27.0, p = 0.003). Improvement in post-concussion symptoms was found to be significantly correlated with cognitive reserve, but only in the mTBI group (Spearman's rho = -0.579, p = .038). Differences in the trajectory of recovery were also observed for fatigability between the two groups (U = 36.5, p = 0.015). Moreover, functional connectivity differences in the frontoparietal network were observed between the groups, and for mTBI patients, functional connectivity differences in an executive control network were observed over time.ConclusionThe findings of this pilot study suggest that mTBI, compared to minor orthopedic trauma, is associated to both functional connectivity changes in the brain and concussion-related symptoms. While there is improvement in these symptoms over time, a small subgroup with lower cognitive reserve appears to experience more persistent and possibly worsening symptoms over time. This, however, needs to be validated in larger studies.Trial registrationNCT05593172. Retrospectively registered.
16.	Eklund, Katarina, et al. (författare) A cost-utility analysis of multimodal pain rehabilitation in primary healthcare 2021 Ingår i: Scandinavian Journal of Pain. - : De Gruyter Open. - 1877-8860 .- 1877-8879. ; 1, s. 48-58 Tidskriftsartikel (refereegranskat)abstract Objectives: Multimodal rehabilitation programs (MMRPs) have been shown to be both cost-effective and an effective method for managing chronic pain in specialist care. However, while the vast majority of patients are treated in primary healthcare, MMRPs are rarely practiced in these settings. Limited time and resources for everyday activities alongside the complexity of chronic pain makes the management of chronic pain challenging in primary healthcare and the focus is on unimodal treatment. In order to increase the use of MMRPs incentives such as cost savings and improved health status in the patient group are needed. The aim of this study was to evaluate the cost-effectiveness of MMRPs for patients with chronic pain in primary healthcare in two Swedish regions. The aim of this study was to evaluate the cost-effectiveness of MMRPs at one-year follow-up in comparison with care as usual for patients with chronic pain in primary healthcare in two Swedish regions.Methods: A cost-utility analysis was performed alongside a prospective cohort study comparing the MMRP with the alternative of continuing with care as usual. The health-related quality of life (HRQoL), using EQ5D, and working situation of 234 participants were assessed at baseline and one-year follow-up. The primary outcome was cost per quality-adjusted life year (QALY) gained while the secondary outcome was sickness absence. An extrapolation of costs was performed based on previous long-term studies in order to evaluate the effects of the MMRP over a five-year time period.Results: The mean (SD) EQ5D index, which measures HRQoL, increased significantly (p<0.001) from 0.34 (0.32) to 0.44 (0.32) at one-year follow-up. Sickness absence decreased by 15%. The cost-utility analysis showed a cost per QALY gained of 18 704 € at one-year follow-up.Conclusions: The results indicate that the MMRP significantly improves the HRQoL of the participants and is a cost-effective treatment for patients with chronic pain in primary healthcare when a newly suggested cost-effectiveness threshold of 19 734 € is implemented. The extrapolation indicates that considerable cost savings in terms of reduced loss of production and gained QALYs may be generated if the effects of the MMRP are maintained beyond one-year follow-up. The study demonstrates potential benefits of MMRPs in primary healthcare for both the patient with chronic pain and the society as a whole. The cost-effectiveness of MMRPs in primary healthcare has scarcely been studied and further long-term studies are needed in these settings.
17.	Eklund, Katarina, et al. (författare) Introduction of a multimodal pain rehabilitation intervention in primary care : a pilot study 2023 Ingår i: Journal of Rehabilitation Medicine - Clinical Communications. - : Medical Journals Sweden AB. - 2003-0711. ; 6 Tidskriftsartikel (refereegranskat)abstract Objective: To evaluate patient-reported outcome measures in patients with chronic musculoskeletal pain 1 year after participation in a case manager-led multimodal rehabilitation intervention in a Finnish primary care centre. Changes in healthcare utilization (HCU) were also explored.Methods: A prospective pilot study with 36 participants. The intervention consisted of screening, multidisciplinary team assessment, a rehabilitation plan and case manager follow-up. Data were collected through questionnaires filled in after the team assessment and 1 year later. HCU data 1 year before and 1 year after team assessment were compared.Results: At follow-up, satisfaction with vocational situation, self-reported work ability and health-related quality of life (HRQoL) had improved and pain intensity had diminished significantly for all participants. The participants who reduced their HCU improved their activity level and HRQoL. Early intervention by a psychologist and mental health nurse was distinctive for the participants who reduced HCU at follow-up.Conclusion: The findings demonstrate the importance of early biopsychosocial management of patients with chronic pain in primary care. Identification of psychological risk factors at an early stage may lead to better psychosocial wellbeing, improve coping strategy and reduce HCU. A case manager may free up other resources and thereby contribute to cost savings.
18.	Falkhamn, Lukasz Mateusz, et al. (författare) Interdisciplinary multimodal pain rehabilitation in patients with chronic musculoskeletal pain in primary care : a cohort study from the Swedish quality registry for pain rehabilitation (SQRP) 2023 Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 20:6 Tidskriftsartikel (refereegranskat)abstract Chronic pain is a major public health issue. Mounting evidence suggests that interdisciplinary multimodal pain rehabilitation programs (IMMRPs) performed in specialist pain care are an effective treatment for patients with chronic pain, but the effects of such treatment if performed in primary care settings have been less studied. The aims of this pragmatic study were to (1) describe characteristics of patients participating in IMMRPs in primary care; (2) examine whether IMMRPs in primary care improve pain, disability, quality of life, and sick leave 1-year post discharge in patients with chronic pain; and (3) investigate if outcomes differ between women and men. Data from 744 (645 women and 99 men, age range 18-65 years) patients with non-malignant chronic pain included in the Swedish Quality Registry for Pain Rehabilitation Primary Care were used to describe patient characteristics and changes in health and sick leave. At 1-year follow-up, the patients had improved significantly (p < 0.01) in all health outcome measures and had reduced sick leave except in men, where no significant change was shown in physical activity level. This study indicates that MMRPs in primary care improved pain and physical and emotional health and reduced sick leave, which was maintained at the 1-year follow-up.
