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  • 1. Alvarez, Gerard
    et al.
    Justribo, Cristian
    Sundberg, Tobias
    Sophiahemmet University.
    Thomson, Oliver P
    Leach, Matthew J
    A national cross-sectional survey of the attitudes, skills and use of evidence-based practice amongst Spanish osteopaths2021In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 21, no 1, article id 130Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although evidence-based practice (EBP) is largely supported across healthcare professions, its implementation in manual therapy professions such as osteopathy remains limited and debated. There is currently little knowledge of how Spanish osteopaths relate to EBP.

    OBJECTIVES: The main aim of this study was to investigate the attitudes, skills and use of EBP among Spanish osteopaths. A secondary aim was to identify barriers and facilitators for the adoption of EBP in the Spanish osteopathic context.

    METHODS: National cross-sectional survey of Spanish osteopaths registered and non-registered to an osteopathic association in Spain. Eligible participants were invited by a range of recruitment strategies including email and social media campaigns to complete the Spanish-translated Evidence-Based practice Attitude and utilization Survey (EBASE) anonymously online.

    RESULTS: A total of 567 osteopaths completed the survey which represents an approximate response rate of 9%. Participant's attitudes toward EBP were largely positive. Most respondents agreed or strongly agreed that EBP was necessary in the practice of osteopathy (89.6%) and that professional literature and research findings were useful to their day-to-day practice (88.9%). Levels of perceived skill in EBP were reported as low to moderate with lowest levels for items related to 'research conduct'. Except reading/reviewing professional literature and using online search engines to find practice-related literature, participant engagement in all other EBP-related activities was generally infrequent. The perceived proportion of clinical practice that was based on clinical research evidence was reported to be very small. Main barriers to EBP uptake included a lack of clinical evidence in osteopathy and insufficient skills for applying research findings. Main facilitators of EBP uptake included access to full-text articles, internet at the workplace and online databases.

    CONCLUSIONS: Spanish osteopaths were largely supportive of evidence-based practice, had low to moderate skills in EBP and engaged in EBP activities infrequently. Formal regulation of the profession in Spain and the inclusion of osteopathic programs into the university sector would potentially improve EBP skills and use.

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  • 2. Cerritelli, Francesco
    et al.
    Iacopini, Alessio
    Galli, Matteo
    Thomson, Oliver P
    Sundberg, Tobias
    Sophiahemmet University.
    Leach, Matthew J
    Adams, Jon
    Evidence-based practice among Italian osteopaths: A national cross-sectional survey2021In: BMC Complementary Medicine and Therapies, ISSN 2662-7671, Vol. 21, no 1, article id 252Article in journal (Refereed)
    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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  • 3.
    Edlund, Klara
    et al.
    Sophiahemmet University.
    Johansson, Fred
    Sophiahemmet University.
    Lindroth, Rebecca
    Bergman, Louise
    Sundberg, Tobias
    Sophiahemmet University.
    Skillgate, Eva
    Sophiahemmet University.
    Body image and compulsive exercise: Are there associations with depression among university students?2022In: Eating and Weight Disorders, ISSN 1124-4909, E-ISSN 1590-1262, Vol. 27, no 7, p. 2397-2405Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Mental health problems among university students have been reported to be significantly increasing and suggested to be associated with college drop-out. Body dissatisfaction and compulsive exercise are both constructs relevant for mental health problems in general and eating disorders in particular. This study examined associations between body dissatisfaction, compulsive exercise and self-reported symptoms of depression among Swedish university students.

    METHODS: Participants (n = 4262) are students in an ongoing cohort study, and data from the baseline assessment were used. Four linear regression models were built to explore the associations between body dissatisfaction, compulsive weight control exercise and depressive symptoms.

    RESULTS: Our findings showed that females reported higher levels of body dissatisfaction than males. Body dissatisfaction and compulsive exercise were associated with self-reported symptoms of depression in this non-clinical population. Results showed that compulsive exercise was negatively associated with reported symptoms of depression, while body dissatisfaction was positively associated with symptoms of depression.

