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1.	Alghamdi, N. H., et al. (författare) The Impact of the Degree of Kinesiophobia on Recovery in Patients With Achilles Tendinopathy 2021 Ingår i: Physical Therapy & Rehabilitation Journal. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 101:11 Tidskriftsartikel (refereegranskat)abstract Objective Kinesiophobia has been proposed to influence recovery in individuals with Achilles tendinopathy. However, whether there are differences in outcomes in individuals with different levels of kinesiophobia is unknown. The purpose of this study was to compare the characteristics of patients at baseline and recovery over time in individuals with Achilles tendinopathy and various levels of kinesiophobia. Methods This study was a secondary analysis of a prospective observational cohort study of 59 individuals with Achilles tendinopathy. The participants were divided into 3 groups on the basis of scores on the Tampa Scale for Kinesiophobia (TSK) (those with low TSK scores [<= 33; low TSK group], those with medium TSK scores [34-41; medium TSK group], and those with high TSK scores [>= 42; high TSK group]). All participants were evaluated with self-reported outcomes, clinical evaluation, tendon morphology, viscoelastic property measurements, and a calf muscle endurance test at baseline, 6 months, and 12 months. No treatment was provided throughout the study period. Results There were 16 participants (8 women) in the low TSK group (age=51.9 [SD=15.3] years, body mass index [BMI]=24.3 [22.3-25.4]), 28 participants (13 women) in the medium TSK group (age=52.7 [SD=15.2] years, BMI=26.4 [22.5-30.8]), and 15 participants (8 women) in the high TSK group (age=61.1 [SD=11.1] years, BMI=28.1 [25.2-33.6]). Among the groups at baseline, the high TSK group had significantly greater BMI and symptom severity and lower quality of life. All groups showed significant improvement over time for all outcomes except tendon viscoelastic properties and tendon thickening when there was an adjustment for baseline BMI. The high and medium TSK groups saw decreases in kinesiophobia at 6 months, but there was no change for the low TSK group. Conclusion Despite the high TSK group having the highest BMI and the worse symptom severity and quality of life at baseline, members of this group showed improvements in all of the outcome domains similar to those of the other groups over 12 months. Impact Evaluating the degree of kinesiophobia in individuals with Achilles tendinopathy might be of benefit for understanding how they are affected by the injury. However, the degree of kinesiophobia at baseline does not seem to affect recovery; this finding could be due to the patients receiving education about the injury and expectations of recovery.
2.	Andersson-Watz, Anna, 1980-, et al. (författare) Introducing Mechanically Assisted Cough for Patients with Progressive Neurological Disease : Patient-Physical Therapist Interaction and Physical Therapist Perspective 2024 Ingår i: Physical Therapy. - : Oxford University Press. - 0031-9023 .- 1538-6724. Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: The goal of this study was to explore patient-physical therapist interaction and the physical therapist's experience of the introductory session for mechanical insufflation-exsufflation (MI-E) device treatment for patients with progressive neurological disease.METHODS: Qualitative content analysis of participant-observation of interaction between patients and physical therapists during 9 MI-E introduction sessions in different clinical care settings and 10 follow-up interviews with 6 physical therapists.RESULTS: The introduction of MI-E emerged as a process of instilling a sense of security in the patient. The process can be described in 4 steps: (1) gain understanding by being responsive to the person's whole life-situation; (2) share knowledge and expectations in a respectful and permissive way; (3) introduce the device in a gentle and reciprocal interactivity; and (4) adapt to home-use in an inclusive dialogue with the patient and their significant others. Physical therapists described a need for assurance to instill a sense of security in the patient, implying a need for confidence, competent peers, guiding yet flexible routines, and emotional support.CONCLUSION: Physical therapists have a need to foster assurance in employing a person-centered approach to make a patient feel secure in the process of introducing MI-E treatment. Multiple modes of professional knowledge were used together with action-based and relational-based ethics to facilitate a person-centered care approach. This seems to be a promising approach for providing good care when introducing MI-E to patients. Further research is needed to explore this from the patient's perspective.IMPACT: This study added to the body of knowledge regarding MI-E treatment in relation to patients. This has direct implication, particularly for inexperienced physical therapists, for informed care for the patient during introduction. Our study also supports that person-centered care should be implemented at all levels of health care to make it possible for physical therapists to practice person-centered care.
3.	André, M., et al. (författare) Thoughts on Pain, Physical Activity, and Body in Patients With Recurrent Low Back Pain and Fear: An Interview Study 2022 Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 1538-6724 .- 0031-9023. ; 102:2 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: The purpose of this study was to explore thoughts and ideas about the body and pain in patients with nonspecific low back pain (LBP) who have a high degree of fear of movement. METHODS: Patients with nonspecific LBP and a high degree of fear of movement, as measured using the Tampa Scale of Kinesiophobia, were asked to participate in the study. Individual semistructured in-depth interviews were conducted with 11 participants. The material was analyzed using content analysis with an inductive approach. RESULTS: From these patients' stories, an overarching theme-decreased confidence in the body becomes a barrier to living life to the fullest-emerged. This theme was further divided into 4 subthemes: (1) "What is wrong with my body?"-the constant search for an explanation; (2) searching for the right way to move; (3) loss of mobility means a lack of meaning in life; and (4) the message from health care professionals guides feelings, thoughts, and movement behavior. CONCLUSION: This study indicates that the message of keeping physically active when experiencing LBP has succeeded, but patients with fear require support to feel secure and have enough confidence in their body to move and exercise. Clinicians need to better incorporate evidence-based practice for patients with fear and support them so that they can apply an understanding of pain to their bodies and their every day life. IMPACT: These results offer guidance for health care professionals to enhance their practice by providing more updated information to their patients who have recurrent LBP and fear. With better support, patients may be able to regain confidence in their bodies and live their lives to the fullest. LAY SUMMARY: If you have recurrent LBP and fear of moving your body, ask your health care professional to provide you with updated knowledge on pain and to help you regain confidence in your body so that you can live your life to the fullest. © The Author(s) 2022. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.
4.	Ariza-Vega, P., et al. (författare) The Journey of Recovery: Caregivers' Perspectives From a Hip Fracture Telerehabilitation Clinical Trial 2021 Ingår i: Physical therapy. - : Oxford University Press (OUP). - 1538-6724 .- 0031-9023. ; 101:3 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: The objective was to explore family caregivers' perspectives of the recovery process of older adults with hip fracture and describe experiences from caregivers who: (1) used the online intervention, or (2) received home-based care provided by the Andalusian Public Health Care System. METHODS: This was an exploratory secondary study with informal family caregivers who had an older adult family member with hip fracture enrolled in a novel telerehabilitation (telerehab) clinical trial. Forty-four caregivers of older adults with hip fracture were interviewed at 6 to 9months after their family member's hip fracture. RESULTS: Caregivers shared concerns of family members' survival and recovery; they recounted increased stress and anxiety due to the uncertainty of new tasks associated with providing care and the impact on their lifestyle. Although most caregivers were satisfied with the health care received, they made suggestions for better organization of hospital discharge and requests for home support. The main reasons why caregivers and their family member chose the telerehab program were to enhance recovery after fracture, gain knowledge for managing at home, and because of the convenience of completing the exercises at home. There were more family caregivers in the control group who expressed a high level of stress and anxiety, and they also requested more social and health services compared with caregivers whose family member received telerehab. CONCLUSION: Family caregivers are an essential component of recovery after hip fracture by providing emotional and physical support. However, future clinical interventions should evaluate person-centered interventions to mitigate possible stress and anxiety experienced by family caregivers. IMPACT: Family caregivers' perspectives are necessary in the co-design of management strategies for older adults after hip fracture. © The Author(s) 2020. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.
5.	Bergbom, Sofia, et al. (författare) Relationship among pain catastrophizing, depressed mood, and outcomes across physical therapy treatments. 2011 Ingår i: Physical Therapy. - 0031-9023 .- 1538-6724. ; 91:5, s. 754-764 Tidskriftsartikel (refereegranskat)
6.	Bergbom, Sofia, 1982-, et al. (författare) Relationship Among Pain Catastrophizing, Depressed Mood, and Outcomes Across Physical Therapy Treatments 2011 Ingår i: Physical Therapy. - : Oxford University Press. - 0031-9023 .- 1538-6724. ; 91:5, s. 754-764 Tidskriftsartikel (refereegranskat)abstract Background: Pain catastrophizing and emotional distress can act as prognosticfactors for pain and disability. Research on how these variables interact withinindividuals and over time is in an early stage. Understanding various patterns ofprognostic factors and how these factors change during treatment is important fordeveloping treatments targeting important factors.Objective: The primary aim of this study was to investigate relationships betweenpain catastrophizing and depressed mood in people seeking primary care for mus-culoskeletal pain. An additional aim was to relate these patterns of prognostic factorsto outcomes during a 6-month period.Design: The design was prospective; data were obtained at baseline and atfollow-up.Methods: Forty-two physical therapists taking part in an educational programrecruited, from their clinical practices in primary care, consecutive patients whowere currently experiencing a pain problem. Patients received various physicaltherapy interventions between baseline and follow-up.Results: On the basis of patterns of scoring for pain catastrophizing and depressedmood, 4 subgroups of participants were found. Belonging to a subgroup withelevated levels of either pain catastrophizing or depressed mood at baseline wasrelated to the absence of improvement and elevated levels of disability after physicaltherapy interventions. Furthermore, elevated levels of both variables were related tothe highest levels of disability.Limitations: The analyses relied on self-report. Neither treatment content norpain-related fear was measured. The sample was a mixture of participants reportingacute pain and subacute pain.Conclusions: The results stress the importance of assessing and targeting prog-nostic factors. Moreover, the results suggest the need to tailor treatments to matchpatterns of prognostic factors and the need to target depressed mood and paincatastrophizing in physical therapy interventions.
