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  • 101.
    Merrick, Daniel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Sundelin, Gunnevi
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    A follow-up of two different rehabiliation strategies for patients with chronic pain, focusing on sick leaveManuskript (preprint) (Annet vitenskapelig)
  • 102.
    Merrick, Daniel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Sundelin, Gunnevi
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    An observational study of two rehabilitation strategies for patients with chronic pain, focusing on sick leave at one-year follow-up2013Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, nr 10, s. 1049-1057Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To follow up 2 rehabilitation strategies for patients with chronic pain: a 2-day interdisciplinary team assessment followed by either (i) a 4-week outpatient multimodal rehabilitation programme, or (ii) a subsequent rehabilitation plan.

    METHODS: After a 2-day interdisciplinary team assessment at our pain rehabilitation clinic, 296 consecutive patients were selected to undergo either multimodal rehabilitation programme (n = 76) or rehabilitation plan (n = 220). They completed questionnaires regarding beliefs about the future (only at assessment), Multidimensional Pain Inventory and sick leave, both at assessment, and at 1-year follow-up.

    RESULTS: Both the rehabilitation plan and multimodal rehabilitation programme groups improved significantly as regards decreased sick leave and the Multidimensional Pain Inventory scales Pain severity, Interference, and Support. The multimodal rehabilitation programme group also improved significantly regarding Life control and Affective distress. For men, low disability level and for women a positive expectation about work was associated with no sick leave at follow-up.

    CONCLUSION: The multimodal rehabilitation programme had long-term positive effects on sick leave and all Multidimensional Pain Inventory scales. However, a less intense intervention (rehabilitation plan) with follow-up in primary care can decrease levels of sick leave and improve some Multidimensional Pain Inventory scales. An interdisciplinary team assessment of patients with chronic pain seems to be useful for selecting which patients should undergo different rehabilitation interventions.

  • 103.
    Merrick, Daniel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Sundelin, Gunnevi
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    One-year follow-up of two different rehabilitation strategies for patients with chronic pain2012Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, nr 9, s. 764-773Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To determine outcomes for 2 rehabilitation strategies for patients with chronic pain: a 2-day interdisciplinary team assessment followed by either: (i) a 4-week outpatient multimodal rehabilitation programme, or (ii) a subsequent rehabilitation plan. Methods: After a 2-day interdisciplinary team assessment at our pain rehabilitation clinic 296 consecutive patients were selected to either multimodal rehabilitation (n = 76) or rehabilitation plan (n = 220). They completed questionnaires regarding pain intensity (Visual Analogue Scale), disability (Disability Rating Index), life satisfaction (LiSat-11), anxiety and depression (Hospital Anxiety and Depression Scale) at assessment and again at 1-year follow-up. Results: Both groups showed significant improvements at 1-year follow-up regarding pain intensity. In addition, the multimodal rehabilitation group improved in the disability items ("light work" and "heavy work"), depression and life satisfaction ("leisure", "somatic health", and "psychological health"). In the rehabilitation plan group "somatic health" improved, although not statistically significant. Conclusion: This study indicates that multimodal rehabilitation may have long-term positive effects on pain, disability, depression and domains of life satisfaction. However, a minor intervention, rehabilitation plan with follow-up in primary care, can improve pain and "somatic health". Based on the biopsychosocial approach, an interdisciplinary assessment of patients with chronic pain seems to be of value for selecting patients to different rehabilitation interventions.

  • 104. Michaëlsson, Karl
    et al.
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Garmo, Hans
    Byberg, Liisa
    Pedersen, Nancy L
    Melhus, Håkan
    Impact of hip fracture on mortality: a cohort study in hip fracture discordant identical twins2014Inngår i: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 29, nr 2, s. 424-431Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Several studies have shown a long-lasting higher mortality after hip fracture but the reasons of the excess risk is not well understood. We aimed to determine whether there exists a higher mortality after hip fracture when controlling for genetic constitution, shared environment, comorbidity and lifestyle by use of a nation-wide cohort study in hip fracture discordant monozygotic twins. All 286 identical Swedish twin pairs discordant for hip fracture (1972-2010) were identified. Comorbidity and lifestyle information was retrieved by registers and questionnaire information. We used intrapair Cox regression to compute multivariable-adjusted hazard ratios (HRs) for death. During follow-up, 143 twins with a hip fracture died (50%) compared to 101 twins (35%) without a hip fracture. Through the first year after hip fracture, the rate of death increased four-fold in women (HR 3.71; 95% confidence interval (CI) 1.32-10.40) and seven-fold in men (HR 6.67; 95% CI 1.47-30.13). The increased rate in women only persisted during the first year after hip fracture (HR after 1 year 0.99; 95% CI 0.66-1.50), whereas the corresponding HR in men was 2.58 (95% CI 1.02-6.62). The higher risk in men after the hip fracture event was successively attenuated during follow-up. After 5 years, the hazard ratio in men with a hip fracture was 1.19 (95% CI 0.29-4.90). On average, the hip fracture contributed to 0.9 years of life lost in women (95% CI 0.06-1.7) and 2.7 years in men (95% CI 1.7-3.7). The potential years of life lost associated with the hip fracture was especially pronounced in older men (>75 years), with an average loss of 47% (95% CI 31-61) of the expected remaining lifetime. We conclude that both women and men display a higher mortality after hip fracture independent of genes, comorbidity and lifestyle.

  • 105.
    Nazemroay, Arzhang
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Kognitiv nedsättning och fatigue efter subarachnoidalblödning: Dess kartläggning samt påverkan på vardagsaktivitet, delaktighet och livskvalité2016Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 106.
    Nilsson, Per A.
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för geografi.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Life satisfaction among inbound university students in northern Sweden2019Inngår i: Fennia, E-ISSN 1798-5617, Vol. 197, nr 1, s. 94-107Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Will life satisfaction among international students change after having an experience of studying abroad? Some previous studies indicate inequalities and issues of social mobility embedded in international student mobility. International student mobility implies physical movement and new experiences gained while studying abroad. The ubiquity of international students and their generally successful adaptation makes it necessary to understand how they manage to turn a seemingly difficult situation into satisfying adaptation. One area of such concern that this study sought to explore was the students’ level of satisfaction with life. This study investigated the self-reported life satisfaction of inbound university students upon arrival to a university in northern Sweden and at follow-up six months later. After the study period abroad, the students’ levels of perceived satisfaction with their somatic health and activities of daily living had significantly increased. Higher levels, while non-significant, were found for the domains life as a whole, study situation and economy. These findings may indicate that studying abroad could have an impact on students’ reported life satisfaction, which highlights the value of a period of studying abroad. However, when exploring life satisfaction outcomes among internationally mobile students, it seems pertinent to study student mobility within a context. This study mostly targets international student mobility in a Western/European contex

  • 107.
    Nilsson Sojka, Birgitta
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Klinisk immunologi.
    Sojka, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    The blood donation experience: self-reported motives and obstacles for donating blood2008Inngår i: Vox Sanguinis, ISSN 0042-9007, E-ISSN 1423-0410, Vol. 94, nr 1, s. 56-63Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and Objectives The aim of the study was to investigate motives for donating blood as well as difficulties and obstacles associated with blood donation as perceived by the donors themselves.

    Materials and Methods Six hundred consecutive blood donors (i.e. all blood donors with a history of at least one previous whole blood donation attending, during nine working days, the Blood Centre of Umea University Hospital) received a self-administered questionnaire that contained questions aimed at elucidating motives for donating blood (general motives for donating blood, specific motives for the first donation and motives for continuing to be an active blood donor). Questions concerning difficulties and obstacles that had to be overcome in order to continue being a blood donor were also included in the questionnaire.

    Results Altogether 531 whole blood donors filled in the questionnaire (88.5%; 322 men and 209 women). No statistically significant differences were found between male and female blood donors concerning general reasons and motives related to donating blood. The most frequently reported reasons for giving blood the first time were 'influence from a friend' (47.2% of donors) and 'request via media' (23.5% of donors). Among general reasons/motives with highest ranking of importance, the most commonly reported motive for donating blood were 'general altruism' (40.3%), 'social responsibility/obligation' (19.7%) and 'influence from friends' (17.9%). General altruism' and 'social responsibility/obligation' were also the most frequent reasons for continuing to donate blood (68.4 and 16.0%, respectively). The most commonly reported obstacle to becoming a regular blood donor was 'laziness' (19.1%) followed by 'fear of needles' (10.5%).

    Conclusions Altruism was the most common general motive for donating blood and also for continuing to be an active blood donor. Yet, for the first blood donation, direct 'influence from friends/relatives', 'media appeal' and other types of recruitment were more commonly reported as reasons or motives for donating blood than altruism. The findings support the notion that different strategies should be used/adopted to get people to donate blood the first time (e.g. recruitment through other blood donors using, for example, the 'bring a friend along' method) and to retain these subjects as active blood donors (e.g. by information and by strengthening their sense of being a blood donor or their self-efficacy etc.).

