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  • 1. Aboagye, Emmanuel
    et al.
    Lilje, Stina
    Sophiahemmet Högskola.
    Bengtsson, Camilla
    Sophiahemmet Högskola.
    Peterson, Anna
    Sophiahemmet Högskola.
    Persson, Ulf
    Skillgate, Eva
    Sophiahemmet Högskola.
    Manual therapy versus advice to stay active for nonspecific back and/or neck pain: A cost-effectiveness analysis2022Ingår i: Chiropractic and Manual Therapies, E-ISSN 2045-709X, Vol. 30, nr 1, artikel-id 27Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Low back and neck pain are the most common musculoskeletal disorders worldwide, and imply suffering and substantial societal costs, hence effective interventions are crucial. The aim of this study was to evaluate the cost-effectiveness of manual therapy compared with advice to stay active for working age persons with nonspecific back and/or neck pain.

    METHODS: The two interventions were: a maximum of 6 manual therapy sessions within 6 weeks, including spinal manipulation/mobilization, massage and stretching, performed by a naprapath (index group), respectively information from a physician on the importance to stay active and on how to cope with pain, according to evidence-based advice, at 2 occasions within 3 weeks (control group). A cost-effectiveness analysis with a societal perspective was performed alongside a randomized controlled trial including 409 persons followed for one year, in 2005. The outcomes were health-related Quality of Life (QoL) encoded from the SF-36 and pain intensity. Direct and indirect costs were calculated based on intervention and medication costs and sickness absence data. An incremental cost per health related QoL was calculated, and sensitivity analyses were performed.

    RESULTS: The difference in QoL gains was 0.007 (95% CI - 0.010 to 0.023) and the mean improvement in pain intensity was 0.6 (95% CI 0.068-1.065) in favor of manual therapy after one year. Concerning the QoL outcome, the differences in mean cost per person was estimated at - 437 EUR (95% CI - 1302 to 371) and for the pain outcome the difference was - 635 EUR (95% CI - 1587 to 246) in favor of manual therapy. The results indicate that manual therapy achieves better outcomes at lower costs compared with advice to stay active. The sensitivity analyses were consistent with the main results.

    CONCLUSIONS: Our results indicate that manual therapy for nonspecific back and/or neck pain is slightly less costly and more beneficial than advice to stay active for this sample of working age persons. Since manual therapy treatment is at least as cost-effective as evidence-based advice from a physician, it may be recommended for neck and low back pain. Further health economic studies that may confirm those findings are warranted. Trial registration Current Controlled Trials ISRCTN56954776. Retrospectively registered 12 September 2006, http://www.isrctn.com/ISRCTN56954776 .

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  • 2. Alghamdi, Nabeel Hamdan
    et al.
    Pohlig, Ryan T
    Lundberg, Mari
    Sophiahemmet Högskola.
    Silbernagel, Karin Grävare
    The impact of the degree of kinesiophobia on recovery in patients with Achilles tendinopathy2021Ingår i: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 101, nr 11, artikel-id pzab178Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Kinesiophobia has been proposed to influence recovery in patients with Achilles tendinopathy. However, whether there are differences in outcomes in patients with different levels of kinesiophobia is unknown. The purpose of this study was to compare the characteristics of patients at baseline and recovery over time in patients with Achilles tendinopathy and various levels of kinesiophobia.

    METHODS: This study was a secondary analysis of a prospective observational cohort study of 59 patients with Achilles tendinopathy. The patients were divided into 3 groups on the basis of scores on the Tampa Scale for Kinesiophobia (TSK) (those with low TSK scores [≤33] [low TSK group], those with medium TSK scores [34-41] [medium TSK group], and those with high TSK scores [≥42] [high TSK group]). All patients were evaluated with self-reported outcomes, clinical evaluation, tendon morphology, viscoelastic property measurements, and a calf muscle endurance test at baseline, 6 months, and 12 months. No treatment was provided throughout the study period.

    RESULTS: There were 16 patients (8 women) in the low TSK group (age = 51.9 [SD = 15.3] years, body mass index [BMI] = 24.3 [22.3-25.4]), 28 patients (13 women) in the medium TSK group (age = 52.7 [SD = 15.2] years, BMI = 26.4 [22.5-30.8]), and 15 patients (8 women) in the high TSK group (age = 61.1 [SD = 11.1] years, BMI = 28.1 [25.2-33.6]). Among the groups at baseline, the high TSK group had significantly greater BMI and symptom severity and lower quality of life. All groups showed significant improvement over time for all outcomes except tendon viscoelastic properties and tendon thickening when there was an adjustment for baseline BMI. The high and medium TSK groups saw decreases in kinesiophobia at 6 months, but there was no change for the low TSK group.

    CONCLUSION: Despite the high TSK group having the highest BMI and the worse symptom severity and quality of life at baseline, members of this group showed improvements in all of the outcome domains similar to those of the other groups over 12 months.

    IMPACT: Evaluating the degree of kinesiophobia in patients with Achilles tendinopathy might be of benefit for understanding how they are affected by the injury. However, the degree of kinesiophobia at baseline does not seem to affect recovery; this finding could be due to the patients receiving education about the injury and expectations of recovery.

  • 3. André, Maria
    et al.
    Lundberg, Mari
    Sophiahemmet Högskola.
    Thoughts on pain, physical activity, and body in patients with recurrent low back pain and fear: An interview study2022Ingår i: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 102, nr 2, artikel-id pzab275Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The purpose of this study was to explore thoughts and ideas about the body and pain in patients with nonspecific low back pain (LBP) who have a high degree of fear of movement.

    METHODS: Patients with nonspecific LBP and a high degree of fear of movement, as measured using the Tampa Scale of Kinesiophobia, were asked to participate in the study. Individual semistructured in-depth interviews were conducted with 11 participants. The material was analyzed using content analysis with an inductive approach.

    RESULTS: From these patients' stories, an overarching theme-decreased confidence in the body becomes a barrier to living life to the fullest-emerged. This theme was further divided into 4 subthemes: (1) "What is wrong with my body?"-the constant search for an explanation; (2) searching for the right way to move; (3) loss of mobility means a lack of meaning in life; and (4) the message from health care professionals guides feelings, thoughts, and movement behavior.

    CONCLUSION: This study indicates that the message of keeping physically active when experiencing LBP has succeeded, but patients with fear require support to feel secure and have enough confidence in their body to move and exercise. Clinicians need to better incorporate evidence-based practice for patients with fear and support them so that they can apply an understanding of pain to their bodies and their every day life.

    IMPACT: These results offer guidance for health care professionals to enhance their practice by providing more updated information to their patients who have recurrent LBP and fear. With better support, patients may be able to regain confidence in their bodies and live their lives to the fullest.

    LAY SUMMARY: If you have recurrent LBP and fear of moving your body, ask your health care professional to provide you with updated knowledge on pain and to help you regain confidence in your body so that you can live your life to the fullest.

  • 4.
    Ardern, Clare L
    et al.
    Sophiahemmet Högskola.
    Büttner, Fionn
    Andrade, Renato
    Weir, Adam
    Ashe, Maureen C
    Holden, Sinead
    Impellizzeri, Franco M
    Delahunt, Eamonn
    Dijkstra, H Paul
    Mathieson, Stephanie
    Rathleff, Michael Skovdal
    Reurink, Guus
    Sherrington, Catherine
    Stamatakis, Emmanuel
    Vicenzino, Bill
    Whittaker, Jackie L
    Wright, Alexis A
    Clarke, Mike
    Moher, David
    Page, Matthew J
    Khan, Karim M
    Winters, Marinus
    Implementing the 27 PRISMA 2020 Statement items for systematic reviews in the sport and exercise medicine, musculoskeletal rehabilitation and sports science fields: The PERSiST (implementing Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science) guidance2022Ingår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 56, nr 4, s. 175-195, artikel-id bjsports-2021-103987Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Poor reporting of medical and healthcare systematic reviews is a problem from which the sports and exercise medicine, musculoskeletal rehabilitation, and sports science fields are not immune. Transparent, accurate and comprehensive systematic review reporting helps researchers replicate methods, readers understand what was done and why, and clinicians and policy-makers implement results in practice. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement and its accompanying Explanation and Elaboration document provide general reporting examples for systematic reviews of healthcare interventions. However, implementation guidance for sport and exercise medicine, musculoskeletal rehabilitation, and sports science does not exist. The Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science (PERSiST) guidance attempts to address this problem. Nineteen content experts collaborated with three methods experts to identify examples of exemplary reporting in systematic reviews in sport and exercise medicine (including physical activity), musculoskeletal rehabilitation (including physiotherapy), and sports science, for each of the PRISMA 2020 Statement items. PERSiST aims to help: (1) systematic reviewers improve the transparency and reporting of systematic reviews and (2) journal editors and peer reviewers make informed decisions about systematic review reporting quality.

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  • 5.
    Ardern, Clare L
    et al.
    Sophiahemmet Högskola.
    Hooper, Nicholas
    O'Halloran, Paul
    Webster, Kate E
    Kvist, Joanna
    A psychological support intervention to help injured athletes "get back in the game": Design and development study2022Ingår i: JMIR Formative Research, E-ISSN 2561-326X, Vol. 6, nr 8, artikel-id e28851Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: After a serious knee injury, up to half of athletes do not return to competitive sport, despite recovering sufficient physical function. Athletes often desire psychological support for the return to sport, but rehabilitation clinicians feel ill-equipped to deliver adequate support.

    OBJECTIVE: We aimed to design and develop an internet-delivered psychological support program for athletes recovering from knee ligament surgery.

    METHODS: Our work for developing and designing the Back in the Game intervention was guided by a blend of theory-, evidence-, and target population-based strategies for developing complex interventions. We systematically searched for qualitative evidence related to athletes' experiences with, perspectives on, and needs for recovery and return to sport after anterior cruciate ligament (ACL) injury. Two reviewers coded and synthesized the results via thematic meta-synthesis. We systematically searched for randomized controlled trials reporting on psychological support interventions for improving ACL rehabilitation outcomes in athletes. One reviewer extracted the data, including effect estimates; a second reviewer checked the data for accuracy. The results were synthesized descriptively. We conducted feasibility testing in two phases-(1) technical assessment and (2) feasibility and usability testing. For phase 1, we recruited clinicians and people with lived experience of ACL injury. For phase 2, we recruited patients aged between 15 and 30 years who were within 8 weeks of ACL reconstruction surgery. Participants completed a 10-week version of the intervention and semistructured interviews for evaluating acceptability, demand, practicality, and integration. This project was approved by the Swedish Ethical Review Authority (approval number: 2018/45-31).

    RESULTS: The following three analytic themes emerged from the meta-synthesis (studies: n=16; participants: n=164): (1) tools or strategies for supporting rehabilitation progress, (2) barriers and facilitators for the physical readiness to return to sport, and (3) barriers and facilitators for the psychological readiness to return to sport. Coping strategies, relaxation, and goal setting may have a positive effect on rehabilitation outcomes after ACL reconstruction (randomized controlled trials: n=7; participants: n=430). There were no trials of psychological support interventions for improving the return to sport. Eleven people completed phase 1 of feasibility testing (technical assessment) and identified 4 types of software errors, which we fixed. Six participants completed the feasibility and usability testing phase. Their feedback suggested that the intervention was easy to access and addressed the needs of athletes who want to return to sport after ACL reconstruction. We refined the intervention to include more multimedia content and support access to and the use of the intervention features.

    CONCLUSIONS: The Back in the Game intervention is a 24-week, internet-delivered, self-guided program that comprises 7 modules that complement usual rehabilitation, changes focus as rehabilitation progresses, is easy to access and use, and includes different psychological support strategies.

