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  • 1.
    Bhambhani, Yagesh
    et al.
    Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.
    Mactavish, Jennifer
    Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada.
    Warren, Sharon
    Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.
    Thompson, Walter R.
    Department of Kinesiology and Health, Georgia State University, Atlanta, GA, United States.
    Webborn, Anthony
    Sussex Centre for Sport and Exercise Medicine, Chelsea School Research Centre, University of Brighton, United Kingdom.
    Bressan, Elizabeth
    Department of Sport Science, Stellenbosch University, South Africa.
    De Mello, Marco Tuilo
    Medicina e Biologia Do Sono, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
    Tweedy, Sean
    School of Human Movement Studies, University of Queensland, Brisbane, Australia.
    Malone, Laurie
    Lakeshore Foundation, Research and Education, Birmingham, AL, United States.
    Fröjd, Kennet
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Sports and health. Swedish Development Centre for Disability and Sport.
    Van De Vliet, Peter
    International Paralympic Committee, Bonn, Germany.
    Vanlandewijck, Yves
    Faculty of Kinesiology and Rehabilitation Sciences, Catholique University, Leuven, Belgium.
    Boosting in athletes with high-level spinal cord injury: Knowledge, incidence and attitudes of athletes in paralympic sport2010In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 32, no 26, p. 2172-2190Article in journal (Refereed)
    Abstract [en]

    Autonomic dysreflexia (AD) is unique to individuals with spinal injuries (SCI) at T6 or above and can be voluntarily induced. Although AD improves wheelchair racing performance in some athletes, it also elicits exaggerated blood pressure, which could be dangerous. The International Paralympic Committee considers AD doping and banned its use. Purpose. The purpose of this study is to evaluate AD knowledge, incidence and attitudes (KIA) of Paralympians with SCI. Methods. An existing questionnaire was modified to include questions of AD KIA, validated by three experts and piloted with a small sample. It was administered on-line, mailed to members of a scientific network and distributed during the Beijing Paralympic Games. Fisher Exact test was used to evaluate differences across gender, injury and education. Results. Of 99 participants, 54.5% had previously heard of AD while 39.4% were unaware; 16.7%, all males, had used AD to enhance performance. Participants reported that AD was (1) useful for middle (78.6%) and long distance (71.4%), marathon (64.3%) and wheelchair rugby (64.3%); (2) somewhat dangerous (48.9%), dangerous (21.3%) or very dangerous (25.5%) to health. Results were not influenced by age, injury level or injury duration. Conclusions. Findings indicate the need for educational programmes directed towards enhancing the AD knowledge of rehabilitation professionals, coaches and trainers working with SCI individuals.

  • 2.
    Björklund, Martin
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, CBF. University of Gävle, Centre for Musculoskeletal Research.
    Hamberg, Jern
    Alfta Research Foundation.
    Heiden, Marina
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, CBF. University of Gävle, Centre for Musculoskeletal Research.
    Barnekow-Bergkvist, Margareta
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, CBF. University of Gävle, Centre for Musculoskeletal Research.
    The ProFitMap-neck: reliability and validity of a questionnaire for measuring symptoms and functional limitations in neck pain2012In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, no 13, p. 1096-1107Article in journal (Refereed)
    Abstract [en]

    Purpose: To assess overall reliability and validity of a neck-specific questionnaire, the Profile Fitness Mapping neck questionnaire (ProFitMap-neck), on three chronic neck pain groups. Method: Participating groups were as follows: whiplash associated disorders, inpatient care (IP-WAD, n = 127); nonspecific neck pain, inpatient care (IP-NS, n = 83) and nonspecific neck pain subjects (non-IP-NS, n  = 104). All groups answered the ProFitMap-neck and the SF-36, whereas non-IP-NS also answered the Neck Disability Index (NDI) and the Functional Self-Efficacy Scale (SES). Internal consistency, test–retest reliability and components of convergent construct, face and content validity were determined for the ProFitMap-neck. Results: The ProFitMap-neck showed good internal consistency in all three groups, and ICC test–retest reliability (0.80–0.91). Good correlation (0.66–0.78) and highest agreement was reached with NDI. According to the International Classification of Functioning, Disability and Health, the symptom scale of the ProFitMap-neck was mainly classified to the domain of impairments–body functions, and the functional limitation scale to the activity limitation domain. Conclusion: The results indicate that the ProFitMap-neck is valid for measuring symptoms and functional limitations in people with chronic neck pain. The combination of a composite total score of symptoms and function as well as separate scores of each domain makes ProFitMap-neck suitable for research as well as in clinical practice.