  • 108.
    Nilsson, Stefan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Treatment-resistant sensory motor symptoms in persons with SCI may be signs of restless legs syndrome2011Inngår i: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 49, nr 6, s. 754-756Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Study design: Case report on the successful treatment with pramipexole in four men with chronic spinal cord injury (SCI) suffering from refractory symptoms that were previously considered to be manifestations of a post-traumatic spastic syndrome or neuropathic pain.

    Objective: To raise awareness among health professionals regarding the diagnostic and therapeutic possibility of restless legs syndrome (RLS) and periodic limb movements (PLMs) in some patients with SCI responding poorly to conventional treatment for spasticity or neuropathic pain.

    Setting: Neurorehabilitation department of the Rehabilitation Medicine Center of Northern University Hospital, Umeå, Sweden.

    Methods: Medical records and clinical data were retrospectively reviewed.

    Results: All cases obtained treatment with pramipexole, initially 0.09–0.72 mg day−1. Two of the cases had RLS and PLMs, one RLS only and one PLMs only. All four reported symptoms in the lower extremities and one also in the upper extremities. Three patients with residual gait function reported RLS score with/without treatment as follows: 32/11, 37/12 and 33/12. One patient with complete paraplegia (with incomplete RLS score) reported 22/10. After a follow-up period of 16, 20, 43 and 49 months, respectively, all four still reported excellent outcomes. Two remained on initial dosage; one had increased dosage from 0.09 to 0.18 mg day−1 and one from 0.27 to 0.80 mg day−1 during the follow-up period.

    Conclusions: In persons with SCI suffering from infralesional involuntary movements and/or dysesthesia and with poor response to conventional antispastic or analgesic treatment, the possibility of RLS or PLMs should be considered, as these conditions seem eminently treatable.

  • 109.
    Nordström, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Edin, Benoni B.
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Fysiologi.
    Lindström, Sara
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Cognitive function and other risk factors for mild traumatic brain injury in young men: nationwide cohort study2013Inngår i: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 346, s. f723-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective To investigate cognitive function and other risk factors for mild traumatic brain injury in young men.

    Design Nationwide prospective cohort study.

    Setting Sweden.

    Participants 305 885 men conscripted for military service from 1989 to 1994.

    Main outcome measure mild traumatic brain injuries in relation to cognitive function and other potential risk factors assessed at conscription and follow-up.

    Results Men with one mild traumatic brain injury within two years before (n=1988) or after cognitive testing (n=2214) had about 5.5% lower overall cognitive function scores than did men with no mild traumatic brain injury during follow up (P<0.001 for both). Moreover, men with at least two mild traumatic brain injuries after cognitive testing (n=795) had 15% lower overall cognitive function scores compared with those with no such injury (P<0.001). Independent strong risk factors (P<1x10(-10)) for at least one mild traumatic brain injury after cognitive testing (n=12 494 events) included low overall cognitive function, a previous mild traumatic brain injury, hospital admission for intoxications, and low education and socioeconomic status. In a sub-cohort of twin pairs in which one twin had a mild traumatic brain injury before cognitive testing (n=63), both twins had lower logical performance and technical performance compared with men in the total cohort with no mild traumatic brain injury (P<0.05 for all).

    Conclusion Low cognitive function, intoxications, and factors related to low socioeconomic status were strong independent risk factors for mild traumatic brain injuries in men. The low cognitive function in twin pairs discordant for mild traumatic brain injury suggests a genetic component to the low cognitive function associated with such injuries. The study included only men, so inferences to women should be made with caution.

  • 110.
    Nordström, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Högström, Gabriel
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Eriksson, Anders
    Department of Health Sciences, Luleå University of Technology, Luleå.
    Bonnerud, Patrik
    Department of Health Sciences, Luleå University of Technology, Luleå.
    Tegner, Yelverton
    Department of Health Sciences, Luleå University of Technology, Luleå.
    Malm, Christer
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Winternet, Boden, Idrottsmedicin.
    Higher muscle mass but lower gynoid fat mass in athletes using anabolic androgenic steroids2012Inngår i: Journal of Strength and Conditioning Research, ISSN 1064-8011, E-ISSN 1533-4287, Vol. 26, nr 1, s. 246-250Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Nordstrom, A, Hogstrom, G, Eriksson, A, Bonnerud, P, Tegner, Y, and Malm, C. Higher muscle mass but lower gynoid fat mass in athletes using anabolic androgenic steroids. J Strength Cond Res 26(1): 246-250, 2012-This study evaluated the relationship between anabolic androgenic steroid (AAS) use and body constitution. Dual-energy x-ray absorptiometry was used to measure bone mineral density (BMD, g.cm(-2)) of the total body, arms, and legs. Total gynoid and android fat mass (grams) and total lean mass (grams) were measured in 10 strength trained athletes (41.4 +/- 7.9 years) who had used AASs for 5-15 years (Doped) and 7 strength trained athletes (29.4 +/- 6.2 years) who had never used AASs (Clean). Seventeen sedentary men (30.3 +/- 2.1 years) served as Controls. Doped athletes had significantly more lean body mass (85.5 +/- 3.8 vs. 75.3 +/- 2.5 vs. 60.7 +/- 1.9, p < 0.001) and a greater index of fat-free/fat mass (5.8 vs. 2.6 vs. 2.5, p < 0.001) compared with Clean athletes and Controls. Doped athletes also had significantly less gynoid fat mass compared with that of Clean athletes (2.8 +/- 0.4 vs. 4.8 +/- 0.2 kg, p = 0.02). There were no differences in BMD between the athletes (p = 0.39-0.98), but both groups had significantly higher BMDs at all sites compared with that of Controls (p = 0.01 to <0.001). Thus, long-term AAS use seems to alter body constitution, favoring higher muscle mass and reduced gynoid fat mass without affecting BMD.

  • 111.
    Nordström, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Neovius, Martin G
    Rössner, Stephan
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Postpubertal development of total and abdominal percentage body fat: an 8-year longitudinal study.2008Inngår i: Obesity, ISSN 1930-7381, Vol. 16, nr 10, s. 2342-2347Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of the present study was to describe postpubertal changes in total and abdominal adiposity in young men and the relation to changes in physical activity (PA). The study included 107 white men with a mean age of 17.1 +/- 1.7 years at baseline. Total percentage body fat (%BF) and abdominal percentage body fat (abd%BF) were measured at baseline and after a mean time of 28, 68, and 92 months using dual-energy X-ray absorptiometry (DXA). PA (h/week) was assessed at each visit by questionnaire. Over the study period, significant increases of 7.8 +/- 5.5%BF and 9.0 +/- 5.6 abd%BF were observed. Subjects who were active athletes throughout the study (n = 24), or nonathletes not changing their level of PA during follow-up (n = 27) increased 5.7 +/- 3.2 and 8.1 +/- 6.7%BF, respectively. Athletes who quit organized training during follow-up period (n = 56) increased by 8.7 +/- 4.9%BF. In the total cohort, the average annual gains in BMI, %BF, and abd%BF were 0.4 kg/m(2), 0.9%BF, and 1.1abd%BF (all P < 0.0001), respectively. Adjustment for changes in PA altered the coefficient magnitudes only marginally. Changes in PA were, however, significantly and inversely associated with changes in %BF and abd%BF (P = 0.005 and P = 0.02, respectively), but were not significantly associated with BMI development (P = 0.15). In summary, our results indicate that the natural course of adiposity development in postpubertal men is characterized by adiposity gains. The influence of PA on especially abd%BF may influence the future risk of cardiovascular disease.

  • 112.
    Nyberg, Vanja
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Pain rehabilitation in Sweden: a quality registry study2011Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Background: Chronic pain, defined as non-malignant pain emanating from the musculoskeletal system, may limit everyday activities, social functioning and the quality of social and working life for individuals, creating disability as well as incurring high economic and public costs for society. Controlled studies show that cognitive-behavioural interdisciplinary rehabilitation has a positive effect on functioning in patients who have been disabled by chronic non-malignant pain conditions. Positive outcomes described include lower pain intensity, less preoccupation with pain, greater independence and lower consumption of healthcare. On the other hand, the return to work rate varies.

    To facilitate comparisons on the national level and to enable audit spirals for single programmes as part of the ongoing quality assurance in healthcare the Swedish Quality Registry for Pain Rehabilitation (SQRP) has aggregated data since 1998 on all patients referred to the majority of Swedish rehabilitation units.