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  • 6.
    Asker, Martin
    et al.
    Sophiahemmet Högskola.
    Hägglund, Martin
    Waldén, Markus
    Källberg, Henrik
    Sophiahemmet Högskola.
    Skillgate, Eva
    Sophiahemmet Högskola.
    Reducing the risk of shoulder and knee injuries in adolescent handball players: A three-armed cluster randomised controlled trial2022Konferensbidrag (Övrigt vetenskapligt)
  • 7.
    Asker, Martin
    et al.
    Sophiahemmet Högskola.
    Hägglund, Martin
    Waldén, Markus
    Källberg, Henrik
    Sophiahemmet Högskola.
    Skillgate, Eva
    Sophiahemmet Högskola.
    The effect of shoulder and knee exercise programmes on the risk of shoulder and knee injuries in adolescent elite handball players: A three-armed cluster randomised controlled trial2022Ingår i: Sports Medicine - Open, ISSN 2199-1170, Vol. 8, nr 1, artikel-id 91Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The risk of injury in adolescent handball is high, and shoulder and knee injuries are among the most frequent and burdensome. The Swedish Knee Control programme reduced the risk of anterior cruciate ligament injuries in female youth football players and traumatic knee injuries in male and female youth floorball players. However, to date, Knee Control has not been evaluated in an elite youth sport setting. The literature on the prevention of shoulder injuries in sport is scarce, and there are to our knowledge no previous studies evaluating the preventative efficacy of injury prevention exercise programmes (IPEPs) on shoulder injuries in adolescent handball players.

    OBJECTIVES: To study the preventive efficacy of IPEPs on shoulder and knee injuries in adolescent elite handball players.

    METHODS: Eighteen Swedish handball-profiled secondary schools (clusters) with players aged 15-19 years, 54% males were randomised into either the Shoulder Group or Knee Group (interventions) or a Control Group. Players in the Shoulder Group were instructed to perform the Shoulder Control programme, and  players in the Knee Group to perform the Knee Control programme, three times per week during May 2018 to May 2019. Control Group players continued their usual training. Outcomes were shoulder and knee injuries defined by the Oslo Sports Trauma Research Center Overuse Injury Questionnaire. Intention-to-treat analyses were performed using Cox regression models with hazard rate ratios (HRRs) with corresponding 95% confidence intervals (CI).

    RESULTS: Six clusters (199 players) in the Shoulder Group, six clusters (216 players) in the Knee Group and six clusters (212 players) in the Control Group were included. There were 100 shoulder injuries and 156 knee injuries. The Shoulder Group had a 56% lower shoulder injury rate, HRR 0.44 (95% CI 0.29 to 0.68), and the Knee Group had a 31% lower knee injury rate, HRR 0.69 (95% CI 0.49 to 0.97) than the Control Group. The absolute risk reduction was 11% and 8%, and the number needed to treat was 9 and 13, respectively.

    CONCLUSIONS: Adolescent elite handball players who performed the Shoulder Control and the Knee Control programmes had a lower risk of shoulder and knee injuries, respectively, than players who continued their usual training. Further research on how these two programmes can be combined to reduce knee and shoulder injuries in a time effective way is warranted. Trial registration ISRCTN15946352. Key points The burden of knee and shoulder injuries in handball is high. The Shoulder Control programme reduces the risk and overall burden of shoulder injuries in adolescent elite handball players. The Knee Control programme reduces the risk and overall burden of knee injuries in adolescent elite handball players.

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  • 8. Asker, Martin
    et al.
    Waldén, Markus
    Källberg, Henrik
    Holm, Lena W
    Skillgate, Eva
    Sophiahemmet Högskola.
    Preseason clinical shoulder test results and shoulder injury rate in adolescent elite handball players: a prospective study2020Ingår i: Journal of Orthopaedic and Sports Physical Therapy, ISSN 0190-6011, E-ISSN 1938-1344, Vol. 50, nr 2, s. 67-74Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    STUDY DESIGN: Prospective cohort study.

    BACKGROUND: Shoulder injuries are common in handball. Shoulder weakness, scapular dyskinesia and range of motion (ROM) deficits are associated with shoulder injury in adults, but studies of adolescent players are scarce.

    OBJECTIVE: To investigate if elite adolescent female and male handball players with shoulder muscle weakness, deficits in shoulder rotation ROM or joint position sense (JPS), or scapular dyskinesia in preseason have an increased shoulder injury rate compared to players not having these characteristics.

    METHODS: 341 uninjured players (452 player-seasons, 50% females) had isometric external rotational (IER), internal rotational (IIR), abduction (IABD) and eccentric external rotational (EER) shoulder strength, shoulder ROM, JPS, and scapular dyskinesia measured during pre-season. Players were monitored weekly regarding match- and training hours and shoulder injuries during one or two seasons. We used multivariable Cox proportional hazard models to calculate hazard rate ratios (HRR) related to the first injury with 95% confidence intervals (95% CI).

    RESULTS: 48 new shoulder injuries were reported during the two seasons. In females, the HRR for IER was 2.37 (95% CI 1.03-5.44), for IIR 2.44 (95% CI 1.06-5.61), and for scapular dyskinesia 1.53 (95% CI 0.36-6.52). In males, the HRR for IER was 1.02 (95% CI 0.44-2.36), for IIR 0.74 (95% CI 0.31-1.75), and for scapular dyskinesia 3.43 (95% CI 1.49-7.92). There were no associations between new shoulder injuries and deficits in ROM or JPS.

    CONCLUSION: In adolescent elite handball, male players with pre-season scapula dyskinesia, and female players with pre-season internal or external rotation shoulder weakness, had an increased shoulder injury rate. J Orthop Sports Phys Ther, Epub 27 Nov 2019. doi:10.2519/jospt.2020.9044.

  • 9. Bendt, Martina
    et al.
    Forslund, Emelie Butler
    Hagman, Göran
    Hultling, Claes
    Sophiahemmet Högskola.
    Seiger, Åke
    Franzén, Erika
    Gait and dynamic balance in adults with spina bifida2022Ingår i: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 96, s. 343-350, artikel-id S0966-6362(22)00188-6Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Spina bifida (SB) is a complex congenital malformation, often causing impaired gait performance depending on the level and extent of malformation. Research regarding gait and balance performance in adults with SB, has not been sufficiently described yet.

    RESEARCH QUESTION: What are the characteristics of spatiotemporal gait parameters and balance performance in adults with SB? Further, do persons with muscle function (MF) level 3 differ regarding gait and balance performance from those with MF level 1-2?

    METHODS: Cross-sectional observational study at an outpatient clinic. 41 adults with SB (18-65 years), who walked regularly. Spatiotemporal parameters of gait was assessed with the APDM system and balance performance with the Mini Balance Evaluation Systems Test (Mini-BESTest). Muscle strength in the legs was assessed with 0-5 manual muscle test, and participants were classified according to level of MF into groups MF1, MF2, and MF3. Two-sided t-test was used for parametric independent variables, and Cohen's d was used for effect sizes. The Mann-Whitney U test was used for non-parametric independent data and effect size was calculated by the z value (r = z/√n).

    RESULTS: Mean gait speed was 0.96 (SD 0.20) m/s and mean stride length 1.08 m (SD 0.17), individuals with MF3 showed significantly slower gaitspeed and shorter stride length (p < 0.05). Lumbar rotation was 21° (SD 11), and thoracic lateral sway 15° (IQR 15) with significantley difference (p < 0.001 and p < 0.05) for individuals in MF3. Mini-BESTest showed a mean score of 11.3 (SD 6.9), and individuals with MF3 showed significantly lower scores (p ≤ 0.001).

    SIGNIFICANCE: Gait and balance performance was reduced compared to normative data in almost all parameters, especially in persons with less muscle function. Increased knowledge from advanced gait analysis may help healthcare professionals to design rehabilitation programmes, in order to achieve and maintain a sustainable gait and balance performance.

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  • 10.
    Berglöf, Mida
    et al.
    Sophiahemmet Högskola.
    Skillgate, Eva
    Sophiahemmet Högskola.
    Hägglund, Martin
    Asker, Martin
    Sophiahemmet Högskola.
    Increased adherence to injury prevention exercise programs in adolescent handball: Cohort study of 3219 player seasons2023Konferensbidrag (Övrigt vetenskapligt)
  • 11.
    Berglöf, Mida
    et al.
    Sophiahemmet Högskola.
    Skillgate, Eva
    Sophiahemmet Högskola.
    Hägglund, Martin
    Asker, Martin
    Sophiahemmet Högskola.
    Increased adherence to injury prevention exercise programs in adolescent handball: Cohort study of 3219 player seasons2023Konferensbidrag (Refereegranskat)
  • 12. Björklund, Glenn
    et al.
    Swarén, Mikael
    Norman, Magnus
    Alonso, Juan
    Johansson, Fredrik
    Sophiahemmet Högskola.
    Från tennisbanan till labbet och tillbaka - är det ens möjligt?2020Konferensbidrag (Övrigt vetenskapligt)
  • 13. Björklund, Glenn
    et al.
    Swarén, Mikael
    Norman, Magnus
    Alonso, Juan
    Johansson, Fredrik
    Sophiahemmet Högskola.
    Metabolic demands, center of mass movement and fractional utilization of VO2max in elite adolescent tennis players during on-court drills2020Ingår i: Frontiers in Sports and Active Living, E-ISSN 2624-9367, Vol. 2, artikel-id 92Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of the study was to investigate the exercise intensity and energy expenditure during four types of on-court tennis drills. Five female and five male tennis players participated in the study (age: 17 ± 2 years; VO2max : 54 ± 6 ml·kg-1·min-1). Anthropometric measures were taken for each player and, on separate days, each player performed (i) treadmill running to determine VO2max and (ii) four different tennis drills (Drill1-4) during which VO2, blood lactate concentration, ratings of perceived exertion (RPE 6-20), and displacement of center of mass (m) using 3D kinematics were recorded. The drills were designed to simulate match play with 90 s of rest between each drill. A repeated two-way ANOVA was used for physiological and biomechanical data and Friedman's test for RPE using < α 0.05. Fractional utilization of VO2max was greatest during Drill1 81.8 ± 7.0% and lowest during Drill4 72.4 ± 5.2% (p < 0.001) with no difference between sexes (p > 0.05). The highest energy expenditure was during Drill1 and lowest during Drill4 (77 ± 15 and 49 ± 11 kcal, respectively, p < 0.05). Energy expenditure per meter for Drill1-Drill4 was subsequently reduced for each drill with 10.5 ± 2.1, 9.9 ± 2.2, 7.6 ± 1.7, and 8.0 ± 1.6 J·kg-1·m-1 (p < 0.01). There were no interaction effects for any of these variables. RPE (6-20) and blood lactate concentration post Drill1-Drill4 were 17.5, 15.5, and 13.0 (overall, legs and arms, p < 0.001) and 5.9 ± 2.0, 4.9 ± 1.9, 5.6 ± 2.0, and 5.0 ± 2.2 mmol·l-1 (p < 0.05). The findings of this study demonstrate that the on-court tennis drills performed here are suitable for high intensity training in junior tennis players. The energy expenditure per minute is comparable to similar sports whereas the energy expenditure per meter is notably greater. 

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  • 14. Cerritelli, Francesco
    et al.
    Iacopini, Alessio
    Galli, Matteo
    Thomson, Oliver P
    Sundberg, Tobias
    Sophiahemmet Högskola.
    Leach, Matthew J
    Adams, Jon
    Evidence-based practice among Italian osteopaths: A national cross-sectional survey2021Ingår i: BMC Complementary Medicine and Therapies, ISSN 2662-7671, Vol. 21, nr 1, artikel-id 252Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: While evidence-based practice (EBP) is widely accepted across healthcare professions, research investigating its implementation in manual therapy professions such as osteopathy is limited. The primary aim of this study was to investigate Italian osteopaths' attitudes, skills, and use of EBP. A secondary purpose was to understand the obstacles and enablers to EBP adoption in the Italian osteopathic context.

