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1.	Dufvenberg, Marlene, et al. (författare) Correction: Dufvenberg et al. Six-Month Results on Treatment Adherence, Physical Activity, Spinal Appearance, Spinal Deformity, and Quality of Life in an Ongoing Randomised Trial on Conservative Treatment for Adolescent Idiopathic Scoliosis (vol 10, 4967, 2021) 2023 Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 12:22 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
2.	Dufvenberg, Marlene, 1961-, et al. (författare) Six-Month Results on Treatment Adherence, Physical Activity, Spinal Appearance, Spinal Deformity, and Quality of Life in an Ongoing Randomised Trial on Conservative Treatment for Adolescent Idiopathic Scoliosis (CONTRAIS) 2021 Ingår i: Journal of Clinical Medicine. - Basel, Switzerland : MDPI. - 2077-0383. ; 10:21 Tidskriftsartikel (refereegranskat)abstract Adolescents with idiopathic scoliosis (AIS) often receive conservative treatments aiming to prevent progression of the spinal deformity during puberty. This study aimed to explore patient adherence and secondary outcomes during the first 6 months in an ongoing randomised controlled trial of three treatment interventions. Interventions consisted of physical activity combined with either hypercorrective Boston scoliosis night brace (NB), scoliosis-specific exercise (SSE), or physical activity alone (PA). Measures at baseline and 6 months included angle of trunk rotation (ATR), Cobb angle, International Physical Activity Questionnaire short form (IPAQ-SF), pictorial Spinal Appearance Questionnaire (pSAQ), Scoliosis Research Society (SRS-22r), EuroQol 5-Dimensions Youth (EQ-5D-Y) and Visual Analogue Scale (EQ-VAS). Patient adherence, motivation, and capability in performing the intervention were reported at 6 months. The study included 135 patients (111 females) with AIS and >1-year estimated remaining growth, mean age 12.7 (1.4) years, and mean Cobb angle 31 (±5.3). At 6 months, the proportion of patients in the groups reporting high to very high adherence ranged between 72 and 95%, while motivation ranged between 65 and 92%, with the highest proportion seen in the NB group (p = 0.014, p= 0.002). IPAQ-SF displayed significant between group main effects regarding moderate activity (F = 5.7; p = 0.004; ηp2 = 0.10), with a medium-sized increase favouring the SSE group compared to NB. Walking showed significant between group main effects, as did metabolic equivalent (MET-min/week), with medium (F = 6.8, p = 0.002; ηp2 = 0.11, and large (F = 8.3, p = < 0.001, ηp2 = 0.14) increases, respectively, for the SSE and PA groups compared to NB. From baseline to 6 months, ATR showed significant between group medium-sized main effects (F = 1.2, p = 0.019, ηp2 = 0.007) favouring the NB group compared to PA, but not reaching a clinically relevant level. In conclusion, patients reported high adherence and motivation to treatment, especially in the NB group. Patients in the SSE and PA groups increased their physical activity levels without other clinically relevant differences between groups in other clinical measures or patient-reported outcomes. The results suggest that the prescribed treatments are viable first-step options during the first 6 months.
3.	Forsberg, Daniel, et al. (författare) Fully automatic measurements of axial vertebral rotation for assessment of spinal deformity in idiopathic scoliosis 2013 Ingår i: Physics in Medicine and Biology. - : Institute of Physics (IOP). - 0031-9155 .- 1361-6560. ; 58:6, s. 1775-1787 Tidskriftsartikel (refereegranskat)abstract Reliable measurements of spinal deformities in idiopathic scoliosis are vital, since they are used for assessing the degree of scoliosis, deciding upon treatment and monitoring the progression of the disease. However, commonly used two dimensional methods (e.g. the Cobb angle) do not fully capture the three dimensional deformity at hand in scoliosis, of which axial vertebral rotation (AVR) is considered to be of great importance. There are manual methods for measuring the AVR, but they are often time-consuming and related with a high intra- and inter-observer variability. In this paper, we present a fully automatic method for estimating the AVR in images from computed tomography. The proposed method is evaluated on four scoliotic patients with 17 vertebrae each and compared with manual measurements performed by three observers using the standard method by Aaro-Dahlborn. The comparison shows that the difference in measured AVR between automatic and manual measurements are on the same level as the inter-observer difference. This is further supported by a high intraclass correlation coefficient (0.971-0.979), obtained when comparing the automatic measurements with the manual measurements of each observer. Hence, the provided results and the computational performance, only requiring approximately 10 to 15Â s for processing an entire volume, demonstrate the potential clinical value of the proposed method.
4.	Fritzell, Peter, et al. (författare) Bacteria : back pain, leg pain and Modic sign—a surgical multicentre comparative study 2019 Ingår i: European spine journal. - : Springer. - 0940-6719 .- 1432-0932. ; 28:12, s. 2981-2989 Tidskriftsartikel (refereegranskat)abstract Purpose: To compare bacterial findings in pain-generating degenerated discs in adults operated on for lumbar disc herniation (LDH), and mostly also suffering from low back pain (LBP), with findings in adolescent patients with non-degenerated non-pain-generating discs operated on for scoliosis, and to evaluate associations with Modic signs on magnetic resonance imaging (MRI). Cutibacterium acnes (Propionibacterium acnes) has been found in painful degenerated discs, why it has been suggested treating patients with LDH/LBP with antibiotics. As multidrug-resistant bacteria are a worldwide concern, new indications for using antibiotics should be based on solid scientific evidence.Methods: Between 2015 and 2017, 40 adults with LDH/LBP (median age 43, IQR 33–49) and 20 control patients with scoliosis (median age 17, IQR 15–20) underwent surgery at seven Swedish hospitals. Samples were cultured from skin, surgical wound, discs and vertebrae. Genetic relatedness of C. acnes isolates was investigated using single-nucleotide polymorphism analysis. DNA samples collected from discs/vertebrae were analysed using 16S rRNA-based PCR sequencing. MRI findings were assessed for Modic changes.Results: No bacterial growth was found in 6/40 (15%) LDH patients, compared with 3/20 (15%) scoliosis patients. Most positive samples in both groups were isolated from the skin and then from subcutis or deep within the wound. Of the four disc and vertebral samples from each of the 60 patients, 235/240 (98%) were DNA negative by bacterial PCR. A single species, C. acnes, was found exclusively in the disc/vertebra from one patient in each group. In the LDH group, 29/40 (72%) patients had at least one sample with growth of C. acnes, compared to 14/20 (70%) in the scoliosis group. Bacterial findings and Modic changes were not associated.Conclusions: Cutibacterium acnes found in discs and vertebrae during surgery for disc herniation in adults with degenerated discs may be caused by contamination, as findings in this group were similar to findings in a control group of young patients with scoliosis and non-degenerated discs. Furthermore, such findings were almost always combined with bacterial findings on the skin and/or in the wound. There was no association between preoperative Modic changes and bacterial findings. Antibiotic treatment of lumbar disc herniation with sciatica and/or low back pain, without signs of clinical discitis/spondylitis, should be seriously questioned.
5.	Öhrn, Annica, et al. (författare) Adverse events in spine surgery in Sweden : A comparison of patient claims data and national quality register (Swespine) data 2011 Ingår i: Acta Orthopaedica. - : Informa. - 1745-3674 .- 1745-3682. ; 82:6, s. 727-731 Tidskriftsartikel (refereegranskat)abstract Background and purpose: Our knowledge of complications and adverse events in spinal surgery is limited, especially concerning incidence and consequences. We therefore investigated adverse events in spine surgery in Sweden by comparing patient claims data from the County Councils' Mutual Insurance Company register with data from the National Swedish Spine Register (Swespine).Methods: We analyzed patient claims (n = 182) to the insurance company after spine surgery performed between 2003 and 2005. The medical records of the patients filing these claims were reviewed and compared with Swespine data for the same period.Results: Two-thirds (119/182, 65%) of patients who claimed economic compensation from the insurance company were registered in Swespine. Of the 210 complications associated with these 182 claims, only 74 were listed in Swespine. The most common causes of compensated injuries (n = 139) were dural lesions (n = 40) and wound infections (n = 30). Clinical outcome based on global assessment, leg pain, disability, and quality of health was worse for patients who claimed economic compensation than for the total group of Swespine patients.Interpretation: We found considerable under-reporting of complications in Swespine. Dural lesions and infections were not well recorded, although they were important reasons for problems and contributed to high levels of disability. By analyzing data from more than one source, we obtained a better understanding of the patterns of adverse events and outcomes after spine surgery.
6.	Öhrn, Annika, et al. (författare) Flest vårdskador inom ortopedi, visar Patientförsäkringen. Skadepanorama och vårdkonsumtion för denna patientgrupp har klartlagts. 2006 Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 103, s. 534-539 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
7.	Öhrn, Annica, et al. (författare) What can we learn from patient claims? : Analysing of patient injuries following orthopaedic surgery 2012 Ingår i: Patient Safety in Surgery. - : Springer Science and Business Media LLC. - 1754-9493. ; 6:2, s. 1-6 Tidskriftsartikel (refereegranskat)abstract Background: Objective data on the incidence and pattern of adverse events after orthopaedic surgical procedures remain scarce, secondary to the reluctance for encompassing reporting of surgical complications. The aim of this study was to analyze the nature of adverse events after orthopaedic surgery reported to a national database for patient claims in Sweden.Methods: In this retrospective review data from two Swedish national databases during a 4-year period were analyzed. We used the "County Councils' Mutual Insurance Company", a national no-fault insurance system for patient claims, and the "National Patient Register at the National Board of Health and Welfare".Results: A total of 6,029 patient claims filed after orthopaedic surgery were assessed during the study period. Of those, 3,336 (55%) were determined to be adverse events, which received financial compensation. Hospital-acquired infections and sepsis were the most common causes of adverse events (n = 741; 22%). The surgical procedure that caused the highest rate of adverse events was "decompression of spinal cord and nerve roots" (code ABC**), with 168 adverse events of 17,507 hospitals discharges (1%). One in five (36 of 168; 21.4%) injured patient was seriously disabled or died.Conclusions: We conclude that patients undergoing spinal surgery run the highest risk of being severely injured and that these patients also experienced a high degree of serious disability. The most common adverse event was related to hospital acquired infections. Claims data obtained in a no-fault system have a high potential for identifying adverse events and learning from them.
