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  • 1.
    Björklund, Martin
    Högskolan i Gävle, Belastningsskadecentrum.
    Effects of Repetitive Work on Proprioception and of Stretching on Sensory Mechanisms: Implications for Work-related Neuromuscular Disorders2004Doktoravhandling, monografi (Annet vitenskapelig)
    Abstract [en]

    Repetitive low-intensïty work constitutes an important risk factor for Chronic Wark Related Neuromuscular Disorders (CWRND)· Derangemcnt of motor control, provoked by loaded or fati ued muscles, has been suggested as one of the underlying mechanisms behind these disorders. Faàgue-induced reduetion of proprioceptive acuity may be one of the factors accounting for the deranged motor eontrol. In contrast to high-intensity work, little ïs known about the effect of repetitive low-intensity work on proprioceptive acuity. Muscle stretching has becn proposed as a rocedure that can prevcnt, alleviate and/or treat CWRND· Before the importance of stretching can be adequately assessed for this purpose, a better understanding of the effects of stretching and the pathophysiological mechanisms behind thc work-related disorders are needed. The aims of the thesis were (i) to investigate the impact of repetitive low-intensity work exposure on proprioception and (ü) to examine effects of muscle stretching (especially sensory effects and effects on muscle nociception) and to relate its application to the prevention, alleviation and/or treatment of CWRND A simulated occupational setting was used to test the effects of low-intensity repetitive work on the shoulder proprioception in healthy subjècts. The effect of working time on the retention of subjective fatigue and their relation to changes in proprioception, and the immediate effect of stretching on shoulder proprioception were investìgated. A new method to test the stretchability of the rectus femoris muscle was investigated for reliability and validity and used to assess the effects of a 2-week stretching regimen on range of motion and an subjecàve stretch sensation. Finally, the interactions between innocuous musclc stretch and naciceptive chemical stimulaàon on discharge behavior of nociceptive dorsal horn neurons in the feline spinal cord were explored. The main findings wcre as follows: 1) The repctiàve low-intensity work to fatigue diminished the shoulder proprioceptian; the working time as well as the retention of subjective fatigue were partly related to the extent of changed praprioception: 2) There was no effect of acute muscle stretching on the proprioccpàon. 3) The ncw method for tesàng musele stretchability proved valid and reliable. A two-week stretching regimen inereased the tolerance to stretch torque, but the range of moàon remained unchanged. 4) Half of the nociceptive dorsal horn neurons that responded to close arterial injections of bradykinin were modulated by muscle stretching applied directly aftér thc injections. h thcsis of an involvement of sensory Altogether, the results give credence to the hypo information distonion due to repeàtive low.intensity work exposure in the development of CWRND· Increased toleranee to stretch torque may be an imponant mechanism i explaining improvements followin stretch treatment. The spinal interactions between innocuaus stretch and nociceptive muscle af erent inputs indicate a possible mrchanism involved in stretching-induced pain alleviaàon.

  • 2. Björklund, Martin
    The ProFitMap-neck questionnaire.2014Inngår i: Neck pain : new perspectives : 14th Physiatric Summer School : 15.-16.08.2013, Helsinki / [ed] Lindgren Karl August, Helsinki: Rehabilitation Orton, Invalid Foundation , 2014, 1, s. 61-68Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 3.
    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)
  • 4.
    Björklund, Martin
    et al.
    Högskolan i Gävle, Belastningsskadecentrum.
    Crenshaw, Albert
    Högskolan i Gävle, Belastningsskadecentrum.
    Djupsjöbacka, Mats
    Högskolan i Gävle, Belastningsskadecentrum.
    Johansson, Håkan
    Högskolan i Gävle, Belastningsskadecentrum.
    Position sense acuity is diminished following repetitive low-intensity work to fatigue in a simulated occupational setting. A critical comment2003Inngår i: European Journal of Applied Physiology and Occupational Physiology, ISSN 0301-5548, E-ISSN 1432-1025, Vol. 88, nr 4-5, s. 485-486Artikkel i tidsskrift (Fagfellevurdert)
  • 5.
    Björklund, Martin
    et al.
    Centre for Musculoskeletal Research, National Institute for Working Life, Umeå Sweden.
    Crenshaw, Albert G.
    Centre for Musculoskeletal Research, National Institute for Working Life, Umeå Sweden.
    Djupsjöbacka, Mats
    Centre for Musculoskeletal Research, National Institute for Working Life, Umeå Sweden.
    Johansson, Håkan
    Centre for Musculoskeletal Research, National Institute for Working Life, Umeå Sweden.
    Position sense acuity is diminished following repetitive low-intensity work to fatigue in a simulated occupational setting2000Inngår i: European Journal of Applied Physiology and Occupational Physiology, ISSN 0301-5548, E-ISSN 1432-1025, Vol. 81, s. 361-367Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Repetitive work to fatigue is soundly associated with work-related musculoskeletal disorders (WMSD), although the underlying mechanisms are poorly understood. In the present study, we tested the hypothesis that fatiguing work leads to proprioceptive deficits, which can be an initiating factor for the occurrence of WMSD. Thus, the position sense of the shoulder was determined for 13 males and 13 females before and after performing repetitive low-intensity arm work to fatigue in a simulated occupational setting. From a starting position of 45grader to the sagittal plane, position sense tests consisted of subjects attempting to actively reproduce target positions of horizontal move- ments to 15grader and 30grader (shoulder adduction) and to 60grader and 75grader (shoulder abduction). An analysis of variance revealed that the absolute error was significantly increased following fatigue for the subjects as a group (P < 0.001). Furthermore, females had an overall higher error than males (P < 0.01). No difference in error was detected for the shorter movements versus the longer movements. However, the overall absolute error for adduction was significantly higher than for abduc- tion (P < 0.001). The results of the present study support the hypothesis of diminished proprioceptive acuity following low-intensity work to fatigue. A reduction in position sense acuity could lead to impairment in motor control, which would further impact on position sense. Thus, a vicious cycle may be activated that might result in WMSD. The poorer position sense acuity observed for females may contribute to the explanation of why females may contribute to explanation of why females demonstrate a higher incidence of WMSD than males. Key Words: Fatigue, Glenohumeral joint, human, Occupational musculoskeletal problems,Proprioception.

  • 6.
    Björklund, Martin
    et al.
    Centre for Musculoskeletal Research, National Institute for Working Life, Umeå Sweden.
    Crenshaw, Albert G.
    Centre for Musculoskeletal Research, National Institute for Working Life, Umeå Sweden.
    Djupsjöbacka, Mats
    Centre for Musculoskeletal Research, National Institute for Working Life, Umeå Sweden.
    Johansson, Håkan
    Centre for Musculoskeletal Research, National Institute for Working Life, Umeå Sweden.
    Repetitive low-back-level arm activity to fatigue diminishes limb position sense1999Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Position sense awareness of the shoulder was determined for 9 males and 9 females before and after performing repetitive low-level arm activity to fatigue. The activity consisted of continuous horizontal internal and external rotations. Position sense awareness tests were performed with subjects blindfolded and seated with the arm in a motorized rig. The subjects were asked to actively reproduce test positions of 10°, 25°, 55° and 70° randomly assigned, while starting at 40° (relative to the sagittal plane). The tests were conducted immediately before and after the fatiguing activity. An ANOVA revealed that the absolute error, measured as test position minus reproduced position, was significantly increased following fatigue for the subjects as a group (p<0.001 ). Furthermore, females had overall higher error than males (p<0.05). The results indicate that repetitive low-level activity to fatigue leads to proprioceptive deficits. These deficits can create a non-optimized motor control, causing an increase in the co-activation of agonist and antagonist muscles and thus increasing the work-load. This could create an unfavorable cycle of events, which would further impact proprioception and thereby enhance the risks for muscle pain and injury. The higher incidence of injuries for female athletes compared to males may be attributed to gender differences in proprioception.

  • 7.
    Björklund, Martin
    et al.
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Djupsjöbacka, Mats
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Crenshaw, Albert G
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Acute muscle stretching and shoulder position sense2006Inngår i: Journal of athletic training, ISSN 1062-6050, E-ISSN 1938-162X, Vol. 41, nr 3, s. 270-274Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Context: Stretching is common within sports as a potential maneuver for injury prevention. Stretching induced changes in muscle spindIe properties is a suggested mechanism. This may imply a reduction in proprioception following stretching, however, little is known of this association. Our finding showing no effect of acute stretching on shoulder position sense provides insight into this issue.

    Objectives: To evaluate if acute stretching of the shoulder muscles affects position sense.

    Design: A crossover design with subjects randomized to 3 groups, as regarded by the I sequence of 3 interventions.

    Setting: A university human research laboratory.

    Patients or Other participants: Nine female (age, 21 +2) and 9 male (24 + 3) healthy volunteers.

    lntervention(s): The interventions consisted of stretching of shoulder 1) agonists, 2) antagonists, and 3) non-stretching control.

