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  • 1.
    Björklund, Martin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning. Institutionen för samhällsmedicin och rehabilitering, fysioterapi, Umeå universitet.
    What works for whom:challenges in personalising physical therapy: Discussion panel2015Konferansepaper (Annet vitenskapelig)
  • 2.
    Björklund, Martin
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning. Dept. of Community Med. and Rehabilitation, Physiotherapy, Umeå Univ., Umeå, Sweden.
    Djupsjöbacka, Mats
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Svedmark, Åsa
    Dept. of Community Med. and Rehabilitation, Physiotherapy, Umeå Univ., Umeå, Sweden.
    Häger, Charlotte
    Dept. of Community Med. and Rehabilitation, Physiotherapy, Umeå Univ., Umeå, Sweden.
    Effects of tailored versus non-tailored treatment on pain and pressure pain threshold in women with nonspecific neck pain: a randomized controlled trial2014Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Aim of the investigation: The evidence for physiotherapy treatments of nonspecific neck pain is modest despite a large increase of intervention studies the last decade. One reason could be different underlying causes for pain in individuals with nonspecific neck pain, and that identification of sub-groups or individual needs is seldom accounted for in studies. In the absence of causal treatment options, a tailored treatment approach based on an explicit clinical decision model guided by assessment of function, clinical signs and symptoms, should be considered. Our aim was to evaluate tailored treatment based on such a decision model, targeting women with nonspecific neck pain. Our main hypothesis was that the tailored treatment (T) would have better short, intermediate and long-term effects on pain intensity and pressure pain threshold for the trapezius muscles than either non-tailored treatment (NT) (same treatment components but applied quasi-randomly) or treatment-as-usual (TAU) (no treatment from the study, no restrictions). We further hypothesized that T or NT has better effect than TAU. For details, cf. Current Controlled Trials registration ISRCTN49348025 and published study protocol.

    Methods: 120 working women with minimum six weeks duration of neck pain were randomized to the T, NT or TAU groups. All participants had more than “no disability” but less than “complete disability” according to the Neck Disability Index, and reported impaired capacity on the quality or quantity to work the preceding month. Main exclusion criteria were trauma-related neck pain, specific diagnoses and generalized pain or concomitant low back pain. The decision model for tailored treatment was based on tests and symptoms with defined cut-off levels comprising the following main categories: reduced cervical mobility, impaired neck-shoulder strength and motor control, trapezius myalgia, cervicogenic headache and impaired eye-head-neck control (cf. published study protocol). Assessment was performed one week before and after the 11-weeks intervention, with follow-ups 6-months (intermediate-term) and 12-months (long-term) after the intervention. Outcome variables were pain intensity (Numeric Rating Scale, NRS, 0 – 10) and pressure pain threshold (PPT) of the upper trapezius muscles (kPa). PPT was not measured at long-term follow-up.  Preliminary statistical analyses for the predefined hypotheses were performed with analysis of covariance (ANCOVA) with baseline outcome values as covariates. This was supplemented with pairwise Bonferroni-compensated comparisons in case of significance of factor group.

    Results: 86% of the participants completed the intervention, and the attrition was similar across groups. Preliminary results for the short term evaluation showed a reduction in NRS from an average of 4.4 and 4.5 to 2.5 in the T and NT groups, respectively, which was significantly greater compared to the TAU group (p=0.024 and p=0.014 for T and NT). For the PPT, there was no difference between T and NT groups at the short term evaluation, but close to a significantly increased threshold for the T compared to the TAU group (p=0,058). No differences were found between treatment groups on the intermediate and long-term evaluations for neither of the two outcome variables.

    Conclusions: The results indicate that tailored treatment for women with nonspecific neck pain may not be more effective, with respect to pain reduction, compared to non-tailored treatment. The hypothesis of superiority of tailored or non-tailored treatment over treatment-as-usual was partly supported for the short-term evaluation. However, the short-term results should be interpreted with caution since the impact of higher attention given to the participants in T and NT groups is not known. Reference:1. Björklund M, Djupsjöbacka M, Svedmark Å, Häger C. (2012) Effects of tailored neck-shoulder pain treatment based on a decision model guided by clinical assessments and standardized functional tests. A study protocol of a randomized controlled trial. BMC Musculoskeletal Disorders. May 20;13(1):75

