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  • 51.
    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 Intervention2018Ingår i: Annals of Work Exposures and Health, ISSN 2398-7316, Vol. 62, nr 5, s. 591-603Artikel i tidskrift (Refereegranskat)
    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.

  • 52.
    Svedmark, Åsa
    et al.
    Institutionen för samhällsmedicin och rehabilitering, fysioterapi, Umeå universitet.
    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.
    Häger, Charlotte
    Institutionen för samhällsmedicin och rehabilitering, fysioterapi. Umeå universitet.
    Sommar, Johan
    Institutionen för folkhälsa och klinisk medicin, yrkes- och miljömedicin. Umeå universitet.
    Wahlström, Jens
    Institutionen för folkhälsa och klinisk medicin, yrkes- och miljömedicin. Umeå universitet.
    Impact of physical and psychosocial workplace exposure and stress on neck pain rehabilitation in women: - a longitudinal study2017Ingår i: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246Artikel i tidskrift (Refereegranskat)
  • 53.
    Svedmark, Åsa
    et al.
    Institutionen för samhällsmedicin och rehabilitering, enheten för fysioterapi, Umeå universitet, Umeå.
    Djupsjöbacka, Mats
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Häger, Charlotte
    Institutionen för samhällsmedicin och rehabilitering, enheten för fysioterapi, Umeå universitet.
    Jull, Gwendolen
    Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, Brisbane, Australia.
    Björklund, Martin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning. Institutionen för samhällsmedicin och rehabilitering, enheten för fysioterapi, Umeå universitet, Umeå.
    Is tailored treatment superior to non-tailored treatment for pain and disability in women with non-specific neck pain?: a randomized controlled trial2016Ingår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 17, nr 1, artikel-id 408Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

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

    METHOD:

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

    RESULTS:

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

    CONCLUSION:

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

  • 54.
    Svedmark, Åsa
    et al.
    Umeå universitet.
    Häger, Charlotte
    Umeå universitet.
    Björklund, Martin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbetshälsovetenskap och psykologi, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning. Umeå universitet.
    Associations between symptoms and physical test outcomes in women with non-specific neck pain: cross-sectinal and longitudinal analyses2019Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background: Non-specific neck pain has a multifaceted symptom picture and the relationship is obscure between individual improvement on physical function and the neck patient's self-rated status.Purpose: The present aim was to determine the associations between physical test outcomes involving the neck and shoulder region, and self-reported neck symptoms before and after a treatment intervention in women with non-specific neck pain.Methods: Data were obtained for 120 women (aged 20-65) who had participated in a previous randomized controlled trial. Data were used from all participants at baseline for cross-sectional analysis and from 69 women for longitudinal analysis (Change-scores). Associations between self-reported neck problems (pain, disability and symptoms from the neck) and physical test outcomes (Neck-Strength, Cervical Axial-Range of Motion and Peak-Speed of cervical rotation) were estimated with linear regression analyses.Results: Self-rated neck pain was only significantly associated to the physical outcome measure Peak-Speed of cervical rotation, i.e., increased pain related to lower speed. This was true at baseline and for Change-scores at 9 months. Increased neck disability and frequency of symptoms were associated to lower Neck Strength and reduced Peak-Speed at baseline, and to reduced Peak-Speed and Cervical Axial-Range of Motion at 3 and 9 months, respectively. Peak-Speed and Cervical Axial-ROM were thus the physical test outcomes with associations to self-rated changes in neck symptoms. At the 9-month follow-up, 26% of the variance of frequency of symptom changes was explained by changes in Cervical Axial-ROM and Peak-Speed, which were also inter-correlated (r=0.55).Conclusion(s): The results indicate that changes in physical functioning, tested as cervical mobility and strength, have only a modest relation to the course of self-rated condition in neck disorders.Implications: The present study calls for reconsideration regarding acting mechanisms behind the apparent effect of, e.g., strength training on neck pain disorders. The specificity and usefulness of various assessments for decision-making, treatment and evaluation might be questioned.Key-Words: Neck pain, Neck strength, Range of motionFunding acknowledgements: Swedish Council for Working Life and Social Research (2009-1403), AFA Insurance (090288), The Centre for Environmental Research (1152383).Ethics approval: Did this work require ethics approval?:YesInstitution: Regional ethical review board in Uppsala SwedenEthics Committee: Regional ethical review board in Uppsala SwedenEthics number: No 2011/081

