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  • 151.
    Sterner, Ylva
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Toolanen, Göran
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Hildingsson, Christer
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    The incidence of whiplash trauma and the effects of different factors on recovery2003In: Journal of Spinal Disorders & Techniques, ISSN 1536-0652, E-ISSN 1539-2465, no 2, p. 195-199Article in journal (Refereed)
  • 152.
    Styrke, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Sojka, Peter
    Institutionen för Hälsovetenskap, Mittuniversitetet.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Bylund, Per-Olof
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Akut- och Katastrofmedicinskt Centrum, Norrlands Universitetssjukhus.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Sex-differences in symptoms, disability, and life satisfaction three years after mild traumatic brain injury: a population-based cohort study2013In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, no 8, p. 749-757Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate sex differences in symptoms, structure of symptoms, disability and life satisfaction 3 years after mild traumatic brain injury. Secondary aims were to find risk factors for adverse outcome.

    DESIGN: Population-based cohort study.Patients: The cohort comprised 137,000 inhabitants at risk in a defined population served by a single hospital in northern Sweden. Patients attending the emergency department following a mild traumatic brain injury in 2001 were included.

    METHODS: Of 214 patients aged 18–64 years, 163 answered a questionnaire on symptoms, disability, and life-satisfaction 3 years post-injury. The instruments were analysed with descriptive statistics. A principal component analysis of the Rivermead Post-Concussion Symptoms Questionnaire was conducted. Risk factors were identified using logistic regression.

    RESULTS: Post-concussion syndrome was found in 50% of the women and 30% of the men. Disability was found in 52% of the women and 37% of the men, and 57% of the women and 56% of the men were satisfied with their lives. For both genders, high frequency of symptoms was a risk factor for disability and low life satisfaction. Back pain was a risk factor for disability. Living alone was a risk factor for low levels of life satisfaction. The principal component analysis revealed differences between the sexes.

    CONCLUSION: There are sex differences in outcome 3 years after mild traumatic brain injury. Women and men should be analysed separately.

  • 153.
    Styrke, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Sojka, Peter
    Institutionen för Hälsovetenskap, Mittuniversitetet.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Symptoms, disability, and life satisfaction five years after whiplash injuries: a population-based cohort studyArticle in journal (Refereed)
    Abstract [en]

    Objective

    To study symptoms and disabilities five years after participants sustained whiplash injuries using questionnaires designed for mild traumatic brain injury. A second aim was to study life satisfaction and a third aim was to investigate differences between women and men regarding these variables.

    Design

    Population-based cohort study

    Methods

    In total 186 persons (100 women and 86 men) aged 18-64 answered questionnaires on pain intensity (Visual Analogue Scale) symptoms (Rivermead Post Concussion Symptoms Questionnaire, RPQ), disabilities (Rivermead Head Injury Follow Up Questionnaire RHFUQ) and life satisfaction (LiSat-11) five years post injury.

    Results

    The most common symptoms reported on the RPQ were fatigue (41%), poor memory (39%), and headache (37%). The presence of three symptoms or more was reported by 54% of the women and 50% of the men. Inability to sustain previous workload (44%) and fatigue at work (43%) were the most frequently reported disabilities on the RHFUQ. Only 39% were satisfied with their somatic health and 60% with their mental health. Women reported significantly higher pain intensity than men. No significant differences between women and men regarding symptoms, disabilities, and life satisfaction were found.

    Conclusion

    These findings highlight the importance of assessing and quantifying symptoms in addition to neck pain in persons with long-term problems after whiplash injury and may provide a possibility to identify subgroups to tailor rehabilitation interventions. The high proportions of disability and low life satisfaction have to be taken into account when managing persons with chronic whiplash associated disorder. 

  • 154.
    Styrke, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Bylund, Per-Olof
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Akut- och Katastrofmedicinskt Centrum, Norrlands Universitetssjukhus.
    Sojka, Peter
    Institutionen för Hälsovetenskap, Mittuniversitetet.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    A 10-year incidence of acute whiplash injuries after road traffic crashes in a defined population in Northern Sweden2012In: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 4, no 10, p. 739-747Article in journal (Refereed)
    Abstract [en]

    Objective

    To examine the annual incidence of acute whiplash injuries after road traffic crashes in a geographic catchment area in Northern Sweden during the period 2000-2009.

    Design

    Descriptive epidemiology determined by prospectively collected data from a defined population.

    Setting

    The study was conducted at a public hospital in Sweden.

    Participants

    The population of the hospital's catchment area (136,600 inhabitants in 1999 and 144,500 in 2009).

    Methods

    At the emergency department, all injured persons (approximately 11,000 per year) were asked to answer a questionnaire about the injury incident. Data from the medical records also were analyzed. From 2000-2009, 15,506 persons were injured in vehicle crashes. Persons who were subject to an acute neck injury within whiplash-associated disorder grades 1-3 were included. The overall and annual incidences were calculated as incidence. Age, gender, type of injury event, and direction of impact were described. The incidences were compared with national statistics on insurance claims from 2003, 2007, and 2008 to detect changes in the proportions of claims.

    Main Outcome Measures

    The annual incidence of acute whiplash injuries. Secondary outcome measures were types of injury events, age and gender distribution, changes in the proportion of rear-end crashes during 2000-2009, and changes in the proportion of insurance claims during 2003-2008.

    Results

    During 2000-2009, 3297 cases of acute whiplash injury were encountered. The overall incidence was 235/100,000/year. The average yearly increase in incidence was 1.0%. Women comprised 51.9% and men 48.1% of the injured. Car occupants (86.4%) and bicycle riders (6.1%) were most frequently injured. The proportion of rear-end crashes decreased from 55% to 45% from 2000-2009. The proportion of insurance claims significantly decreased between 2003 and 2008 (P < .0001, χ2 test).

    Conclusion

    The incidence of emergency department visits attributable to acute whiplash injuries after road traffic crashes have been relatively stable during the past decade in our area, except in 2007 and 2008, when a peak occurred.

  • 155.
    Styrke, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Bylund, Per-Olof
    Sojka, Peter
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Neck injury after whiplash trauma in a defined population in Northern Sweden: long term sick leave and costs of low productivity2014In: Epidemiology: Open Access, ISSN 2161-1165, Vol. 4, no 4, article id 1000170Article in journal (Refereed)
    Abstract [en]

    Background: Neck injuries following whiplash trauma can lead to long-term sequelae. Population-based studies covering traffic and non-traffic whiplash trauma are rare. The aim was to describe the incidence of neck injuries following whiplash trauma during one year, from a well-defined area served by a single hospital, and the resulting long-term sick leave during a five-year follow-up. Possible risk factors for sick leave and the cost of lost productivity were also studied.

    Methods: From the injury register of Umeå University Hospital, the year 2001’s data set of soft tissue neck injuries and fractures was extracted. Those injured by whiplash trauma were included. The Swedish Social Insurance Agency provided five-year post-injury data on sick leave in 2006. Epidemiological aspects were described, a logistic regression was conducted to find risk factors for long-term sick leave, and the cost of lost productivity was calculated.

    Results: Four hundred and seventeen cases were included. The incidence was 383 per 100,000 person-year. In 14% of 18-64 year olds, sick leave was granted for more than two weeks and the median number of sick days in this group was 298. Old age, having a Whiplash Associated Disorders (WAD) grade of 1, being injured in traffic and being injured at velocity exceeding 50 km/h were significant risk factors for sick leave. A few (6%) had fractures, however, their average sick-leave time was not significantly longer than the sick leave of those with only soft tissue injuries. The cost to society for lost productivity was estimated at 4.4 million Euros during the five-year follow-up.

    Conclusion: Neck injuries following whiplash trauma arise from both traffic and non-traffic injury events and affect people of all ages. Consequently long-term sick leave occur in a minority of the patients, commonly among older persons and persons injured in traffic. The costs to society from lost productivity is high.

  • 156.
    Styrke, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Bylund, Per-Olof
    Akut- och Katastrofmedicinskt Centrum, Norrlands Universitetssjukhus.
    Sojka, Peter
    Institutionen för Hälsovetenskap, Mittuniversitetet.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Whiplash trauma: epidemiology, long-term sick leave and its' costsArticle in journal (Other academic)
    Abstract [en]

    Introduction

    Neck injuries following whiplash trauma are common and primarily caused by traffic incidents but are also caused by fall incidents and sporting mishaps. The economic consequences to society for the consequent sick leave are significant. Original studies covering all types of cervical spine injuries (WAD-grade 1-4) following whiplash trauma and the following sick leave are rare. The aim of this study was to describe the epidemiology of neck injuries caused by whiplash trauma and the resulting long-term sick leave of patients in a well-defined area who sought medical attention within a one-year period and with a five-year follow-up. Possible risk factors for sick leave and the cost of loss of productivity were also studied.