8.	Anderson, Mattias, et al. (författare) Limited angular remodelling after in-situ fixation for slipped capital femoral epiphysis 2024 Ingår i: BMC Musculoskeletal Disorders. - : BMC. - 1471-2474. ; 25:1 Tidskriftsartikel (refereegranskat)abstract BackgroundIn Sweden, most children with slipped capital femoral epiphysis (SCFE) are operated on with a single smooth pin or a short-threaded screw, allowing further growth of the femoral neck. Using the Swedish Pediatric Orthopaedic Quality registry, SPOQ, we investigated whether angular remodelling occurs adjacent to the proximal femoral epiphysis after fixation of SCFE using implants, allowing continued growth of the femoral neck.MethodsDuring 2008-2010 a total national population of 155 children were reported to the SPOQ registry. Following our strict inclusion criteria, radiographs of 51 hips were further assessed. The lateral Head Shaft Angle (HSA), the Notzli 3-point alpha-angle, the anatomic alpha-angle, and the Anterior Offset Ratio (AOR) on the first postoperative radiographs and at follow-up were measured to describe the occurrence of remodelling. Slip severity was categorised as mild, moderate or severe according to postoperative HSA.ResultsMean and SD values for the change in HSA were 3,7 degrees (5,0 degrees), for 3-point alpha-angle 6,8 degrees (8,9 degrees), and anatomic alpha-angle 13,0 degrees (16,3 degrees). The overall increase in AOR was 0,038 (0.069). There were no significant differences between the slip severity groups.ConclusionsWe found limited angular remodelling after in situ fixation with smooth pins or short threaded screws for SCFE. The angular remodelling and the reduction of the CAM deformity was less than previously described after fixation of SCFE with similar implants. Results about the same magnitude with non-growth sparing techniques suggest that factors other than longitudinal growth of the femoral neck are important for angular remodelling.
9.	Berg, Svante, 1953-, et al. (författare) Disc height and motion patterns in the lumbar spine in patients treated with total disc replacement or fusion for discogenic back pain : Results from a randomized controlled trial 2011 Ingår i: The spine journal. - : Elsevier. - 1529-9430 .- 1878-1632. ; 11:11, s. 991-998 Tidskriftsartikel (refereegranskat)abstract Study Design. Comparison of X-ray measurements in a randomized controlled trial between instrumented posterior fusion (N=72) and total disc replacement (TDR) (N=80) for chronic low back pain assumed to be discogenic. Results were compared to clinical outcome. Objective. To see if surgical goals for respective treatments had been reached, if clinical outcome was related to this, and if differences in disc height and adjacent segment motion patterns between groups occurred. Summary of Background Data. Fusion is considered the “gold standard” in surgical treatment of degenerated disc disease, though the resulting stiffness may induce degeneration in adjacent segments. TDR aims to restore and maintain mobility by replacing a painful disc. Little is known about the degree and quality of mobility in artificial discs in vivo, and whether maintained mobility reduces stress on adjacent segments. Methods. Flexion-extension X-rays were analyzed pre- and two years postoperatively using Distortion Compensated Roentgen Analysis (DCRA) at treated and adjacent levels, mobility following fusion and TDR was estimated. Changes in disc height and changes in mobility patterns in adjacent segments were compared. The results were compared with clinical outcome regarding back pain. Results. 78% of fused patients had no mobility whereas 89% of TDR-patients were mobile, but with less than normal mobility. The fulfilment of surgical goals was not correlated to clinical outcome. Fused segments were lower and TDR-segments were higher than normal. There were minor differences, there being more translation or flexion-extension at adjacent levels in the fusion group than in the TDR group. Conclusions. This very accurate X-ray method (DCRA) indicates that surgical goals were reached in most patients. This however, was not correlated to outcome. Differences between the groups in postoperative disc height and motion patterns at adjacent segments may lead to differences in outcome in the long-term perspective, but this was not detectable after two years.
10.	Berg, Svante, 1953- (författare) On Total Disc Replacement 2010 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Low back pain consumes a large part of the community’s resources dedicated to health care and sick leave. Back disorders also negatively affect the individual leading to pain suffering, decreased quality-of-life and disability. Chronic low back pain (CLBP) due to degenerative disc disease (DDD) is today often treated with fusion when conservative treatment has failed and symptoms are severe. This treatment is as successful as arthroplasty is for hip arthritis in restoring the patient’s quality of life and reducing disability. Even so, there are some problems with this treatment, one of these being recurrent CLBP from an adjacent segment (ASD) after primarily successful surgery. This has led to the development of alternative surgical treatments and devices that maintain or restore mobility, in order to reduce the risk for ASD. Of these new devices, the most frequently used are the disc prostheses used in Total Disc Replacement (TDR).This thesis is based on four studies comparing total disc replacement with posterior fusion. The studies are all based on a material of 152 patients with DDD in one or two segments, aged 20-55 years that were randomly treated with either posterior fusion or TDR.The first study concerned clinical outcome and complications. Follow-up was 100% at both one and two years. It revealed that both treatment groups had a clear benefit from treatment and that patients with TDR were better in almost all outcome scores at one-year follow-up. Fusion patients continued to improve during the second year. At two-year follow-up there was a remaining difference in favour of TDR for back pain. 73% in the TDR group and 63% in the fusion group were much better or totally pain-free (n.s.), while twice as many patients in the TDR group were totally pain free (30%) compared to the fusion group (15%).Time of surgery and total time in hospital were shorter in the TDR group.There was no difference in complications and reoperations, except that seventeen of the patients in the fusion group were re-operated for removal of their implants.The second study concerned sex life and sexual function. TDR is performed via an anterior approach, an approach that has been used for a long time for various procedures on the lumbar spine. A frequent complication reported in males when this approach is used is persistent retrograde ejaculation. The TDR group in this material was operated via an extra-peritoneal approach to the retroperitoneal space, and there were no cases of persistent retrograde ejaculation. There was a surprisingly high frequency of men in the fusion group reporting deterioration in ability to have an orgasm postoperatively.Preoperative sex life was severely hampered in the majority of patients in the entire material, but sex life underwent a marked improvement in both treatment groups by the two-year follow-up that correlated with reduction in back pain.The third study was on mobility in the lumbar spinal segments, where X-rays were taken in full extension and flexion prior to surgery and at two-year follow-up. Analysis of the films showed that 78% of the patients in the fusion group reached the surgical goal (non-mobility) and that 89% of the TDR patients maintained mobility.Preoperative disc height was lower than in a normative database in both groups, and remained lower in the fusion group, while it became higher in the TDR group. Mobility in the operated segment increased in the TDR group postoperatively. Mobility at the rest of the lumbar spine increased in both treatment groups. Mobility in adjacent segments was within the norm postoperatively, but slightly larger in the fusion group.In the fourth study the health economics of TDR vs Fusion was analysed. The hospital costs for the procedure were higher for patients in the fusion group compared to the TDR group, and the TDR patients were on sick-leave two months less.In all, these studies showed that the results in the TDR group were as good as in the fusion group. Patients are more likely to be totally pain-free when treated with TDR compared to fusion. Treatment with this new procedure seems justified in selected patients at least in the short-term perspective. Long-term follow-up is underway and results will be published in due course.
11.	Berg, Svante, et al. (författare) Sex life and sexual function in men and women before and after total disc replacement compared with posterior lumbar fusion 2009 Ingår i: The spine journal. - : Elsevier BV. - 1529-9430 .- 1878-1632. ; 9:12, s. 987-994 Tidskriftsartikel (refereegranskat)abstract Background contextSex life and sexual function may be affected by low back pain (LBP). Sexual dysfunction after anterior lumbar fusion is reported in both men and women, but focus is mainly on impaired male biological function (retrograde ejaculation) as this may cause infertility. This has led to concern as to whether anterior surgery should be employed in men, at least in younger age groups.PurposeTo investigate how chronic low back pain (CLBP) of assumed discogenic origin affects sex life and sexual function in patients considered for surgical treatment, whether this is affected by surgical treatment (total disc replacement [TDR] or posterolateral fusion [PLF]/posterior lumbar interbody fusion [PLIF]), and if so, are there differences between the surgical procedures undertaken.Study designA randomized controlled trial comparing TDR and instrumented lumbar spine fusion, performed either as a PLF or PLIF.Patient sampleOne hundred fifty-two patients were included in this randomized controlled trial to compare the effect on CLBP of either TDR via an anterior retroperitoneal approach or instrumented posterior lumbar fusion, PLF or PLIF.Outcome measuresGlobal assessment of back pain, back pain (visual analog scale [VAS] 0-100), function (Oswestry Disability Index [ODI] 0–100), quality of life (EQ5D [EuroQol] 0–1), and answers on specific sexual function.MethodsOutcome was assessed using data from the Swedish Spine Register (SweSpine). In ODI, one question, ODI 8, reflects the impact of back pain on sex life. This question was analyzed separately. Patients also answered a gender-specific questionnaire preoperatively and at the 2-year follow-up to determine any sexual dysfunction regarding erection, orgasm, and ejaculation. Follow-up was at 1 and 2 years.ResultsBefore surgery, 34% reported that their sex life caused some extra LBP, and an additional 30% that their sex life was severely restricted by LBP. After surgery, sex life improved in both groups, with a strong correlation to a reduction of LBP. The gender-specific questionnaire used to measure sexual function after 2 years revealed no negative effect of TDR or Fusion in men regarding erection or retrograde ejaculation. However, 26% of all men in the Fusion group, compared with 3% in the TDR group, reported postoperative deterioration in the ability to achieve orgasm, despite a reduction of LBP.ConclusionsImpairment of sex life appears to be related to CLBP. An improvement in sex life after TDR or lumbar fusion was positively correlated to a reduction in LBP. Total disc replacement in this study, performed through an anterior retroperitoneal approach, was not associated with greater sexual dysfunction compared with instrumented lumbar fusion performed either as a PLF or as a PLIF. Sexual function, expressed as orgasm, deteriorated in men in the Fusion group postoperatively, in spite of this group reporting less LBP after 2 years.
12.	Berg, Svante, et al. (författare) Total disc replacement compared to lumbar fusion : a randomised controlled trial with 2-year follow-up 2009 Ingår i: EUROPEAN SPINE JOURNAL. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 18:10, s. 1512-1519 Tidskriftsartikel (refereegranskat)abstract The study design includes a prospective, randomised controlled study comparing total disc replacement (TDR) with posterior fusion. The main objective of this study is to compare TDR with lumbar spinal fusion, in terms of clinical outcome, in patients referred to a spine clinic for surgical evaluation. Fusion is effective for treating chronic low back pain (LBP), but has drawbacks, such as stiffness and possibly adjacent level degradation. Motion-preserving options have emerged, of which TDR is frequently used because of these drawbacks. How the results of TDR compare to fusion, however, is uncertain. One hundred and fifty-two patients with a mean age of 40 years (21-55) were included: 90 were women, and 80 underwent TDR. The patients had not responded to a conservative treatment programme and suffered from predominantly LBP, with varying degrees of leg pain. Diagnosis was based on clinical examination, radiographs, MRI, and in unclear cases, diagnostic injections. Outcome measures were global assessment (GA), VAS for back and leg pain, Oswestry Disability Index, SF36 and EQ5D at 1 and 2 years. Follow-up rate was 100%, at both 1 and 2 years. All outcome variables improved in both groups between preoperative and follow-up assessment. The primary outcome measure, GA, revealed that 30% in the TDR group and 15% in the fusion group were totally pain-free at 2 years (P = 0.031). TDR patients had reached maximum recovery in virtually all variables at 1 year, with significant differences compared to the fusion group. The fusion patients continued to improve and at 2 years had results similar to TDR patients apart from numbers of pain-free. Complications and reoperations were similar in both groups, but pedicle screw removal as additive surgery, was frequent in the fusion group. One year after surgery, TDR was superior to spinal fusion in clinical outcome, but this difference had diminished by 2 years, apart from (VAS for back pain and) numbers of pain-free. The long-term benefits have yet to be examined.