7.	Bernhardsson, Susanne, 1958, et al. (författare) Determinants of Guideline Use in Primary Care Physical Therapy: A Cross-Sectional Survey of Attitudes, Knowledge, and Behavior 2014 Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 94:3, s. 343-354 Tidskriftsartikel (refereegranskat)abstract Background. Understanding of attitudes, knowledge, and behavior related to evidence-based practice (ESP) and use of evidence-based clinical practice guidelines in primary care physical therapy is limited. Objectives. The objectives of this study were: (1) to investigate self-reported attitudes, knowledge, behavior, prerequisites, and barriers related to EBP and guideline use among physical therapists in primary care and (2) to explore associations of self-reported use of guidelines with these social cognitive factors 'along with demographic and workplace characteristics. Methods. A web-based survey of 419 physical therapists in primary care in western Sweden was performed. Multiple logistic regression analysis was performed to examine factors associated with guideline use. Results. The response rate was 64.7%. Most respondents had positive attitudes toward EBP and guidelines: 90% considered EBP necessary, and 96% considered guidelines important. Approximately two thirds reported confidence in finding and using evidence. One third reported being aware of guidelines. Thirteen percent knew where to find guidelines, and only 9% reported having easy access to guidelines. Fewer than half reported using guidelines frequently. The most important barriers to using guidelines were lack of time, poor availability, and limited access to guidelines. Young age and brief work experience were associated with positive attitudes toward EBP. A postgraduate degree was associated with higher application of EBP. Positive attitudes, awareness of guidelines, considering guidelines to facilitate practice, and knowing how to integrate patient preferences with guideline use were associated with frequent use of guidelines. Limitations. Data were self-reported, which may have increased the risk of social.desirability bias. Conclusions. Use of guidelines was not as frequent as could be expected in view of the positive attitudes toward EBP and guidelines among physical therapists. Awareness of and perceived access to guidelines were limited. The identified determinants can be addressed when developing 'guideline implementation strategies.
8.	Bernhardsson, Susanne, 1958, et al. (författare) Measuring Evidence-Based Practice in Physical Therapy: Translation, Adaptation, Further Development, Validation, and Reliability Test of a Questionnaire 2013 Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 93:6, s. 819-832 Tidskriftsartikel (refereegranskat)abstract Background. Evidence-based practice (EBP) and evidence-based clinical practice guidelines are Objective. The 3 objectives of this study were: (1) to translate and cross-culturally adapt a Design. This was an instrument development study with validity and reliability testing. Methods. A previously used questionnaire about EBP was translated and cross-culturally adapted to a Results. The development process resulted in a first questionnaire draft containing 48 items. The Limitations. Only face validity and content validity were tested. Conclusions. The final translated and adapted questionnaire was determined to have good face and
9.	Boisgontier, MP, et al. (författare) Physical Inactivity: A Behavioral Disorder in the Physical Therapist's Scope of Practice 2020 Ingår i: Physical therapy. - : Oxford University Press (OUP). - 1538-6724 .- 0031-9023. ; 100:5, s. 743-746 Tidskriftsartikel (refereegranskat)
10.	Bäck, Maria, et al. (författare) Perceptions of Kinesiophobia in Relation to Physical Activity and Exercise After Myocardial Infarction: A Qualitative Study 2020 Ingår i: Physical therapy. - : Oxford University Press (OUP). - 1538-6724 .- 0031-9023. ; 100:12, s. 2110-2119 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: Physical activity and exercise are central components in rehabilitation after a myocardial infarction. Kinesiophobia (fear of movement) is a well-known barrier for a good rehabilitation outcome in these patients; however, there is a lack of studies focusing on the patient perspective. The aim of this study was to explore patients' perceptions of kinesiophobia in relation to physical activity and exercise 2 to 3months after an acute myocardial infarction. METHODS: This qualitative study design used individual semi-structured interviews. Face-to-face interviews were conducted with 21 patients post-myocardial infarction who were screened for kinesiophobia (≥32 on the Tampa Scale for Kinesiophobia Heart). The interviews were transcribed and analyzed according to an inductive content analysis. RESULTS: An overarching theme was defined as "coping with fear of movement after a myocardial infarction-a dynamic process over time" comprising 2 subthemes and explaining how coping with kinesiophobia runs in parallel processes integrating the patient's internal process and a contextual external process. The 2 processes are described in a total of 8 categories. The internal process was an iterative process governed by a combination of factors: ambivalence, hypervigilance, insecurity about progression, and avoidance behavior. The external process contains the categories of relatives' anxiety, prerequisites for feeling safe, information, and the exercise-based cardiac rehabilitation program. CONCLUSION: Coping with fear of movement after a myocardial infarction is a dynamic process that requires internal and external support. To further improve cardiac rehabilitation programs, person-centered strategies that support the process of each person-as well as new treatment strategies to reduce kinesiophobia-need to be elaborated. IMPACT: Patients with a myocardial infarction were found to be ambivalent about how they expressed their fear of movement; therefore, it is crucial for physical therapists to acknowledge signs of fear by listening carefully to the patient's full story in addition to using adequate self-reports and tests of physical fitness. These results will inform the design, development, and evaluation of new treatment strategies, with the overall aim of reducing kinesiophobia and increasing physical activity and participation in exercise-based cardiac rehabilitation. © The Author(s) 2020. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.
11.	Caneiro, J. P., et al. (författare) From Fear to Safety : A Roadmap to Recovery from Musculoskeletal Pain 2022 Ingår i: Physical Therapy. - : Oxford University Press. - 0031-9023 .- 1538-6724. ; 102:2 Tidskriftsartikel (refereegranskat)abstract Contemporary conceptualizations of pain emphasize its protective function. The meaning assigned to pain drives cognitive, emotional, and behavioral responses. When pain is threatening, and a person lacks control over their pain experience, it can become distressing, self-perpetuating, and disabling. Although the pathway to disability is well established, the pathway to recovery is less researched and understood. This Perspective draws on recent data on the lived experience of people with pain-related fear to discuss both fear and safety learning processes and their implications for recovery for people living with pain. Recovery is here defined as achievement of control over pain, as well as improvement in functional capacity and quality of life. Based on the common-sense model, this Perspective proposes a framework utilizing cognitive functional therapy to promote safety learning. A process is described in which experiential learning combined with "sense making" disrupts a person's unhelpful cognitive representation and behavioral and emotional response to pain, leading them on a journey to recovery. This framework incorporates principles of inhibitory processing that are fundamental to pain-related fear and safety learning.
12.	Conradsson, Mia, et al. (författare) Berg Balance Scale : intrarater test-retest reliability among older people dependent in activities of daily living and living in residential care facilities 2007 Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 87:9, s. 1155-1163 Tidskriftsartikel (refereegranskat)abstract The Berg Balance Scale (BBS) is frequently used to assess balance in older people, but knowledge is lacking about the absolute reliability of BBS scores. The aim of this study was to investigate the absolute and relative intrarater test-retest reliability of data obtained with the BBS when it is used among older people who are dependent in activities of daily living and living in residential care facilities. The participants were 45 older people (36 women and 9 men) who were living in 3 residential care facilities. Their mean age was 82.3 years (SD=6.6, range=68-96), and their mean score on the Mini Mental State Examination was 17.5 (SD=6.3, range=4-30). The BBS was assessed twice by the same assessor. The intrarater test-retest reliability assessments were made at approximately the same time of day and with 1 to 3 days in between assessments. Absolute reliability was calculated using an analysis of variance with a 95% confidence level, as suggested by Bland and Altman. Relative reliability was calculated using the intraclass correlation coefficient (ICC). The mean score was 30.1 points (SD=15.9, range=3-53) for the first BBS test and 30.6 points (SD=15.6, range=4-54) for the retest. The mean absolute difference between the 2 tests was 2.8 points (SD=2.7, range=0-11). The absolute reliability was calculated as being 7.7 points, and the ICC was calculated to .97. Despite a high ICC value, the absolute reliability showed that a change of 8 BBS points is required to reveal a genuine change in function among older people who are dependent in activities of daily living and living in residential care facilities. This knowledge is important in the clinical setting when evaluating an individual's change in balance function over time in this group of older people.
