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  • 1.
    Ahlgren, Christina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Hamberg, Katarina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Johansson, Eva E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    The meanings given to gender in studies on multimodal rehabilitation for patients with chronic musculoskeletal pain: a literature review2016Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, nr 23, 2255-2270 s.Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Purpose: The purpose of this study is to assess and describe the meanings given to "gender" in scientific publications that evaluate multidisciplinary, interdisciplinary or multimodal rehabilitation for patients with chronic musculoskeletal pain.

    Method: A systematic literature search for papers evaluating multimodal rehabilitation was conducted. The PubMed and EBSCO databases were searched from 1995 to 2015. Two or three researchers independently read each paper, performed a quality assessment and coded meanings of gender using qualitative content analysis.

    Results: Twenty-seven papers were included in the review. Gender was used very differently in the MMR studies investigated but primarily it referred to factual differences between men and women. Only one paper provided a definition of the concept of gender and how it had been used in that study. In the content analysis, the meaning of gender formed three categories: "Gender as a factual difference", "The man is the ideal" and "Gender as a result of social role expectations".

    Conclusions: The meaning of the concept of gender in multimodal rehabilitation is undefined and needs to be developed further. The way the concept is used should be defined in the design and evaluation of multimodal rehabilitation in future studies.

    Implications for rehabilitation

    Healthcare professionals should reflect on gender relations in encounters with patients, selection of patients into rehabilitation programs and design of programs. In rehabilitation for chronic pain the patients' social circumstances and cultural context should be given the same consideration as biological sex and pain symptoms.

  • 2.
    Alfredson, Håkan
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Forsgren, Sture
    Umeå universitet, Medicinsk fakultet, Integrativ medicinsk biologi, Anatomi.
    Thorsen, Kim
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Fahlström, Martin
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Johansson, Håkan
    Lorentzon, Ronny
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Glutamate NMDAR1 receptors localised to nerves in human Achilles tendons. Implications for treatment?2001Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 9, nr 2, 123-126 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In this investigation, we show the presence of both free glutamate (microdialysis) and glutamate NMDAR1 receptors (immunohistochemical analyses of tendon biopsies), in tendons from patients with chronic Achilles tendon pain (Achilles tendinosis) and in controls (pain-free tendons). The NMDAR1 immunoreaction was usually confined to acetylcholinesterase-positive structures, implying that the reaction is present in nerves. Glutamate is a potent pain mediator in the human central nervous system, and in animals it has been shown that peripherally administered glutamate NMDA receptor antagonists diminish the response to formalin-induced nociception. Our present finding of glutamate NMDA receptors in human Achilles tendons might have implications for pain treatment.

  • 3.
    Alfredson, Håkan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Zeisig, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    No normalisation of the tendon structure and thickness after intratendinous surgery for chronic painful midportion Achilles tendinosis.2009Inngår i: British journal of sports medicine, ISSN 1473-0480, Vol. 43, nr 12, 948-9 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To characterise Achilles tendon structure and thickness a minimum of 8 years after intra-tendinous surgery. Material and METHODS: Fourteen patients (16 tendons; 9 men and 5 women, mean age 43 years, range 27-55) surgically treated (intra-tendinous surgery) for chronic painful midportion Achilles tendinosis, were followed with clinical examination and grey-scale ultrasonography for a minimum of 8 years (range 8-16 years, mean 13 years). RESULTS: All patients were satisfied with the result of surgery and were active in Achilles tendon loading activities without restrictions. In all operated tendons, structural abnormalities remained and tendons remained thicker than normal tendons. CONCLUSIONS: Resection of tendinosis is associated with persistent structural abnormalities and thickening of the tendon 13 years after surgery, despite successful clinical outcomes.