    CONCLUSION: In line with previous research, there was a gender difference in body dissatisfaction where females displayed higher levels of dissatisfaction than males.  Body dissatisfaction was  positively associated with reported symptoms of depression, suggesting support of previous research indicating body dissatisfaction to increase mental health problems. Compulsive exercise was negatively associated with symptoms of depression suggesting a behavior negatively reinforced, supporting both constructs to be of interest for reported symptoms of depression in a non-clinical population of Swedish university students.

    LEVEL OF EVIDENCE: III, cohort study.

    TRIAL REGISTRATION: http://clinicaltrials.gov/ID : NCT04465435.

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  • 4.
    Edlund, Klara
    et al.
    Sophiahemmet University.
    Sundberg, Tobias
    Sophiahemmet University.
    Johansson, Fred
    Sophiahemmet University.
    Onell, Clara
    Sophiahemmet University.
    Rudman, Ann
    Holm, Lena W
    Sophiahemmet University.
    Grotle, Margreth
    Jensen, Irene
    Côté, Pierre
    Skillgate, Eva
    Sophiahemmet University.
    Sustainable UNiversity Life (SUN) study: Protocol for a prospective cohort study of modifiable risk and prognostic factors for mental health problems and musculoskeletal pain among university students2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 4, article id e056489Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Mental health problems and musculoskeletal pain are common health problems among young adults including students. Little is known about the aetiology and prognosis of these problems in university students. We aim to determine the role of personal, sociodemographic, academic and environmental factors for risk and prognosis of symptoms of depression, anxiety and stress as well as musculoskeletal pain in university students. The constructs that will be studied are based on the biopsychosocial model and psychopathology associated with disabling pain. This model acknowledges illness to consist of interrelated mechanisms categorised into biological, psychological, environmental and social cues.

    METHODS AND ANALYSIS: This cohort study aims to recruit around 5000 Swedish full-time students. Data will be collected using five online surveys during one academic year. A subgroup (n=1851) of the cohort, recruited before the COVID-19 pandemic, receive weekly text messages with three short questions assessing mood, worry and pain, sent through the web-based platform SMS-track . Statistical analyses will include Kaplan-Meier estimates, Cox regression analyses, multinomial logistic regression analyses and generalised estimating equations. We will assess effect measure modification when relevant and conduct sensitivity analyses to assess the impact of lost to follow-up.

    PROTOCOL AMENDMENTS: Due to opportunity and timing of the study, with relevance to the outbreak of the COVID-19 pandemic, this study further aims to address mental health problems, musculoskeletal pain and lifestyle in university students before and during the pandemic.

    ETHICS AND DISSEMINATION: The Sustainable UNiversity Life study was approved by the Swedish ethics authority (2019-03276; 2020-01449). Results will be disseminated through peer-reviewed research papers, reports, research conferences, student theses and stakeholder communications.

    TRIAL REGISTRATION NUMBER: NCT04465435.

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  • 5.
    Johansson, Fred
    et al.
    Sophiahemmet University.
    Côté, Pierre
    Hogg-Johnson, Sheilah
    Rudman, Ann
    Holm, Lena W
    Grotle, Margreth
    Jensen, Irene
    Sundberg, Tobias
    Sophiahemmet University.
    Edlund, Klara
    Sophiahemmet University.
    Skillgate, Eva
    Sophiahemmet University.
    Depression, anxiety and stress among Swedish university students before and during six months of the COVID-19 pandemic: A cohort study2021In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 49, no 7, p. 741-749, article id 14034948211015814Article in journal (Refereed)
    Abstract [en]

    AIMS: The COVID-19 pandemic has had a profound effect on societies and citizens worldwide, raising concerns about potential mental health impacts. We aimed to describe trajectories of depression, anxiety and stress symptoms during the COVID-19 outbreak compared to before the outbreak, and to determine if trajectories were modified by pre-pandemic loneliness, poor sleep quality and mental health problems.