19.	Gerdle, Björn, 1953-, et al. (författare) Smärtanalys : diagnos, smärtmekanismer, psykologisk och social bedömning 2020. - 1 Bok (övrigt vetenskapligt/konstnärligt)
20.	Ghafouri, Bijar, et al. (författare) Swedish Chronic Pain Biobank : protocol for a multicentre registry and biomarker project 2022 Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:11 Tidskriftsartikel (refereegranskat)abstract INTRODUCTION: About 20% of the adult population have chronic pain, often associated with psychological distress, sick leave and poor health. There are large variations in the clinical picture. A biopsychosocial approach is used in investigation and treatment. The concept of personalised medicine, that is, optimising medication types and dosages for individual patients based on biomarkers and other patient-related factors, has received increasing attention in different diseases but used less in chronic pain. This cooperative project from all Swedish University Hospitals will investigate whether there are changes in inflammation and metabolism patterns in saliva and blood in chronic pain patients and whether the changes correlate with clinical characteristics and rehabilitation outcomes.METHODS AND ANALYSIS: Patients at multidisciplinary pain centres at University Hospitals in Sweden who have chosen to participate in the Swedish Quality Registry for Pain Rehabilitation and healthy sex-matched and age-matched individuals will be included in the study. Saliva and blood samples will be collected in addition to questionnaire data obtained from the register. From the samples, proteins, lipids, metabolites and micro-RNA will be analysed in relation to, for example, diagnosis, pain characteristics, psychological distress, body weight, pharmacological treatment and clinical rehabilitation results using advanced multivariate data analysis and bioinformatics.ETHICS AND DISSEMINATION: The study is approved by the Swedish Ethical Review Authority (Dnr 2021-04929) and will be conducted in accordance with the declaration of Helsinki.The results will be published in open access scientific journals and in popular scientific relevant journals such as those from patient organisations. Data will be also presented in scientific meetings, meeting with healthcare organisations and disseminated in different lecturers at the clinics and universities.
21.	Glavare, Maria, et al. (författare) Virtual reality exercises in an interdisciplinary rehabilitation programme for persons with chronic neck pain: A feasibility study 2021 Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081 .- 2003-0711. ; 4 Tidskriftsartikel (refereegranskat)abstract Objective: To investigate the feasibility of a virtual reality exercise intervention within an interdisciplinary rehabilitation programme for persons with chronic neck pain. The effects of the intervention on symptom severity, variables related to chronic neck pain, and patients' experience of exercises were assessed.Methods: Nine women and 3 men participated in a 6-week virtual reality exercise intervention during an interdisciplinary rehabilitation programme. Symptom severity was rated before and after each session of virtual reality exercise, using questionnaires before and after the interdisciplinary rehabilitation programme, and questions about participants' experiences.Results: Neck pain symptoms increased temporarily during the exercises, but no lasting deterioration was found after the interdisciplinary rehabilitation programme. Depression, pain interference, pain control, sleep and kinesiophobia improved significantly after the programme. Participants experienced that the virtual reality exercises increased motivation to exercise and provided a focus other than pain. However, the equipment was heavy; and exercising was tiring and reminded them of their challenges.Conclusion: This study indicates that virtual reality exercises as part of an interdisciplinary rehabilitation programme are feasible and safe for patients with chronic neck pain. Pain symptoms may increase temporarily during the exercises. Virtual reality exercises may support participants by increasing motivation to exercise and providing helpful feedback. Further research into the added value of virtual reality exercises in an interdisciplinary rehabilitation programme for patients with chronic neck pain is warranted.
22.	Holmqvist, Anna, et al. (författare) Fatigue and cognitive fatigability in patients with chronic pain 2024 Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter. - 1877-8860 .- 1877-8879. ; 24:1 Tidskriftsartikel (refereegranskat)abstract Objectives: Fatigue is common in patients with chronic pain. Still, there is a lack of studies examining objectively measurable cognitive aspects of fatigue: cognitive fatigability (CF). We aimed to investigate the presence of CF in patients with chronic pain and its relation to self-rated fatigue, attention, pain characteristics, sleep disturbance, depression, and anxiety.Methods: Two hundred patients with chronic pain and a reference group of 36 healthy subjects underwent a comprehensive neuropsychological test battery, including measurement of CF with the Wechsler Adult Intelligence Scale-III Coding subtest, and self-assessment of trait and state fatigue.Results: The patients with chronic pain did not show more CF as compared to the reference group. There was an association between CF and processing speed on a test of sustained and selective attention in the chronic pain group, while self-rated fatigue measures and pain characteristics were not associated with CF. Self-rated fatigue measures were highly correlated with self-rated pain intensity, spreading of pain, depression, anxiety, and sleep disturbance.Conclusions: The findings highlight the distinction between objective and subjective aspects of fatigue in chronic pain, and that the underlying causes of these different aspects of fatigue need to be studied further.
23.	Holmström, Anna-Karin, et al. (författare) Effect on orofacial pain in patients with chronic pain participating in a multimodal rehabilitation programme : a pilot study 2023 Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter. - 1877-8860 .- 1877-8879. ; 23:4, s. 656-661 Tidskriftsartikel (refereegranskat)abstract OBJECTIVES: Orofacial pain in patients taking part in a multimodal rehabilitation programme (MMRP) due to chronic bodily pain is common but it is not known whether such a rehabilitation programme can also have an effect on the presence of orofacial pain. The first aim of this study was to evaluate the effect of an MMRP on orofacial pain frequency. The second aim was to evaluate differences in the effect on quality of life and on psychosocial factors related to chronic pain.METHODS: MMRP was evaluated through validated questionnaires from the Swedish Quality Registry for Pain Rehabilitation (SQRP). Fifty-nine patients participating in MMRP filled out the two screening questions for orofacial pain in addition to the SQRP questionnaires before and after participation in MMRP during the period August 2016 to March 2018.RESULTS: Pain intensity decreased significantly after the MMRP (p=0.005). Fifty patients (69.4 %) reported orofacial pain before MMRP and no significant decrease after the programme (p=0.228). Among individuals with orofacial pain, the self-reported level of depression decreased after participation in the programme (p=0.004).CONCLUSIONS: Even though orofacial pain is common among patients with chronic bodily pain, participation in a multimodal pain programme was not enough to reduce frequent orofacial pain. This finding implies that specific orofacial pain management including information about jaw physiology could be a justified component of patient assessment prior to a multimodal rehabilitation programme for chronic bodily pain.