  • 3.
    Björklund, Martin
    et al.
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Hamberg, Jern
    Alfta Research Foundation, Alfta, Sweden.
    Heiden, Marina
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Barnekow-Bergkvist, Margareta
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    The profile fitness mapping scales, validity of a new back-specific questionnaire2009Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Background: Disability questionnaires for LBP-patients mostlyemanate from health professionals and have a content of differentdomains of disability presented as a single sum score, makingit difficult to derive changes within a specific domain. Thisstudy introduces a new back-specific questionnaire, the ProfileFitness Mapping questionnaire (PFM), which was based on patient’sself-reported characteristics of the LBP. The PFM incorporatesboth a functional limitation and a symptom scale, with furthersubdivision of the symptom scale in separate indices for severityand temporal aspects. The aim of the study was to assess theoverall validity of the PFM.

    Methods and Results: Chronic LBP-patients (n=193) answered thePFM and four validated back-specific criterion questionnaires.The correlation coefficients between the PFM and the criterionquestionnaires showed good concurrent criterion validity (0.61– 0.83). The best discriminative ability between patientswith different pain severity was demonstrated by the functionallimitation scale of the PFM. Classification according to theICF revealed a high degree of homogeneous item content of thesymptom scale to the domain of impairments, and of the functionallimitation scale to the domain of activity limitations. Wellcentered score distribution indicates that the PFM has the potentialto detect improvement or worsening of symptoms and functionallimitations in chronic LBP-patients.

    Conclusion: The results of the study signify that the PFM isa valid indicator of symptoms and functional limitations ofLBP-patients. It provides the combination of a composite totalscore and the possibility of evaluations within specific domainsof disability.

  • 4.
    Björklund, Martin
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning. Department of Community Medicine and Rehabilitation, Physiotherapy, Umea University, Umeå Sweden.
    Wiitavaara, Birgitta
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Heiden, Marina
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Responsiveness and minimal important change for the ProFitMap-neck questionnaire and the Neck Disability Index in women with neck-shoulder pain2017Inngår i: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 26, nr 1, s. 161-170Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose

    The aim was to determine the responsiveness and minimal important change (MIC) of the questionnaire ProFitMap-neck that measures symptoms and functional limitations in people with neck pain. The same measurement properties were determined for Neck Disability Index (NDI) for comparison purposes.

    Methods

    Longitudinal data were derived from two randomized controlled trials, including 103 and 120 women with non-specific neck pain, with questionnaire measurements performed before and after interventions. Sensitivity and specificity to discriminate between improved and non-improved participants, based on categorization of a global rating of change scale (GRCS), were determined for the ProFitMap-neck indices and NDI by using area under receiver operator curves (AUC). Correlations between the GRCS anchor and change scores of the questionnaires were also used to assess responsiveness. The change score that showed the highest combination of sensitivity and specificity was set for MIC.

    Results

    The ProFitMap-neck indices showed similar responsiveness as NDI with AUC exceeding 0.70 (Range: ProFitMap-neck, 0.74 – 0.83; NDI, 0.75 – 0.86). The MIC in the two samples ranged between 6.6 – 13.6% for ProFitMap-neck indices and 5.2 and 6.3% for NDI. Both questionnaires had significant correlations with GRCS (Spearman’s rho 0.47 – 0.72).

    Conclusions

    Validity of change scores was demonstrated for the ProFitMap-neck indices with adequate ability to discriminate between improved and non-improved participants. Values of minimal important change were presented.

  • 5.
    Blomqvist, Sven
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Idrottsvetenskap.
    Rehn, Börje
    Institutionen för Samhällsmedicin och Rehabilitering, Fysioterapi, Umeå universitet.
    Fysisk aktivitet och hälsa för personer med utvecklingsstörning2015Inngår i: Fysioterapi, ISSN 1653-5804, nr 1, s. 26-31Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [sv]

    Hälsa är en förutsättning för att kunna förverkliga sina mål i livet. Personer med utvecklingsstörning, cirka 90 000 i Sverige, har nedsatt hälsa jämfört med personer utan utvecklingsstörning och det leder till att denna grupp har svårare att uppfylla sina mål. Personer med utvecklingsstörning drabbas i större utsträckning av övervikt, typ 2-diabetes, hjärt- och kärlsjukdomar, högt blodtryck, benskörhet och depression. Undersökningar visar också på nedsatt fysisk aktivitet, motorik, syreupptagningsförmåga, muskelstyrka och postural balans hos denna grupp. Dessa sjukdomar och nedsatta förmågor går att påverkai positiv riktning med fysisk aktivitet. Fysioterapeuter som har bred kunskap om hälsa och anpassning av fysisk aktivitet kan vara till stor hjälp vid prevention, bedömning och träning.