    METHODS: We conducted a cohort study with 1836 Swedish university students entering the study before 13 March 2020, the onset of the pandemic, with follow-ups within three (FU1) and six months (FU2) of the outbreak. Generalized Estimating Equations were used to estimate mean differences in symptom levels over time-periods, and to estimate potential effect modifications.

    RESULTS: We found small differences in mean levels of the depression, anxiety and stress scale (DASS-21) over time. Compared to before the pandemic, depression increased by 0.25 points of 21 (95% CI: 0.04 to -0.45) at FU1 and decreased by 0.75/21 (95% CI:-0.97 to -0.53) at FU2. Anxiety decreased from baseline to FU1 by 0.09/21 (95% CI: -0.24 to -0.07) and by 0.77/21 (95% CI: -0.93 to -0.61) to FU2. Stress decreased from baseline to FU1 by 0.30/21 (95% CI: -0.52 to -0.09) and by 1.32/21 (95% CI: -1.55 to -1.09) to FU2. Students with pre-pandemic loneliness, poor sleep quality or pre-pandemic mental health problems did not have worse trajectories of mean mental health symptoms.

    CONCLUSIONS: Symptom levels were relatively stable during the first three months of the pandemic, while there was a slight decrease during the summer months, probably due to seasonality effects.

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  • 6.
    Johansson, Fred
    et al.
    Sophiahemmet University.
    Côté, Pierre
    Onell, Clara
    Sophiahemmet University.
    Källberg, Henrik
    Sophiahemmet University.
    Sundberg, Tobias
    Sophiahemmet University.
    Edlund, Klara
    Sophiahemmet University.
    Skillgate, Eva
    Sophiahemmet University.
    Strengths of associations between depressive symptoms and loneliness, perfectionistic concerns, risky alcohol use and physical activity across levels of sleep quality in Swedish university students: A cross-sectional study2023In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 32, no 2, article id e13745Article in journal (Refereed)
    Abstract [en]

    Previous research shows that sleep quality may interact with some other predictors of depression, such that poor sleep could strengthen the association between these factors and depression. We aimed to determine the presence of statistical interactions between sleep quality and loneliness, risky alcohol use, perfectionistic concerns and/or physical inactivity in relation to depressive symptoms. Further, we aimed to describe the functional form of the statistical interactions and associations. We used a cross-sectional design and included 4262 Swedish university students. All measures were self-reported, sleep quality was measured with the Pittsburgh Sleep Quality Index, and depressive symptoms with the short-form Depression, Anxiety and Stress Scale. Regression models of increasing complexity (linear and non-linear, with and without interactions) were compared to determine the presence of associations and statistical interactions, and to explore the best functional form for these associations and interactions. Out-of-sample R2 from repeated cross-validation was used to select the final models. We found that sleep quality was associated with depressive symptoms in all final models. Sleep quality showed a linear interaction with perfectionistic concerns in relation to depressive symptoms, such that perfectionistic concerns were more strongly associated with depressive symptoms when sleep quality was poor. Loneliness, risky alcohol use and physical inactivity were non-linearly associated with depressive symptoms but did not interact with sleep quality. We concluded that out of the four examined variables, only perfectionistic concerns interacted with sleep quality in relation to depressive symptoms. This interaction was weak and explained little of the overall variance in depressive symptoms.