24.	Lampa, Ewa, et al. (författare) The Course of Orofacial Pain and Jaw Disability after Whiplash Trauma : A 2-year Prospective Study 2020 Ingår i: Spine. - : Wolters Kluwer. - 0362-2436 .- 1528-1159. ; 45:3, s. E140-E147 Tidskriftsartikel (refereegranskat)abstract Study Design: Prospective cohort study.Objective: To evaluate the course of orofacial pain and jaw disability in relation to neck pain, neck disability and psychosocial factors at the acute stage and the chronic stage after whiplash trauma.Summary of Background Data: Many individuals report chronic pain in the orofacial region after whiplash trauma. The possible association between whiplash trauma and orofacial pain is debated. Prospective studies are therefore needed to evaluate the development of orofacial pain after whiplash trauma.Methods: Within one month following a whiplash trauma, 176 cases were examined and compared to 116 controls with questionnaires concerning neck and jaw pain and related disability, non-specific physical symptoms and depression. At the 2-year follow-up, 119 cases (68%) and 104 controls (90%) were re-examined.Results: Compared to controls, cases reported more jaw and neck pain, both at baseline and follow-up. A majority (68%) of cases with pain in the jaw region in the acute stage also reported jaw pain at the follow-up. The intensity of jaw and neck pain was correlated both at baseline and follow-up. Both neck pain and jaw pain was correlated to non-specific physical symptoms and to depression.Conclusion: Orofacial pain and jaw disability related to neck pain is often present already at the acute stage after whiplash trauma and persist into the chronic stage for most individuals. Assessment following whiplash trauma should therefore include both the neck and the orofacial regions. More studies are needed to further evaluate risk factors for development of orofacial pain after whiplash trauma.Level of Evidence: 3
25.	Lövsund, Anneli, et al. (författare) Multiprofessional assessment of patients with chronic pain in primary healthcare 2020 Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter. - 1877-8860 .- 1877-8879. ; 20:2, s. 319-327 Tidskriftsartikel (refereegranskat)abstract Background and aims: Chronic pain is a common reason to seek health care. Multimodal rehabilitation is frequently used to rehabilitate patients with complex pain conditions. The multiprofessional assessment that patients go through before entering multimodal rehabilitation may, in itself, have a positive impact on patient outcome but little is known regarding patients own view. Therefore, the purpose of this study was to discover how patients experienced this multiprofessional assessment project.Methods: Ten patients participating in a multiprofessional assessment at a primary healthcare centre in Western Finland were interviewed using a semi-structured interview. Qualitative content analysis was used to analyse the interviews.Results: The analysis resulted in six categories of participant description of their multiprofessional assessment experiences and the rehabilitation plan they received. Feeling chosen or not quite fitting in was a category describing participant feelings upon starting the assessment. They expressed their thoughts on the examinations in the category more than just an examination. Being affirmed described participant desire to be taken seriously and treated well. Receiving support described the perceived roles of the team members. Participant negative experiences of the assessment were described in confusion and disappointment. Finally, in taking and receiving responsibilities, participants described their own role in the team.Conclusions: Experiences of patients in a multiprofessional assessment were mostly positive. This highlights the value of a team assessment that takes several aspects of chronic pain into account when assessing complex patients.
26.	Magnusson, Beatrice M., et al. (författare) Symptoms and disability after mild traumatic brain injury : a five-year follow-up 2024 Ingår i: Journal of Integrative Neuroscience. - : IMR Press. - 0219-6352 .- 1757-448X. ; 23:2 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Every year, many people suffer from traumatic brain injuries (TBI) with dramatic consequences for both the victim and their close relatives in the form of remaining lifelong symptoms and functional disabilities as a result.METHODS: This study evaluates the outcomes of 49 patients after mild TBI (mTBI) at follow-up after 5 years by using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) to assess post-TBI symptoms and the Glasgow Outcome Scale Extended (GOSE) to assess disability. The specific aim was to evaluate post-TBI characteristics concerning age, gender, pre-injury systemic disease, computed tomography (CT) result and additional TBIs.RESULTS: Almost eighty percent reported RPQ symptoms, the most common for both genders being fatigue (51%) and poor concentration (51%). Seventy-six percent had a good recovery, 18% moderate disability, while 6% reported severe disability. The number of symptoms was significantly correlated to the level of disability. All participants with severe disability had repeated mTBI. Only twenty-one percent reported that they received some form of rehabilitation intervention after their mTBI.CONCLUSIONS: Five years after suffering mTBI, patients reported high rates of symptoms and disabilities. Our findings suggest that tailored rehabilitation interventions should be designed to identify mTBI patients in need of early rehabilitation. This would result in minimized suffering for the individual and improved cost-effectiveness for society.
27.	Marklund, Ingela, et al. (författare) Lower-extremity constraint-induced movement therapy improved motor function, mobility, and walking after stroke 2023 Ingår i: European Journal of Physical and Rehabilitation Medicine. - : Edizioni Minerva Medica. - 1973-9087 .- 1973-9095. ; 59:2, s. 136-144 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: To regain the ability to walk is one of the most commonly stated goals for people who have had a stroke due to its importance in everyday life. Walking ability affects patients' mobility, self-care, and social lives. Constraint-induced movement therapy (CIMT) is known to be effective in improving upper extremity outcomes post-stroke. However, there is insufficient evidence regarding its efficacy in improving lower extremity outcomes.AIM: To investigate whether a highly intensive CIMT for lower extremity (LE-CIMT) function post-stroke can improve motor function, functional mobility, and walking ability. Furthermore, it also aimed to investigate whether age, gender, stroke type, more-affected side, or time after stroke onset affect the efficacy of LE-CIMT on walking ability outcomes. DESIGN: Longitudinal cohort study.SETTING: Outpatient clinic in Stockholm, Sweden.POPULATION: A total of 147 patients mean age 51 years (68% males; 57% right-sided hemiparesis), at the sub-acute or chronic phases post-stroke who had not previously undergone LE-CIMT.METHODS: All patients received LE-CIMT for 6 hours per day over 2 weeks. The Fugl-Meyer Assessment (FMA) of the lower extremity, Timed Up and Go (TUG) test, Ten-Meter Walk Test (10MWT), and six-Minute Walk Test (6MWT) were used to assess functional outcomes before and directly after the 2-week treatment was complete as well at 3-month post-intervention.RESULTS: Compared to baseline values, FMA (P<0.001), TUG (P<0.001), 10MWT (P<0.001) and 6MWT (P<0.001) scores were statistically significantly improved directly after the LE-CIMT intervention. These improvements persisted at the 3-month post-intervention follow-up. Those who completed the intervention 1-6 months after stroke onset had statistically significant larger improvements in 10MWT compared to those who received the intervention later than 6 months after stroke onset. Age, gender, stroke type, and more-affected side did not impact 10MWT results.CONCLUSIONS: In an outpatient clinic setting, high-intensity LE-CIMT statistically significant improved motor function, functional mobility, and walking ability in middle-aged patients in the sub-acute and chronic post-stroke phases. However, studies with more robust designs need to be conducted to deepen the understanding of the efficacy of LE-CIMT.CLINICAL REHABILITATION IMPACT: High-intensity LE-CIMT may be a feasible and useful treatment option in outpatient clinics to improve post-stroke walking ability.