  • 6.
    Blomqvist, Sven
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Idrottsvetenskap.
    Wester, Anita
    Department of Research and Evaluation, Swedish National Agency for Education.
    Lönnberg, Lisa
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University.
    Sundelin, Gunnevi
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University.
    Rehn, Börje
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University.
    Physical exercise frequency seem not to influence postural balance but trunk muscle endurance in young persons with intellectual disability2017Inngår i: Journal of Physical Education and Sports Management, ISSN 2373-2156, E-ISSN 2373-2164, Vol. 4, nr 2, s. 38-47Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background The influence of various physical exercise frequencies on postural balance and muscle performance among young persons with intellectual disability (ID) is not well understood.

    Method Cross-sectional data from 26 elite athletes were compared with 37 students at a sports school and to 57 students at a special school, all diagnosed with mild to moderate ID and with different exercise frequencies. Data were also compared with a group of 149 age-matched participants without ID.

    Results There were no significant differences in postural balance between young ID groups regardless of physical exercise frequency, all of them had however impaired postural balance compared to the non-ID group. The group with high exercise performed better than the other ID groups in the trunk muscle endurance test.

    Conclusions It appears as if physical exercise frequency don’t improve postural balance but endurance in the trunk muscles for young persons with ID.

  • 7.
    Bring, Annika
    et al.
    Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden.
    Bring, Johan
    Högskolan i Gävle, Akademin för teknik och miljö, Avdelningen för elektronik, matematik och naturvetenskap, Statistik.
    Söderlund, Anne
    Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden, and School of Health, Care and Social Welfare, Physiotherapy, Mälardalen University, Västerås, Sweden.
    Wasteson, Elisabet
    Division of Psychology, Department of Social Sciences, Mid Sweden University, Östersund , Sweden.
    Åsenlöf, Pernilla
    Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden.
    Coping Patterns and Their Relation to Daily Activity, Worries, Depressed Mood, and Pain Intensity in Acute Whiplash-Associated Disorders2013Inngår i: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 20, nr 2, s. 293-303Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND

    There is a lack of knowledge regarding how individuals with acute whiplash-associated disorders (WAD) appraise and cope with situation-specific stressors.

    PURPOSE

    The aim of the study was to describe the daily process of coping reported in a daily coping assessment by individuals with acute WAD within 1 month after the accident. More specifically, profiles of coping strategies were identified and patterns between stressors, primary and secondary appraisals, and coping strategy profiles were described in relation to reported level of activity, worries, depressed mood and pain intensity during the day.

    METHOD

    A descriptive and exploratory design was applied. Two hundred and twenty-nine whiplash-associated disorders-daily coping assessment (WAD-DCA) collected during seven consecutive days from 51 participants with acute WAD in Sweden, were included. Cluster analysis was used to obtain coping strategy profiles and data were graphically visualised as patterns through the coping process.

    RESULTS

    When measuring coping as a daily process relating to the specific stressful situation, different coping pocess patterns appeared. During days with a high degree of physical and mental well-being, high self-efficacy beliefs seemed to be working as an important secondary appraisal, whereas during days with a low degree of physical and mental well-being primary appraisals of the stressor as a threat and catastrophic thoughts were present in the coping process.

    CONCLUSIONS

    Early identification of situational- and individual-specific stressors, appraisals and coping efforts as measured by the WAD-DCA may contribute to the understanding of the coping process in the acute stage of WAD and its possible impact on recovery and adjustment.

  • 8.
    Djupsjöbacka, Mats
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Röiijezon, Ulrik
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Häger-Ross, Charlotte
    Ortopedkliniken, Norrlands universitetssjukhus, Umeå.
    Björklund, Martin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Sensomotorisk funktion hos personer med nackbesvär2010Inngår i: Fysioterapi, ISSN 1653-5804, nr 6-7, s. 38-45Artikkel, forskningsoversikt (Annet vitenskapelig)
    Abstract [en]

    Nackbesvär är vanligt förekommande och utgör en betydande orsak till ohälsa och inskränkt arbetsförmåga. Vanligen går det inte att klarlägga organisk orsak till långvariga nackbesvär men mycket tyder på att de oftast är ett komplext tillstånd där både biologiska och psykosociala faktorer är av betydelse. Forskning har visat på samband mellan långvariga nackbesvär och störningar i olika sensomotoriska funktioner och att graden av funktionspåverkan ofta är kopplad till graden av upplevda besvär. Undersökning av sensomotorisk funktion kan därför vara en viktig del i bedömningen av denna patientgrupp. Forskning har även visat att det finns evidens för positiva effekter av sensomotorisk träning vid nackbesvär på kort sikt, medan kunskap om långtidseffekter saknas. Vid träning av sensomotorisk funktion är det viktigt att beakta grundläggande kunskap inom motorisk inlärning för att öka möjligheterna till bestående träningseffekter och att dessa överförs till vardagliga situationer.

