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  • 1.
    Björklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Effects of repetitive work on proprioception and of stretching on sensory mechanisms: implications for work-related neuromuscular disorders2004Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The aims of the thesis were (i) to investigate the impact of repetitive low-intensity work exposure on proprioception and (ii) to examine effects of muscle stretching (especially sensory effects and effects on muscle nociception) and to relate its application to the prevention, alleviation and/or treatment of work-related neuromuscular disorders.

    The effects of low-intensity repetitive work on the shoulder proprioception were tested in healthy subjects. The effect of working time on the retention of subjective fatigue and their relation to changes in proprioception, and the immediate effect of stretching on shoulder proprioception were investigated. A new method to test the stretchability of the rectus femoris muscle was investigated for reliability and validity and used to assess the effects of a two-week stretching regimen on range of motion and on subjective stretch sensation. Finally, the interactions between innocuous muscle stretch and nociceptive chemical stimulation on discharge behavior of nociceptive dorsal horn neurons in the feline spinal cord were explored.

    The main findings were as follows: 1) The repetitive low-intensity work to fatigue diminished the shoulder proprioception; the working time as well as the retention of subjective fatigue were partly related to the extent of changed proprioception. 2) There was no effect of acute muscle stretching on the proprioception. 3) The new method for testing muscle stretchability proved valid and reliable. A two-week stretching regimen increased the tolerance to stretch torque, but the range of motion remained unchanged. 4) Half of the nociceptive dorsal horn neurons that responded to close arterial injections of bradykinin were modulated by muscle stretching applied directly after the injections.

    Altogether, the results give credence to the hypothesis of an involvement of sensory information distortion due to repetitive low-intensity work exposure in the development of work-related neuromuscular disorders. Increased tolerance to stretch torque may be an important mechanism in explaining improvements following stretch treatment. The spinal interactions between innocuous stretch and nociceptive muscle afferent inputs indicate a possible mechanism involved in stretching-induced pain alleviation.

  • 2.
    Björklund, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Crenshaw, A G
    Djupsjöbacka, M
    Johansson, H
    Letter to the editor: Position sense acuity is diminished following repetitive low-intensity work to fatigue in a simulated occupational setting: a critical comment2003Inngår i: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 88, nr 4-5, s. 485-486Artikkel i tidsskrift (Fagfellevurdert)
  • 3.
    Björklund, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Crenshaw, Albert G
    Djupsjöbacka, Mats
    Johansson, H
    Position sense acuity is diminished following repetitive low-intensity work to fatigue in a simulated occupational setting.2000Inngår i: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 81, nr 5, s. 361-367Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 4.
    Björklund, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Djupsjöbacka, Mats
    Crenshaw, Albert G
    Acute muscle stretching and shoulder position sense2006Inngår i: Journal of athletic training, ISSN 1062-6050, E-ISSN 1938-162X, Vol. 41, nr 3, s. 270-274Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Context: Stretching is common among athletes as a potential method for injury prevention. Stretching-induced changes in the muscle spindle properties are a suggested mechanism, which may imply reduced proprioception after stretching; however, little is known of this association.

    Objective: To evaluate whether acute stretching of the shoulder muscles affects position sense.

    Design: A crossover design with subjects randomized to 3 groups.

    Setting: A university human research laboratory. Patients or Other Participants: Nine male (age = 24 +/- 3 years) and 9 female (age = 21 +/- 2 years) healthy volunteers.

    Intervention(s): Stretching of shoulder (1) agonists or (2) antagonists or (3) nonstretching control.

    Main Outcome Measure(s): We determined position sense acuity of the right shoulder before and after the interventions by having subjects attempt to reproduce arm positions of 15 degrees and 30 degrees (shoulder adduction) while starting at 45 degrees to the sagittal plane. The outcome variables were response variability (variable error) and overall accuracy (absolute error).

    Results: The relative change in variable error (ie, variable error after/variable error before) was not significantly different between the interventions ( P = .38). Similarly, no change in absolute error was found ( P = .76). Furthermore, no differences were noted regarding test sequence or the interaction of intervention x sequence for either variable error ( P = .73 and .53, respectively) or absolute error ( P = .71 and .67, respectively).

    Conclusions: We found no effect on shoulder position sense after an acute bout of stretching of either agonist or antagonist shoulder muscles.

  • 5.
    Björklund, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik. Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden.
    Djupsjöbacka, Mats
    Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden.
    Svedmark, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik. Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden.
    Häger, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Effects of tailored neck-shoulder pain treatment based on a decision model guided by clinical assessments and standardized functional tests: a study protocol of a randomized controlled trial2012Inngår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 13, artikkel-id 75Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

    DISCUSSION: We have chosen not to include women with psychological ill-health and focus on biomedical aspects of neck pain. Future studies should aim at including psychosocial aspects in a widened treatment decision model. No important adverse events or side-effects are expected.

    Trial registration: Current Controlled Trials registration ISRCTN49348025.