  • 55.
    Svedmark, Åsa
    et al.
    Institutionen för samhällsmedicin och rehabilitering, fysioterapi, Umeå universitet, Umeå, Svergie.
    Häger, Charlotte
    Institutionen för samhällsmedicin och rehabilitering, fysioterapi, Umeå universitet, Umeå, Sverige.
    Djupsjöbacka, Mats
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Björklund, Martin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning. Institutionen för samhällsmedicin och rehabilitering, fysioterapi, Umeå universitet, Umeå, Sverige.
    Self-estimated general improvement in function and health after tailored and non-tailored neck-shoulder pain treatment in women : A randomized controlled trial2015Ingår i: World Confederation for Physical Therapy Congress 2015, Singapore, 1-4 May, 2015., 2015Konferensbidrag (Refereegranskat)
  • 56.
    Svedmark, Åsa
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF.
    Sandsjö, Leif
    Borås Universitet.
    Häger, Charlotte
    Umeå Universitet.
    Björklund, Martin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF.
    Progressive Individualized EMG Biofeedback Training for Women2012Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    INTRODUCTION: The use of EMG biofeedback in workplace ergonomic intervention is well established. Its systematic application in tailored neck pain rehabilitation is, however, less developed.

    AIM: To introduce a tailored and gradually progressive biofeedback training program for trapezius myalgia and to assess the feasibility and the subjective experience of the program.

    METHODS: The study  sample was a subgroup in an ongoing randomized controlled trial (RCT) to evaluate 11- weeks of individualized neck pain rehabilitation in women  with  at least six weeks of work related nonspecific neck pain (target number of participants 105, ISRCTN49348025). The intervention period included 27 treatment sessions. The treatment decision model for the individualization of the RCT included five main treatment components of which biofeedback training was one. Each subject  was assigned two treatment components at minimum. Criterion for being assigned biofeedback training was a diagnosis of trapezius myalgia and a cut off level of pain pressure threshold, defined by previous cross sectional data. The biofeedback treatment program consisted of eight standardized exercises with  gradual progression of difficulty level followed by functional training in specific tasks individualized for each subject. The latter were disentangled with the Problem Elicitation Technique  (Bakker et al. 1995) and indicated the a ctivities that  were most important to the individual and most difficult to do because of the neck pain. In the functional training, principles of motor learning  were applied in order to enhance retention of the training tasks and transfer to new tasks and environments. The ability to perform three  standardized biofeedback exercises and the elinica I applicability of the individualized program was evaluated by subjects and therapists (n=4).

    RESULTS: Preliminary result from the therapist evaluation shows a positive opinion about  the biofeedback program. To date, 60% of the 105 subjects planned for the RCT have been recruited. Based on the number of subjects fulfilling the criterion so far for biofeedback training, we expect the final sample to be around 18 subjects. Results will be ready in June 2012.

    CONCLUSION: This study will provide valuable information on the feasibility and applicability of gradually progressive biofeedback training as part of an intervention program addressing work related non-specific neck pain.

    REFERENCE:

    Bakker C., van der Linden S., van Santen-Hoeufft M., Bolwijn  P., Hidding A. Problem elicitation to assess patient priorities in ankylos ing spondylitis and fibromyalgia. J. Rheumatol. 1995 Jul;22(7):1304-1

     

  • 57.
    Tronarp, Rebecca
    et al.
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
    Nyberg, André
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
    Hedlund, Mattias
    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.
    McDonough, Suzanne
    Institute of Nursing and Health Research, Ulster University, Jordanstown, UK.
    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.
    Office-cycling: a promising way to raise pain thresholds and increase metabolism with minimal compromising of work performance2018Ingår i: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, Vol. 2018, artikel-id 5427201Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Sedentary behaviour constitutes a risk for lifestyle related diseases and musculoskeletal pain which does not seem to be compensated for by shorter bouts of high intensity physical activity. A way of tackling this may be long term light intensity physical activity while performing office work.

    Aim: Establish the effects of low intensity cycling (LC), moderate intensity cycling (MC) and standing at a simulated office workstation on pain modulation, metabolic expenditure and work performance.

    Methods: 36 healthy adults (21 females), mean age 26.8 (SD 7.6) years, partook in this randomized 3x3 cross-over trial with 75 minutes of LC on 20% of maximum aerobic power output (MAP), 30 minutes of MC on 50% of MAP and standing 30 minutes with 48 hours wash-out periods. Outcome measures were pain modulation (pressure- and thermal pain thresholds, (PPT and TPT)), work performance (transcription, mouse pointing and cognitive performance) and metabolic expenditure.