  • 9.
    Gustafsson, Fredrik
    et al.
    Högskolan i Gävle, Institutionen för pedagogik, didaktik och psykologi.
    Bergman, Joakim
    Högskolan i Gävle, Institutionen för pedagogik, didaktik och psykologi.
    ”Det hänger ju mycket på en själv” – en undersökning om hemträningsprogram och dess följsamhet2008Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Syftet med studien var att undersöka hur patienter upplevde en sjukgymnasts metodik i samband med utlärningen av hemträningsprogram de fått ordinerade i rehabiliterande syfte för sina skador. Dessutom undersöktes hur väl sjukgymnastens metodik gällande hemträningsprogram stämde överens med tidigare forsknings rekommendationer, och ifall samband kunde ses mellan patienternas följsamhet och de faktorer som påverkar den. Undersökningen var en modifierad fallstudie och genomfördes med relativt högt strukturerade telefonintervjuer. Undersökningsgruppen bestod av sju patienter som alla hade ordinerats hemträningsprogram ifrån samma sjukgymnast, för olika typer av skador. Resultatet av studien visade på att patienterna upplevde mottagningens metodik som väl fungerande. Sjukgymnastens metodik stämde även väl överens med tidigare forskningsrekommendationer för en hög följsamhet utav träningsprogrammen bland patienterna. Samband mellan patienternas följsamhet och tidigare forsknings rekommendationer visade sig vara starka.

  • 10.
    Rudolfsson, Thomas
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning. Umeå universitet, Sjukgymnastik.
    Sensorimotor control and cervical range of motion in women with chronic neck pain: Kinematic assessments and effects of neck coordination exercise2014Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Introduction: Neck pain is a common problem in society and is more prevalent among women. The consequences of neck pain for the individual often include activity and participation limitations, thus affecting many dimensions of life. There is still a lack of understanding of the underlying mechanisms of the disorder and likewise of efficient rehabilitation for people with neck pain. However, coordination exercises have shown promising short-term effects. To carry this line of research forward, there is a need to improve methods for objective characterization of impairments and to investigate novel methods of rehabilitation.

    Aims: To characterize impairments of active cervical range of motion of the upper and lower cervical levels in women with chronic neck pain with a novel method (Study I and II) and identify the influence of head posture and movement strategies (Study II). Further, to investigate the effects of a novel method for neck coordination exercise on sensorimotor function and neck pain (study III) and the consistencies of motor variability metrics in a goal directed arm movement task to aid the design of future clinical research (Study IV).

    Methods: All studies were laboratory based with kinematic assessments of neck movements (Study I-III), balance (Study III) and goal directed arm movements (Study III, IV). The studies had designs that were: cross-sectional (I and II), randomized controlled trial (III) or test-retest reliability study (IV). Participants in Study I (n=135) and II (n=160) were women with chronic non-specific neck pain and healthy controls. In Study III, women with chronic non-specific neck pain (n=108) were randomized into three different individually supervised 11 week interventions. Study IV included healthy women (n=14).

    Results: It was found that cervical range of motion impairments in women with non-specific neck pain were direction- and level-specific; impairments were greater in extension in the upper and flexion in the lower levels of the cervical spine. The magnitude of impairments in range of motion was associated to self-ratings of functioning and health. Possible group differences in natural head posture were rejected as a cause for the direction specific effects. Neither could the effects be explained by a strategy to minimize torque in the cervical spine during movement execution. The neck coordination training was not superior to strength training (best-available) and massage treatment (sham) in improving sensorimotor functions or pain according to short-term and 6 months follow ups. The results from the study of the goal directed movement task showed that between and within-subject sizes of most motor variability metrics were too large to make the test suitable for application in clinical research.