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  • 7.
    Johansson, Fred
    et al.
    Sophiahemmet University.
    Edlund, Klara
    Sophiahemmet University.
    Sundgot-Borgen, J
    Björklund, C
    Côté, P
    Onell, Clara
    Sophiahemmet University.
    Sundberg, Tobias
    Sophiahemmet University.
    Skillgate, Eva
    Sophiahemmet University.
    Sexual harassment, sexual violence and subsequent depression and anxiety symptoms among Swedish university students: A cohort studyManuscript (preprint) (Other academic)
  • 8.
    Johansson, Fred
    et al.
    Sophiahemmet University.
    Rozental, Alexander
    Edlund, Klara
    Sophiahemmet University.
    Côté, Pierre
    Sundberg, Tobias
    Sophiahemmet University.
    Onell, Clara
    Sophiahemmet University.
    Rudman, Ann
    Skillgate, Eva
    Sophiahemmet University.
    Associations between procrastination and subsequent health outcomes among university students in Sweden2023In: JAMA Network Open, E-ISSN 2574-3805, Vol. 6, no 1, p. e2249346-, article id e2249346Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE: Procrastination is prevalent among university students and is hypothesized to lead to adverse health outcomes. Previous cross-sectional research suggests that procrastination is associated with mental and physical health outcomes, but longitudinal evidence is currently scarce.

    OBJECTIVE: To evaluate the association between procrastination and subsequent health outcomes among university students in Sweden.

    DESIGN, SETTING, AND PARTICIPANTS: This cohort study was based on the Sustainable University Life study, conducted between August 19, 2019, and December 15, 2021, in which university students recruited from 8 universities in the greater Stockholm area and Örebro were followed up at 5 time points over 1 year. The present study used data on 3525 students from 3 time points to assess whether procrastination was associated with worse health outcomes 9 months later.

    EXPOSURE: Self-reported procrastination, measured using 5 items from the Swedish version of the Pure Procrastination Scale rated on a Likert scale from 1 ("very rarely or does not represent me") to 5 ("very often or always represents me") and summed to give a total procrastination score ranging from 5 to 25.

    MAIN OUTCOMES AND MEASURES: Sixteen self-reported health outcomes were assessed at the 9-month follow-up. These included mental health problems (symptoms of depression, anxiety, and stress), disabling pain (neck and/or upper back, lower back, upper extremities, and lower extremities), unhealthy lifestyle behaviors (poor sleep quality, physical inactivity, tobacco use, cannabis use, alcohol use, and breakfast skipping), psychosocial health factors (loneliness and economic difficulties), and general health.

    RESULTS: The study included 3525 participants (2229 women [63%]; mean [SD] age, 24.8 [6.2] years), with a follow-up rate of 73% (n = 2587) 9 months later. The mean (SD) procrastination score at baseline was 12.9 (5.4). An increase of 1 SD in procrastination was associated with higher mean symptom levels of depression (β, 0.13; 95% CI, 0.09-0.17), anxiety (β, 0.08; 95% CI, 0.04-0.12), and stress (β, 0.11; 95% CI, 0.08-0.15), and having disabling pain in the upper extremities (risk ratio [RR], 1.27; 95% CI, 1.14-1.42), poor sleep quality (RR, 1.09, 95% CI, 1.05-1.14), physical inactivity (RR, 1.07; 95% CI, 1.04-1.11), loneliness (RR, 1.07; 95% CI, 1.02-1.12), and economic difficulties (RR, 1.15, 95% CI, 1.02-1.30) at the 9-month follow-up, after controlling for a large set of potential confounders.

    CONCLUSIONS AND RELEVANCE: This cohort study of Swedish university students suggests that procrastination is associated with subsequent mental health problems, disabling pain, unhealthy lifestyle behaviors, and worse psychosocial health factors. Considering that procrastination is prevalent among university students, these findings may be of importance to enhance the understanding of students' health.

