| 1. |
- Bruvoll, Mona, et al.
(författare)
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Feasibility of high dose medical exercise therapy in patients with long-term symptomatic knee osteoarthritis
- 2022
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Ingår i: Physiotherapy Theory and Practice. - : Informa UK Limited. - 0959-3985 .- 1532-5040. ; 38:11, s. 1615-1623
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: High repetition high dose medical exercise therapy (MET) is a promising treatment for patients with musculoskeletal pain. However, little is known regarding the feasibility of MET in patients with symptomatic knee osteoarthritis (OA). The aim of this study was to investigate the feasibility of MET in patients with symptomatic knee pain with radiographic verified OA. Methods: Patients with symptomatic knee osteoarthritis were recruited to a group-based high repetitive high dose MET intervention for 12 weeks in a primary health care setting. Indicators of feasibility included processes (recruitment, program adherence, and exercise compliance), and scientific feasibility (safety and pain evaluated by using the Visual Analogue Scale (VAS)). Results: Out of 31 individuals with symptomatic knee OA, 29 (93%) were included in this study. A total of 26 patients (90%) completed the intervention and 83% reached an attendance rate of >= 30 treatments. No adverse events were reported, and a majority of the patients reported a pain intensity <30 mm (VAS) throughout the intervention period. The results showed a 70% reduction of median pain intensity between baseline (33 mm, IQR: 39), and post-assessment (10 mm, IQR: 25, P = .003). Conclusion: These findings support an overall positive feasibility of MET for patients with symptomatic knee OA. The results also demonstrated that achieving a high dose of exercises might be challenging for this population. Thus, individual variations in exercise dose may be a confounding factor when evaluating high dose MET in future clinical studies.
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| 3. |
- de Alwis, M.P., et al.
(författare)
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Crew acceleration exposure, health and performance in high-speed operations at sea
- 2017
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Konferensbidrag (refereegranskat)abstract
- The presented research program investigates the association between working conditions aboard High-Speed Craft (HSC) and its outcomes in terms of acceleration exposure and crew health and systems performance respectively. The aim is to identify the related risk factors and further, to use them to improve the assessment criteria in a simulation-based-design framework. The investigation initially document a seaborne population by a web-based questionnaire tailored for High-Performance Marine Craft Personnel (HPMCP) and similar populations. Then data is collected during regular service by measuring craft acceleration and through another questionnaire especially resolute on perceived work-exposure, health and performance. Exposure and performance data is collected daily and health data weekly, depending on seaborne frequency. The population repeats the prevalence questionnaire about a year later enabling a longitudinal follow-up for identifying long-term effects of exposure. The paper reports the two questionnaires´ development and pilot test as well as the first application for baseline data collection in the target group. The results indicate health and performance characteristics of the study population and data shows a promising correlation between the self-reported subjective exposure and the measured objective acceleration. Data indicates a comparatively higher prevalence of musculoskeletal pain in the study population than that of the general population.
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| 4. |
- de Alwis, Manudul Pahansen, et al.
(författare)
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Development and validation of a web-based questionnaire for surveying the health and working conditions of high-performance marine craft populations
- 2016
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 6:6
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Tidskriftsartikel (refereegranskat)abstract
- Background High-performance marine craft crews are susceptible to various adverse health conditions caused by multiple interactive factors. However, there are limited epidemiological data available for assessment of working conditions at sea. Although questionnaire surveys are widely used for identifying exposures, outcomes and associated risks with high accuracy levels, until now, no validated epidemiological tool exists for surveying occupational health and performance in these populations. Aim To develop and validate a web-based questionnaire for epidemiological assessment of occupational and individual risk exposure pertinent to the musculoskeletal health conditions and performance in high-performance marine craft populations. Method A questionnaire for investigating the association between work-related exposure, performance and health was initially developed by a consensus panel under four subdomains, viz. demography, lifestyle, work exposure and health and systematically validated by expert raters for content relevance and simplicity in three consecutive stages, each iteratively followed by a consensus panel revision. The item content validity index (I-CVI) was determined as the proportion of experts giving a rating of 3 or 4. The scale content validity index (S-CVI/Ave) was computed by averaging the I-CVIs for the assessment of the questionnaire as a tool. Finally, the questionnaire was pilot tested. Results The S-CVI/Ave increased from 0.89 to 0.96 for relevance and from 0.76 to 0.94 for simplicity, resulting in 36 items in the final questionnaire. The pilot test confirmed the feasibility of the questionnaire. Conclusions The present study shows that the web-based questionnaire fulfils previously published validity acceptance criteria and is therefore considered valid and feasible for the empirical surveying of epidemiological aspects among high-performance marine craft crews and similar populations.