    The aim of this dissertation was to improve the knowledge base of pain rehabilitation in Sweden using the validated self-reported instruments of pain and its consequences included in the SQRP.

    Methods: The SQRP data were collected before, at the end and 1 year after the intervention for all individuals included, and concerns self-reported demographic variables, pain intensity, activities, thought patterns, impact of pain on daily life and life satisfaction. Individual sick leave data were collected from the Swedish Social Insurance after 1 year. Data collected from 19833 patients (6002 men and 13831 women) of which 7289 participate in work ability improving programmes, were used.

    Results: The results of four studies included in this thesis showed that the SQRP provided a basis for scientific works since it use the validated self-report instruments of pain and its consequences and contain a large amount of patient’s data. However, a lack of follow-up data from some units influenced the opportunity of to analyse long-term outcomes. Nevertheless, the SQRP was a useful tool to audit and evaluate as well as to propose optimising of pain rehabilitation. It seemed that contextual factors such as patients’ own beliefs and expectations, education, gender, actual sick leave and employment situation had more importance for the effect of rehabilitation programme than pain characteristics, depression or activity limitation.

    The Multidimensional Pain Inventory (MPI) scale scores and MPI coping profiles might be used for assessing the outcomes of treatment interventions. A reduction of MPI scale scores for Pain severity and Interference decreased the risk of being on full-time sick leave. On the other hand, the MPI coping profiles Dysfunctional, among both men and women, and Interpersonally distressed, among women, were associated with higher odds of being on full-time sick leave.

    Conclusions: Attending cognitive-behavioural interdisciplinary pain rehabilitation programmes in Sweden resulted in improvements of the MPI scales after completing a pain rehabilitation programme and this improvement was sustained after 1 year. Moreover, these programmes decreased the levels of full-time sick leave 1 year after completed programme. The findings suggest also the need to tailor rehabilitative strategies differently for men and women as well as for different pain coping profiles.

  • 113.
    Nyberg, Vanja E
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Novo, Mehmed
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Sjölund, Bengt H
    Dep of Public Health, University of Southern Denmark, Odense.
    Can registry data be used as predictive factors for effective pain rehabilitation?Manuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Purpose: The aim of this study were: a) using registry data to analyse which patients with disability from chronic pain that were offered participation in the rehabilitation programme after assessment in interdisciplinary teams, and b) to analyse if there were registry data features which could already before the programme predict a positive outcome, i.e. less sick leave.

    Method: An observational study of data derived from 8509 patients, 2588 men and 5951, collected from the Swedish Quality Register for Pain Rehabilitation.

    Results: Being a woman, having higher education and being on full time sick leave increased, whereas being unemployed or being of non-Swedish origin decreased the chance to be offered a rehabilitation programme. Patients with shorter time outside work had higher probability to be offered a programme. On the other hand, the strongest predictive factors for a return to work were not being on full time sick leave and employment situation as well as patients’ own beliefs and expectations.

    Conclusion: It seemed that variables that measured pain and its health consequences were of less importance for the future sick leave situation. It is possible that contextual factors not covered by the registry may play a crucial role here.

    Key words: Chronic pain, sick leave benefits, pain rehabilitation, register study.

  • 114.
    Nyberg, Vanja E.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Novo, Mehmed
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Sjölund, Bengt H.
    Changes in multidimensional pain inventory profile after a pain rehabilitation programme indicate the risk of receiving sick leave benefits one year later2014Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, nr 10, s. 1006-1013Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To determine whether coping profile changes after rehabilitation, assessed with the Multidimensional Pain Inventory (MPI), can predict which persons disabled by chronic musculoskeletal pain will be in receipt of sick leave benefits in the long term. Methods: Study of MPI data from 2,784 patients (709 men and 2,075 women) collected from the Swedish Quality Register for Pain Rehabilitation (SQRP) before and at the end of rehabilitation and compared with independent sick leave data for 1 year later. Results: After rehabilitation there was a significantly decreased share of Dysfunctional profiles (DYS) among both men (44% before, 31% after) and women (39% before, 26% after), but an increased share of Adaptive Coper profiles (men 15% before, 24% after, women 14% before, 24% after). The number of patients on full-time sick leave decreased significantly among men (from 57% to 46%) and women (from 57% to 50%). Persons with a DYS profile after rehabilitation had a low probability of having no or part-time sick leave. Conclusion: The number of persons with DYS profiles decreased after rehabilitation. Those with other profiles had less full-time sick leave one year later than those with DYS profiles, indicating that leaving the DYS profile is a positive prognostic sign long-term. Furthermore, the gender differences observed suggest the need to tailor rehabilitative strategies differently for men and women.

  • 115.
    Nyberg, Vanja E
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Novo, Mehmed
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Sjölund, Bengt H
    Rehabilitation and Research Centre for Torture Victims, Copenhagen, Denmark ; Department of Public Health, University of Southern Denmark, Odense, Denmark.
    Do multidimensional pain inventory scale score changes indicate risk of receiving sick leave benefits 1 year after a pain rehabilitation programme?2011Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, nr 17-18, s. 1548-1556Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To study whether scale score changes in the Multidimensional Pain Inventory (MPI) can predict which persons disabled by pain will receive sick leave benefits 1 year after completing a pain rehabilitation programme.

    Method: An observational study of MPI data derived from 1468 patients, 388 men and 1080 women, who had participated in multidisciplinary cognitive-behavioural oriented pain rehabilitation programmes in Sweden, collected from the Swedish Quality Register for Pain Rehabilitation, before, at the end and 1 year after the programme.

    Results: Most MPI scale scores showed improvements after completing a pain rehabilitation programme and this improvement was sustained after 1 year. Moreover, we found that a decrease in MPI scales scores for Pain severity and Interference immediately after the pain rehabilitation programme decreased the risk of being on full-time sick leave 1 year later [OR 0.85, (95% CI 0.73–0.99) and OR 0.73, (95% CI 0.61–0.87), respectively]. The Interference scale, which may be considered to include ICF components of both activities and participation, might represent the core of suffering among persons disabled with pain.

    Conclusions: A rehabilitation intervention directed to combating the consequences of pain in activities and participation rather than against pain per se might lead to improved working capacity.

  • 116.
    Nyberg, Vanja E
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Sanne, Harald
    Primary Health Care Service, Occupational Rehab Center, Gothenburg.
    Sjölund, Bengt H
    Dep of Public Health, University of Southern Denmark, Odense.
    Swedish quality registry for pain rehabilitation:: purpose, design, implementation and characteristics of referred patients2011Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 43, nr 1, s. 50-57Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: In order to facilitate comparisons of pain rehabilitationprogrammes in Sweden and to enable audit spirals for single programmes as well as outcome studies, the Swedish Association for Rehabilitation Medicine initiated a national quality registry in 1995.

    Patients: Referred for rehabilitation due to pain-related disability.

    Methods: The registry collects standardized self-reports before assessment, after rehabilitation and one year later, covering demographic, educational and psychometric data, pain intensity, physical disability and life satisfaction. Sick leave data are collected from the National Insurance Board before and up to two years after rehabilitation. At each programme unit self-reports are processed into individual assessment profiles relevant to plan rehabilitation. Data are sent annually to the central registry for analysis and compared with“return to work” data. Each unit can compare its results with national means.

    Results and conclusion: The organization of the registry is described. Data indicating that contextual factors, but not pain characteristics, depression or activity limitations vary between patients referred to different centres, makes comparisons difficult. As of 2007, data from the multidisciplinary assessment of 19,833 patients have been collected. A total of 7289 patients attended a rehabilitation programme, generating two more self-reports. A limitation of the study is a lack of follow-up data from some units.

  • 117.
    Nyberg, Vanja
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Novo, Mehmed
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Sjölund, Bengt H
    Dep of Public Health, University of Southern Denmark, Odense.
    MPI profile changes after a pain rehabilitation programme indicate risk of receiving sick leave benefits one year laterManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Purpose: to study whether changes of coping profiles derived from the Multidimensional Pain Inventory MPI can predict which persons disabled by chronic pain will receive sick leave benefits 1 year after completing a pain rehabilitation programme.

    Method: An observational study of MPI data derived from 2784 patients, 709 men and 2075 women, who had participated in interdisciplinary cognitive-behavioural oriented pain rehabilitation programmes in Sweden, collected from the Swedish Quality Register for Pain Rehabilitation, before and at the end of the programme.

    Results: After a pain rehabilitation programme, there was a significantly decreased share of dysfunctional profile among both men (44 % before compared to 31% after), and women (39% to 26%) as well as an increased share of Adaptive coper profiles (men 15% to 24% and women 14% to 24%). The number of those with full-time sick leave decreased significantly (p<0.001) both among men (from 57% to 46%) and women (57% and 50% respectively). At the same time level of women who had part-time sick leave increased from 20% to 30%. Persons staying with or moving into a dysfunctional profile after a rehabilitation programme had a low probability of having no or part-time sick leave.