    Materials and Methods

    From the ongoing injury registration of Umeå University Hospital, the only hospital in the area, we extracted the year 2001’s data set of neck injuries (acute WAD 1-4). Those injured by whiplash trauma were included. The Swedish Social Insurance Agency provided five-year post-injury data on sick leave because of the injury in question. This is a compulsory register of all Swedes. Epidemiological aspects were described and follow-up data were analysed to find risk factors for long-term sick leave.

    Results

    The incidence was 383/100,000/year for all ages. In 14% of 18-64 year olds, sick leave was granted for more than two weeks and the median number of sick days in this group was 298. Older age, having a WAD-grade of 1, being injured in traffic crashes and being injured at velocity exceeding 50 km/h were significant risk factors for being granted sick leave. A few (6%) had more serious cervical spine injuries (WAD 4). However, their average time on sick leave was not significantly longer than the sick leave of those with WAD 1-3. The cost to society for loss of productivity was estimated at 5.6 million USD during the 5-year follow-up.

    Conclusion

    Whiplash injuries affect many people including the young. The long-term periods of sick leave described in this paper indicate individual suffering as well as a societal economic burden. Finding preventive measures is of most importance.

  • 157.
    Styrke, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Sojka, Peter
    Institutionen för Hälsovetenskap, Mittuniversitetet.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Traumatic brain injuries in a well-defined population: epidemiological aspects and severity2007In: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 24, no 9, p. 1425-1436Article in journal (Refereed)
    Abstract [en]

    The aim was to describe epidemiological and medical aspects of 449 cases of traumatic brain injury (TBI) from a well-defined geographical area with a population of 137,000 inhabitants. An episode of disturbed consciousness was a prerequisite for inclusion in the study. The incidence of TBI was 354/100,000 inhabitants. Median age was 23 years, range 0–91 years; 55% were men and 45% were women; 33% children 0–14 years, 50% adults 15–64 years, and 17% elderly persons 65–91 years old. Severity classification was based on Glasgow Coma Scale (GCS) on arrival; mild TBI 97% (GCS 13–15), moderate 1% (GCS 9–12), and severe 2% (GCS 3–8). The most common injury events were falls (55%) and vehicle-related events (30%). The percentage of falls was high among children and elderly persons but among adults vehicle-related injury events were also prominent. At least 17% of all patients were under the influence of alcohol, especially adult male bicyclists. CT was performed on 163 cases (36%) revealing 34 cases with intracranial hemorrhage (ICH) which is 21% of the examined or 8% of all the injured. The rate of ICH increased with increasing age (from 3% among children to 17% among the elderly persons) and also increased with decreasing GCS from 6% in the group of mild TBI to 60% among those with severe TBI. Attention should be directed to acute management of mild TBI in order to detect potentially dangerous ICH as well as to preventive actions against falls and vehicle related accidents.

  • 158.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Community integration, social support and life satisfaction in relation to symptoms 3 years after mild traumatic brain injury2007In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 21, no 9, p. 933-942Article in journal (Refereed)
    Abstract [en]

    PRIMARY OBJECTIVE: To investigate the relation between psychosocial functioning (community integration, life satisfaction and social support) and symptoms (post-concussion, post-traumatic stress and depression) in persons with mild traumatic brain injury (MTBI) 3 years after the trauma.

    METHODS: Population-based follow-up study of 163 patients. At follow-up, an assessment of community integration, social support, life satisfaction and symptoms was made.

    RESULTS: Total score of Community Integration Questionnaire (CIQ) was negatively correlated to total score of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ, r = -0.270, p < 0.001) and to total score of the Beck Depression Inventory (BDI, r = -0.332, p < 0.001). Life satisfaction (LiSat-11) was negatively correlated to the RPQ (r = -0.459, p < 0.001), to total score of the Impact of Event Scale (IES, r = -0.365, p < 0.001) and to the BDI (r = -0.642, p < 0.001). Low levels of life satisfaction were common at follow-up.

    CONCLUSIONS: A large proportion of the individuals with MTBI experienced both psychosocial difficulties, with low levels of life satisfaction in particular and symptoms (post-concussion, post-traumatic stress and depression) 3 years after trauma. Since the possibility of pre-injury factors contributing to the condition at follow-up cannot be ruled out, the study indicates that all these factors should be taken into consideration in the management of persons with MTBI.

  • 159.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Life satisfaction in patients with chronic pain: relation to pain intensity, disability, and psychological factors2011In: Neuropsychiatric Disease and Treatment, ISSN 1176-6328, E-ISSN 1178-2021, Vol. 7, no 1, p. 683-689Article in journal (Refereed)
  • 160.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Postconcussion symptoms in patients with injury-related chronic pain2012In: Rehabilitation Research and Practice, ISSN 2090-2867, E-ISSN 2090-2875, no 528265Article in journal (Refereed)
    Abstract [en]

    Background: Postconcussion symptoms (PCSs)—such as fatigue, headache, irritability, dizziness, and impaired memory—are commonly reported in patients who have mild traumatic brain injuries (MTBIs). Evaluation of PCS after MTBI is proposed to have a diagnostic value although it is unclear whether PCS are specific to MTBI. After whiplash injuries, patients most often complain of headaches and neck pain; the other PCS are not as closely evaluated. In patients with chronic pain because of other injuries, the presence of PCS is unclear. This study aimed to describe the frequency of PCS in patients with injury-related pain and to examine the relationships between PCS, pain, and psychological factors.

    Methods: This study collected data using questionnaires addressing PCS (Rivermead Postconcussion Questionnaire, RPQ), pain intensity (Visual Analogue Scale), depression, anxiety (Hospital, Anxiety, and Depression Scale), and posttraumatic stress (Impact of Event Scale).

    Results: Fatigue (90.7%), sleep disturbance (84.9%), headache (73.5%), poor concentration (88.2%), and poor memory (67.1%) were some of the most commonly reported PCS. Significant relationships were found between PCS and posttraumatic stress, depression, and anxiety.

    Conclusion: To optimize treatment, it is important to assess each patient’s PCS, the mechanism of injury, and factors such as posttraumatic stress and depression.

  • 161.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Post-traumatic stress, depression, and community integration a long time after whiplash injury2010In: Mental Illness, ISSN 2036-7457, E-ISSN 2036-7465, Vol. 2, no 1, p. 16-19Article in journal (Refereed)
    Abstract [en]

    Psychological factors such as post-traumatic stress and depression may play an important role in the recovery after whiplash injuries. Difficulties in psychosocial functioning with limitations in everyday life may dominate for some time after the injury. Our study therefore investigates the relationships between pain, post-traumatic stress, depression, and community integration. A set of questionnaires was answered by 191 persons (88 men, 103 women) five years after a whiplash injury to assess pain intensity (visual analogue scale, VAS), whiplash-related symptoms, post-traumatic stress (impact of event scale, IES), depression (Beck depression inventory, BDI-II), community integration (community integration questionnaire, CIQ), life satisfaction (LiSat-11). One or more depressive symptoms were reported by 74% of persons; 22% reported scores that were classified as mild to severe depression. The presence of at least one post-traumatic symptom was reported by 70% of persons, and 38% reported mild to severe stress. Total scores of community integration for women were statistically significantly higher than for men. The total VAS score was correl-ated positively to the IES (r=0.456, P less than 0.456), the BDI (r=0.646, P less than 0.001), and negatively to the CIQ (r=-0.300, P less than 0.001). These results highlight the view that a significant proportion of people experience both pain and psycho- logical difficulties for a long time after a whiplash injury. These findings should be taken into consideration in the management of subjects with chronic whiplash symptoms and may support a multi-professional rehabilitation model that integrates physical, psychological, and psychosocial factors.

  • 162.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Relationship between symptoms and psychological factors five years after whiplash injury.2009In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 41, no 5, p. 353-359Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aims of this study were: to describe the frequency of whiplash-related symptoms and psychological factors in persons 5 years after a whiplash injury; to study the relationship between symptoms and psychological factors; to examine gender differences; and to investigate the cause of sick leave. METHODS: Questionnaires addressing neck pain, pain intensity, whiplash-related symptoms, post-traumatic stress, depression, social support and life satisfaction were used. RESULTS: Neck pain was reported by 59% of subjects, whiplash-related symptoms (Rivermead Post-Concussion Symptoms Questionnaire, RPQ) by 76%, depression (Beck's Depression Inventory, BDI) by 22%, and post-traumatic stress (Impact of Event Scale, IES), by 38%. The scores of pain intensity and RPQ were correlated to BDI, IES and LiSat-11 scores. Men reported a lower level of quality of social support than women. Men reporting many symptoms also reported reduced availability of social interaction, whereas women with many symptoms reported reduced availability of attachment (i.e. lack of intimate partner, close family and friends). A multivariate logistic regression showed an association between sick leave and depression. CONCLUSION: These findings indicate the importance of assessing possible relationships between symptoms, depression and post-traumatic stress in persons with long-term problems after whiplash injury, and of treating existing symptoms, especially depression. Because social support may play a role in recovery, social relationships should also be examined.