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| 5. |
- de Alwis, Pahansen, 1980-, et al.
(författare)
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Exposure aboard high-performance Marine craft increases musculoskeletal pain and lowers contemporary work capacity of the occupants
- 2021
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Ingår i: Journal of Engineering for the Maritime Environment (Part M). - : SAGE Publications. - 1475-0902 .- 2041-3084. ; 235:3, s. 750-762
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Tidskriftsartikel (refereegranskat)abstract
- High-Performance Marine Craft (HPMC) occupants are currently being investigated for various psychophysical impairments degrading work performance postulating that these deteriorations are related to their occupational exposures. However, scientific evidence for this is lacking and the association of exposure conditions aboard HPMC with adverse health and performance effects is unknown. Therefore, the study estimates the prevalence of musculoskeletal pain (MSP) among HPMC occupants and the association of their work exposure with MSP and performance degradation. It also presents a criterion for evaluating the self-reported exposure severity aboard three different types of mono-hull HPMC; displacement, semi-displacement and planing, on a par with the available standard criteria for objectively measurable exposures. Furthermore, another criterion is proposed to assess the performance-degradation of HPMC occupants based on self-reported fatigue symptoms and MSP. Swedish Coast Guard HPMC occupants were surveyed for MSP, fatigue symptoms as well as for work-related and individual risk indicators using a validated web-based questionnaire. Prevalence of MSP and performance-degradation during the past 12 months were assessed and presented as a percentage of the sample. Associations of exposure conditions aboard HPMC with MSP and performance-capacity were systematically evaluated using multiple logistic regression models and expressed as odds ratio (OR). Prevalence of MSP was 72% among which lower back pain was the most prevalent (46%) followed by neck pain (29%) and shoulder pain (23%) while 29% with degraded performance. Exposure to severe conditions aboard semi-displacement craft was associated with lower back (OR = 2.3) and shoulder (OR = 2.6) pain while severe conditions aboard planing craft with neck pain (OR = 2.3) and performance-degradation (OR = 2.6). MSP is common among Swedish coast guards. Severe exposure conditions aboard HPMC are significantly associated with both MSP and performance-degradation. The spine and shoulders are the most susceptible to work-related MSP among HPMC occupants which should be targeted in work-related preventive and corrective measures.
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| 8. |
- Gerdle, Björn, et al.