    Conclusion: Persons with dysfunctional profiles have higher levels of sick-leave compared to adaptive coper and interpersonally distressed. The presently used cognitive behavioural pain rehabilitation programmes in Sweden, decreased the levels of full-time sick leave one year later. Our findings suggest also the need to tailor rehabilitative strategies differently for men and women

    Keywords: Chronic pain, sick leave benefits, pain rehabilitation, Multidimensional Pain Inventory

  • 118. Nygren DeBoussard, Catharina
    et al.
    Lannsjö, Marianne
    Stenberg, Maud
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Godbolt, Alison K
    Behavioural problems in the first year after Severe traumatic brain injury: a prospective multicentre study2017Inngår i: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 31, nr 4, s. 555-566Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To investigate the occurrence of behavioural problems in patients with severe traumatic brain injury during the first year after injury and potential associations with outcome. An additional post hoc objective was to analyse the frequency of behaviours with need for intervention from staff.

    DESIGN AND SETTING: In a prospective population based cohort study 114 patients with severe traumatic brain injury were assessed at three weeks, three months and one year after injury.

    MAIN MEASURES: Assessments included clinical examination and standardised instruments. Agitation was assessed with the Agitated Behaviour Scale, the course of recovery by the Rancho Los Amigo Scale and outcome by Glasgow Outcome Scale Extended.

    RESULTS: Agitation were most common at 3 weeks post injury and 28% (n=68) of the patients showed at least one agitated behaviour requiring intervention from staff. Presence of significant agitation at 3 weeks after injury was not associated with poor outcome. At 3 months agitation was present in 11% (n=90) and apathy in 26 out of 81 assessed patients. At 3 months agitation and apathy were associated with poor outcome at one year.

    CONCLUSIONS: Most agitated behaviours in the early phase are transient and are not associated with poor outcome. Agitation and apathy are uncommon at three months but when present are associated with poor outcome at one year after injury. In the early phase after a severe traumatic brain injury agitated behaviour in need of interventions from staff occur in a substantial proportion of patients.

  • 119. Nygren-de Boussard, Catharina
    et al.
    Holm, Lena W
    Cancelliere, Carol
    Godbolt, Alison K
    Boyle, Eleanor
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Hincapié, Cesar A
    Cassidy, J David
    Borg, Jörgen
    Nonsurgical interventions after mild traumatic brain injury: a systematic review: Results on the international collaboration on mild traumatic brain injury prognosis2014Inngår i: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 95, nr 3, Suppl, s. S257-S264Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Objective

    To synthesize the best available evidence regarding the impact of nonsurgical interventions on persistent symptoms after mild traumatic brain injury (MTBI).

    Data Sources

    MEDLINE and other databases were searched (2001–2012) with terms including “rehabilitation.” Inclusion criteria were original, peer-reviewed research published in English and other languages. References were also identified from the bibliographies of eligible articles.

    Study Selection

    Controlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to have a minimum of 30 MTBI cases and assess nonsurgical interventions using clinically relevant outcomes such as self-rated recovery.

    Data Extraction

    Eligible studies were critically appraised using a modification of the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Two reviewers independently reviewed each study and extracted data from the admissible studies into evidence tables.

    Data Synthesis

    The evidence was synthesized qualitatively according to the modified SIGN criteria. Recommendations were linked to the evidence tables using a best-evidence synthesis. After 77,914 records were screened, only 2 of 7 studies related to nonsurgical interventions were found to have a low risk of bias. One studied the effect of a scheduled telephone intervention offering counseling and education on outcome and found a significantly better outcome for symptoms (6.6 difference in adjusted mean symptom score; 95% confidence interval, 1.2–12.0), but no difference in general health outcome at 6 months after MTBI. The other was a randomized controlled trial of the effectiveness of 6 days of bed rest on posttraumatic complaints 6 months postinjury, compared with no bed rest, and found no effect.

    Conclusions

    Some evidence suggests that early, reassuring educational information is beneficial after MTBI. Well-designed intervention studies are required to develop effective treatments and improve outcomes for adults and children at risk for persistent symptoms after MTBI.

  • 120. Nygren-DeBoussard, Catharina
    et al.
    Godbolt, Alison
    Stenberg, Maud
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Ulfarsson, Trandur
    Lindgren, Marie
    Karlsdottir, Gudrun
    Borg, Jorgen
    Trajectories of Recovery and Outcome after Severe Traumatic Brain Injury: Design and baseline data from the "PROBRAIN" study2012Inngår i: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 26, nr 4-5, s. 560-561Artikkel i tidsskrift (Annet vitenskapelig)
  • 121.
    Ohlsson, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Berg, Linda
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Ljungberg, Hanna
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Söderman, Kerstin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Heart Rate Distribution during Training and a Domestic League Game in Swedish Elite Female Soccer Players2015Inngår i: Annals of Sports Medicine and Research, ISSN 2379-0571, Vol. 2, nr 4, artikkel-id 1025Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Soccer is a complex sport with high cardiovascular demands. Preparation for the demands of competition often involves game-simulation practice. This is supposed to improve the physiological adaptions. The main purpose of this study was to compare heart rate (HR) distribution among elite female soccer players during in-season training sessions and a game. Methods: Fifteen players were observed during three regular training sessions, and at a domestic league game using Polar Team2 HR monitors. HR was categorized into HR zones to compare intensities of each activity observed. Results: HR values were significantly higher during the game (HRmean: 168±9 beats per minute (bpm), HRpeak: 189±8 bpm) than during training (HRmean: 134±11 bpm, HRpeak: 183±9 bpm, p<0.001). Players spent 55% of the game and 11% of the total training time at high intensity (HR above 90% of HRpeak, p<0.001).HRmean and HRpeak were significantly higher in the first half compared with the second half of the game (p<0.05). Conclusion: The present study demonstrates higher HR values and longer duration at high intensity during game play in comparison with training, which indicates higher demands on the players' internal load during the game. Thus, the results suggest the need to include high intensity exercise sessions during training.

  • 122. Ovchinnikova, Olga
    et al.
    Gylfe, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Klinisk bakteriologi.
    Bailey, Leslie
    Umeå universitet, Medicinska fakulteten, Institutionen för molekylärbiologi (Medicinska fakulteten).
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Rudling, Mats
    Jung, Christian
    Bergström, Sven
    Umeå universitet, Medicinska fakulteten, Institutionen för molekylärbiologi (Medicinska fakulteten).
    Waldenström, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Hansson, Göran K
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Osteoprotegerin promotes fibrous cap formation in atherosclerotic lesions of ApoE-deficient mice--brief report.2009Inngår i: Arteriosclerosis, Thrombosis and Vascular Biology, ISSN 1079-5642, E-ISSN 1524-4636, Vol. 29, nr 10, s. 1478-1480Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Osteoprotegerin (OPG) is a tumor necrosis factor receptor-related cytokine, initially found to inhibit osteoclastogenesis. In the present study we investigated the effect of OPG treatment on atherosclerosis. METHODS AND RESULTS: Hypercholesterolemic apoe(-/-) mice were treated with recombinant 15 mg/kg OPG or vehicle injections twice a week for 10 consecutive weeks. Mice treated with OPG showed increased amounts of smooth muscle cells and collagen within the atherosclerotic lesions. OPG treatment did not affect atherosclerotic lesion size (8.2% versus 7.6%) or total vessel area but led to a 250% increase in lesion collagen, formation of mature collagen fibers in subendothelial fibrous caps, and upregulated mRNA for lysyl oxidase that promotes collagen crosslinking. In cell culture studies, OPG promoted cell proliferation in rat aortic smooth muscle cells. In contrast, OPG treatment did not affect markers of vascular or systemic inflammation. CONCLUSIONS: OPG treatment promotes smooth muscle accumulation, collagen fiber formation, and development of fibrous caps but does not affect inflammatory properties of atherosclerotic lesions. Its effects may contribute to plaque stabilization.

  • 123.
    Persson, Ann L
    et al.
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Brogårdh, Christina
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Sjölund, Bengt H
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Tender or not tender: test-retest repeatability of pressure pain thresholds in the trapezius and deltoid muscles of healthy women.2004Inngår i: Journal of Rehabilation Medicine, ISSN 1650-1977, Vol. 36, nr 1, s. 17-27Artikkel i tidsskrift (Fagfellevurdert)
  • 124.
    Persson, Ann L
    et al.
    Rehabilitation and Research Centre for Torture Victims (RCT), Copenhagen, Denmark.
    Westermark, Sofia
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Merrick, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Sjölund, Bengt
    Rehabilitation and Research Centre for Torture Victims (RCT), Copenhagen, Denmark.
    Validity of electrical stimulus magnitude matching in chronic pain2009Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 41, nr 11, s. 898-903Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To examine the validity of the PainMatcher in chronic pain.