  • 163.
    Stålnacke, Britt-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Alenius, Gerd-Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Kan hård träning och lågt energi-intag framkalla och driva anorektiskt beteende?1992In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 89, no 50, p. 4356-4358Article in journal (Refereed)
  • 164.
    Stålnacke, Britt-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Karlsson, Kurt
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Sojka, Peter
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    One-year follow-up of patients with mild traumatic brain injury: post-concussion symptoms, disabilities and life satisfaction at follow-up in relation to serum levels of S-100B and neuron-specific enolase in acute phase2005In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 37, no 5, p. 300-305Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate, in patients with mild traumatic brain injury, serum concentrations of S-100B and neurone-specific enolase in acute phase and post-concussion symptoms, disabilities and life satisfaction 1 year after the trauma.

    DESIGN: Prospective study.

    PATIENTS: Eighty-eight patients (age range 18-87 years).

    METHODS: Blood samples were taken on admission and about 7 hours later. At follow-up 15 +/- 4 months later, the patients filled in questionnaires about symptoms (Rivermead Post Concussion Symptoms), disability (Rivermead Head Injury Follow-up) and life satisfaction (LiSat-11).

    RESULTS: Concentrations of S-100B and neurone-specific enolase were regularly increased in the first blood sample. Of the 69 patients participating in the follow-up, 45% reported post-concussion symptom, 48% exhibited disability and 55% were satisfied with "life as a whole". In comparison with the "sick-leave" situation on admission to hospital, 3 patients were on sick-leave at the time of follow-up because of the head trauma. Stepwise forward logistic regression analysis revealed a statistically significant association (p<0.05) between disability and S-100B and dizziness.

    CONCLUSION: In spite of frequent persistent symptoms, disabilities and low levels of life satisfaction, the sick-leave frequency was low at follow-up. The association between S-100B and disability supports the notion that long-term consequences of a mild brain injury may partly be a result of brain tissue injury.

  • 165.
    Stålnacke, Britt-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Elgh, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Sojka, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    One-year follow-up of mild traumatic brain injury: cognition, disability and life satisfaction of patients seeking consultation.2007In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 39, no 5, p. 405-11Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate cognitive function, symptoms, disabilities and life satisfaction of patients with mild traumatic brain injury who accepted consultation one year post-trauma. Design: Prospective study. Patients: Sixty-nine patients (16 accepted the consultation offered, 53 declined). Methods: At follow-up, the patients answered questionnaires about symptoms, disabilities (RHFUQ) and life satisfaction (LiSat-11). The patients who underwent consultation and their healthy control subjects were administered a neuropsychological evaluation. Results: In the group undergoing consultation, the number of cognitive tests with outcomes below cut-off limits (–1.5 SD) was statistically significantly higher compared with a control group (21 tests in 11 patients vs 8 tests in 7 control subjects; p = 0.025). The number of patients with one or more disability was statistically significantly higher among patients with consultation than without (94% and 34%, respectively; p < 0.001). Total RHFUQ score was statistically significantly higher for the group with consultation than without (5.9 ± 3.7 and 1.1 ± 2.3, respectively, p < 0.001). The group with consultation exhibited a lower level of life satisfaction (41.5 ± 10.4 vs 45.8 ± 13.8 for the non-consulting group; p = 0.057). Conclusion: The high frequency of occurrence of disabilities and lower cognitive functioning, together with the lower level of life satisfaction, appear to characterize patients choosing consultation 1 year post-injury. This highlights the importance of offering consultation for persons suffering mild head injuries.

  • 166.
    Stålnacke, Britt-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Haukenes, Inger
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Bergen, Norway.
    Lehti, Arja
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Wiklund, Anncristine Fjellman
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Is there a gender bias in recommendations for further rehabilitation in primary care of patients with chronic pain after an interdisciplinary team assessment?2015In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, no 4, p. 365-371Article in journal (Refereed)
    Abstract [en]

    Objective: To examine potential gender bias in recommendations of further examination and rehabilitation in primary care for patients with chronic musculoskeletal pain after an interdisciplinary team assessment. Methods: The population consisted of consecutive patients (n=589 women, 262 men) referred during a 3-year period from primary healthcare for assessment by interdisciplinary teams at a pain specialist rehabilitation clinic. Patient data were collected from the Swedish Quality Registry for Pain Rehabilitation. The outcome was defined as the examination or rehabilitation that was specified in the patient's record. Results: Men had a significantly higher likelihood than women of being recommended physiotherapy and radiological examination, and the gender difference was not explained by confounding variables and covariates (age, marital status, ethnicity, education, working status, pain severity, pain interference, pain sites, anxiety and depression). There was no significant gender difference in recommendations to treatment by specialist physician, occupational therapist, psychologist or social worker. Conclusion: Our findings indicate that the interdisciplinary teams in specialist healthcare may discriminate against women with chronic pain when physiotherapy and radiological investigation are recommended. The team's choice of recommendations might be influenced by gendered attitudes, but this field of research needs to be studied further.

  • 167.
    Stålnacke, Britt-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Möller, Riitta
    Karolinska Institutet.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Visst undervisas det om smärta i Umeå och vid KI2018In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 115Article in journal (Other (popular science, discussion, etc.))
  • 168.
    Stålnacke, Britt-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Nygren-Deboussard, Catharina
    Godbolt, Alison
    af Geijerstam, Jean-Luc
    Holm, Lena
    Borg, Jörgen
    Mild traumatic brain injuries and their sequelae. II: at risk of clinical neglect?2012In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, no 11, p. 989-990Article in journal (Refereed)
  • 169.
    Stålnacke, Britt-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Ohlsson, Anna
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Tegner, Yelverton
    Department of Health Sciences, Luleå Technical University, Boden.
    Sojka, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Serum concentrations of two biochemical markers of brain tissue damage S-100B and neurone specific enolase are increased in elite female soccer players after a competitive game2006In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 40, no 4, p. 313-316Article in journal (Refereed)
    Abstract [en]

    Background: It is a matter of debate whether or not ordinary heading of the ball in soccer causes injury to brain tissue. Objective: To analyse concentrations of the biochemical markers of brain tissue damage S-100B and neurone specific enolase (NSE) in serum of female elite soccer players in association with a competitive game. Methods: Venous blood samples were obtained from 44 female soccer players before and after a competitive game for analysis. The number of headers and trauma events (falls, collisions, etc) was assessed from videotape recordings for each player. Results: Concentrations of both brain damage markers were increased after the game (S-100B, 0.18 (0.11) v 0.11 (0.05) mg/l (p = 0.000); NSE, 10.14 (1.74) v 9.05 (1.59) mg/l (p = 0.001)). There was a significant correlation between changes in S-100B concentrations and both the number of headers (r = 0.430, p = 0.004) and the number of other trauma events (r = 0.517, p < 0.001). Conclusion: The concentrations of both S-100B and NSE were increased by game associated activities and events. The increases in S-100B concentration were significantly related to the number of headers and other trauma events, which indicates that both these factors may have contributed to these increases.

  • 170.
    Stålnacke, Britt-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Stenberg, Maud
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Long-Term Follow-Up of Disability, Cognitive, and Emotional Impairments after Severe Traumatic Brain Injury2019In: Behavioural Neurology, ISSN 0953-4180, E-ISSN 1875-8584, Vol. 2019, article id 9216931Article in journal (Refereed)
    Abstract [en]

    Aim. To assess the clinical course of disability, cognitive, and emotional impairments in patients with severe TBI (s-TBI) from 3 months to up to 7 years post trauma. Methods. A prospective cohort study of s-TBI in northern Sweden was conducted. Patients aged 18-65 years with acute Glasgow Coma Scale 3-8 were assessed with the Glasgow Outcome Scale Extended (GOSE), the Hospital Anxiety and Depression Scale (HADS), and the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) at 3 months, 1 year, and 7 years after the injury. Results. The scores on both GOSE and BNIS improved significantly from 3 months (GOSE mean: 4.4 +/- 2.3, BNIS mean: 31.5 +/- 7.0) to 1 year (GOSE mean: 5.5 +/- 2.7, p=0.003, BNIS mean: 33.2 +/- 6.3, p=0.04), but no significant improvement was found from 1 year to 7 years (GOSE mean: 4.7 +/- 2.8, p=0.13, BNIS mean: 33.5 +/- 3.9, p=0.424) after the injury. The BNIS subscale "speech/language" at 1 year was significantly associated with favourable outcomes on the GOSE at 7 years (OR=2.115, CI: 1.004-4.456, p=0.049). Conclusions. These findings indicate that disability and cognition seem to improve over time after s-TBI and appear to be relatively stable from 1 year to 7 years. Since cognitive function on some of the BNIS subscales was associated with outcome on the GOSE, these results indicate that both screening and follow-up of cognitive function could be of importance for the rehabilitation of persons with s-TBI.