13.	Brink, Rob C., et al. (författare) Anterior Spinal Overgrowth Is the Result of the Scoliotic Mechanism and Is Located in the Disc 2017 Ingår i: Spine. - : LIPPINCOTT WILLIAMS & WILKINS. - 0362-2436 .- 1528-1159. ; 42:11, s. 818-822 Tidskriftsartikel (refereegranskat)abstract Study Design. Cross-sectional study. Objective. To investigate the presence and magnitude of anterior spinal overgrowth in neuromuscular scoliosis and compare this with the same measurements in idiopathic scoliosis and healthy spines. Summary of Background Data. Anterior spinal overgrowth has been described as a potential driver for the onset and progression of adolescent idiopathic scoliosis (AIS). Whether this anterior overgrowth is specific for AIS or also present in nonidiopathic scoliosis has not been reported. Methods. Supine computed tomography (CT) scans of thirty AIS patients (thoracic Cobb 21-81 degrees), thirty neuromuscular (NM) scoliotic patients (thoracic Cobb 19-101 degrees) and 30 nonscoliotic controls were used. The difference in length in per cents between the anterior and posterior side {[(Delta A-P)/P] * 100%, abbreviated to A-P%} of each vertebral body and intervertebral disc, and between the anterior side of the spine and the spinal canal (A-C%) were determined. Results. The A-P% of the thoracic curves did not differ between the AIS (+1.2 perpendicular to 2.2%) and NM patients (+0.9 +/- 4.1%, P = 0.663), both did differ, however, from the same measurements in controls (-3.0 +/- 1.6%; Pamp;lt; 0.001) and correlated linearly with the Cobb angle (AIS r = 0.678, NM r = 0.687). Additional anterior length was caused by anterior elongation of the discs (AIS: A-P% disc +17.5 +/- 12.7% vs. A-P% body - 2.5 +/- 2.6%; Pamp;lt; 0.001, NM: A-P% disc + 19.1 +/- 18.0% vs. A-P% body -3.5 +/- 5.1%; Pamp;lt; 0.001). The A-C% T1-S1 in AIS and NM patients were similar (+ 7.9 +/- 1.8% and + 8.7 +/- 4.0%, P = 0.273), but differed from the controls (+4.2 +/- 3.3%; Pamp;lt; 0.001). Conclusion. So called anterior overgrowth has been postulated as a possible cause for idiopathic scoliosis, but apparently it occurs in scoliosis with a known origin as well. This suggests that it is part of a more generalized scoliotic mechanism, rather than its cause. The fact that the intervertebral discs contribute more to this increased anterior length than the vertebral bodies suggests an adaptation to altered loading, rather than a primary growth disturbance.
14.	Brink, Rob C., et al. (författare) Three-dimensional pelvic incidence is much higher in (thoraco)lumbar scoliosis than in controls 2019 Ingår i: European spine journal. - Heidelberg : Springer. - 0940-6719 .- 1432-0932. ; 28:3, s. 544-550 Tidskriftsartikel (refereegranskat)abstract PurposeThe pelvic incidence (PI) is used to describe the sagittal spino-pelvic alignment. In previous studies, radiographs were used, leading to less accuracy in establishing the three-dimensional (3D) spino-pelvic parameters. The purpose of this study is to analyze the differences in the 3D sagittal spino-pelvic alignment in adolescent idiopathic scoliosis (AIS) subjects and non-scoliotic controls.MethodsThirty-seven female AIS patients that underwent preoperative supine low-dose computed tomography imaging of the spine, hips and pelvis as part of their general workup were included and compared to 44 non-scoliotic age-matched female controls. A previously validated computerized method was used to measure the PI in 3D, as the angle between the line orthogonal to the inclination of the sacral endplate and the line connecting the center of the sacral endplate with the hip axis.ResultsThe PI was on average 46.8° ± 12.4° in AIS patients and 41.3° ± 11.4° in controls (p = 0.025), with a higher PI in Lenke type 5 curves (50.6° ± 16.2°) as compared to controls (p = 0.042), whereas the Lenke type 1 curves (45.9° ± 12.2°) did not differ from controls (p = 0.141).ConclusionLenke type 5 curves show a significantly higher PI than controls, whereas the Lenke type 1 curves did not differ from controls. This suggests a role of pelvic morphology and spino-pelvic alignment in the pathogenesis of idiopathic scoliosis. Further longitudinal studies should explore the exact role of the PI in the initiation and progression of different AIS types.
15.	Daghighi, Abtin, et al. (författare) Computed tomography lung volume estimation and its relation to lung capacities and spine deformation 2019 Ingår i: Journal of spine surgery (Hong Kong). - : OSS Press Ltd. - 2414-4630 .- 2414-469X. ; 5:1, s. 132-141 Tidskriftsartikel (refereegranskat)abstract Scoliosis is a three-dimensional deformity which is believed to impact lung function, mechanics of respiratory muscles, lung compliance, etc. It is thus of interest to investigated the relationship between degree of scoliosis in terms of apex rotation or Cobb angle respectively and normalized vital capacity (VC). Furthermore it is interesting to study the possibility of estimating lung volumes (and indirectly lung function) using CT volumetric reconstruction.
16.	Daghighi, Abtin, et al. (författare) F.E.M. Stress-Investigation of Scolios Apex 2018 Ingår i: Open Biomedical Engineering Journal. - : Bentham Open. - 1874-1207. ; 12, s. 51-71 Tidskriftsartikel (refereegranskat)abstract In scoliosis, kypholordos and wedge properties of the vertebrae should be involved in determining how stress is distributed in the vertebral column. The impact is logically expected to be maximal at the apex.
17.	De Kleuver, Marinus, et al. (författare) Defining a core outcome set for adolescent and young adult patients with a spinal deformity A collaborative effort for the Nordic Spine Surgery Registries 2017 Ingår i: Acta Orthopaedica. - : TAYLOR & FRANCIS LTD. - 1745-3674 .- 1745-3682. ; 88:6, s. 612-618 Tidskriftsartikel (refereegranskat)abstract Background and purpose - Routine outcome measurement has been shown to improve performance in several fields of healthcare. National spine surgery registries have been initiated in 5 Nordic countries. However, there is no agreement on which outcomes are essential to measure for adolescent and young adult patients with a spinal deformity. The aim of this study was to develop a core outcome set (COS) that will facilitate benchmarking within and between the 5 countries of the Nordic Spinal Deformity Society (NSDS) and other registries worldwide. Material and methods - From August 2015 to September 2016, 7 representatives (panelists) of the national spinal surgery registries from each of the NSDS countries participated in a modified Delphi study. With a systematic literature review as a basis and the International Classification of Functioning, Disability and Health framework as guidance, 4 consensus rounds were held. Consensus was defined as agreement between at least 5 of the 7 representatives. Data were analyzed qualitatively and quantitatively. Results - Consensus was reached on the inclusion of 13 core outcome domains: "satisfaction with overall outcome of surgery", "satisfaction with cosmetic result of surgery", "pain interference", physical functioning", "health-related quality of life", "recreation and leisure", "pulmonary fatigue", "change in deformity", "selfimage", "pain intensity", "physical function", "complications", and "re-operation". Panelists agreed that the SRS-22r, EQ-5D, and a pulmonary fatigue questionnaire (yet to be developed) are the most appropriate set of patient-reported measurement instruments that cover these outcome domains. Interpretation - We have identified a COS for a large subgroup of spinal deformity patients for implementation and validation in the NSDS countries. This is the first study to further develop a COS in a global perspective.
18.	de Reuver, Steven, et al. (författare) Anterior lengthening in scoliosis occurs only in the disc and is similar in different types of scoliosis 2020 Ingår i: The spine journal. - : ELSEVIER SCIENCE INC. - 1529-9430 .- 1878-1632. ; 20:10, s. 1653-1658 Tidskriftsartikel (refereegranskat)abstract BACKGROUND CONTEXT: Relative anterior spinal overgrowth was proposed as a generalized growth disturbance and a potential initiator of adolescent idiopathic scoliosis (AIS). However, anterior lengthening has also been observed in neuromuscular (NM) scoliosis and was shown to be restricted to the apical areas and located in the intervertebral discs, not in the bone. This suggests that relative anterior spinal overgrowth does not rightfully describe anterior lengthening in scoliosis, as it seems not a generalized active growth phenomenon, nor specific to AIS. PURPOSE: To determine if compensatory curves in congenital scoliosis exhibit a mechanism of anterior lengthening without changes in the vertebral body, similar to curves in AIS and NM scoliosis. STUDY DESIGN/SETTING: Cross-sectional. PATIENT SAMPLE: CT-scans were included of patients in whom a short segment congenital malformation had led to a long thoracic compensatory curve without bony abnormality. Based on data of other scoliosis types, the calculated required sample size was n=12 to detect equivalence of vertebral bodies as compared with nonscoliotic controls. Out of 143 congenital scoliosis patients, 18 fit the criteria and compared with 30 nonscoliotic controls, 30 AIS and 30 NM scoliosis patients. OUTCOME MEASURES: The anterior-posterior length discrepancy (AP%) of the total curve and for vertebral bodies and intervertebral discs separately. METHODS: Of each vertebral body and intervertebral disc in the compensatory curve, the anterior and posterior length was measured on CT-scans in the exact mid-sagittal plane, corrected for deformity in all three planes. The AP% was calculated for the total compensatory curve (Cobb-to-Cobb) and for the vertebral bodies and the intervertebral discs separately. Positive AP% indicated that the anterior side was longer than the posterior side. RESULTS: The total AP% of the compensatory curve in congenital scoliosis showed lordosis (+1.8%) that differed from the kyphosis in nonscoliotic controls (-3.0%; p<.001) and was comparable to the major curve in AIS (+1.2%) and NM scoliosis (+0.5%). This anterior lengthening was not located in the bone; the vertebral body AP% showed kyphosis (-3.2%), similar to nonscoliotic controls (-3.4%) as well as AIS (-2.5%) and NM scoliosis (-4.5%; p=1.000). However, the disc AP% showed lordosis (+24.3%), which sharply contrasts to the kyphotic discs of controls (-1.5%; p<.001), but was similar to AIS (+17.5%) and NM scoliosis (+20.5%). CONCLUSIONS: The current study on compensatory curves in congenital scoliosis confirms that anterior lengthening is part of the three-dimensional deformity in different types of scoliosis and is exclusively located in the intervertebral discs. The bony vertebral bodies maintain their kyphotic shape, which indicates that there is no active anterior bony overgrowth. Anterior lengthening appears to be a passive result of any scoliotic deformity, rather than being related to the specific cause of AIS. (C) 2020 Elsevier Inc. All rights reserved.