    Design: Comparison of parallel pain estimates from visual analogue scales with electrical stimulus magnitude matching.

    Patients: Thirty-one patients with chronic musculoskeletal pain.

    Methods: Twice a day ongoing pain was rated on a standard 100-mm visual analogue scale, and thereafter magnitude matching was performed using a PainMatcher. The sensory threshold to electrical stimulation was tested twice on separate occasions.

    Results: In 438 observations visual analogue scale ranged from 3 to 95 (median 41) mm, and PainMatcher magnitudes from 2.67 to 27.67 (median 6.67; mean 7.78) steps. There was little correlation between visual analogue scale and magnitude data (r = 0.29; p < 0.0001). The mean sensory threshold was 3.67 steps, indicating that the PainMatcher, on average, stimulated at 2.1 times the perception threshold at matching point.

    Conclusion: Electrical magnitude matching of chronic pain intensity elicited limited activation of nerve fibres at 2.0–2.2 times sensory threshold, indicating that the induced pain was evoked by coarse nociceptive Aδ fibres. While the visual analogue scale estimates covered the whole range of the instrument, the PainMatcher readings utilized only a small part of the instrument range and, importantly, had little or no relation to the visual analogue scale estimates. The validity of the PainMatcher procedure is doubtful.

  • 125.
    Pietilä Holmner, Elisabeth
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Multimodal rehabilitation of patients with chronic musculoskeletal pain, focusing on primary care2018Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Background: Chronic pain is a complex condition that has consequences both for individual people and for society. The individual often experiences impact on function, activity and participation. Society is affected by high healthcare and sick leave costs and a loss of workforce. Multimodal rehabilitation programmes (MMRP) have mainly been provided through specialist care but it is now also available through primary care. The overall aim of this thesis was to evaluate the effects of MMRP in patients with chronic musculoskeletal pain and to explore patients’ and healthcare professionals’ experiences of MMRP.

    Study I: Aim: To evaluate the effects of an interdisciplinary team assessment and MMRP for patients with chronic pain in a specialist care setting. Design: Longitudinal cohort study. Method: Pain intensity, pain dimensions, anxiety and depression were measured at assessment and at the start and end of MMRP.  A total of 93 women were evaluated. Result: Pain and pain-related measures were significantly improved both after the interdisciplinary assessment and after MMRP.

    Study II: Aim: To explore healthcare professionals’ experiences of MMRP in primary care. Design: Individual interviews, analysed with qualitative content analysis. Method: Fourteen healthcare professionals (11 women, 3 men) were interviewed about their work with MMRP. Result: Healthcare professionals considered that MMRP was useful but also challenging. It was difficult to select appropriate patients, and health care professionals felt they were torn between following healthcare legislation and the goals of MMRP. They had to deal with ethical dilemmas as well as decide what constitutes good results.

    Study III: Aim: To explore patients’ experiences of participating in MMRP in primary care. Design: Individual interviews, analysed with qualitative content analysis. Method: Twelve former patients (7 women and 5 men) were interviewed about their experiences of MMRP in primary care. Result: Patients in primary care experienced a complex, ongoing process of accepting chronic pain. Obtaining redress, learning about chronic pain, and experiencing fellowship with others with the same condition contributed to the acceptance process.

    Study IV: Aim: To evaluate the effects of MMRP in primary care at one-year follow-up for all patients together and for men and women separately and to identify predictive factors for being employable at follow-up. Design: Prospective longitudinal cohort study. Method: Pain, physical and emotional functioning, coping, health-related quality of life, work-related factors, sick leave extent and sickness compensation were evaluated prior to and one year after MMRP in 234 patients, 34 men and 200 women. Result: All patients improved significantly in most measures at one-year follow-up, and the effect was larger in women. Sick leave decreased while no significant difference was found for total sickness compensation. Patients’ self-reported rating of current work ability before MMRP was significantly associated with being employable at follow-up.

    General conclusions and implications: 

    MMRP seems to be effective for patients with chronic musculoskeletal pain, both in specialist care and in primary care. MMRP was more effective for women than for men, and the reasons for this need to be investigated further. An interdisciplinary team assessment could also be beneficial for decreasing pain and pain-related measures. Patients in primary care experience a complex, ongoing process of accepting chronic pain. Healthcare professionals have to deal with conflicting emotions with regard to different commitments from healthcare legislation and the goals of MMRP.                         

  • 126.
    Pietilä Holmner, Elisabeth
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    The effects of interdisciplinary team assessment and a rehabilitation program for patients with chronic pain2013Inngår i: American Journal of Physical Medicine & Rehabilitation, ISSN 0894-9115, E-ISSN 1537-7385, Vol. 92, nr 1, s. 77-83Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim of this study was to evaluate the effects of interdisciplinary team assessment and a 4-wk rehabilitation program in chronic pain patients.

    Design: This was a longitudinal cohort study evaluating interdisciplinary pain rehabilitation measures in a specialist care setting. A total of 93 women (42.2 +/- 9.5 yrs) with chronic musculoskeletal pain (median pain duration, 8 yrs) were evaluated at assessment and at the start and end of the rehabilitation program. Pain intensity measured with a visual analog scale, pain dimensions measured with the Multidimensional Pain Inventory, and anxiety and depression measured with the Hospital Anxiety and Depression Scale were registered.

    Results: The participants exhibited significantly improved results of pain and pain-related measures. The results were seen both after the short-term intervention in the form of the interdisciplinary assessment and after the 4-wk rehabilitation program. The improvements seen after the assessment were not related to specific interventions, such as change of medication, and therefore seem to be a result of the interdisciplinary assessment concept as such.

    Conclusions: Both interdisciplinary assessment and rehabilitation program seem to be effective in chronic pain rehabilitation, at least for women. Further studies are needed to investigate potential sex differences, as well as content and duration for optimal pain rehabilitation programs.

  • 127.
    Pietilä Holmner, Elisabeth
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Enthoven, Paul
    Stenberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    "The acceptance" of living with chronic pain – an ongoing process: A qualitative study of patient experiences of multimodal rehabilitation in primary care2018Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50, nr 1, s. 73-79Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To explore patient experiences of participating in multimodal pain rehabilitation in primary care.

    SUBJECTS: Twelve former patients (7 women and 5 men) in multimodal rehabilitation in primary care were interviewed about their experiences of multimodal rehabilitation.

    METHODS: The interviews were analysed using qualitative content analysis.

    RESULTS: Analysis resulted in 4 categories: (i) from discredited towards obtaining redress; (ii) from uncertainty towards knowledge; (iii) from loneliness towards togetherness; and (iv) "acceptance of pain": an ongoing process. The results show that having obtained redress, to obtain knowledge about chronic pain, and to experience fellowship with others with the same condition were helpful in the acceptance process. However, there were patients who found it difficult to reconcile themselves with a life with chronic pain after multimodal rehabilitation. To find what was "wrong" and to have a medical diagnosis and cure were important.

    CONCLUSION: Patients in primary care multimodal rehabilitation experience a complex, ongoing process of accepting chronic pain. Four important categories were described. These findings will help others to understand the experience and perspective of patients with chronic pain who engage in multimodal rehabilitation.

  • 128.
    Pinto, Susana
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Faculdade de Medicina, Instituto de Fisiologia e Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal; Department of Neurosciences and Mental Health, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte, Lisbon, Portugal.
    de Carvalho, Mamede
    SVC Is a Marker of Respiratory Decline Function, Similar to FVC , in Patients With ALS2019Inngår i: Frontiers in Neurology, ISSN 1664-2295, E-ISSN 1664-2295, Vol. 10, artikkel-id 109Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Respiratory function is a critical predictor of survival in amyotrophic lateral sclerosis (ALS). We aimed to determine if slow vital capacity (SVC) is a predictor of functional loss in ALS as compared to forced vital capacity (FVC). Methods: Consecutive ALS patients in whom respiratory tests were performed at baseline and 6 months later were included. All patients were evaluated with revised ALS functional rating scale (ALSFRS-R) and the respiratory tests, SVC, and FVC. Significant independent variables of functional decay were assessed by univariate Kaplan-Meier log-rank test and multivariate Cox proportional hazards model. A monthly decay not exceeding 0.92 in ALSFRS was considered as the time event. Results: We included 232 patients (134 men; mean onset-age 59.1 +/- 11.23 years; mean disease duration from first symptoms to first visit: 14.5 +/- 12.9 months; 166 spinal and 66 bulbar onset). All variables studied declined significantly between the two evaluations (p < 0.001). FVC and SVC were strongly correlated at study entry (r2 = 0.98, p < 0.001) and FVC and SVC decays between first evaluation and 6 months after were the only significant prognostic variables of functional decay (p < 0.001). Conclusion: FVC and SVC decay are inter-changeable in predicting functional decay in ALS. Pharmacological interventions reducing the decline rate of FVC and SVC can have a positive impact on the global functional impairment, with relevant implications for clinical trials' design and interpretation.