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  • 9.
    Larsson, Kristina
    et al.
    Sophiahemmet University.
    Onell, Clara
    Sophiahemmet University.
    Edlund, Klara
    Sophiahemmet University.
    Källberg, Henrik
    Sophiahemmet University.
    Holm, Lena W
    Sundberg, Tobias
    Sophiahemmet University.
    Skillgate, Eva
    Sophiahemmet University.
    Lifestyle behaviors in Swedish university students before and during the first six months of the COVID-19 pandemic: A cohort study2022In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, no 1, article id 1207Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Changes in Swedish university students' lifestyle behaviors during the COVID-19 pandemic are unknown. This study aimed to assess physical activity, sitting time, meal frequency and risk substance use (alcohol, tobacco, and illicit use of drugs) in Swedish university students before and during the first six months of the COVID-19 pandemic, for all and stratified by age and sex.

    METHODS: Data were obtained from the Sustainable University Life cohort study in which web-based surveys were sent to university students repeatedly for one year. Baseline assessment (before the pandemic) was between August 2019-March 2020, follow-up 1 (FU1) between March-June 2020, and follow-up 2 (FU2) between June-September 2020. Participants reported weekly minutes of physical activity, daily sitting hours, meal frequency by weekly intake of different meals, and motivation for eating irregularly, if so. Also, harmful use of alcohol, tobacco and illicit drugs was assessed. Population means and differences with 95% confidence intervals (95% CI) in lifestyle behaviors between time points were calculated with Generalized Estimating Equations.

    RESULTS: 1877 students (73% women, mean age 26.5 years) answered the baseline survey. Weekly exercise decreased by -5.7 min (95% CI: -10.0, -1.5) and -7.7 min (95% CI: -12.6, -2.8) between baseline and FU1 and FU2, respectively. Weekly daily activities increased by 5.6 min (95% CI: 0.3, 11.7) and 14.2 min (95% CI: 7.9, 20.5) between baseline and FU1 and FU2. Daily sitting time decreased by -1.4 h (95% CI: -1.7, -1.2) between baseline and FU2. Breakfast intake increased by 0.2 days per week (95% CI: 0.1, 0.3) between baseline and FU2. Lunch intake decreased by -0.2 days per week (95% CI: -0.2, -0.1) between baseline and FU1 and by -0.2 days per week (95% CI: -0.3, -0.0) between baseline and FU2. Dinner intake decreased by -0.1 days per week (95% CI: -0.2, -0.0) between baseline and both FU1 and FU2. Only minor differences in risk substance use were observed. Similar changes were observed in analyses stratified by age and sex.

    CONCLUSIONS: Lifestyle behaviors in Swedish university students slightly improved during the first six months of the COVID-19 pandemic compared to before.

    TRIAL REGISTRATION: ClinicalTrials.gov, NCT04465435 . 10/07/2020.

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  • 10. Leach, Matthew J
    et al.
    Palmgren, Per J
    Thomson, Oliver P
    Fryer, Gary
    Eklund, Andreas
    Lilje, Stina
    Sophiahemmet University.
    Adams, Jon
    Skillgate, Eva
    Sophiahemmet University.
    Sundberg, Tobias
    Sophiahemmet University.
    Skills, attitudes and uptake of evidence-based practice: A cross-sectional study of chiropractors in the Swedish Chiropractic Association2021In: Chiropractic and Manual Therapies, E-ISSN 2045-709X, Vol. 29, no 1, article id 2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Evidence-based practice (EBP) is integral to the delivery of high-quality health care. Chiropractic has been a licensed health profession in Sweden since 1989, but little is known of the uptake of EBP in this professional group. This study explored the self-reported skills, attitudes and uptake of EBP, and the enablers and barriers of EBP uptake, among licensed chiropractors in Sweden.

    METHODS: Licensed chiropractors (n = 172) of the Swedish Chiropractic Association (Legitimerade Kiropraktorers Riksorganisation) were invited to participate in an anonymous online questionnaire, using the Evidence-Based Practice Attitude and Utilisation Survey (EBASE) in February 2019.