19.	Dufvenberg, Marlene, 1961- (författare) Adolescent Idiopathic Scoliosis : Postural Stability, Prognostic factors and Impact of Conservative Treatments on Radiologic, Clinical and Self-Reported Outcomes 2024 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Background: Adolescent idiopathic scoliosis (AIS) is a three-dimensional distortion of spinal curvature of unknown cause that develops during puberty. If the frontal plane curvature exceeds a Cobb angle of 24°, full-time bracing is recommended to prevent curve progression, negative health consequences or need for surgery. However, many patients decline full-time bracing, and limited evidence exists regarding alternative conservative treatments. Increasing knowledge of risk factors enables better identification of high-risk patients, thereby reducing the risk of over- or undertreatment. The overall aim of this thesis was to evaluate evidence of association between scoliosis and postural stability to inform a potential treatment target, to investigate the effectiveness of three alternative conservative treatments for patients who declined full-time bracing, and to develop a prognostic model for future risk of increased curvature in AIS. Methods: Data collection is based on one systematic literature review and meta-analysis, and one randomised controlled trial (RCT) for patients with AIS. In Paper I, literature was reviewed, and utilized posturography data to assess static postural stability to identify potential differences between patients with AIS and the control group (CON). In Papers II and III, patients were randomly assigned to either physical activity combined with hypercorrective Boston scoliosis night brace (NB), scoliosis-specific exercises (SSE), or a control group with physical activity alone (PA). Effects on trunk rotation, Cobb angle, self-reported physical activity, spinal appearance, and health-related quality of life were evaluated. Likewise, adherence, capability, and motivation in performing self-managed treatment were assessed. Follow-up was conducted at 6 months intervals until endpoint. The endpoint was defined as non-progression if the curvature increased by 6° or less at skeletal maturity, i.e., less than 1cm of growth over 6 months, or progression if the curvature increased by more than 6° before skeletal maturity. In Paper IV, data from the RCT were used for a longitudinal cohort analysis, developing and validating a prognostic model using Cox Proportional Hazards survival analysis. Results: Paper I found reduced postural stability in AIS patients compared to CON with increased sway area, mediolateral and anteroposterior range, and a posterior shift in the sagittal plane. The RCT included 135 individuals, mean age of 12.7 years (SD1.4) and Cobb angle of 31° (SD5.3). At 6 months, patients reported high adherence (72-95%) and motivation (65-92%) to the treatment, particularly in the NB group. Both the SSE and PA groups increased physical activity levels compared to the NB group. At endpoint, adherence remained adequate, but better in the NB and PA groups compared with the SSE group (50-89%). Adherence increased with higher capability and motivation, which explained 53% of the variance in adherence at endpoint. The SSE group had higher proportion of moderate problems in mobility and usual activities than the NB and PA groups, with no other clinically relevant between-group differences. The prognostic model (n=127) for curve progression showed acceptable discriminative ability (0.791), with risk factors including skeletal immaturity, larger major curve, and worsening spinal appearance. The model was adjusted for treatment exposure, as NB reduced the risk of curve progression. Conclusions: Patients with AIS have decreased postural stability with a posterior positional shift. Treatment evaluation at endpoint showed few between-group differences. However, the SSE group had higher proportion of moderate problems in mobility and usual activities compared to the other groups. Treatment adherence was adequate, but better in the NB and PA groups. Higher capability and motivation increased long-term adherence to the treatment. The treatment alternatives could be considered as the first option following a clinical decision on treatment. Including self-reported spinal appearance as a risk factor in the prognostic model may be clinically important for predicting which patients are at risk of curve progression.
20.	Ellinger, Frank, et al. (författare) Magnetically controlled growing rod treatment for early-onset scoliosis: analysis of 52 consecutive cases demonstrates improvement of coronal deformity 2023 Ingår i: Journal of spine surgery (Hong Kong). - : OSS Press Ltd. - 2414-4630 .- 2414-469X. ; 9:3, s. 259-268 Tidskriftsartikel (refereegranskat)abstract Background: The purpose of this study was to report the radiographic results and complications of magnetically controlled growing rod (MCGR) treatment in patients with early-onset scoliosis (EOS).Methods: Patient records and radiographs from a consecutive series of patients treated with MCGR for EOS at two Swedish institutions were reviewed retrospectively. Radiographic analysis included Cobb angle, T1-T12 height, T1-S1 height, thoracic kyphosis, and lung height. Subgroup analyses were performed on primary versus conversion cases and single versus dual rods using one-way analysis of variance (ANOVA) and independent samples t-test.Results: Fifty-two cases treated with MCGR (24 single rods, 28 dual rods) were included from local surgical records into this cohort study, 32 primary and 20 converted from other growth friendly surgical treatment. Mean age at MCGR implantation was 7.4 (2.0-14.6) years old in the primary group and 9.3 (5.0-16.1) years old in the converted group. Mean follow-up time was 3.7 (2.0-7.6) years. Mean (standard deviation; SD) Cobb angle of the major curve changed from 62° (17°) preoperatively to 42° (16°) postoperatively to 46° (18°) at final follow-up (P<0.001). Mean (SD) overall thoracic kyphosis changed from 41° (19°) preoperatively to 32° (14°) postoperatively to 39° (17°) at final follow-up (P=0.018). Mean T1-T12 height was 177 mm (34 mm) preoperatively, 183 mm (35 mm) immediate postoperative and 199 mm (35 mm) at final follow-up (P=0.047). The mean T1-T12 height increased significantly in the primary group but not in the converted group. The number of surgeries was 114 (78 planned, 36 unplanned). The rate of unplanned surgeries did not differ significantly between single and dual rods. The total number of complications was 70 of which 38 were implant related. The overall mean complication rate was 1.4 (0-4). There were no significant differences in complication rates between subgroups.Conclusions: MCGR treatment enabled and maintained correction of spinal deformity while allowing spinal growth. There were no significant differences in complication rates or unplanned surgeries between the groups treated with single or dual rods.
21.	Eriksson, Thérèse, et al. (författare) A pain relieving reimbursement program? Effects of a value-based reimbursement program on patient reported outcome measures 2020 Ingår i: BMC Health Services Research. - : BMC. - 1472-6963. ; 20:1 Tidskriftsartikel (refereegranskat)abstract Background Value-based reimbursement programs have become increasingly common. However, little is known about the effect of such programs on patient reported outcomes.Thus, the aim of this study was to analyze the effect of introducing a value-based reimbursement program on patient reported outcome measures and to explore whether a selection bias towards less complicated patients occurred. Methods This is a retrospective observational study with a before and after design based on the introduction of a value-based reimbursement program in Region Stockholm, Sweden. We analyzed patient level data from inpatient and outpatient care of patients undergoing lumbar spine surgery during 2006-2015. Patient reported outcome measures used was Global Assessment, EQ-5D-3L and Oswestry Disability Index. The case-mix of surgically treated patients was analyzed using medical and socioeconomic factors. Results The value-based reimbursement program did not have any effect on targeted or non-targeted patient reported outcome measures. Moreover, the share of surgically treated patients with risk factors such as having comorbidities and being born outside of Europe increased after the introduction. Hence, the value-based reimbursement program did not encourage discrimination against sicker patients. However, the income was higher among patients surgically treated after the introduction of the value-based reimbursement. This indicates that a value-based reimbursement program may contribute to increased inequalities in access to healthcare. Conclusions The value-based reimbursement program did not have any effect on patient reported outcome measures. Our study contributes to the understanding of the effects of a value-based reimbursement program on patient reported outcome measures and to what extent cherry-picking arises.
22.	Eriksson, Thérèse, et al. (författare) Correction: A pain relieving reimbursement program? Effects of a value-based reimbursement program on patient reported outcome measures (vol 20, 805, 2020) 2020 Ingår i: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 20:1 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract An amendment to this paper has been published and can be accessed via the original article.
23.	Eriksson, Thérèse, 1988- (författare) Promises and pitfalls of value-based reimbursement in healthcare : A mixed method health economic approach 2021 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Financial incentives can be an effective tool to influence behaviour in almost any context and healthcare is no exception. The healthcare market is, however complex, characterised by uncertainty, information asymmetry and multiple agency connections. The reach and limits of financial incentives in healthcare has been widely debated for decades. Some argue that financial incentives increase efficient use of scarce resources, while others voice that it provides a hotbed for unintended and unethical behaviour. A well-functioning value-based reimbursement programme (VBRP) should facilitate alignment between financial incentives and professional values to secure both efficient and equitable healthcare. This thesis explores the promises and pitfalls of value-based reimbursement in the context of a value-based reimbursement programme within elective spine surgery in Region Stockholm, Sweden. By using mixed methods, this thesis explores what incentives arise from introducing a value-based reimbursement programme and how these incentives affect the provision of healthcare services. This thesis consists of four papers. Paper I examines the performance of healthcare providers (spine surgery clinics) on patient-reported outcome measures after the introduction of a value-based reimbursement programme and whether it has any effect on case mix regarding clinical and socio-economic factors. Paper II examines how a value-based reimbursement programme affects the cost of elective spine surgery to a third party payer/regional authority. Paper III explores how the intended incentives of the reimbursement programme was perceived by healthcare providers. In Paper IV, institutional logics within healthcare-providing organisations are identified and how their centrality and compatibility affect the institutionalisation of a value-based reimbursement programme in Region Stockholm. The results show that the VBRP had no effect on patient-reported outcome measures but decreased the mean cost per surgery. Thus, elective spine surgery in Region Stockholm may be considered more effective after the introduction of the VBRP. The removal of a production ceiling allowed healthcare providers to surgically treat more patients than was previously possible. The volume increased by 22 per cent, and the total cost increased by 11 percent. No indications of discrimination against sicker patients were found. A higher value was generated in elective spine surgery after the introduction of the VBRP. The idea of a VBRP was aligned with professional values. However, not all incentives were perceived as intended. The focus on minimising costs of post-discharge care was perceived to have a negative impact on quality aspects of physiotherapy and nursing. Taken together, a well-designed VBRP has the potential to promote a holistic healthcare perspective through 1) the level to which healthcare providers are held accountable for healthcare provision that increase the willingness to collaborate across healthcare providers and medical disciplines, 2) a better overall picture of patients healthcare utilisation and 3) challenging the traditional structures and ideas within healthcare that quality foremost depends on the performance of physicians. However, there are also challenges that needs to be addressed, 1) functioning routines for communication and follow-up between healthcare providers and the regional health authority, 2) to get different professions within a traditional hierarchical organisation to cooperate on equal terms, and 3) to create IT systems that create transparency and an understanding of the reimbursement programme. Continuous communication between healthcare providers and the regional health authority is therefore crucial to make the incentives of the reimbursement programme meaningful.
