| 1. |
- Broqvist, Mari, 1958-, et al.
(author)
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Beslutsstöd för prioriteringar på individnivå : Exempel från hjälpmedelsverksamhet
- 2019
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Reports (other academic/artistic)abstract
- Alltsedan 1997 då den etiska plattformen för resursfördelning introducerades i den svenska hälso- och sjukvården har metodutveckling pågått i syfte att stödja vårdens aktörer i de svåra avvägningar som prioriteringar ofta innebär. Fokus har varit på de stora frågorna, om resursfördelning på regionnivå och policybeslut i olika verksamheter, men det stora antalet prioriteringar görs på daglig basis i mötet mellan personal och patienter.Den här rapporten vänder sig till er som vill arbeta med att göra prioriteringar på individnivå på mer likvärdiga grunder i linje med de riktlinjer om prioriteringar som riksdagen beslutat om. Här presenteras ett verktyg, Beslutsstöd för prioriteringar på individnivå, som syftar till att styra insamlandet och analys gällande vårdbehov så att behovs-solidaritetsprincipen och kostnadseffektivitetsprincipen i riksdagens riktlinjer för prioriteringar beaktas vid bedömningen. Beslutsstödet är resultatet av ett mångårigt utvecklingsarbete, byggt på erfarenheter framför allt inom hjälpmedelsverksamheter i flera olika regioner. Utöver att användas vid hjälpmedelsförskrivning är beslutsstödet även tänkt att kunna prövas för andra typer av hälso- och sjukvårdsåtgärder.Beslutsstödet som används för att avgöra hur prioriterat en persons hälsoproblem och en tänkt åtgärd bör vara består av ett bedömningsformulär och en manual. Svårighetsgrad, patientnytta och patientnytta i relation till kostnad bedöms där i ett antal bedömningspunkter som styr bedömningen mot en prioriteringsgrad.Ett syfte med beslutsstödet är att skapa prioriteringar på mer lika grunder. Infört på ett välorganiserat sätt, kan det bidra till att skapa förståelse och acceptans för gemensamma grunder och en större öppenhet i prioriteringar. I den här rapporten ges ett exempel på en genomtänkt implementeringsprocess från hjälpmedelsverksamheten i Region Jönköpings län. En viktig slutsats av det arbetet är att stöd från ledning och politiker, metodstöd till användarna av beslutsstödet samt uthållighet är huvudingredienser för att lyckas i ett sådant arbete.
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| 2. |
- Bäck, Maria, 1978, et al.
(author)
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How does kinesiophobia change over time in patients with acute coronary artery disease?
- 2015
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In: Physiotherapy, Oral presentation, World Confederation for Physical Therapy (WCPT), 1-4 May 2015Singapore. - : Elsevier BV. ; 101:Suppl. 1
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Conference paper (other academic/artistic)abstract
- The occurrence of kinesiophobia and the impact on kinesiophobia by clinical variables with influence on rehabilitation outcomes in exercise-based cardiac rehabilitation (CR) has by us been identified six months after acute coronary artery disease (CAD). However, the occurrence of kinesiophobia in the acute phase of CAD and how it changes over time has not previously been studied. Moreover, the gender perspective has not been highlighted. The primary purpose was to identify levels of kinesiophobia in the acute phase of CAD and to study changes over time and in relation to gender. Participants: In total, 105 patients with CAD (25 women), mean age 63.1±11.5 were included in the study at the cardiac intensive care, Sahlgrenska University Hospital, Sweden between October 2013 and June 2014. Design and statistics: The patients were asked to fill in a set of questionnaires including the Tampascale for Kinesiophobia Heart (TSK-SV Heart), the Hospital Anxiety and Depression Scale (HADS), Harm Avoidance (HA) and the Positive and Negative Affect Schedule (PANAS). The patients filled in the questionnaires at three different time points: At the cardiac intensive care (T1), after 2 weeks (T2) and after 4 months (T3). A linear mixed model (LMM) procedure was used to compare kinesiophobia across time points. The within-subjects-design factor was data collection time (T1-T3), and the between-subjects-design factor was gender. The dependent variable was kinesiophobia. The questionnaires reflecting personality traits and affective states (HADS, PANAS, HA) were used as covariates in order to discover any effects these might have on differences across groupings. Covariates were included in two steps: first all five, then only those that contributed significantly at p-level < 0.05. Thirty-five patients were excluded due to loss of follow-up or missing data. The mean value on the TSK-SV Heart was 32.1 at T1, 30.3 at T2 and 29.2 at T3. The presence of a high level of kinesiophobia was 24% at T1 and 19% at T2 and T3. Without covariates, there was an effect of gender (p=0.011), with a higher TSK-SV Heart mean score for women, and over time points (p=0.013), with lower TSK-SV Heart mean score at T3. No interaction effect was found. Inclusion of the covariates showed that the HADS variables had no impact on kinesiophobia. Although negative affect (p=0.016), positive affect (p=0.002), and HA (p=0.057) had impact on kinesiophobia, this did not influence the significane of gender (p=0.042) and over time points (p=0.004). Kinesiophobia decreased over time after acute CAD, independent of patients´ personality traits and affective states. Female gender had a significant influence on kinesiohobia. Still 19% of the patients were identified with a high level of kinesiophobia at T3. The further establishment of the impact of kinesiophobia in CR and the design of a treatment intervention should be prioritized in future studies. The results of this study suggest that it is desirable to screen for kinesiophobia in the acute phase of CAD, as recognition may facilitate the appropriate treatment for these patients with the overall target of enhancing attendance at CR.
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| 3. |
- Bäck, Maria, et al.
(author)
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Kinesiophobia mediates the influences on attendance at exercise-based cardiac rehabilitation in patients with coronary artery disease.
- 2016
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In: Physiotherapy Theory and Practice. - : Informa UK Limited. - 0959-3985 .- 1532-5040. ; 32:8, s. 571-580
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Journal article (peer-reviewed)abstract
- PURPOSE: To identify predictors of attendance at exercise-based cardiac rehabilitation (CR) and to test the hypothesis that kinesiophobia mediates the influence on attendance at CR in patients with coronary artery disease (CAD).PATIENTS: In total, 332 patients (75 women; mean age 65 ± 9.1 years) with a diagnosis of CAD were recruited at Sahlgrenska University Hospital, Sweden.METHODS: The patients were tested in terms of objective measurements, self-rated psychological measurements, and level of physical activity. A path model with direct and indirect effects via kinesiophobia was used to predict participation in CR. An exploratory selection of significant predictors was made.RESULTS: A current incidence of coronary bypass grafting (p < 0.001) and a diagnosis of ST-elevation myocardial infarction (p = 0.004) increased the probability of attendance at CR, while kinesiophobia (p = 0.001) reduced attendance. As a mediator, kinesiophobia was influenced by four predictors and the following indirect effects were found. General health and muscle endurance increased the probability of attendance at CR, while self-rated anxiety and current incidence of heart failure had the opposite effect.CONCLUSIONS: This study suggests that kinesiophobia has an influence on and a mediating role in attendance at CR. The results need to be further investigated in relation to clinical practice.
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| 4. |
- Bäck, Maria, et al.
(author)
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Relevance of Kinesiophobia in Relation to Changes Over Time Among Patients After an Acute Coronary Artery Disease Event
- 2018
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In: JOURNAL OF CARDIOPULMONARY REHABILITATION AND PREVENTION. - : LIPPINCOTT WILLIAMS & WILKINS. - 1932-7501 .- 1932-751X. ; 38:4, s. 224-230
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Journal article (peer-reviewed)abstract
- Purpose: To identify levels of kinesiophobia during the first 4 months after an acute episode of coronary artery disease (CAD), while controlling for gender, anxiety, depression, and personality traits. Methods: In all, 106 patients with CAD (25 women), mean age 63.1 11.5 years, were included in the study at the cardiac intensive care unit, Sahlgrenska University Hospital, Sweden. The patients completed questionnaires at 3 time points: in the cardiac intensive care unit (baseline), 2 weeks, and 4 months after baseline. The primary outcome measure was kinesiophobia. Secondary outcome measures were gender, anxiety, depression, harm avoidance, and positive and negative affect. A linear mixed model procedure was used to compare kinesiophobia across time points and gender. Secondary outcome measures were used as covariates. Results: Kinesiophobia decreased over time (P = .005) and there was a significant effect of gender (P = .045; higher values for women). The presence of a high level of kinesiophobia was 25.4% at baseline, 19% after 2 weeks, and 21.1% after 4 months. Inclusion of the covariates showed that positive and negative affect and harm avoidance increased model fit. The effects of time and gender remained significant. Conclusions: This study highlights that kinesiophobia decreased over time after an acute CAD episode. Nonetheless, a substantial part of the patients were identified with a high level of kinesiophobia across time, which emphasizes the need for screening and the design of a treatment intervention.