  • 129.
    Reine, Ieva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Novo, Mehmed
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Hammarström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Unemployment and ill health - a gender analysis: results from a 14-year follow-up of the Northern Swedish cohort2013Inngår i: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 127, nr 3, s. 214-222Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives. To investigate the experience of suicidal expressions (death wishes, life weariness, ideation, plans and attempts) in young Swedish Sami, their attitudes toward suicide (ATTS), and experience of suicidal expressions and completed suicide in significant others and to compare with Swedes in general. Methods. A cross-sectional study comprising 516 Swedish Sami, 18-28 years of age together with an age and geographically matched reference group (n = 218). Parts of the ATTS questionnaire have been used to cover different aspects of the suicidal complex. Data were analysed with regard to gender, occupation, counties and experience of negative societal treatment due to Sami background. Results. Both young Sami and young Swedes reported suicidal ideation, life weariness, and death wishes in a high degree (30-50%), but it was more common among the Sami. Having had plans to commit suicide showed a significant gender difference only in the Sami. The prevalence of suicide attempts did not differ significantly between Sami and Swedes. Subgroups of the Sami reported a higher degree of suicidal behaviour, Sami women and reindeer herders reported a 3, 5-fold higher odds of suicide attempts and a 2-fold higher odds having had plans committing suicide. Sami living in Vasterbotten/Jamtland/Vasternorrland and Sami with experience of ethnicity related bad treatment 2-fold higher odds of suicidal plans compared to those living in other counties. Conclusion. An increased occurrence of suicidal ideation/death wishes/life weariness in young Sami compared to young majority Swedes was found, but not an increased prevalence of suicide attempts and positive attitudes together with an increased awareness to handle suicide problems could be a contributing factor. Severe circumstances and experience of ethnicity-related bad treatment seems to contribute to increased levels of suicidal plans and attempts in subgroups of Sami.

  • 130.
    Reine, Ieva
    et al.
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Allmänmedicin.
    Novo, Mehmed
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Allmänmedicin. Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Hammarström, Anne
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Allmänmedicin.
    Does the association between ill health and unemployment differ between young people and adults?: results from a 14-year follow-up study with a focus on psychological health and smoking2004Inngår i: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 118, nr 5, s. 337-345Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives. Research has given a comprehensive picture of the negative health consequences of unemployment without offering sufficient comparison between different age groups.

    The aim of this study was to analyse whether the associations between ill health, particularly poor psychological health and smoking, and unemployment differ between young and adult men and women.

    Study design. A 14-year follow-up study of graduates of compulsory school in an industrial town in northern Sweden was undertaken. The subjects were analysed at ages 16, 21 and 30 years. Complete data on the cohort were collected for 1044 individuals with the aid of a comprehensive questionnaire. The response rate was 96.4%.

    Methods. The main health measurements used in this study were poor psychological health and smoking, analysed by multivariate logistic regression.

    Results. After controlling for several background variables, associations between long-term unemployment and poor psychological health were found in young men and women, and adult men. Long-term unemployment was only associated with smoking inyoung people.

    Conclusions. The association between long-term unemployment and psychological health, as well as smoking, seemed to be stronger in young people than adults.

  • 131.
    Reine, Ieva
    et al.
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Allmänmedicin.
    Novo, Mehmed
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Allmänmedicin. Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Hammarström, Anne
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Allmänmedicin.
    Does transition from an unstable labour market position to permanent employment protect mental health?: results from a 14-year follow-up of school-leavers2008Inngår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 8, nr 159Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Having secure employment, in contrast to being unemployed, is regarded as an important determinant of health. Research and theories about the negative health consequences of unemployment indicated that transition from unemployment to a paid job could lead to improved health. The objective of this study was to test the hypothesis that obtaining permanent employment after being in an unstable labour market position protects mental health.

    Methods: A 14-year follow-up of all graduates from compulsory school in an industrial town in northern Sweden was performed at ages 16, 18, 21 and 30 years. Complete data on the cohort were collected for 1044 individuals with the aid of a comprehensive questionnaire. The response rate was 96.4%. The health measurement used in this study was the psychological symptoms analysed by multivariate logistic regression. Those who obtained permanent employment were the focus of the analysis. This group consisted of people who were in an unstable labour market position for a year or more between the ages of 25 and 29, and who had acquired a permanent job one year before and at the time of the investigation.

    Results: After controlling for gender as well as for an indicator of health-related selection, possible confounders and mediators, an association was found between the lower probability of psychological symptoms and obtaining permanent employment (OR = 0.35, 95% CI 0.19–0.63) as well as having permanent employment (OR = 0.22, 95% CI 0.10–0.51).

    Conclusion: Our findings suggest that transition from an unstable labour market position topermanent employment could be health-promoting, even after controlling for possible confounders and mediators, as well as for an indicator of health-related selection. However, as there are few studies in the field, there is a need for more longitudinal studies in order to further analyse the relationship and to examine possible explanations. The policy implication of our study is that the transformation of unstable labour market positions into permanent employment could contribute to better public health.

  • 132.
    Reine, Ieva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Novo, Mehmed
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Hammarström, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Is participation in labour market programmes related to mental health?: results from a 14-year follow-up of the Northern Swedish cohort2011Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, nr 1, s. 26-34Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: There is a lack of empirical studies assessing the possible impact of active labour market programmes (ALMP) on health. The aim of this study was to analyze whether participation in ALMP, in contrast to being unemployed and not participating in ALMP (UNALMP), was related to mental health at different ages.

    Methods: The study was carried out in a medium-sized industrial town in the north of Sweden. The cohort, consisting of all 1,083 pupils who attended or should have attended the last year of compulsory school in 1981, was followed up at the ages of 16, 18, 21 and 30. Data on 381 individuals at age 21, and 281 at age 30 were used in the study. The main health measurement was psychological symptoms among participants of ALMP in contrast to UNALMP at ages 21 and 30, and was analyzed by propensity score matching method (PSM) and multivariate logistic regression.

    Results: Generally, ALMP had higher scores of psychological symptoms than UNALMP. Nevertheless, participation in ALMP was not related to mental health. Due to methodological shortages our results have to be interpreted with caution. Adjustment for either all background selection variables or the propensity score in multivariate logistic regression showed similar associations, suggesting that propensity score could be used to adjust for background selection variables.

    Conclusions: There is a need for more well-designed studies, using a theoretical framework, within the field, that are based on larger samples.

  • 133.
    Ring, Louise
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Multimodal rehabilitation in primary health care for patients with Ehlers-Danlos Syndrome and hypermobility syndrome. - A pilot study2018Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 134. Rivano Fischer, Marcelo
    et al.
    Persson, Elisabeth B.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Karolinska Institutet, Department of Clinical Sciences, Division of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden.
    Schult, Marie-Louise
    Lofgren, Monika
    Return to work after interdisciplinary pain rehabilitation: one- and two-year follow-up study based on the Swedish quality registry for pain rehabiliation2019Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 51, nr 4, s. 281-289Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To investigate: (1) changes in sick-leave benefits from 1 year prior to multimodal rehabilitation to 1 and 2 years after rehabilitation; (ii) sex differences in sick leave; and (iii) the impact of policy changes on sick leave.

    Methods: All patients undergoing multimodal rehabilitation registered in a national pain database for 2007-11 (n = 7,297) were linked to the Swedish Social Insurance Agency database. Sick leave was analysed in 3-month periods: T0: 1 year before rehabilitation; T1: before start; T2: 1 year after; and T3: 2 years after rehabilitation. Four sick-leave benefit categories were constructed: no sick leave, part-time sick leave, full-time sick leave, and full-time permanent sick leave. The individual change in sick-leave category at each time-period was analysed.

    Results: Sick-leave benefits increased from T0 to T1 (p <0.001) and decreased from T1 to T3 (p < 0.001). Reductions were significant for both men and women from T1 to T3, but men had less sick-leave benefits at T2 and T3. Positive changes in sick-leave benefits at T2 and T3 were found both prior to and after policy changes, with less sick-leave benefits after policy changes at all time-points.

    Conclusion: Multimodal rehabilitation may positively influence sick-leave benefits for patients with chronic pain, regardless of their sick-leave situation, sex or policy changes.