24.	Fritzell, P, et al. (författare) Correction to: Bacteria: back pain, leg pain and Modic sign-a surgical multicenter comparative study 2020 Ingår i: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. - : Springer Science and Business Media LLC. - 1432-0932 .- 0940-6719. ; 29:1, s. 196-197 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
25.	Fritzell, Peter, et al. (författare) Cost effectiveness of disc prosthesis versus lumbar fusion in patients with chronic low back pain: randomized controlled trial with 2-year follow-up : 2011 Ingår i: European spine journal. - : Springer. - 0940-6719 .- 1432-0932. ; 20:7, s. 1001-1011 Tidskriftsartikel (refereegranskat)abstract When low back pain becomes chronic, surgery is sometimes performed. The gold standard today is lumbar fusion (FUS), using a variety of procedures. Total disc replacement (TDR) aimed at motion preservation is increasing in popularity. This randomized controlled health economic study assesses the cost-effectiveness of TDR (Charité/Prodisc/Maverick) compared with instrumented FUS (posterior lumbar fusion (PLF)/posterior lumbar interbody fusion (PLIF). Social and healthcare perspectives after two years are reported. In all, 152 patients were randomized to either TDR (n=80) or FUS (n=72). Cost to society, (total mean cost/patient, Swedish kronor=SEK, standard deviation) for TDR was SEK 599,560 (400,272), and for FUS SEK 685,919 (422,903) (ns). TDR was significantly less costly from a healthcare perspective, SEK 22,996 (43,055- -1,202). Number of days on sick leave among those who returned to work was 185 (146) in the TDR group, and 252 (189) in the FUS group (ns). Using EQ-5D, the total gain in quality adjusted life years (QALYs) over two years was 0.41 units for TDR and 0.40 units for FUS (ns). Based on EQ-5D, the incremental cost effectiveness ratio (ICER) of using TDR instead of FUS was difficult to analyze due to the “non-difference” in treatment outcome, which is why cost/QALY could not be defined. Using cost-effectiveness probabilistic analysis, the net benefit with CI) was found to be SEK 91,359 (-73,643 – 249,114) (ns). Conclusion: It is not possible to state whether TDR or FUS is more cost-effective after two years. Since disc replacement and lumbar fusion are based on different conceptual approaches, it is important to follow these results over time.
26.	Fritzell, Peter, et al. (författare) Cost-effectiveness of lumbar fusion and nonsurgical treatment for chronic low back pain in the Swedish lumbar spine study : A multicenter, randomized, controlled trial from the Swedish Lumbar Spine Study Group 2004 Ingår i: Spine. - : Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 29:4, s. 421-434 Tidskriftsartikel (refereegranskat)abstract Study Design. A cost-effectiveness study was performed from the societal and health care perspectives. Objective. To evaluate the costs-effectiveness of lumbar fusion for chronic low back pain (CLBP) during a 2-year follow-up. Summary of Background Data. A full economic evaluation comparing costs related to treatment effects in patients with CLBP is lacking. Patients and Methods. A total of 284 of 294 patients with CLBP for at least 2 years were randomized to either lumbar fusion or a nonsurgical control group. Costs for the health care sector ( direct costs), and costs associated with production losses ( indirect costs) were calculated. Societal total costs were identified as the sum of direct and indirect costs. Treatment effects were measured using patient global assessment of improvement, back pain ( VAS), functional disability (Owestry), and return to work. Results. The societal total cost per patient ( standard deviations) in the surgical group was significantly higher than in the nonsurgical group: Swedish kroner (SEK) 704,000 ( 254,000) vs. SEK 636,000 ( 208,000). The cost per patient for the health care sector was significantly higher for the surgical group, SEK 123,000 ( 60,100) vs. 65,200 ( 38,400) for the control group. All treatment effects were significantly better after surgery. The incremental cost-effectiveness ratio ( ICER), illustrating the extra cost per extra effect unit gained by using fusion instead of nonsurgical treatment, were for improvement: SEK 2,600 ( 600 - 5,900), for back pain: SEK 5,200 ( 1,100 - 11,500), for Oswestry: SEK 11,300 ( 1,200 - 48,000), and for return to work: SEK 4,100 ( 100 21,400). Conclusion. For both the society and the health care sectors, the 2-year costs for lumbar fusion was significantly higher compared with nonsurgical treatment but all treatment effects were significantly in favor of surgery. The probability of lumbar fusion being cost-effective increased with the value put on extra effect units gained by using surgery.
27.	Gauffin, Håkan, et al. (författare) Function testing in patients with old rupture of the anterior cruciate ligament 1990 Ingår i: International Journal of Sports Medicine. - : Georg Thieme Verlag KG. - 0172-4622 .- 1439-3964. ; 11:1, s. 73-77 Tidskriftsartikel (refereegranskat)abstract Fifteen patients with isolated old rupture of the anterior cruciate ligament (ACL) were examined to judge their functional disability. The following basic factors were used for evaluation: thigh muscle strength testing, stabilometry in a one-leg stance with straight and flexed knee, gait analysis, performance tests, knee function score, activity grading scale, and clinical joint laxity tests. We found that these rehabilitated patients mainly had impaired performance in those tests which greatly stressed the knee joint's sagittal stability. One-leg hop length was impaired for the injured limb. This group of patients had bilateral impairment of postural control compared with a reference group. This dysfunction was not revealed when comparing limbs. A derotation brace (ECKO) had neither a positive nor a negative effect in the tests. Different aspects of knee function evaluation are emphasized. Some of the altered functions are suggested to be due to central adjustments of motor control.
28.	Joelson, Anders, 1970- (författare) High-grade spondylolisthesis in young patients : Long-term results of in situ fusion 2020 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract The purpose of this long-term follow-up of 38 of 40 consecutive patients was to evaluate the results of uninstrumented in situ fusion for high-grade isthmic spondylolisthesis three decades after surgery. The mean age at surgery was 14 (range 9-24) years. The first of four studies evaluated clinical outcome, function, work status, and health-related quality of life (HRQoL) after in situ fusion in relation to age-matched Swedish population data. The second study evaluated effects on sagittal balance after in situ fusion. The third study evaluated adjacent segment disk degeneration after in situ fusion. The fourth study evaluated self-imageand HRQoL after in situ fusion in relation to healthy controls.The main findings were that (1) young patients fused in situ for highgrade isthmic spondylolisthesis have long-term HRQoL similar to the general Swedish population and controls matched for age and gender, (2) signs of non-compensated sagittal imbalance were observed only ina few individuals whereas compensated sagittal balance was the norm, (3) there was no correlation between any radiographic sagittal balance parameter and HRQoL outcome, (4) there was only a minor reduction inadjacent segment disk height which had no impact on HRQoL outcome, and (5) the only patient reported outcome measure indicating a detrimental effect at long-term follow-up was self-assessed trunk appearance which was slightly negatively affected.
29.	Larsson, Eva-Lena, et al. (författare) Long-term follow-up of functioning after spinal surgery in patients with Rett syndrome 2009 Ingår i: European spine journal(European spine journal(ISSN 0940-6719)(EISSN 1432-0932). - : Springer. - 0940-6719 .- 1432-0932. ; 18:4, s. 506-511 Tidskriftsartikel (refereegranskat)abstract In a prospective study, 23 consecutive girls with Rett syndrome and neuromuscular scoliosis were evaluated for functioning at a long-term follow-up. The patients had mostly improved, which was confirmed by their parents. Rett syndrome is associated with neuromuscular scoliosis and has a typically long C-shaped thoracolumbar kyphoscoliosis. Prospective long-term follow-up studies related to these patients total situation are sparse. Most studies focus on the Cobb angle of the scoliosis, whereas parents are mainly concerned about the girls continued functioning. Twenty-three patients with Rett syndrome and neuromuscular scoliosis were evaluated preoperatively from 1993 to 2002. At follow-up, 19 patients remained in the study. Three patients died (not due to surgery), and one patient could not participate because it was too far to travel. Mean follow-up time was 74 months (range 49-99 months). The assessments comprised the sitting balance, seating supports in wheelchair, weight distribution, time used for rest, care given, and angle of scoliosis. Follow-up questionnaires and two-open-ended questions about the positive and negative effects of surgery were sent to parents. Sitting balance, number of seating supports in wheelchair, weight distribution, time used for rest, and the Cobb angle had all improved after surgery. The parents assessed improvement in seating position, daily activities, time used for rest, and cosmetic appearance. We can conclude that the stabilized spine resulted in sufficient strength to keep the body upright with the possibility of looking around at the surroundings more easily. The girls got better seating position with less need for seating adaptations in the wheelchair and with reduced time needed for resting during the day. Finally we can conclude that the indication for surgery is to get a better posture which lead to less risk of pressure sores, and that un upright position lead to better possibility to easily breath with fewer episodes of pneumonia and a better general health as result. The evidence of positive surgical effects for girls with Rett syndrome is of great importance in indication for surgery in the decision-making process.
30.	Laslett, Mark, 1950-, et al. (författare) Agreement between diagnoses reached by clinical examination and available reference standards : A prospective study of 216 patients with lumbopelvic pain 2005 Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 6 Tidskriftsartikel (refereegranskat)abstract Background: The tissue origin of low back pain (LBP) or referred lower extremity symptoms (LES) may be identified in about 70% of cases using advanced imaging, discography and facet or sacroiliac joint blocks. These techniques are invasive and availability varies. A clinical examination is non-invasive and widely available but its validity is questioned. Diagnostic studies usually examine single tests in relation to single reference standards, yet in clinical practice, clinicians use multiple tests and select from a range of possible diagnoses. There is a need for studies that evaluate the diagnostic performance of clinical diagnoses against available reference standards. Methods: We compared blinded clinical diagnoses with diagnoses based on available reference standards for known causes of LBP or LES such as discography, facet, sacroiliac or hip joint blocks, epidurals injections, advanced imaging studies or any combination of these tests. A prospective, blinded validity design was employed. Physiotherapists examined consecutive patients with chronic lumbopelvic pain and/or referred LES scheduled to receive the reference standard examinations. When diagnoses were in complete agreement regardless of complexity, "exact" agreement was recorded. When the clinical diagnosis was included within the reference standard diagnoses, "clinical agreement" was recorded. The proportional chance criterion (PCC) statistic was used to estimate agreement on multiple diagnostic possibilities because it accounts for the prevalence of individual categories in the sample. The kappa statistic was used to estimate agreement on six pathoanatomic diagnoses. Results: In a sample of chronic LBP patients (n = 216) with high levels of disability and distress, 67% received a patho-anatomic diagnosis based on available reference standards, and 10% had more than one tissue origin of pain identified. For 27 diagnostic categories and combinations, chance clinical agreement (PCC) was estimated at 13%. "Exact" agreement between clinical and reference standard diagnoses was 32% and "clinical agreement" 51%. For six pathoanatomic categories (disc, facet joint, sacroiliac joint, hip joint, nerve root and spinal stenosis), PCC was 33% with actual agreement 56%. There was no overlap of 95% confidence intervals on any comparison. Diagnostic agreement on the six most common patho-anatomic categories produced a kappa of 0.31. Conclusion: Clinical diagnoses agree with reference standards diagnoses more often than chance. Using available reference standards, most patients can have a tissue source of pain identified. © 2005 Laslett et al, licensee BioMed Central Ltd.