    Main Outcome Measure(s): Position sense acuity of the right shoulder was determined before and arter the interventions by subjects at tempting to reproduce arm positions of 15° and 30° (shoulder adduction) while starting at 45° to the sagittal plane. The outcome variables were the response variability (variable error, VE) and overall accuracy (absolute error, AE).

    Results: A multivariate repeated measures analysis ofvariance revealed that the relative change in VE (i.e., VE after/VE before) was not significantly different between the interventions (p = 0.38). Similarly no change in AE was found (p = 0.76). Furthermore, there were no differences regarding test sequence or in the interaction 'intervention x sequence' for either VE (p = 0.73 and 0.53, respectively) or for AE (p = 0.71 and 0.67, respectively)

    Conclusions: The present study showed no effect on shoulder position sense after an acute bout of stretching either agonist or antagonist shoulder muscles.

  • 8.
    Björklund, Martin
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF.
    Djupsjöbacka, Mats
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF.
    Svedmark, Åsa
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF.
    Häger, Charlotte
    Inst samhällsmedicin och rehabilitering, sjukgymnastik, Umeå univeristet.
    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 trial2012Inngår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 13, nr 75Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    A major problem with rehabilitation interventions for neck pain is that the condition may have multiple causes, thus a single treatment approach is seldom efficient. The present study protocol outlines a single blinded randomised controlled trial evaluating the effect of tailored treatment for neck-shoulder pain. The treatment is based on a decision model guided by standardized clinical assessment and functional tests with cut-off values. Our main hypothesis is that the tailored treatment has better short, intermediate and long-term effects than either non-tailored treatment or treatment-as-usual (TAU) on pain and function. We sub-sequentially hypothesize that tailored and non-tailored treatment both have better effect than TAU.

    Methods

    120 working women with minimum six weeks of nonspecific neck-shoulder pain aged 20-65, are allocated by minimisation with the factors age, duration of pain, pain intensity and disability in to the groups tailored treatment (T), non-tailored treatment (NT) or treatment-as-usual (TAU). Treatment is given to the groups T and NT for 11 weeks (27 sessions evenly distributed). An extensive presentation of the tests and treatment decision model is provided. The main treatment components are manual therapy, cranio-cervical flexion exercise and strength training, EMG-biofeedback training, treatment for cervicogenic headache, neck motor control training. A decision algorithm based on the baseline assessment determines the treatment components given to the each participant of T- and NT-groups. Primary outcome measures are physical functioning (Neck Disability Index) and average pain intensity last week (Numeric Rating Scale). Secondary outcomes are general improvement (Patient Global Impression of Change scale), symptoms (Profile Fitness Mapping neck questionnaire), capacity to work in the last 6 weeks (quality and quantity) and pressure pain threshold of m. trapezius. Primary and secondary outcomes will be reported for each group with effect size and its precision.

    Discussion

    We have chosen not to include women with psychological ill-health and focus on biomedical aspects of neck pain. Future studies should aim at including psychosocial aspects in a widened treatment decision model. No important adverse events or side-effects are expected. Trial registration: Current Controlled Trials registration ISRCTN49348025. Key words: Neck, trapezius, myalgia, neck-shoulder pain, RCT, individualized treatment, rehabilitation, physiotherapy, tailored

  • 9.
    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

  • 10.
    Björklund, Martin
    et al.
    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.
    Wijk, Katarina
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Sundelin, Gunnevi
    Institutionen för samhällsmedicin och rehabilitering.
    Gellerstedt, Sten
    LO.
    Minska värken: Åtgärder mot värk i nacke och rygg2010Rapport (Annet (populærvitenskap, debatt, mm))
    Abstract [sv]

    Denna skrift vänder sig till dig som har ständig värk i rygg eller nacke, eller som vid flera tillfällen haft en diffus smärta i rygg eller nacke. Här kan du läsa om vilka åtgärder forskare rekommenderar och vad du själv kan göra för att minska värken. Forskningen om vilka åtgärder som hjälper har gjort framsteg och även för dig som haft långvarig värk finns det goda möjligheter att minska smärtan.

  • 11.
    Björklund, Martin
    et al.
    Centre for Musculoskeletal Research, National Institute for Working Life, Umeå Sweden.
    Hamberg, Jern
    Stiftelsen Alfta Kurhem, Alfta Rehab Center, Alfta, Sweden.
    Crenshaw, Albert G.
    Centre for Musculoskeletal Research, National Institute for Working Life, Umeå Sweden.
    Sensory adaptation after a 2-week stretching regimen of the rectus femoris muscle2001Inngår i: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 82, nr 9, s. 1245-1250Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To study the effects of a muscle stretching regimen for the rectus femoris muscle on subjective stretch sensation and range of motion (ROM). DESIGN: A 2 x 2 crossover design comprising 2 treatments and 2 intervention periods.

    SETTING: A military base in Sweden.

    PARTICIPANTS: A volunteer sample of 29 male military conscripts divided into 2 groups, with each group subjected to both experimental and control treatments at different time periods.

    INTERVENTION: Two weeks of supervised stretching (4 times/wk) of the rectus femoris muscle (experimental treatment) and the calf muscles (control treatment).

    MAIN OUTCOME MEASURES: Subjective rating of the stretch sensation for the anterior aspect of the thigh determined on a category ratio scale. Passive knee flexion ROM determined on each test with the same applied torque, specific for each subject.

    RESULTS: An additive analysis of variance revealed that the stretch sensation after the experimental treatment was decreased, compared with the control treatment (p <.01). The knee flexion, however, remained the same regardless of the treatment.

    CONCLUSION: Sensory adaptation seems to be an important mechanistic factor in the effect stretching has on ROM changes. The lack of change in knee flexion suggests that the stretching, as performed in this study, did not influence stiffness of the rectus femoris muscle. Sensory adaptation may also be an underlying mechanism in the alleviating effect of stretching when applied to tired, tender, and painful muscles.

  • 12.
    Björklund, Martin
    et al.
    Högskolan i Gävle, Centrum för belastningsskadeforskning. Alfta Research Foundation, Alfta, Sweden.
    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 assessment of symptoms and functional limitations in low back pain patients: validity and reliability of a new questionnaire2007Inngår i: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 16, nr 11, s. 1799-1811Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Many of the existing low back pain (LBP) questionnaires of function and symptoms have a content of different domains of disability presented as a single sum score, making it difficult to derive changes within a specific domain. The present study describes the development of a clinically derived back-specific questionnaire incorporating both a functional limitation and a symptom scale, with a further subdivision of the symptom scale in separate indices for severity and temporal aspects. The aims of the study were to assess the overall reliability and validity of the new questionnaire, named the Profile Fitness Mapping questionnaire (PFM). A total of 193 chronic LBP patients answered the PFM together with five validated criterion questionnaires. For the internal consistency of the questionnaires, the three indices of the PFM had the highest Cronbach's alpha (0.90-0.95) and all items had item-total correlations above 0.2. The correlation coefficients between the PFM and the back-specific criterion questionnaires ranged between 0.61 and 0.83, indicating good concurrent criterion validity. The best discriminative ability between patients with different pain severities was demonstrated by the functional limitation scale of the PFM. Well centered score distribution with no patient's score at the floor or the ceiling level indicates that the PFM has the potential to detect the improvement or worsening of symptoms and functional limitations in chronic LBP patients. Classification according to the International Classification of Functioning, Disability and health (ICF) of WHO revealed a high degree of homogeneous item content of the symptom scale to the domain of impairments, and of the functional limitation scale to the domain of activity limitations. The present study suggests that the PFM has a high internal consistency and is a valid indicator of symptoms and functional limitations of LBP patients. It offers the combination of a composite total score and the possibility of evaluations within specific domains of disability. Complementary evaluation of test-retest reliability and responsiveness to change is warranted.

  • 13.
    Björklund, Martin
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Hamberg, Jern
    Alfta Research Foundation, Sweden.
    Heiden, Marina
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Barnekow-Bergkvist, Margareta
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    The profile fitness mapping questionnaire for the neck. Reliability and validity of a new questionnaire for symptoms and functional limitations in subjects with neck pain. (Poster)2010Inngår i: Proceedings of the Premus 2010 conference, 2010Konferansepaper (Fagfellevurdert)
  • 14.
    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.

  • 15.
    Björklund, Martin
    et al.
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Hamberg, Jern
    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 questionnaire2007Inngår i: The 2007 Society for Back Pain Research Meeting, 2007Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    BACKGROUND: Disability questionnaires for LBP-patients mostly emanate from health professionals and have a content of different domains of disability presented as a single sum score, making it difficult to derive changes within a specific domain. This study introduces a new back-specific questionnaire, the Profile Fitness Mapping questionnaire (PFM), which was based on patient’s self-reported characteristics of the LBP. The PFM incorporates both a functional limitation and a symptom scale, with further subdivision of the symptom scale in separate indices for severity and temporal aspects. The aim of the study was to assess the overall validity of the PFM.