    RESULTS: Fifty-six (33%) chiropractors completed the survey. Participants were predominantly male, aged 30-49 years, held a Master's degree, and had received their highest qualification and practiced chiropractic for over a decade. Chiropractors rated their EBP skill-level mostly in the moderate to moderate-high range. The majority of chiropractors reported positive attitudes towards EBP, with most agreeing or strongly agreeing that EBP is necessary in the practice of chiropractic, and that EBP assists in making decisions about patient care. Chiropractors reported an average level of engagement in EBP activities. All participants indicated professional literature and research findings were useful in their day-to-day chiropractic practice. The main perceived enabler of EBP uptake was internet access in the workplace, whereas the main barrier to EBP uptake was lack of clinical evidence in chiropractic.

    CONCLUSIONS: Participating chiropractors of the Swedish Chiropractic Association were generally favourable of EBP, though only reported modest levels of EBP-related skills and engagement in EBP activities. Our findings suggest future studies investigating interventions focussed on improving chiropractors' skills and uptake of EBP are warranted.

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  • 11. Leach, MJ
    et al.
    Austin, P
    Fryer, G
    Thomson, OP
    Adams, J
    Skillgate, Eva
    Sophiahemmet University.
    Sundberg, Tobias
    Sophiahemmet University.
    Attitudes, skills, and use of evidence-based practice: A cross-sectional survey of Swedish osteopaths2020In: International Journal of Osteopathic Medicine, ISSN 1746-0689, E-ISSN 1878-0164, Vol. 38, p. 41-49Article in journal (Refereed)
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  • 12.
    Lilje, Stina
    et al.
    Sophiahemmet University.
    Eklund, Andreas
    Wykman, Anders
    Sundberg, Tobias
    Sophiahemmet University.
    Skillgate, Eva
    Sophiahemmet University.
    Naprapathy versus orthopaedic standard care for common musculoskeletal disorders: Aan 8-year follow-up of a pragmatic randomized controlled trial in Sweden2021In: Chiropractic and Manual Therapies, E-ISSN 2045-709X, Vol. 29, no 1, article id 43Article in journal (Refereed)
    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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  • 13. Myhrvold, Birgitte Lawaetz
    et al.
    Axén, Iben
    Leach, Matthew J
    Sundberg, Tobias
    Sophiahemmet University.
    Gausel, Anne Marie
    Investigating attitudes, skills, and use of evidence-based practice among Norwegian chiropractors: A national cross-sectional study2023In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, article id 385Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Evidence-based practice (EBP) is essential in improving the quality of healthcare and of importance for all health care personnel. No study in Norway has investigated attitudes, skills and use related to EBP among chiropractors. The aim of this study was to describe Norwegian chiropractors' attitudes, skills, and use of EBP, as well as the barriers and facilitators to their use of EBP.

    METHODS: A national cross-sectional survey, the online version of the Evidence Based practice Attitudes & Utilisation SurvEy (EBASE), was sent by email to 770 Norwegian practicing chiropractors, all members of the Norwegian Chiropractic Association. Three EBASE sub-scores were generated (Attitudes, Skills and Use), and the demographic characteristics of the sample were reported. Linear regression analyses were conducted to examine the association between responses of the three sub-scores and demographic characteristics. Information on main barriers and facilitators of EBP was collected and described.

    RESULTS: A total of 312 (41%) chiropractors responded to the survey, and 95% agreed that EBP is necessary for chiropractic practice. While overall use of EBP activities was low participants were interested in learning and improving their skills to incorporate EBP into practice. Chiropractors' attitudes, skills, and use of EBP were positively associated with being female and having spent more than one hour per week on research, but negatively associated with having practiced more than 10 years. Main barriers of EBP were lack of skills to critically evaluate, interpret, and apply research findings to practice. Main facilitators of EBP included access to the internet and free online databases in the workplace.

    CONCLUSION: Although chiropractors in Norway reported positive attitudes and moderate skills in EBP, their use of EBP activities was limited. The main barriers and facilitators to EBP were primarily related to perceived skills deficits, whilst enablers of EBP were mostly related to infrastructure requirements.