31.	Laslett, Mark, 1950-, et al. (författare) Clinical predictors of screening lumbar zygapophyseal joint blocks : development of clinical prediction rules 2006 Ingår i: The spine journal. - : Elsevier BV. - 1529-9430 .- 1878-1632. ; 6:4, s. 370-379 Tidskriftsartikel (refereegranskat)abstract Background: Only controlled intra-articular zygapophyseal joint (ZJ) injections or medial branch blocks can diagnose ZJ-mediated low back pain. The low prevalence of ZJ pain implies that identification of clinical predictors of a positive response to a screening block is needed. Purpose: To estimate the predictive power of clinical findings in relation to pain reduction after screening ZJ blocks. Study design: As part of a wider prospective blinded study investigating diagnostic accuracy of clinical variables, a secondary analysis was carried out to seek evidence of variables potentially valuable as predictors of screening ZJ block outcomes. Patient sample: Chronic low back pain patients received screening ZJ blocks (n=151) with 120 patients included in the analysis after exclusions. Outcome measures: Pain intensity was measured using a 100-mm visual analog scale, and responses were categorized according to 75% through 95% or more pain reduction in 5% increments. Methods: Patients completed pain drawings, questionnaires, and a clinical examination before screening lumbar ZJ blocks. History, demographic and clinical variables were evaluated in cross tabulation and regression analyses with diagnostic accuracy values calculated for variables and variable clusters in relation to different pain reduction standards. Results: At the 75% pain reduction standard, 24.5% responded to screening ZJ blocks and 10.8% responded at the 95% standard. The centralization phenomenon is not associated with pain reduction using any standard. No variables were useful predictors of post-ZJ block pain reduction of less than 90%. Seven clinical findings were associated with 95% pain reduction after blocks. Five useful clinical prediction rules (CPRs) were found for ruling out a 95% pain reduction (100% sensitivity), and one CPR had a likelihood ratio of 9.7, producing a fivefold improvement in posttest probability. Conclusions: A negative extension rotation test, the centralization phenomenon, and four CPRs effectively rule out pain ablation after screening ZJ block. One CPR generates a fivefold improvement in posttest probability of a negative or positive response to ZJ block. © 2006 Elsevier Inc. All rights reserved.
32.	Laslett, Mark, et al. (författare) Clinical predictors of screening lumbar zygapophysial joint blocks : a prospective study of chronic low back pain patients Annan publikation (övrigt vetenskapligt/konstnärligt)abstract Background A screening block followed by a confrrmatory block using different anesthetic agent is a common method used to identify the zygapophysial joint (ZJ) as a tissue origin of LBP. While previous studies have identified potentially valuable clinical tests, identification of patients unlikely to respond to the initial screeuing block is desirable.Purpose To estimate the predictive power of specific clinical findings in relation to screening ZJ blocks.Study DesignA prospective blioded study carried was out in a private radiology clinic specializing in the diagnosis of spinal pain.Patient sampleChronic LBP patients received screening ZJ blocks (N=151) with 120 patients included in the analysis after exclusions.Outcome MeasuresPre and post procedure pain intensity was measured using a standardized VAS. A 95% reduction in pain following ZJ block was defmed as a positive response.Methods Patients completed pain drawings, psychosocial distress and disability questionnaires. Thereafter they received a clinical examination and screening lumbar zygapophysial blocks. History, demographic and clinical variables were evaluated in logistic regression models with sensitivity, specificity and likelihood ratios being calculated for potentially useful variables.Results A positive screeulng ZJ block was reported by 10.8% of patients. Sensivity of the extension rotation test was 100% and specificity 22%. No positive responders reported centralization or peripheralization of pain. The best predictors of a positive response to ZJ block were: age over 55 (odds ratio 3.55, p=0.06); report that walking (odds ratio 4.79, p=0.02) and sitting (odds ratio 4.27, p=0.04) were the best activities for pain.Conclusions A negative extension rotation test, centralization or peripheralization can rule out ZJ mediated pain. Age over 55 and report of walking and sitting being the best activities for pain, are associated with a positive response to screening ZJ blocks.
33.	Laslett, Mark, et al. (författare) Strength of agreement between diagnoses reached by clinical examination and available reference standards : a prospective validity study of 216 patients with lumbopelvic pain and/or symptoms referred into the lower extremity Annan publikation (övrigt vetenskapligt/konstnärligt)abstract Background The tissue origin of low back pain (LBP) or referred lower extremity symptoms (LES) may be identified in about 70% of cases using advanced imaging, discography and facet or sacroiliac joint blocks. These techniques are invasive and availability varies. A clinical examination is non-invasive and widely available but its validity is questioned. Diagnostic studies usually examine tests in relation to single reference standards, yet in clinical practice, clinicians select from a range of possible diagnoses. There is a need for studies that evaluate the diagnostic performance of clinical diagnoses against available reference standards.Methods We compared blinded clinical diagnoses with diagnoses based on available reference standards for known causes of LBP or LES such as discography, facet, sacroiliac or hip joint blocks, epidurals injections, advanced imaging studies or any combination of these tests. A prospective, blinded validity design was employed. Physiotherapists examined consecutive patients with chronic lumbopelvic pain and/or referred LES scheduled to receive the reference standard examinations. When diagnoses were in complete agreement regardless of complexity, "exact" agreement was recorded. When the clinical diagnosis was included within the reference standard diagnoses, "clinical agreement" was recorded. The proportional chance criterion (PCC) statistic was used to estimate agreement on multiple diagnostic possibilities because it accounts for the prevalence of individual categories in the sample. The kappa statistic was used to estimate agreement on six pathoanatomic diagnoses.Results In a sample of chronic LBP patients (n=216) with high levels of disability and distress, 67% received a patho-anatomic diagnosis based on available reference standards, and 10% had more than one tissue origin of pain identified. For 27 diagnostic categories and combinations, chance clinical agreement (PCC) was estimated at 13.3%. "Exact" agreement between clinical and reference standard diagnoses was 31.9% and "clinical agreement" 51.4%. For six pathoanatomic categories (disc, facet joint, sacroiliac joint, hip joint, nerve root and spinal stenosis), PCC was 33.5% with actual agreement 56.2%. There was no overlap of 95% confidence intervals on any comparison. Diagnostic agreement on the six most common patho-anatornic categories produced a kappa of 0.31 (0.18, 0.44).Conclusions Clinical diagnoses agree with reference standards diagnoses more often than chance. Using available reference standards, most patients can have a tissue source of pain identified.
34.	Lindbäck, Yvonne, 1967-, et al. (författare) Altered somatosensory profile according to quantitative sensory testing in patients with degenerative lumbar spine disorders scheduled for surgery 2017 Ingår i: BMC Musculoskeletal Disorders. - : BIOMED CENTRAL LTD. - 1471-2474. ; 18 Tidskriftsartikel (refereegranskat)abstract Background: Somatosensory profiling in affected and non-affected body regions can strengthen our insight regarding the underlying pain mechanisms, which can be valuable in treatment decision making and to improve outcomes, in patients with degenerative lumbar spine disorders pre-surgery. The aim was to describe somatosensory profiles in patients with degenerative lumbar spine disorders, to identify the proportion with altered somatosensory profile, and to analyze demographic characteristics, self-reported function, pain, and health pre- and 3 months post-surgery. Methods: In this prospective cohort study in a Spine Clinic, 105 patients scheduled for surgery for spinal stenosis, disc herniation, degenerative disc disease, or spondylolisthesis were consecutively recruited. Exclusion criteria were; indication for acute surgery or previous surgery at the same spinal level or severe grade of pathology. Quantitative sensory testing (QST) and self-reported function, pain, and health was measured pre- and 3 months post-surgery. The somatosensory profile included cold detection threshold, warmth detection threshold, cold pain threshold, heat pain threshold and pressure pain threshold in affected and non-affected body regions. Results: On a group level, the patients somatosensory profiles were within the 95% confidence interval (CI) from normative reference data means. On an individual level, an altered somatosensory profile was defined as having two or more body regions (including a non-affected region) with QST values outside of normal ranges for reference data. The 23 patients (22%) with altered somatosensory profiles, with mostly loss of function, were older (P = 0.031), more often female (P = 0.005), had higher back and leg pain (P = 0.016, 0.020), lower mental health component summary score (SF 36 MCS) (P = 0.004) and larger pain distribution (P = 0.047), compared to others in the cohort. Post-surgery there was a tendency to worse pain, function and health in the group with altered somatosensory profile pre-surgery. Conclusions: On a group level, patients with degenerative lumbar spine disorders scheduled for surgery were within normal range for the QST measurements compared to reference values. On an individual level, an altered somatosensory profile outside of normal range in both affected and non-affected body regions occurred in 22% of patients, which may indicate disturbed somatosensory function. Those patients had mostly loss of sensory function and had worse self-reported outcome pre-surgery, compared to the rest of the cohort. Future prospective studies are needed to further examine whether these dimensions can be useful in predicting post-surgery outcome and guide need of additional treatments.
35.	Lindbäck, Yvonne, 1967-, et al. (författare) Association between pain sensitivity in the hand and outcomes after surgery in patients with lumbar disc herniation or spinal stenosis. 2017 Ingår i: European spine journal. - : Springer. - 0940-6719 .- 1432-0932. ; 26:10, s. 2581-2588 Tidskriftsartikel (refereegranskat)abstract PURPOSE: To investigate the association between pain sensitivity in the hand pre-surgery, and patient-reported outcomes (PROs) in function, pain and health pre- and post-surgery in patients with disc herniation or spinal stenosis.METHODS: This is a prospective cohort study with 82 patients. Associations between pressure-, cold- and heat pain threshold (PPT, CPT, HPT) in the hand pre-surgery and Oswestry, VAS pain, EQ-5D, HADS, and Self-Efficacy Scale, pre- and three months post-surgery; were investigated with linear regression.RESULTS: Patients with disc herniation more sensitive to pressure pain pre-surgery showed lower function and self-efficacy, and higher anxiety and depression pre-surgery, and lower function, and self-efficacy, and higher pain post-surgery. Results for cold pain were similar. In patients with spinal stenosis few associations with PROs were found and none for HPT and PROs.CONCLUSIONS: Altered pain response in pressure- and cold pain in the hand, as a sign of widespread pain pre-surgery had associations with higher pain, lower function and self-efficacy post-surgery in patients with disc herniation.
36.	Lindbäck, Yvonne, 1967- (författare) Pre-surgery physiotherapy and pain thresholds in patients with degenerative lumbar spine disorders 2018 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Background: Patients scheduled for spinal surgery often experience long duration of pain, which may influence the pain-regulation system, function and health and have an impact on post-surgery outcome. Prehabilitation potentially augments functional capacity before surgery, which may have beneficial effects after surgery.Aim: The overall aim of the thesis is to study pre-surgery physiotherapy and somatosensory function in patients with degenerative lumbar spine disorders and to explore the patients’ experiences of pre-surgery physiotherapy.Methods: Somatosensory function was measured with quantitative sensory testing (QST). Pre-surgery physiotherapy was evaluated with patient-reported outcome measures (n = 197). Patients’ experiences of how symptoms are explained and their experiences of the influences on back-related health after pre-surgery physiotherapy were explored.Results: Half of the patients reported back or leg pain for more than 2 years. On a group level, the somatosensory profiles were within the reference range. On an individual level, an altered somatosensory profile was found in 23/105 patients, these were older, more often women, and reported higher pain, larger pain distribution and worse SF-36 MCS (mental health component summary). Patients with disc herniation, more sensitive to pressure pain in the hand presurgery, was associated with poorer function, self-efficacy, anxiety and depression score pre-surgery, worse function, self-efficacy and leg pain 3 months post-surgery and worse health related quality of life, self-efficacy, depression score 1 year postsurgery. The results for sensitivity for cold pain were similar, except that it even was associated with poorer function and pain 1 year post-surgery. The pre-surgery physiotherapy group had less back pain, better function, health, self-efficacy, fear avoidance score, depression score and physical activity level than the waiting-list group after the pre-surgery intervention. The effects were small. Both groups improved significantly after surgery, with no differences between groups, except that the higher physical activity level in the physiotherapy group remained at the 1-year follow-up. Only 58% of the patients reported a minimum of one visit for rehabilitation during the 1 year preceding the decision to undergo surgery. Patients experienced that pre-surgery physiotherapy had influenced symptoms, physical function, coping, well-being and social functioning to various degrees. Pre-surgery physiotherapy was experienced as a tool for reassurance and an opportunity to reflect about treatment and lifestyle. The patients mainly used biomedical explanatory models based on image reports to explain their backrelated symptoms. Both broader and more narrow, as well as lack of explanations of symptoms emerged. Further, wanting and sometimes struggling to be wellinformed about symptoms and interventions were described.Conclusions: Being more sensitive to pressure- and cold pain in the hand, as a sign of widespread pain pre-surgery, was associated with poorer function, pain and health at post-surgery in patients with disc herniation. Pre-surgery physiotherapy decreased pain, fear avoidance, improved health related quality of life; and it decreased the risk of a worsening in psychological well-being before surgery. The improvements were small, and improvements after surgery were similar for both groups. At the 1-year follow-up, the physiotherapy group still had a higher activity level than the waiting list group. The pre-surgery physiotherapy was well tolerated. Patients’ reported experiences also illustrates the influence on function, pain and health. Patients experienced that pre-surgery physiotherapy provided reassurance and gave time to reflect on treatments and lifestyle. Symptoms were mainly described in line with a biomedical explanatory model. Those using a broader explanation were confident that physiotherapy and self-management could influence their back-related symptoms.