  • 6.
    Björklund, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Djupsjöbacka, Mats
    Svedmark, Åsa
    Häger, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Effects of tailored versus non-tailored treatment on pain and pressure pain threshold in women with non-specific neck pain: A randomized controlled trial2014Konferansepaper (Annet vitenskapelig)
  • 7.
    Björklund, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Hamberg, Jern
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Crenshaw, Albert G
    Sensory adaptation after a 2-week stretching regimen of the rectus femoris muscle2001Inngår i: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 82, nr 9, s. 1245-1250Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To study the effects of a muscle stretching regimen for the rectus femoris muscle on subjective stretch sensation and range of motion (ROM). DESIGN: A 2 x 2 crossover design comprising 2 treatments and 2 intervention periods. SETTING: A military base in Sweden. PARTICIPANTS: A volunteer sample of 29 male military conscripts divided into 2 groups, with each group subjected to both experimental and control treatments at different time periods. INTERVENTION: Two weeks of supervised stretching (4 times/wk) of the rectus femoris muscle (experimental treatment) and the calf muscles (control treatment). MAIN OUTCOME MEASURES: Subjective rating of the stretch sensation for the anterior aspect of the thigh determined on a category ratio scale. Passive knee flexion ROM determined on each test with the same applied torque, specific for each subject. RESULTS: An additive analysis of variance revealed that the stretch sensation after the experimental treatment was decreased, compared with the control treatment (p <.01). The knee flexion, however, remained the same regardless of the treatment. CONCLUSION: Sensory adaptation seems to be an important mechanistic factor in the effect stretching has on ROM changes. The lack of change in knee flexion suggests that the stretching, as performed in this study, did not influence stiffness of the rectus femoris muscle. Sensory adaptation may also be an underlying mechanism in the alleviating effect of stretching when applied to tired, tender, and painful muscles.

  • 8.
    Björklund, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Hamberg, Jern
    Heiden, Marina
    Barnekow-Bergkvist, Margareta
    The ProFitMap-neck - reliability and validity of a questionnaire for measuring symptoms and functional limitations in neck pain2012Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, nr 13, s. 1096-1107Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 9.
    Björklund, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Radovanovic, S
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Ljubisavljevic, M
    Windhorst, U
    Johansson, H
    Muscle stretch-induced modulation of noxiously activated dorsal horn neurons of feline spinal cord2004Inngår i: Neuroscience research, ISSN 0168-0102, E-ISSN 1872-8111, Vol. 48, nr 2, s. 175-184Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 10.
    Björklund, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Ga¨vle.
    Wiitavaara, Birgitta
    Heiden, Marina
    Responsiveness and minimal important change for the ProFitMap-neck questionnaire and the Neck Disability Index in women with neck-shoulder pain2017Inngår i: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 26, nr 1, s. 161-170Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: The aim was to determine the responsiveness and minimal important change (MIC) of the questionnaire ProFitMap-neck that measures symptoms and functional limitations in women with neck pain. The same measurement properties were determined for Neck Disability Index (NDI) for comparison purposes.

    METHODS: Longitudinal data were derived from two randomized controlled trials, including 103 and 120 women with non-specific neck pain, with questionnaire measurements performed before and after interventions. Sensitivity and specificity to discriminate between improved and not or little changed participants, based on categorization of a global rating of change scale (GRCS), were determined for the ProFitMap-neck indices and NDI by using area under receiver operating characteristic curves (AUC). Correlations between the GRCS anchor and change scores of the questionnaires were also used to assess responsiveness. The change score that showed the highest combination of sensitivity and specificity was set for MIC.

    RESULTS: The ProFitMap-neck indices showed similar responsiveness as NDI with AUC exceeding 0.70 (Range: ProFitMap-neck, 0.74-0.83; NDI, 0.75-0.86). The MIC in the two samples ranged between 6.6 and 13.6 % for ProFitMap-neck indices and 5.2 and 6.3 % for NDI. Both questionnaires had significant correlations with GRCS (Spearman's rho 0.47-0.72).

    CONCLUSIONS: Validity of change scores was endorsed for the ProFitMap-neck indices and NDI with adequate ability to discriminate between improved and not or little changed participants. Values of minimal important change were presented.

  • 11. Bohman, Tony
    et al.
    Bottai, Matteo
    Björklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Department of Occupational Health Sciences and Psychology, University of Gävle, Gävle, Sweden.
    Predictive models for short-term and long-term improvement in women under physiotherapy for chronic disabling neck pain: a longitudinal cohort study2019Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 4, artikkel-id e024557Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To develop predictive models for short-term and long-term clinically important improvement in women with non-specific chronic disabling neck pain during the clinical course of physiotherapy.

    Design: Longitudinal cohort study based on data from a randomised controlled trial evaluating short-term and long-term effects on sensorimotor function over 11 weeks of physiotherapy.

    Participants and settings: Eighty-nine women aged 31–65 years with non-specific chronic disabling neck pain from Gävle, Sweden.

    Measures: The outcome, clinically important improvement, was measured with the Patient Global Impression of Change Scale (PGICS) and the Neck Disability Index (NDI), assessed by self-administered questionnaires at 3, 9 and 15 months from the start of the interventions (baseline). Twelve baseline prognostic factors were considered in the analyses. The predictive models were built using random-effects logistic regression. The predictive ability of the models was measured by the area under the receiver operating characteristic curve (AUC). Internal validity was assessed with cross-validation using the bootstrap resampling technique.