28.	Marklund, Ingela, 1970- (författare) Lower-extremity constraint-induced movement therapy in individuals with stroke : improvements, experiences, and health-related quality of life 2023 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Background: Stroke is the third-leading cause of disability worldwide, and there are rehabilitation needs not only in the first year but throughout the lifetime. The ability to walk is crucial in everyday life since it affects mobility, self-care, and social activities. National guidelines recommend treating impairments with repetitive task- and goal-oriented exercises. One form of highly intensive and task-specific treatment is constraint-induced movement therapy (CIMT), a treatment method developed based on understanding brain plasticity with a behavioural explanatory model. There is insufficient evidence regarding CIMT for the lower extremities (LE-CIMT) since it has only been investigated in a few published studies involving only a small number of participants.Aim: The overall aims of this thesis were to explore the extent to which LE-CIMT (six hours per day for two weeks) can improve impaired body functions and limited activities, describe how the treatment is experienced, and investigate whether it affects the health-related quality of life (HRQoL) in individuals with stroke.Methods: This thesis contains five papers that analysed data from two study populations using quantitative and qualitative research methods. A single-subject experimental study with five subjects and a longitudinal uncontrolled cohort study with 147 subjects with stroke treated with LECIMT and follow-up after three and six months were conducted. Subjects were assessed with Fugl–Meyer assessment, the Berg balance scale (BBS), single-leg stance, step test, timed up and go with and without dual-task, ten-metre (10MWT) and six-minute (6MWT) walk tests, one repetition maximum, and weight-bearing standing on two scales. Data were analysed with the two-standard deviation band method and linear mixed modelling, controlling for heterogeneity. Seven individual semistructured interviews were performed and analysed with qualitative content analysis to explore LE-CIMT experiences. Finally, a questionnaire including RAND-36 was sent out to former LE-CIMT participants, with 106 responses (response rate 65%). Data were compared with norm-baseddata and analysed with the summary independent-samples t-test. Univariable analysis was performed to investigate the linear relationships between RAND-36 health domain scores and the 6MWT result per 100meters, time since treatment, living alone, and need for home care. Independent t-tests were used for drop-out analyses.Results: Highly intensive LE-CIMT significantly improved motor function, strength, balance, dual-task ability, mobility, and walking ability in individuals in the sub-acute and chronic post-stroke phases. They maintained or improved their weight bearing on the more affected leg to provide a more symmetric distribution. The improvements remained at the three- and six-month follow-up. There was a significant interaction for time and age. Those who completed LE-CIMT within six months after their stroke onset had significantly greater improvements in 10MWT self-selected speed during the follow-up than those who completed LE-CIMT after at least seven months. Younger participants had higher BBS scores than older participants. The informants’ experiences generated the overall theme that LE-CIMT gave them knowledge about themselves and how their body works, facilitating the opportunity to live life more easily. There was still hope and opportunity for functional improvements to increase their independence and self-esteem. While LE-CIMT was intense and challenging, it was experienced as entirely necessary. The participants had significantly reduced HRQoL, overall and by sex in physical functioning, role-functioning physical, general health (not females), and social functioning compared to the general population. A significant relationship existed between their previous 6MWT result and the HRQoL physical functioning domain. Every 100-metre improvement in the 6MWT led to a 6.45 higher physical functioning score. No other significant associations were found. The dropout analysis showed no significant differences in characteristics between the participants and those who did not complete all three assessments or answer the questionnaire.Conclusion: LE-CIMT seems helpful in improving lower extremity body functioning and activities, even a long time after the stroke, leading to persistent improvements. The patients perceived LE-CIMT as entirely necessary. LE-CIMT may be a feasible treatment option and could be conducted in both day hospital rehabilitation and outpatient settings. Six minutewalk performance predicts physical functioning in HRQoL, emphasising the importance of mobility and gait training in rehabilitation after stroke.
29.	Molander, Peter, et al. (författare) Ehlers-Danlos Syndrome and Hypermobility Syndrome Compared with Other Common Chronic Pain Diagnoses-A Study from the Swedish Quality Registry for Pain Rehabilitation 2020 Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 9:7 Tidskriftsartikel (refereegranskat)abstract Although chronic pain is common in patients with Ehlers-Danlos syndrome (EDS) and hypermobility syndromes (HMS), little is known about the clinical characteristics of these groups. The main aim was to compare EDS/HMS with common local and generalized pain conditions with respect to Patient Reported Outcome Measures (PROMs). Data from the Swedish Quality Register for Chronic Pain (SQRP) from 2007 to 2016 (n= 40,518) were used, including patients with EDS/HMS (n= 795), fibromyalgia (n= 5791), spinal pain (n= 6693), and whiplash associated disorders (WAD) (n= 1229). No important differences in the PROMs were found between EDS and HMS. Women were represented in > 90% of EDS/HMS cases and fibromyalgia cases, and in about 64% of the other groups. The EDS/HMS group was significantly younger than the others but had a longer pain duration. The pain intensity in EDS/HMS was like those found in spinal pain and WAD; fibromyalgia had the highest pain intensity. Depressive and anxiety symptoms were very similar in the four groups. Vitality-a proxy for fatigue-was low both in EDS/HMS and fibromyalgia. The physical health was lower in EDS/HMS and fibromyalgia than in the two other groups. Patients with EDS/HMS were younger, more often female, and suffered from pain for the longest time compared with patients who had localized/regional pain conditions. Health-care clinicians must be aware of these issues related to EDS/HMS both when assessing the clinical presentations and planning treatment and rehabilitation interventions.