13.	Crea, Simona, et al. (författare) Time-Discrete Vibrotactile Feedback Contributes to Improved Gait Symmetry in Patients With Lower Limb Amputations : Case Series 2017 Ingår i: Physical Therapy. - : AMER PHYSICAL THERAPY ASSOC. - 0031-9023 .- 1538-6724. ; 97:2, s. 198-207 Tidskriftsartikel (refereegranskat)abstract Background. Reduced sensory feedback from lower leg prostheses results in harmful gait patterns and entails a significant cognitive burden because users have to visually monitor their locomotion. Objectives. The purpose of this study was to validate a sensory feedback device designed to help elderly patients with transfemoral amputation to improve their temporal gait symmetry after a training program aimed at associating the vibrotactile patterns with symmetrical walking. Design. This was a prospective quasi-experimental study including 3 elderly patients walking with lower leg prostheses. Methods. During training sessions, participants walked on a treadmill equipped with feedback device that controlled vibrotactile stimulators based on signals from a sensorized insole while provided with visual feedback about temporal gait symmetry. The vibrotactile stimulators delivered short-lasting, low-intensity vibrations synchronously with certain gait phase transitions. During pretraining and posttraining sessions, participants walked without visual feedback about gait symmetry under 4 conditions: with or without vibrotactile feedback while performing or not performing a secondary cognitive task. The primary outcome measure was temporal gait symmetry. Results. with <= 52 hours of training,the participants improved their temporal gait symmetry from 0.82 to 0.84 during the pretraining evaluation session to 0.98 to 1.02 during the follow-up session across all conditions. Following training, participants were able to maintain good temporal gait synmsetry, without any evidence of an increased cognitive burden. Limitations. The small sample size and short follow-up time do not allow straightforward extrapolations to larger populations or extended time periods. Conclusions. Low-cost, gait phase-specific vibrotactile feedback after training combined with visual feedback may improve the temporal gait synmsetry in patients with transfemoral amputation without representing an additional cognitive burden.
14.	Danielsson, Louise, 1979, et al. (författare) “Crawling Out of the Cocoon”: Patients’ Experiences of a Physical Therapy Exercise Intervention in the Treatment of Major Depression. 2016 Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 96, s. 1241-1250 Tidskriftsartikel (refereegranskat)abstract Background: While the effectiveness of physical exercise for depression has been studied for many years, few studies have described patients’ experiences of what exercise means to them, beyond the biological focus. Moreover, exercise as a treatment for depression is rarely explored in a physical therapy context. Objectives: The purpose was to explore a physical therapy exercise intervention, as experienced by persons suffering from major depression. Design: This study had an inductive approach and employed qualitative content analysis. Methods: Semi-structured interviews were conducted with 13 persons who participated in physical therapist-guided aerobic exercise in a randomized controlled trial. The participants were all diagnosed with major depression according to the Diagnostic and Statistical Manual of Mental Disorders. Data were collected and analyzed in an inductive tradition using qualitative content analysis according to Graneheim and Lundman. Results: Four categories emerged: struggling toward a healthy self, challenging the resistance, feeling alive but not euphoric, and needing someone to be there for you. The participants experienced that although the exercise intervention was hard work, it enhanced the feeling of being alive and made them feel that they were doing something good for themselves. These feelings were a welcome contrast to the numbness and stagnation they experienced during depression. Conclusions: Exercise in a physical therapy context can improve the participants’ perception of their physical ability and create a sense of liveliness, improving their depressed state. The therapeutic relationship is essential for supporting the patient’s vulnerability and ambiguity in an empathic and perceptive way.
15.	Dean, E., et al. (författare) Health Competency Standards in Physical Therapist Practice 2019 Ingår i: Physical Therapy. - : NLM (Medline). - 0031-9023 .- 1538-6724. ; 99:9, s. 1242-1254 Tidskriftsartikel (refereegranskat)abstract Although the physical therapist profession is the leading established, largely nonpharmacological health profession in the world and is committed to health promotion and noncommunicable disease (NCD) prevention, these have yet to be designated as core physical therapist competencies. Based on findings of 3 Physical Therapy Summits on Global Health, addressing NCDs (heart disease, cancer, hypertension, stroke, diabetes, obesity, and chronic lung disease) has been declared an urgent professional priority. The Third Summit established the status of health competencies in physical therapist practice across the 5 World Confederation for Physical Therapy (WCPT) regions with a view to establish health competency standards, this article's focus. Three general principles related to health-focused practice emerged, along with 3 recommendations for its inclusion. Participants acknowledged that specific competencies are needed to ensure that health promotion and NCD prevention are practiced consistently by physical therapists within and across WCPT regions (ie, effective counseling for smoking cessation, basic nutrition, weight control, and reduced sitting and increased activity/exercise in patients and clients, irrespective of their presenting complaints/diagnoses). Minimum accreditable health competency standards within the profession, including use of the WCPT-supported Health Improvement Card, were recommended for inclusion into practice, entry-to-practice education, and research. Such standards are highly consistent with the mission of the WCPT and the World Health Organization. The physical therapist profession needs to assume a leadership role vis-à-vis eliminating the gap between what we know unequivocally about the causes of and contributors to NCDs and the long-term benefits of effective, sustained, nonpharmacological lifestyle behavior change, which no drug nor many surgical procedures have been reported to match.
16.	Dell'Isola, Andrea, et al. (författare) Factors Associated With the Outcome of a First-Line Intervention for Patients With Hip or Knee Osteoarthritis or Both : Data From the BOA Register 2020 Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 100:10, s. 1771-1781 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: This study explored the association of patients' demographics, health status, symptom severity, previous osteoarthritis (OA) care, and psychological status with the change in pain severity following a first-line intervention including education and exercise for OA provided nationwide in Swedish primary care. METHODS: This register-based cohort study included 23,309 people with knee or hip OA from the Better Management of Patients with OA register. Linear regression models were used to assess the association of independent variables with the change in pain from baseline to 3 and 12 months. All the analyses were stratified based on the affected joint (hip vs knee). RESULTS: In people with hip and people with knee OA, high levels of baseline pain were associated with decreased pain at both follow-ups (3 months: knee B = -.67; hip B = -.64; 12 months: knee B = -.70; hip B = -.66), whereas being older, overweight, or female had a weak or no association. Finally, at both follow-ups, bilateral OA was associated with increased pain only in people with knee OA, whereas comorbidities and the willingness to undergo surgery were associated with increased pain regardless of the affected joint. CONCLUSIONS: Baseline pain showed the strongest association among the analyzed variables, whereas sex, age, and body mass index appear to be weakly associated with the pain change after a first-line intervention. Comorbidities and willingness to undergo surgery showed a potentially important association and may have a negative impact on the pain change following a first-line intervention. IMPACT: In people with hip or knee OA, age, sex, body mass index, and previous surgery are only weakly associated with the change in pain after a first-line intervention supporting the evidence recommending exercise and education as a foundation for all OA therapy. Having comorbidities and being willing to undergo surgery is associated with a worse outcome from a first-line intervention, including exercise and education. Individualized treatments addressing the disease perception and the specific comorbidity profile may improve the outcomes.
17.	Eklund, Caroline, 1983-, et al. (författare) The Meaning of Sedentary Behavior as Experienced by People in the Transition From Working Life to Retirement : An Empirical Phenomenological Study 2021 Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 101:8 Tidskriftsartikel (refereegranskat)abstract ObjectiveSedentary behavior (SB) is defined as a mean of >6 hours of daytime sitting or lying down. SB has been shown to increase with older age and is a risk factor for disease. During the transition from working life to retirement, changes in daily life activities occur, risking increased SB. The aim of the present study was to gain a deeper understanding of SB in relation to the transition from working life to retirement as experienced by persons in retirement.MethodsThe study was grounded in a phenomenological life-world perspective. Fourteen semi-structured interviews were conducted with participants aged 64–75. Data were analyzed using the empirical phenomenological psychological method.ResultsThe participants described that voluntary sedentary time was positively related to general health and well-being, while involuntary sedentary time was negatively related to health. Increased sedentary time was described as natural when aging. Retirement was expressed as a time for rest after hard work and the ability to choose a slower pace in life. Internal and external demands and daily routines interrupted SB, whereas loneliness was perceived to increase SB. Participants strived to find a balance between physical activity and sedentary time. The variations in the participants’ descriptions formed three typologies: in light of meaningful sedentary behavior, in the shadow of involuntary sedentary behavior, and a dual process – postponing sedentary behavior with physical activity.ConclusionsIncreased SB was perceived as natural when aging, but something that may be postponed by conscious choices. SB was perceived as associated with health, rest and recovery but also with the risk of deteriorating health.ImpactThis knowledge of the experienced meaning of SB could guide the design of health promotion interventions and may be helpful in targeting those in need of support and individualizing interventions to decrease SB in retirement.Lay SummaryThis study reveals how persons in retirement describe sedentary behavior as something healthy but also as unhealthy and that sedentary behavior is natural in aging and can be postponed by physical activity.
18.	Elvén, Maria, 1973-, et al. (författare) Predictors of Clinical Reasoning Using the Reasoning 4 Change Instrument With Physical Therapist Students 2019 Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 99:8, s. 964-976 Tidskriftsartikel (refereegranskat)abstract Although physical therapist students must be well prepared to integrate biopsychosocial and behavioral perspectives into their clinical reasoning, there is a lack of knowledge regarding factors that influence such competence. This study explored the associations among the independent variables-knowledge, cognition, metacognition, psychological factors, contextual factors, and curriculum orientation vis-a-vis behavioral medicine competencies-and the dependent variables-outcomes of input from client (IC), functional behavioral analysis (FBA), and strategies for behavior change (SBC) as levels in physical therapist students' clinical reasoning processes. This study used an exploratory cross-sectional design. The Reasoning 4 Change instrument was completed by 151 final-semester physical therapist students. Hierarchical multiple regression analyses for IC, FBA, and SBC were conducted. In the first step, curriculum orientation was inserted into the model; in the second step, self-rated knowledge, cognition, and metacognition; and in the third step, psychological factors. All independent variables except contextual factors explained 37% of the variance in the outcome of IC. Curriculum orientation explained 3%, cognitive and metacognitive factors an additional 22%, and attitudes another 15%. Variance in the outcomes of FBA and SBC were explained by curriculum orientation only (FBA change in R-2=0.04; SBC change in R-2=0.05). Higher scores of the dependent variables were associated with a curriculum having behavioral medicine competencies. The limitations of this study are that it was cross-sectional. Cognitive and metacognitive capabilities and skills and positive attitudes are important predictors of physical therapist students' clinical reasoning focused on behavior change at the IC level. Curricula with behavioral medicine competencies are associated with positive outcomes at all clinical reasoning levels.