    Conclusions: Women with chronic non-specific neck pain have direction- and level-specific impairments in cervical sagittal range of motion. The underlying causes of these specific impairments remains unresolved, but the direction specific impairments are not related to natural head posture. The clinical validity of the method of characterization of cervical range of motion was supported and it can be useful in future clinical research. The novel method of neck coordination exercise showed no advantages on sensorimotor functions or pain compared with best-available treatment in women with chronic non-specific neck pain.

  • 11.
    Rudolfsson, Thomas
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Björklund, Martin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Djupsjöbacka, Mats
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Range of motion in the upper and lower cervical spine in people with chronic neck pain2012Inngår i: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 17, nr 1, s. 53-59Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Reduced cervical range of motion (ROM) is a common finding in people with neck pain. With few exceptions, only the angle between head and thorax has been measured. Our aim was to use an extended model to compare active cervical flexion and extension, separate for upper and lower cervical levels, between people with chronic non-traumatic neck pain and controls. We also investigated associations between ROM measures, symptoms and self-rated functioning. In this cross-sectional study, 102 subjects with neck pain and 33 healthy controls participated. An electromagnetic tracker system was used to measure the kinematics to construct a three-segment model including the thorax, cervical spine and head. Neutral flexion/extension were defined at subjects’ self-selected seated posture. We found that in the neck pain group, extension in the upper cervical levels and predominately flexion for the lower levels were reduced. The ratio between ROM for the upper and lower levels was altered in the neck pain group so that the lower levels contributed to a lesser extent to the total sagittal ROM compared to controls. These findings could not be explained by a greater forward head posture but must have other origins. For the neck pain group, ROM measures were weakly associated to pain and self-rated functioning. Altogether, this implies that using a three-segment model for assessment of ROM can be a valuable improvement for characterisation of patients and treatment evaluation.

  • 12.
    Rudolfsson, Thomas
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Björklund, Martin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Djupsjöbacka, Mats
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Range of motion in the upper and lower cervical spine in people with chronic neck pain2010Inngår i: The XVIII Congress of the International Society of Electrophysiology and Kinesiology (ISEK), Aalborg, Denmark, 2010Konferansepaper (Fagfellevurdert)
    Abstract [en]

    AIM: Several studies have reported reduced cervical range of motion (ROM) in people with neck pain. Different methodologies have been used, but with a few exception they measure only head-trunk relationship and do not discriminate between upper and lower cervical motion. Recent strategies for treatment of neck pain condition include retraining the function of the deep cervical flexors that act in cranio-cervical movements. Thus objective measures of cervical ROM in flexion-extension that includes determination of cervical level can be valuable for treatment evaluation.

    The aim of the present study was to compare cervical flexion and extension, separate for upper and lower cervical levels, between people with chronic neck pain and controls. Also, the association between upper and lower cervical ROM and self rated characteristics was studied.

    METHODS: In a cross-sectional study design, 135 subjects (non-traumatic neck pain: n = 102, controls: n = 33) performed three trials of maximum active cervical flexion and extension. Subjects were seated in a chair with belts crossed over the chest. An electromagnetic tracker system was used to register the kinematics to construct a three-segment model including the trunk, cervical spine and head. The angle for the upper cervical level was defined as the angle between the head and the cervical spine segments. The angle for the lower cervical level was defined as the angle between the cervical spine and the trunk segments. Pressure pain thresholds, pain ratings as well as self ratings of functioning and physical activity were assessed.

    RESULTS: Total ROM was reduced in the neck pain group for both the lower (controls: mean = 26.5, SD=6.7, neck pain: mean=19.0, SD =6.5 degrees) and the upper cervical levels (controls: mean = 84.7, SD = 7.9, neck pain: mean = 73.0, SD = 11.2 degrees). This reduction was direction specific: in the upper cervical level only extension was reduced and in the lower cervical level the reduction was predominately in flexion. Multivariate regression analysis revealed that lower level of physical activity, greater impairments of physical functioning, self reported problems with head movements and lower pressure pain thresholds were related to a greater reduction in ROM in the neck pain group.

    CONCLUSION: Reduction of ROM is present for both the upper and lower levels of the cervical spine in people with non-traumatic neck pain. For the upper cervical level this reduction is direction specific so that only extension is reduced. The limited extension range of the upper cervical spine in the neck pain group could reflect a habituated sitting posture that includes a more extended upper cervical spine. Alternatively it could reflect an impaired functioning of the deep cervical flexors. For the lower cervical level the reduction was mainly limited to flexion. This could be a reflection of a ‘head forward posture’ that has previously been reported in people with neck pain. The associations between self rated characteristics and range of motion variables supports the validity of this methodology in research on neck pain conditions.