    Implications for Rehabilitation

    • The ProFitMap-neck can be used as a valid self-assessment tool for measuring symptoms and functional limitations in people belonging to the most prevalent categories of neck pain.

    • The combination of the symptom and functional limitation questionnaire scores in a total score can be used for an overall clinical judgment.

  • 3.
    Elfving, Britt
    et al.
    Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.
    Åsell, Malin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, CBF. University of Gävle, Centre for Musculoskeletal Research.
    Bergsten, Charlotte Luning
    Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.
    Alexanderson, Kristina
    Karolinska Inst, Div Insurance Med, Dept Clin Neurosci, Stockholm, Sweden.
    Exploring activity limitations and sick leave among patients with spinal pain participating in multidisciplinary rehabilitation2010In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 32, no 4, p. 292-299Article in journal (Refereed)
    Abstract [en]

    Purpose. To describe limitations in 12 activities at baseline, after multidisciplinary rehabilitation and at a 6-month follow-up for patients with spinal pain and, further, to investigate whether low limitation in any of the activities or in the mean score at baseline might predict increased working time at follow-up. Method. A prospective cohort study of 302 patients, 22- to 63-years old, who participated in multidisciplinary rehabilitation because of chronic neck, thoracic and/or lumbar pain. Data from the Disability Rating Index questionnaire were obtained at baseline, after the 4-week rehabilitation programme, and at the 6-month follow-up. Two subgroups are described: patients who at baseline (1) worked full-time or (2) were on part- or full-time sick leave. Results. The degree of limitation in the 12 activities (items) showed large variations in median scores (7-91). Both subgroups showed significant improvements in most activities after rehabilitation, which remained at the follow-up. Nevertheless, in the sick-leave group, patients who had increased their working time at follow-up (62%) were still very limited in running, heavy work, and lifting heavy objects. In logistic regressions, low limitation in standing bent over a sink at baseline was the only single activity that predicted increased working time at the follow-up: odds ratio (OR) 1.93 (95% CI 1.1-3.5). OR for the mean score was 1.8 (1.0-3.3). Conclusion. A profile of the separate activities demonstrates the large variation in the degree of limitation, which is concealed in a mean score. The single items can be useful when evaluabing interventions. However, to predict increased working time after rehabilitation, the mean score, as well as the activity standing bent over a sink, proved useful.

  • 4.
    Elfving, Britt
    et al.
    Section of Personal Injury Prevention, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
    Åsell, Malin
    University of Gävle, Centre for Musculoskeletal Research.
    Ropponen, Annina
    Section of Personal Injury Prevention, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Institute of Biomedicine, Department of Physiology/Ergonomics, University of Kuopio, Kuopio, Finland.
    Alexanderson, Kristina
    Section of Personal Injury Prevention, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    What factors predict full or partial return to work among sickness absentees with spinal pain participating in rehabilitation?2009In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, no 16, p. 1318-1327Article in journal (Refereed)
    Abstract [en]

    Purpose. To identify the factors that predict full or partial return to work among long-term (>= 90 days) sickness absentees due to spinal pain who begin a multidisciplinary rehabilitation programme. Method. In a prospective cohort study, 312 patients with neck, thoracic and/or lumbar pain, aged 20-64, participated in a 4-week multidisciplinary rehabilitation programme in Sweden. Questionnaire data at inclusion were used. Factors included in logistic regressions were as follows: age, gender, type of work, pain location, pain intensity (visual analogue scale), activity limitations [Disability Rating Index (DRI)], health-related quality of life (SF-36), pain-related fear of movement (Tampa Scale of Kinesiophobia), motivation (Self Motivation Inventory), sickness absence at baseline and number of sick-leave days during the previous 2 years. Outcome factor was increased versus not increased working time at follow-up 6 months later. Results. Most patients (68%) reported two or three pain locations. At baseline, 56% were full-time sickness absent and 23% at follow-up; 61% had increased their working time. Predictors for increased working time were age below 40 years, low activity limitation (DRI < 50), low SF-36 bodily pain (>30) and high SF-36 social functioning (>60). Number of sick-leave days during the previous 2 years (md 360; range 90-730) had no influence. Conclusions. Even patients with long previous sick leave can increase working time after a multidisciplinary rehabilitation programme, especially if they are younger, have lower levels of activity limitations and pain and better social functioning. To include information on part-time work is useful when evaluating work ability following rehabilitation programmes.

  • 5. Hultman, Lill
    et al.
    Forinder, Ulla
    Stockholms universitet, Institutionen för socialt arbete - Socialhögskolan.
    Pergert, Pernilla
    Assisted normality - a grounded theory of adolescent's experiences of living with personal assistance2016In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, no 11, p. 1053-1062Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of the study was to explore how adolescents with disabilities experience everyday life with personal assistants.