    METHODS: A cross-sectional national survey was conducted (April to June 2020) among a sample of Italian osteopaths. Eligible participants were invited to complete the Italian-translated Evidence-Based practice Attitude and Utilization Survey (EBASE) anonymously online using various recruitment strategies, including email and social media campaigns. In addition to the three EBASE sub-scores (attitudes, skills and use), the demographic characteristics of the sample were considered.

    RESULTS: A total of 473 osteopaths responded to the survey. The sample appeared to represent the Italian osteopathic profession. The majority of participants had a favorable attitude toward EBP. Eighty-eight percent of respondents agreed that EBP was necessary for osteopathy practice and that scientific literature and research findings were beneficial to their clinical scenario (95%). Perceived skill levels in EBP were rated as moderate, with the lowest scores for items relating to clinical research and systematic review conduct. Apart from reading/reviewing scientific literature and using online search engines to locate relevant research papers, participant engagement in all other EBP-related activities was generally low. Clinical practice was perceived to be based on a very small proportion of clinical research evidence. The primary obstacles to EBP implementation were a dearth of clinical evidence in osteopathy, and poor skills in applying research findings. The primary enablers of EBP adoption were access to full-text articles, internet connectivity at work, and access to online databases.

    CONCLUSIONS: Italian osteopaths were largely supportive of evidence-based practice but lacked basic skills in EBP and rarely engaged in EBP activities. The updating of osteopathic training curriculum and professional formal regulation in Italy could provide a suitable framework to improve EBP skills and use.

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  • 15. Cools, Ann M
    et al.
    Maenhout, Annelies G
    Vanderstukken, Fran
    Declève, Philippe
    Johansson, Fredrik
    Sophiahemmet Högskola.
    Borms, Dorien
    The challenge of the sporting shoulder: From injury prevention through sport-specific rehabilitation toward return to play2021Ingår i: Annals of Physical and Rehabilitation Medicine, ISSN 1877-0657, E-ISSN 1877-0665, Vol. 64, nr 4, artikel-id S1877-0657(20)30082-8Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Shoulder injuries and sports-related shoulder pain are substantial burdens for athletes performing a shoulder loading sport. The burden of shoulder problems in the athletic population highlights the need for prevention strategies, effective rehabilitation programs, and a individually based return-to-play (RTP) decision. The purpose of this clinical commentary is to discuss each of these 3 challenges in the sporting shoulder, to assist the professional in: (1) preventing injury; (2) providing evidence-based practice rehabilitation and; (3) to guide the athlete toward RTP. The challenges for injury prevention may be found in the search for (the interaction between) relevant risk factors, develop valid screening tests, and implement feasible injury prevention programmes with maximal adherence from the athletes. Combined analytical and functional testing seems mandatory screening an athlete's performance. Many questions arise when rehabilitating the overhead athlete, from exercise selection, over the value of stretching, toward kinetic chain implementation and progression to high performance training. Evidence-based practice should be driven by the available research, clinical expertise and the patient's expectations. Deciding when to return to sport after a shoulder injury is complex and multifactorial. The main concern in the RTP decision is to minimize the risk of re-injury. In the absence of a "gold standard", clinicians may rely on general guidelines, based on expert opinion, regarding cutoff values for normal range of motion, strength and function, with attention to risk tolerance and load management.

  • 16. de Zoete, Annemarie
    et al.
    Rubinstein, Sidney M
    de Boer, Michiel R
    Ostelo, Raymond
    Underwood, Martin
    Hayden, Jill A
    Buffart, Laurien M
    van Tulder, Maurits W
    The effect of spinal manipulative therapy on pain relief and function in patients with chronic low back pain: An individual participant data meta-analysis2021Ingår i: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 112, s. 121-134, artikel-id S0031-9406(21)00025-0Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: A 2019 review concluded that spinal manipulative therapy (SMT) results in similar benefit compared to other interventions for chronic low back pain (LBP). Compared to traditional aggregate analyses individual participant data (IPD) meta-analyses allows for a more precise estimate of the treatment effect.

    PURPOSE: To assess the effect of SMT on pain and function for chronic LBP in a IPD meta-analysis.

    DATA SOURCES: Electronic databases from 2000 until April 2016, and reference lists of eligible trials and related reviews.

    STUDY SELECTION: Randomized controlled trials (RCT) examining the effect of SMT in adults with chronic LBP compared to any comparator.

    DATA EXTRACTION AND DATA SYNTHESIS: We contacted authors from eligible trials. Two review authors independently conducted the study selection and risk of bias. We used GRADE to assess the quality of the evidence. A one-stage mixed model analysis was conducted. Negative point estimates of the mean difference (MD) or standardized mean difference (SMD) favors SMT.

    RESULTS: Of the 42 RCTs fulfilling the inclusion criteria, we obtained IPD from 21 (n=4223). Most trials (s=12, n=2249) compared SMT to recommended interventions. There is moderate quality evidence that SMT vs recommended interventions resulted in similar outcomes on pain (MD -3.0, 95%CI: -6.9 to 0.9, 10 trials, 1922 participants) and functional status at one month (SMD: -0.2, 95% CI -0.4 to 0.0, 10 trials, 1939 participants). Effects at other follow-up measurements were similar. Results for other comparisons (SMT vs non-recommended interventions; SMT as adjuvant therapy; mobilization vs manipulation) showed similar findings. SMT vs sham SMT analysis was not performed, because we only had data from one study. Sensitivity analyses confirmed these findings.

    LIMITATIONS: Only 50% of the eligible trials were included.

    CONCLUSIONS: Sufficient evidence suggest that SMT provides similar outcomes to recommended interventions, for pain relief and improvement of functional status. SMT would appear to be a good option for the treatment of chronic LBP. Systematic Review Registration Number PROSPERO CRD42015025714.

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  • 17. Dijkstra, H Paul
    et al.
    Ardern, Clare
    Sophiahemmet Högskola.
    Serner, Andreas
    Mosler, Andrea Britt
    Weir, Adam
    Roberts, Nia Wyn
    Mc Auliffe, Sean
    Oke, Jason L
    Khan, Karim M
    Clarke, Mike
    Glyn-Jones, Siôn
    Primary cam morphology; bump, burden or bog-standard?: A concept analysis2021Ingår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 55, nr 21, s. 1212-1221, artikel-id bjsports-2020-103308Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Cam morphology, a distinct bony morphology of the hip, is prevalent in many athletes, and a risk factor for hip-related pain and osteoarthritis. Secondary cam morphology, due to existing or previous hip disease (eg, Legg-Calve-Perthes disease), is well-described. Cam morphology not clearly associated with a disease is a challenging concept for clinicians, scientists and patients. We propose this morphology, which likely develops during skeletal maturation as a physiological response to load, should be referred to as primary cam morphology. The aim of this study was to introduce and clarify the concept of primary cam morphology.

    DESIGN: We conducted a concept analysis of primary cam morphology using articles that reported risk factors associated with primary cam morphology; we excluded articles on secondary cam morphology. The concept analysis method is a rigorous eight-step process designed to clarify complex 'concepts'; the end product is a precise definition that supports the theoretical basis of the chosen concept.

    RESULTS: We propose five defining attributes of primary cam morphology-tissue type, size, site, shape and ownership-in a new conceptual and operational definition. Primary cam morphology is a cartilage or bony prominence (bump) of varying size at the femoral head-neck junction, which changes the shape of the femoral head from spherical to aspherical. It often occurs in asymptomatic male athletes in both hips. The cartilage or bone alpha angle (calculated from radiographs, CT or MRI) is the most common method to measure cam morphology. We found inconsistent reporting of primary cam morphology taxonomy, terminology, and how the morphology is operationalised.

    CONCLUSION: We introduce and clarify primary cam morphology, and propose a new conceptual and operational definition. Several elements of the concept of primary cam morphology remain unclear and contested. Experts need to agree on the new taxonomy, terminology and definition that better reflect the primary cam morphology landscape-a bog-standard bump in most athletic hips, and a possible hip disease burden in a selected few.

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  • 18. Fernandez-Fernandez, Jaime
    et al.
    Moreno-Perez, Victor
    Cools, Ann
    Nakamura, Fábio Yuzo
    Teixeira, Anderson Santiago
    Ellenbecker, Todd
    Johansson, Fredrik
    Sophiahemmet Högskola.
    Sanz-Rivas, David
    The effects of a compensatory training program adding an isoinertial device in the shoulder function on young tennis players2023Ingår i: Journal of Strength and Conditioning Research, ISSN 1064-8011, E-ISSN 1533-4287, Vol. 37, nr 5, s. 1096-1103Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to analyze whether a compensatory training program, including isoinertial flywheel training, could reduce shoulder imbalances in a group of asymptomatic young tennis players. After an initial evaluation, 26 young tennis players were assigned to either a supervised flywheel training group (FTG, n = 13) or a control group (CG, n = 13). Shoulder passive internal (IR) and external rotation (ER) range of motion (ROM) as well as shoulder IR and ER maximal isometric strength were measured before and after a 12-week training intervention, performed 3 times per week. After the intervention, results showed significant changes for IR (p < 0.001, effect size [ES] = 1.83) and ER (p < 0.001, ES = 1.77) on the dominant (D) side, and IR on the nondominant (ND) side (p < 0.001, ES = 2.24) in the FTG compared with the CG. Regarding the ROM values, results showed that the FTG achieved significantly greater increases for the IR ROM (p < 0.001, ES = 3.32) and total ROM (TROM) (p = 0.004, ES = 1.39) on the D and ND sides (IR ROM: p = 0.002, ES = 1.53; TROM: p < 0.001, ES = 2.35) than the CG. Moreover, the CG displayed larger decrements in ER ROM (p = 0.016, ES = 1.12) on the ND side after the training period than the FTG. The conducted compensatory training program was effective to increase the ER strength and IR mobility of the FTG players, which led to a reduction in the glenohumeral imbalances.

  • 19. Franzén, Erika
    et al.
    Johansson, Hanna
    Freidle, Malin
    Ekman, Urban
    Wallén, Martin Benka
    Schalling, Ellika
    Lebedev, Alexander
    Lövdén, Martin
    Holmin, Staffan
    Svenningsson, Per
    Hagströmer, Maria
    Sophiahemmet Högskola.
    The EXPANd trial: effects of exercise and exploring neuroplastic changes in people with Parkinson's disease2019Ingår i: BMC Neurology, E-ISSN 1471-2377, Vol. 19, nr 1, artikel-id 280Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Parkinson's disease (PD) affects many physiological systems essential for balance control. Recent studies suggest that intensive and cognitively demanding physical exercise programs are capable of inducing plastic brain changes in PD. We have developed a highly challenging balance training (the HiBalance) program that emphasizes critical aspects of balance control through progressively introducing more challenging exercises which incorporates dual-tasking. Earlier studies have shown it to be effective in improving balance, gait and dual-tasking. The study design has thereafter been adjusted to link intervention-induced behavioral changes to brain morphology and function. Specifically, in this randomized controlled trial, we will determine the effects of the HiBalance program on balance, gait and cognition and relate this to task-evoked functional MRI (fMRI), as well as brain-derived neurotrophic factor (BDNF) in participants with mild-moderate PD.