    METHODS AND RESULTS: Chronic LBP-patients (n=193) answered the PFM and four validated back-specific criterion questionnaires. The correlation coefficients between the PFM and the criterion questionnaires showed good concurrent criterion validity (0.61 – 0.83). The best discriminative ability between patients with different pain severity was demonstrated by the functional limitation scale of the PFM. Classification according to the ICF revealed a high degree of homogeneous item content of the symptom scale to the domain of impairments, and of the functional limitation scale to the domain of activity limitations. Well centered score distribution indicates that the PFM has the potential to detect improvement or worsening of symptoms and functional limitations in chronic LBP-patients.

    CONCLUSION: The results of the study signify that the PFM is a valid indicator of symptoms and functional limitations of LBP-patients. It provides the combination of a composite total score and the possibility of evaluations within specific domains of disability.

  • 16.
    Björklund, Martin
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Hamberg, Jern
    Alfta Research Foundation.
    Heiden, Marina
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Barnekow-Bergkvist, Margareta
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    The ProFitMap-neck: reliability and validity of a questionnaire for measuring symptoms and functional limitations in neck pain2012Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, nr 13, s. 1096-1107Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 17.
    Björklund, Martin
    et al.
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Radovanovic, Sasa
    Ljubisavljevic, Milos
    Windhorst, Uve
    Johansson, Håkan
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Effects of combined mechanical and nociceptive stimuli on nociceptive-responsive dorsal horn neurons of cat spinal cord2000Konferansepaper (Fagfellevurdert)
    Abstract [en]

    The effects of large ramp and hold stretch of the gastrocnemius muscles were studied on dorsal horn nociceptive-responsive neurons (DHN) in decerebrated cats. The stretch consisted of 3 subsequent plateaus, ending with a release phase from a near maximal physiological length of the muscle. This was done in order to mimic the "therapeutical stretches" used in clinical settings to alleviate muscle tenderness and stiffness. Stretch was applied before and after i.a. injection of bradykinin (50 microg.) into the gastrocnemius muscles. Changes in DHN activity were extracellularly recorded with high impedance glass microelectrodes. Only neurons up to approximately 1 mm were recorded. Neurons were identified as nociceptive on the basis of their response to an identification procedure applied on beforehand. Responsiveness of the DHN to stretch was variable. If responsive, a typical behavior was an increased firing rate during the ramp phases, followed by a gradual decrease during the hold phases and a reduction in firing rate or a complete silence during and after the release phase, usually lasting up to 50 s. Bradykinin injections induced either excitation or inhibition of DHN.. Stretch applied directly after the bradykinin injection in most cases elicited changes in the bradykinin-induced response of the DHN, changing both response profile as well as its strength. Results indicate that nociceptive-responding DHN could be influenced by innocuous ramp and hold stretch both in conjunction with and without chemically induced activation. The behavior of the DHN to stretch in the presence of the painful stimuli may be one of the possible mechanisms that could explain the short term relieving effects of muscle stretching when applied on stiff and tender muscles.

  • 18.
    Björklund, Martin
    et al.
    Högskolan i Gävle, Belastningsskadecentrum.
    Radovanovic, Sasa
    Högskolan i Gävle, Belastningsskadecentrum.
    Ljubisavljevic, Milos
    Högskolan i Gävle, Belastningsskadecentrum.
    Windhorst, Uwe
    Högskolan i Gävle, Belastningsskadecentrum.
    Johansson, Håkan
    Högskolan i Gävle, Belastningsskadecentrum.
    Muscle stretch-induced modulation of noxiously activated dorsal horn neurons of feline spinal cord.2004Inngår i: Neuroscience research, ISSN 0168-0102, E-ISSN 1872-8111, Vol. 48, nr 2, s. 175-184Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The present work was designed to check for the possibility of interactions between mechanical innocuous and chemically induced noxious muscle afferent inputs on discharge behavior of nociceptive superficial dorsal horn neurons (SDHNs) of the spinal cord in decerebrated cats. The innocuous and noxious stimuli were applied separately and in combination, so that the effects of the innocuous stimulus on nociceptive processing could be evaluated. The innocuous stimulus consisted of ramp-and-hold stretches of the gastrocnemius muscles, whereas the noxious stimulus consisted of i.a. injections of bradykinin (BK; 0.5-1 ml, 50 microg/ml) into the arterial circulation of same muscles. Only neurons up to approximately 1mm depth and those that responded to noxious pinch of the gastrocnemius muscles were selected for further analysis. The activity of 16 dorsal horn neurons was recorded extracellularly with high-impedance glass microelectrodes, out of which seven responded to stretch, while 12 neurons responded to bradykinin injections. The bradykinin injections induced three types of responses: excitatory, inhibitory and mixed. The majority of the neurons that showed excitatory and mixed responses to bradykinin were also influenced by stretches applied directly after the bradykinin injection. In these neurons, the stretch usually counteracted the bradykinin-induced response, i.e. shortening and reducing bradykinin-induced excitation and re-exciting the cells after bradykinin-induced inhibition. The mechanism of the stretch modulation is proposed to reside in a segmental spinal control of the nociceptive transmission.

  • 19.
    Björklund, Martin
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning. Umea University, Dept of Community Medicine and Rehabilitation; Physiotherapy, Umeå, Sweden,.
    Tronarp, Rebecca
    Umea University, Dept of Community Medicine and Rehabilitation; Physiotherapy, Umeå, Sweden.
    Granås, Marie
    Umea University, Dept of Community Medicine and Rehabilitation; Physiotherapy, Umeå, Sweden.
    Dahlgren, Gunilla
    Umea University, Dept of Community Medicine and Rehabilitation; Physiotherapy, Umeå, Sweden.
    McDonough, Suzanne
    University of Ulster, UK.
    Nyberg, André
    Umea University, Dept of Community Medicine and Rehabilitation; Physiotherapy, Umeå, Sweden.
    Häger, Charlotte
    Umea University, Dept of Community Medicine and Rehabilitation; Physiotherapy, Umeå, Sweden.
    Office-cycling while working: An innovative concept to prevent and reduce musculoskeletal pain in office workers - a controlled feasibility study2015Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Background: According to the World Health Organization, WHO, a sedentary lifestyle is the single largest health risk for a number of diseases including musculoskeletal disorders and metabolic diseases. The negative health effects of excessive sitting are not compensated for by shorter bouts of increased physical activity. However, evidence shows that increased physical activity reduces musculoskeletal pain, which is very prevalent in those who are inactive. About 50-70 % of those who work at a computer report musculoskeletal pain and spend on average about 5 hours/day with very low energy metabolism. Work places are therefore an important arena for prevention and intervention by means of reducing sedentary time and increasing physical activity both for general health benefits and effects on the musculoskeletal pain.

    Purpose: To test the feasibility of office-cycling in an office work place and explore its potential effects on musculoskeletal pain in office workers.

    Methods: Twenty office workers (ages 27-61, 5 males) with musculoskeletal pain participated in this three-week controlled pilot field study. The intervention group (n=10), had access to an innovative customized cycle ergometer (OfficeBiking®) at their regular office workstation whilst performing their usual work tasks. Offie-cycling was an alternative to sitting/standing by their height adjustable office desk; they were instructed to bike as often as comfortable. The control group (n=10) was instructed to continue to work as usual. The experiences of office-cycling and how it influenced work performance was studied with a questionnaire. Musculoskeletal pain was evaluated using pain drawings and pain ratings and participants' total pain was calculated by adding each individuals' self-reported pain from their three most painful areas (NRS 0-10).

    Results: Importantly, office-cycling did not reduce self-reported work performance; the majority (9/10) would like daily access; and made suggestions to improve the user-friendliness of the bike. Office-cycling was used regularly (median, 11/15 workdays; median active time 59 min/day IQR 39;91). There was no observed difference regarding either number of self-reported areas of pain (NSAP) or general musculoskeletal pain (GMP) between the intervention group and the control group at baseline. Self-reported GMP decreased in 8 persons in the intervention group which was one more than in the control group (n=7). NSAP decreased in the intervention group (n=7; md -1,0 IQR -2,3;0,0); and the control group (n=5; md -0,5 IQR -1,3;0,3). The difference in total pain (intervention end-baseline) revealed a clinically important change in the intervention group (NRS -2,5, IQR -8,8;4,0) but not in the control group (NRS 0,0 IQR -6,2;2,5).

    Conclusions: The results suggest that office-cycling is a feasible method for use in work place interventions with some promising results. Future research suggestions are: underlying mechanisms regarding effects of physical activity on pain in parallel with controlled studies in laboratory environments to investigate dose-effects for metabolic expenditure and optimal pain reduction whilst office-cycling.

    Implications: The results in this feasibility study indicate a promising potential of the innovative office-cycling concept to prevent and reduce musculoskeletal pain in sedentary office workers.

  • 20.
    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.

