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- Bertilson, Bo C., et al.
(författare)
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Inter-examiner reliability in the assessment of low back pain (LBP) using the Kirkaldy-Willis classification (KWC)
- 2006
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Ingår i: European spine journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 15:11, s. 1695-1703
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Tidskriftsartikel (refereegranskat)abstract
- Reliable classification systems and clinical tests are sought for the care of patients with low back pain (LBP). The objectives of this clinical study were to evaluate inter-examiner reliability in the classification of patients with LBP, the influence of radiological findings on the classification and the reliability of some clinical tests. Two examiners independently assessed 50 outpatients with LBP. Inter-examiner reliability in classification of patients with LBP using Kirkkaldy-Willis classification (KWC) system and in 30 clinical tests was calculated as percentage agreement and kappa coefficients (kappa). Inter-examiner reliability was excellent (kappa > 0.8) for classification according to KWC. Radiological findings did not influence the reliability. Age of the patient, movement range, and pain and neurological signs seemed to guide the decision on classification. The reliability of clinical tests was good (kappa > 0.6) in 6 tests and moderate (kappa > 0.4) in 12 tests. Good inter-examiner reliability was found for the SLR test, movement range and sensibility testing with spurs in dermatome areas. We conclude that the KWC for classifying patients with LBP seems to be a reliable classification system depending on a few key observations and that moderate and good inter-examiner reliability can be achieved in several clinical tests in the assessment of LBP.
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| 2. |
- Bertilson, Bo C
(författare)
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On the assessment of nerve involvement and of dysfunction in patients with spinal pain
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Nerve involvement originating in the spine can cause pain and/or organ dysfunction. Reliable and valid assessment of nerve involvement is a prime diagnostic task as it may require other than symptomatic treatment. The aim of this thesis was to analyse the reliability of, and association between, some diagnostic methods and classifications used in the assessment of patients with spinal pain. In particular the reliability of, and association between, methods used to detect nerve involvement originating in the spine. Material: Articles I and II are based on study A where 100 consecutive primary health care patients with neck- and/or shoulder discomfort were assessed by 2 independent examiners using a simplified pain drawing, patient history and a physical exam with 66 clinical tests focused on neurology. Article III is based on study B on 50 consecutive outpatients with low back pain (LBP), assessed by 2 independent examiners using patient history and a physical exam with 30 clinical tests. Article IV is based on study C on 61 consecutive patients referred to magnetic resonance imaging (MRI) of the lumbar spine where we used the simplified pain drawing, patient history and a physical exam focused on neurology to detect nerve involvement originating in the spine. Results: In study A inter-examiner reliability was less than acceptable for many tests. Only a bimanual sensibility test with spurs reached K > 0.6 indicating good reliability and no bias. With known history, prevalence of positive findings increased but not reliability. Four out of five patients had, in the region of discomfort, 2 or more clinical test findings indicating nerve involvement originating in the spine. Interexaminer reliability based on a first impression assessment of the pain drawing reached 88% overall agreement and a sensitivity of 90 % to the final assessment. Two thirds of the patients added symptoms to the pain drawing during history session. In study B excellent inter-examiner reliability (K > 0.8) was found for using Kirkaldy-Willis Classification of LBP. Radiological findings had no impact. Good inter-examiner reliability was found for straight leg raise, movement range and sensibility testing with spurs. In study C we found that MRI visible nerve involvement significantly underestimated the high percentage of nerve involvement detected in the physical exam and in the pain drawing. Conclusions: Nerve involvement can be detected reliably, simply and quickly with a bimanual sensibility test with spurs and a pain drawing. MRI visible nerve involvement in the lumbar spine underestimates presence of nerve involvement detected in a physical exam and a pain drawing. Nerve involvement in both the cervical and lumbar spine may be a greatly underestimated cause of pain and/or organ dysfunction. This may explain part of today s poor treatment outcome of spinal pain and should encourage further studies on diagnostics and treatment of nerve involvement originating in the spine.
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| 3. |
- Degerman, Marianne, et al.