    METHODS: One hundred participants with idiopathic PD, Hoehn & Yahr stage 2 or 3, ≥ 60 years of age, ≥ 21 on Montreal Cognitive Assessment will be recruited in successive waves and randomized into either the HiBalance program or to an active control group (the HiCommunication program, targeting speech and communication). Both interventions will be performed in small groups, twice a week with 1 h sessions for 10 weeks. In addition, a 1 h, once a week, home exercise program will also be performed. A double-blinded design will be used. At the pre- and post-assessments, participants will be assessed on balance (main outcome), gait, cognitive functions, physical activity, voice/speech function, BDNF in serum and fMRI (3 T Philips) during performance of motor-cognitive tasks.

    DISCUSSION: Since there is currently no cure for PD, findings of neuroplastic brain changes in response to exercise would revolutionize the way we treat PD, and, in turn, provide new hope to patients for a life with better health, greater independence and improved quality of life.

    TRIAL REGISTRATION: ClincalTrials.gov: NCT03213873, first posted July 11, 2017.

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  • 20.
    Fältström, Anne
    et al.
    Sophiahemmet Högskola.
    Skillgate, Eva
    Sophiahemmet Högskola.
    Tranaeus, Ulrika
    Weiss, Nathan
    Sophiahemmet Högskola.
    Källberg, Henrik
    Sophiahemmet Högskola.
    Lyberg, Victor
    Sophiahemmet Högskola.
    Nomme, Mathias
    Thome, Nicolai
    Omsland, Truls
    Pedersen, Eirik
    Hägglund, Martin
    Waldén, Markus
    Asker, Martin
    Sophiahemmet Högskola.
    Normative values and changes in range of motion, strength, and functional performance over 1 year in adolescent female football players: Data from 418 players in the Karolinska football Injury Cohort study.2022Ingår i: Physical Therapy in Sport, ISSN 1466-853X, E-ISSN 1873-1600, Vol. 58, s. 106-116, artikel-id S1466-853X(22)00135-3Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To study normative values of range of motion (ROM), strength, and functional performance and investigate changes over 1 year in adolescent female football players.

    DESIGN: Cross-sectional.

    PARTICIPANTS: 418 adolescent female football players aged 12-17 years.

    MAIN OUTCOME MEASURES: The physical characteristic assessments included (1) ROM assessment of the trunk, hips, and ankles; (2) strength measures (maximal isometric and eccentric strength for the trunk, hips, and knees, and strength endurance for the neck, back, trunk and calves), and (3) functional performance (the one-leg long box jump test and the square hop test).

    RESULTS: Older players were stronger, but not when normalized to body weight. Only small differences in ROM regarding age were found. ROM increased over 1 year in most measurements with the largest change in hip external rotation, which increased by 6-7° (Cohen's d = 0.83-0.87). Hip (d = 0.28-1.07) and knee (d = 0.38-0.53) muscle strength and the square hop test (d = 0.71-0.99) improved over 1 year.

    CONCLUSIONS: Normative values for ROM and strength assessments of neck, back, trunk, hips, knees, calves and ankles are presented for adolescent female football players. Generally, fluctuations in ROM were small with little clinical meaning, whereas strength improved over 1 year.

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  • 21. Heijne, Annette
    et al.
    Silbernagel, Karin Grävare
    Lundberg, Mari
    Sophiahemmet Högskola.
    "I don't opt out of things because I think I will get a sore knee, but I don't expose myself to stupid risks either": Patients' experiences of a second ACL injury-an interview study2021Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: The purpose of this qualitative study was to describe women's experiences with anterior cruciate ligament reconstruction (ACLR) and a subsequent ACL rupture, and to identify potential facilitators and barriers for coping with rehabilitation after the second injury.

    METHODS: Eight women between 17 and 36 years (mean 26, SD 6.5) who had experienced ACLR, followed by another ACL rupture, participated in the study. Semi-structured interviews were conducted, and data were analyzed using qualitative content analysis.

    RESULTS: One overarching theme, "Rehabilitation after a second ACL injury-A lifelong adaptive coping process", emerged from analyses. Undergoing a second rehabilitation is described as a process of adaptation, beginning with the first injury and still ongoing, more than 5 years later. Participants applied different coping strategies to adapt to these life-altering injuries, but the common denominator was of major life adjustments with no return to previous activity levels. Initially, after the reinjury, it was about coping with the catastrophe of the dreaded second injury. Over time, they accepted their "new" life and reset their recovery/rehabilitation goal not just as "return to sport" but rather as a "personal life goal".

    CONCLUSION: Undergoing a second ACL injury is a long process that challenges the patient's coping skills. Given these results, rehabilitation programs need to be more person centred according to the patients-adjusted life goals.

    LEVEL OF EVIDENCE: 3.

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  • 22. Holm, Lena W
    et al.
    Onell, Clara
    Sophiahemmet Högskola.
    Carlseus, Martin
    Ekwurtzel, Robin
    Holmertz, Olle
    Bohman, Tony
    Skillgate, Eva
    Sophiahemmet Högskola.
    Vigorous regular leisure-time physical activity is associated with a clinically important improvement in back pain: A secondary analysis of randomized controlled trials2021Ingår i: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 22, nr 1, artikel-id 857Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Neck and back pain are musculoskeletal conditions with serious individual and societal consequences. Current evidence about the prognostic value for neck and back pain is limited and conflicting. This prospective cohort study aimed to assess the association between leisure-time physical activity (LPA) and improvement of neck and/or back pain in a working population receiving manual therapy or general care in one of two randomized controlled trials (RCTs).

    METHODS: Analyses of data from two RCTs evaluating the effect of manual therapies for neck and/or back pain was conducted. Participants (n = 1 464) answered questionnaires about frequency and effort level of LPA at baseline. LPA on moderate or vigorous levels was compared to no or low/irregular moderate and vigorous levels. Pain intensity was assessed with numerical scales at baseline and 3-, 6-, and 12-month follow-up. The outcome was minimal clinically important improvement in pain intensity, defined as ≥2 points improvement in mean pain intensity at follow-up. Crude- and adjusted risk ratios (RR) with 95% confidence intervals (CI) were calculated with Poisson regression analysis and stratified by pain location.

    RESULTS: Participants with neck and/or back pain performing vigorous LPA showed a minimal clinically important improvement after 12 months compared to the control group; RR 1.35 (95% CI; 1.06-1.73). No effect was observed at 3 or 6 months. Moderate LPA did not improve pain intensity in any follow-up. Stratified analyses revealed that the effect of vigorous LPA at 12 months in back pain was RR 1.83 (95% CI; 1.26-2.66) and neck pain RR 1.06 (95% CI; 0.75-1.49).

    CONCLUSIONS: Persons with neck and/or back pain receiving manual therapy or general evidence-based care have greater chance of improvement after 12 months if they prior to treatment frequently practice vigorous LPA. When analyzed separately, the effect was only present for back pain.

    TRIAL REGISTRATION: Registration in Current Controlled Trials (ISRCTN), Stockholm Manual Intervention Trial (MINT), ISRCTN92249294 BJORN-trial, ISRCTN56954776.

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  • 23. Jakobsson, Max
    et al.
    Hagströmer, Maria
    Sophiahemmet Högskola.
    Lotzke, Hanna
    von Rosen, Philip
    Lundberg, Mari
    Sophiahemmet Högskola.
    Fear of movement was associated with sedentary behaviour 12 months after lumbar fusion surgery in patients with low back pain and degenerative disc disorder2023Ingår i: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 24, artikel-id 874Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Movement behaviours, such as sedentary behaviour (SB) and moderate to vigorous physical activity (MVPA), are linked with multiple aspects of health and can be influenced by various pain-related psychological factors, such as fear of movement, pain catastrophising and self-efficacy for exercise. However, the relationships between these factors and postoperative SB and MVPA remain unclear in patients undergoing surgery for lumbar degenerative conditions. This study aimed to investigate the association between preoperative pain-related psychological factors and postoperative SB and MVPA in patients with low back pain (LBP) and degenerative disc disorder at 6 and 12 months after lumbar fusion surgery.

    METHODS: Secondary data were collected from 118 patients (63 women and 55 men; mean age 46 years) who underwent lumbar fusion surgery in a randomised controlled trial. SB and MVPA were measured using the triaxial accelerometer ActiGraph GT3X+. Fear of movement, pain catastrophising and self-efficacy for exercise served as predictors. The association between these factors and the relative time spent in SB and MVPA 6 and 12 months after surgery was analysed via linear regression models, adjusting for potential confounders.

    RESULTS: Preoperative fear of movement was significantly associated with relative time spent in SB at 6 and 12 months after surgery (β = 0.013, 95% confidence interval = 0.004 to 0.022, p = 0.007). Neither pain catastrophising nor self-efficacy for exercise showed significant associations with relative time spent in SB and MVPA at these time points.

    CONCLUSIONS: Our study demonstrated that preoperative fear of movement was significantly associated with postoperative SB in patients with LBP and degenerative disc disorder. This finding underscores the potential benefits of preoperative screening for pain-related psychological factors, including fear of movement, preoperatively. Such screenings could aid in identifying patients who might benefit from targeted interventions to promote healthier postoperative movement behaviour and improved health outcomes.

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  • 24.
    Johansson, Fred
    et al.
    Sophiahemmet Högskola.
    Tranaeus, Ulrika
    Asker, Martin
    Sophiahemmet Högskola.
    Skillgate, Eva
    Sophiahemmet Högskola.
    Johansson, Fredrik
    Sophiahemmet Högskola.
    Athletic identity and shoulder overuse injury in competitive adolescent tennis players: The Smash cohort study2022Ingår i: Frontiers in Sports and Active Living, E-ISSN 2624-9367, Vol. 4, artikel-id 940934Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Our primary aim was to determine if athletic identity is prospectively associated with shoulder overuse injuries. Secondly, we aimed to determine if athletic identity is prospectively associated with playing through pain and to describe how athletic identity relates to sex, age, playing level, weekly training load, and match volume.

    Methods: A cohort of 269 adolescent tennis players were followed over a period of 52 weeks. Cox regression was used to estimate the hazard rate ratio (HRR) of first-time shoulder overuse injury associated with every 10-unit increase on the Athletic Identity Measurement Scale (AIMS).

    Results: The adjusted HRR of shoulder overuse injury was 0.89 (95% CI: 0.36-2.20) and the odds ratio of playing through pain was 2.41 (95% CI: 0.74-8.96) for every 10 unit increase on AIMS. The level of athletic identity was higher among players at the national level than among players at the regional level and was weakly correlated to weekly hours of tennis matches, tennis training, and fitness training.

    Conclusions: Our results indicate that higher levels of athletic identity may be associated with a lower incidence of shoulder overuse injuries, and potentially with playing through pain, although these results are inconclusive due to wide confidence intervals.

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  • 25.
    Johansson, Fredrik
    et al.
    Sophiahemmet Högskola.
    Asker, Martin
    Sophiahemmet Högskola.
    Malmberg, Andreas
    Fernandez-Fernandez, Jaime
    Warnqvist, Anna
    Cools, Ann
    Eccentric and isometric shoulder rotation strength and range of motion: Normative values for adolescent competitive tennis players2022Ingår i: Frontiers in Sports and Active Living, E-ISSN 2624-9367, Vol. 4, artikel-id 798255Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this cross-sectional study was to investigate isometric internal rotation (IR), external rotation (ER), abduction (ABD), and eccentric external rotation (eccER) shoulder strength and rotational range of motion (ROM) in adolescent male and female competitive tennis players. Additional aims of the study were to provide a tennis-specific normative database based on a large sample of players to deepen the knowledge regarding shoulder strength and ROM for adolescent competitive tennis players, and to discuss differences based on sex, age, and level of play. Shoulder strength and ROM was assessed in 301 adolescent competitive tennis players, 176 boys and 125 girls with a mean age of 14.6 and 14.4 years, respectively. Outcome variables of interest were isometric IR and ER strength, ABD strength, eccER shoulder strength, intermuscular strength ratios ER/IR and eccER/IR, IR ROM, ER ROM, and total range of motion (TROM). A General Linear Model two-way ANOVA was used to analyze differences in sex, age, and level of play. The findings of this study demonstrated age, side, and sex differences in the shoulder isometric strength, the eccER strength and ROM in adolescent competitive tennis players. Furthermore, when strength was expressed as ratios ER/IR and eccER/IR both sexes showed a lower ratio for eccER/IR in national players (0.95 ± 0.22 and 0.95 ± 0.23) compared to regional players (1.01 ± 0.32 and 1.07 ± 0.29) for male and female players, respectively. In conclusion, this paper presents a tennis-specific normative database for shoulder rotation strength and ROM in adolescent male and female competitive players. The key points in this evaluation are strength values normalized to body mass, intermuscular ratios, and TROM.