  • 135.
    Sjölund, Bengt H
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Persson, Ann L
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Pressure pain threshold changes after repeated mechano-nociceptive stimulation of the trapezius muscle: possible influence of previous pain experience2007Inngår i: Journal of Pain, ISSN 1526-5900, E-ISSN 1528-8447, Vol. 8, nr 4, s. 355-362Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We examined the relation between repeated noxious pressure over the trapezius muscle and changes in pressure pain thresholds (PPTs) in a before-after trial design. A conditioning series of 30 mechano-nociceptive stimuli was applied manually with a handheld algometer probe, and PPTs were measured over 1 trapezius muscle (skin anaesthetized) in 27 healthy women before and after the intervention. With a mean stimulation rate of 0.40 Hz and a mean nociceptive stimulation intensity of 1.78 x Threshold, subjects were found to systematically react with a change in PPT, either a decrease or an increase. Normalized data, transformed into mean unidirectional PPT differences, showed statistically highly significant changes after intervention. The relative risk of reacting with lowered PPTs on noxious stimulation was 3.7 times higher for subjects who had not given birth to children than for subjects who had given birth to 1 or several children (P <.046). When 11 subjects were tested at a second session, a clear correlation of PPT reactions (r = 0.527; P <.001) was found. In summary, repetitive mechano-nociceptive stimulation of the trapezius muscle in healthy females evokes moderate and temporary changes in PPT that last for at least 35 minutes after cessation of stimulation. Perspective: A possible development of the response with transiently decreased PPTs into a model for human muscle pain is an intriguing possibility, since other models usually involve the introduction of chemical or thermal agents in the muscle, but this must await further research.

  • 136.
    Sojka, Peter
    et al.
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Grimby, Gunnar
    Muskelfunktion och condition - mätning och träning2006Inngår i: Rehabiliteringsmedicin: Teori och praktik, Studentlitteratur, , 2006, s. 48-58Kapittel i bok, del av antologi (Annet (populærvitenskap, debatt, mm))
  • 137.
    Sojka, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Normala fynd vid datortomografi utesluter inte CNS-skada1999Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 96, nr 6, s. 616-Artikkel i tidsskrift (Fagfellevurdert)
  • 138.
    Spinord, Linda
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Department of Research, Region Norrbotten, Luleå.
    Kassberg, Ann-Charlotte
    Stenberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Lundqvist, Robert
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Comparison of two multimodal pain rehabilitation programmes, in relation to sex and age2018Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50, nr 7, s. 619-628Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To evaluate patient-reported outcome measures in 2 different multimodal pain rehabilitation programmes and to determine whether outcomes are related to sex or age at 1-year follow-up.

    Design: Longitudinal retrospective study.

    Subjects: Patients who had participated in 1 of 2 multimodal pain rehabilitation programmes at 2 rehabilitation centres. A total of 356 women and 83 men, divided into 3 age groups.

    Methods: Data from the Swedish Quality Registry for Pain Rehabilitation regarding activity and physical functions, pain intensity, health status and emotional functions analysed with descriptive statistics.

    Results: Significant improvements in activity and physical functions, pain intensity and emotional functions were found in both multimodal pain rehabilitation programmes. Women improved more than men. The older group improved in all emotional functions (depression, anxiety, mental component summary), while the younger group improved only in depression. The intermediate group improved in all variables except anxiety.

    Conclusion: Patients improved regardless of the design of the multimodal pain rehabilitation programme. Although only small differences were found between men and women and among the 3 age groups in terms of the measured variables, these findings may have clinical relevance and indicate a need to vary the design of the interventions in multimodal rehabilitation programmes for these subgroups.

  • 139.
    Starnberg, Nils
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Kognitiva nedsättningar hos strokepatienter under akutskedet2015Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 140.
    Stenberg, Gunilla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Henje, Catharina
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Designhögskolan vid Umeå universitet.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Lindström, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Arbetsterapi.
    Living with an electric wheelchair: the user perspective2016Inngår i: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 11, nr 5, s. 385-394Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To explore the experiences of using an electric wheelchair in daily living. Methods: Fifteen participants, eight women and seven men, living in different parts of a Nordic country were interviewed. The interviews were conducted in the home or at the workplace. Open-ended questions were used. The data were collected and analyzed according to the grounded theory. Results: Analysis resulted in one core category: "Integrating the electric wheelchair - a manifold process", describing a process commencing from initial resistance against use of an electric wheelchair, to acceptance with various extent of integration. Six categories emerged that represent this core process: incorporating the electric wheelchair into the self-identity process, calculating functional consequences, encountering the reactions of others, facing duality in movability, using proactive strategies, and being at the mercy of the system. Findings indicate that the integration process is complex and manifold. Practical, personal, and social dimensions were intertwined and significantly involved. Conclusions: Integrating an electric wheelchair is a process closely connected to symbolic value, usability, community mobility and identity. These aspects should be considered in the production, prescription, and adaptation processes. Implications for Rehabilitation Integrating an electric wheelchair is a process closely connected to symbolic value, usability, community mobility, and identity. These aspects should be considered in the wheelchair production, prescription, and adaptation processes.

  • 141.
    Stenberg, Gunilla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Holmner, Elisabeth Pietilä
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Enthoven, Paul
    Healthcare professional experiences with patients who participate in multimodal pain rehabilitation in primary care: a qualitative study2016Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, nr 21, s. 2085-2094Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: Exploring healthcare professional experiences of Multimodal rehabilitation (MMR) in primary care.

    Methods: Fourteen healthcare professionals (11 women, 3 men) were individually interviewed about their work with MMR in primary care. Interviews covered experiences of assessing patients and work with patients in the programme. Transcribed interviews were analysed by qualitative content analysis.

    Results: The analysis resulted in four categories: select patients for success; a multilevel challenge; ethical dilemmas and considering what is a good result. MMR work was experienced as useful and efficient, but also challenging because of patient complexity. Preconceptions about who is a suitable patient for MMR influenced the selection of patients (e.g. gender, different culture). Interviewees were conflicted about not to being able to offer MMR to patients who were not going to return to work. They thought that there were more factors to evaluate MMR than by the proportion that return to work.

    Conclusions: Healthcare professionals perceive MMR as a helpful method for treating chronic pain patients. At the same time, they thought that only including patients who would return to work conflicted with their ethical views on equal healthcare for all patients. Preconceptions can influence selection for, and work with, MMR.

  • 142.
    Stenberg, Gunilla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Enthoven, Paul
    Implementing multimodal pain rehabilitation in primary care: a health care professional perspective2017Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 39, nr 21, s. 2173-2181Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To explore professional perspectives on how to start and work with multimodal pain rehabilitation within primary healthcare. Methods: Fourteen healthcare professionals (11 women, 3 men) were individually interviewed about their experiences of starting and working with multimodal pain. Interviews were transcribed and analyzed by qualitative content analysis. This study was part of a larger project, which aimed at evaluating multimodal pain rehabilitation in primary care. Results: The analysis resulted in six categories. Two categories were about management engagement: putting the focus on rehabilitation and creating appropriate conditions. Three were about professional engagement: importance of driving spirits, creating a program - a process, and good teamwork - not a coincidence. The last category was about professional gain from multimodal rehabilitation (MMR): team work is enriching. Conclusions: To enable implementation of MMR in primary care, managers on all organizational levels must take responsibility for allowing rehabilitation to be a priority. A driving spirit among the professionals facilitates the start, but the entire team is important when processing a program. Creating good teamwork requires hard work, e.g., negotiations for consensus about rehabilitation, and assumption of responsibility by each team member. Collaboration between professionals was perceived to strengthen and enhance knowledge about the patients.

  • 143.
    Stenberg, Maud
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Severe traumatic brain injury: clinical course and prognostic factors2016Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Traumatic brain injury (TBI) constitutes a major health problem and is a leading cause of long-term disability and death. Patients with severe traumatic brain injury, S-TBI, comprise a heterogeneous group with varying complexity and prognosis. The primary aim of this thesis was to increase knowledge about clinical course and outcome with regard to prognostic factors. Papers I, II and III were based on data from a prospective multicentre observational study from six neurotrauma centers (NCs) in Sweden and Iceland of patients (n=103-114), 18-65 years with S-TBI requiring neurosurgical intensive care or collaborative care with a neurosurgeon (the “PROBRAIN” study).  Paper IV and V were performed on a regional subset (n=37).

    In Paper I, patients with posttraumatic disorders of consciousness (DOC) were assessed as regards relationship between conscious state at 3 weeks and outcomes at 1 year. The number of patients who emerged from minimally conscious state (EMCS) 1 year after injury according to status at 3 weeks were: coma (0/6), unresponsive wakeful syndrome (UWS) (9/17), minimally conscious state (MCS) (13/13), anaesthetized (9/11). Outcome at 1 year was good (Glasgow Outcome Scale Extended (GOSE>4) in half of the patients in MCS (or anaesthetized) at 3 weeks, but not for any of the patients in coma or UWS.  