  • 13.
    Rudolfsson, Thomas
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning. Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
    Björklund, Martin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning. Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
    Svedmark, Åsa
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning. Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
    Srinivasan, Divya
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Djupsjöbacka, Mats
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Direction-specific impairments in cervical range of motion in women with chronic neck pain: influence of head posture and gravitationally induced torque2017Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, nr 1, artikkel-id e0170274Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Cervical range of motion (ROM) is commonly assessed in clinical practice and research. In a previous study we decomposed active cervical sagittal ROM into contributions from lower and upper levels of the cervical spine and found level- and direction-specific impairments in women with chronic non-specific neck pain. The present study aimed to validate these results and investigate if the specific impairments can be explained by the neutral posture (defining zero flexion/extension) or a movement strategy to avoid large gravitationally induced torques on the cervical spine.

    Methods: Kinematics of the head and thorax was assessed in sitting during maximal sagittal cervical flexion/extension (high torque condition) and maximal protraction (low torque condition) in 120 women with chronic non-specific neck pain and 40 controls. We derived the lower and upper cervical angles, and the head centre of mass (HCM), from a 3-segment kinematic model. Neutral head posture was assessed using a standardized procedure.

    Findings: Previous findings of level- and direction-specific impairments in neck pain were confirmed. Neutral head posture was equal between groups and did not explain the direction-specific impairments. The relative magnitude of group difference in HCM migration did not differ between high and low torques conditions, lending no support for our hypothesis that impairments in sagittal ROM are due to torque avoidance behaviour.

    Interpretation: The direction- and level-specific impairments in cervical sagittal ROM can be generalised to the population of women with non-specific neck pain. Further research is necessary to clarify if torque avoidance behaviour can explain the impairments.

  • 14.
    Rudolfsson, Thomas
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning. Umeå universitet.
    Djupsjöbacka, Mats
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Häger, Charlotte
    Umeå universitet.
    Björklund, Martin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning. Umeå universitet, Alfta Research Foundation.
    Effects of neck coordination exercise on sensorimotor function in chronic neck pain: a randomized controlled trial2014Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, nr 9, s. 908-914Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To evaluate the effect of neck coordination exercise on sensorimotor function in women with neck pain compared with best-available treatment and sham treatment. Design: Observer-blinded randomized controlled trial with short-term and 6-month follow-ups. Subjects: Women with chronic non-specific neck pain were randomized to 3 groups: neck coordinationexercise with a novel training device; strength training for the neck and shoulders; or massage. Each group had 36 participants. Methods: The intervention period was 11 weeks with 22 individually supervised sessions. Primary outcomes were postural sway measures and precision of goal-directed arm movements. Secondary outcomes were range of motion for the neck, peak speed of axial rotation, and neck pain. A repeated measures multivariate analysis of variance (MANOVA) was conducted separately on the primary outcomes for the short-term and 6-month evaluations and on the sensorimotor secondary outcomes for the 6-month effect. The 6-month effect on pain was analysed with a repeated measures analysis ofvariance (ANOVA). Results: No significant treatment effects in favour of neck coordination exercise were found for short-term or 6-month evaluations. Conclusion: Neck coordination exercise is no better than strength training and massage in improvingsensorimotor function. Further research should investigate the use of cutoffs for sensorimotordysfunctions prior to proprioceptive or coordinative training.

  • 15.
    Sandlund, Jonas
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning. Department for Community Medicine and Rehabilitation, Umeå University.
    Srinivasan, Divya
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Mathiassen, Svend Erik
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Consistency of individual motor variability patterns in repetitive precision work2015Inngår i: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 101, nr Suppl. 1, s. e1334-e1335Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Background:

    A longstanding hypothesis in physical therapy and occupational research is that workers repeating a task very stereotypically will be more prone to develop musculoskeletal disorders than workers that manage to vary postures and loads. Increased movement variability (MV), presumably, modify tissue loads, distribute stresses more equally, and thus reduce the cumulative load on any particular tissue. A handful of studies of MV have indicated less overuse injuries and faster recovery from musculoskeletal pain disorders. Even when repeating strictly controlled tasks individuals may differ in motor consistency, some showing higher levels of MV than others. However, whether the extent of MV is indeed a consistent individual trait across different tasks and different days is not known.