30.	Molander, Peter, et al. (författare) Interdisciplinary pain rehabilitation for patients with Ehlers-Danlos syndrome and hypermobility spectrum disorders 2024 Ingår i: Journal of Rehabilitation Medicine. - : Foundation for Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 56 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: Chronic pain is a common manifestation of Ehlers-Danlos syndrome and hypermobility spectrum disorders; thus it is often suggested that patients undergo generic interdisciplinary pain rehabilitation, despite there being little evidence to support this decision. The aim of this study is to examine the effectiveness of standard rehabilitation programmes for chronic pain on patients with Ehlers-Danlos syndrome and hypermobility spectrum disorders, compared with patients with other chronic pain disorders.SUBJECTS: Data, collected between 2008 and 2016, were extracted from a Swedish national registry. The patient data comprised of 406 cases with Ehlers-Danlos syndrome or hypermobility spectrum disorders, 784 cases with a whiplash-related diagnosis, 3713 cases with diagnoses relating to spinal pain, and 2880 cases of fibromyalgia.METHODS: The differences between groups on key outcome measures from pre- to 1-year follow-up after interdisciplinary pain rehabilitation were analysed using linear mixed effects models. Sensitivity analysis in the form of pattern-mixture modelling was conducted to discern the impact of missing data. RESULTS: No significant differences were found in improvements from pre- to 1-year follow-up for patients with Ehlers-Danlos syndrome or hypermobility spectrum disorder compared with other diagnostic groups regarding measures of health-related quality of life, mental health, or fatigue. At follow-up, differences in pain interference (d = -0.34 (95% confidence interval [95% CI] -0.5 to -0.18)), average pain (d = 0.22 (95% CI 0.11-0.62)) and physical functioning (d = 2.19 (95% CI 1.61-2.77)) were detected for the group with spinal-related diagnoses in relation to those with EDS/HSD, largely due to pre-treatment group differences. Sensitivity analysis found little evidence for missing data influencing the results.CONCLUSION: This study suggests that patients with Ehlers-Danlos syndrome/hypermobility spectrum disorders may benefit from inclusion in an interdisciplinary pain rehabilitation programme.
31.	Möller, Marika C., et al. (författare) Cognitive and mental fatigue in chronic pain : cognitive functions, emotional aspects, biomarkers and neuronal correlates - protocol for a descriptive cross-sectional study 2023 Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 13:3 Tidskriftsartikel (refereegranskat)abstract INTRODUCTION: Chronic pain (CP) is one of the most frequently presenting conditions in health care and many patients with CP report mental fatigue and a decline in cognitive functioning. However, the underlying mechanisms are still unknown.METHODS AND ANALYSIS: This study protocol describes a cross-sectional study aimed at investigating the presence of self-rated mental fatigue, objectively measured cognitive fatigability and executive functions and their relation to other cognitive functions, inflammatory biomarkers and brain connectivity in patients with CP. We will control for pain-related factors such as pain intensity and secondary factors such as sleep disturbances and psychological well-being. Two hundred patients 18-50 years with CP will be recruited for a neuropsychological investigation at two outpatient study centres in Sweden. The patients are compared with 36 healthy controls. Of these, 36 patients and 36 controls will undergo blood sampling for inflammatory markers, and of these, 24 female patients and 22 female controls, between 18 and 45 years, will undergo an functional MRI investigation. Primary outcomes are cognitive fatigability, executive inhibition, imaging and inflammatory markers. Secondary outcomes include self-rated fatigue, verbal fluency and working memory. The study provides an approach to study fatigue and cognitive functions in CP with objective measurements and may demonstrate new models of fatigue and cognition in CP.ETHICS AND DISSEMINATION: The study has been approved by the Swedish Ethics Review Board (Dnr 2018/424-31; 2018/1235-32; 2018/2395-32; 2019-66148; 2022-02838-02). All patients gave written informed consent to participate in the study. The study findings will be disseminated through publications in journals within the fields of pain, neuropsychology and rehabilitation. Results will be spread at relevant national and international conferences, meetings and expert forums. The results will be shared with user organisations and their members as well as relevant policymakers.TRIAL REGISTRATION NUMBER: NCT05452915.
32.	Nilsson, Per A., 1957-, et al. (författare) Swedes Studying Abroad: Pre- and Post-COVID-19 2021. - 1 Ingår i: Tackling Online Education. - : Cambridge Scholars Publishing. - 9781527572621 - 1527572625 ; , s. 133-149 Bokkapitel (refereegranskat)
33.	Pietilä Holmner, Elisabeth, 1953-, et al. (författare) Long-term outcomes of multimodal rehabilitation in primary care for patients with chronic pain 2020 Ingår i: Journal of Rehabilitation Medicine. - Uppsala : Foundation Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 52:2 Tidskriftsartikel (refereegranskat)abstract Objectives: To investigate the outcomes one year after multimodal rehabilitation programmes in primary care for patients with chronic pain, both as a whole and for men and women separately. A second aim was to identify predictive factors for not being on sickness absence at follow-up after one year.Methods: A prospective longitudinal cohort study of 234 patients, 34 men and 200 women, age range 18–65 years, who participated in multimodal rehabilitation programmes in primary care in 2 Swedish county councils. Pain, physical and emotional functioning, coping, health-related quality of life, work-related factors, sickness absence (sick leave, sickness compensation/disability pension) were evaluated prior to and one year after multimodal rehabilitation programmes.Results: Patients showed significant improvements at 1-year follow-up for all measures (all p ≤ 0.004) except satisfaction with vocation (p = 0.060). The proportion of patients on sick leave decreased significantly at follow-up (p = 0.027), while there was no significant difference regarding the proportion of patients on sickness compensation/disability pension (p = 0.087). Higher self-rated work ability was associated with not being on sickness absence at 1-year follow-up (odds ratio (OR) 1.19, 95% confidence interval (CI) 1.21–1.06, p = 0.005).Conclusion: This study indicates that multimodal rehabilitation programmes in primary care could be beneficial for patients with chronic pain, since the outcomes at 1-year follow-up for pain, physical and emotional functioning, coping, and health-related quality of life were positive. However, the effect sizes were small and thus further development of multimodal rehabilitation programmes is warranted in order to improve the outcomes.
34.	Rivano Fischer, Marcelo, et al. (författare) Comment on 'The value of interdisciplinary treatment for sickness absence in chronic pain: A nationwide register-based cohort study' 2022 Ingår i: European Journal of Pain. - : John Wiley & Sons. - 1090-3801 .- 1532-2149. ; 26:2, s. 543-544 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
35.	Semedo, Bruno, et al. (författare) A qualitative study among women immigrants from Somalia : experiences from primary health care multimodal pain rehabilitation in Sweden 2020 Ingår i: European Journal of Physiotherapy. - : Taylor & Francis. - 2167-9169 .- 2167-9177. ; 22:4, s. 197-205 Tidskriftsartikel (refereegranskat)abstract Background: Immigrants often experience difficulties with acculturation and post migratory stress after arrival in a host country and studies report poor health, chronic pain and depression. This is a challenge for primary health care and interventions need to be evaluated.Objectives: To explore the experiences of a group of women from Somalia who took part in a multimodal pain rehabilitation programme in primary healthcare in Northern Sweden.Methods: Seven individual interviews a few months after participation, and a focus group discussion one year after the programme were conducted and analysed with Grounded theory.Results: A core category regained life emerged from the data. This was described as a process in two categories: panic and connection. The participants experienced that the programme was helpful and that the pain was reduced. They became more open-minded; got new ideas and knowledge; were helped to improve their societal adaptation and integration; experienced that they were not alone; and learned that there is benefits when a group of people share experiences and feelings.Conclusions: Multimodal pain rehabilitation can be helpful for women immigrants from Somalia. The programme triggered positive changes in their lives and they received knowledge about how to manage pain and improved their self-confidence and health.