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| 5. |
- Gutke, Annelie, 1967-, et al.
(author)
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Adaptation to a changed body : Experiences of living with long-term pelvic girdle pain after childbirth
- 2018
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In: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 40:25, s. 3054-3060
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Journal article (peer-reviewed)abstract
- Purpose: To explore how women experience living with long-term pregnancy-related pelvic girdle pain.Materials and methods: Nine women with persistent pregnancy-related pelvic girdle pain of 2–13 years were recruited by means of purposive sampling from long-term follow-up studies. The women were 28–42 years of age and had given birth to 2–3 children. Audio-taped in-depth interview with open-ended questions were used with the guiding question 'How do you experience living with pregnancy-related pelvic girdle pain?'. The Empirical Phenomenological Psychological method was chosen for analysis.Results: The pregnancy-related pelvic girdle pain syndrome has a profound impact on everyday life for many years after pregnancy. Three constituents were identified as central to the experience of living with pregnancy-related pelvic girdle pain: (1) the importance of the body for identity, (2) the understanding of pain, and (3) stages of change. The manner in which the women experienced their pain was interpreted in terms of two typologies: the ongoing struggle against the pain, and adaptation and acceptance.Conclusion: The participants’ narratives highlighted that the pain led to severe functional limitations that threatened their capability to perform meaningful daily activities, and interfered with their sense of identity. It appears essential to meet with each patient individually and to manage long-term pregnancy-related pelvic girdle pain as a pain syndrome.IMPLICATIONS FOR REHABILITATIONChronic pregnancy-related pelvic girdle painPregnancy-related pelvic girdle pain impairs women’s capacity to perform meaningful activities of daily life for many years after pregnancy.The participants’ narratives highlighted that the pain interfered with their sense of identity.It appears essential to meet with each patient individually and to manage long-term pregnancy-related pelvic girdle pain as a pain syndrome.
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| 6. |
- Jakobsson, Max, et al.
(author)
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Level of Evidence for Reliability, Validity, and Responsiveness of Physical Capacity Tasks Designed to Assess Functioning in Patients With Low Back Pain: A Systematic Review Using the COSMIN Standards.
- 2019
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In: Physical Therapy. - : Oxford University Press (OUP). - 1538-6724 .- 0031-9023. ; 99:4, s. 457-477
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Journal article (peer-reviewed)abstract
- BACKGROUND: Physical capacity tasks (ie, observer-administered outcome measures that comprise a standardized activity) are useful for assessing functioning in patients with low back pain. PURPOSE: The purpose of this study was to systematically review the level of evidence for the reliability, validity, and responsiveness of physical capacity tasks. DATA SOURCES: MEDLINE, CINAHL, PsycINFO, Scopus, the Cochrane Library, and relevant reference lists were used as data sources. STUDY SELECTION: Two authors independently selected articles addressing the reliability, validity, and responsiveness of physical capacity tasks, and a third author resolved discrepancies. DATA EXTRACTION AND QUALITY ASSESSMENT: One author performed data extraction, and a second author independently checked the data extraction for accuracy. Two authors independently assessed the methodological quality with the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) 4-point checklist, and a third author resolved discrepancies. DATA SYNTHESIS AND ANALYSIS: Data synthesis was performed by all authors to determine the level of evidence per measurement property per physical capacity task. The 5-repetition sit-to-stand, 5-minute walk, 50-ft (∼15.3-m) walk, Progressive Isoinertial Lifting Evaluation, and Timed "Up & Go" tasks displayed moderate to strong evidence for positive ratings of both reliability and construct validity. The 1-minute stair-climbing, 5-repetition sit-to-stand, shuttle walking, and Timed "Up & Go" tasks showed limited evidence for positive ratings of responsiveness. LIMITATIONS: The COSMIN 4-point checklist was originally developed for patient-reported outcome measures and not physical capacity tasks. CONCLUSIONS: The 5-repetition sit-to-stand, 50-ft walk, 5-minute walk, Progressive Isoinertial Lifting Evaluation, Timed "Up & Go," and 1-minute stair-climbing tasks are promising tests for the measurement of functioning in patients with chronic low back pain. However, more research on the measurement error and responsiveness of these tasks is needed to be able to fully recommend them as outcome measures in research and clinical practice.