19.	Ericson, Mats O, et al. (författare) Patellofemoral joint forces during ergometric cycling. 1987 Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 67:9, s. 1365-9 Tidskriftsartikel (refereegranskat)abstract We estimated the patellofemoral joint forces generated during pedaling on a bicycle ergometer. Our calculations were based on measurements from a force transducer mounted on the pedal, 16-mm cine-film sequences, and biomechanical models of the cycling motion and of the patellofemoral joint. Six healthy male subjects cycled at different work loads, pedaling rates, saddle heights, and pedal foot positions. The maximum patellofemoral compressive force was 905 N (1.3 times body weight [BW]) when cycling with an anterior foot position at 120 W, 60 rpm, and middle saddle height. The mean peak compressive force between the quadriceps tendon and the intercondylar groove was 295 N (0.4 BW), and the patellar-tendon and quadriceps-tendon strain forces were 661 N (0.9 BW) and 938 N (1.3 BW), respectively. The patellofemoral joint forces were increased with increased work load or decreased saddle height. Different pedaling rates or foot positions did not significantly change these forces.
20.	Eriksson Crommert, Martin, 1974-, et al. (författare) Predictors of disability attributed to symptoms of increased interrecti distance in women after childbirth : an observational study 2021 Ingår i: Physical Therapy. - : Oxford University Press. - 0031-9023 .- 1538-6724. ; 101:6 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: The purpose of this study was to investigate how various physical and psychological factors are linked to disability attributed to symptoms from increased interrecti distance (IRD) in women after childbirth.METHODS: In this cross-sectional observational study, 141 women with an IRD of at least 2 finger widths and whose youngest child was between the ages of 1 and 8 years participated. A multilinear regression model was performed with disability as the outcome variable and fear-avoidance beliefs, emotional distress, body mass index, lumbopelvic pain, IRD, and physical activity level as predictor variables.RESULTS: The regression model accounted for 60% (R2 = 0.604, adjusted R2 = 0.586) of the variance in disability (F6,132 = 33.5). The 2 strongest predictors were lumbopelvic pain with a regression coefficient of 1.4 (95% CI = 1.017 to 1.877) and fear avoidance with a regression coefficient of 0.421 (95% CI = 0.287 to 0.555). The actual IRD, with a regression coefficient of -0.133 (95% CI = -1.154 to 0.888), did not contribute significantly to the variation in disability.CONCLUSION: Disability attributed to symptoms from an increased IRD is explained primarily by the level of lumbopelvic pain but also by the degree of fear-avoidance beliefs and emotional distress.IMPACT: This study highlights pain intensity and psychological factors as crucial factors for understanding disability attributed to increased IRD.
21.	Falsiroli Maistrello, Luca, et al. (författare) Perceptions and Experiences of Individuals With Neck Pain : A Systematic Critical Review of Qualitative Studies With Meta-Summary and Meta-Synthesis 2022 Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 102:8 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: This study aimed at exploring the perspectives and experiences of individuals with neck pain by synthesizing all available qualitative studies. METHODS: A systematic, qualitative meta-summary and meta-synthesis was conducted following the 5-step methodology proposed by Sandelowski and Barroso. A systematic search of 9 electronic databases was conducted in May 2021. Methodological quality was assessed using the Critical Appraisal Skills Programme tool. RESULTS: Nine studies were included in the meta-synthesis for a total of 103 participants (73 women). Eleven categories were identified as belonging to 3 main themes: physical ("My neck has gone wrong"); psychological ("I am worried about my recovery"); and social ("Pain limits my life"). In the physical theme, the categories with the highest frequency were symptoms (67%) followed by body perception (44%). The psychological theme frequencies from highest to lowest were psychological consequences (100%), coping strategies (100%), mindset (67%), expectations from health care professionals (44%), and gender influence (22%). In the social theme, frequencies from highest to lowest were social relationships (56%), work, and activities of daily living and physical activity (44%, respectively). CONCLUSION: An individual's experience with neck pain is a multidimensional phenomenon in which physical, psychological, and social dimensions influence each other. These findings suggested that health care professionals should be aware of recognizing and evaluating all of the individual's experiences to offer a truly patient-centered care pathway. IMPACT: This qualitative meta-synthesis responded to a call to action to explore perspectives and experiences of individuals with neck pain. These findings can provide crucial guidance for clinicians as they plan and implement evidence-based recommendations for neck pain.
22.	Filbay, Stephanie, et al. (författare) Fear of Reinjury Following Surgical and Nonsurgical Management of Anterior Cruciate Ligament Injury : An Exploratory Analysis of the NACOX Multicenter Longitudinal Cohort Study 2022 Ingår i: Physical Therapy. - : Oxford University Press. - 0031-9023 .- 1538-6724. ; 102:2 Tidskriftsartikel (refereegranskat)abstract Objectives The purpose of this study was to compare fear and certainty of reinjury between follow-up time points and treatment groups (no anterior cruciate ligament [ACL] reconstruction [no ACLR], pre-ACLR, post-ACLR) and to identify prognostic factors for fear of reinjury at 3 and 12 months following injury or ACLR. Methods An exploratory analysis of the Natural Corollaries and Recovery After ACL-injury multicenter longitudinal cohort study was conducted. Patients (n = 275) with primary ACL injury and 15 to 40 years of age received usual care (initial physical therapist-supervised rehabilitation, before considering ACLR). Fear of reinjury (as measured with the Anterior Cruciate Ligament Quality of Life instrument [ACL-QOL] item 31 and the Anterior Cruciate Ligament Return to Sport After Injury instrument [ACL-RSI] item 9) and certainty of reinjury (as measured with the Knee Self-Efficacy Scale item D2) were evaluated at baseline and at 3, 6, and 12 months following ACL injury or ACLR. Comparisons were performed with linear mixed models. Linear regression assessed potential prognostic factors (age, sex, preinjury activity, baseline knee function, baseline general self-efficacy, and expected recovery time) for fear of reinjury (ACL-QOL item 31) at the 3- and 12-month follow-up assessments. Results Fear of reinjury was common regardless of ACL treatment. Fear of reinjury decreased between 3 and 6 months and 3 and 12 months (mean difference: ACL-QOL = 9 [95% CI = 2 to 15]; ACL-RSI = 21 [95% CI = 13 to 28]) after injury. This improvement was not observed in patients who later underwent ACLR, who reported worse fear of reinjury at 3 months (ACL-QOL = 10 [95% CI = 3 to 18]) and at 12 months (ACL-RSI = 22 [95% CI = 2 to 42]) postinjury compared with those who did not proceed to ACLR. Following ACLR, fear of reinjury decreased between the 3- and 12-month follow-up assessments (ACL-QOL = 10 [95% CI = 4 to 16]; ACL-RSI = 12 [95% CI = 5 to 19]). Greater baseline general self-efficacy was associated with reduced fear of reinjury at 12 months after injury (adjusted coefficient = 1.7 [95% CI = 0.0 to 3.5]). Female sex was related to more fear of reinjury 3 months after ACLR (-14.5 [95% CI = -25.9 to -3.1]), and better baseline knee function was related to reduced fear of reinjury 12 months after ACLR (0.3 [95% CI = 0.0 to 0.7]). Conclusion People who had ACLR reported worse fear of reinjury before surgery than those who did not proceed to ACLR. Different prognostic factors for fear of reinjury were identified in people treated with ACLR and those treated with rehabilitation alone. Impact Fear of reinjury is a concern following ACL injury. Clinicians should evaluate and address reinjury fears. These results may assist in identifying individuals at risk of fear of reinjury following surgical and nonsurgical management of ACL injury.
23.	Fongen, Camilla, et al. (författare) Responsiveness and Interpretability of 2 Measures of Physical Function in Patients With Spondyloarthritis. 2020 Ingår i: Physical therapy. - : Oxford University Press (OUP). - 1538-6724 .- 0031-9023. ; 100:4, s. 728-738 Tidskriftsartikel (refereegranskat)abstract Maintenance or improvement of physical function is an important treatment target in the management of patients with axial spondyloarthritis (axSpA); measurement tools that can detect changes in physical function are therefore important.The objective of this study was to compare responsiveness and interpretability of the patient reported Bath Ankylosing Spondylitis (AS) Functional Index (BASFI) and the AS performed based Improvement (ASPI) in measuring change in physical function after exercise in patients with axSpA.This was a sub-study of 58 patients nested within a randomized controlled trial comparing the effect of 12-weeks exercise with usual care.Responsiveness and interpretability was assessed according to the Consensus-based Standards for the selection of health status Measurement Instrument (COSMIN). Responsiveness was assessed by testing eight predefined hypotheses for ASPI and BASFI. Interpretability was assessed by (1) using patients' reported change as an anchor ("a little better" = minimal important change [MIC]) and (2) by categorizing patients with a 20% improvement as responders.For ASPI and BASFI; 5 of 8 (63%) vs. 2 of 8 (25%), of the predefined hypotheses for responsiveness were confirmed. The MIC values for improvement in physical function were 3.7sec in ASPI and 0.8 points (on a scale from 0-10) for BASFI. In the intervention group, 21 of 30 (70%) and 13 of 30 (43%) of the patients were categorized as responders measured with ASPI and BASFI, respectively. There was a tendency towards a floor effect in BASFI, as 8 of 58 (14%) patients scored the lowest value at baseline.This study was limited by its moderate sample size.Our findings suggest that ASPI is preferable over BASFI when evaluating physical function after exercise interventions in patients with axSpA.