  • 171.
    Stålnacke, Britt-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Sojka, Peter
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Repeatedly Heading a Soccer Ball Does Not Increase Serum Levels of S-100B, a Biochemical Marker of Brain Tissue Damage: an Experimental Study.2008In: Biomarker Insights, ISSN 1177-2719, E-ISSN 1177-2719, Vol. 3, p. 87-91Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of the study was to analyse whether the controlled heading of soccer balls elicits increased serum concentrations of a biochemical marker of brain tissue damage S-100B. METHODS: Nineteen male soccer players were randomly divided into two groups, A and B. Group A headed a soccer ball falling from 18 m five times, while group B served as controls (no heading). Blood samples were taken before and 0.5 h, 2 h and 4 h after the heading for analysis of S-100B. RESULTS: No statistically significant (p > 0.05) increases in serum concentrations of S-100B were encountered in group A at 0.5 h (0.109 +/-0.024 mug/L), 2 h (0.098 +/- 0.026 mug/L), and 4 h (0.113 +/- 0.035 mug/L) when the blood samples obtained before and after the heading were compared (0.157 +/- 0.134 mug/L). No statistically significant difference was found when the serum concentrations of S-100B were compared between groups A and B either before or after heading. CONCLUSIONS: Heading a soccer ball dropped from a height of 18 m five times was not found to cause an increase in serum concentrations of S-100B, indicating that the impact was not sufficient to cause biochemically discernible damage of brain tissue.

  • 172.
    Stålnacke, Britt-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Sojka, Peter
    Institutionen för hälsovetenskap, Mittuniversitetet, Östersund.
    [S100B for diagnosis and prognosis of sequelae following minor head injury: contradictory results according to studies]2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 24-25, p. 1840-1845Article in journal (Refereed)
    Abstract [en]

    S-100B is a protein that leaks from injured brain tissue into the cerebrospinal fluid and blood, where it can be traced and quantified. Accordingly, it may serve as a 'biochemical marker of brain tissue injury'. The aim of this paper is to survey studies that investigate symptoms, impairments, disabilities and life satisfaction exhibited by patients with mild traumatic brain injury long after the trauma (>3 months) in relation to blood concentrations of S-100B in acute stage. A PubMed search and further analysis revealed 15 papers corresponding to these criteria. The results of these papers conflict and no clear-cut conclusion can be drawn with respect to clinical use of S-100B as a predictor for late sequelae of mild traumatic brain injury. New studies that adequately take into account biological characteristics of S-100B as a 'marker of brain tissue injury' are needed.

  • 173.
    Stålnacke, Britt-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Tegner, Yelverton
    Winternet, Institution of Health Sciences, Luleå University of Technology, Boden, Swerige.
    Sojka, Peter
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Playing ice hockey and basketball increases serum levels of S-100B in elite players: a pilot study2003In: Clinical Journal of Sports Medicine, ISSN 1050-642X, E-ISSN 1536-3724, Vol. 13, no 5, p. 292-302Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate changes in serum concentrations of the biochemical markers of brain damage S-100B and neuron-specific enolase (NSE) in ice hockey and basketball players during games. Design: Descriptive clinical research. Setting: Competitive games of the Swedish Elite Ice Hockey League and the Swedish Elite Basketball League. Participants: Twenty-six male ice hockey players (from two teams) and 18 basketball players (from two teams). Interventions: None. Main Outcome Measures: S-100B and NSE were analyzed using two-site immunoluminometric assays. The numbers of acceleration/deceleration events were assessed from videotape recordings of the games. Head trauma-related symptoms were monitored 24 hours after the game using the Rivermead Post Concussion Symptoms Questionnaire. Results: Changes in serum concentrations of S-100B (postgame - pregame values) were statistically significant after both games (ice hockey, 0.072 +/- 0.108 [mu]g/L, P = 0.00004; basketball, 0.076 +/- 0.091 [mu]g/L, P = 0.001). In basketball, there was a significant correlation between the change in S-100B (postgame - pregame values) and jumps, which were the most frequent acceleration/deceleration (r = 0.706, P = 0.002). For NSE, no statistically significant change in serum concentration was found in either game. For one ice hockey player who experienced concussion during play, S-100B was increased more than for the other players.Conclusions: S-100B was released into the blood of the players as a consequence of game-related activities and events. Analysis of the biochemical brain damage markers (in particular S-100B) seems to have the potential to become a valuable additional tool for assessment of the degree of brain tissue damage in sport-related head trauma and probably for decision making about returning to play.

  • 174.
    Stålnacke, Britt-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Östman, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Post-traumatic stress in patients with injury-related chronic pain participating in a multimodal rehabilitation program2010In: Neuropsychiatric Disease and Treatment, ISSN 1176-6328, E-ISSN 1178-2021, Vol. 6, no 1, p. 59-66Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate post-traumatic stress, pain intensity, depression, and anxiety in patients with injury-related chronic pain before and after participating in multimodal pain rehabilitation.

    Methods: Twenty-eight patients, 21 women and seven men, who participated in the multimodal rehabilitation programs (special whiplash program for whiplash injuries within 1.5 years after the trauma or ordinary program) answered a set of questionnaires to assess post-traumatic stress (Impact of Event Scale [IES], pain intensity [Visual Analogue Scale (VAS)], depression, and anxiety (Hospital Anxiety and Depression Scale [HAD] before and after the programs.

    Results: Both pain intensity and post-traumatic stress decreased significantly after the rehabilitation programs in comparison with before (VAS: 57.8 ± 21.6 vs. 67.5 ± 21.9; P = 0.009, IES total score 21.8 ± 13.2 vs. 29.5 ± 12.9; P < 0.001). Patients younger than 40 years reported a statistically higher level of post-traumatic stress compared with patients older than 40 years both before (P = 0.037) and after rehabilitation (P = 0.023). No statistically significant differences were found on the HAD scores.

    Conclusion: The multimodal rehabilitation programs were effective in reducing both pain intensity and post-traumatic stress. The experience of higher levels of post-traumatic stress in younger persons has to be taken into account when managing patients with injury-related chronic pain.

  • 175.
    Suarez, Nivia Carballeira
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Levi, Richard
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Bullington, Jennifer
    Regaining health and wellbeing after traumatic spinal cord injury2013In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, no 10, p. 1023-1027Article in journal (Refereed)
    Abstract [en]

    Objective: Traumatic spinal cord injury is typically a devastating event, leading to permanent physical disability. Despite the severity of the condition, many persons with traumatic spinal cord injury manage to lead both active and independent lives. The aim of this study was to investigate the experience of health and wellbeing of persons living with a traumatic spinal cord injury for at least 20 years.

    Design and methods: A qualitative design was used. Data was analysed using a phenomenological-hermeneutical method. Rich narratives were obtained from 14 persons with paraplegia due to traumatic spinal cord injury sustained at least 20 years ago.

    Results: The key finding was that health and wellbeing were attained when persons were able to perceive themselves as being "normal" in everyday relationships and circumstances. The normalization process involved learning to negotiate and/or prevent potentially embarrassing situations by acting in a "parallel world", covertly "behind the scenes".

    Conclusion: The subjective experience of wellbeing and health after traumatic spinal cord injury depends upon the ability to prevent or resolve potentially embarrassing situations without this being noticed by others. Performing this work "behind the scenes", enables persons with traumatic spinal cord injury to interact smoothly with others and thereby be perceived as normal, despite substantial disability.

  • 176. Sunding, Kerstin
    et al.
    Willberg, Lotta
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Werner, Suzanne
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Forssblad, Magnus
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Treatment of patellar tendinopathy with sclerosing injections or ultrasound-guided arthroscopic shaving: a long term follow-up of ultrasound findings and clinical resultsManuscript (preprint) (Other academic)
  • 177. Svanberg, Mikael
    et al.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine.
    Enthoven, Paul
    Brodda-Jansen, Gunilla
    Gerdle, Björn
    Boersma, Katja
    Impact of emotional distress and pain-related fear on patients with chronic pain: subgroup analysis of patients referred to multimodal rehabilitation2017In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, no 4, p. 354-361Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Multimodal rehabilitation programmes (MMRP) for chronic pain could be improved by determining which patients do not benefit fully. General distress and pain-related fear may explain variations in the treatment effects of MMRP.

    DESIGN: Cohort study with a cross-sectional, prospective part.

    PATIENTS: Chronic musculoskeletal pain patients referred to 2 hospital-based pain rehabilitation clinics.

    METHODS: The cross-sectional part of this study cluster analyses patients (n = 1,218) with regard to distress and pain-related fear at first consultation in clinical pain rehabilitation and describes differences in external variables between clusters. The prospective part follows the subsample of patients (n = 260) participating in MMRP and describes outcome post-treatment.

    RESULTS: Four distinct subgroups were found: (i) those with low levels of distress and pain-related fear; (ii) those with high levels of pain-related fear; (iii) those with high levels of distress; and (iv) those with high levels of distress and pain-related fear. These subgroups showed differences in demogra-phics, pain characteristics, quality of life, and acceptance, as well as the degree of MMRP participation and MMRP outcome.