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| 7. |
- Jakobsson, Max, et al.
(author)
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One-minute stair climbing, 50-foot walk, and timed up-and-go were responsive measures for patients with chronic low back pain undergoing lumbar fusion surgery
- 2019
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In: Bmc Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 20
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Journal article (peer-reviewed)abstract
- BackgroundPhysical capacity tasks are useful tools to assess functioning in patients with low back pain (LBP), but evidence is scarce regarding the responsiveness (ability to detect change over time) and minimal important change (MIC). The aim was to investigate the responsiveness and MIC of 5-min walk, 1-min stair climbing, 50-ft walk, and timed up-and-go in patients with chronic LBP undergoing lumbar fusion surgery.MethodsIn this clinimetric study, 118 patients scheduled for lumbar fusion surgery for motion-elicited chronic LBP with degenerative changes were included. All patients performed the physical capacity tasks 5-min walk, 1-min stair climbing, 50-ft walk, and timed up-and-go 8-12weeks before and six months after surgery. Responsiveness was evaluated by testing five a priori responsiveness hypotheses. The hypotheses concerned the area under the receiver operating characteristics (ROC) curve and correlations (Spearman's rho) between the change scores of the physical capacity tasks, the Oswestry Disability Index 2.0 (ODI), and back pain intensity measured with visual analog scale (VAS). At least 80% of the hypotheses would have to be confirmed for adequate responsiveness. Absolute and relative MICs for improvement were determined by the optimal cut-off point of the ROC curve based on the classification of improved and unchanged patients according to construct-specific global perceived effect (GPE) scales.ResultsOne-minute stair climbing, 50-ft walk and timed up-and-go displayed adequate responsiveness ( 80% of hypotheses confirmed), while 5-min walk did not (40% of hypotheses confirmed). The absolute MICs for improvement were 45.5m for 5-min walk, 20.0 steps for 1-min stair climbing, -0.6s for 50-ft walk, and-1.3s for timed up-and-go.ConclusionsThe results of responsiveness for 1-min stair climbing, 50-ft walk, and timed up-and-go implies that these have the ability to detect changes in physical capacity over time in patients with chronic LBP who have undergone lumbar fusion surgery.
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| 8. |
- Jakobsson, Max, et al.
(author)
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Prediction of Objectively Measured Physical Activity and Self-Reported Disability Following Lumbar Fusion Surgery.
- 2019
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In: World neurosurgery. - : Elsevier BV. - 1878-8769 .- 1878-8750. ; 121
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To investigate the predictive value of preoperative fear-avoidance factors (self-efficacy for exercise, pain catastrophizing, kinesiophobia, and depression), walking capacity, and traditional predictor variables for predicting postoperative changes in physical activity level and disability 6 months after lumbar fusion surgery in patients with chronic low back pain (LBP). METHODS: We prospectively enrolled 118 patients scheduled for lumbar fusion surgery for motion-elicited chronic LBP with degenerative changes in 1-3 segments of the lumbar spine. Associations between the predictors and the dependent variables were investigated with multiple linear regression analysis. Dependent variables were physical activity level as objectively measured with a triaxial accelerometer and disability as measured with the Oswestry Disability Index. RESULTS: Preoperative physical activity level (β=-0.349; P < 0.001) and self-efficacy for exercise (β= 0.176; P= 0.021) were significant predictors of the postoperative change in physical activity. Preoperative disability (β=-0.790; P < 0.001), self-efficacy for exercise (β= 0.152; P= 0.024), and pain catastrophizing (β= 0.383; P= 0.033) were significant predictors for the change in the Oswestry Disability Index. CONCLUSIONS: Patients with low levels of preoperative physical activity were more likely to increase their level of physical activity after lumbar fusion surgery, especially when their self-efficacy for exercise was high. However, most of these patients still had low levels of physical activity after surgery, and they may therefore need extra support in increasing their postoperative physical activity levels.