(författare)
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Photobiomodulation, as additional treatment to traditional dressing of hard-to-heal venous leg ulcers, in frail elderly with municipality home healthcare
- 2022
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 17:9
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Tidskriftsartikel (refereegranskat)abstract
- The main objectives of the study were to explore whether laser Photobiomodulation (PBM) in addition to traditional dressing of hard-to-heal venous leg ulcer, reduced healing time of the ulcer and if the duration of the ulcer before PBM impacted the treatment time with PBM to healing. The intervention group was frail, elderly patients with home healthcare in the municipality of Skellefteå, registered in the Swedish quality registry RiksSar for ulcer treatment with hard-to-heal venous leg ulcer. The control group with equivalent physical conditions was obtained from the same quality registry. Definition of hard-to-heal ulcer was six weeks duration or more. The PBM was performed two times per week with laser type infrared GaAs, 904nm, 60mW, and 700Hz, targeting lymphatic area and ulcer area. Laser type red visible, GaAllnp, 635nm, 75mW and 250Hz, targeting ulcer area. The intervention group treated with PBM in addition to traditional dressing healed significantly faster than the control group with a mean of 123 days (p = 0.0001). Duration of the ulcer before PBM did not impact the healing time. To conclude, the findings indicate that using PBM in addition to dressing may have multiple benefits on hard-to-heal venous leg ulcer, saving valuable time and resources for patients, healthcare providers, and institutions.
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| 4. |
- Söderberg, Daniel, et al.
(författare)
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Individual Patient Factors Associated with the Use of Physical or Digital Primary Care in Sweden
- 2024
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Ingår i: Telemedicine journal and e-health. - : Mary Ann Liebert, Inc., publishers. - 1530-5627 .- 1556-3669.
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Little is known about factors that influence patients' choice to use physical or digital primary care. This study aimed to compare self-rated health, internet habits, and what patients deem important when choosing health care between users of physical and digital primary health care. Methods: We recruited 2,716 adults visiting one of six physical or four digital primary health care providers in Stockholm, Sweden, October 2020 to May 2021. Participants answered a questionnaire with questions about sociodemography, self-rated health, internet habits, and what they considered important when seeking care. We used logistic regression and estimated odds ratios (ORs) for choosing digital care. Results: Digital users considered themselves healthier and used the internet more, compared with physical users (p < 0.001). Competence of health care staff was the most important factor when seeking care to both physical and digital users (90% and 78%, respectively). Patients considering it important to avoid leaving home were more likely to seek digital care (OR 29.55, 95% confidence interval [CI] 12.65?69.06), while patients valuing continuity were more likely to seek physical care (OR 0.25, 95% CI 0.19?0.32). These factors were significant also when adjusting for self-rated health and sociodemographic characteristics. Conclusion: What patients considered important when seeking health care was associated with what type of care they sought. Patient preferences should be considered when planning health care to optimize resource allocation.
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| 5. |
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| 6. |
- Zhang, Cheng, 1987-, et al.
(författare)
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Diagnostic Prediction Using Discomfort Drawing with IBTM
- 2016
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Konferensbidrag (refereegranskat)abstract
- In this paper, we explore the possibility to apply machine learning to make diagnostic predictions using discomfort drawings. A discomfort drawing is an intuitive way for patients to express discomfort and pain related symptoms. These drawings have proven to be an effective method to collect patient data and make diagnostic decisions in real-life practice. A dataset from real-world patient cases is collected for which medical experts provide diagnostic labels. Next, we use a factorized multimodal topic model, Inter-Battery Topic Model (IBTM), to train a system that can make diagnostic predictions given an unseen discomfort drawing. The number of output diagnostic labels is determined by using mean-shift clustering on the discomfort drawing. Experimental results show reasonable predictions of diagnostic labels given an unseen discomfort drawing. Additionally, we generate synthetic discomfort drawings with IBTM given a diagnostic label, which results in typical cases of symptoms. The positive result indicates a significant potential of machine learning to be used for parts of the pain diagnostic process and to be a decision support system for physicians and other health care personnel.
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