36.	Spinord, Linda, et al. (författare) Finding self-worth : Experiences during a multimodal rehabilitation program when living at a residency away from home 2020 Ingår i: Canadian Journal of Pain - Revue canadienne de la douleur. - : Taylor & Francis. - 2474-0527. ; 4:1, s. 237-246 Tidskriftsartikel (refereegranskat)abstract BackgroundPatients with chronic pain who live in rural areas often need to travel long distances to participate in multimodal rehabilitation programs. To reduce traveling during the programs, patients sometimes live at a residency close to the clinic and thus far from home.AimsThe aim of this study was to explore how patients with chronic pain experience participation in an Multimodal rehabilitation program while living at a residencyMethodTwelve patients from two specialist clinics in northern Sweden were interviewed about their experiences of participating in multimodal rehabilitation program. The data were analysed qualitatively using a grounded theory method with an emergent design.ResultsThe analyses resulted in a model with the core category “Finding my self-worth” consisting of four categories: “Space for myself”, “Mirroring myself”, “I am of value” and “Dealing with returning to everyday life”. The model illustrates the process whereby participants are given space for themselves and an opportunity to mirror themselves in interaction with other participants. That provided insight about their self-worth which was valuable for return to everyday life at home and work.ConclusionLiving at a residency during multimodal rehabilitation provided added value when patients were relived from the obligations of everyday life at home, and given time for reflection and interaction with others in similar situations. This contributed to awareness of their own value and the necessity of taking care of themselves. This new insight led to increased motivation to act differently at home.
37.	Spinord, Linda, 1973- (författare) Multimodal rehabilitation for patients with chronic pain in northern Sweden, focusing on gender and age 2021 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract The overall aim of this thesis was to study outcomes and experiences of multimodal rehabilitation programmes (MMRP) for patients with chronic pain in northern Sweden, focusing on gender and age. This thesis is based on four studies that used both quantitative and qualitative methods. The quantitative studies (I-III) investigated patient-reported outcome measures (PROM) from the Swedish Quality Registry for Pain Rehabilitation (SQRP) collected during 2011-2016 at two specialist clinics in northern Sweden. Adults aged 18-65 years were included, n=436 (356 women and 83 men), divided into three age groups (18-30, 31-45 and 46-65 years of age). Data from the two programmes at three measurement occasions were used, at the start of MMRP, immediately after MMRP and at one-year follow-up. Descriptive and multivariate statistics were used in Studies I-III.The analyses were performed separately for women, men and three different age groups. In Study I, the analysis was performed in two steps: in the first step the two patient populations in the two MMRPs were analysed separately and in the next step, the patients in the two programmes were analysed together. In Studies (II-III), the patient in the programmes were analysed together. In Study IV, a qualitative design was used to explore how patients with chronic pain experienced staying at a residency during participation in MMRP. In Study IV, a grounded theory method with emergent design was used for data collection and analysis. Individual semi-structured interviews with 12 patients (8 women and 4 men) with experiences of MMRP were conducted.In Study I, patients improved regardless of the design of the MMRP in terms of pain intensity, emotional functioning, activity and physical functioning at the one-year follow-up. For both programmes, the women were found to improve in more variables than the men did.In Study II, all subgroups (men, women and age groups) improved in terms of pain intensity and emotional functioning immediately after MMRP. The results revealed that the men showed greater short-term improvements than the women did. The women improved in more variables at one-year follow-up than the men did. The youngest age group was found to have greater positive effects of MMRP in terms of pain intensity and emotional functioning, immediately after MMRP and at one-year follow-up, than the other two age groups.In Study III, a number of interacting factors influenced whether patients participating in MMRP ended up on full-time sick leave at one-year follow-up, or not. Sick leave at start was an important factor for all subgroups. For women at start, low physical functioning, low health-related quality of life, low work importance and low affective distress were related to full-time sick leave at one-year follow-up. The results showed that unemployed men who reported widespread pain were related to full-time sick leave at one-year follow-up. The 31-45 years age group, which reported high pain intensity, low emotional functioning and low activity and physical functioning, was related to full-time sick leave at one-year follow-up. Those in the 46-65 years age group with low education, low work importance, low belief in recovery and long duration of pain were found to be related to full-time sick leave at one-year follow-up.In Study IV, the analysis resulted in a core category “Finding my self-worth”, consisting of the four categories: “Space for myself”, “Mirroring myself”, “I am of value” and “Dealing with returning to everyday life”. The results showed that the patients who stayed at a residency during MMRP were more likely to be released from the obligations of chores in their everyday life at home. This created space and time for reflection and interaction with others. The patients’ participation in MMRP while staying at a residency contributed to experiences of awareness of their own value and the significance of taking care of themselves and changing their behaviour after returning home.In conclusion, the results showed that MMRP seems to be an effective method of treating patients with chronic pain, in terms of reduced pain, improved emotional functioning, activity and physical functioning and health. The results also revealed that men seemed to need more support after MMRP to sustain the effects of MMRP while woman were more likely to sustain the positive effects at one-year follow-up. Full-time sick leave for patients with chronic pain at one-year follow-up can be affected by a number of interacting factors and these factors differ for women, men and different age groups. The opportunity to be released from everyday obligations, enjoy time for reflection and interaction with others can contribute to personal awareness which facilitates the implementation of changes at home following MMRP.