    Results: Factors included in the final PGICS model were neck disability and age, and in the NDI model, neck disability, depression and catastrophising. In both models, the odds for short-term and long-term improvement increased with higher baseline neck disability, while the odds decreased with increasing age (PGICS model), and with increasing level of depression (NDI model). In the NDI model, higher baseline levels of catastrophising indicated increased odds for short-term improvement and decreased odds for long-term improvement. Both models showed acceptable predictive validity with an AUC of 0.64 (95% CI 0.55 to 0.73) and 0.67 (95% CI 0.59 to 0.75), respectively.

    Conclusion: Age, neck disability and psychological factors seem to be important predictors of improvement, and may inform clinical decisions about physiotherapy in women with chronic neck pain. Before using the developed predictive models in clinical practice, however, they should be validated in other populations and tested in clinical settings.

  • 12.
    Degerstedt, Frida
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Enberg, Birgit
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Keisu, Britt-Inger
    Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS). Umeå Universitet.
    Björklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Centre for Musculoskeletal Research, Department of Occupational Health Sciences and Psychology, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.
    Inequity in physiotherapeutic interventions for children with Cerebral Palsy in Sweden: a national registry study2019Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

    Conclusion: The results of this study indicate inequity in care in Sweden towards children with Cerebral Palsy born in other counties. Further, physiotherapeutic interventions were not equally distributed in different geographical regions of Sweden. Knowledge of inequity is crucial in order to address the problem.

  • 13. Ericsson, Pernilla
    et al.
    Björklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Wahlström, Jens
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Exposure assessment in different occupational groups at a hospital using Quick Exposure Check (QEC): A pilot study2012Inngår i: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 41, nr Supplement 1, s. 5718-5720Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 14. Ferreira, Mariana Cândido
    et al.
    Björklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences. Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.
    Dach, Fabiola
    Chaves, Thais Cristina
    Cross-Cultural Adaptation of the Profile Fitness Mapping Neck Questionnaire to Brazilian Portuguese: Internal Consistency, Reliability, and Construct and Structural Validity2017Inngår i: Journal of Manipulative and Physiological Therapeutics, ISSN 0161-4754, E-ISSN 1532-6586, Vol. 40, nr 3, s. 176-186Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

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

  • 15. Gold, Judith E.
    et al.
    Hallman, David M.
    Hellström, Fredrik
    Björklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden.
    Crenshaw, Albert G.
    Djupsjobacka, Mats
    Heiden, Marina
    Mathiassen, Svend Erik
    Piligian, George
    Barbe, Mary F.
    Systematic review of biochemical biomarkers for neck and upper-extremity musculoskeletal disorders2016Inngår i: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 42, nr 2, s. 103-124Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

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

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

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

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

  • 16. Gold, Judith E.
    et al.
    Hallman, David M.
    Hellström, Fredrik
    Björklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Univ Gävle, Ctr Musculoskeletal Res, Dept Occupat & Publ Hlth Sci, Gävle, Sweden.
    Crenshaw, Albert G.
    Mathiassen, Svend Erik
    Barbe, Mary F.
    Ali, Sayed
    Systematic review of quantitative imaging biomarkers for neck and shoulder musculoskeletal disorders2017Inngår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 18, artikkel-id 395Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

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

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

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

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

  • 17.
    Hadrevi, Jenny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Idrottsmedicin.
    Bjorklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Kosek, E.
    Hallgren, Solveig
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Antti, Henrik
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Fahlstrom, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Hellstrom, F.
    Systemic differences in serum metabolome: a cross sectional comparison of women with localised and widespread pain and controls2015Inngår i: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 5, artikkel-id 15925Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 18. Hallman, David M.
    et al.
    Holtermann, Andreas
    Björklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Department of Occupational Health Sciences and Psychology, Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden.
    Gupta, Nidhi
    Norregaard Rasmussen, Charlotte D.
    Sick leave due to musculoskeletal pain: determinants of distinct trajectories over 1 year2019Inngår i: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 92, nr 8, s. 1099-1108Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

    Methods: Data on 981 blue- and white-collar workers were analyzed in the DPHACTO cohort (2012-2014). The number of days on sick leave due to pain was reported using text messages at 4-week intervals across 1 year. Latent class growth analysis was used to distinguish sub-groups with different trajectories of sick leave. A web-based questionnaire at baseline was used to assess personal, occupational (physical and psychosocial), lifestyle, and pain-related factors. Multinomial regression models were constructed to determine associations between baseline factors and trajectories of sick leave (referencing no sick leave), with adjustment for potential confounders.