    Purpose:

    To investigate whether individual profiles of MV is stabile between days, the consistency of MV patterns from kinematic recordings, repeated across three days, was studied when performing repetitive upper-extremity precision work.

    Methods:

    A laboratory-based simulation of precision work; a 'pipetting' task paradigm, was developed in which liquid was repeatedly transferred from one tube to another, with a cycle time of 2.8s. Fourteen healthy female subjects, aged 20-45 years, right-handed and with experience in pipetting participated on 3 different days under identical conditions. Kinematic data were obtained using an electromagnetic motion capture system (FASTRAK). MV in shoulder elevation, elbow flexion and shoulder-elbow coordination were operationalized using cycle-to-cycle standard deviations across 20 pipetting cycles of kinematics parameters including joint range of motion, average and peak velocities, time to peak velocities, average angle and phase. Multivariate analysis was conducted using principal component analysis (PCA) (SIMCA+P, 12.0) to analyze relationships among variables and individual patterns in the data matrix of the recordings from day1. Thereafter, in order to confirm the observed structure of inter-individual MV patterns, classification of the data from day2 and day3 was performed using the parameters of the model from day1.

    Results:

    Four PCA components (Eigenvalues>1) accounted for 80 percent of the total variance in the model for day1. In the subsequent prediction model where data from day2 and 3 were projected into the model of day1, all subject observations except one could be predicted with 95% confidence (Hotelling T2). And individual data scores from all three days were clustered in relative proximity to each other, indicating consistency in MV between days.

    Conclusion(s):

    The findings indicate, even in this small and homogenous sample of young healthy females, that there may indeed be consistent individual traits in motor variability. A next step would be to answer whether these traits remain consistent if work factors such as work pace or precision are altered, and whether individual profiles of MV are associated with physiological responses related to risk for developing musculoskeletal disorders.

    Implications:

    Consistency of individual MV patterns substantiate previous notions that some people appear prone to repeat themselves while others tend to vary their motor behavior when performing the same task. Assessment of MV by physical therapists in research and practice could be valuable to further explore and address the relation of MV and musculoskeletal health.

  • 16.
    Stensdotter, Ann-Katrin
    et al.
    Umeå University, Umeå, Sweden; Sør-Trøndelag University College, Trondheim, Norway.
    Bjerke, Joakim
    Umeå University, Umeå, Sweden; Sør-Trøndelag University College, Trondheim, Norway.
    Djupsjöbacka, Mats
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Postural sway in single-limb and bilateral quiet standing after unilateral total knee arthroplasty2015Inngår i: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 41, nr 3, s. 769-773Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: To investigate whether total knee arthroplasty (TKA) was associated with stability in single-limb stance and whether reduced stability in single-limb stance was associated with increased postural sway in bilateral quiet standing. Methods: 3D kinematics for center of mass was used to assess postural sway in 23 subjects with TKA and 23 controls. Tests included bilateral quiet standing with and without vision and on a compliant surface, and single-limb stance. Results: 30% of the subjects in the TKA group were unable to maintain single-limb stance for 20. s on any leg. Of the 70% in the TKA group able to stand on one leg, mean sway velocity in the medio-lateral direction was marginally higher for the prosthetic side (p = .02), but no differences were found between the TKA and the control group in single-limb stance. Performance in bilateral quiet standing was similar in TKA-subjects, able as well as unable to stand on one leg, and controls. Reduced quadriceps strength in the contralateral leg, higher BMI, and older age predicted failure to maintain single-limb stance. Conclusion: In subjects able to stand on one leg, performance was considered comparable between the prosthetic and contralateral side and between groups. Inability to stand on one leg did not affect postural sway in bilateral quiet standing. The results suggest that inability to maintain single-limb stance is explained by reduced physical capacity rather than the knee condition in itself. The present study emphasizes the importance of physical activity to improve strength and functional capacity.

  • 17.
    Sundahl, Lina
    et al.
    Department Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
    Zetterbreg, Marie
    Department Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
    Wester, Anita
    Department of Research and Evaluation, Swedish National Agency for Education, Stockholm, Sweden.
    Rehn, Börje
    Department Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
    Blomqvist, Sven
    Swedish Development Centre for Disability Sport, Bollnäs, Sweden.
    Physical activity levels among adolescent and young adults women and men with and without intellectual disability2016Inngår i: JARID: Journal of applied research in intellectual disabilities, ISSN 1360-2322, E-ISSN 1468-3148, Vol. 29, nr 1, s. 93-98Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    As physical activity can prevent overweight and promote general health, the aim was to investigate the amount of physical activity among adolescent and young adult women and men with intellectual disability (ID), compared to age-matched control groups without intellectual disability. A further aim was to examine whether physical activity level was associated with the body mass index (BMI).