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  • 14.
    Sundberg, Tobias
    et al.
    Sophiahemmet University.
    Leach, Matthew J
    Lilje, Stina
    Thomson, Oliver P
    Fryer, Gary
    Palmgren, Per J
    Adams, Jon
    Skillgate, Eva
    Sophiahemmet University.
    Attitudes, skills and implementation of evidence-based practice: A national cross-sectional survey of licensed naprapaths in Sweden2023In: Chiropractic and Manual Therapies, E-ISSN 2045-709X, Vol. 31, article id 3Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Evidence-based practice (EBP) is fundamental to the delivery of high-quality, safe and effective health care. Naprapaths, manual therapy providers that specialize in the treatment of musculoskeletal pain and dysfunction, became a Swedish licensed health profession in 1994. This study investigated the attitudes, skills and implementation of EBP among licensed naprapaths in Sweden.

    METHODS: Licensed naprapaths (n = 950) of Svenska Naprapatförbundet (the Swedish Naprapathy Association) were invited by email to take part in this cross-sectional anonymous online study using the Evidence-Based Practice Attitude and Utilisation Survey in February 2019.

    RESULTS: Fourteen percent (137/950) of invited naprapaths completed the survey. There was an approximately equal gender divide among responders; most were in the mid-career age range, practiced in city areas, and had a university or college certificate/diploma as their highest qualification. The majority of naprapaths agreed or strongly agreed that EBP was necessary in the practice of naprapathy, assisted them in making care decisions, and improved the quality of patient care. Naprapaths' self-reported skills in EBP were mostly in the moderate to moderate-high range. The majority of participating naprapaths reported infrequent implementation of EBP. Perceived minor or moderate barriers to EBP uptake included a lack of colleague support for EBP and a lack of relevant resources. Access to the internet and free online databases were reported as very useful enablers to improving EBP uptake.

    CONCLUSIONS: The licensed naprapaths participating in this survey reported positive attitudes toward EBP, moderate levels of EBP skills, and infrequent implementation of EBP.

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  • 15.
    Sundberg, Tobias
    et al.
    Sophiahemmet University.
    Skillgate, Eva
    Sophiahemmet University.
    Gustavsson, Petter
    Rudman, Ann
    Early career demanding psychosocial work environment and severe back pain and neck/shoulder pain in experienced nurses: A cohort study2023In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, article id 14034948231151992Article in journal (Refereed)
    Abstract [en]

    AIMS: Back pain and neck/shoulder pain are common among nurses. The aim of this study was to investigate the association between nurses' exposure to a demanding psychosocial work environment during the first three years after graduation and the occurrence of severe back pain and neck/shoulder pain in the longer term, 11-15 years later.

    METHODS: The Longitudinal Analysis of Nursing Education (LANE) study (nursing graduates from 26 Swedish universities in the years 2002, 2004 and 2006) was used to create two risk cohorts of nurses not reporting severe back pain (n=1764) or neck/shoulder pain (n=1707). Nurses exposed to a demanding psychosocial work environment for one, two or three of the first three years in their career were compared to nurses not having a demanding psychosocial work environment for any of these three years regarding the incidence of severe back pain or neck/shoulder pain at follow-up, 11-15 years later. Relative risks (RR) with 95% confidence intervals (CI) were calculated using binomial regression.

    RESULTS: The RR (95% CI) of having severe back pain for nurses who had a demanding psychosocial work environment for one of the three years was 1.36 (0.82-2.28) and 2.08 (1.21-3.57) for two of the three years and 2.82 (1.43-5.55) for all three years. Corresponding RRs (95% CIs) for severe neck/shoulder pain were 1.35 (0.87-2.10), 1.49 (0.88-2.51) and 1.41 (0.62-3.20), respectively.

    CONCLUSIONS: Nurses who were repeatedly exposed to a demanding psychosocial work environment early in their career reported severe back pain to a higher extent in the longer term.

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