  • 4.
    Awad, Amar
    et al.
    Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI). Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Fysiologi.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Lindgren, Lenita
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Fysiologi. Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI).
    Hultling, Claes
    Department of Neurobiology, Care Sciences and Society (Neurorehabilitation), Karolinska Institute, Stockholm, Sweden.
    Westling, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Fysiologi.
    Nyberg, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Fysiologi. Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI). Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Eriksson, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Fysiologi. Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI).
    Preserved somatosensory conduction in a patient with complete cervical spinal cord injury2015Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, Vol. 47, nr 5, 426-431 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Neurophysiological investigation has shown that patients with clinically complete spinal cord injury can have residual motor sparing ("motor discomplete"). In the current study somatosensory conduction was assessed in a patient with clinically complete spinal cord injury and a novel ethodology for assessing such preservation is described, in this case indicating "sensory discomplete" spinal cord injury. Methods: Blood oxygenation level-dependent functional magnetic resonance imaging (BOLD fMRI) was used to examine the somatosensory system in a healthy subject and in a subject with a clinically complete cervical spinal cord injury, by applying tactile stimulation above and below the level of spinal cord injury, with and without visual feedback. Results: In the participant with spinal cord injury, somatosensory stimulation below the neurological level of the lesion gave rise to BOLD signal changes in the corresponding areas of the somatosensory cortex. Visual feedback of the stimulation strongly modulated the somatosensory BOLD signal, implying that cortico-cortical rather than spino-cortical connections can drive activity in the somatosensory cortex. Critically, BOLD signal change was also evident when the visual feedback of the stimulation was removed, thus demonstrating sensory discomplete spinal cord injury. Conclusion: Given the existence of sensory discomplete spinal cord injury, preserved but hitherto undetected somatosensory conduction might contribute to the unexplained variability related to, for example, the propensity to develop decubitus ulcers and neuropathic pain among patients with clinically complete spinal cord injury.

  • 5.
    Bailey, Leslie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för molekylärbiologi (Medicinska fakulteten).
    Engström, Patrik
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för molekylärbiologi (Teknisk-naturvetenskaplig fakultet).
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Bergström, Sven
    Umeå universitet, Medicinska fakulteten, Institutionen för molekylärbiologi (Medicinska fakulteten).
    Waldenström, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Chlamydia pneumoniae infection results in generalized bone loss in mice2008Inngår i: Microbes and infection, ISSN 1286-4579, E-ISSN 1769-714X, Vol. 10, nr 10-11, 1175-1181 s.Artikkel i tidsskrift (Fagfellevurdert)
  • 6.
    Berginström, Nils
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Ekman, Urban
    Eriksson, Johan
    Andersson, Micael
    Nyberg, Lars
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Using Functional Magnetic Resonance Imaging to Detect Chronic Fatigue in Patients With Previous Traumatic Brain Injury: Changes Linked to AlteredStriato-Thalamic-Cortical FunctioningInngår i: The journal of head trauma rehabilitation, ISSN 0885-9701, E-ISSN 1550-509XArtikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To investigate whether functional magnetic resonance imaging (fMRI) can be used to detect fatigue after traumatic brain injury (TBI).

    Setting: Neurorehabilitation clinic.

    Participants: Patients with TBI (n = 57) and self-experienced fatigue more than 1 year postinjury, and age- and gender-matched healthy controls (n = 27).

    Main Measures: Self-assessment scales of fatigue, a neuropsychological test battery, and fMRI scanning during performance of a fatiguing 27-minute attention task.

    Results: During testing within the fMRI scanner, patients showed a higher increase in self-reported fatigue than controls from before to after completing the task (P < .001).The patients also showed lower activity in several regions, including bilateral caudate, thalamus, and anterior insula (all P < .05). Furthermore, the patients failed to display decreased activation over time in regions of interest: the bilateral caudate and anterior thalamus (all P < .01). Left caudate activity correctly identified 91% of patients and 81% of controls, resulting in a positive predictive value of 91%.

    Conclusion: The results suggest that chronic fatigue after TBI is associated with altered striato-thalamic-cortical functioning. It would be of interest to study whether fMRI can be used to support the diagnosis of chronic fatigue in future studies.

  • 7.
    Bernspång, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Consequences of stroke: aspects of impairments, disabilities and life satisfaction : with special emphasis on perception and on occupational therapy1987Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Perceptual and motor functions and self-care ability after stroke were assessed within two weeks (n:109; mean age 69±10) and 4-6 years (n:75;70±9) after admission to a non-intensive care stroke unit. Sixty-two of the long-term stroke survivors reported on their life satisfaction (7 items) as experienced (in retrospect) before the stroke and at the time of the investigation. Perceptual functions and actual levels of life satisfaction were registered in 60 clinically healthy subjects aged about 60 or about 80 years.