    Results: PPTs increased in all conditions. Median increase in PPT trapezius was highest after LC; 39.3 kilopascal (kPa) (15.6;78.6) compared to MC; 17.0 kPa (2.8;49.9) and standing; 16.8 kPa (-5.6;39.4), p=0.015. TPT showed no change. Work performance; compared to standing, transcription was reduced during LC and MC, mouse pointing was faster in LC but had more errors while slower with more errors in MC. Performance in the cognitive task did not differ between conditions. Metabolic expenditure rates differed between all conditions (p<0.001) and were 1.4 (1.3;1.7), 3.3 (2.3;3.7) and 7.5 (5.8;8.7) kilocalories per minute during standing, LC and MC, respectively.

    Conclusions: LC seem to be the preferred option since it raised PPTs, more than doubled metabolic expenditure, while minimally influencing work performance when compared to standing. Thus, LC is promising but requires corroboration in field studies.

  • 58.
    Wiitavaara, Birgitta
    et al.
    Högskolan i Gävle, Centrum för belastningsskadeforskning. Department of Nursing, Ume̊ University, Umeå, Sweden.
    Björklund, Martin
    Högskolan i Gävle, Centrum för belastningsskadeforskning. Alfta Research Foundation, Alfta, Sweden.
    Brulin, Christine
    Department of Nursing, Ume̊ University, Umeå, Sweden.
    Djupsjöbacka, Mats
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    How well do questionnaires on symptoms in neck-shoulder disorders capture the experiences of those who suffer from the disorders?: A content analysis of questionnaires and interviews2009Ingår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 10, nr 1, artikel-id 30Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Previous research has indicated neck-shoulder disorders to have a fluctuating course incorporating a variety of symptoms. These findings awoke our interest to make a comparison between symptoms experienced by people affected with the disorder and the content of questionnaires that assess pain and other symptoms in neck-shoulder disorders. Thus the aims of this study were: -to explore the symptoms experienced by people with non-specific neck-shoulder problems, as well as experiences of nuances and temporal variations (fluctuations) of symptoms; -to investigate which sources were used in the development of ten questionnaires for assessing pain and other symptoms in the neck-shoulder; -to analyse the item content of the questionnaires; -to analyse the correspondence between the item content of the questionnaires and the symptoms described by the informants. METHODS: Content analysis of interviews with 40 people with non-specific neck-shoulder pain, and 10 questionnaires used to assess pain and other symptoms in neck-shoulder disorders. RESULTS: The interviews revealed a variety of symptoms indicating a bodily, mental/cognitive, and emotional engagement, and more general and severe symptoms than are usually considered in neck-shoulder questionnaires. Taking all questionnaires together many of the symptoms were considered, but most questionnaires only included a few of them. The informants were able to distinguish fluctuation of symptoms, and a variety of different qualities which were not usually considered in the questionnaires. Only two questionnaires had made use of the opinions of affected people in the development. CONCLUSIONS: Few of the questionnaires had made use of the experiences of affected people in the development. The correspondence between the symptoms expressed by the affected and the content of the questionnaires was low. A variety of symptoms were expressed by the interviewees, and the participants were also able to distinguish nuances and fluctuations of symptoms. The present study points to the importance of other aspects than just pain and physical functioning as clinical trial outcome measures related to neck-shoulder disorders. To develop a condition-specific questionnaire, it is important to decide on the specific symptoms for the condition. Using the experiences of those affected, in combination with relevant research and professional knowledge, can enhance the validity of the questionnaires.

  • 59.
    Wiitavaara, Birgitta
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF.
    Björklund, Martin
    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.
    Nilsson, Annika
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Vårdvetenskap.
    Can internationally recommended outcome domains capture aspects that are prominent for the health experiences of women with neck- and shoulder pain?: A factor analysis. (Poster)2010Ingår i: Proceedings of the Premus 2010 conference (Seventh International Conference on Prevention of Work-Related Musculoskeletal Disorders) August 29-September 2, Angers, France, 2010, s. 283-Konferensbidrag (Refereegranskat)
  • 60.
    Wiitavaara, Birgitta
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF.
    Björklund, Martin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF.
    Nilsson, Annika
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Vårdvetenskap.
    An initial factor analysis of prominent aspects of health experiences for women with neck-shoulder pain2012Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, nr 11, s. 934-942Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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