    CONCLUSION: Among patients with chronic pain referred to MMRP there are subgroups with different profiles of distress and pain-related fear, which are relevant to understanding the adaptation to pain and MMRP outcome. This knowledge may help us to select patients and tailor treatment for better results.

  • 178.
    Svensson, Elin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Nilsson, Karin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Levi, Richard
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Suarez, Nivia Carballeira
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Parents' experiences of having and caring for a child with an eating disorder2013In: Eating Disorders, ISSN 1064-0266, E-ISSN 1532-530X, Vol. 21, no 5, p. 395-407Article in journal (Refereed)
    Abstract [en]

    Eating disorders (ED) are serious conditions that affect both patients and their families. Little is known about the influence of these disorders on family life in a Swedish population and the ways that affected families actually attempt to cope. The aim of this study was to specifically investigate parental experiences of having and caring for a child with ED. A qualitative approach was used and rich narratives were obtained from interviews with 10 parents. Results promote insights into lived experiences concerning social disruption, emotional impact, and coping strategies related to ED. This knowledge can be utilized to further develop programs to help affected families.

  • 179. Söderlund, Anne
    et al.
    Löfgren, Monika
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Department of Clinical Sciences Karolinska Institutet and Department of Rehabilitation Medicine, Danderyd Hospital AB, Mörbygårdsvägen, SE 182 88 Stockholm, Sweden.
    Predictors before and after multimodal rehabilitation for pain acceptance and engagement in activities at a 1-year follow-up for patients with whiplash-associated disorders (WAD)-a study based on the Swedish Quality Registry for Pain Rehabilitation (SQRP)2018In: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632, Vol. 18, no 8, p. 1475-1482Article in journal (Refereed)
    Abstract [en]

    BACKGROUND CONTEXT: Studies have shown that pain acceptance strategies related to psychological flexibility are important in the presence of chronic musculoskeletal pain. However, the predictors of these strategies have not been studied extensively in patients with whiplash-associated disorders (WAD).

    PURPOSE: The purpose of this study was to predict chronic pain acceptance and engagement in activities at 1-year follow-up with pain intensity, fear of movement, perceived responses from significant others, outcome expectancies, and demographic variables in patients with WAD before and after multimodal rehabilitation (MMR).

    STUDY DESIGN: The design of this investigation was a cohort study with 1-year postrehabilitation follow-up.

    STUDY SETTING: The subjects participated in MMR at a Swedish rehabilitation clinic during 2009-2015.

    PATIENT SAMPLE: The patients had experienced a whiplash trauma (WAD grade I-II) and were suffering from pain and reduced functionality. A total of 386 participants were included: 297 fulfilled the postrehabilitation measures, and 177 were followed up at 1 year after MMR.

    OUTCOME MEASURES: Demographic variables, pain intensity, fear of movement, perceived responses from significant others, and outcome expectations were measured at the start and after MMR. Chronic pain acceptance and engagement in activities were measured at follow-up.

    METHODS: The data were obtained from a Swedish Quality Registry for Pain Rehabilitation (SQRPR).

    RESULTS: Outcome expectancies of recovery, supporting and distracting responses of significant others, and fear of (re)injury and movement before MMR were significant predictors of engagement in activities at follow-up. Pain intensity and fear of (re)injury and movement after MMR significantly predicted engagement in activities at follow-up. Supporting responses of significant others and fear of (re)injury and movement before MMR were significant predictors of pain acceptance at the 1-year follow-up. Solicitous responses of significant others and fear of (re)injury and movement at postrehabilitation significantly predicted pain acceptance at follow-up.

    CONCLUSION: For engagement in activities and pain acceptance, the fear of movement appears to emerge as the strongest predictor, but patients' perceived reactions from their spouses need to be considered in planning the management of WAD.

  • 180. Söderlund, Anne
    et al.
    Nordgren, Lena
    Sterling, Michele
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Department of Clinical Sciences, Karolinska Institute, Stockholm, Sweden; Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden.
    Exploring patients' experiences of the whiplash injury-recovery process: a meta-synthesis2018In: Journal of Pain Research, ISSN 1178-7090, E-ISSN 1178-7090, Vol. 11, p. 1263-1271Article, review/survey (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to conduct a meta-synthesis to analyze qualitative research findings and thereby understand patients' experiences of whiplash-associated disorders (WAD) and the injury-recovery process.

    Materials and methods: A qualitative meta-synthesis, which is an interpretive integration of existing qualitative findings, was performed. The databases PubMed, PsychINFO, Scopus, and Web of Science were searched. The Critical Assessment Skills Programme was used to assess the quality of the included studies.

    Results: Four studies were included. The synthesis resulted in several codes, 6 categories, and 3 themes (distancing from normalcy, self-efficacy in controlling the life situation after the injury, and readjustment and acceptance) that described the participants' pain beliefs, their WAD-related life situation and their future expectations and acceptance. Changes in self-image were difficult to cope with and likely led to perceived stigmatization. Struggling with feelings of loss of control appeared to lead to low confidence and insecurity. Focusing on increasing knowledge and understanding the pain and its consequences were believed to lead to better strategies for handling the situation. Furthermore, recapturing life roles, including returning to work, was challenging, but an optimistic outlook reinforced symptom improvements and contributed to feelings of happiness.

    Conclusion: The results of the present study provide a comprehensive understanding of patients' complex, multifaceted experiences of WAD, and the injury-recovery process. The findings can guide us in the development of new ways to evaluate and manage WAD. The results also indicate that a more patient-centered approach is needed to determine the depth and breadth of each patient's problems.

  • 181.
    Tervo, Taru
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine.
    Physical activity, bone gain and sustainment of peak bone mass2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Weak and osteoporotic bones are an increasing cause of mortality and painful physical impairment among the elderly, especially in the Western world. Bone mineral density (BMD, g/cm2) accrual during childhood and adolescence is thought to influence an individual’s risk of osteoporosis and the related fractures.

    A main aim of this thesis is to investigate the effects that various types of weight-bearing physical activity have on bone accretion in young males during their active sports careers and to study the effects that detraining has on BMD. The results suggest that bone is sensitive to loading after puberty in males, and important gains in BMD stemming from physical activity were observed during the 12-year follow-up period (papers I-III). These gains seem to be site-specific and related to the type and amount of physical activity in which individuals participate (papers I-III). For example, badminton, a sport that is characterized by jumps and rapid versatile moments in multiple directions was associated with greater gains in BMD than ice hockey was. In addition, our results indicate that with reduced training, exercise-induced bone benefits decline, predominantly at trabecular sites (paper II). In contrast, high bone density attained from previous physical loading was partially preserved at cortical bone sites after about eight years of reduced activity (papers I-II). In study IV, the associations between self-perceived health, BMD, and other lifestyle factors were studied in a well-defined group of women and men of varying ages. We found that self-perceived health was related to several lifestyle factors, such as physical activity, which were also related to BMD at the femoral neck.

    In summary, BMD in young males seem to be especially sensitive to activities associated with supposed high strains in unusual directions at specific bone sites. A high bone density stemming from previous weight-bearing physical activity is largely lost at trabecular bone sites with reduced physical activity levels. Finally, self-perceived health seems to be associated with several lifestyle factors that are also associated with BMD at the femoral neck.

  • 182.
    Tervo, Taru
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Neovius, Martin
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Constant adaptation of bone to current physical activity level in men: a 12-year longitudinal study2008In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 93, no 12, p. 4873-4879Article in journal (Refereed)
    Abstract [en]

    CONTEXT: A high peak bone mineral density (BMD; grams per square centimeter) could reduce the risk of osteoporosis related fractures later in life. OBJECTIVE: This 12-yr longitudinal study investigated whether a high BMD from previous high physical activity is maintained with reduced activity later in life. DESIGN: This was a longitudinal study. PARTICIPANTS: Three groups were investigated with a mean age of 17 yr at baseline; 51 athletes who stopped their active careers during follow-up (former athletes), 16 who were active throughout follow-up (active athletes), and 25 controls. Main Outcome Measures: BMD of the femoral neck, total body, and lumbar spine were examined five times during the 12-yr follow-up period. RESULTS: After adjustment for age, weight, and height, the former athletes were found to have higher BMD at all sites at every follow-up visit except the last one, when compared with controls (P < 0.05). The active athletes were found to have significantly higher BMD at all measured locations when compared with controls throughout the entire study (P < 0.05). From the first to the final follow-up visit, the former athletes were found to have lost more femoral neck BMD than both the active athletes (mean difference, 0.12 g/cm(2); P = 0.003) and controls (mean difference 0.08 g/cm(2); P = 0.02). CONCLUSION: This study suggests that BMD constantly adapts to the present physical activity levels in young men. Thus, increased BMD due to previous high physical activity may not prevent osteoporosis in later years.