  • 21. Blesic, S.
    et al.
    Ljubisavljevic, M.
    Radovanovic, S.
    Björklund, Martin
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Milosevic, S.
    Johansson, Håkan
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    A random walk model analysis of spinal dorsalhorn neuron discharges2000Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Methods of statistical physics have been recently successfully ap- plied to the study of spatial ánd temporal randomness in various biological systems, like the analýsts of the DNA nucleotide sequences and the heartbeat time series. We study the interspike intervals (ISI) time series of the spinal dorsal horn nociceptive- responsive neurons (DHN) activity in decerebrate cats applying the detrended fluctuatìon analysis (DFA) that is a modification of the standard random walk model analysis. Specifically, we focus on ISI variability as an important quantity to help elucidate sensory coding and signal processing performed by DHN. DFA has been applied for it permtts quantification of correlation properties of a nonstationary time series of neuronal discharge, Changes in DHN activity were extracellularly recorded with high impedance glass microelectrodes from superficial laminae of the dorsal horn, during different experimentally simúlated conditions. We háve analyzed DHN discharge patterns during spontaneous activity, as well as in the presence of diflerent noxious and non- noxious mechanical stimuli. Application of DFA method showed significant changes in dynamics of neural discharge when the ex- ternal stimulus is appliéd. These findings demonstrate the relevance of the application of methods of statistical. physics to identify the changes in aflerent inflow, and to characterize temporal patterns of activity of neurons under study

  • 22.
    Bohman, Tony
    et al.
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Bottai, Matteo
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Björklund, Martin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbetshälsovetenskap och psykologi, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning. Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
    Predictive models for short-term and long-term improvement in women under physiotherapy for chronic disabling neck pain: a longitudinal cohort study2019Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 4, artikkel-id e024557Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives To develop predictive models for short-term and long-term clinically important improvement in women with non-specific chronic disabling neck pain during the clinical course of physiotherapy. Design Longitudinal cohort study based on data from a randomised controlled trial evaluating short-term and long-term effects on sensorimotor function over 11 weeks of physiotherapy. Participants and settings Eighty-nine women aged 31-65 years with non-specific chronic disabling neck pain from Gavle, Sweden. Measures The outcome, clinically important improvement, was measured with the Patient Global Impression of Change Scale (PGICS) and the Neck Disability Index (NDI), assessed by self-administered questionnaires at 3, 9 and 15 months from the start of the interventions (baseline). Twelve baseline prognostic factors were considered in the analyses. The predictive models were built using random-effects logistic regression. The predictive ability of the models was measured by the area under the receiver operating characteristic curve (AUC). Internal validity was assessed with cross-validation using the bootstrap resampling technique. Results Factors included in the final PGICS model were neck disability and age, and in the NDI model, neck disability, depression and catastrophising. In both models, the odds for short-term and long-term improvement increased with higher baseline neck disability, while the odds decreased with increasing age (PGICS model), and with increasing level of depression (NDI model). In the NDI model, higher baseline levels of catastrophising indicated increased odds for short-term improvement and decreased odds for long-term improvement. Both models showed acceptable predictive validity with an AUC of 0.64 (95% CI 0.55 to 0.73) and 0.67 (95% CI 0.59 to 0.75), respectively. Conclusion Age, neck disability and psychological factors seem to be important predictors of improvement, and may inform clinical decisions about physiotherapy in women with chronic neck pain. Before using the developed predictive models in clinical practice, however, they should be validated in other populations and tested in clinical settings.

  • 23.
    Borg, Tina
    et al.
    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. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi..
    Djupsjöbacka, Mats
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Wänman, Anders
    Hellström, Fredrik
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Perceived muscular tension in healthy subjects: a cross-sectional study2016Inngår i: PREMUS2016: Book of abstracts, 2016, s. 411-411Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Background. Perceived muscular tension (PMT) has been suggested to predict development of neck/shoulder pain. It has been hypothesized to be an early sign of musculoskeletal disorder and a possible mediator of stress on symptoms. However, the content of the concept of PMT is not clear. This study examined the association between PMT and physical and psychosocial factors and physical activity in a group of healthy students.

    Methods. This cross-sectional study was conducted on the baseline measurements of an ongoing longitudinal case-control study. A total of 63 healthy university students without complaints of neck/shoulder pain were included (21 males, 42 females, mean age 24 years). PMT was measured by asking the question “Have you, during the past month, experienced muscular tension (for example, wrinkled your forehead, ground your teeth, raised your shoulders)?” with the following response options: never, a few times, a few times per week, or one or several times per day. Self-reports on symptoms in the neck, anxiety, depression, stress, mental health, physical health, sleep and physical activity were collected with questionnaires, as well as by tenderness on palpation of neck muscles and trapezius pressure pain threshold. This produced a total of 15 variables. The relationship between these variables and PMT were analyzed using Spearman’s rank correlation coefficient.

    Results. Positive correlations were found between PMT and temporomandibular complaints (rho= .34, p < .001), neck crepitus (rho= .33, p < .001), anxiety (rho= .33, p < .001), depression (rho= .31, p < .05), tenderness on palpation (rho= .25, p < .05). There was a negative correlation between PMT and mental health (rho= -.26, p < .05). Frequent experience of PMT had weak to moderate correlations with frequency of symptoms and higher psychosocial strain, but not with stress. This suggests some covariance between PMT and both physical and psychosocial factors.

  • 24.
    Degerstedt, Frida
    et al.
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden; Umeå Center for Gender Studies, Umeå University, Umeå, Sweden.
    Enberg, Birgit
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
    Keisu, Britt-Inger
    Umeå Center for Gender Studies, Umeå University, Umeå, Sweden.
    Björklund, Martin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbetshälsovetenskap och psykologi, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning. Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
    Inequity in physiotherapeutic interventions for children with Cerebral Palsy in Sweden - a national registry study.2019Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: The aim of this study was to investigate the distribution of physiotherapeutic interventions for children with Cerebral Palsy in Sweden from an equity perspective, considering sex, country of birth and geographical region.

    METHOD: This national cross-sectional registry study includes children with Cerebral Palsy aged 0-18 years who participated in 2015 in the Swedish national quality registry, the Cerebral Palsy follow-up program, CPUP. Comparisons and associations between physiotherapeutic interventions and sex, country of birth and geographical regions were conducted using Chi2 and logistic regression analysis, controlling for cognitive level, level of motor function, age group and dominating symptom.

    RESULTS: Of the 2855 participants, 2201 (79%) had received physiotherapy. Children born in Sweden had 1.60 times higher odds (95% CI 1.10-2.33) of receiving physiotherapy compared with children born in foreign countries. Distribution of physiotherapeutic interventions differed significantly between geographical regions. No associations between sex and physiotherapeutic interventions were observed.

    CONCLUSION: The results of this study indicate inequity in care in Sweden towards children with Cerebral Palsy born in other counties. Further, physiotherapeutic interventions were not equally distributed in different.

  • 25.
    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.

  • 26.
    Ericsson, Pernilla
    et al.
    Work and Environmental Medicine, Umeå University Hospital, Umeå, Sweden.
    Björklund, Martin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Wahlström, Jens
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
    Exposure assessment in different occupational groups at a hospital using Quick Exposure Check (QEC): a pilot study2012Inngår i: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 41, nr Suppl. 1, s. 5718-5720Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In order to test the feasibility and sensitivity of the ergonomic exposure assessment tool Quick Exposure Check (QEC), a pilot-study was conducted. The aim was to test QEC in different occupational groups to compare the exposure in the most common work task with the exposure in the work task perceived as the most strenuous for the neck/shoulder region, and to test intra-observer reliability. One experienced ergonomist observed 23 workers. The mean observation time was 45 minutes, waiting time and time for complementary questions included. The exposure scores varied between the different occupational groups as well as between workers within the occupational groups. Eighteen workers rated their most common work task as also being the most strenuous for the neck/shoulder region. For the remaining five workers, the mean exposure score were higher both for the neck and shoulder/arm in the most common work task. Intra-observer reliability shows agreement in 86% of the exposure interactions in the neck and in 71% in the shoulder/arm. QEC seems to fulfill the expectations of being a quick, sensible and practical exposure assessment tool that covers physical risk factors in the neck, upper extremities and low back.

  • 27.
    Ferreira, Mariana Candido
    et al.
    Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus. School of Medicine, Ribeirão Preto. University of São Paulo, São Paulo, Brasil .
    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, Umea University, Umeå Sweden.
    Dach, Fabiola
    Department of Neurosciences and Behavioral Sciences, School of Medicine, Ribeirão Preto, University of São Paulo, São Paulo, Brasil .
    Chaves, Thais Cristina
    Department of Neurosciences and Behavioral Sciences. School of Medicine, Ribeirão Preto University of São Paulo, São Paulo, Brasil .
    Cross-cultural adaptation of the profile fitness mapping neck questionnaire to brazilian Portuguese: internal consistency, reliability, and construct and structural validity2017Inngår i: Journal of Manipulative and Physiological Therapeutics, ISSN 0161-4754, E-ISSN 1532-6586, Vol. 40, nr 3, s. 176-186Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    The purpose of this study was to adapt and evaluate the psychometric properties of the ProFitMap-neck to Brazilian Portuguese.