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

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

  • 19. Hamberg, Jern
    et al.
    Björklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Nordgren, Bengt
    Sahlstedt, Bo
    Stretchability of the rectus femoris muscle: investigation of validity and intratester reliability of two methods including x-ray analysis of pelvic tilt.1993Inngår i: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 74, nr 3, s. 263-270Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 20. Hellström, Fredrik
    et al.
    Gouveia-Figueira, Sandra
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen. Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Farmakologi.
    Nording, Malin L.
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Farmakologi.
    Björklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Department of Occupational and Public Health Sciences, Centre for Musculoskeletal Research, University of Gävle, Sweden.
    Fowler, Christopher J.
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Farmakologi.
    Association between plasma concentrations of linoleic acid-derived oxylipins and the perceived pain scores in an exploratory study in women with chronic neck pain2016Inngår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 17, artikkel-id 103Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

    Conclusions: The data obtained in this exploratory study indicate that although no group differences are seen in plasma lipid concentrations, there is an association between the NRSday scores and the 9- and 13-hydroxy-octadecadienoic acid levels. Whether or not the association reflects a causality (i.e. that the circulating lipids contribute to the perceived pain of the pain participants), requires further investigation.

  • 21.
    Martin, Björklund
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Hamberg, Jern
    Heiden, Marina
    Barnekow-Bergkvist, Margareta
    The assessment of symptoms and functional limitations in low back pain patients. Validity and reliability of a new questionnaire2007Inngår i: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 16, s. 1799-1811Artikkel i tidsskrift (Fagfellevurdert)
  • 22. Richter, Hans
    et al.
    Röijezon, Ulrik
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Martin, Björklund
    Djupsjöbacka, Mats
    Long-term adaptation to neck/shoulder pain and perceptual performance in a hand laterality motor imagery test2010Inngår i: Perception, ISSN 0301-0066, E-ISSN 1468-4233, Vol. 39, nr 1, s. 119-130Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The effect of neck/shoulder pain on the performance in a hand laterality motor imagery test was studied. Responses to the Cooper and Shepard (1975, Journal of Experimental Psychology: Human Perception and Performance 104 48–56) hand laterality test were explored in twenty-four individuals with chronic non-specific neck pain and twenty-one subjects with chronic neck pain of traumatic origin (whiplash-associated disorder). Twenty-two controls were also included in the study. Digitalised right- or left-hand stimuli were presented at five different stimulus angles (0°, 45° laterally, 90° laterally, 135° laterally, and 180°). The experimental task was to decide the laterality as fast and accurately as possible. The performance, both reaction time (RT) and accuracy, of the two experimental groups was contrasted with that of the control group. The main results revealed that the subjects afflicted with whiplash injury on the average exhibited a faster response pattern than symptom-free healthy controls. Despite their musculoskeletal deficits and experience of pain these volunteers also exhibited a preserved speed–accuracy tradeoff. Longer duration of time with symptoms of neck pain was, moreover, associated with progressively faster RTs. These results point to perceptual learning and may reflect different stages of adaptation to neck pain.

  • 23.
    Rudolfsson, Thomas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Björklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Djupsjöbacka, Mats
    Centrum för belastningsskadeforskning, Högskolan i Gävle.
    Range of motion in the upper and lower cervical spine in people with chronic neck pain2012Inngår i: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 17, nr 1, s. 53-59Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Reduced cervical range of motion (ROM) is a common finding in people with neck pain. With few exceptions, only the angle between head and thorax has been measured. Our aim was to use an extended model to compare active cervical flexion and extension, separate for upper and lower cervical levels, between people with chronic non-traumatic neck pain and controls. We also investigated associations between ROM measures, symptoms and self-rated functioning. In this cross-sectional study, 102 subjects with neck pain and 33 healthy controls participated. An electromagnetic tracker system was used to measure the kinematics to construct a three-segment model including the thorax, cervical spine and head. Neutral flexion/extension were defined at subjects’ self-selected seated posture. We found that in the neck pain group, extension in the upper cervical levels and predominately flexion for the lower levels were reduced. The ratio between ROM for the upper and lower levels was altered in the neck pain group so that the lower levels contributed to a lesser extent to the total sagittal ROM compared to controls. These findings could not be explained by a greater forward head posture but must have other origins. For the neck pain group, ROM measures were weakly associated to pain and self-rated functioning. Altogether, this implies that using a three-segment model for assessment of ROM can be a valuable improvement for characterisation of patients and treatment evaluation.

  • 24.
    Rudolfsson, Thomas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Centre for Musculoskeletal Research, University of Gävle, Umeå, Sweden.
    Björklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Centre for Musculoskeletal Research, University of Gävle, Umeå, Sweden.
    Svedmark, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Centre for Musculoskeletal Research, University of Gävle, Umeå, Sweden.
    Srinivasan, Divya
    Djupsjöbacka, Mats
    Direction-Specific Impairments in Cervical Range of Motion in Women with Chronic Neck Pain: Influence of Head Posture and Gravitationally Induced Torque2017Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, nr 1, artikkel-id e0170274Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Cervical range of motion (ROM) is commonly assessed in clinical practice and research. In a previous study we decomposed active cervical sagittal ROM into contributions from lower and upper levels of the cervical spine and found level- and direction-specific impairments in women with chronic non-specific neck pain. The present study aimed to validate these results and investigate if the specific impairments can be explained by the neutral posture (defining zero flexion/extension) or a movement strategy to avoid large gravitationally induced torques on the cervical spine.