24.	Forsberg, Anette, et al. (författare) Validity of the Dynamic Gait Index in People With Multiple Sclerosis 2013 Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 93:10, s. 1369-1376 Tidskriftsartikel (refereegranskat)abstract Background: Evaluation of walking capacity and risk of falls in people with multiple sclerosis often are performed in rehabilitation. The Dynamic Gait Index (DGI) evaluates walking during different tasks, but the feasibility in identifying people at risk for falls needs to be further investigated.Objective: The objective of this study was to investigate (1) the construct validity (known groups, convergent, and discriminant) of the DGI and (2) the accuracy of predicting falls and establishing a cutoff point to identify fallers.Design: This trial was a multicenter, cross-sectional study.Methods: A convenience sample was composed of 81 people with multiple sclerosis with subjective gait and balance impairment who were able to walk 100 m (comparable to Expanded Disability Status Scale 1-6). Mean age of the participants was 49 years; 76% were women. The 25-Foot Timed Walk Test, Timed "Up & Go" Test, Four Square Step Test, Timed Sit-to-Stand Test, MS Walking Scale, Multiple Sclerosis Impact Scale, and self-reported falls during the previous 2 months were used for validation, to establish cutoff points for identifying fallers, and to investigate predictive values.Results: Significantly lower DGI scores (P <=.001) were found for participants reporting falls (n=31). High sensitivity (87%) in identifying falters was found, with a cutoff score <= 19. The positive predictive value was 50%, and the negative predictive value was 87%. The positive likelihood ratio was 1.77, and the negative likelihood ratio was 0.26. The convergent validity was moderate to strong (rho=0.58-0.80), with the highest correlation coefficient found for the 25-Foot Timed Walk Test. Discriminant validity was shown with low correlation for the psychological subscale of the Multiple Sclerosis Impact Scale.Limitations: The sample included ambulatory people participating in a randomized controlled trial investigating balance training.Conclusions: The DGI is a valid measure of dynamic balance during walking for ambulatory people with multiple sclerosis. With the cutoff point of <= 19, sensitivity was high in identifying people at risk of falls.
25.	Fritz, Johanna, et al. (författare) Do Physical Therapists Practice a Behavioral Medicine Approach? : A Comparison of Perceived and Observed Practice Behaviors 2023 Ingår i: Physical Therapy. - : NLM (Medline). - 0031-9023 .- 1538-6724. ; 103:5 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: A behavioral medicine approach, incorporating a biopsychosocial view and behavior change techniques, is recommended in physical therapy for the management of musculoskeletal pain. However, little is known about physical therapists' actual practice behavior regarding the behavioral medicine approach. The aim of this study was to examine how physical therapists in primary health care judge their own practice behavior of a behavioral medicine approach in the assessment and treatment of patients with persistent musculoskeletal pain versus how they practice a behavioral medicine approach as observed by independent experts in video recordings of patient consultations. METHODS: A prospective cohort study was conducted. Video recordings of 23 physical therapists' clinical behavior in 139 patient consultations were observed by independent experts and compared with the physical therapists' self-reported practice behavior, using a protocol including 24 clinical behaviors. The difference between observed and self-reported clinical behaviors was analyzed with a Chi-square test and a Fisher exact test. RESULTS: The behavioral medicine approach was, in general, practiced to a small extent and half of the self-reported clinical behaviors were overestimated when compared with the observed behaviors. According to the observations, the physical perspective dominated in assessment and treatment, the functional behavioral analysis was never performed, and the mean number of behavior change techniques used was 0.7. CONCLUSION: There was a discrepancy between how physical therapists perceived the extent to which they practiced a behavioral medicine approach in their clinical behavior compared with what the independent researchers observed in the video recordings. IMPACT: This study demonstrates the importance of using observations instead of using self-reports when evaluating professionals' clinical behavior. The results also suggest that-to ensure that physical therapy integrates the biopsychosocial model of health-physical therapists need to increase their focus on psychosocial factors in clinical practice.
26.	Gephine, Sarah, et al. (författare) Specific contribution of quadriceps muscle strength, endurance, and power to functional exercise capacity in people with chronic obstructive pulmonary disease : a multicenter study 2021 Ingår i: Physical Therapy. - : Oxford University Press. - 0031-9023 .- 1538-6724. ; 101:6, s. 1-8 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: Various functional muscle properties affect different aspects of functional exercise capacity in people with COPD. The purpose of this study was to investigate the contribution of quadriceps muscle strength, endurance, and power to the 6-minute walking distance (6MWD) and the 1-minute sit-to-stand test (1STS) performance in people with COPD.METHODS: The study was a prospective, multicenter cross-sectional study. Anthropometrics, Medical Research Council (MRC) dyspnea scale, lung function, 6MWD and the 1STS number of repetitions were assessed. Isometric quadriceps strength (Strength-ISOM) and endurance (Endurance-ISOM), isotonic quadriceps endurance (Endurance-ISOT), isokinetic quadriceps strength (Strength-ISOKIN), and power (Power-ISOKIN) were assessed on a computerized dynamometer while functional quadriceps power was determined during 5 sit-to-stand repetitions (Power-5STS). Univariate and multivariate analyses were performed to determine the contribution of functional muscle properties on the 6MWD and the 1STS number of repetitions.RESULTS: The study included 70 people with COPD (mean % predicted FEV1 = 58.9 [SD = 18.2]). The 6MWD correlated with each functional muscle property, except the Endurance-ISOM. The number of repetitions during the 1STS correlated with each functional muscle property except isometric measurements. Multivariate models explained respectively 60% and 39% of the variance in the 6MWD and 1STS number of repetitions, with Power-5STS being the muscle functional property with the strongest contribution to the models.CONCLUSION: Except for isometric endurance, quadriceps strength, endurance, and power were associated with functional exercise capacity in people with moderate COPD. Among these functional muscle properties, muscle power contributed the most to the 6MWD and 1STS number of repetitions, suggesting that muscle power is more relevant to functional exercise capacity than muscle strength or endurance in people with COPD.IMPACT: Understanding the individual contribution of muscle properties to functional status is important to designing interventions. This study provides the guidance that muscle power may be more important to functional exercise capacity than muscle strength or endurance in people with COPD.
27.	Hammer, Ann M., et al. (författare) Effects of forced use on arm function in the subacute phase after stroke : a randomized, clinical pilot study 2009 Ingår i: Physical Therapy. - Alexandria, VA. : American Physical Therapy Association. - 0031-9023 .- 1538-6724. ; 89:6, s. 526-539 Tidskriftsartikel (refereegranskat)abstract BACKGROUND AND OBJECTIVE: Following stroke, it is common to exhibit motor impairments and decreased use of the upper limb. The objective of the present study was to evaluate forced use on arm function during the subacute phase after stroke.DESIGN: A comparison of standard rehabilitation only and standard rehabilitation together with a restraining sling was made through a randomized, nonblinded, clinical pilot trial with assessments before intervention, after intervention, and at 1- and 3-month follow-ups.SETTING: The present study took place at the departments of rehabilitation medicine, geriatrics, and neurology at a university hospital.PARTICIPANTS: A convenience sample of 30 people 1 to 6 months (mean, 2.4 mo) after stroke was randomized into 2 groups (forced-use group and standard training group) of 15 people each. Twenty-six participants completed the 3-month follow-up.INTERVENTION: All participants received their standard rehabilitation program with training 5 days per week for 2 weeks as inpatients or outpatients. The forced-use group also wore a restraining sling on the nonparetic arm with a target of 6 hours per day.MEASUREMENTS: The Fugl-Meyer (FM) test, the Action Research Arm Test, the Motor Assessment Scale (MAS) (sum of scores for the upper limb), a 16-hole peg test (16HPT), a grip strength ratio (paretic hand to nonparetic hand), and the Modified Ashworth Scale were used to obtain measurements. RESULTS: The changes in the forced-use group did not differ from the changes in the standard training group for any of the outcome measures. Both groups improved over time, with statistically significant changes in the FM test (mean score changed from 52 to 57), MAS (mean score changed from 10.1 to 12.4), 16HPT (mean time changed from >92 seconds to 60 seconds), and grip strength ratio (mean changed from 0.40 to 0.55).LIMITATIONS: The limitations of this pilot study include an extended study time, a nonblinded assessor, a lack of control of treatment content, and a small sample size.CONCLUSIONS: The results of the present pilot study did not support forced use as a reinforcement of standard rehabilitation in the subacute phase after stroke. Forced use did not generate greater improvements with regard to motor impairment and capacity than standard rehabilitation alone. The findings of this effectiveness study will be used to help design future clinical trials with the aim of revealing a definitive conclusion regarding the clinical implementation of forced use for upper-limb rehabilitation.