    Methods

    The cross-cultural adaptation consisted of 5 stages, and 180 female patients with chronic neck pain participated in the study. A subsample (n = 30) answered the pretest, and another subsample (n = 100) answered the questionnaire a second time. Internal consistency, test-retest reliability, and construct validity (hypothesis testing and structural validity) were estimated. For construct validity, the scores of the questionnaire were correlated with the Neck Disability Index (NDI), and the Hospital Anxiety and Depression Scale (HADS), the Tampa Scale of Kinesiophobia (TSK), and the 36-item Short-Form Health Survey (SF-36).

    Results

    Internal consistency was determined by adequate Cronbach's α values (α > 0.70). Strong reliability was identified by high intraclass correlation coefficients (ICC > 0.75). Construct validity was identified by moderate and strong correlations of the Br-ProFitMap-neck with total NDI score (–0.56 < R < –0.71) and with the SF-36, HADS-anxiety, HADS-depression, and TSK (–0.32 < R < –0.82). Exploratory factor analysis revealed 2 factors for the Symptom scale: intensity index and the Function scale. Symptom scale–frequency index identified 1 factor. Structural validity was determined by percentage of cumulative variance >50%, Kaiser-Meyer-Olkin index > 0.50, eigenvalue > 1, and factor loadings > 0.2.

    Conclusion

    Br-ProFitMap-neck had adequate psychometric properties and can be used in clinical settings, as well as research, in patients with chronic neck pain.

  • 28.
    Gold, Judith E
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Hallman, David
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Hellström, Fredrik
    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. Department of Community Medicine and Rehabilitation, Physiotherapy, Umea University, Umeå Sweden.
    Crenshaw, Albert G.
    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.
    Heiden, Marina
    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.
    Piligian, George
    Department of Occupational Medicine, Epidemiology and Prevention, North Shore-Long Island Jewish Health System, Great Neck, NY, USA.
    Barbe, Mary F.
    Department of Anatomy and Cell Biology, Temple University Medical School, Philadelphia, PA, USA..
    Systematic review of biochemical biomarkers for neck and upper-extremity musculoskeletal disorders2016Inngår i: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 42, nr 2, s. 103-124Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Objective:  This study systematically summarizes biochemical biomarker research in non-traumatic musculoskeletal disorders (MSDs).  Two research questions guided the review:  1) Are there biochemical markers associated with neck and upper extremity MSDs? and, 2) Are there biochemical markers associated with the severity of neck and upper extremity MSDs? 

    Methods:  A literature search was conducted in PubMed and SCOPUS.  Eighty-seven studies met primary inclusion criteria.  Following a quality screen, data were extracted from 44 sufficient quality articles.

    Results:  Most of the 87 studies were cross-sectional and utilized convenience samples of patients as both cases and controls.  A response rate was explicitly stated in only 11 (13%) studies.  Less than half of the studies controlled for potential confounding through restriction or in the analysis.  Most sufficient quality studies were conducted in older populations (mean age in one or more analysis group > 50 yrs).

    In sufficient quality articles, 82% demonstrated at least one statistically significant association between the MSD(s) and biomarker(s) studied.  Evidence suggested that: a) the collagen repair marker TIMP-1 is decreased in fibroproliferative disorders, b) 5-HT (serotonin) is increased in trapezius myalgia, and c) triglycerides are increased in a variety of MSDs.  Only five studies showed an association between a biochemical marker and MSD severity.

    Conclusion: While some MSD biomarkers were identified, limitations in the articles examined included possible selection bias, confounding, spectrum effect (potentially heterogeneous biomarker associations in populations according to symptom severity or duration) and insufficient attention to co-morbid conditions. A list of recommendations for future studies is provided.

  • 29.
    Gold, Judith
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning. Gold Standard Research Consulting, Bryn Mawr, PA, USA.
    Hallman, David
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Hellström, Fredrik
    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. Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
    Crenshaw, Albert G.
    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.
    Barbe, Mary
    Department of Anatomy and Cell Biology, Temple University Medical School,.
    Ali, Sayed
    Department of Radiology, Temple University Medical School,.
    Systematic review of quantitative imaging biomarkers for neck and shoulder musculoskeletal disorders2017Inngår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 18, artikkel-id 395Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Background

    This study systematically summarizes quantitative imaging biomarker research in non-traumatic neck and shoulder musculoskeletal disorders (MSDs). There were two research questions: 1) Are there quantitative imaging biomarkers associated with the presence of neck and shoulder MSDs?, 2) Are there quantitative imaging biomarkers associated with the severity of neck and shoulder MSDs?

    Methods

    PubMed and SCOPUS were used for the literature search. One hundred and twenty-five studies met primary inclusion criteria. Data were extracted from 49 sufficient quality studies.

    Results

    Most of the 125 studies were cross-sectional and utilized convenience samples of patients as both cases and controls. Only half controlled for potential confounders via exclusion or in the analysis. Approximately one-third reported response rates. In sufficient quality articles, 82% demonstrated at least one statistically significant association between the MSD(s) and biomarker(s) studied. The literature synthesis suggested that neck muscle size may be decreased in neck pain, and trapezius myalgia and neck/shoulder pain may be associated with reduced vascularity in the trapezius and reduced trapezius oxygen saturation at rest and in response to upper extremity tasks. Reduced vascularity in the supraspinatus tendon may also be a feature in rotator cuff tears. Five of eight studies showed an association between a quantitative imaging marker and MSD severity.

    Conclusions

    Although research on quantitative imaging biomarkers is still in a nascent stage, some MSD biomarkers were identified. There are limitations in the articles examined, including possible selection bias and inattention to potentially confounding factors. Recommendations for future studies are provided.

  • 30.
    Gold, Judith
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Hallman, David
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Hellström, Fredrik
    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.
    Mathiassen, Svend Erik
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Piligian, George
    Department of Occupational Medicine, Epidemiology and Prevention, North Shore-Long Island Jewish Health System, Great Neck, NY.
    Barbe, Mary F.
    Department of Anatomy and Cell Biology, Temple University Medical School, Philadelphia.
    Biochemical biomarkers for MSDs: systematic review results2016Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Background. Although the potential for musculoskeletal disorder (MSD) biomarkers to detect subclinical disease and monitor MSD severity was discussed more than 20 years ago, only one review on biochemical biomarkers exclusive to humans has been published (Saxton 2000). The aim of this study was to systematically summarize biochemical biomarker research in neck and upper extremity MSDs that could appear in a work-related context. Two research questions guided the review: (1) Are there biochemical markers associated with neck and upper extremity MSDs? (2) Are there biochemical markers associated with the severity of neck and upper extremity MSDs?

    Methods: A literature search was conducted in PubMed and SCOPUS. 87 studies met primary inclusion criteria. Following a quality screen, data were extracted from 44 sufficient-quality articles.

    Results. Most of the 87 studies were cross-sectional and utilized convenience samples of patients as both cases and controls. A response rate was explicitly stated in only 11 (13%) studies. Less than half of the studies controlled for potential confounding through restriction or in the analysis. Most sufficient-quality studies were conducted in older populations (mean age in one or more analysis group > 50 yrs). In sufficient-quality articles, 82% demonstrated at least one statistically significant association between the MSD(s) and biomarker(s) studied. Evidence suggested that: (a) the collagen repair marker TIMP-1 is decreased in fibroproliferative disorders, (b) 5-HT (serotonin) is increased in trapezius myalgia, and (c) triglycerides are increased in a variety of MSDs. Only five studies showed an association between a biochemical marker and MSD severity.

    Discussion. While some MSD biomarkers were identified, limitations in the articles examined included possible selection bias, confounding, spectrum effect (potentially heterogeneous biomarker associations in populations according to symptom severity or duration) and insufficient attention to co-morbid conditions. A list of recommendations for future studies is provided.

  • 31.
    Hadrévi, Jenny
    et al.
    Department of Community Medicine and Rehabilitation, Sports Medicine Unit, 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, Sports Medicine Unit, Umeå University, Umeå, Sweden.
    Kosek, Eva
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Hällgren, Solveig
    Department of Clinical Sciences, Professional Development, Umeå University, Sweden.
    Antti, Henrik
    Department of Chemistry, Faculty of Science and Technology, Umeå University, Umeå, Sweden.
    Fahlström, Martin
    Department of Clinical Sciences, Professional Development, Umeå University, Sweden.
    Hellström, Fredrik
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Systemic differences in serum metabolome: a cross sectional comparison of women with localised and widespread pain and controls2015Inngår i: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 5, artikkel-id 15925Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Chronic musculoskeletal pain exists either as localised to a single region or as widespread to multiple sites in several quadrants of the body. Prospective studies indicate that widespread pain could act as a far end of a continuum of musculoskeletal pain that started with chronic localised pain. The mechanism by which the transition from localised pain to widespread occurs is not clear, although many studies suggest it to be an altered metabolism. In this study, systemic metabolic differences between women with chronic localised neck-shoulder pain (NP), women with chronic widespread pain (CWP) and women who were healthy (CON) were assessed. Blood samples were analysed taking a metabolomics approach using gas chromatography mass spectrometry (GC-MS) and orthogonal partial least square discriminant analysis (OPLS-DA). The metabolomics analysis showed a clear systematic difference in the metabolic profiles between the subjects with NP and the CON but only a weak systematic difference between the subjects with CWP and the CON. This most likely reflects a difference in the portion of the metabolome influenced by the two pain conditions. In the NP group, the overall metabolic profile suggests that processes related to energy utilisation and lipid metabolism could be central aspects of mechanisms maintaining disorder.