    Methods Kinematics of the head and thorax was assessed in sitting during maximal sagittal cervical flexion/extension (high torque condition) and maximal protraction (low torque condition) in 120 women with chronic non-specific neck pain and 40 controls. We derived the lower and upper cervical angles, and the head centre of mass (HCM), from a 3-segment kinematic model. Neutral head posture was assessed using a standardized procedure. 

    Findings Previous findings of level- and direction-specific impairments in neck pain were confirmed. Neutral head posture was equal between groups and did not explain the direction-specific impairments. The relative magnitude of group difference in HCM migration did not differ between high and low torques conditions, lending no support for our hypothesis that impairments in sagittal ROM are due to torque avoidance behaviour. 

    Interpretation The direction-and level-specific impairments in cervical sagittal ROM can be generalised to the population of women with non-specific neck pain. Further research is necessary to clarify if torque avoidance behaviour can explain the impairments.

  • 25.
    Rudolfsson, Thomas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Djupsjöbacka, Mats
    Häger, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Björklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Effects of neck coordination exercise on sensorimotor function in chronic neck pain: A randomized controlled trial.2014Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, nr 9, s. 908-914Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To evaluate the effect of neck coordination exercise on sensorimotor function in women with neck pain compared with best-available treatment and sham treatment.

    DESIGN: Observer-blinded randomized controlled trial with short-term and 6-month follow-ups.

    SUBJECTS: Women with chronic non-specific neck pain were randomized to 3 groups: neck coordination exercise with a novel training device; strength training for the neck and shoulders; or massage. Each group had 36 participants.

    METHODS: The intervention period was 11 weeks with 22 individually supervised sessions. Primary outcomes were postural sway measures and precision of goal-directed arm movements. Secondary outcomes were range of motion for the neck, peak speed of axial rotation, and neck pain. A repeated measures multivariate analysis of variance (MANOVA) was conducted separately on the primary outcomes for the short-term and 6-month evaluations and on the sensorimotor secondary outcomes for the 6-month effect. The 6-month effect on pain was analysed with a repeated measures analysis of variance (ANOVA).

    RESULTS: No significant treatment effects in favour of neck coordination exercise were found for short-term or 6-month evaluations.

    CONCLUSION: Neck coordination exercise is no better than strength training and massage in improving sensorimotor function. Further research should investigate the use of cut-offs for sensorimotor dysfunctions prior to proprioceptive or coordinative training.

  • 26.
    Röijezon, Ulrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden; Alfta Research Foundation, Alfta, Sweden .
    Björklund, Martin
    Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden; Alfta Research Foundation, Alfta, Sweden.
    Bergenheim, Mikael
    Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden Department of Surgery, Central Hospital Karlstad, Karlstad, Sweden.
    Djupsjöbacka, Mats
    Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden.
    A novel method for neck coordination exercise: a pilot study on persons with chronic non-specific neck pain2008Inngår i: Journal of NeuroEngineering and Rehabilitation, ISSN 1743-0003, E-ISSN 1743-0003, Vol. 5, s. 36-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Chronic neck pain is a common problem and is often associated with changes in sensorimotor functions, such as reduced proprioceptive acuity of the neck, altered coordination of the cervical muscles, and increased postural sway. In line with these findings there are studies supporting the efficacy of exercises targeting different aspects of sensorimotor function, for example training aimed at improving proprioception and muscle coordination. To further develop this type of exercises we have designed a novel device and method for neck coordination training. The aim of the study was to investigate the clinical applicability of the method and to obtain indications of preliminary effects on sensorimotor functions, symptoms and self-rated characteristics in non-specific chronic neck pain

    METHODS: The study was designed as an uncontrolled clinical trial including fourteen subjects with chronic non-specific neck pain. A new device was designed to allow for an open skills task with adjustable difficulty. With visual feedback, subjects had to control the movement of a metal ball on a flat surface with a rim strapped on the subjects' head. Eight training sessions were performed over a four week period. Skill acquisition was measured throughout the intervention period. After intervention subjects were interviewed about their experience of the exercise and pain and sensorimotor functions, including the fast and slow components of postural sway and jerkiness-, range-, position sense-, movement time- and velocity of cervical rotation, were measured. At six-month follow up, self-rated pain, health and functioning was collected.

    RESULTS: The subjects improved their skill to perform the exercise and were overall positive to the method. No residual negative side-effects due to the exercise were reported. After intervention the fast component of postural sway (p = 0.019) and jerkiness of cervical rotation (p = 0.032) were reduced. The follow up showed decreased disability (one out of three indices) and fear of movement, and increased general health (three out of eight dimensions).

    CONCLUSION: The results support the clinical applicability of the method. The improvements in sensorimotor functions may suggest transfer from the exercise to other, non-task specific motor functions and justifies a future randomized controlled trial.

  • 27.
    Röijezon, Ulrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Björklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Djupsjöbacka, Mats
    Högskolan i Gävle.
    The slow and fast components of postural sway in chronic neck pain2011Inngår i: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 16, nr 3, s. 273-278Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To evaluate the slow and fast components of postural control in quiet stance in subjects with chronic neck pain, associations between postural sway and self-rated characteristics and to study the impact of anthropometrics on postural sway.