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  • 26.
    Johansson, Fredrik
    et al.
    Sophiahemmet Högskola.
    Cools, Ann
    Gabbett, Tim
    Fernandez-Fernandez, Jaime
    Skillgate, Eva
    Sophiahemmet Högskola.
    Association between spikes in external training load and shoulder injuries in competitive adolescent tennis players: The SMASH cohort study2022Ingår i: Sports Health, ISSN 1941-0921, s. 103-110, artikel-id 19417381211051643Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Few studies have examined the association between the acute:chronic workload ratio (ACWR) and complaints/injuries in young tennis players. Primary aims of this study were to investigate if accumulated external workload "spikes" in ACWR of tennis training, match play, and fitness training, and to see if high or low workload/age ratio were associated with the rate of shoulder complaints/injuries in competitive adolescent tennis players. Additional aims were to report the incidence of complaints/injuries stratified by sex and level of play and to describe shoulder injury characteristics.

    HYPOTHESIS: Rapid increases in external workload are associated with the incidence of shoulder complaints and injuries.

    STUDY DESIGN: A cohort study.

    LEVEL OF EVIDENCE: Level 3.

    METHODS: At baseline, 301 adolescent competitive tennis players, 13 to 19 years, were screened and followed weekly for 52 weeks with questionnaires, in the years 2018 to 2019. Information about time-varying accumulated external workload spikes (uncoupled ACWR >1.3), and workload/age ratio, in 252 uninjured players were used in Cox regression analyses with the outcomes shoulder complaints (≥20) and injuries (≥40) (Oslo Sports Trauma Research Center Overuse Injury Questionnaire).

    RESULTS: For each additional workload spike in tennis training/match play, the hazard rate ratio (HRR) was 1.26 (95% CI, 1.13-1.40) for a shoulder complaint and 1.26 (95% CI, 1.15-1.39) for a shoulder injury. The HRR for fitness training was 1.11 (95% CI, 1.02-1.20) for a shoulder complaint and 1.18 (95% CI, 1.09-1.27) for a shoulder injury. Workload/age ratio was not associated with the rate of shoulder complaints or injuries.

    CONCLUSION: Accumulated external workload spikes of tennis training, match play, and/or fitness training are associated with a higher rate of shoulder complaints and shoulder injuries in competitive adolescent tennis players.

    CLINICAL RELEVANCE: Consistency in training load on a weekly basis is most likely more beneficial for adolescent tennis players regarding shoulder complaints/injuries than a training schedule comprising rapid increases (ie, spikes) in workload.

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  • 27.
    Johansson, Fredrik
    et al.
    Sophiahemmet Högskola.
    Gabbett, Tim
    Svedmark, Per
    Skillgate, Eva
    Sophiahemmet Högskola.
    External training load and the association with back pain in competitive adolescent tennis players: Results from the SMASH cohort study2022Ingår i: Sports Health, ISSN 1941-0921, Vol. 14, nr 1, s. 111-118, artikel-id 19417381211051636Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: In young tennis players, high loads on the spine and high training volumes in relation to age are associated with a high lifetime prevalence of back pain. The primary aim of this study was to investigate if accumulated external workload "spikes" in the acute:chronic workload ratio (ACWR) of tennis training, match play, and fitness training, and if high or low workload/age ratio were associated with back pain events in competitive adolescent tennis players. Additional aims were to report the incidence of back pain stratified by sex and level of play and to describe the characteristics of players with back pain.

    HYPOTHESIS: Rapid increases in external workload are associated with the incidence of back pain.

    STUDY DESIGN: Cohort study of 198 competitive tennis players, 13 to 19 years, with a weekly follow-up for 52 consecutive weeks.

    LEVEL OF EVIDENCE: Level 3.

    METHODS: Accumulated external workload spikes (uncoupled ACWR >1.3), and the workload/age ratio, were time-varying exposures in Cox regression analyses with the outcome back pain (pain intensity ≥2/10 in the lower back and/or in the upper back/neck with a pain-related disability).

    RESULTS: For each additional workload spike in tennis training/match play, the hazard rate ratio (HRR) was 1.17 (95% CI, 1.06-1.28) for back pain. The corresponding HRR for fitness training was 1.13 (95% CI, 1.05-1.22). Training workload/age ratio was not related to back pain.

    CONCLUSION: Accumulated external workload spikes of tennis training, match play, and/or fitness training are associated with a higher rate of back pain events in competitive adolescent tennis players.

    CLINICAL RELEVANCE: Back pain is a troublesome clinical problem that may affect the performance of talented young tennis players. Structuring the training schedule to minimize rapid increases (ie, spikes) of training load on a weekly basis may enhance performance and reduce back pain in adolescent tennis players.

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  • 28.
    Johansson, Fredrik
    et al.
    Sophiahemmet Högskola.
    Skillgate, Eva
    Sophiahemmet Högskola.
    Gabbett, Tim
    Fernandez, Jaime
    Cools, Ann
    Workload and shoulder injuries in adolescent competitive Swedish tennis players: The SMASH cohort study2020Konferensbidrag (Övrigt vetenskapligt)
  • 29. Johansson, Hanna
    et al.
    Franzén, Erika
    Roaldsen, Kirsti Skavberg
    Hagströmer, Maria
    Sophiahemmet Högskola.
    Leavy, Breiffni
    Controlling the uncontrollable: Perceptions of balance in people with parkinson disease2019Ingår i: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 99, nr 11, s. 1501-1510, artikel-id pzz117Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Exercise improves balance in Parkinson disease (PD), yet the majority of people with the diagnosis are physically inactive. Insights gained from understanding how people with PD (PwPD) make sense of their symptoms and their ability to control them may inform the communication strategies and motivational approaches adopted by physical therapists. No previous study has qualitatively explored how PwPD perceive the concept of balance and the beliefs they hold concerning their ability to affect balance.

    OBJECTIVE: This study aimed to explore the meaning of balance for PwPD and the beliefs they hold regarding their ability to influence their balance in everyday life.

    DESIGN: The design is a qualitative study with an inductive approach.

    METHODS: In-depth interviews were conducted with 18 participants with PD (age range 46 to 83 years, Hoehn and Yahr range 1 to 4), and transcripts were analyzed using qualitative content analysis.

    RESULTS: Five main themes emerged from the analysis: remaining in control over the body; adapting behavior to deal with uncertainty; directing focus to stay one step ahead; resilience as a defense, and exercise beliefs and reservations. Interpretation of the underlying patterns in the main themes yielded the overarching theme of focus and determination to regain control over shifting balance.

    CONCLUSIONS: The concept of balance was perceived as both bodily equilibrium and mind-body interplay and was described in the context of remaining in control over one's body and everyday life. Cognitive resources were utilized in order to direct focus and attention during balance-challenging situations in a process involving internal dialogue. Even participants who did not express beliefs in their ability to affect balance through exercise used psychological resilience to counter the challenges of impaired balance.

  • 30. Johansson, Hanna
    et al.
    Freidle, Malin
    Ekman, Urban
    Schalling, Ellika
    Leavy, Breiffni
    Svenningsson, Per
    Hagströmer, Maria
    Sophiahemmet Högskola.
    Franzén, Erika
    Feasibility aspects of exploring exercise-induced neuroplasticity in Parkinson's disease: A pilot randomized controlled trial2020Ingår i: Parkinson's Disease, ISSN 2090-8083, E-ISSN 2042-0080, Vol. 2020, artikel-id 2410863Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Recent studies indicate that exercise can induce neuroplastic changes in people with Parkinson's disease (PwPD). Reports of feasibility outcomes from existing pilot trials however are, of date, insufficient to enable replication by others in larger definitive trials.

    Objective: To evaluate trial design for a definitive trial by exploring process and scientific feasibility.

    Methods: The trial design was a parallel-group RCT pilot with a 1 : 1 allocation ratio to either HiBalance or an active control group (HiCommunication). Both groups received one-hour sessions twice weekly, plus home exercises weekly, for 10 weeks. Participants with mild-to-moderate Parkinson's disease (PD) were recruited via advertisement. Assessment included physical performance, structural and functional MRI, blood sampling, neuropsychological assessment, and speech/voice assessment. Process and scientific feasibility were monitored throughout the study. Process feasibility involved recruitment, participant acceptability of assessments and interventions, assessment procedures (focus on imaging, blood sampling, and dual-task gait analysis), and blinding procedures. Scientific feasibility involved trends in outcome response and safety during group training and home exercises. Data are presented in median, minimum, and maximum values. Changes from pre- to postintervention are reported descriptively.

    Results: Thirteen participants were included (4 women, mean age 69.7 years), with a recruitment rate of 31%. Attendance rates and follow-up questionnaires indicated that both groups were acceptable to participate. Image quality was acceptable; however, diplopia and/or sleepiness were observed in several participants during MRI. With regard to dual-task gait performance, there appeared to be a ceiling effect of the cognitive tasks with seven participants scoring all correct answers at pretest. Blinding of group allocation was successful for one assessor but was broken for half of participants for the other.

    Conclusions: The overall trial design proved feasible to perform, but further strengthening ahead of the definitive RCT is recommended, specifically with respect to MRI setup, cognitive dual-tasks during gait, and blinding procedures. This trial is registered with NCT03213873.

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  • 31. Johansson, Hanna
    et al.
    Hagströmer, Maria
    Sophiahemmet Högskola.
    Grooten, Wilhelmus J A
    Franzén, Erika
    Exercise-induced neuroplasticity in Parkinson's disease: A metasynthesis of the literature2020Ingår i: Neural Plasticity, ISSN 2090-5904, E-ISSN 1687-5443, Vol. 2020, artikel-id 8961493Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Parkinson's disease (PD) is a neurodegenerative disorder for which there is currently only symptomatic treatment. During the last decade, there has been an increased interest in investigating physical exercise as a neuroprotective mechanism in PD. Animal studies have suggested that exercise may in fact induce neuroplastic changes, but evidence in humans is still scarce. A handful of reviews have previously reported on exercise-induced neuroplasticity in humans with PD, but few have been systematic, or have mixed studies on both animals and humans, or focused on one neuroplastic outcome only. Here, we provide a systematic review and metasynthesis of the published studies on humans in this research field where we have also included different methods of evaluating neuroplasticity. Our results indicate that various forms of physical exercise may lead to changes in various markers of neuroplasticity. A narrative synthesis suggests that brain function and structure can be altered in a positive direction after an exercise period, whereas a meta-analysis on neurochemical adaptations after exercise points in disparate directions. Finally, a GRADE analysis showed that the current overall level of evidence for exercise-induced neuroplasticity in people with PD is very low. Our results demonstrate that even though the results in this area point in a positive direction, researchers need to provide studies of higher quality using more rigorous methodology.