     In Paper II, the relationships between clinical care descriptors and outcome at 1 year were assessed. A longer length of stay in intensive care, and longer time between discharge from intensive care and admission to inpatient rehabilitation, were both associated with a worse outcome on the GOSE. The number of intervening care units between intensive care and rehabilitation, was not significantly associated with outcome at 1 year.

     In Paper III, the clinical course of cognitive and emotional impairments as reflected in the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) and the Hospital Anxiety and Depression Scale (HADS) were assessed from 3 weeks to 1 year together with associations with outcomes GOSE and Rancho Los Amigos Cognitive Scale-Revised (RLAS-R) at 1 year. Cognition improved over time and appeared to be stable from 3 months to 1 year.

     In Paper IV, clinical parameters, the clinical pathways from injury to 3 months after discharge from the NC in relation to outcomes 3 months post-injury. Ratings on the RLAS-R improved significantly over time. Eight patients had both “superior cognitive functioning” on the RLAS-R and “favourable outcome” on the GOSE. Acute transfers to the one regional NC was direct and swift, transfers for postacute rehabilitation scattered patients to many hospitals/hospital departments, not seldom by several transitional stages.

     In Paper V, an initial computerized tomography of the brain (CTi) and a further posttraumatic brain CT after 24 hours (CT24) were evaluated according to protocols for standardized assessment, the Marshall and Rotterdam classifications. The CT scores only correlated with clinical outcome measures (GOSE and RLAS-R) at 3 months, but failed to yield prognostic information regarding outcome at 1 year. A prognostic model was also implemented, based on acute data (CRASH model). This model predicted unfavourable outcomes for 81% of patients with bad outcome and for 85% of patients with favourable outcome according to GOSE at 1 year. When assessing outcomes per se, both GOSE and RLAS-R improved significantly from 3 months to 1 year.

     The papers in this study point both to the generally favourable outcomes that result from active and aggressive management of S-TBI, while also underscore our current lack of reliable instruments for outcome prediction. In the absence of an ability to select patients based on prognostication, the overall favourable prognosis lends support for providing active rehabilitation to all patients with S-TBI. The results of these studies should be considered in conjunction with the prognosis of long-term outcomes and the planning of rehabilitation and care pathways. The results demonstrate the importance of a combination of active, acute neurotrauma care and intensive specialized neurorehabilitation with follow-up for these severely injured patients.

  • 144.
    Stenberg, Maud
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Godbolt, Alison K.
    Nygren De Boussard, Catharina
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Cognitive impairment after severe traumatic brain injury, clinical course and impact on outcome: a Swedish-Icelandic study2015Inngår i: Behavioural Neurology, ISSN 0953-4180, E-ISSN 1875-8584, artikkel-id 680308Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. To assess the clinical course of cognitive and emotional impairments in patients with severe TBI (sTBI) from 3 weeks to 1 year after trauma and to study associations with outcomes at 1 year.

    Methods. Prospective, multicenter, observational study of sTBI in Sweden and Iceland. Patients aged 18-65 years with acute Glasgow Coma Scale 3-8 were assessed with the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) and the Hospital Anxiety and Depression Scale (HADS). Outcome measures were Glasgow Outcome Scale Extended (GOSE) and Rancho Los Amigos Cognitive Scale-Revised (RLAS-R).

    Results. Cognition was assessed with the BNIS assessed for 42 patients out of 100 at 3 weeks, 75 patients at 3 months, and 78 patients at 1 year. Cognition improved over time, especially from 3 weeks to 3 months. The BNIS subscales "orientation" and "visuospatial and visual problem solving" were associated with the GOSE and RLAS-R at 1 year.

    Conclusion. Cognition seemed to improve over time after sTBI and appeared to be rather stable from 3 months to 1 year. Since cognitive function was associated with outcomes, these results indicate that early screening of cognitive function could be of importance for rehabilitation planning in a clinical setting.

  • 145.
    Stenberg, Maud
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Koskinen, Lars-Owe D
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Neurokirurgi.
    Jonasson, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Levi, Richard
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Computed tomography and clinical outcome in patients with severe traumatic brain injuryManuskript (preprint) (Annet vitenskapelig)
  • 146.
    Stenberg, Maud
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Koskinen, Lars-Owe D
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
    Jonasson, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Levi, Richard
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Department of Clinical Sciences, Danderyd University Hospital, Division of Rehabilitation Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden.
    Computed tomography and clinical outcome in patients with severe traumatic brain injury2017Inngår i: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 31, nr 3, s. 351-358Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To study: (i) acute computed tomography (CT) characteristics and clinical outcome; (ii) clinical course and (iii) Corticosteroid Randomisation after Significant Head Injury acute calculator protocol (CRASH) model and clinical outcome in patients with severe traumatic brain injury (sTBI).

    METHODS: Initial CT (CTi) and CT 24 hours post-trauma (CT24) were evaluated according to Marshall and Rotterdam classifications. Rancho Los Amigos Cognitive Scale-Revised (RLAS-R) and Glasgow Outcome Scale Extended (GOSE) were assessed at three months and one year post-trauma. The prognostic value of the CRASH model was evaluated.

    RESULTS: Thirty-seven patients were included. Marshall CTi and CT24 were significantly correlated with RLAS-R at three months. Rotterdam CT24 was significantly correlated with GOSE at three months. RLAS-R and the GOSE improved significantly from three months to one year. CRASH predicted unfavourable outcome at six months for 81% of patients with bad outcome and for 85% of patients with favourable outcome according to GOSE at one year.

    CONCLUSION: Neither CT nor CRASH yielded clinically useful predictions of outcome at one year post-injury. The study showed encouragingly many instances of significant recovery in this population of sTBI. The combination of lack of reliable prognostic indicators and favourable outcomes supports the case for intensive acute management and rehabilitation as the default protocol in the cases of sTBI.

  • 147.
    Stenberg, Maud
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Koskinen, Lars-Owe D
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Severe traumatic brain injuries in Northern Sweden: a prospective 2-year study2013Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, nr 8, s. 792-800Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    To assess: (i) the clinical characteristics and injury descriptors of patients with severe traumatic brain injury in Northern Sweden admitted to the single Neurotrauma Center (NC) serving this region; (ii) the care pathway of patients from injury to 3 months after discharge from the NC; and (iii) the outcomes at 3 months post-injury. Population-based prospective 2-year cohort study.Patients age 17–65 years with acute severe traumatic brain injury, lowest non-sedated Glasgow Coma Scale (GCS) score of 3–8 within 24 h post-trauma. Patients were treated according to an intracranial pressure-oriented protocol based on the Lund concept at the NC. They were assessed at 3 weeks after injury with Rancho Los Amigos Cognitive Scale Revised (RLAS-R), Levels of Cognitive functioning, and at 3 months with RLAS-R and Glasgow Outcome Scale Extended (GOSE).A total of 37 patients were included. Hospital deaths within 3 months post-injury occurred in 5 patients. After 3 months the RLAS-R scores were significantly improved (< 0.001). Eight patients had both “superior cognitive functioning” on the RLAS-R and “favourable outcome” on the GOSE. Thirty-four patients (92%) were directly admitted to the NC. By contrast, after discharge patients were transferred back to one of several county hospitals or to one of several local hospitals, and some had multiple transfers between different hospitals and departments. Overall outcomes were surprisingly good in this group of severely injured patients. The routines for transferring patients with severe traumatic brain injury from a geographically large, sparsely populated region to a regional NC to receive well-monitored neurosurgical care seem to work very well. The post-acute clinical pathways are less clearly reflecting an optimized medical and rehabilitative strategy.

  • 148.
    Stenberg, Maud
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Family Illness Trajectory During Seven Years After A Severe Traumatic Brain Injury-Family Interviews2019Inngår i: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 33, s. 147-147Artikkel i tidsskrift (Annet vitenskapelig)
  • 149.
    Stenberg, Maud
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Long-Term Follow-Up Observation Study 7 Years after Severe Traumatic Brain Injury in Northern Sweden2019Inngår i: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 33, s. 161-161Artikkel i tidsskrift (Annet vitenskapelig)
  • 150.
    Sterner, Ylva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Toolanen, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Hildingsson, Christer
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    The incidence of whiplash trauma and the effects of different factors on recovery2003Inngår i: Journal of Spinal Disorders & Techniques, ISSN 1536-0652, E-ISSN 1539-2465, nr 2, s. 195-199Artikkel i tidsskrift (Fagfellevurdert)
12345 101 - 150 of 212
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