    Design: A single-blinded cross-sectional study including two separate data collections.

    Subjects: Sample 1: Persons with chronic non-specific neck pain (NS, n=24), whiplash associated disorders (WAD, n=21). Healthy subjects were controls (CON, n=21). Sample 2: Women only, 98 NS and 32 CON subjects.

    Methods: Subject performed a quiet stance test with eyes closed on a force platform while the center of pressure (CoP) trajectory was measured. Sample 1 was tested on a firm surface for 30 seconds, while sample 2 was tested on both firm and foam surfaces for 190 seconds. The CoP signal was decomposed into the slow and fast components and the magnitude of these signals were calculated. Anthropometrics were included as covariate in the analysis of group differences if correlated with postural sway variables. Group differences in the sway variables were evaluated, as well as association between postural sway and self-ratings of symptoms, functioning and kinesiophobia.

    Results: Increased magnitude of the slow sway component was found for both neck pain groups. Increasing age was associated with increased magnitude of the fast component. Surface conditions had no effect on group difference. For WAD, associations were found between the magnitude of the slow component and self-rated characteristics related to physical functioning, sensory alterations and psychosocial functioning. For NS, concurrent low back pain was associated with increased postural sway.

    Conclusion: Postural control can be altered in chronic neck pain. This effect was present only for the slow sway component, which implies aberration in sensory feedback or processing of sensory information. Associations between postural sway and self-rated characteristics in WAD support the clinical validity of postural control assessment in this group. Increased postural sway found in NS with concurrent low back pain suggests an important role of generalised spinal pain on postural control alterations.

  • 28.
    Röijezon, Ulrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Centre for Musculoskeletal Research, University of Gävle, Sweden; Alfta Research Foundation, Alfta, Sweden .
    Djupsjöbacka, Mats
    Centre for Musculoskeletal Research, University of Gävle, Sweden.
    Björklund, Martin
    Centre for Musculoskeletal Research, University of Gävle, Sweden; Alfta Research Foundation, Alfta, Sweden.
    Häger Ross, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Grip, Helena
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Centrum för medicinsk teknik och fysik (CMTF). Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Liebermann, Dario
    Sackler Faculty of Medicine, Tel Aviv University, Israel.
    Kinematics of fast cervical rotations in persons with chronic neck pain: a cross-sectional and reliability study2010Inngår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 11, s. 222-Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Background

    Assessment of sensorimotor function is useful for classification and treatment evaluation of neck pain disorders. Several studies have investigated various aspects of cervical motor functions. Most of these have involved slow or self-paced movements, while few have investigated fast cervical movements. Moreover, the reliability of assessment of fast cervical axial rotation has, to our knowledge, not been evaluated before.

    Methods

    Cervical kinematics was assessed during fast axial head rotations in 118 women with chronic nonspecific neck pain (NS) and compared to 49 healthy controls (CON). The relationship between cervical kinematics and symptoms, self-rated functioning and fear of movement was evaluated in the NS group. A sub-sample of 16 NS and 16 CON was re-tested after one week to assess the reliability of kinematic variables. Six cervical kinematic variables were calculated: peak speed, range of movement, conjunct movements and three variables related to the shape of the speed profile.

    Results

    Together, peak speed and conjunct movements had a sensitivity of 76% and a specificity of 78% in discriminating between NS and CON, of which the major part could be attributed to peak speed (NS: 226 ± 88 °/s and CON: 348 ± 92 °/s, p < 0.01). Peak speed was slower in NS compared to healthy controls and even slower in NS with comorbidity of low-back pain. Associations were found between reduced peak speed and self-rated difficulties with running, performing head movements, car driving, sleeping and pain. Peak speed showed reasonably high reliability, while the reliability for conjunct movements was poor.

    Conclusions

    Peak speed of fast cervical axial rotations is reduced in people with chronic neck pain, and even further reduced in subjects with concomitant low back pain. Fast cervical rotation test seems to be a reliable and valid tool for assessment of neck pain disorders on group level, while a rather large between subject variation and overlap between groups calls for caution in the interpretation of individual assessments.

  • 29.
    Sandlund, Jonas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Centre for Musculoskeletal Research, University of Gävle; Alfta Research Foundation, Alfta.
    Djupsjöbacka, Mats
    Centre for Musculoskeletal Research, University of Gävle.
    Ryhed, Bengt
    Alfta Research Foundation, Alfta.
    Hamberg, Jern
    Alfta Research Foundation, Alfta.
    Björklund, Martin
    Centre for Musculoskeletal Research, University of Gävle; Alfta Research Foundation, Alfta.
    Predictive and discriminative value of shoulder proprioception tests for patients with whiplash-associated disorders2006Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 38, nr 1, s. 44-49Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To evaluate whether patients suffering from whiplash-associated disorders have impaired shoulder proprioception and whether the acuity of shoulder proprioception is reflected in the patients’ symptoms and self-rated function.

    Design: A comparative group design, including a correlation design for the patient group.