37.	Lindbäck, Yvonne, et al. (författare) PREPARE: Pre-surgery physiotherapy for patients with degenerative lumbar spine disorder: a randomized controlled trial protocol 2016 Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central. - 1471-2474. ; 17:270 Tidskriftsartikel (refereegranskat)abstract Background: Current guidelines for the management of patients with specific low back pain pathology suggest non-surgical intervention as first-line treatment, but there is insufficient evidence to make recommendations of the content in the non-surgical intervention. Opinions regarding the dose of non-surgical intervention that should be trialled prior to decision making about surgery intervention vary. The aim of the present study is to investigate if physiotherapy administrated before surgery improves function, pain and health in patients with degenerative lumbar spine disorder scheduled for surgery. The patients are followed over two years. A secondary aim is to study what factors predict short and long term outcomes. Methods: This study is a single blinded, 2-arm, randomized controlled trial with follow-up after the completion of pre-surgery intervention as well as 3, 12 and 24 months post-surgery. The study will recruit men and women, 25 to 80 years of age, scheduled for surgery due to; disc herniation, spinal stenosis, spondylolisthesis or degenerative disc disease. A total of 202 patients will be randomly allocated to a pre-surgery physiotherapy intervention or a waiting list group for 9 weeks. The waiting-list group will receive standardized information about surgery, post-surgical rehabilitation and advice to stay active. The pre-surgery physiotherapy group will receive physiotherapy 2 times per week, consisting of a stratified classification treatment, based on assessment findings. One of the following treatments will be selected; a) Specific exercises and mobilization, b) Motor control exercises or c) Traction. The pre-surgery physiotherapy group will also be prescribed a tailor-made general supervised exercise program. The physiotherapist will use a behavioral approach aimed at reducing patient fear avoidance and increasing activity levels. They will also receive standardized information about surgery, post-surgical rehabilitation and advice to stay active. Primary outcome measure is Oswestry Disability Index. Secondary outcome measures are the visual analogue scale for back and leg pain, pain drawing, health related quality of life, Hospital anxiety and depression scale, Fear avoidance beliefs questionnaire, Self-efficacy scale and Work Ability Index. Discussion: The study findings will help improve the treatment of patients with degenerative lumbar spine disorder scheduled for surgery.
38.	Lindbäck, Yvonne, 1967-, et al. (författare) PREPARE: presurgery physiotherapy for patients with degenerative lumbar spine disorder : a randomized controlled trial 2018 Ingår i: The spine journal. - : Elsevier. - 1529-9430 .- 1878-1632. ; 18:8, s. 1347-1355 Tidskriftsartikel (refereegranskat)abstract Background ContextSurgery because of disc herniation or spinal stenosis results mostly in large improvement in the short-term, but mild to moderate improvements for pain and disability at long-term follow-up. Prehabilitation has been defined as augmenting functional capacity before surgery, which may have beneficial effect on outcome after surgery.PurposeThe aim was to study if presurgery physiotherapy improves function, pain, and health in patients with degenerative lumbar spine disorder scheduled for surgery.Study DesignA single-blinded, two-arm, randomized controlled trial (RCT).Patient SampleA total of 197 patients were consecutively included at a spine clinic. The inclusion criteria were patients scheduled for surgery because of disc herniation, spinal stenosis, spondylolisthesis, or degenerative disc disease (DDD), 25–80 years of age.Outcome MeasuresPrimary outcome was Oswestry Disability Index (ODI). Secondary outcomes were pain intensity, anxiety, depression, self-efficacy, fear avoidance, physical activity, and treatment effect.MethodsPatients were randomized to either presurgery physiotherapy or standardized information, with follow-up after the presurgery intervention as well as 3 and 12 months post surgery. The study was funded by regional research funds for US$77,342. No conflict of interest is declared.ResultsThe presurgery physiotherapy group had better ODI, visual analog scale (VAS) back pain, EuroQol-5D (EQ-5D), EQ-VAS, Fear Avoidance Belief Questionnaire-Physical Activity (FABQ-PA), Self-Efficacy Scale (SES), and Hospital Anxiety and Depression Scale (HADS) depression scores and activity level compared with the waiting-list group after the presurgery intervention. The improvements were small, but larger than the study-specific minimal clinical important change (MCIC) in VAS back and leg pain, EQ-5D, and FABQ-PA, and almost in line with MCIC in ODI and Physical Component Summary (PCS) in the physiotherapy group. Post surgery, the only difference between the groups was higher activity level in the physiotherapy group compared with the waiting-list group.ConclusionsPresurgery physiotherapy decreases pain, risk of avoidance behavior, and worsening of psychological well-being, and improves quality of life and physical activity levels before surgery compared with waiting-list controls. These results were maintained only for activity levelspost surgery. Still, presurgery selection, content, dosage of exercises, and importance of being active in a presurgery physiotherapy intervention is of interest to study further to improve long-term outcome.
39.	Lundberg, Ulf, et al. (författare) Arbetsmiljöns betydelse för ryggproblem : En systematisk litteraturöversikt 2014 Rapport (refereegranskat)abstract The Swedish Council on Health Technology Assessment (SBU) conducted a systematic literature review of research on the association between occupational exposures and back disorders. In this review, we use back disorders as an umbrella term to include the more specific terms back trouble (a subjective experience of pain, ache or discomfort in the back), symptoms of sciatica, intervertebral disc changes and diseases of the back. The report is focused on disorders of the thoracic and lumbar spine. A wide range of occupational exposures were investigated, including: physical work load, vibration, organizational and psychosocial factors, chemical and biological factors, noise, environmental factors and contagious substances.Background: Since 2011 SBU has had a mandate from the Swedish government to systematically assess the evidence associating occupational exposures to health issues. The objective of this review was to assess the scientific basis describing the influence of occupational exposures on back disorders. Back disorders are common. Between 60 and 70 percent of the general population world-wide suffer from back pain at least once in their life. For affected individuals, back disorders are the source of both suffering and decreased functioning. The costs to society are also considerable in terms of direct health care costs, financial support to individuals with work disability, as well as costs due to loss of production.Method: A systematic review was undertaken following the PRISMA statement and standard methods used by SBU adapted to an occupational context. A literature search covering years 1980 to January 2014 was conducted in international medical and occupational data bases. The review assessed almost 8 000 abstracts. Studies that fulfilled strict inclusion criteria were assessed for relevance and quality, using pre-set protocols. Relevance and quality assessments were conducted by two experts, working in an evaluation pair. After conducting independent assessments, the two experts had to agree on a mutual relevance and quality classification. Some articles required that all exporters participated in discussion and made a collective assessment. A total of 109 studies were classified as moderate or high quality, representing more than 150 000 study participants. The strength of the scientific evidence was assessed with the GRADE system.Results: There is an association between occupational exposure and back disorders. This result is based on investigations of a large variety of work environments, mainly in Europe and North America. In most studies passing the quality criteria, researchers investigated occupational exposure and back disorders in populations consisting of both women and men with at least one year of follow up.Conclusions: People in the following groups develop more back trouble over time than those who are not subjected to the specified exposure at work:– Those who work with manual handling (e.g. lift) or in a posture where the back is bent or rotated– Those who work in a kneeling or squatting posture, or have physically demanding work tasks– Those exposed to whole body vibration– Those who experience work as mentally stressful; or those who find their work demanding, but lack decision latitude (personal control of their own working situation); or those who have insufficient opportunities for personal development– Those who work outside standard office hours.In some work environments, people have less back trouble. Those who experience high influence over work-related decisions, those who get social support at work and those with high job satisfaction develop less back trouble than others.Women and men with similar occupational exposures develop back troubles to the same extent.Those who work in forward bent postures or are exposed to whole body vibration in their work develop more symptoms of sciatica than others, while those with high job satisfaction develop less such symptoms. Those whose work entails manual handling develop more intervertebral disc changes than others.This systematic literature review has uncovered a substantial body of knowledge concerning occupational exposures and back disorders. Future research should include intervention studies, i.e. studies that scientifically test the effect of well defined interventions on back disorders over extended periods of time in authentic work situations.Project groupExperts: Karin Harms-Ringdahl (Chair), Sven Ove Hanson (Ethics), Olle Hägg, Ulf Lundberg, Svend Erik Mathiasen, Gunnevi Sundelin, Magnus Svartengren, and Hans Tropp.SBU: Charlotte Hall (Project Director), Karin Stenström (Assistant Project Director), Agneta Brolund (Information Specialist), Therese Kedebring (Project Administrator), Laura Lintamo (Investigator), Maria Skogholm (Project Administrator), Lena Wallgren (Scientific Writer)Scientific reviewers: Eva Denison, Mats Hagberg, Gunnar Nemeth, Esa-Pekka Takala.