  • 32.
    Hallman, David
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbetshälsovetenskap och psykologi, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Holtermann, Andreas
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Björklund, Martin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbetshälsovetenskap och psykologi, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning. Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
    Gupta, Nidhi
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Nørregaard Rasmussen, Charlotte D.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Sick leave due to musculoskeletal pain : determinants of distinct trajectories over 1 year2019Inngår i: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose

    This study aimed to identify sub-groups of workers with different trajectories of sick leave due to musculoskeletalpain over 1 year, and to investigate the extent to which the identified trajectories are associated with personal, occupational,lifestyle, and pain-related factors at baseline.

    Methods

    Data on 981 blue- and white-collar workers were analyzed in the DPHACTO cohort (2012–2014). The numberof days on sick leave due to pain was reported using text messages at 4-week intervals across 1 year. Latent class growthanalysis was used to distinguish sub-groups with different trajectories of sick leave. A web-based questionnaire at baselinewas used to assess personal, occupational (physical and psychosocial), lifestyle, and pain-related factors. Multinomial regressionmodels were constructed to determine associations between baseline factors and trajectories of sick leave (referencingno sick leave), with adjustment for potential confounders.

    Results

    Four distinct sub-groups were identified, with trajectories of sick leave due to pain ranging from no sick leave(prevalence 76%; average 0.5 days/year) to some days and increasing sick leave due to pain over 1 year (2%; 89 days/year).The increasing trajectory of sick leave was associated with higher perceived physical exertion, more time in manual work,less social community and influence at work, less leisure-time physical activity, smoking, and more severe symptoms (e.g.,multisite pain, low back pain intensity, and pain interference).

    Conclusions

    We identified four distinct trajectories of sick leave due to musculoskeletal pain. The sub-group with increasingsick leave due to pain was associated with several modifiable physical and psychosocial factors at work and outside work,which may have implications for prevention.

  • 33.
    Hallman, David
    et al.
    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.
    Heiden, Marina
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Birk Jørgensen, Marie
    Holtermann, Andreas
    Rudolfsson, Thomas
    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.
    Svedmark, Åsa
    Djupsjöbacka, Mats
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Hellström, Fredrik
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Rönnlund Borg, Tina
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Häger, Charlotte
    Sommar, Johan
    Wahlström, Jens
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Symposium: Arbete, individ och nacksmärta: Forskning vid Forte-centret “Kroppen i arbete – från problem till potential”2018Inngår i: FALF KONFERENS 2018 Arbetet - problem eller potential för en hållbar livsmiljö? 10-12 juni 2018 i Gävle: Program och Abstracts / [ed] Per Lindberg, Gävle: Gävle University Press , 2018, s. 102-Konferansepaper (Fagfellevurdert)
    Abstract [sv]

    Besvär ifrån kroppens muskler och leder såsom nack- och ryggbesvär är fortfarande ett stort problem inom arbetslivet. Muskuloskeletal diagnos är den vanligaste orsaken till lång sjukfrånvaro inom privat sektor och näst vanligast inom kommuner och landsting. Orsakerna till dessa besvär kan vara relaterade till exponering både under arbete och på fritid, men även till individfaktorer. Vår forskargrupp har en bred ansats för att fylla kunskapsluckor inom detta område och kommer att presentera resultat från flera forskningsprojekt i symposiet Arbete, individ och nacksmärta.

    Långvarigt sittande har blivit alltmer vanligt förekommande i många yrkesgrupper. Långvarigt sittande och låg fysisk aktivitet har också uppmärksammats som ett betydande hälsoproblem i dagens arbetsliv och även som en möjlig riskfaktor för smärta i nacke-skuldra. Men forskningen om betydelsen av långvarigt sittande för smärta i nacke-skuldra är fortfarande begränsad. Likaså är det oklart om huvudets hållning vid sittandet och nackens funktion, exempelvis nackens rörelsefunktion och styrka, har betydelse för besvärsutveckling. Statiskt arbete med nacken i vridna och böjda positioner misstänks vara en riskfaktor för nack-skuldersmärta i yrken såsom tandläkare, men det är oklart varför vissa exponerade individer drabbas medan andra inte får ont. För de med långvarig smärta krävs ofta rehabiliterande åtgärder, och hur väl dessa åtgärder lyckas kan även det vara beroende av individens fysiska och psykosociala arbetsmiljö. Individens arbetsmiljö påverkar således inte bara risken för om man får besvär utan kan också ha betydelse för hur rehabiliteringen av besvären lyckas.

    Syftet med detta symposium är att presentera studier från Centrum för belastningsskadeforskning som handlar om nacksmärta i arbetslivet, sammanfatta kunskapsläget inom området och diskutera hur arbetet kan utformas för att bli hållbart och inkluderande. De forskningsexempel som presenteras berör stillasittande och hållning i arbetslivet och dess tänkbara konsekvenser för nacksmärta och hälsa, riskfaktorer för nacksmärta i tandläkaryrket och arbetsmiljöns betydelse för resultatet av rehabilitering vid nacksmärta. Symposiet avslutas med en frågestund och gemensam diskussion.

  • 34.
    Hamberg, Jern
    et al.
    Stiftelsen Alfta Kurhem, Alfta Rehab Center, Alfta, Sweden.
    Björklund, Martin
    Centre for Musculoskeletal Research, National Institute for Working Life, Umeå Sweden.
    Nordgren, Bengt
    Sahlstedt, Bo
    Stretchability of the rectus femoris muscle: Investigation of validity and intratester reliability of two methods including x-ray analysis of pelvic tilt1993Inngår i: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 74, nr 3, s. 263-270Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Validity and intratester reliability of two test methods designed to identify stretchability of the rectus femoris muscle (RFM) was investigated, combined with x-ray analysis of pelvic tilt in the sagittal plane. The first method is commonly used in clinical practice. The second is a new technique supposed to tilt the pelvis posteriorly and thus further separate the origin and insertion of the muscle. Investigation of validity and intratester reliability of the two methods was made by testing and retesting a random sample of 71 persons. The tests were performed with an equipment that automatically recorded the angle of knee flexion from a previously determined applied torque, indicating the end point of motion for that particular subject. Angle of knee flexion and subjective estimation of pain sensation due to stretch were recorded at each measurement. The pelvic tilt-analysis consisted of test-retest reliability of x-ray measurements, comparison be- tween the methods in both starting and final position, and x-ray and electronic goniometer measurements. All applied torques were measured with a strain gauge. Two out of three criteria of validity favored the new method and the third pointed out the two methods as equal. The two methods as well as the x-ray measurements showed high reliability, and the hypothesis of a more posterior tilted pelvis in the new method was confirmed. The electronic goniometer was less sensitive than x-ray, but proposed to analyse pelvic tilt clinically. Methodology procedures for joint angle measurements are discussed.

  • 35.
    Hellström, Fredrik
    et al.
    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.
    Björklund, Martin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Metabolic profiles and inflammatory cytokines in people with generalized or local muscle pain2012Konferansepaper (Fagfellevurdert)
  • 36.
    Hellström, Fredrik
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Gouveia-Figueira, Sandra
    Department of Chemistry, Umeå University, Umeå; Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå.
    Nording, Malin
    Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå.
    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, Umeå University, Umeå.
    Fowler, Christopher John
    Department of Community Medicine and Rehabilitation, Umeå universitet, Umeå.
    Association between plasma concentrations of linoleic acid-derived oxylipins and the perceived pain scores in an exploratory study in women with chronic neck pain2016Inngår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 17, nr 1, artikkel-id 103Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Chronic musculoskeletal pain may be associated with changes in the balance of algogenic and anti-nociceptive compounds, and that such changes may be visible in plasma samples. We have undertaken an exploratory study to measure the levels of endocannabinoids, related N-acylethanolamines and oxylipins (primarily those derived from linoleic acid) in plasma samples from women with chronic neck pain (NP) and chronic widespread pain (CWP), and to investigate whether the observed levels are associated with the pain experienced by these women.

    Methods: Blood samples from 35 women with NP, 15 with CWP and 27 age-matched controls were analysed for the lipids using an ultra performance liquid chromatography coupled to tandem mass spectrometry method. Current pain ("NRSday") and the average pain during the last week ("NRSweek") were rated by the participants using a numerical rating scale.