    Subjects: Patients with chronic whiplash-associated disorders (n/37) and healthy subjects (n/41). The groups were matched for age and gender.

    Methods: All subjects underwent a shoulder proprioception test involving active ipsilateral arm position-matching. Group difference was evaluated by multiple analysis of variance and analysis of variance. The patient group completed questionnaires addressing functioning and health and performed pain ratings. Associations between proprioceptive acuity and selfrated functioning and symptoms were studied by correlation and regression analyses.

    Results: The patient group showed significantly lower acuity of shoulder proprioception. Moderate correlations were found between proprioceptive acuity and questionnaire scores representing physical functioning, so that low proprioceptive acuity was associated with low self-rated physical functioning. Scores representing pain-intensity did not correlate with proprioceptive acuity.

    Conclusion: The results show that, at the group level, patients with whiplash-associated disorders have impaired shoulder proprioception. The clinical relevance of this finding is strongly supported by the association between shoulder proprioceptive acuity and self-rated functioning in the patient group.

  • 30.
    Sandlund, Jonas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Centre for Musculoskeletal Research, University of Gävle, Gävle; Alfta Research Foundation, Alfta, Sweden.
    Röijezon, Ulrik
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Centre for Musculoskeletal Research, University of Gävle, Gävle; Alfta Research Foundation, Alfta, Sweden.
    Björklund, Martin
    Centre for Musculoskeletal Research, University of Gävle, Gävle; Alfta Research Foundation, Alfta, Sweden.
    Djupsjöbacka, Mats
    Centre for Musculoskeletal Research, University of Gävle, Gävle.
    Acuity of goal-directed arm movements to visible targets in chronic neck pain2008Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, nr 5, s. 366-374Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To evaluate end-point acuity in goal-directed arm movements in subjects with chronic neck pain, while taking the trade-off between speed and accuracy into account, and to evaluate associations between reduced acuity and self-rated characteristics.

    Design: Single-blinded, controlled, comparative group study.

    Subjects: Forty-five subjects with chronic non-traumatic, non-specific neck pain (n = 24) and whiplash-associated disorders (n = 21). Healthy subjects served as controls (n = 22). The groups were age- and sex-matched.

    Methods: Subjects performed fast and accurate pointing movements to a visual target. Group differences in end-point variability, controlled for peak velocity, were evaluated. Associations between end-point variability and self-rated symptoms, functioning, self-efficacy and kinesiophobia were analysed.

    Results: End-point acuity, controlled for peak velocity, was reduced for both neck-pain groups. Similar spatial error patterns across all groups indicated no direction-specific reduction. For both neck-pain groups, associations were found between end-point acuity and neck movement deficits, physical functioning and, in whiplash, also balance and pain.

    Conclusion: Acuity of goal-directed arm movements can be reduced in chronic neck pain. Associations between acuity and self-rated characteristics support the clinical validity of the results and indicate that impaired neck function contributes to reduced end-point acuity. The results can be of importance for characterization and rehabilitation of neck disorders.

  • 31.
    Svedmark, Åsa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Björklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University Of Gävle, Gävle, Sweden.
    Häger, Charlotte K.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Nilsson Sommar, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Wahlström, Jens
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Impact of workplace exposure and stress on neck pain and disabilities in women: a longitudinal follow-up after a rehabilitation intervention2018Inngår i: Annals of Work exposure and Health, ISSN 2398-7308, Vol. 62, nr 5, s. 591-603Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

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

  • 32.
    Svedmark, Åsa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Djupsjöbacka, Mats
    Häger, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Jull, Gwendolen
    Björklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden.
    Is tailored treatment superior to non-tailored treatment for pain and disability in women with non-specific neck pain?: A randomized controlled trial2016Inngår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 17, artikkel-id 408Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

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

    TRIAL REGISTRATION: Current Controlled Trials ISRCTN 49348025. Registered 2 August 2011.

  • 33.
    Svedmark, Åsa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Häger, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Björklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Associations between self-rated and physical test outcomes before and after intervention in women with non-specific neck pain: Cross-sectional and longitudinal analysesManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Abstract

    Non-specific neck pain is common, especially in women. There is often a multifaceted symptom picture while the etiology remains unclear. Consequently, a wide arsenal of treatments exists. While the underlying mechanisms of pain relief are complex, the relationship between individual improvement on physical function and the neck patient’s self-rated status is also obscure. The present aim was to determine the associations between physical test outcomes involving the neck and shoulder region, and self-reported neck problems before and after (Change-scores) a treatment intervention in women with non-specific neck pain.

    Methods: Data were obtained for 120 women (aged 47±11 years) with non-specific neck pain who had participated in a previous randomized controlled trial involving physiotherapy treatment. Data were used from all participants at baseline prior to treatment for cross-sectional analysis, and for longitudinal analysis for 69 women at baseline, at the end of treatment after 3 months, and at 9-month follow-up (Change-scores). Associations between self-reported neck problems (pain, disability, symptoms) and physical test outcomes (neck-strength, flexibility, motor control) were estimated with cross-sectional (baseline) and longitudinal (Change-scores) linear regression analyses.