    Both early on and late after stroke the 16 items of perceptual function were clearly grouped into two factors, which neatly fitted an ecological perceptual concept. One factor characterized low-order and the other higher-order perception. Impairments of low-order perception occurred for about 10% of the patients, whether investigated early or late after stroke. No one among the reference populations had such impairments. Higher-order perceptual impairments prevailed in 60% early on and in 57% late after stroke and were often more pronounced than those occurring in the reference populations, among whom 35% of the 60 year olds and significantly more - 77% - of the 80 year olds had such impairments. Hence, perceptual impairments are common after stroke, but slight age-dependent reductions should be considered when higher-order perceptual function is assessed and treated after stroke.

    Together with motor function, which was impaired in 52% of the early and 36% of the late stroke samples, higher-order perceptual function and to a limited extent low-order perception could predict the level of self-care ability in 70% and 62% of the early and late samples, respectively.

    Whereas levels of global and of domain specific variables of life satisfaction were similar in the two reference populations, the stroke had lead to a reduction in life satisfaction for 61% of the long-term survivors. Reductions were particularly pronounced for global life satisfaction and for satisfaction with leisure and sexuality. Although significantly associated with motor impairment and self-care disability, these reductions could not be attributed only to impairments and disability.

    The findings are discussed with particular reference to assessment and treatment in occupational therapy.

  • 8.
    Bernspång, Birgitta
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Arbetsterapi.
    Asplund, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Eriksson, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Fugl-Meyer, Axel R.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Motor and perceptual impairments in acute stroke patients: effects on self-care ability1987Inngår i: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 18, nr 6, 1081-1086 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The relative importance of motor, perceptual, and some cognitive functions for self-care ability was analyzed in a representative sample of 109 subjects within 2 weeks of acute stroke. Forty-nine patients (45%) were dependent or partly dependent in self-care. Profound motor dysfunction was present in 39%, low-order perceptual deficits in 10%, high-order perceptual deficits in 60%, and disorientation in time and space in 13% of the patients. There was a significant covariation between motor function and self-care ability and between low-order perception and orientation function. Low-order and high-order perception covaried only weakly. Discriminant analyses showed that the actual level of self-care proficiency could be correctly predicted in 70% of the cases by the 4 indexes of motor function, low-order perception, high-order perception, and orientation. The dominating predictor was motor function, and the next highest was high-order perception. When a program for early training is designed with the aim to alleviate long-term self-care disability after stroke, correct assessment of motor and perceptual functions in the individual stroke patient is essential.

  • 9.
    Bernspång, Birgitta
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Arbetsterapi.
    Fugl-Meyer, Axel R.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Viitanen, Matti
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Perceptual function in the elderly and after stroke1988Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 2, nr 2, 75-79 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Perceptual function was assessed in 60 clinically healthy subjects aged about 60 (n=34) and 80 (n=26), and in stroke survivors who were assessed either early (n=109) or four to six years (n=75) after the stroke. Using two indices, one characterising low-order perception and the other higher-order perception, the clinically healthy subjects invariably had no impairment in the low-order index. Slight impairments occurred in 35% of 60-year-old and 77% of 80-year-old healthy subjects. Considerably more pronounced disturbances occurred in the stroke victims, among whom about 60% had impairment or higher-order perceptual function and about 10% had low-order perceptual deficits. Thus as higher-order perception is age dependent, it appears that in rehabilitation of stroke allowance should be made for predictable signs of advancing age.

  • 10.
    Berzelius, Adam
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Cognitive impairments in stroke patients at acute stage. Comparison of three neuropsychological screening tests2014Independent thesis Advanced level (professional degree), 20 poäng / 30 hpOppgave
  • 11.
    Björhagen, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Living with consequences of severe traumatic brain injury. A cross-sectional quantitative study five to seven years after severe traumatic injury2016Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 12.
    Brogårdh, Christina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Department of Rehabilitation, Lund University Hospital, Lund.
    Vestling, Monika
    Sjölund, Bengt H
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. 3Rehabilitation and Research Centre for Torture Victims, Copenhagen and University of Southern Denmark, Odense, Denmark.
    Shortened constraint-induced movement therapy in subacute stroke - no effect of using a restraint: a randomized controlled study with independent observers2009Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 41, nr 4, 231-236 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To examine the effect of using a mitt during shortened constraint-induced movement therapy for patients in the subacute phase after stroke.