38.	Spinord, Linda, et al. (författare) Multivariate correlations between pain, life interference, health-related quality of life and full-time sick leave 1 year after multimodal rehabilitation, focus on gender and age 2022 Ingår i: Scandinavian Journal of Occupational Therapy. - : Taylor & Francis. - 1103-8128 .- 1651-2014. ; 29:8, s. 645-659 Tidskriftsartikel (refereegranskat)abstract BackgroundChronic pain is a major and complex health condition associated with reduced work performance. A multimodal rehabilitation programme (MMRP) is a common intervention for chronic pain conditions, the goal being for the person to maintain or return to work.AimTo investigate the multivariate relationships between health-related quality of life, life interference, pain, physiological factors before MMRP and full-time sick leave 1 year after MMRP.Material and MethodsData were collected from the Swedish Quality Registry for Pain Rehabilitation. The study included 284 participants. Separate analyses were performed for women, men and three age groups.ResultsThere were correlations between sick leave, physical functioning, pain duration, health-related quality of life, and self-assessed importance of work before MMRP and sick leave 1 year after MMRP. The patterns of factors associated with full-time sick leave varied for women, men and age groups.ConclusionsThese findings indicate that full-time sick leave for patients with chronic pain is affected by a number of interacting factors. Occupational therapy interventions aiming to develop activity skills in relation to work roles and enable patients to develop skills required to manage the physical, psychological and social demands to return to work or maintain work could be valuable to increase the possibility of attaining a sustainable work situation.
39.	Spinord, Linda, et al. (författare) Sex and Age Group Focus on Outcomes after Multimodal Rehabilitation for Patients with Chronic Pain in Northern Sweden 2022 Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden. - 1650-1977 .- 1651-2081. ; 54 Tidskriftsartikel (refereegranskat)abstract OBJECTIVES: To investigate the outcomes of a multimodal rehabilitation programme (MMRP) regarding pain intensity, emotional functioning, activity and physical functioning, social response, and health, with regard to sex and age.METHODS: This retrospective longitudinal study was based on data from patients at 2 specialist pain clinics in northern Sweden immediately after MMRP (short-term) and at 1-year follow-up (long-term). Data from 439 patients were analysed according to sex and to age groups 18-30, 31-45 and 46-65 years.RESULTS: The men improved with larger effect sizes (ESs) than women immediately after MMRP. The youngest age group showed improvements with greater ESs compared with the older age groups, both in the short and long term. Social support decreased for both women and men and in all 3 age groups in the long term. Improvements in both the short and long term were found in pain intensity, emotional functioning, and activity and physical functioning, in both women and men, as well as the different age groups.CONCLUSION: Both women and men with chronic pain, and from all of the different age groups, benefitted from MRRP. Since improvements for men were not sustained over time, they may need further support after the programme.
40.	Stam, Henk J., et al. (författare) Covid-19 and post intensive care syndrome : a call for action 2020 Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 52:4 Tidskriftsartikel (refereegranskat)abstract Although we are currently overwhelmed by the astonishing speed of infection of the Covid-19 pandemic, and the daily onslaught of new, and ever-worsening predictions, it is vital that we begin to prepare for the aftershocks of the pandemic. Prominent among this will be the cohort of post-intensive case survivors who have been mechanically ventilated and will like experience short- and medium-term consequences. The notion that patients surviving intensive care and mechanical ventilation for several weeks can be discharged home without further medical attention is a dangerous illusion. Post Intensive Care Syndrome and other severe conditions will require not only adequate screening but early rehabilitation and other interventions. Action must be taken now to prepare for this inevitable aftershock to the healthcare system.
41.	Stenberg, Gunilla, 1968-, et al. (författare) Patients selected to participate in multimodal pain rehabilitation programmes in primary care : a multivariate cross-sectional study focusing on gender and sick leave 2020 Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter. - 1877-8860 .- 1877-8879. ; 20:3, s. 511-524 Tidskriftsartikel (refereegranskat)abstract Background and aims: A multimodal rehabilitation programme (MMRP) is an evidence-based treatment of chronic pain conditions. The complexity involved in chronic pain needs to be identified and evaluated in order to adapt the rehabilitation to patients' needs. The aim was to investigate the multivariate relationships between self-reported variables in patients with chronic pain before taking part in MMRP in primary care, with a special focus on gender and degree of sick leave.Methods: Prior to MMRP, 397 patients (339 women and 58 men) filled in a questionnaire about pain, healthcare aspects, health-related quality of life, anxiety and depression, coping, physical function, and work-related variables e.g. sick leave. Data were analysed by principal component analysis (PCA) and partial least square analysis.Results: The PCA identified four components that explained 47% of the variation in the investigated data set. The first component showed the largest variation and was primarily explained by anxiety and depression, quality of life, acceptance (activity engagement), and pain-related disability. Gender differences were only seen in one component with the pain variables having the highest loadings. Degree of sick leave was not well explained by the variables in the questionnaire.Conclusions: The questionnaire filled out by the patients prior to participation in MMRP in primary care identified much of the complexity of chronic pain conditions but there is room for improvement, e.g. regarding explanation of work-related factors. In the multivariate analysis, gender did not fall out as an important factor for how most patients answered the questions.
42.	Stucki, Gerold, et al. (författare) Reflections of the European Academy of rehabilitation medicine on the first global estimates of the need for rehabilitation and the implications for physical and rehabilitation medicine 2020 Ingår i: Journal of Rehabilitation Medicine. - : Foundation for Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 52:2 Tidskriftsartikel (refereegranskat)
43.	Svanberg, Mikael, 1958-, et al. (författare) Opioid Prescriptions in Chronic Pain Rehabilitation : A Prospective Study on the Prevalence and Association between Individual Patient Characteristics and Opioids 2021 Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 10:10 Tidskriftsartikel (refereegranskat)abstract While against recommendations, long-term opioid therapy (LTOT) for chronic pain is common. This study aimed to describe the prevalence of opioid prescriptions and to study the association of patient characteristics (demographics, pain characteristics, anxiety, depressive symptoms and pain coping) with future LTOT. The sample included N = 1334 chronic musculoskeletal pain patients, aged 18–65, who were assessed for Interdisciplinary Multimodal Pain Rehabilitation (IMMR) in Swedish specialist rehabilitation. Prescriptions were tracked across a two-year target period after assessment. In total, 9100 opioid prescriptions were prescribed to 55% of the sample (Mmedian = 6, IQR = 14). Prediction of LTOT was analyzed separately for those who did (24%) and did not (76%) receive IMMR. The odds of receiving opioids was similar for these subsamples, after controlling for differences in baseline characteristics. In both samples, there were significant associations between patient characteristics and future opioid prescriptions. Dysfunctional pain coping was a unique predictor of LTOT in those who received IMMR while pain intensity and depressive symptoms were unique predictors in those who did not receive IMMR. The results underscore that opioid treatment is common among patients in chronic pain rehabilitation and relates to pain and psychological factors. Understanding in detail why these factors relate to opioid prescription patterns is an important future study area as it is a prerequisite for better management and fundamental for preventing overuse.