(författare)
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The importance of emotional distress, cognitive behavioural factors and pain for life impact at baseline and for outcomes after rehabilitation - a SQRP study of more than 20,000 chronic pain patients
- 2019
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Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter GmbH. - 1877-8860 .- 1877-8879. ; 19:4, s. 693-711
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims Although literature concerning chronic pain patients indicates that cognitive behavioural variables, specifically acceptance and fear of movement/(re)injury, are related to life impact, the relative roles of these factors in relation to pain characteristics (e.g. intensity and spreading) and emotional distress are unclear. Moreover, how these variables affect rehabilitation outcomes in different subgroups is insufficiently understood. This study has two aims: (1) to investigate how pain, cognitive behavioural, and emotional distress variables intercorrelate and whether these variables can regress aspects of life impact and (2) to analyse whether these variables can be used to identify clinically meaningful subgroups at baseline and which subgroups benefit most from multimodal rehabilitation programs (MMRP) immediately after and at 12-month follow-up. Methods Pain aspects, background variables, psychological distress, cognitive behavioural variables, and two life impact variables were obtained from the Swedish Quality Registry for Pain Rehabilitation (SQRP) for chronic pain patients. These data were analysed mainly using advanced multivariate methods. Results The study includes 22,406 chronic pain patients. Many variables, including acceptance variables, showed important contributions to the variation in clinical presentations and in life impacts. Based on the statistically important variables considering the clinical presentation, three clusters/subgroups of patients were identified at baseline; from the worst clinical situation to the relatively good situation. These clusters showed significant differences in outcomes after participating in MMRP; the subgroup with the worst situation at baseline showed the most significant improvements. Conclusions Pain intensity/severity, emotional distress, acceptance, and life impacts were important for the clinical presentation and were used to identify three clusters with marked differences at baseline (i.e. before MMRP). Life impacts showed complex relationships with acceptance, pain intensity/severity, and emotional distress. The most significant improvements after MMRP were seen in the subgroup with the lowest level of functioning before treatment, indicating that patients with complex problems should be offered MMRP. Implications This study emphasizes the need to adopt a biopsychosocial perspective when assessing patients with chronic pain. Patients with chronic pain referred to specialist clinics are not homogenous in their clinical presentation. Instead we identified three distinct subgroups of patients. The outcomes of MMRP appears to be related to the clinical presentation. Thus, patients with the most severe clinical presentation show the most prominent improvements. However, even though this group of patients improve they still after MMRP show a complex situation and there is thus a need for optimizing the content of MMRP for these patients. The subgroup of patients with a relatively good situation with respect to pain, psychological distress, coping and life impact only showed minor improvements after MMRP. Hence, there is a need to develop other complex interventions for them.
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| 9. |
- Gerdle, Björn, et al.
(författare)
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Who benefits from multimodal rehabilitation - an exploration of pain, psychological distress, and life impacts in over 35,000 chronic pain patients identified in the Swedish Quality Registry for Pain Rehabilitation
- 2019
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Ingår i: Journal of Pain Research. - : DOVE Medical Press Ltd.. - 1178-7090. ; 12, s. 891-908
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic pain patients frequently suffer from psychological symptoms. There is no consensus concerning the prevalence of severe anxiety and depressive symptoms and the strength of the associations between pain intensity and psychological distress. Although an important aspect of the clinical picture is understanding how the pain condition impacts life, little is known about the relative importance of pain and psychological symptoms for individual's life impact. The aims of this study were to identify subgroups of pain patients; to analyze if pain, psychological distress, and life impact variables influence subgrouping; and to investigate how patients in the subgroups benefit from treatments.Methods: Background variables, pain aspects (intensity/severity and spreading), psychological distress (depressive and anxiety symptoms), and two life impact variables (pain interference and perceived life control) were obtained from the Swedish Quality Registry for Pain Rehabilitation for chronic pain patients and analyzed mainly using advanced multivariate methods.Results: Based on >35,000 patients, 35%-40% had severe anxiety or depressive symptoms. Severe psychological distress was associated with being born outside Europe (21%-24% vs 6%-8% in the category without psychological distress) and low education level (20.7%-20.8% vs 26%-27% in the category without psychological distress). Dose relationships existed between the two psychological distress variables and pain aspects, but the explained variances were generally low. Pain intensity/severity and the two psychological distress variables were significantly associated (R2=0.40-0.48; P>0.001) with the two life impact variables (pain interference and life control). Two subgroups of patients were identified at baseline (subgroup 1: n=15,901-16,119; subgroup 2: n=20,690-20,981) and the subgroup with the worst situation regarding all variables participated less in an MMRP (51% vs 58%, P<0.001) but showed the largest improvements in outcomes.Conclusion: The results emphasize the need to assess both pain and psychological distress and not take for granted that pain involves high psychological stress in the individual case. Not all patients benefit from MMRP. A better matching between common clinical pictures and the content of MMRPs may help improve results. We only partly found support for treatment resistance in patients with psychological distress burden.
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