    Method: In this qualitative study, individual interviews were conducted at 35 occasions with 16 Swedish adolescents with disabilities, in the ages 16-21. Data were analyzed using grounded theory methodology.

    Results: The adolescents' main concern was to achieve normality, which is about doing rather than being normal. They try to resolve this by assisted normality utilizing personal assistance. Assisted normality can be obtained by the existing relationship, the cooperation between the assistant and the adolescent and the situational placement of the assistant. Normality is obstructed by physical, social and psychological barriers.

    Conclusion: This study is from the adolescents' perspective and has implications for understanding the value of having access to personal assistance in order to achieve assisted normality and enable social interaction in everyday life. Implications for Rehabilitation Access to personal assistance is important to enable social interaction in everyday life. A good and functional relationship is enabled through the existing relation, co-operation and situational placement of the assistant. If the assistant is not properly sensitized, young people risk turning into objects of care. Access to personal assistants cannot compensate for disabling barriers in the society as for example lack of acceptance.

  • 6.
    Lűning-Bergsten, Charlotte
    et al.
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society.
    Lundberg, Marie
    University of Gothenburg, Department of Orthopaedics.
    Lindberg, Per
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, CBF. University of Gävle, Centre for Musculoskeletal Research.
    Elfving, Britt
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society .
    Change in kinesiophobia and its relation to activity limitation after multidisciplinary rehabilitation in patients with chronic back pain2012In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, no 10, p. 852-858Article in journal (Refereed)
    Abstract [en]

    Purpose.

    To explore the change in kinesiophobia in relation to activity limitation after a multidisciplinary rehabilitation programme in patients with chronic back pain.

    Method.

    A prospective cohort study was made including 265 patients. Data were collected at baseline, after rehabilitation, and at 6-months follow-up. Outcome measures were the Tampa Scale for Kinesiophobia (TSK) and the Disability Rating Index (DRI). The smallest detectable change (SDC) in TSK was set to 8 scores. Relationships between kinesiophobia and activity limitation/physical ability were explored with regard to subgroups with high, medium and low baseline TSK scores, and for those patients who did or did not reach the SDC in TSK.

    Results.

    Improvements in TSK showed high effect sizes in the groups with high and medium baseline TSK scores. Improvements in DRI showed medium effect sizes in all three TSK subgroups. One third of the patients reached the SDC in TSK, and this group also improved significantly more in DRI. The correlation between change in TSK and change in DRI was low. Half of the patients with high TSK score at baseline remained having high DRI at follow-up.

    Conclusions.

    Improvement in physical ability was not related to the initial degree of kinesiophobia but to the smallest detectable change in TSK. To prevent patients with high kinesiophobia from preserving high activity limitations it might be useful to include targeted treatment of kinesiophobia.

  • 7.
    Wiitavaara, Birgitta
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Bengs, Carita
    Sociologiska institutionen, Umeå universitet.
    Brulin, Christine
    Institutionen för omvårdnad, Umeå universitet.
    Well, I'm healthy, but...: lay perspectives on health among people with musculoskeletal disorders2016In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, no 1, p. 71-80Article in journal (Refereed)
    Abstract [en]

    urpose: The purpose was to investigate lay perspectives on health among people with musculoskeletal disorders. Method: Semi-structured interviews were performed with 39 women and 30 men, (aged 22–63 years) with long-term, non-specific musculoskeletal disorders in the neck, shoulder and/or low back. Data was analysed using qualitative content analysis. Results: These people experienced health as “having resources and opportunities to lead the life one wants”. Three categories, “a good enough physical and psychological functioning, freedom of action, and a positive state of emotion and an enriching life”, illustrate the different resources and opportunities that the informants described as important for them to perceive themselves as healthy. The informants also reflected on “being ill” and “being well” and what makes the difference. Five aspects influenced the dynamics of their health experiences: “body and soul, prognosis, character of symptoms, physical and social activity, and emotional state”. Consequently, the informants expressed a holistic view of health, where the focus lies on the opportunity and the ability to lead their lives the way they want. Conclusions: This study points at the value of taking lay perspectives on health into account, as it might increase the opportunity to design effective, personalized rehabilitation strategies.