44.	Uhlin, Karin, et al. (författare) Healthcare professionals' experiences and perspectives of team-based interdisciplinary pain rehabilitation with immigrants requiring an interpreter : A qualitative study 2023 Ingår i: Disability and Rehabilitation. - : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 45:15, s. 2434-2445 Tidskriftsartikel (refereegranskat)abstract Purpose: There is a lack of knowledge about interprofessional rehabilitation for culturally diverse patients with chronic pain. This study explores experiences of healthcare professionals developing and working with rehabilitation with patients in need of an interpreter and their experience of working with interpreters.Methods: Twelve healthcare professionals at two Swedish specialist rehabilitation centres were interviewed. Grounded theory principles were used for the data collection and analysis.Results: The main category "Demanding and Meaningful Work" represents three concurrently interacting categories: “Frustration” includes the informants’ doubts regarding the benefits of the rehabilitation, lack of care for patients and cultural dissonance between professionals and patients. "Challenges" describes problems in the rehabilitation work due to the need for interpreted mediated communication, the complexity in health status and social aspects among the patients. "Solutions" represents practical working methods and personal approaches developed by the informants for managing frustrations and challenges.Conclusions: The informants’ frustration and challenges when working with a new group of patients, vulnerable and different in their preconceptions, led to new solutions in working methods and approaches. When starting a pain rehabilitation programme for culturally diverse patients, it is important to consider the rehabilitation team’s need for additional time and support.IMPLICATIONS FOR REHABILITATION Healthcare professionals who encounter immigrants with chronic pain need resources to develop their own skills in order to handle complex ethical questions as the patients represent a vulnerable patient group with many low status identities In order to adapt rehabilitation programmes to patient groups with different languages and pre-understandings of chronic pain, there is a need for a team with specific qualities, i.e., close cooperation, an innovative atmosphere, time and also support from experts For appropriate language interpretation it is important to have a professional interpreter and a healthcare professional who are aware of and adopt the rules, possibilities and restrictions of interpretation The rehabilitation of patients in need of language interpretation needs more time and organisation compared to the rehabilitation of patients who speak the national language.
45.	Uhlin, Karin, et al. (författare) Interdisciplinary pain rehabilitation for immigrants with chronic pain who need language interpretation 2024 Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden. - 1650-1977 .- 1651-2081. ; 56 Tidskriftsartikel (refereegranskat)abstract Objective: To investigate outcomes in patients with chronic pain after participation in an interdisciplinary pain rehabilitation programme with language interpreters, and to investigate the outcomes in women and men separately.Design: Prospective multi-centre cohort study. Patients: Ninety-five patients in Sweden with chronic pain who have insufficient knowledge of the Swedish language.Methods: Duration and intensity of pain, anxiety and depression, health-related quality of life and fear of movement were evaluated before and after the pro-gramme. Patients were compared with a reference group comprising Swedish-speaking patients participating in an ordinary interdisciplinary pain rehabilitation programme.Results: Before the interdisciplinary pain rehabilitation programme with language interpreters, all variables except pain duration differed significantly to the detriment of the studied group. The studied group showed significant improvements after the interdisciplinary pain rehabilitation programme with language interpreters, with regards to pain inten-sity, depression and fear of movement. The reference group improved significantly for all variables. The women in the studied group showed significant improvements for the same variables as the whole group, while the men in the studied group did not improve in any of the variables.Conclusion: This study indicates that patients with chronic pain, and especially women, who have insufficient knowledge of Swedish seem to benefit from participating in an interdisciplinary pain rehabilitation programme with language interpreters. The result may be of value for the further development of rehabilitation programmes with language interpreters.
46.	Wågberg, Sophia, et al. (författare) Gender and age differences in outcomes after mild traumatic brain injury 2023 Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 12:15 Tidskriftsartikel (refereegranskat)abstract Many people who suffer traumatic brain injury (TBI) have long-term residual symptoms. This study evaluates post-TBI symptoms and disabilities seven to eight years after mild TBI (mTBI), with specific aims to evaluate gender and age differences, and whether repeated TBI leads to the deterioration of symptoms and function. Telephone interviews with 595 patients were conducted using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) to assess post-TBI symptoms, and the Glasgow Outcome Scale Extended (GOSE) was used to assess disability. Thirty-four percent reported post-concussion symptoms (40% of females and 29% of males). The symptom burden was higher in women than in men, and higher in patients with repeated TBI. The distribution of symptoms was similar for women and men. Women reported a significantly higher level of disability on GOSE; 31% had not returned fully to daily life, compared with 17% of men (p < 0.001), the biggest difference being in the age group of 25–49 years. Patients with repeated mTBI reported significantly lower scores on GOSE; 31% had not returned fully to daily life, compared with 21% of the single-TBI patients (p < 0.05). After mild TBI, one of three patients reported at least one post-TBI symptom. Women and individuals with repeated TBI presented a worse GOSE outcome. These findings have implications for clinical practice and research and should be taken into consideration when planning the rehabilitation and follow-up of mTBI patients. This also emphasises the importance of informing patients about post-concussion symptoms and when to seek healthcare.
47.	Åhlfeldt, Douglas Anderson, et al. (författare) Healthcare Professionals' Perceptions of and Attitudes towards a Standardized Content Description of Interdisciplinary Rehabilitation Programs for Patients with Chronic Pain-A Qualitative Study 2023 Ingår i: International Journal of Environmental Research and Public Health. - : Journal Issues Limited. - 1661-7827 .- 1660-4601. ; 20:9 Tidskriftsartikel (refereegranskat)abstract Interdisciplinary pain rehabilitation (IPR) is a recommended treatment for people with chronic pain. An inadequate description of the content of IPR programs makes it difficult to draw conclusions regarding their effects. The purpose of this study was to describe the perceptions and attitudes of healthcare professionals toward a content description of IPR programs for patients with chronic pain. Individual interviews with healthcare professionals (n = 11) working in IPR teams in Sweden were conducted between February and May 2019. Analysis of the interviews resulted in a theme: interdisciplinary pain rehabilitation is a complex intervention, with three categories: limitations in the description of IPR programs; lack of knowledge about IPR and chronic pain; and facilitating and hindering factors for using the content description of IPR programs. Conclusion: Healthcare professionals perceived that IPR programs could be described through a general content description. A general content description could enhance the quality of IPR programs through a better understanding of their content and a comparison of different IPR programs. Healthcare professionals also expressed the importance of a content description being a guide rather than a steering document.

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