    Materials and methods

    Fifty-two adolescent and young adult women and men with intellectual disability and 48 without intellectual disability, between the ages 16 and 20 years, BMIs ranging from 16.3 to 50.3 kg/m2, were measured for number of steps taken with a pedometer for five consecutive days (Sunday–Thursday).

    Results

    The only group to meet recommendations regarding number of steps (10 000–12 000/day) was women without intellectual disability. No significant associations were found between total number of steps taken and BMI.

    Conclusion

    As the majority of adolescents and young adults with intellectual disability, especially women, did not reach recommended activity levels regardless of their BMIs, this call for broad measures to increase physical activity.

  • 18.
    Svedmark, Åsa
    et al.
    Institutionen för samhällsmedicin och rehabilitering, enheten för fysioterapi, Umeå universitet, Umeå.
    Djupsjöbacka, Mats
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Häger, Charlotte
    Institutionen för samhällsmedicin och rehabilitering, enheten för fysioterapi, Umeå universitet.
    Jull, Gwendolen
    Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, Brisbane, Australia.
    Björklund, Martin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning. Institutionen för samhällsmedicin och rehabilitering, enheten för fysioterapi, Umeå universitet, Umeå.
    Is tailored treatment superior to non-tailored treatment for pain and disability in women with non-specific neck pain?: a randomized controlled trial2016Inngår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 17, nr 1, artikkel-id 408Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    The evidence for the effect of treatments of neck pain is modest. In the absence of causal treatments, a possibility is to tailor the treatment to the individuals' functional limitations and symptoms. The aim was to evaluate treatment effects of a tailored treatment versus a non-tailored treatment. Our hypothesis was that tailored treatment (TT) would have better effect on pain intensity and disability than either non-tailored treatment (NTT) (same treatment components but applied quasi-randomly) or treatment-as-usual (TAU) (no treatment from the study, no restrictions). We further hypothesized that TT and NTT would both have better effect than TAU.

    METHOD:

    One hundred twenty working women with subacute and chronic non-specific neck pain were allocated to 11 weeks of either TT, NTT or TAU in a randomized controlled trial with follow-ups at 3, 9 and 15 months. The TT was designed from a decision model based on assessment of function and symptoms with defined cut-off levels for the following categories: reduced cervical mobility, impaired neck-shoulder strength and motor control, impaired eye-head-neck control, trapezius myalgia and cervicogenic headache. Primary outcomes were pain and disability. Secondary outcomes were symptoms, general improvement, work productivity, and pressure pain threshold of m. trapezius.

    RESULTS:

    Linear mixed models analysis showed no differences between TT and NTT besides work productivity favoring TT at 9- and 15-months follow-ups. TT and NTT improved significantly more than TAU on pain, disability and symptoms at 3-month follow-up. General improvement also favored TT and NTT over TAU at all follow-ups.

    CONCLUSION:

    Tailored treatment according to our proposed decision model was not more effective than non-tailored treatment in women with subacute and chronic neck pain. Both tailored and non-tailored treatments had better short-term effects than treatment-as-usual, supporting active and specific exercise therapy, although therapist-patient interaction was not controlled for. Better understanding of the importance of functional impairments for pain and disability, in combination with a more precise tailoring of specific treatment components, is needed to progress.

  • 19.
    Svedmark, Åsa
    et al.
    Institutionen för samhällsmedicin och rehabilitering, fysioterapi, Umeå universitet, Umeå, Svergie.
    Häger, Charlotte
    Institutionen för samhällsmedicin och rehabilitering, fysioterapi, Umeå universitet, Umeå, Sverige.
    Djupsjöbacka, Mats
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Björklund, Martin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning. Institutionen för samhällsmedicin och rehabilitering, fysioterapi, Umeå universitet, Umeå, Sverige.
    Self-estimated general improvement in function and health after tailored and non-tailored neck-shoulder pain treatment in women : A randomized controlled trial2015Inngår i: World Confederation for Physical Therapy Congress 2015, Singapore, 1-4 May, 2015., 2015Konferansepaper (Fagfellevurdert)
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