  • 8.
    Wiitavaara, Birgitta
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, CBF.
    Björklund, Martin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, CBF.
    Nilsson, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    An initial factor analysis of prominent aspects of health experiences for women with neck-shoulder pain2012In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, no 11, p. 934-942Article in journal (Refereed)
    Abstract [en]

    Purpose: The prospect of adequate comparisons is essential to decide on the effectiveness of different treatments. As there is a lack of unity in choice of questionnaires and included measures concerning musculoskeletal disorders, further investigations based on international recommendations are of interest. The intention of present study was to initiate the development of a clinically useful short-form questionnaire.  The aim was to select items that capture prominent health aspects for women with neck-shoulder pain and thereby reduce the number of items to a clinically more convenient amount, and to determine the underlying structure of included items. Method: Data were collected in a randomised controlled trial including women with non-specific neck-shoulder pain >3 months (n = 117). Data collection included three core domains: pain intensity, physical and emotional functioning, and analysis was performed using Principal component analysis, and Varimax rotation. Results: The resulting 9-factor solution included interference, solicitous/distracting responses, mood and feelings about self and relations, pain intensity, punishing responses, personal growth, life-control, sleep, and appetite (29 items). Conclusions: The results will contribute to the development of a reduced battery of questions representing core dimensions. Such questionnaire would lighten the assessment load in the clinic as well as in research.

  • 9.
    Wiitavaara, Birgitta
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Heiden, Marina
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Content and psychometric evaluations of questionnaires for assessing physical function in people with low back disorders: a systematic review of the literature2018In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose was to investigate how physical function is assessed in people with musculoskeletal disorders in the low back. Specifically:

    • Which questionnaires are used to assess physical function in people with musculoskeletal disorders in the low back?
    • What aspects of physical function do those questionnaires measure?
    • What are the measurement properties of the questionnaires?

    Materials and methods: A systematic review was performed to identify questionnaires and psychometric evaluations of them. The content of the questionnaires was categorised according to the International Classification of Function, Disability and Health, and the psychometric evaluations were categorised using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist.

    Results: The questionnaires measured disability or ability to cope in everyday life, rather than physical function as such. Different aspects of a person’s mobility and ability to attend to one’s personal care were most often included regarding activity and participation. For body functions, items about sleep and pain were most often included. The Oswestry Disability Index and the Quebec Back Pain Disability Scale showed adequate psychometric properties in most evaluations.

    Conclusions: The extent of psychometric evaluations differed substantially, as did the items included. Focus of measurement was predominantly on activities in daily life.

    • Implications for rehabilitation
    • Valid and reliable instruments that measure relevant aspects of low back disorders are needed to provide early diagnostics and effective treatment.
    • Most questionnaires need more psychometric evaluations to establish the quality.
    • The Oswestry Disability Index and the Quebec Back Pain Disability Scale showed adequate psychometric properties in most evaluations.
    • The results may be useful when making decisions about which measurement instruments to use when evaluating low back disorders.
  • 10.
    Wiitavaara, Birgitta
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Heiden, Marina
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Content and psychometric evaluations of questionnaires for assessing physical function in people with neck disorders –  A systematic review of the literature2018In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 40, no 19, p. 2227-2235Article, review/survey (Refereed)
    Abstract [en]

    Purpose: The purpose was to investigate how physical function is assessed in people with musculoskeletal disorders (MSD) in the neck. Specifically, we aimed to determine: (1) Which questionnaires are used to assess physical function in people with MSD in the neck? (2) What do those questionnaires measure? (3) What are the measurement properties of the questionnaires?

    Materials and methods: A systematic review was performed to identify questionnaires and psychometric evaluations. The content of the questionnaires was categorized according to the International Classification of Function, Disability and Health, and the psychometric properties were quality-rated using the COnsensus-based Standards for the selection of health Measurement INstruments checklist.

    Results: Ten questionnaires and 32 articles evaluating measurement properties were analyzed. Most questionnaires covered only the components body functions and activity and participation, more often activity participation than body function. Internal consistency was adequate in most questionnaires, whereas responsiveness was generally low. Neck Disability Index was most evaluated, but the evaluations of all questionnaires tended to cover most properties in the checklist.

    Conclusions: The questionnaires differed substantially in items and extent to which their psychometric properties had been evaluated. Focus of measurement was on activities in daily life rather than physical function as such.

    • Implications for Rehabilitation
    • To provide early diagnostics and effective treatment for patients with neck disorders, valid and reliable instruments that measure relevant aspects of the disorders are needed.

    • This paper presents an overview of content and quality of questionnaires used to assess physical function in neck disorders, which may facilitate informed decisions about which measurement instruments to use when evaluating the course of neck disorders.

    • Most of the questionnaires need more testing to judge the quality, however the NDI was the most frequently tested questionnaire.

    • The COnsensus-based Standards for the selection of health Measurement INstruments checklist is a useful tool in relation to psychometric testing of questionnaires, but clear definitions of interpretation of the quality criteria in each study would enhance comparability of results.

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