28.	Hammer, Ann M., et al. (författare) On "Effects of forced use on arm function in the subacute phase ..." Hammer AM, Lindmark B. Phys Ther. 2009; 89:526-539 Response 2009 Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 89:9, s. 995-997 Tidskriftsartikel (refereegranskat)
29.	Hamre, Charlotta, et al. (författare) Balance and Gait After First Minor Ischemic Stroke in People 70 Years of Age or Younger : A Prospective Observational Cohort Study 2020 Ingår i: Physical Therapy. - : American Physical Therapy Association. - 0031-9023 .- 1538-6724. ; 100:5, s. 798-806 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Two-thirds of patients with stroke experience only mild impairments in the acute phase, and the proportion of patients < 70 years is increasing. Knowledge about balance and gait and predictive factors are scarce for this group.OBJECTIVE: The objective of this study was to explore balance and gait in the acute phase and after 3 and 12 months in patients ≤70 years with minor ischemic stroke (National Institute of Health Stroke Scale (NIHSS) score ≤3). This study also explored factors predicting impaired balance after 12 months.DESIGN: This study was designed as an explorative longitudinal cohort study.METHODS: Patients were recruited consecutively from two stroke units. Balance and gait were assessed with the Mini-BESTest, Timed Up and Go (TUG), and preferred gait speed. Predictors for impaired balance were explored using logistic regression.RESULTS: This study included 101 patients. Mean (SD) age was 55.5 (11.4) years, 20% were female and mean (SD) NIHSS score was 0.6 (0.9) points. The Mini-BESTest, gait speed, and TUG improved significantly from the acute phase to 3 months, gait speed also improved from 3 to 12 months. At 12 months, 26% had balance impairments and 33% walked slower than 1.0 m/s. Poor balance in the acute phase (odds ratio =0.92, 95% CI = 0.85 - 0.95) was the only predictor of balance impairments (Mini-BESTest score ≤ 22) at 12 months post-stroke.LIMITATIONS: Limitations include lack of information about pre-stroke balance and gait impairment, and post-stroke exercise. Few women limits the generalizability.CONCLUSIONS: This study observed improvements in both balance and gait during the follow-up, still about one third had balance or gait impairments at 12 months post-stroke. Balance in the acute phase predicted impaired balance at 12 months.
30.	Hansson, Nils, et al. (författare) Nobel Prize for Physical Therapy? Rise, Fall, and Revival of Medico-Mechanical Institutes 2015 Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 95:8, s. 1184-1194 Tidskriftsartikel (refereegranskat)abstract This historical vignette explores the considerations of the Nobel Prize Committee for Physiology or Medicine by vetting the Nobel Prize chances of Dr Gustaf Zander (1835–1920). His way to stardom started 150 years ago when he began mechanizing the passive and active movements that physical therapists manually used to treat diseases. A glance at his machines shows that they parallel surprisingly well what can be found in modern fitness studios. By combining files from the Nobel Prize Archive and sources from the first physical therapists, this vignette pieces together why Zander was considered one of the best candidates for the Nobel Prize in 1916. By providing this glimpse of history, questions about the origin of physical therapy concepts and the profession of the physical therapist are raised.
31.	Hsieh, Yu-Hsin, et al. (författare) Collaborative Home-Visit Program for Young Children With Motor Delays in Rural Taiwan : A Pilot Randomized Controlled Trial 2020 Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 100:6, s. 979-994 Tidskriftsartikel (refereegranskat)abstract Background. Caregiver engagement and collaborative team early childhood intervention (ECI) services are international trends; however, relevant evidence of collaborative home-visiting ECI in rural areas is as yet undetermined.Objective. The study aimed to investigate the effectiveness of a collaborative ECI program in a rural area of Taiwan.Design. The study was a pilot randomized control led trial.Methods. Children aged 6 to 33 months experiencing motor delays and their caregivers were enrolled in Taitung, Taiwan. Using stratified randomization, 24 participants were allocated to either experimental or control groups, and both received 5 home visits within 3 months. The experimental group received ECI services based on the International Classification of Functioning, Disability and Health framework and family-centered approaches. The control group received regular home visits by local social workers. Child outcomes included Pediatric Evaluation of Disability Inventory Chinese Version and Peabody Developmental Motor Scale, 2nd edition. Family outcomes included the Disability-Adapted Infant–Toddler version of Home Observation for Measurement, and Chinese versions of the Knowledge of Infant Development Inventory and Parental Stress Index-Short Form. A tester blinded to the study conducted assessments at baseline, postintervention, and 3-month follow-up. Two-way mixed analysis of variance was used with α = .05 (2-tailed).Results. The experimental group improved scores on the Disability-Adapted Infant–Toddler version of Home Observation for Measurement significantly more than the control group with an effect size of 0.64 at follow-up. In other outcomes, both groups showed no significant differences. The follow-up rate was 69%, and adherence to the ECI program was acceptable.Limitations. A limitation of the study was the heterogeneity of the sample.Conclusions. This pilot study revealed possible effectiveness in implementing collaborative ECI programs based on family-centered approaches and the International Classification of Functioning, Disability and Health in rural areas. Larger field studies are needed to confirm our findings.
32.	Huisstede, Bionka M A, et al. (författare) Consensus on a Multidisciplinary Treatment Guideline for De Quervain Disease: Results From the European HANDGUIDE Study. 2014 Ingår i: Physical therapy. - : Oxford University Press (OUP). - 1538-6724 .- 0031-9023. ; 94:8, s. 1095-1110 Tidskriftsartikel (refereegranskat)abstract ObjectiveTo achieve consensus on a multidisciplinary treatment guideline for De Quervain's disease.MethodsA European Delphi consensus strategy was initiated. A systematic review reporting on the effectiveness of surgical and non-surgical interventions was conducted and published, and used as an evidence-based starting point for this study. In total, 35 experts (hand therapists/hand surgeons selected by the national member associations of their European federations, and Physical Medicine & Rehabilitation physicians) participated in the Delphi consensus strategy. Each Delphi round consisted of a questionnaire, an analysis and a feedback report.ResultsConsensus was achieved on the description, symptoms and diagnosis of De Quervain's disease. The experts agreed that patients with this disorder should always receive instructions and that these instructions should be combined with another form of treatment and should not be used as a sole treatment. Instructions combined with NSAIDs, splinting, NSAIDs plus splinting, corticosteroid injection, corticosteroid injections plus splinting, or surgery were considered suitable treatment options. Details on the use of instructions, NSAIDs, splinting, corticosteroid injections, and surgery were described. Main factors for selecting one of the above-mentioned treatment options were identified: severity and duration of the disorder, and previous treatments given. A relation between the severity and duration, and choice of therapy was indicated by the experts and reported in the guideline.ConclusionsThis multidisciplinary treatment guideline may help in the treatment of and research on De Quervain's disease.
33.	Huisstede, Bionka M A, et al. (författare) Multidisciplinary Consensus Guideline for Managing Trigger Finger: Results From the European HANDGUIDE Study. 2014 Ingår i: Physical therapy. - : Oxford University Press (OUP). - 1538-6724 .- 0031-9023. ; 94:10, s. 1421-1433 Tidskriftsartikel (refereegranskat)abstract BackgroundTrigger finger is characterized by -sometimes painful- snapping or locking when flexing the finger. Although trigger finger is frequently seen in clinical practice, no standard treatment protocol has been established as 'best practice'.ObjectiveTo achieve consensus on a multidisciplinary treatment guideline for trigger finger.DesignA European Delphi consensus strategy was initiated. Systematic reviews reporting on the effectiveness of surgical and non-surgical interventions were conducted and used as an evidence-based starting point for this study.SettingIn total, 35 experts (hand therapists /hand surgeons selected by the national member associations of their European federations, and Physical Medicine & Rehabilitation (PM&R) physicians) participated in the Delphi consensus strategy.MeasurementsEach Delphi round consisted of a questionnaire, an analysis and a feedback report.ResultsAfter four Delphi rounds, consensus was achieved on the description, symptoms, and diagnosis of trigger finger. The experts agreed that splinting, corticosteroid injections, corticosteroid injections plus splinting, and surgery are suitable treatment options. Relevant details for the use of splinting, corticosteroid injections, and surgery were described. Main factors for selecting one of these treatment options were identified as severity and duration of the disease, and previous treatments received. A relation between the severity/duration and choice of therapy was indicated by the experts and reported on in the guideline.LimitationsThe results represent a group's opinion at a given point in time. When the evidence for the effectiveness of interventions increases, experts' opinions will change and the guideline should be re-evaluated and adjusted in view of these new insights.ConclusionsThis multidisciplinary treatment guideline may help involved therapists and physicians in the treatment of trigger finger, and indicate areas requiring additional research.
34.	Igelström, Helena, 1976-, et al. (författare) Level of agreement between methods for measuring moderate-to-vigorous physical activity and sedentary time in people with obstructive sleep apnea and obesity 2013 Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 93:1, s. 50-59 Tidskriftsartikel (refereegranskat)abstract BackgroundThere is ambiguity about what measures to use to best identify physical activity and sedentary behavior, and agreement between methods for measuring physical activity and sedentary behavior in people with obstructive sleep apnea syndrome (OSAS) and obesity has not been evaluated.ObjectiveThe objective of this study was to examine the level of agreement between an accelerometer and a self-report questionnaire (International Physical Activity Questionnaire [IPAQ]) or a logbook for measuring time spent on moderate to vigorous physical activity and time spent sedentary in people with OSAS and obesity.DesignThis prospective study was a psychometric evaluation of agreement between measurement methods.MethodsThirty-nine people who were obese (mean body mass index 36.1 kg/m2, SD=4.35) and had moderate to severe OSAS (apnea-hypopnea index of ≥15) were consecutively recruited from a sleep clinic in Sweden. All were treated with continuous positive airway pressure and were waiting for a follow-up sleep evaluation.ResultsAgreement between the measurement methods was limited. For physical activity, the mean difference between the accelerometer and the IPAQ was 47 minutes, and the mean difference between the accelerometer and the logbook was 32 minutes. Agreement was limited for sedentary time as well; the mean difference between the accelerometer and the IPAQ was 114 minutes, and the mean difference between the accelerometer and the logbook was 86 minutes.LimitationsThe small sample size may affect the interpretation and generalizability of the results.ConclusionsThe results imply that the methods cannot be used interchangeably. A combination of an accelerometer and a daily logbook seems to provide a detailed description of physical activity and sedentary behavior.