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  • 32.
    Karlsson, Emelie
    et al.
    Sophiahemmet Högskola.
    Hanafi, Rikard
    Sophiahemmet Högskola.
    Brisby, Helena
    Fors, Andreas
    Kemani, Mike
    Hedman, Håkan
    Nijs, Jo
    Lundberg, Mari
    Sophiahemmet Högskola.
    Get Back, a person-centred digital programme targeting physical activity for patients undergoing spinal stenosis surgery: A study protocol of a randomized feasibility study2024Ingår i: Pilot and Feasibility Studies, ISSN 2055-5784, Vol. 10, artikel-id 16Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Spinal stenosis is the most common reason for elective spine surgery, and the cardinal symptom is leg pain and discomfort when walking. Patients with spinal stenosis have a decreased level of physical activity and thereby an increased risk of poor health. Get Back is a person-centred digital programme that strives to support patients being physically active after surgery. The aim is to explore if Get Back, in its present format (referred to as Get Backfeasibility), is feasible and contributes to detectable change in variables related to intervention content.

    METHODS: Thirty patients planned for decompression surgery due to central lumbar spinal stenosis who present with low physical activity, pain catastrophizing or fear of movement, will be included in a randomized feasibility study. All patients will be randomly allocated to either Get Backfeasibility or usual physical therapy. Get Backfeasibility aims to increase the patient's physical activity level by combining a person-centred and cognitive behavioural approach. It comprises 10 video and telephone sessions led by a physical therapist over 12 weeks (pre/postoperatively). Outcomes are treatment fidelity (treatment dose, adherence, and content), process feasibility (recruitment, intervention use, and acceptability of measurements and intervention), and variables related to the intervention content (steps per day, physical activity level, pain catastrophizing, fear of movement, and general self-efficacy). Treatment fidelity and feasibility data will be assessed during the full study period (12 weeks). Physical activity, physical capacity, and patient-reported outcomes will be assessed digitally at baseline (2 weeks preoperatively) and 11-12 weeks postoperatively. Variables related to the intervention content will be monitored weekly through a digital application. Feasibility data will be analysed descriptively and inferentially using a nonparametric approach, data from repeated measures will be displayed graphically and data from telephone interviews will be analysed using content analysis with a descriptive manifest approach.

    DISCUSSION: The results will provide information on whether Get Back in its present format is feasible and can be evaluated for effectiveness in a larger randomized controlled trial, for patients with a low physical activity level and a high fear of movement who are undergoing decompression surgery.

    TRIAL REGISTRATION: Registered at ClinicalTrails.gov 04/08/2023, registration no. NCT05806593.

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  • 33. Leavy, Breiffni
    et al.
    Joseph, Conran
    Löfgren, Niklas
    Johansson, Hanna
    Hagströmer, Maria
    Sophiahemmet Högskola.
    Franzén, Erika
    Outcome evaluation of highly challenging balance training for people with Parkinson disease: A multicenter effectiveness-implementation study2020Ingår i: Journal of Neurologic Physical Therapy, ISSN 1557-0576, E-ISSN 1557-0584, Vol. 44, nr 1, s. 15-22Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND PURPOSE: In order for people with Parkinson disease (PwPD) to benefit from neurorehabilitation research, interventions tested in research settings require assessment in real-world clinical practice. There is little evidence for whether efficacious exercise interventions for PwPD remain effective when transferred to standard clinical settings. The aim of this study was to assess the clinical effectiveness of the adapted HiBalance program on balance control and gait among PwPD.

    METHODS: Participants (n = 117) with mild-moderate Parkinson disease were consecutively included into either the 10-week HiBalance group training (n = 61) or the control (n = 56) group. The main outcome was balance performance (Mini-BESTest). Secondary outcomes were comfortable gait speed (10-m Walk Test); functional mobility (Timed Up and Go [TUG] test) and dual-task interference (cognitive TUG test); physical activity level (steps per day); perceived balance confidence (Activities-specific Balance Confidence scale) and perceived walking difficulty (Walk-12G) and self-rated health (EQ-5D visual analog scale).

    RESULTS: In total, 98 people completed the trial. Compared with controls, the training group showed significant improvement in balance performance (P < 0.001), gait speed (P = 0.001), and dual-task interference (P = 0.04) following the intervention. No group differences were observed for physical activity level or any patient-reported measures.

    DISCUSSION AND CONCLUSIONS: Highly challenging balance training is effective at improving balance, gait, and dual-task performance when delivered at a clinically feasible dose, in a range of rehabilitation settings, without direct involvement of the research group.Video Abstract available for more insights from the authors (see the Video, Supplementary Digital Content 1, available at: http://links.lww.com/JNPT/A299).

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  • 34.
    Lilje, Stina
    et al.
    Sophiahemmet Högskola.
    Eklund, Andreas
    Wykman, Anders
    Sundberg, Tobias
    Sophiahemmet Högskola.
    Skillgate, Eva
    Sophiahemmet Högskola.
    Naprapathy versus orthopaedic standard care for common musculoskeletal disorders: Aan 8-year follow-up of a pragmatic randomized controlled trial in Sweden2021Ingår i: Chiropractic and Manual Therapies, E-ISSN 2045-709X, Vol. 29, nr 1, artikel-id 43Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Musculoskeletal pain is among the most common reasons for seeking care, specialist competence for its treatment in primary care limited and waiting lists for orthopaedics often amongst the longest. Many referrals to orthopaedics do not concern disorders that benefit from surgery. Manual therapy is effective, yet not integrated in national health care systems, and there is a lack of research on other than neck and low back pain, and a lack of long-term follow-ups. The present study evaluates the long-term effects of a manual therapy (naprapathy) for common orthopaedic disorders.

    METHODS: An 8-year follow-up (96 months) of a pragmatic randomized controlled trial of naprapathy (experimental group) versus standard orthopaedic care (control group) for non-surgical patients of working age with the most common musculoskeletal disorders on the waiting lists (n = 78). Bodily pain, physical function (SF36), Quality of life (QoL; SF6D), and data on health care utilization were collected. The treatments lasted from January 2007 to November 2007.

    RESULTS: N = 75 participants in the original study sample completed the 8-year follow-up. The differences in bodily pain (21.7 (95% CI: 9.1-34.3)), physical function (17.6 (6.7-28.4)), and QoLs (0.823 (95% CI: 0.785-0.862) compared with 0.713 (95% CI: 0.668-0.758)) were statistically significantly in favor of the experimental group (p-values < 0.01). After sensitivity analysis the experimental group had altogether 260 health care visits compared with 1161 in the control group.

    CONCLUSIONS: Naprapathy is a continuously effective treatment. Together with earlier research our study suggests that specialized manual therapy should be considered when triaging patients with common non-surgical musculoskeletal disorders in national health care systems.

    TRIAL REGISTRATION: Not applicable, as per information given by ClinicalTrials.gov.

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  • 35. Lluch-Girbés, Enrique
    et al.
    Requejo-Salinas, Néstor
    Fernández-Matías, Rubén
    Revert, Esther
    Vila Mejías, Mar
    Rezende Camargo, Paula
    Jaggi, Anju
    Sciascia, Aaron
    Horsley, Ian
    Pontillo, Marisa
    Gibson, Jo
    Richardson, Ellie
    Johansson, Fredrik
    Sophiahemmet Högskola.
    Maenhout, Annelies
    Oliver, Gretchen D
    Turgut, Elif
    Jayaraman, Chandrasekaran
    Düzgün, Irem
    Borms, Dorien
    Ellenbecker, Todd
    Cools, Ann
    Kinetic chain revisited: Consensus expert opinion on terminology, clinical reasoning, examination and treatment in people with shoulder pain2023Ingår i: Journal of shoulder and elbow surgery, ISSN 1058-2746, E-ISSN 1532-6500, Vol. 32, nr 8, s. e415-e428, artikel-id S1058-2746(23)00082-4Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To determine the most appropriate terminology and issues related to clinical reasoning, examination and treatment of the kinetic chain (KC) in people with shoulder pain by an international experts panel.

    DESIGN: Delphi study METHODS: A three-round Delphi study that involved an international panel of experts with extensive clinical, teaching and research experience in the study topic was conducted. A search equation of terms related to KC in Web of Science and a manual search were used to find the experts. Participants were asked to rate items across five different domains (terminology, clinical reasoning, subjective examination, physical examination and treatment) using a 5-point Likert-type scale. An Aiken's Validity Index ≥ 0.7 was considered indicative of group consensus.

    RESULTS: Participation rate was 30.2% (n=16) while retention rate was high throughout the 3 rounds (100%, 93.8%, 100%). A total of 15 experts from different fields and countries completed the study. After the three rounds, consensus was reached on 102 items: 3 items were included in the "terminology" domain, 17 items in the "rationale and clinical reasoning" domain, 11 items in the "subjective examination" domain, 44 items in the "physical examination" domain and 27 items in the "treatment" domain. "Terminology" was the domain with the highest level of more agreement with two items achieving an Aiken's V of 0.93, whereas "physical examination" and "treatment" of the KC where the two areas with less consensus. Together with "terminology" items, one item from the "treatment" and two items from the "rationale and clinical reasoning" domains reached the highest level of agreement (v=0.93 and 0.92, respectively).

    CONCLUSION: This study defined a list of 102 items across five different domains (terminology, rationale and clinical reasoning, subjective examination, physical examination and treatment) regarding to KC in people with shoulder pain. The term KC was preferred and a definition for this concept agreed. Dysfunction of a segment in the chain (i.e., weak link) was agreed to result in altered performance or injury to distal segments. Experts considered important to assess and treat the KC in particular in throwing/overhead athletes and agreed that no one size fits all approach exist when implementing shoulder KC exercises within the rehabilitation process. Further research is now required to determine the validity of the identified items.

  • 36. Mansell, Gemma
    et al.
    den Hollander, Marlies
    Lotzke, Hanna
    Smeets, Rob J E M
    Lundberg, Mari
    Sophiahemmet Högskola.
    A person-centred prehabilitation program based on cognitive behavioural physical therapy for patients scheduled for lumbar fusion surgery: A mediation analysis to assess fear of movement (kinesiophobia), self-efficacy and catastrophizing as mediators of health outcomes2022Ingår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 26, nr 8, s. 1790-1799Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To investigate whether early changes in fear of movement (kinesiophobia), self-efficacy and catastrophizing were mediators of the relationship between allocation to the pre-habilitation intervention and later changes in health outcomes.

    METHODS: The original pre-habilitation trial (PREPARE, ISRCTN17115599) recruited 118 participants awaiting lumbar fusion surgery, half of whom received a prehabilitation intervention designed based on the modified fear-avoidance model and half of whom received usual care. Mediation analysis was performed to test each mediator separately. Analysis was performed on each outcome of interest separately (Oswestry disability index, patient-specific function, EQ general health and moderate/vigorous physical activity). Mediation analysis was carried out using PROCESS. Beta coefficients and bootstrapped 95% CIs were used to interpret the results.

    RESULTS: None of the potential mediators was found to mediate the relationship between allocation to the intervention and 3-month scores on any of the health outcomes tested.

    CONCLUSIONS: Screening patients for higher levels of catastrophizing and fear avoidance and lower levels of self-efficacy could help ensure only the patients who are most likely to benefit from the intervention are included.

    SIGNIFICANCE: Prehabilitation interventions for spinal fusion surgery have been found to improve health outcomes for patients. Theory-based interventions that target key mechanisms are more effective at improving outcomes than non-theory-based interventions. While no mediating effects were found for this particular intervention, the analysis suggests that the underlying theoretical model and treatment targets are appropriate and could drive improvement if more strongly targeted.