  • 183.
    Tervo, Taru
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Neovius, Martin
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute (Solna), Stockholm, Sweden.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Reduced physical activity corresponds with greater bone loss at the trabecular than the cortical bone sites in men2009In: Bone, ISSN 8756-3282, E-ISSN 1873-2763, Vol. 45, no 6, p. 1073-1078Article in journal (Refereed)
    Abstract [en]

    Previous research has been inconclusive as to whether high peak bone mineral density (BMD, g/cm(2)) resulting from previous physical activity is retained with reduced activity later in life. The aim of this 12-year longitudinal study was to investigate the association between BMD loss and reduced physical activity (h/wk) at trabecular and cortical bone sites in men. Three groups with a mean age of 17 years at baseline were investigated: i) 51 athletes who discontinued their active careers during the follow-up period (former athletes), ii) 16 athletes who were active throughout the follow-up period (active athletes), and iii) 25 controls. BMD loss at the hip, spine, and pelvis (mainly trabecular bone) was compared to BMD loss at femur, humerus, and legs (mainly cortical bone) during a 12-year follow-up period. Across the total follow-up period in the total cohort, reduced physical activity was more strongly associated with changes at trabecular BMD sites, i.e. hip, spine, and pelvis (B=0.008-0.005 g/cm(2) per weekly hour physical activity (h), p<0.001), than at cortical bone sites, i.e. humerus, legs (B=0.002-0.003 g/cm(2)/h, p<0.05), and femur (p>0.05). At the final follow-up, former athletes showed higher BMD than controls only at the cortical bone sites of the humerus, legs, and femur (difference 0.05-0.10 g/cm(2), p<0.05). In conclusion, this study indicates that predominantly trabecular bone is lost with reduced physical activity levels in young men. Benefits were still evident at the more cortical sites eight years after the discontinuation of an active sports career.

  • 184.
    Tervo, Taru
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Association between self-perceived health, physical activity, and BMD in middle-aged men and women2011In: The Open Bone Journal, ISSN 1876-5254, no 3, p. 6-10Article in journal (Refereed)
    Abstract [en]

    Background: Osteoporosis is a skeletal disease that affects one out of every two women and one out of every five men. The clinical significance of this disease lies in the associated increased risk of fractures that mainly affect the femoral neck, spine, and wrist. One of the strongest risk factors for low-energy fractures is low bone mineral density (BMD, g/cm2). The purpose of this study was to examine the relationship between BMD, self-perceived health, and lifestyle factors in a well-defined cohort of middle-aged men and women.

    Methods: The Västerbotten Intervention Project (VIP) is a study that has been ongoing in Västerbotten since 1985. All people in Västerbotten who are 40, 50 and 60 years of age are offered a comprehensive health survey in which a questionnaire is completed and blood pressure and blood lipids are measured. BMD has been measured in the Sports Medicine Unit in Umeå since 1991. As of December 31, 2006, 4,333 women and 2,320 men had been evaluated.  Of these, 1,595 were examined as part of the VIP before their BMD was measured, and these subjects included in the present study.  

    Results: The mean age of the investigated cohort was 57 years (range 30-74). After adjusting for age, weight, sex, and follow-up time, self-perceived health (Beta = 0.08, p<0.001), training[ED1]  (Beta = 0.11, p<0.001), snow shoveling (Beta = 0.07, p=0.001), and smoking more than 15 cigarettes per day (Beta =- 0.05, p=0.04) were found to be related to femoral neck BMD. Only self-perceived health, age, and weight were found to be related to spine BMD. Self-perceived health was found to be related to some of the lifestyle factors that were significantly related to BMD, such as training (r = 0.14, p <0.001) and snow shoveling (Beta = 0.15, p <0.001).

    Conclusion: In this cohort study, several lifestyle factors related to self-perceived health were also found to be related to bone mineral density in a well-defined cohort of middle-aged men and women.

     

  • 185.
    Tervo, Taru
    et al.
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Sports Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Effetcs of badminton and ice hockey on bone mass in young males: a 12-year follow-upManuscript (preprint) (Other academic)
    Abstract [en]

    The purpose of the present study was to investigate the influence of different types of weight bearing physical activity on bone gain during an active sports career and to identify any residual benefits in BMD after the active sports career. Beginning at 17 years of age, BMD was measured 5 times, during 12 years, at multiple sites in 19badminton players, 48 ice hockey players and 25 controls. Levels of vitamin D and fatty acids were also evaluated in relation to changes in BMD during the study. During the time the athletes were active, badminton players were found to have gained significantly more BMD in their femoral neck, humerus, and lumbar spine in comparison to control subjects (mean difference = 0.05-0.17 g/cm2, p < 0.05 for all), and significantly more in their legs compared to both ice hockey players and controls (mean difference = 0.03-0.05 g/cm2, p < 0.05). At final follow-up, badminton players had significantly higher BMD of the femoral neck, humerus, lumbar spine and legs (mean difference = 0.08-0.20 g/cm2, p<0.01 for all) than both ice hockey players and controls. Levels of vitamin D and fatty acids were not related to changes in BMD at any bone site (p > 0.05 for all). In summary, the present study suggests that badminton is a more osteogenic sport and therefore related to greater gains in BMD compared to ice hockey. These BMD benefits were partly sustained with reduced activity.

  • 186.
    Toss, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Wiklund, Peder
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Franks, Paul W
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Eriksson, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Abdominal and gynoid adiposity and the risk of stroke2011In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 35, no 11, p. 1427-1432Article in journal (Refereed)
    Abstract [en]

    Background: Previous studies have indicated that fat distribution is important in the development of cardiovascular disease (CVD). We investigated the association between fat distribution, as measured by dual energy X-ray absorptiometry (DXA), and the incidence of stroke.

    Methods: A cohort of 2751 men and women aged 40 years was recruited. Baseline levels of abdominal, gynoid and total body fat were measured by DXA. Body mass index (BMI, kg m(-2)) was calculated. Stroke incidence was recorded using the regional stroke registry until subjects reached 75 years of age.

    Results: During a mean follow-up time of 8 years and 9 months, 91 strokes occurred. Of the adiposity indices accessed abdominal fat mass was the best predictor of stroke in women (hazard ratio (HR)=1.66, 95% confidence interval (CI)=1.23-2.24 per standard deviation increase), whereas the ratio of gynoid fat to total fat mass was associated with a decreased risk of stroke (HR=0.72, 95% CI=0.54-0.96). Abdominal fat mass was the only of the adiposity indices assessed that was found to be a significant predictor of stroke in men (HR=1.49, 95% CI=1.06-2.09). The associations between abdominal fat mass and stroke remained significant in both women and men after adjustment for BMI (HR=1.80, 95% CI=1.06-3.07; HR=1.71, 95% CI=1.13-2.59, respectively). However, in a subgroup analyses abdominal fat was not a significant predictor after further adjustment for diabetes, smoking and hypertension.

    Conclusion: Abdominal fat mass is a risk factor for stroke independent of BMI, but not independent of diabetes, smoking and hypertension. This indicates that the excess in stroke risk associated with abdominal fat mass is at least partially mediated through traditional stroke risk factors.International Journal of Obesity advance online publication, 22 February 2011; doi:10.1038/ijo.2011.9.

  • 187.
    Toss, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Wiklund, Peder
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Body composition and mortality risk in later life2012In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 41, no 5, p. 677-681Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: body mass index is used widely to define overweight and obesity. Both high and low body mass indices are associated with increased mortality risk during middle age, but the relationship is less clear in later life. Thus, studies on the relationships between other aspects of body composition and mortality among older subjects are needed.

    OBJECTIVE: to investigate associations between different aspects of body composition and mortality in older people.

    METHODS: the study population comprised 921 participants aged ≥65 years who underwent dual-energy X-ray (DXA) absorptiometric examination at the Sports Medicine Unit, Umeå University. The main reason for admission was clinical suspicion of osteoporosis. Total, abdominal and gynoid fat masses and lean body mass were measured by DXA absorptiometry at baseline, and the cohort was followed (mean duration, 9.2 years) for mortality events.

    RESULTS: during follow-up, 397 participants died. Lean mass was associated negatively with mortality in men and women (P < 0.001). Total fat mass showed a U-shaped association with mortality in men (P < 0.01) and a negative association in women (P < 0.01). A higher ratio of abdominal to gynoid fat mass increased mortality risk in women (P = 0.04), but not in men (P = 0.91).

    CONCLUSIONS: lean mass is associated strongly with survival in older subjects. Greater fat mass is protective in older women, whereas very low or very high fat mass increases the risk of death in men. Further research is needed to better understand the mechanisms underlying these associations.