35.	Jakobsson, M, et al. (författare) Author Response to Denteneer et al 2020 Ingår i: Physical therapy. - : Oxford University Press (OUP). - 1538-6724 .- 0031-9023. ; 100:6, s. 1036-1037 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
36.	Jakobsson, Max, et al. (författare) 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 Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 1538-6724 .- 0031-9023. ; 99:4, s. 457-477 Tidskriftsartikel (refereegranskat)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.
37.	Jette, AM, et al. (författare) The Value of Qualitative Research in Physical Therapy 2019 Ingår i: Physical therapy. - : Oxford University Press (OUP). - 1538-6724 .- 0031-9023. ; 99:7, s. 819-820 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
38.	Johansson, Hanna, et al. (författare) Controlling the uncontrollable : Perceptions of balance in people with parkinson disease 2019 Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 99:11, s. 1501-1510 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Exercise improves balance in Parkinson disease (PD), yet the majority of people with the diagnosis are physically inactive. Insights gained from understanding how people with PD (PwPD) make sense of their symptoms and their ability to control them may inform the communication strategies and motivational approaches adopted by physical therapists. No previous study has qualitatively explored how PwPD perceive the concept of balance and the beliefs they hold concerning their ability to affect balance.OBJECTIVE: This study aimed to explore the meaning of balance for PwPD and the beliefs they hold regarding their ability to influence their balance in everyday life.DESIGN: The design is a qualitative study with an inductive approach.METHODS: In-depth interviews were conducted with 18 participants with PD (age range 46 to 83 years, Hoehn and Yahr range 1 to 4), and transcripts were analyzed using qualitative content analysis.RESULTS: Five main themes emerged from the analysis: remaining in control over the body; adapting behavior to deal with uncertainty; directing focus to stay one step ahead; resilience as a defense, and exercise beliefs and reservations. Interpretation of the underlying patterns in the main themes yielded the overarching theme of focus and determination to regain control over shifting balance.CONCLUSIONS: The concept of balance was perceived as both bodily equilibrium and mind-body interplay and was described in the context of remaining in control over one's body and everyday life. Cognitive resources were utilized in order to direct focus and attention during balance-challenging situations in a process involving internal dialogue. Even participants who did not express beliefs in their ability to affect balance through exercise used psychological resilience to counter the challenges of impaired balance.
39.	Johansson, Kajsa, et al. (författare) Effects of acupuncture versus ultrasound for patients with impingement syndrome : Randomized clinical trial 2005 Ingår i: Physical Therapy. - 0031-9023 .- 1538-6724. ; 85:6, s. 490-501 Tidskriftsartikel (refereegranskat)abstract Background and Purpose. There is no definitive evidence for the efficacy of the physical therapy interventions used for patients with impingement syndrome. The purpose of this study was to compare manual acupuncture and continuous ultrasound, both applied in addition to home exercises, for patients diagnosed with impingement syndrome. Subjects and Methods. Eighty-five patients with clinical signs of impingement syndrome were randomly assigned to either a group that received acupuncture (n=44) or a group that received ultrasound (n=41). Both interventions were given by physical therapists twice a week for 5 weeks in addition to a home exercise program. Scores from 3 shoulder disability measures, combined in the analysis, measured change during a period of 12 months. Results. Both groups improved, but the acupuncture group had a larger improvement in the combined score. Discussion and Conclusion. The results suggest that acupuncture is more efficacious than ultrasound when applied in addition to home exercises.
40.	Johansson, Kajsa, 1971-, et al. (författare) "Effects of Acupuncture Versus Ultrasound in Patients With Impingement Syndrome : A Randomized Clinical Trial" comment and author reply 2006 Ingår i: Physical Therapy. - 0031-9023 .- 1538-6724. ; 86, s. 143-145 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
41.	Joseph, C, et al. (författare) Client Perspectives on Reclaiming Participation After a Traumatic Spinal Cord Injury in South Africa 2016 Ingår i: Physical therapy. - : Oxford University Press (OUP). - 1538-6724 .- 0031-9023. ; 96:9, s. 1372-1380 Tidskriftsartikel (refereegranskat)abstract BackgroundThe development of rehabilitation services promoting participation in people living with a traumatic spinal cord injury (TSCI) is of major concern for physical therapists. What the client sees as effective participation, barriers, and facilitators might be different due to their particular context. This study was conducted to gain insight into the experiences of attaining an important outcome in a developing context.ObjectiveThe aim of this study was to explore the experiences of reclaiming participation in community-dwelling people with TSCI in South Africa.DesignThis was an explorative, qualitative study with inductive content analysis.MethodsIndividual semistructured interviews were conducted with 17 adults living with a TSCI in order to explore their experience of participation. The verbatim transcripts were analyzed, and the end result was an overall theme that included 4 emerging categories.ResultsThe theme “participation possibility” denotes the eventual involvement in life situations. Within this theme, there were 4 categories that emerged as a representation of essential aspects along the continuum of reclaiming participation: (1) dealing with the new self, (2) a journey dominated by obstacles, (3) the catalyst of participation, and (4) becoming an agent. Dealing with and recognizing these intervening conditions seem critical for clients to reconstruct the meaning that is necessary for a broader conception of participation.LimitationsThe transferability of these findings to dissimilar contexts may be limited.ConclusionClient perspectives on reclaiming participation after injury affirm the notion of eventual participation, with each person finding strategies to succeed. In order to help clients reclaim participation, health professionals should develop contextually sensitive programs that include peer mentoring and reduce the influence of hindering factors.
42.	Jönsson, Charlotta, et al. (författare) Impedance of Extracellular Fluid, Volume, and Local Tissue Water Can Be Reliably Measured in People with Lower Limb Lymphedema 2022 Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 102:5 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: Lower limb lymphedema (LLL) is a chronic condition. To be able to evaluate changes of LLL over time and effects of interventions reliable measurement methods are important. Currently, there is limited knowledge of the reliability of commonly used measurement methods in LLL. The study objective was to evaluate the test-retest (intrarater) reliability of impedance of extracellular fluid, volume, and local tissue water measurements in people with unilateral or bilateral LLL and measurement errors both for a group of people and for a single individual.METHODS: Forty-two people with mild to moderate unilateral or bilateral, primary or secondary LLL were measured twice, 2 weeks apart. Impedance of extracellular fluid was measured by bioimpedance spectroscopy and calculated as arm-to-leg ratio, volume with circumference measurements every 4 cm, and local tissue water with tissue dielectric constant at 14 points. Test-retest reliability was evaluated using the ICC(2,1), changes in the mean, standard error of measurement in relative terms (SEM%), and the smallest real difference in relative terms (SRD%).RESULTS: For the impedance ratio, the reliability was high [ICC(2,1) = 0.79 to 0.90] and the measurement errors were acceptable (SEM% = 5.0%-5.2%; SRD% = 14.0%-14.4%). For volume, the reliability was high (ICC = 0.99) and the measurement errors were low (SEM% = 1.1%-1.7%; SRD% = 3.1%-4.6%). For the tissue dielectric constant, the reliability was fair to excellent [ICC(2,1) = 0.68 to 0.96] and the measurement errors were acceptable (SEM% = 4.2%-9.7%; SRD% = 11.7%-26.8%).CONCLUSIONS: Impedance of extracellular fluid, volume, and local tissue water are reliable in people with mild to moderate LLL. The measurement errors were acceptable in all 3 methods indicating that real, clinical changes in lymphedema can be measured both for a group of people and a single individual.
43.	Kemani, M K, et al. (författare) Long-term follow-up of a person-centered prehabilitation program based on cognitive-behavioral physical therapy for patients scheduled for lumbar fusion 2024 Ingår i: Physical Therapy. - 0031-9023 .- 1538-6724. Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: Long-term follow-ups of prehabilitation programs for lumbar spine surgery are lacking, and more comprehensive evaluations are needed. In the current study, we evaluated the long-term effects of a prehabilitation program compared with conventional care in relation to lumbar fusion surgery in patients with degenerative disc disease.METHODS: Patients (n = 118) receiving lumbar fusion surgery were included in a multicenter randomized controlled trial, involving 1 university hospital and 2 spine clinics. The intervention was a person-centered prehabilitation program based on cognitive-behavioral physical therapy that targeted psychological presurgical risk factors, physical activity, and overall health. The control group received conventional preoperative care. Patient-reported outcome measures (PROMs) included assessments at 8 time-points: Low back disability (primary outcome), back pain intensity, leg pain intensity, pain catastrophizing, fear of movement, anxiety and depressive mood, health-related quality of life, and patient-specific functioning. Physical activity and physical capacity were assessed at 5 time points. Linear mixed models were used to analyze the effects of the intervention.RESULTS: There were no significant differences between groups at the 12- and 24-month follow-ups for any outcome, except for the One Leg Stand test 1 year following surgery, in favor of the control group. There were significant improvements for both groups, from baseline to the 12- and 24-month follow-ups for all physical capacity test and PROMs, except for leg pain and self-efficacy for exercise.CONCLUSIONS: No long-term effects were found for the prehabilitation program compared to conventional care. Physical activity did not improve over time, despite significantly improved self-reported functioning and physical capacity measurements.IMPACT: These findings have implications for the current understanding of the long-term effects of prehabilitation and suggest that future research should focus on programs promoting physical activity both before and after lumbar spine surgery to decrease the risk of long-term adverse health outcomes.