    Results: There were no significant differences in the plasma concentrations of the fifteen lipids investigated between the pain subjects and the controls. However, significant correlations were seen for the NP group between the NRSday scores and the plasma concentrations of the linoleic acid derivatives 9- and 13- hydroxy-10E,12Zoctadecadienoic acid (Spearman's rho values 0.51 [P=0.0016]) and 0.53 [P=0.0011], respectively).

    Conclusions: The data obtained in this exploratory study are consistent with a model whereby the underlying inflammatory nature of the musculoskeletal disorders leads both to an increase in the NRSday scores and the hydroxy-10E,12Z-octadecadienoic acid levels, and these increases further influence the perceived pain of in the NP subjects.

  • 37.
    Richter, Hans O.
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Röijezon, Ulrik
    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.
    Long-term adaptation to neck/shoulder pain and perceptual performance in a hand laterality motor imagery test2010Inngår i: Perception, ISSN 0301-0066, E-ISSN 1468-4233, Vol. 39, nr 1, s. 119-130Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The effect of neck/shoulder pain on the performance in a hand laterality motor imagery test was studied. Responses to the Cooper and Shepard (1975, Journal of Experimental Psychology: Human Perception and Performance 104 48 ^ 56) hand laterality test were explored in twenty-four individuals with chronic non-specific neck pain and twenty-one subjects with chronic neck pain of traumatic origin (whiplash-associated disorder). Twenty-two controls were also included in the study. Digitalised right- or left-hand stimuli were presented at five different stimulus angles (08, 458 laterally, 908 laterally, 1358 laterally, and 1808). The experimental task was to decide the laterality as fast and accurately as possible. The performance, both reaction time (RT) and accuracy, of the two experimental groups was contrasted with that of the control group. The main results revealed that the subjects afflicted with whiplash injury on the average exhibited a faster response pattern than symptom-free healthy controls. Despite their  usculoskeletal deficits and experience of pain these volunteers also exhibited a preserved speed ^ accuracy tradeoff. Longer duration of time with symptoms of neck pain was, moreover, associated with progressively faster RTs. These results point to perceptual learning and may reflect different stages of adaptation to neck pain.

  • 38.
    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.

  • 39.
    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.

  • 40.
    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.

  • 41.
    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.

  • 42.
    Rudolfsson, Thomas
    et al.
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Domkin, Dmitry
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Björklund, Martin
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Djupsjöbacka, Mats
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Is neck pain associated with altered body sway kinematics?2009Inngår i: Sjukgymnastdagarna, Stockholmsmässan i Älvsjö, Stockholm: Legitimerade Sjukgymnasters Riksförbund, Stockholm , 2009, s. -40Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Introduction:Several studies have reported impaired postural control in people with neck pain. Many of these studies have analysed centre of pressure data from a force plate in quiet standing but to our knowledge none has investigated the kinematics of postural sway in people with neck pain. From studies on healthy controls there are two well established strategies of maintaining upright stance: hip and ankle strategies. Recent work has shown that these co-exist simultaneously. The purpose of this study is to investigate these kinematic strategies in people with neck pain. This could give a greater understanding of the mechanisms behind the postural control impairments and give implications for specific rehabilitation interventions.Methods:Seventy subjects (neck pain n=44, controls n=26) stood with their feet together, arms crossed and their eyes closed for 180 s. An electromagnetic tracker was used to record the kinematics for a two segment model (leg, trunk). An in-phase pattern between these segments corresponds to ankle strategy and an anti-phase pattern to hip-strategy. The strength of the in-phase pattern was quantified using coherence analysis.Results:Preliminary results indicate that people with neck pain rely less on ankle strategy in quiet standing than healthy controls. There were no differences in variability of the segment angles between groups. However people with neck pain tended to stand with a greater degree of extension in the hip.Conclusion:It’s generally considered that hip-strategy is used more when the difficulty of the task is higher. One speculative interpretation to the weaker ankle strategy in the neck pain group is that they perceived the task as more demanding. The method of coherence analysis used in this study can be a valuable tool in future studies for understanding postural sway in people with spinal pain.

  • 43.
    Röijezon, Ulrik
    et al.
    Högskolan i Gävle, Centrum för belastningsskadeforskning. Department of Community Medicine and Rehabilitation, Physiotherapy, University of Umeå, Umeå, Sweden; Alfta Research Foundation, Alfta, Sweden.
    Björklund, Martin
    Högskolan i Gävle, Centrum för belastningsskadeforskning. Alfta Research Foundation, Alfta, Sweden.
    Bergenheim, Mikael
    Högskolan i Gävle, Centrum för belastningsskadeforskning. Department of Surgery, Central Hospital Karlstad, Karlstad, Sweden.
    Djupsjöbacka, Mats
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    A novel method for neck coordination exercise: a pilot study on persons with chronic non-specific neck pain2008Inngår i: Journal of NeuroEngineering and Rehabilitation, ISSN 1743-0003, E-ISSN 1743-0003, Vol. 5, artikkel-id 36Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Chronic neck pain is a common problem and is often associated with changes in sensorimotor functions, such as reduced proprioceptive acuity of the neck, altered coordination of the cervical muscles, and increased postural sway. In line with these findings there are studies supporting the efficacy of exercises targeting different aspects of sensorimotor function, for example training aimed at improving proprioception and muscle coordination. To further develop this type of exercises we have designed a novel device and method for neck coordination training. The aim of the study was to investigate the clinical applicability of the method and to obtain indications of preliminary effects on sensorimotor functions, symptoms and self-rated characteristics in non-specific chronic neck pain METHODS: The study was designed as an uncontrolled clinical trial including fourteen subjects with chronic non-specific neck pain. A new device was designed to allow for an open skills task with adjustable difficulty. With visual feedback, subjects had to control the movement of a metal ball on a flat surface with a rim strapped on the subjects' head. Eight training sessions were performed over a four week period. Skill acquisition was measured throughout the intervention period. After intervention subjects were interviewed about their experience of the exercise and pain and sensorimotor functions, including the fast and slow components of postural sway and jerkiness-, range-, position sense-, movement time- and velocity of cervical rotation, were measured. At six-month follow up, self-rated pain, health and functioning was collected. RESULTS: The subjects improved their skill to perform the exercise and were overall positive to the method. No residual negative side-effects due to the exercise were reported. After intervention the fast component of postural sway (p = 0.019) and jerkiness of cervical rotation (p = 0.032) were reduced. The follow up showed decreased disability (one out of three indices) and fear of movement, and increased general health (three out of eight dimensions). CONCLUSION: The results support the clinical applicability of the method. The improvements in sensorimotor functions may suggest transfer from the exercise to other, non-task specific motor functions and justifies a future randomized controlled trial.

  • 44.
    Röijezon, Ulrik
    et al.
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Björklund, Martin
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Djupsjöbacka, Mats
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    A novel method of neck coordination exercise: effects on sensorimotor functions and self reported health and functioning2007Inngår i: 15th International WCPT Congress, World Physical Therapy, 2007Konferansepaper (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: The efficacy of exercises targeting sensorimotor functions in treatment of neck pain is increasingly acknowledged. To further develop this type of exercises we have designed a novel device (patent pending) and method for neck coordination training. The purpose of this study was to obtain indications of the usability of the method and its effects on sensorimotor functions, pain and functioning in neck pain patients. METHODS: Subjects with non-traumatic chronic neck pain (n=14) participated in this uncontrolled clinical trial. The neck exercise was an open skills task with adjustable difficulty. With visual feedback, subjects had to control the movement of a metal ball on a flat surface with a rim which was strapped on the subjects’ head. Before and after the intervention (eight sessions), pain ratings, postural sway and jerkiness-, range-, position sense-, movement time- and velocity of cervical rotation were assessed. At six-month follow up self rated pain, health and functioning was collected. RESULTS: Patients were overall positive to the exercise. A significant reduction in postural sway and jerkiness of cervical rotation was revealed after the training. The six-month follow up showed decreased disability and fear of movement, as well as increased general health and well being. CONCLUSION: The results support the clinical applicability of the method. The improved sensorimotor functions suggest transfer from the exercise to more general, non-task specific motor functions. The follow up may indicate a long term beneficial effect.

  • 45.
    Röijezon, Ulrik
    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.
    The slow and fast components of postural sway in chronic neck pain2011Inngår i: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 16, nr 3, s. 273-278Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Several studies have reported altered postural control in people with neck pain. The aim of this study was to increase the understanding of the nature of altered postural control in neck pain by studying the slow and fast components of body sway. Methods: Subjects with whiplash associated disorders (WAD, n = 21) and chronic non-specific neck pain (NS, n = 24) were compared to healthy controls (CON, n = 21) in this cross-sectional study. The magnitudes of the slow and fast sway components were assessed in Rhomberg quiet stance for 30 s on a force plate with eyes closed. We also investigated associations between postural sway and symptoms, self-ratings of functioning and kinesiophobia. Results: Increased magnitude of the slow sway component was found in WAD, but not in NS. Greater magnitude of the slow component in WAD was associated with poorer physical functioning, including balance disturbances, and more severe sensory symptoms. Conclusions: Increased magnitude of the slow sway component implies an aberration in sensory feedback or processing of sensory information in WAD. The associations between postural sway and self-rated characteristics support the clinical validity of the test. Further investigation into NS, involving a longer test time is warranted. (C) 2010 Elsevier Ltd. All rights reserved.