40.	Lysholm, Jack, et al. (författare) Fotledens kompensatoriska betydelse vid knäinstabilitet studerad med stabilometri 1983 Ingår i: Program & sammanfattningar. 40. - Stockholm : Svenska läkaresällskapet. Konferensbidrag (övrigt vetenskapligt/konstnärligt)
41.	Malmqvist, Marcus, et al. (författare) Patients With Idiopathic Scoliosis Run an Increased Risk of Schizophrenia 2019 Ingår i: Spine deformity. - : Springer. - 2212-1358 .- 2212-134X. ; 7:2, s. 262-266 Tidskriftsartikel (refereegranskat)abstract STUDY DESIGN: Retrospective cohort study.OBJECTIVES: To investigate a possible linkage between idiopathic scoliosis (IS) and schizophrenia in an adolescent population.SUMMARY OF BACKGROUND DATA: There is an interesting link between schizophrenia and idiopathic scoliosis: schizophrenia is a disturbance of mental equilibrium, and scoliosis of physical equilibrium, both are multifactorial, genetically determined, start at a young age, and brain development is thought to play a role. Furthermore, both may be presenting symptoms of the genetic disorder 22q11 deletion syndrome. This study poses the question whether these two poorly understood disorders are related.METHODS: A retrospective cohort study was conducted and consisted of 3,702 Swedish adolescents, collected from the National Patient Register, that underwent inpatient care for IS during 1997-2015. These were matched by age, sex, and date of diagnosis to 370,200 controls, collected from Swedish population data, and then followed up in the National Patient Register to identify in- and outpatient care for schizophrenia diagnosis. Follow-up time was calculated from first IS diagnosis date until date of schizophrenia diagnosis or end of follow-up. Cox proportional regression analysis was performed to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for being diagnosed with schizophrenia.RESULTS: Over a median follow-up time of 9.5 years, 0.7% of patients with IS developed schizophrenia versus 0.5% of controls (p = .04). The risk of schizophrenia was significantly higher in patients with IS (HR, 1.52; 95% CI, 1.03-2.23). Using only hospitalized schizophrenia as event, the prevalence for schizophrenia was 0.5% versus 0.3% (p ≤.01; HR, 1.83; 95% CI, 1.17-2.84).CONCLUSION: This study suggests that patients with IS have increased risk of schizophrenia. Dissatisfaction with one's physical appearance might lead to psychological distress and provoke mental illness in predisposed persons. Alternatively, these two disorders may share a common genetic background.LEVEL OF EVIDENCE: Level 2B.
42.	Perneros, Gerd, et al. (författare) Development, validity, and reliability of The Assessment of Pain and Occupational Performance (POP) : a new instrument using two dimensions in the investigation of disability in back pain. 2009 Ingår i: The spine journal : official journal of the North American Spine Society. - : Elsevier BV. - 1878-1632. ; 9:6, s. 486-98 Tidskriftsartikel (refereegranskat)abstract BACKGROUND CONTENT: Questionnaires for measuring the functional status of patients with low back pain (LBP) focus on disability and present responses for each question in a predetermined, fixed relationship between "can do/difficulties and pain." Their design does not permit a separation of the two. PURPOSE: To present the development of The Assessment of Pain and Occupational Performance (POP) and to evaluate validity and reliability. STUDY DESIGN: A prospective, consecutive study of patients investigated by use of the POP. PATIENT SAMPLE: A total of 220 patients participated in the study. METHODS: In a cross-sectional study including 53 patients with chronic musculoskeletal pain, empirical tests of content and construct validity established the definitive version of the POP. The POP focuses on performance of activities. It is a disease-specific, discriminative assessment instrument designed for patients with back pain (BP) and LBP. Based on a semi-structured interview the POP investigates each of 36 activities in two dimensions, with separate, defined scales from "normally healthy" to "extremes" for level of activity (x-scale) and pain intensity (y-scale). The final scores are expressed in percent, 0% to 100%. Patients with chronic LBP (CLBP) (n=142) were allocated to the specific (S) group, that is, patients with specific LBP problems (n=97) or to the nonspecific (NS) group, that is, those with NS BP (n=45). The ability of the POP to differentiate between the two known groups was evaluated. Construct-convergent validity between the POP and the Oswestry Disability Index (ODI) was carried out for the S group. Inter-rater reliability was established between six pairs of raters who examined 25 patients recruited from primary health care, the P-LBP group. RESULTS: In construct known group validity, the median, the interquartile range, and the Mann-Whitney U test showed that the S group had a significantly higher level of activity (p<.001) combined with worse pain (p=.001) compared with the NS group. There were significant differences between the two groups in performing activities in the forward bending position (10 items) and in the upright standing position (9 items). The result of Spearman rank order correlation showed a strong relationship between the ODI and the POP for level of activity (r=0.70, p
43.	Perneros, Gerd, et al. (författare) Evaluation of occupational performance and pain intensity: before and after back surgery and rehabilitation 2014 Ingår i: Scandinavian Journal of Occupational Therapy. - : Informa Healthcare. - 1103-8128 .- 1651-2014. ; 21:1, s. 69-81 Tidskriftsartikel (refereegranskat)abstract Objective: The study had a descriptive, longitudinal design and evaluated occupational performance and pain intensity in daily occupations for patients with low back pain (LBP), assessed preoperatively, and at six and 12 months after surgery and rehabilitation. Methods: Patients were assessed by surgeons and occupational therapists (OTs) to determine whether surgery was required. The OTs used the Assessment of Pain and Occupational Performance (POP) instrument. The POP measures 36 occupations in two dimensions: occupational performance and pain intensity. Patients with specific LBP (n = 97) were included. Results: Preoperatively, 23 occupations showed lower performance and "severe pain". At six months, 27 occupations were performed "without restriction" (p = n.s. -less than 0.001) and without pain or with "mild pain" (p less than 0.001). A comparison of preoperative values with those at 12 months showed that 35 occupations were significantly changed on both scales, and 31 occupations were performed "without restriction" (p less than 0.01-less than 0.001) and "without pain" (p less than 0.001). Conclusions: The results indicate significant improvements between baseline, six months, and 12 months. Moreover, when occupational performance and pain intensity were separately identified, it was shown that patients had regained their performance at an ordinary level without pain. This underlines the added value of differentiating between disability and pain.
44.	Pettersson, Gunnar, et al. (författare) Functional testing in patients with old rupture of the anterior cruciate ligament 1988 Ingår i: Biomechanics XI. - Amsterdam : Free University. - 9062566790 Konferensbidrag (refereegranskat)
45.	Pettersson, Gunnar, et al. (författare) Funktionella tester på patienter med inverterad främre korsbandsskada 1987 Ingår i: IMN journalen. ; :2, s. 17- Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
46.	Reigo, Tomas, et al. (författare) Absence of back disorders in adults and work-related predictive factors in a 5-year perspective 2001 Ingår i: European spine journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 10:3, s. 215-220 Tidskriftsartikel (refereegranskat)abstract Factors important for avoiding back disorders in different age-groups have seldom been compared and studied over time. We therefore set out to study age-related differences in socio-economic and work-related factors associated with the absence of back disorders in a 5-year comparative cohort study using a mailed questionnaire. Two subgroups (aged 25-34 and 54-59 years) derived from a representative sample of the Swedish population were followed at baseline, 1 year and 5 years. Questions were asked about the duration of back pain episodes, relapses, work changes and work satisfaction. A work adaptability, partnership, growth, affection, resolve (APGAR) score was included in the final questionnaire. Multivariate logistic regression was used to identify factors predicting the absence of back disorders. Absence of physically heavy work predicted an absence of back disorders [odds ratio (OR), 2.86, 95% confidence interval (CI), 1.3-6.3] in the older group. In the younger age-group, the absence of stressful work predicted absence of back disorders (OR, 2.0, 95% CI, 1.1-3.6). Thirty-seven per cent of the younger age-group and 43% of the older age-group did not experience any back pain episodes during the study period. The exploratory work APGAR scores indicated that back disorders were only associated with lower work satisfaction in the older group. The analyses point out the importance of avoiding perceived psychological stress in the young and avoiding perceived physically heavy work in the older age-group for avoiding back disorders. The results suggest a need for different programmes at workplaces to avoid back disorders depending on the age of the employees concerned.
47.	Reigo, Tomas, et al. (författare) Back pain in an adult population : One year incidence, sick leave, and recovery from pain Annan publikation (övrigt vetenskapligt/konstnärligt)abstract Objective - To study the incidence of self-reported hack pain in a general population and to identify risk factors for sick leave and factors associated with recovery from back pain.Population - A cross-sectional sample (n=1344) of a general adult population.Setting - In a semi-urban Swedish county.Design - One-year prospective study of a single cohort.Main outcome measures - The incidence of back pain, risk factors for sick leave, factors predisposing for recovery.Results - The incidence of back pain was 24 % (95% C.I. 22% to 27%). 79% of the pain episodes lasted less than two months. History of previous back pain predisposed to developing new episodes of back pain, while stress at work combined with low work satisfaction were associated factors. Factors predisposing to recovery were young age, skilled work, and living in the countryside. Unskilled work, pain debut at work, previous history and back pain at the start of the study were factors predisposing to sick listing for back pain. Long-term sick leave was predisposed by previous history of back pain and ongoing back pain at the start of the study.
48.	Reigo, Tomas, et al. (författare) Clinical findings in a population with back pain : Relation to one-year outcome and long-term sick leave 2000 Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 18:4, s. 208-214 Tidskriftsartikel (refereegranskat)abstract Objective - To investigate whether physical examination findings can be used in predicting recovery from back pain and new episodes of sick leave.Design - One-year prospective study of a single cohort.Settings - Semi-rural Swedish county.Population - A cross-section of a general population with back pain (207 women, 176 men) between 20 and 59 years of age.Main outcome measures - Cumulative incidence of sick leave due to back pain, cumulative incidence of sick leave due to back pain > 30 days, incidence of recovery from back pain.Results - For recovery from pain, the absence of tenderness in the trapezius muscle (OR 0.33, CI 0.1-0.5) was predictive. New sick leave was predicted by tenderness in the trapezius muscle (OR 2.67, CI 1.5-4.9), and had a tendency to be associated with a flattened lumbar lordosis and a restricted cervical range of motion. For long-term sick leave, the same findings and also observation of scoliosis (OR 3.44, CI 1.1-10.5) were predictive.Conclusion - There are subgroups with back pain predisposed to development of more persistent symptoms and a higher risk for sick-listing.
49.	Reigo, Tomas, et al. (författare) Disability pension due to back pain : A ten-year prospective survey Annan publikation (övrigt vetenskapligt/konstnärligt)abstract Back pain contributes to a large number of disability pensions. The process toward disability is not well understood. In a 10-year (1988-1998) prospective study of a single cohort (n=1902) representative of the general adult population in a semi-nrban Swedish county, the incidence of disability pensions based on back pain was studied. Socio-demographic and work-related risk factors for disability pension were analysed.Eigbt percent of respondents to a baseline survey (n=1344) and 10% of the non-respondents (n=558) were granted full-time disability pension on back pain diagnosis during the 10-year period. Age over 40, low professional status, primary sick leave because of back pain and the perception of work tasks as unsatisfying were found to predict disability.Disability pension granted due to back pain appears to have a variation over time and is affected by both social insurance and work-related factors.
50.	Reigo, Thomas, et al. (författare) Pain drawing evaluation–the problem with the clinically biased surgeon : Intra- and interobserver agreement in 50 cases related to clinical bias 1998 Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682 .- 0001-6470. ; 69:4, s. 408-411 Tidskriftsartikel (refereegranskat)abstract To assess whether the clinical knowledge of the treating surgeon had any effect on the reliability of the pain-drawing evaluation, drawings from 50 low-back pain patients were evaluated by the treating surgeon and by three colleagues who had no clinical knowledge of the patient. The evaluation was repeated after 10 days. The treating surgeons were also blinded to clinical data. The kappa value in the evaluation when the surgeon had clinical knowledge of the patient was lower (0.29 (95% CI 0.13–0.45)) than the kappa value in the evaluations made without clinical knowledge (0.60 (CI 0.45–0.75)). The differences observed in interobserver reliability between open and blind evaluations suggest that clinical knowledge of a patient influences the evaluation of the pain drawings.

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