    Results: Neck pain was only significantly associated to the physical outcome measure Peak-Speed of cervical rotation, i.e., increased pain related to lower speed. This was true at baseline and for Change-scores at 9 months. Increased neck disability and frequency of symptoms were associated to lower neck strength and Peak-Speed at baseline, and to reduced Peak-Speed and cervical Axial-Range of Motion (A-ROM) at 3 and 9 months, respectively. Peak-Speed and A-ROM were thus the physical test outcomes with associations to changes in neck problems. At the 9-month follow-up, 26% of the variance of frequency of symptom changes was explained by changes in A-ROM and Peak-Speed, which were also inter-correlated (r=0.55).

    Conclusion: If changes in physical functioning, tested as cervical mobility and strength, have only a modest relation to the course of self-rated condition in neck disorders, then the specificity and usefulness of various assessments for decision-making, treatment and evaluation might be questioned. This also calls for reconsideration regarding acting mechanisms behind the apparent effect of, e.g., strength training on neck pain disorders.

  • 34.
    Svedmark, Åsa
    et al.
    Högskolan i Gävle,Centrum för belastningsskadeforskning, Högskolan i Gävle, Akademin för hälsa och arbetsliv (Department of occupational and public health sciences).
    Sandsjö, Leif
    Borås Universitet, MedTech/School of Engineering.
    Häger, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Björklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Progressive individualized EMG biofeedback training for women2012Inngår i: International society of electrophysiology and kinesiology, Brisbane, Australia 19-21 july 2012: Neuroplasticity, Motor control, Cutting-Edge Technology and Rehabilitation, 2012, s. 75-Konferansepaper (Annet (populærvitenskap, debatt, mm))
  • 35.
    Svedmark, Åsa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Sandsjö, Leif
    Häger, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Björklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Progressive individualized EMG biofeedback training for women with work related neck-shoulder pain – a feasibility study2012Konferansepaper (Fagfellevurdert)
  • 36.
    Tronarp, Rebecca
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Nyberg, André
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Hedlund, Mattias
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Häger, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    McDonough, Suzanne
    Björklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden.
    Office-cycling: a promising way to raise pain thresholds and increase metabolism with minimal compromising of work performance2018Inngår i: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, artikkel-id 5427201Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

    Results: PPTs increased in all conditions. PPT trapezius showed the highest increase after LC, 39.3 kilopascals (kPa) (15.6; 78.6), compared to MC, 17.0 kPa (2.8; 49.9), and standing, 16.8 kPa (-5.6; 39.4),p = 0.015. Transcription was reduced during LC and MC. Mouse pointing precision was best during standing and worst and slowest during MC. Cognitive performance did not differ between conditions. Metabolic expenditure rates were 1.4 (1.3; 1.7), 3.3 (2.3; 3.7), and 7.5 (5.8; 8.7) kcal/minute during standing, LC, and MC, respectively (p < 0.001).

    Conclusions: LC seems to be the preferred option; it raised PPTs, more than doubled metabolic expenditure, whilst minimally influencing work performance.

  • 37.
    Wiitavaara, Birgitta
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Centre for Musculoskeletal Research, University of Gävle, S-801 76 Gävle, Sweden .
    Björklund, Martin
    Centre for Musculoskeletal Research, University of Gävle, Box 7629, S-907 12 Umeå, Sweden ; Alfta Research Foundation, Box 94, S-822 22 Alfta, Sweden.
    Brulin, Christine
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Djupsjöbacka, Mats
    Centre for Musculoskeletal Research, University of Gävle, Box 7629, S-907 12 Umeå, Sweden .
    How well do questionnaires on symptoms in neck-shoulder disorders capture the experiences of those who suffer from neck-shoulder disorders?: A content analysis of questionnaires and interviews2009Inngår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 10, nr 30, s. 1-14Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 38. Wiitavaara, Birgitta
    et al.
    Björklund, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Nilsson, Annika
    An initial factor analysis of prominent aspects of health experiences for women with neck-shoulder pain2012Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, nr 11, s. 934-942Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: The prospect of adequate comparisons is essential to decide on the effectiveness of different treatments. As there is a lack of unity in choice of questionnaires and included measures concerning musculoskeletal disorders, further investigations based on international recommendations are of interest. The intention of present study was to initiate the development of a clinically useful short-form questionnaire. The aim was to select items that capture prominent health aspects for women with neck-shoulder pain and thereby reduce the number of items to a clinically more convenient amount, and to determine the underlying structure of included items.

    Method: Data were collected in a randomised controlled trial including women with non-specific neck-shoulder pain > 3 months (n = 117). Data collection included three core domains: pain intensity, physical and emotional functioning, and analysis was performed using Principal component analysis, and Varimax rotation.

    Results: The resulting 9-factor solution included interference, solicitous/distracting responses, mood and feelings about self and relations, pain intensity, punishing responses, personal growth, life control, sleep, and appetite (29 items).

    Conclusions: The results will contribute to the development of a reduced battery of questions representing core dimensions. Such questionnaire would lighten the assessment load in the clinic as well as in research.

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