  • 46.
    Röijezon, Ulrik
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF. Högskolan i Gävle, Centrum för belastningsskadeforskning. Alfta Research Foundation, Alfta, Sweden.
    Djupsjöbacka, Mats
    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. Alfta Research Foundation, Alfta, Sweden.
    Häger-Ross, Charlotte
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
    Grip, Helena
    Department of Biomedical Engineering & Informatics, University Hospital of Umeå, Umeå, Sweden; Department of Biomedical Engineering and Informatics, University Hospital of Umeå, Umeå, Sweden .
    Liebermann, Dario G.
    Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Israel.
    Kinematics of fast cervical rotations in persons with chronic neck pain: a cross-sectional and reliability study2010Inngår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 11, artikkel-id 222Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Assessment of sensorimotor function is useful for classification and treatment evaluation of neck pain disorders. Several studies have investigated various aspects of cervical motor functions. Most of these have involved slow or self-paced movements, while few have investigated fast cervical movements. Moreover, the reliability of assessment of fast cervical axial rotation has, to our knowledge, not been evaluated before. Methods: Cervical kinematics was assessed during fast axial head rotations in 118 women with chronic nonspecific neck pain (NS) and compared to 49 healthy controls (CON). The relationship between cervical kinematics and symptoms, self-rated functioning and fear of movement was evaluated in the NS group. A sub-sample of 16 NS and 16 CON was re-tested after one week to assess the reliability of kinematic variables. Six cervical kinematic variables were calculated: peak speed, range of movement, conjunct movements and three variables related to the shape of the speed profile. Results: Together, peak speed and conjunct movements had a sensitivity of 76% and a specificity of 78% in discriminating between NS and CON, of which the major part could be attributed to peak speed (NS: 226 ± 88°/s and CON: 348 ± 92°/s, p < 0.01). Peak speed was slower in NS compared to healthy controls and even slower in NS with comorbidity of low-back pain. Associations were found between reduced peak speed and self-rated difficulties with running, performing head movements, car driving, sleeping and pain. Peak speed showed reasonably high reliability, while the reliability for conjunct movements was poor. Conclusions: Peak speed of fast cervical axial rotations is reduced in people with chronic neck pain, and even further reduced in subjects with concomitant low back pain. Fast cervical rotation test seems to be a reliable and valid tool for assessment of neck pain disorders on group level, while a rather large between subject variation and overlap between groups calls for caution in the interpretation of individual assessments.

  • 47.
    Sandlund, Jonas
    et al.
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Djupsjöbacka, Mats
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Ryhed, Bengt
    Hamberg, Jern
    Björklund, Martin
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Predictive and discriminative value of shoulder proprioception tests for patients with whiplash-associated disorders2006Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 38, nr 1, s. 44-49Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To evaluate whether patients suffering from whiplash-associated disorders have impaired shoulder proprioception and whether the acuity of shoulder proprioception is reflected in the patients' symptoms and self-rated function. DESIGN: A comparative group design, including a correlation design for the patient group. SUBJECTS: Patients with chronic whiplash-associated disorders (n=37) and healthy subjects (n=41). The groups were matched for age and gender. METHODS: All subjects underwent a shoulder proprioception test involving active ipsilateral arm position-matching. Group difference was evaluated by multiple analysis of variance and analysis of variance. The patient group completed questionnaires addressing functioning and health and performed pain ratings. Associations between proprioceptive acuity and self-rated functioning and symptoms were studied by correlation and regression analyses. RESULTS: The patient group showed significantly lower acuity of shoulder proprioception. Moderate correlations were found between proprioceptive acuity and questionnaire scores representing physical functioning, so that low proprioceptive acuity was associated with low self-rated physical functioning. Scores representing pain-intensity did not correlate with proprioceptive acuity. CONCLUSION: The results show that, at the group level, patients with whiplash-associated disorders have impaired shoulder proprioception. The clinical relevance of this finding is strongly supported by the association between shoulder proprioceptive acuity and self-rated functioning in the patient group.

  • 48.
    Sandlund, Jonas
    et al.
    Högskolan i Gävle, Centrum för belastningsskadeforskning. Department of Surgery and Perioperative Sciences, Division of Sports Medicine, University of Umeå, Alfta, Sweden; Alfta Research Foundation, Alfta, Sweden.
    Röijezon, Ulrik
    Högskolan i Gävle, Centrum för belastningsskadeforskning. Department of Community Medicine and Rehabilitation, Physiotherapy, University of Umeå, Umeå, Sweden; Alfta Research Foundation, Alfta, Swede.
    Björklund, Martin
    Högskolan i Gävle, Centrum för belastningsskadeforskning. Alfta Research Foundation, Alfta, Swede.
    Djupsjöbacka, Mats
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Acuity of goal-directed arm movements to visible targets in chronic neck pain2008Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, nr 5, s. 366-374Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To evaluate end-point acuity in goal-directed arm movements in subjects with chronic neck pain, while taking the trade-off between speed and accuracy into account, and to evaluate associations between reduced acuity and self-rated characteristics. DESIGN: Single-blinded, controlled, comparative group study. SUBJECTS: Forty-five subjects with chronic non-traumatic, non-specific neck pain (n = 24) and whiplash-associated disorders (n = 21). Healthy subjects served as controls (n = 22). The groups were age- and sex-matched. METHODS: Subjects performed fast and accurate pointing movements to a visual target. Group differences in end-point variability, controlled for peak velocity, were evaluated. Associations between end-point variability and self-rated symptoms, functioning, self-efficacy and kinesiophobia were analysed. RESULTS: End-point acuity, controlled for peak velocity, was reduced for both neck-pain groups. Similar spatial error patterns across all groups indicated no direction-specific reduction. For both neck-pain groups, associations were found between end-point acuity and neck movement deficits, physical functioning and, in whiplash, also balance and pain. CONCLUSION: Acuity of goal-directed arm movements can be reduced in chronic neck pain. Associations between acuity and self-rated characteristics support the clinical validity of the results and indicate that impaired neck function contributes to reduced end-point acuity. The results can be of importance for characterization and rehabilitation of neck disorders.

  • 49.
    Sandlund, Jonas
    et al.
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Röijezon, Ulrik
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Björklund, Martin
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Djupsjöbacka, Mats
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Acuity of goal-directed reaching movements to visible targets in chronic neck disorders2007Inngår i: Sixth International Scientific Conference on Prevention of Work-Related Musculoskeletal Disorders, 2007, s. 10-Konferansepaper (Annet vitenskapelig)
  • 50.
    Svedmark, Åsa
    et al.
    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.
    Häger, Charlotte K.
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
    Nilsson Sommar, Johan
    Department of Public Health & Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
    Wahlström, Jens
    Department of Public Health & Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
    Impact of Workplace Exposure and Stress on Neck Pain and Disabilities in Women: A Longitudinal Follow-up After a Rehabilitation Intervention2018Inngår i: Annals of Work Exposures and Health, ISSN 2398-7316, Vol. 62, nr 5, s. 591-603Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: The aim was to evaluate if pain, disability, and work productivity are influenced by physical and psychosocial work exposures as well as by stress, up to 1 year after a randomized controlled trial treatment intervention, and to determine whether any such association differed between treatment and control groups.

    Methods: Ninety-seven working women suffering non-specific neck pain (n = 67 treatment group, n = 30 control group) were followed from end of treatment intervention and at 9- and 15-month follow-ups, respectively. Physical and psychosocial exposures, as well as perceived stress, were assessed after the treatment intervention. Pain, neck disability, and work productivity were assessed at baseline, after intervention 3 months later and at 9- and 15-month follow-ups. Longitudinal assessment was conducted using the exposure level at 3 months as predictor of pain, disability, and work productivity at 3, 9, and 15 months, respectively. Mixed models were used to estimate longitudinal associations, accounting for within-individual correlation of repeated outcome measures by incorporation of a random intercept. Age and duration of neck pain were adjusted for in all models. To evaluate group differences, interactions between exposures and treatment groups were estimated.

    Results: High perceived stress was associated with more neck pain, more neck disability, and decreased work productivity in both cross-sectional and longitudinal analyses. High 'control of decision' was associated with less neck pain, less neck disability, and higher work productivity in cross-sectional analyses but only to less disability and higher productivity in longitudinal analyses. Shoulder/arm load was the only physical exposure variable that was significantly associated with work productivity in the univariate analyses. Only small differences were observed between treatment and control groups.

    Conclusion: High perceived stress and low 'control of decision' were associated with more neck pain, increased neck disability, and decreased work productivity. Treatment interventions for individuals with neck pain should take into account psychosocial workplace exposures and stress to improve intermediate and long-term results.

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