  • 188. Tseli, Elena
    et al.
    Grooten, Wilhelmus Johannes Andreas
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Department of Clinical Sciences, Department of Rehabilitation Medicine, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    Boersma, Katja
    Enthoven, Paul
    Gerdle, Björn
    Äng, Björn Olov
    Predictors of multidisciplinary rehabilitation outcomes in patients with chronic musculoskeletal pain: protocol for a systematic review and meta-analysis2017In: Systematic Reviews, E-ISSN 2046-4053, Vol. 6, no 1, article id 199Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Chronic musculoskeletal pain is a major public health problem. Early prediction for optimal treatment results has received growing attention, but there is presently a lack of evidence regarding what information such proactive management should be based on. This study protocol, therefore, presents our planned systematic review and meta-analysis on important predictive factors for health and work-related outcomes following multidisciplinary rehabilitation (MDR) in patients with chronic musculoskeletal pain.

    METHODS: We aim to perform a synthesis of the available evidence together with a meta-analysis of published peer-reviewed original research that includes predictive factors preceding MDR. Included are prospective studies of adults with benign, chronic (> 3 months) musculoskeletal pain diagnoses who have taken part in MDR. In the studies, associations between personal and rehabilitation-based factors and the outcomes of interest are reported. Outcome domains are pain, physical functioning including health-related quality of life, and work ability with follow-ups of 6 months or more. We will use a broad, explorative approach to any presented predictive factors (demographic, symptoms-related, physical, psychosocial, work-related, and MDR-related) and these will be analyzed through (a) narrative synthesis for each outcome domain and (b) if sufficient studies are available, a quantitative synthesis in which variance-weighted pooled proportions will be computed using a random effects model for each outcome domain. The strength of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation.

    DISCUSSION: The strength of this systematic review is that it aims for a meta-analysis of prospective cohort or randomized controlled studies by performing an extensive search of multiple databases, using an explorative study approach to predictive factors, rather than building on single predictor impact on the outcome or on predefined hypotheses. In this way, an overview of factors central to MDR outcome can be made and will help strengthen the evidence base and inform a wide readership including health care practitioners and policymakers.

    SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016025339.

  • 189. Tseli, Elena
    et al.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet; Department of Rehabilitation Medicine, Danderyd Hospital.
    Boersma, Katja
    Enthoven, Paul
    Gerdle, Björn
    Äng, Björn Olov
    Grooten, Wilhelmus Johannes Andreas
    Prognostic Factors for Physical Functioning After Multidisciplinary Rehabilitation in Patients with Chronic Musculoskeletal Pain: A Systematic Review and Meta-analysis2019In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 35, no 2, p. 148-173Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVES: This systematic review aimed to identify and evaluate prognostic factors for long-term (≥6 mo) physical functioning in patients with chronic musculoskeletal pain following multidisciplinary rehabilitation (MDR).

    METHODS: Electronic searches conducted in MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, and Cochrane CENTRAL revealed 25 original research reports, published 1983-2016, (n=9436). Potential prognostic factors relating to initial pain and physical and psychological functioning were synthesized qualitatively and quantitatively in random effects meta-analyses. The level of evidence (LoE) was evaluated with GRADE.

    RESULTS: Pain related factors (intensity and chronicity) were not associated with function/disability at long-term follow up, OR=0.84, 95% CI: 0.65-1.07 and OR=0.97, 95% CI: 0.93-1.00 respectively (moderate LoE). A better function at follow up was predicted by Physical factors; higher levels of initial self-reported functioning, OR=1.07, 95% CI: 1.02-1.13 (low LoE), and Psychological factors; low initial levels of emotional distress, OR=0.77, 95% CI: 0.65-0.92, low levels of cognitive behavioural risk factors, OR 0.85, 95% CI: 0.77-0.93 and high levels of protective cognitive behavioural factors, OR=1.49; 95% CI: 1.17-1.90 (moderate LoE).

    DISCUSSION: While pain intensity and long-term chronicity did not predict physical functioning in chronic pain patients after MDR, poor pre-treatment physical and psychological functioning influenced the prognosis negatively. Thus, treatment should further target and optimize these modifiable factors and an increased focus on positive, psychological protective factors may perhaps provide an opening for yet untapped clinical gains.

  • 190.
    Viitanen, Matti
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Long-term effects of stroke1987Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Stroke, which has an increasing incidence with age, causes an irreversible brain damage which may lead to impairment, disability and decreased life satisfaction or death.

    Risk factors for death, recurrent stroke and myocardial infarction, were analyzed in 409 stroke patients treated at the Stroke Unit, Department of Medicine, Umeå University Hospital, between Jan. 1, 1978 and Dec. 31, 1982. The causes of death were related with the time of survival. In fully co-operable (n=62) 4-6 year stroke survivors, the occurrence of motor and perceptual impairments, of self-care (ADL) disability and of self-reported decreased life satisfaction due to stroke was determined.

    The probability of survival was 77% three months after stroke, 69% after one year, and 37% after five years. Multivariate statistical analysis indicated that impairment of consciousness was the most important risk factor for death followed by age, previous cardiac failure, diabetes mellitus, intracerebral hemorrhage and male sex. During the first week, cerebrovascular disease (90%) was the most dominant primary cause of death, from the second to the fourth week pulmonary embolism (30%), bronchopneumonia during the second and third months and cardiac disease (37%) later than three months after stroke. The risk of recurrence was 14% during the first year after stroke and the accumulated risk of stroke recurrence after 5 years was 37% after stroke. The estimated probability of myocardial infarction was 7% at one year and 19% at 5 years. High age and a history of cardiac failure increased the risk of recurrent stroke. The risk of myocardial infarction was associated with high age, angina pectoris and diabetes mellitus. The highest risk of epilepsy was found between 6 and 12 months after stroke. Motor impairment prevailed in 36% of the long-term survivors, perceptual impairments in up to 57% and decreased ADL-capacity in 32%. As regards ecological perception, perceptual function variables were distinctly grouped into low and high level perception which together with motor function explained 71% of the variance of self-care ADL. While levels of global and of domain specific variables of life satisfaction appeared stable in clinically healthy reference populations aged 60 and 80 years, the stroke had produced a decrease in one or more aspects of life satisfaction for 61% of the long-term survivors. Although significantly associated with motor impairments and ADL disability, these changes could not only be attributed to physical problems.

  • 191.
    Viitanen, Matti
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Fugl-Meyer, K. S.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Fugl-Meyer, Axel R
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Life satisfaction in long-term survivors after stroke1988In: Scandinavian Journal of Rehabilitation Medicine, ISSN 0036-5505, E-ISSN 1940-2228, Vol. 20, no 1, p. 17-24Article in journal (Refereed)
    Abstract [en]

    Different aspects of the quality of life before and after stroke were registered for 62 communicable, representative long-term (4-6 years) survivors, who reported the global and domain specific life satisfaction that they experienced (7 items, 6 graded-ordinal scales). Reference subjects were 60 healthy individuals in two age cohorts (60-61 years, n = 34; 79-81 years, n = 26) none of whom had been hospitalized during the last seven years prior to the investigation. The main finding is that, after the stroke, at least one aspect of the quality of life had decreased for 61% of them; this concerned global, sexual and leisure satisfaction mainly. Moreover, persisting motor impairment and ADL-disability had a negative effect on several aspects of life satisfaction. As nearly 30% of the non-impaired and the non-disabled interviewees reported decreased global life satisfaction, these changes indicate that they do not cope psychosocially with the stroke as such nor with its sequelae. In contrast, the levels of life satisfaction were similar for the 60-61 and 79-81 year-old interviewees, clinically healthy respondents, indicating stability in the quality of life that they experienced from late middle age into senectitude. For the patients, social integration estimated normatively did not covariate significantly with post-stroke satisfaction derived from social relationships.

  • 192.
    Wahman, Kerstin
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Neurorehabil, Stockholm ; Rehab Stn Stockholm, Spinalis R&D Unit, Stockholm.
    Nash, Mark S
    Univ Miami, Miller Sch Med, Dept Neurol Surg, ; Univ Miami, Miller Sch Med, Dept Rehabil Med, ; Univ Miami, Miller Sch Med, Miami Project Cure Paralysis.
    Lewis, John E
    Univ Miami, Miller Sch Med, Dept Psychiat & Behav Sci, ; Univ Miami, Miller Sch Med, Ctr Complementary & Integrat Med..
    Seiger, Åke
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Neurorehabil, Stockholm ; Rehab Stn Stockholm, Spinalis R&D Unit, Stockholm ; Stockholms Sjukhem Fdn, Stockholm.
    Levi, Richard
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Neurorehabil, Stockholm, Sweden.
    Cardiovascular disease risk and the need for prevention after paraplegia determined by conventional multifactorial risk models: the Stockholm spinal cord injury study2011In: Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine, ISSN 1651-2081, Vol. 43, no 3, p. 237-242Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess the need for intervention on cardio-vascular disease risks in persons with paraplegia according to: (i) two multifactorial risk models; and (ii) these models in combination with the additional risk of overweight/obesity.

    DESIGN: Cross-sectional.

    SUBJECTS: A total of 134 out of 153 persons, comprising more than 80% of a regional prevalence population with traumatic paraplegia (American Spinal Injury Association Impairment Scale A-C) of minimum one year duration.