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  • 37. Moksnes, Håvard
    et al.
    Ardern, Clare L
    Sophiahemmet Högskola.
    Kvist, Joanna
    Engebretsen, Lars
    Risberg, May Arna
    Myklebust, Grethe
    Grindem, Hege
    Assessing implementation, limited efficacy, and acceptability of the BEAST tool: A rehabilitation and return-to-sport decision tool for nonprofessional athletes with anterior cruciate ligament reconstruction2021Ingår i: Physical Therapy in Sport, ISSN 1466-853X, E-ISSN 1873-1600, Vol. 52, s. 147-154, artikel-id S1466-853X(21)00144-9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To assess the implementation, limited efficacy, and acceptability of the BEAST (better and safer return to sport) tool - a rehabilitation and return-to-sport (RTS) decision tool after anterior cruciate ligament reconstruction (ACLR) in nonprofessional athletes.

    DESIGN: Prospective cohort.

    PARTICIPANTS: 43 nonprofessional pivoting sport athletes with ACLR.

    MAIN OUTCOME: Clinician- and athlete-experienced implementation challenges (implementation), changes in quadriceps power, side hop and triple hop performance from 6 to 8 months after ACLR (limited efficacy), athletes' beliefs about the individual rehabilitation and RTS plans produced by the BEAST tool (acceptability).

    RESULTS: The BEAST tool was developed and then implemented as planned for 39/43 (91%) athletes. Hop and quadriceps power performance improved significantly, with the largest improvement in involved quadriceps power (standardised response mean 1.4, 95% CI:1.1-1.8). Athletes believed the rehabilitation and RTS plan would facilitate RTS (8.2 [SD: 2.0]) and reduce injury risk (8.3 [SD: 1.2]; 0 = not likely at all, 10 = extremely likely).

    CONCLUSION: The BEAST tool was implemented with few challenges and adjustments were rarely necessary. Athletes had large improvements in quadriceps power and hop performance on the involved leg. Athletes believed that the individual rehabilitation and RTS plans produced by the tool would facilitate RTS and reduce injury risk.

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  • 38. Najafi, Fatemeh
    et al.
    Zare, Zahra
    Javad Mortazavi, Seyed Mohammad
    Lundberg, Mari
    Sophiahemmet Högskola.
    Shahsavari, Hooman
    Overcoming fear of movement resulting from knee replacement; strategies used by patients: An interview study2022Ingår i: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 45, artikel-id 100904Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND AIMS: Fear of movement is among the main concerns of patients following knee replacement surgery and a determining factor in the success of surgery. The strategies adopted by patients to overcome this fear have not yet been identified, but once pin pointed, these strategies can be strengthened and modified through intervention. The aim of the present study was to explore the personal strategies adopted by patients following knee replacement to overcome fear of movement.

    MATERIALS AND METHODS: Interviews were conducted with 15 patients who had undergone knee replacement, selected by purposive sampling. Data were collected through in-depth semi-structured interviews and analyzed using inductive content analysis.

    RESULTS: The patients' strategies as depicted in their narratives were classified into three categories: 1) Movement based on awareness; 2) Movement based on support; and 3) Movement based on hope. These three categories are described in eight subcategories and show what strategies the patients used to overcome their fear of movement.

    CONCLUSION: These findings can help to increase awareness about strategies to overcome fear of movement in patients following knee replacement and to develop and support tailored treatment strategies with the aim of reducing such fear of movement and increasing physical activity among the patients.

  • 39. Nijs, Jo
    et al.
    Kosek, Eva
    Chiarotto, Alessandro
    Cook, Chad
    Danneels, Lieven A
    Fernández-de-Las-Peñas, César
    Hodges, Paul W
    Koes, Bart
    Louw, Adriaan
    Ostelo, Raymond
    Scholten-Peeters, Gwendolyne G M
    Sterling, Michele
    Alkassabi, Othman
    Alsobayel, Hana
    Beales, Darren
    Bilika, Paraskevi
    Clark, Jacqui R
    De Baets, Liesbet
    Demoulin, Christophe
    de Zoete, Rutger M J
    Elma, Ömer
    Gutke, Annelie
    Hanafi, Rikard
    Sophiahemmet Högskola.
    Hotz Boendermaker, Sabina
    Huysmans, Eva
    Kapreli, Eleni
    Lundberg, Mari
    Sophiahemmet Högskola.
    Malfliet, Anneleen
    Meziat Filho, Ney
    Reis, Felipe J J
    Voogt, Lennard
    Zimney, Kory
    Smeets, Rob
    Morlion, Bart
    de Vlam, Kurt
    George, Steven Z
    Nociceptive, neuropathic, or nociplastic low back pain?: The low back pain phenotyping (BACPAP) consortium's international and multidisciplinary consensus recommendations2024Ingår i: The Lancet. Rheumatology, ISSN 2665-9913, Vol. 6, nr 3, s. e178-e188Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The potential to classify low back pain as being characterised by dominant nociceptive, neuropathic, or nociplastic mechanisms is a clinically relevant issue. Preliminary evidence suggests that these low back pain phenotypes might respond differently to treatments; however, more research must be done before making specific recommendations. Accordingly, the low back pain phenotyping (BACPAP) consortium was established as a group of 36 clinicians and researchers from 13 countries (five continents) and 29 institutions, to apply a modified Nominal Group Technique methodology to develop international and multidisciplinary consensus recommendations to provide guidance for identifying the dominant pain phenotype in patients with low back pain, and potentially adapt pain management strategies. The BACPAP consortium's recommendations are also intended to provide direction for future clinical research by building on the established clinical criteria for neuropathic and nociplastic pain. The BACPAP consortium's consensus recommendations are a necessary early step in the process to determine if personalised pain medicine based on pain phenotypes is feasible for low back pain management. Therefore, these recommendations are not ready to be implemented in clinical practice until additional evidence is generated that is specific to these low back pain phenotypes.

  • 40.
    Onell, Clara
    et al.
    Sophiahemmet Högskola.
    Skillgate, Eva
    Sophiahemmet Högskola.
    Melin, Anna
    Källberg, Henrik
    Waldén, Markus
    Edlund, Klara
    Sophiahemmet Högskola.
    Hägglund, Martin
    Côté, Pierre
    Asker, Martin
    Sophiahemmet Högskola.
    Dietary habits in adolescent male and female handball players: The Swedish Handball Cohort2023Konferensbidrag (Övrigt vetenskapligt)
  • 41.
    Onell, Clara
    et al.
    Sophiahemmet Högskola.
    Skillgate, Eva
    Sophiahemmet Högskola.
    Melin, Anna
    Källberg, Henrik
    Waldén, Markus
    Edlund, Klara
    Sophiahemmet Högskola.
    Hägglund, Martin
    Côté, Pierre
    Asker, Martin
    Sophiahemmet Högskola.
    Matvanor inom svensk ungdomshandboll2023Konferensbidrag (Övrigt vetenskapligt)
  • 42. Rasmussen-Barr, E
    et al.
    Nordin, M
    Skillgate, Eva
    Sophiahemmet Högskola.
    Are respiratory disorders risk factors for troublesome neck/shoulder pain?: A study of a general population cohort in Sweden2023Ingår i: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 32, nr 2, s. 659-666Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: The etiology of neck/shoulder pain is complex. Our purpose was to investigate if respiratory disorders are risk factors for troublesome neck/shoulder pain in people with no or occasional neck/shoulder pain.

    METHODS: This prospective cohort study was based on the Stockholm Public Health Cohorts (SPHC) 2006/2010 and the SPHC 2010/2014. We included adults who at baseline reported no or occasional neck/shoulder pain in the last six months, from the two subsamples (SPHC 06/10 n = 15 155: and SPHC 2010/14 n = 25 273). Exposures were self-reported asthma at baseline in SPHC 06/10 and Chronic Obstructive Pulmonary Disease (COPD) at baseline in SPHC 10/14. The outcome was having experienced at least one period of troublesome neck/shoulder pain which restricted work capacity or hindered daily activities to some or to a high degree during the past six months, asked for four years later. Binomial regression analyses were used to calculate risk ratios (RR) with 95% confidence intervals (95% CI).

    RESULTS: Adjusted results indicate that those reporting to suffer from asthma at baseline had a higher risk of troublesome neck/shoulder pain at follow-up four years later (RR 1.48, 95% CI 1.10-2.01) as did those reporting to suffer from COPD (RR 2.12 95%CI 1.54-2.93).

    CONCLUSION: Our findings indicate that those with no or occasional neck/shoulder pain and reporting to suffer from asthma or COPD increase the risk for troublesome neck/shoulder pain over time. This highlights the importance of taking a multi-morbidity perspective into consideration in health care. Future longitudinal studies are needed to confirm our findings.

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  • 43. Richter, Martinus
    et al.
    Ågren, Per-Henrik
    Sophiahemmet Högskola.
    Besse, Jdan-Luc
    Coester, Maria
    Kofoed, Hakon
    Maffulli, Nicola
    Steultjens, Martijn
    Côrte-Real, Nuno
    Dias, Rafael
    EFAS Score: Validation of portuguese version by the score committee of the European Foot and Ankle Society (EFAS)2022Ingår i: Foot and Ankle Surgery, ISSN 1268-7731, E-ISSN 1460-9584, Vol. 28, nr 6, s. 709-713, artikel-id S1268-7731(22)00107-2Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The Score Committee of the European Foot and Ankle Society (EFAS) developed, validated, and published the EFAS Score in ten languages (English, German, French, Italian, Polish, Dutch, Swedish, Finnish, Turkish, Portuguese). From other languages under validation, the Portuguese version completed data acquisition and underwent further validation.

    METHODS: The Portuguese version of the EFAS Score was developed and validated in three stages: 1) item (question) identification (completed during initial validation study), 2) item reduction and scale exploration (completed during initial validation study), 3) confirmatory analyses and responsiveness of Portuguese version (completed during initial validation study in nine other languages). The data were collected pre-operatively and post-operatively at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using classical test theory and item response theory.

    RESULTS: The internal consistency was confirmed in the Portuguese version (Cronbach's Alpha 0.84). The Standard Error of Measurement (SEM) was 0.27 and is similar to other language versions. Between baseline and follow-up, 69.4% of patients showed an improvement on their EFAS score, with adequate responsiveness (effect size 0.64).

    CONCLUSIONS: The Portuguese EFAS Score version was successfully validated in patients with a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.net.

  • 44. Richter, Martinus
    et al.
    Ågren, Per-Henrik
    Sophiahemmet Högskola.
    Besse, Jean-Luc
    Coster, Maria
    Kofoed, Hakon
    Maffulli, Nicola
    Steultjens, Martijn
    Alvarez, Fernando
    Espinal, Laia
    Metsna, Vahur
    Raukas, Marju
    EFAS Score-Validation of Spanish and Estonian Versions by the score committee of the European Foot and Ankle Society (EFAS)2023Ingår i: Foot and Ankle Surgery, ISSN 1268-7731, E-ISSN 1460-9584, Vol. 29, nr 3, s. 180-187, artikel-id S1268-7731(23)00039-5Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The Score Committee of the European Foot and Ankle Society (EFAS) developed, validated, and published the EFAS Score in 11 languages (Dutch, English, German, Finnish, French, Italian, Polish, Portuguese, Persian, Swedish, Turkish). From other languages under validation, the Spanish and Estonian versions completed data acquisition and underwent further validation.

    METHODS: The EFAS Score was developed and validated in three stages: 1) item (question) identification (completed during the initial validation study), 2) item reduction and scale exploration (completed during the initial validation study), 3) confirmatory analyses and responsiveness of the Spanish and Estonian versions (completed during the initial validation study in seven other languages). The data were collected pre-operatively and post-operatively at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using classical test theory and item response theory.

    RESULTS: The internal consistency of the scale was confirmed in the Spanish and Estonian versions (Cronbach's Alpha>0.8). Responsiveness was good, with moderate to large effect sizes in both languages, and evidence of a statistically significant positive association between the EFAS Score and patient-reported improvement.