44.	Kemani, Mike K., et al. (författare) Long-Term Follow-Up of a Person-Centered Prehabilitation Program Based on Cognitive-Behavioral Physical Therapy for Patients Scheduled for Lumbar Fusion 2024 Ingår i: PHYSICAL THERAPY. - 0031-9023 .- 1538-6724. Tidskriftsartikel (refereegranskat)abstract Objective Long-term follow-ups of prehabilitation programs for lumbar spine surgery are lacking, and more comprehensive evaluations are needed. In the current study, we evaluated the long-term effects of a prehabilitation program compared with conventional care in relation to lumbar fusion surgery in patients with degenerative disc disease. Methods Patients (n = 118) receiving lumbar fusion surgery were included in a multicenter randomized controlled trial, involving 1 university hospital and 2 spine clinics. The intervention was a person-centered prehabilitation program based on cognitive-behavioral physical therapy that targeted psychological presurgical risk factors, physical activity, and overall health. The control group received conventional preoperative care. Patient-reported outcome measures (PROMs) included assessments at 8 time-points: Low back disability (primary outcome), back pain intensity, leg pain intensity, pain catastrophizing, fear of movement, anxiety and depressive mood, health-related quality of life, and patient-specific functioning. Physical activity and physical capacity were assessed at 5 time points. Linear mixed models were used to analyze the effects of the intervention. Results There were no significant differences between groups at the 12- and 24-month follow-ups for any outcome, except for the One Leg Stand test 1 year following surgery, in favor of the control group. There were significant improvements for both groups, from baseline to the 12- and 24-month follow-ups for all physical capacity test and PROMs, except for leg pain and self-efficacy for exercise. Conclusions No long-term effects were found for the prehabilitation program compared to conventional care. Physical activity did not improve over time, despite significantly improved self-reported functioning and physical capacity measurements. Impact These findings have implications for the current understanding of the long-term effects of prehabilitation and suggest that future research should focus on programs promoting physical activity both before and after lumbar spine surgery to decrease the risk of long-term adverse health outcomes.
45.	Kjeken, Ingvild, et al. (författare) How to Develop Patient-Centered Research: Some Perspectives Based on Surveys Among People With Rheumatic Diseases in Scandinavia 2010 Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 90:3, s. 450-460 Tidskriftsartikel (refereegranskat)abstract Patient-centered research addresses the research agenda of patients and captures aspects of health and functioning that they consider important. Yet, those who live with a disease or condition have limited influence when it comes to setting the research agenda, and we know little about how they experience being participants in research studies. Furthermore, knowledge is limited concerning factors enhancing or hindering patients' participation in trials and the format that people with rheumatic diseases and their families prefer for dissemination of the results from clinical research. This perspective article describes the research priorities of people with rheumatic diseases in Scandinavia, their experiences and attitudes concerning participation in research projects, and which format for research information they prefer. Based on results from 3 surveys organized by the Scandinavian Rheumatism Associations and on related research literature, the possible implications for future research also are discussed.
46.	Kvist, Joanna, et al. (författare) Fear of Movement and Reinjury in Sports Medicine: Relevance for Rehabilitation and Return to Sport 2022 Ingår i: Physical Therapy. - : OXFORD UNIV PRESS INC. - 0031-9023 .- 1538-6724. ; 102:2 Tidskriftsartikel (refereegranskat)abstract Athletes are defined by their ability to move and are often accustomed to pain as it relates to their sports and exercise regime. The forced movement restriction and pain associated with an acute or overuse injury has a profound effect not only on their physical abilities but also on their psychological well-being and social context. With the goal of returning to sport, the rehabilitation focus historically has been on recovery of physical attributes, but more recent research is addressing the psychological factors. This Perspective proposes that-according to the current evidence in sports medicine-the fear that affects choice of treatment, rehabilitation, and return to sports is intertwined with physical capacity and recovery of function. Past injury is also 1 of the main risk factors for a sports injury; therefore, fear of reinjury is not irrational. For an athlete, the fear related to a sports injury encompasses the fear of reinjury along with fear of not being able to return to the sport at their highest performance level-and the fear of having lifelong debilitating pain and symptoms. This Perspective reviews the evidence for the influence of fear of movement and reinjury on choice of treatment, rehabilitation, and return to sport and provides suggestions on how to address this fear during the continuum of treatment and return to sports.
47.	Linton, Steven J., et al. (författare) Impact of psychological factors in the experience of pain 2011 Ingår i: Physical Therapy. - : Oxford University Press. - 0031-9023 .- 1538-6724. ; 91:5, s. 700-711 Tidskriftsartikel (refereegranskat)abstract This article reviews the role of psychological factors in the development of persistent pain and disability, with a focus on how basic psychological processes have been incorporated into theoretical models that have implications for physical therapy. To this end, the key psychological factors associated with the experience of pain are summarized, and an overview of how they have been integrated into the major models of pain and disability in the scientific literature is presented. Pain has clear emotional and behavioral consequences that influence the development of persistent problems and the outcome of treatment. Yet, these psychological factors are not routinely assessed in physical therapy clinics, nor are they sufficiently utilized to enhance treatment. Based on a review of the scientific evidence, a set of 10 principles that have likely implications for clinical practice is offered. Because psychological processes have an influence on both the experience of pain and the treatment outcome, the integration of psychological principles into physical therapy treatment would seem to have potential to enhance outcomes.
48.	Linton, Steven J., 1952-, et al. (författare) Understanding the Etiology of Chronic Pain From a Psychological Perspective 2018 Ingår i: Physical Therapy. - : American Physical Therapy Association. - 0031-9023 .- 1538-6724. ; 98:5, s. 315-324 Tidskriftsartikel (refereegranskat)abstract The etiology of chronic pain-related disability is not fully understood, particularly from a clinical perspective. Investigations to date have identified risk factors and elucidated some important processes driving the development of persistent pain problems. Yet this knowledge and its application are not always accessible to practicing physical therapists or other clinicians. This article aims to summarize the main psychological processes involved in the development of chronic pain disability and to derive some guidelines for treatment and future research. To this end, the focus is on the paradox of why coping strategies that are helpful in the short term continue to be used even when-ironically-they maintain the problem in the long term. To aid in summarizing current knowledge, 4 tenets that elucidate the etiology of chronic pain are described. These tenets emphasize that chronic pain disability is a developmental process over time, contextual factors set the stage for this development, underlying transdiagnostic psychological factors fuel this development, and the principles of learning steer the development of pain behaviors. With these tenets, an explanation of how a chronic problem develops for one person but not another is provided. Finally, hypotheses that can be empirically tested to guide clinical application as well as basic research are generated. In conclusion, understanding the psychological processes underlying the etiology of chronic pain provides testable ideas and a path forward for improving treatment interventions.
49.	Littbrand, Håkan, 1966-, et al. (författare) A high-intensity functional weight-bearing exercise program for older people dependent in activities of daily living and living in residential care facilities : evaluation of the applicability with focus on cognitive function 2006 Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 86:4, s. 489-498 Tidskriftsartikel (refereegranskat)abstract BACKGROUND AND PURPOSE: Knowledge concerning the applicability and the effect of high-intensity exercise programs is very limited for older people with severe cognitive and physical impairments. The primary aim of this study was to evaluate the applicability of a high-intensity functional weight-bearing exercise program among older people who are dependent in activities of daily living and living in residential care facilities. A second aim was to analyze whether cognitive function was associated with the applicability of the program. SUBJECTS: The subjects were 91 older people (mean age=85.3 years, SD=6.1, range=68-100) who were dependent in personal activities of daily living and randomly assigned to participate in an exercise intervention. Their mean score for the Mini-Mental State Examination (MMSE) was 17.5 (SD=5.0, range=10-29). METHODS: A high-intensity functional weight-bearing exercise program was performed in groups of 3 to 7 participants who were supervised by physical therapists. There were 29 exercise sessions over 13 weeks. Attendance, intensity of lower-limb strength and balance exercises, and occurrence and seriousness of adverse events were the outcome variables in evaluating the applicability of the program. RESULTS: The median attendance rate was 76%. Lower-limb strength exercises with high intensity were performed in a median of 53% of the attended exercise sessions, and balance exercises with high intensity were performed in a median of 73% of the attended exercise sessions. The median rate of sessions with adverse events was 5%. All except 2 adverse events were assessed as minor and temporary, and none led to manifest injury or disease. No significant differences were observed in applicability when comparing participants with dementia and participants without dementia. In addition, there was no significant correlation between applicability and the MMSE score. DISCUSSION AND CONCLUSION: The results suggest that a high-intensity functional weight-bearing exercise program is applicable for use, regardless of cognitive function, among older people who are dependent in activities of daily living, living in residential care facilities, and have an MMSE score of 10 or higher.
50.	Lotzke, Hanna, et al. (författare) A Person-Centered Prehabilitation Program Based on Cognitive-Behavioral Physical Therapy for Patients Scheduled for Lumbar Fusion Surgery: A Randomized Controlled Trial 2019 Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 99:8, s. 1069-1088 Tidskriftsartikel (refereegranskat)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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