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| 9. |
- Kemani, Mike K, et al.
(author)
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Factor structure and internal consistency of a Swedish version of the Pain Catastrophizing Scale.
- 2019
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In: Acta anaesthesiologica Scandinavica. - : Wiley. - 1399-6576 .- 0001-5172. ; 63:2, s. 259-266
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Journal article (peer-reviewed)abstract
- Pain catastrophizing is highly relevant to assess in the context of long-standing pain. The Pain Catastrophizing Scale (PCS) is a well-established questionnaire used to measure catastrophizing in individuals with long-standing pain. So far, no Swedish translation has been evaluated in regard to validity and reliability. The aims of this study were to translate the PCS questionnaire from English to Swedish, and to investigate its construct validity (face, content, and structural validity) and reliability (internal consistency).We translated the original English version of the PCS to Swedish and collected item responses from 194 persons suffering from primarily long-standing musculoskeletal pain. We used confirmatory factor analysis to evaluate structural validity, and tested the model fit of a one-factor model, an oblique two-factor model, and an oblique three-factor model. We evaluated the measure's reliability in regard to internal consistency calculated with Cronbach's alpha.A three-factor model comprising a four-item rumination factor, a three-item magnification factor, and a six-item helplessness factor provided the best fit to the data. Internal consistency was adequate and Cronbach's α was 0.92 for the entire scale, 0.84 for the rumination subscale; 0.69 for the magnification subscale, and 0.89 for the helplessness subscale.The results indicated adequacy of a three-factor solution and the questionnaire's internal consistency, and provide initial support for the structural validity and internal consistency of a Swedish version of the PCS. Future studies should replicate the study in larger samples and extend the current evaluation in regard to validity and reliability.
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| 10. |
- Lotzke, Hanna, et al.
(author)
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A Person-Centered Prehabilitation Program Based on Cognitive-Behavioral Physical Therapy for Patients Scheduled for Lumbar Fusion Surgery: A Randomized Controlled Trial
- 2019
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In: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 99:8, s. 1069-1088
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Journal article (peer-reviewed)abstract
- Background Prehabilitation programs have led to improved postoperative outcomes in several surgical contexts, but there are presently no guidelines for the prehabilitation phase before lumbar fusion surgery. Objective The objective was to investigate whether a person-centered physical therapy prehabilitation program, based on a cognitive-behavioral approach, is more effective than conventional care in reducing disability and improving functioning after lumbar fusion surgery in patients with degenerative disk disease. Setting The study took place at 2 private spine clinics and 1 university hospital. Patients We prospectively enrolled 118 patients scheduled for lumbar fusion surgery. Intervention The active intervention used a person-centered perspective and focused on promoting physical activity and targeting psychological risk factors before surgery. The control group received conventional preoperative care. Measurements The primary outcome was the Oswestry Disability Index score. Secondary outcomes were back and leg pain intensity, catastrophizing, kinesiophobia, self-efficacy, anxiety, depression, health-related quality of life, and patient-specific functioning, physical activity, and physical capacity. Data were collected on 6 occasions up to 6 months postoperatively. A linear mixed model was used to analyze the change scores of each outcome. Results No statistically significant between-group difference was found on the primary outcome (disability) over time (baseline to 6 months). Among secondary outcome measures, a statistically significant interaction effect (Group x Time) was seen for the European Quality of Life 5 Dimensions Questionnaire. The largest between-group difference on the European Quality of Life 5 Dimensions Questionnaire index was seen 1 week prior to surgery and favored the active intervention. The largest between-group effect sizes at the 6-month follow-up favored the active intervention, and were seen for physical activity intensity, steps per day, and the One Leg Stand Test. Both groups reached the minimal important change for the primary outcome and, in several secondary outcomes (pain intensity, back and leg; pain catastrophizing; anxiety; health-related quality of life [EQ5D VAS]), already at 8-week follow-up. Limitations The participants' preoperative level of disability was lower than normative values, which suggests selection bias. Conclusions Both interventions led to clinically important changes, but it is not clear what kind of prehabilitation program is the most effective.
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