    METHODS: Participants were screened for cardiovascular disease risk using two multifactorial risk models: the Systematic Coronary Risk Evaluation and the Framingham Risk Equation. Risk factors included were: age, gender, systolic blood pressure, antihypertensive medication, smoking, total cholesterol, high-density lipoprotein cholesterol, and total cholesterol/total cholesterol ratio. In addition, overweight/obesity was assessed by body mass index.

    RESULTS: Twenty-seven percent to 36% of the cohort was eligible for cardiovascular disease risk intervention, depending on the risk model used. When overweight/obesity (spinal cord injury adjusted cut-score body mass index ≥ 22) was also considered, over 80% of the participants qualified for intervention.

    CONCLUSION: Almost one-third of persons with paraplegia were eligible for cardiovascular disease risk intervention according to authoritative assessment tools. The number in need of intervention was dramatically increased when overweight/obesity as a cardiovascular disease risk was considered.

  • 193. Wahman, Kerstin
    et al.
    Nash, Mark S
    Lewis, John E
    Seiger, Åke
    Levi, Richard
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Increased cardiovascular disease risk in Swedish persons with paraplegia: the Stockholm spinal cord injury study2010In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, no 5, p. 489-492Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Comparison of prevalence of cardiovascular disease risks in persons with chronic traumatic paraplegia with those in the general population.

    DESIGN: Cross-sectional comparative study.

    SUBJECTS: A total of 135 individuals, age range 18-79 years, with chronic (> or = 1 year) traumatic paraplegia.

    METHODS: The prevalences of diabetes mellitus, dyslipidaemia, hypertension, overweight, and smoking, were assessed in the study population and were compared with an age- and gender-matched sample of the general population in the region under study. History of myocardial infarction and medication for dyslipidaemia, hypertension, and diabetes mellitus were also recorded. chi2 tests were used to compare the paraplegic cohort with the general population sample.

    RESULTS: Significantly more persons with paraplegia reported a history of myocardial infarction (5.9%) than those in the comparison group (0.7%). The prevalences of diabetes mellitus (5.9%), dyslipidaemia (11.1%), and hypertension (14.1%) were also significantly higher in the paraplegic group, as were drug treatment for these disorders.

    CONCLUSION: Persons with paraplegia report increased prevalences of diabetes mellitus, hypertension, and dyslipidaemia, in particular, compared with the general population. Population-based screening and therapeutic counter-measures for these conditions may therefore be particularly indicated for this patient group.

  • 194. Wahman, Kerstin
    et al.
    Nash, Mark S
    Westgren, Ninni
    Lewis, John E
    Seiger, Åke
    Levi, Richard
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Cardiovascular disease risk factors in persons with paraplegia: the Stockholm spinal cord injury study2010In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, no 3, p. 272-278Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To examine cardiovascular disease risk factors and risk clusters in Swedish persons with traumatic wheelchair-dependent paraplegia.

    DESIGN: Prospective examination.

    SUBJECTS: A total of 135 individuals aged 18-79 years with chronic (>or= 1 year) post-traumatic paraplegia.

    METHODS: Cardiovascular disease risk factors; dyslipidemia, impaired fasting glucose, hypertension, overweight, smoking, and medication usage for dyslipidemia, hypertension, and diabetes mellitus, were analyzed according to authoritative guidelines. Stepwise regression tested the effects of age, gender, and injury characteristics on cardiovascular disease risks.

    RESULTS: High-prevalence risk factors were dyslipidemia (83.1%), hypertension (39.3%), and overweight (42.2%) with pervasive clustering of these risks. Being older was related to increased cardiovascular disease risk, except for dyslipidemia. Hypertension was more common in low-level paraplegia. Prevalence of impaired fasting glucose was lower than previously reported after paraplegia. A high percentage of persons being prescribed drug treatment for dyslipidemia and hypertension failed to reach authoritative targets for cardiovascular disease risk reduction.

    CONCLUSION: Swedish persons with paraplegia are at high risk for dyslipidemia, hypertension, and overweight. Impaired fasting glucose was not as common as reported in some previous studies. Pharmacotherapy for dyslipidemia and hypertension often failed to achieve recommended targets. Population-based screening and therapeutic countermeasures to these cardiovascular disease risks are indicated.

  • 195.
    Waller, Simon
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    The presence of post-concussion symptoms among Swedish elite female football players2017Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 196.
    Weidung, Bodil
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Department of Public Health and Caring Sciences, Geriatric Medicine, Uppsala University, Uppsala.
    Toots, Annika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Systolic blood pressure decline in very old individuals is explained by deteriorating health: Longitudinal changes from Umea85+/GERDA2017In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 96, no 51, article id e9161Article in journal (Refereed)
    Abstract [en]

    Declining systolic blood pressure (SBP) is common in very old age and is associated with adverse events, such as dementia. Knowledge of factors associated with SBP changes could explain the etiology of this decline in SBP. This study investigated longitudinal changes in socioeconomic factors, medical conditions, drug prescriptions, and assessments and their associations with SBP changes among very old followed individuals.The study was based on data from the Umea85+/Gerontological Regional Database (GERDA) cohort study, which provided cross-sectional and longitudinal data on participants aged 85, 90, and 95 years from 2000 to 2015. Follow-up assessments were conducted after 5 years. The main outcome was a change in SBP. Factors associated with SBP changes were assessed using multivariate linear regression models.In the Umea85+/GERDA study, 454 surviving individuals underwent follow-up assessment after 5 years. Of these, 297 had SBP measured at baseline and follow-up. The mean changestandard deviation in SBP was -12 +/- 25mm Hg. SBP decline was associated independently with later investigation year (P=.009), higher baseline SBP (P<.001), baseline antidepressant prescription (P=.011), incident acute myocardial infarction during follow-up (P=.003), new diuretic prescription during follow-up (P=.044), and a decline in the Barthel Activities of Daily Living index at follow-up (P<.001).In conclusion, SBP declines among very old individuals. This decline seems to be associated with initial SBP level, investigation year, and health-related factors.

  • 197. Welford, Paul
    et al.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Achilles insertion bone pathology not related to pain in a triathlete with cystic fibrosis2018In: Journal of Surgical Case Reports, ISSN 2042-8812, E-ISSN 2042-8812, no 8, article id rjy182Article in journal (Refereed)
    Abstract [en]

    This report concerns the unusual case of a 48-year old, world-class triathlete who has won 11 ironman competitions. She has reached the top level of international endurance sport in spite of being diagnosed with cystic fibrosis. This patient presented with Achilles pain and severe bony pathology at her left Achilles insertion. Traditionally this condition is treated via tendon detachment and re-attachment or intra-tendinous surgery, followed by a protracted rehabilitation. These procedures were considered risky due to this patient's chronic disease with vulnerability to immobilization. Instead, she was treated by surgical removal of the superficial bursa alone, under local anaesthetic. This allowed the patient to become active and load her Achilles tendon immediately, and resulted in a significant symptomatic improvement. This case illustrates that despite the presence of severe tendon and bone pathology at the Achilles insertion, pain may originate in the superficial bursa; a structure ignored by traditional operations.

  • 198.
    Wenngren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Computerized assessment of pain drawing area: A pilot study.2009In: Neuropsychiatric disease and treatment, ISSN 1176-6328, Vol. 5, p. 451-456Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate if pain area in patients with chronic pain could be measured by a computerized assessment on previously marked pain drawings on paper figures and to analyze the further application of the method. METHODS: Seventy-two patients (54 women and 18 men) who were admitted to Umeå University Hospital during 2003 for assessment of chronic pain answered a set of questionnaires (pain intensity on the visual analog scale [VAS], disability on the Disability Rating Index [DRI], life satisfaction on the LiSat-11) and filled in pain drawings on paper figures of the human body. The pain drawings were later analyzed by using computerized assessment. RESULTS: Women marked a greater pain area than men, but the difference was not significant (p =0.433). No significant difference was shown for the previous seven days between men and women on the VAS (p =0.914), DRI (p =0.493), or LiSat-11 (p =0.124). A statistically significant correlation was found between pain area and VAS for the previous seven days (r =0.250; p =0.046). Pain area was statistically significantly correlated to the DRI (r =0.336; p =0.014) and close to negatively correlated to the LiSat-11 (r =0.687; p =0.057). CONCLUSION: This pilot study shows that pain drawing area could be measured by a computerized assessment of pain drawings. The method points to the possibility of relating pain area with other instruments. In the present study, an association between the patients' pain drawing area and pain intensity and between pain area and level of activity was shown.

  • 199.
    Westlund, Madelene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Consequences after aneurysmal subarachnoid hemorrhage: Longitudinal evaluation of cognitive function, emotional health and fatigue2016Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 200.
    Widerström, Charlotta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Multimodal rehabilitation forpatients with chronic pain inprimary health careFocusing on physical activity2018Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
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