    CONCLUSIONS: The Spanish and Estonian EFAS Score versions were successfully validated in orthopaedic ankle and foot surgery patients, with a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.net.

  • 45. Rosvall, Felicia
    et al.
    Jedeskog, Ulrika
    Andersson, Jonny K
    Söderberg, Thor
    Hagert, Elisabet
    Sophiahemmet Högskola.
    Intrarater reliability test of the ISOmetric power device: A new instrument for assessment of isometric force in six directions of wrist motion2020Ingår i: Journal of Hand Therapy, ISSN 0894-1130, E-ISSN 1545-004X, artikel-id S0894-1130(20)30012-0Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    STUDY DESIGN: Descriptive reliability study.

    INTRODUCTION: A well-functioning wrist requires sufficient range of motion accompanied by adequate strength in every movement and direction-factors that are not regularly measured simultaneously in patients with wrist problems today. The ISOmetric Power device (ISOP) is a new instrument that measures isometric wrist force in all six directions of motion, but its intrarater reliability in a healthy population has not yet been evaluated.

    PURPOSE OF THE STUDY: The purpose of this study was to perform an intrarater reliability test of the ISOP in healthy participants.

    METHODS: Thirty-two healthy study participants (16 women/16 men; mean age 38.3 years; SD 6.5) were included. With a standardized testing protocol, the three planes of wrist motion- wrist flexion/extension, radial/ulnar deviation, pro/supination-were measured at one time interval (T1) and repeated after one week (T2). The results were analyzed using the intraclass correlation coefficient (ICC). A paired-samples t-test was also performed to determine if a statistically significant difference (P < .05) existed between the first and the second test values. Measurements with Jamar Dynamometer were performed at both time intervals, for internal control of measurement intrarater reliability.

    RESULTS: Excellent correlations (ICC: 0.90-0.99) were found for all test-retests performed. The lowest value (ICC: 0.90) was seen for supination and the highest value (ICC: 0.99) for flexion of the left hand. No statistically significant differences were found in any of the pairs (P > .05) in terms of test-re-test, which additionally strengthen the correlation between the first and second test values.

    DISCUSSION: Contrary to the Jamar Dynamometer, the ISOP is not designed for measuring grip strength, but for assessing the isometric muscle force in flexion, extension, pronation, supination, and radial and ulnar deviation. A systematic review has reported a moderate to strong correlation between isometric strength and dynamic performances. Thus, the ISOP is a more complete and applicable instrument for evaluating the functional strength in different directions in the upper extremity.

    CONCLUSIONS: The ISOmetric Power device shows excellent intrarater reliability and is proposed to be a possible valuable wrist strength assessment tool to aid in both diagnostics and outcome measures of wrist and upper extremity disorders.

  • 46. Schubert-Hjalmarsson, Elke
    et al.
    Fasth, Anders
    Ickmans, Kelly
    Mårdbrink, Eva-Lott
    Söderpalm, Ann-Charlott
    Lundberg, Mari
    Sophiahemmet Högskola.
    Central sensitization in adolescents with hypermobility spectrum disorder or hypermobile Ehlers-Danlos syndrome: A feasibility study2023Ingår i: Pilot and Feasibility Studies, ISSN 2055-5784, Vol. 9, nr 1, artikel-id 97Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Pain is a major symptom in adolescents with hypermobility spectrum disorder or hypermobile Ehlers-Danlos syndrome. Although the underlying mechanism causing generalized pain in children with hypermobility spectrum disorder or hypermobile Ehlers-Danlos syndrome is unclear, central sensitization has been suggested as a possible explanation. The aim of this study was to explore the feasibility of a study protocol for a future case-control study, investigating features of central sensitization in adolescents with hypermobility spectrum disorder or hypermobile Ehlers-Danlos syndrome.

    METHODS: Central sensitization features were measured in ten patients and nine healthy controls aged 13-17 years via experimental pain measurement quantifying primary and secondary hyperalgesia, endogenous pain modulation, and exercise-induced hyperalgesia. Descriptive statistics were used. Frequency, median, and range values were calculated.

    RESULTS: Eleven out of 57 patients chose to participate. No control could be recruited through public schools. Therefore, a convenience sampling strategy was used for the recruitment of the control group. The process of assessing primary and secondary hyperalgesia, endogenous pain modulation, and exercise-induced hyperalgesia was well tolerated by all participants (patients and controls). When assessing endogenous pain modulation via conditioned pain modulation, two participants in the patient group and three in the control group did not achieve a pain experience ≥ 3 on the numerical rating scale when immersing their hands in cold water.

    CONCLUSION: This study investigated the feasibility, safety, and toleration of experimental pain measurements in adolescents with hypermobility spectrum disorder or hypermobile Ehlers-Danlos syndrome. Although the test protocol proved to be sufficiently feasible for use with the participant group, it will need to be adapted in the main study in order to obtain more reliable data. Recruitment, especially of participants for the control group, can be a major obstacle for future studies and requires careful planning.

    TRIAL REGISTRATION: Researchweb.org, 270,501. Registered on 9 May 2019.

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  • 47. Schwank, Ariane
    et al.
    Blazey, Paul
    Asker, Martin
    Sophiahemmet Högskola.
    Møller, Merete
    Hägglund, Martin
    Gard, Suzanne
    Skazalski, Christopher
    Haugsbø Andersson, Stig
    Horsley, Ian
    Whiteley, Rod
    Cools, Ann M
    Bizzini, Mario
    Ardern, Clare L
    2022 Bern Consensus Statement on shoulder injury prevention, rehabilitation, and return to sport for athletes at all participation levels2022Ingår i: Journal of Orthopaedic and Sports Physical Therapy, ISSN 0190-6011, E-ISSN 1938-1344, Vol. 52, nr 1, s. 11-28Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    SYNOPSIS: There is an absence of high-quality evidence to support rehabilitation and return-to-sport decisions following shoulder injuries in athletes. The Athlete Shoulder Consensus Group was convened to lead a consensus process that aimed to produce best-practice guidance for clinicians, athletes, and coaches for managing shoulder injuries in sport. We developed the consensus via a 2-round Delphi process (involving more than 40 content and methods experts) and an in-person meeting. This consensus statement provides guidance with respect to load and risk management, supporting athlete shoulder rehabilitation, and decision making during the return-to-sport process. This statement is designed to offer clinicians the flexibility to apply principle-based approaches to managing the return-to-sport process within a variety of sporting backgrounds. The principles and consensus of experts working across multiple sports may provide a template for developing additional sport-specific guidance in the future. J Orthop Sports Phys Ther 2022;52(1):11-28. doi:10.2519/jospt.2022.10952.

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  • 48. Skavberg Roaldsen, Kirsti
    et al.
    Lindholm, Christina
    Sophiahemmet Högskola.
    Fysisk aktivitet och träning vid venös och arteriell insufficiens och bensår2012Ingår i: Äldres hälsa: ett sjukgymnastiskt perspektiv / [ed] Elisabeth Rydwik, Lund: Studentlitteratur, 2012, 1, s. 259-270Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 49. Smedbråten, Kaja
    et al.
    Grotle, Margreth
    Jahre, Henriette
    Richardsen, Kåre Rønn
    Småstuen, Milada Cvancarova
    Skillgate, Eva
    Sophiahemmet Högskola.
    Øiestad, Britt Elin
    Lifestyle behaviour in adolescence and musculoskeletal pain 11 years later: The Trøndelag Health Study2022Ingår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 26, nr 9, s. 1910-1922Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There is limited knowledge on the association between lifestyle behaviour in adolescence and musculoskeletal pain in young adulthood. This study aimed to investigate whether an accumulation of adverse lifestyle behaviours in adolescents with and without musculoskeletal pain at baseline, was associated with persistent musculoskeletal pain (pain duration ≥3 consecutive months the last year) 11 years later.

    METHODS: Longitudinal data from the Trøndelag Health Study in Norway including 1824 adolescents (13-19 years old) was analysed. The outcome was persistent musculoskeletal pain (≥3 months). The number of adverse lifestyle behaviours (low physical activity level, sleep problems, insufficient fruit/vegetables consumption, smoking, frequent alcohol intoxication [drunkenness] and/or illicit drug use) were summed up to comprise an ordinal variable and analysed with 0 or 1 adverse behaviours as the reference. Multiple logistic regression analyses, stratified by individuals with and without baseline musculoskeletal pain, were conducted. The results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs).

    RESULTS: In adolescents with musculoskeletal pain at baseline, reporting ≥ four adverse lifestyle behaviours increased the odds of persistent musculoskeletal pain (OR 2.23, 95% CI 1.36, 3.66) 11 years later. Two and three adverse behaviours were not associated with future persistent musculoskeletal pain. In adolescents without musculoskeletal pain at baseline, an accumulation of adverse lifestyle behaviours was not associated with future persistent musculoskeletal pain.

    CONCLUSION: An accumulation of adverse lifestyle behaviours in adolescents with musculoskeletal pain at baseline was associated with persistent musculoskeletal pain 11 years later, but not in adolescents without musculoskeletal pain at baseline.

    SIGNIFICANCE: An accumulation of four or more adverse lifestyle behaviours in adolescents with musculoskeletal pain was associated with persistent musculoskeletal pain in young adulthood. In future health care of adolescents with musculoskeletal pain, lifestyle behaviours should be assessed, with emphasis on accumulation of multiple adverse lifestyle behaviours. Focusing on an accumulation of multiple adverse lifestyle behaviours, rather than each individual behaviour, might provide a potential area for future research and interventions targeting musculoskeletal pain in youth.

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  • 50. Smitheman, Hayley Powell
    et al.
    Lundberg, Mari
    Sophiahemmet Högskola.
    Härnesand, Malin
    Gelfgren, Sara
    Grävare Silbernagel, Karin
    Putting the fear-avoidance model into practice: What can patients with chronic low back pain learn from patients with Achilles tendinopathy and vice versa?2023Ingår i: Revista Brasileira de Fisioterapia, ISSN 1413-3555, E-ISSN 1809-9246, Vol. 27, nr 5, artikel-id 100557Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Fear-avoidance variables are present in patients with musculoskeletal pain conditions, such as chronic low back pain (CLBP) and Achilles tendinopathy (AT) and can lead to reduced function and recovery. It is unknown how these variables relate in populations with different etiologies but similar pain provocation mechanisms.

    OBJECTIVE: To compare kinesiophobia, pain catastrophizing, and disability between these two groups.

    METHODS: Patients with CLBP and those with AT were included. Tampa Scale of Kinesiophobia (TSK-17) and Pain Catastrophizing Scale (PCS-13) were evaluated in both groups. The CLBP group completed the Oswestry Disability Index (ODI) and the AT group completed the PROMIS-29 questionnaire. Gait speed was calculated for each group. Disability outcomes were normalized between groups.

    RESULTS: 119 patients in the CLBP group (64 female, 46 ± 8 years) and 83 patients in the AT group (42 female, 48 ± 12 years) were included. Both groups (CLBP, AT) presented with high prevalence of kinesiophobia (67%, 55%) but the CLBP group presented with higher prevalence of pain catastrophizing (22%, 2%). The CLBP group demonstrated higher levels of disability via normalized ODI (MD= 12.4, 95% CI: 9.2, 15.5) but the AT group demonstrated slower gait speed (MD= 0.1 m/s, 95% CI: 0.0, 0.2).

    CONCLUSION: Similarly high prevalence of kinesiophobia was found in patients with CLBP and patients with AT. While the CLBP group reported greater prevalence of catastrophizing thoughts and greater disability, the AT group had slower gait speed. Overall, these findings demonstrate that CLBP and AT have similarities that may allow clinicians to learn from one to inform treatment of the other.

    CLINICAL TRIAL REGISTRATION NUMBERS: NCT03523325, ISRCTN17115599.

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