    Subjects: Twenty-four patients with stroke (mean age 57.6 (standard deviation 8.5) years; average 7 weeks post-stroke) with mild to moderate impaired hand function.

    Methods: The patients were randomized to mitt use or no mitt use on the less affected hand for 90% of waking hours for 12 days. All patients received 3 h of arm and hand training per day for 2 weeks. Assessments were made by blinded observers using the modified Motor Assessment Scale, the Sollerman hand function test, the 2-Point Discrimination test and Motor Activity Log test.

    Results: Patients in both groups showed significant improvements in arm and hand motor performance and on self-reported motor ability after 2 weeks of therapy and at 3 months follow-up. However, no statistically significant differences between the groups were found in any measures at any point in time.

    Conclusion: In this study, no effect of using a restraint in patients with subacute stroke was found. Thus, this component in the constraint-induced therapy concept seems to be of minor importance for the outcome.

  • 13. Cancelliere, Carol
    et al.
    Cassidy, J David
    Cote, Pierre
    Hincapie, Cesar A
    Harvigsen, Jan
    Carrol, Linda J
    Marras, Connie
    Boyle, Eleanor
    Kristman, Vicki
    Hung, Ryan
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Rumney, Peter
    Coronado, Victor
    Holm, Lena W
    Borg, Jörgen
    Nygren-de Boussard, Catharina
    af Geijerstam, Jean-Luc
    Keightley, Michelle
    Protocol for a systematic review of prognosis after mild traumatic brain injury: an update of the WHO Collaborating Centre Task Force findings2012Inngår i: Systematic Reviews, ISSN 2046-4053, nr 1, 17- s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Mild traumatic brain injury (MTBI) is a major public-health concern and represents 70-90% of all treated traumatic brain injuries. The last best-evidence synthesis, conducted by the WHO Collaborating Centre for Neurotrauma, Prevention, Management and Rehabilitation in 2002, found few quality studies on prognosis. The objective of this review is to update these findings. Specifically, we aim to describe the course, identify modifiable prognostic factors, determine long-term sequelae, and identify effects of interventions for MTBI. Finally, we will identify gaps in the literature, and make recommendations for future research.

    Methods: The databases MEDLINE, PsychINFO, Embase, CINAHL and SPORTDiscus were systematically searched (2001 to date). The search terms included 'traumatic brain injury', 'craniocerebral trauma', 'prognosis', and 'recovery of function'. Reference lists of eligible papers were also searched. Studies were screened according to pre-defined inclusion and exclusion criteria. Inclusion criteria included original, published peer-reviewed research reports in English, French, Swedish, Norwegian, Danish and Spanish, and human participants of all ages with an accepted definition of MTBI. Exclusion criteria included publication types other than systematic reviews, meta-analyses, randomized controlled trials, cohort studies, and case-control studies; as well as cadaveric, biomechanical, and laboratory studies. All eligible papers were critically appraised using a modification of the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Two reviewers performed independent, in-depth reviews of each eligible study, and a third reviewer was consulted for disagreements. Data from accepted papers were extracted into evidence tables, and the evidence was synthesized according to the modified SIGN criteria.

    Conclusion: The results of this study form the basis for a better understanding of recovery after MTBI, and will allow development of prediction tools and recommendation of interventions, as well as informing health policy and setting a future research agenda.

  • 14. Cancelliere, Carol
    et al.
    Hincapié, Cesar A
    Keightley, Michelle
    Godbolt, Alison K
    Coté, Pierre
    Kristman, Vicki L
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Caroll, Linda J
    Hung, Ryan
    Borg, Jörgen
    Nygren-de Boussard, Chatarina
    Coronado, Victor G
    Donovan, James
    Cassidy, J David
    Systematic review of prognosis and return to play after sport concussion: results of the international collaboration on mild traumatic brain injury prognosis2014Inngår i: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 95, nr 3, Suppl, S210-S229 s.Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Objective

    To synthesize the best available evidence on prognosis after sport concussion.

    Data Sources

    MEDLINE and other databases were searched (2001–2012) with terms including “craniocerebral trauma” and “sports.” Reference lists of eligible articles were also searched.

    Study Selection

    Randomized controlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to have a minimum of 30 concussion cases.

    Data Extraction

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

    Data Synthesis

    Evidence was synthesized qualitatively according to modified SIGN criteria, and studies were categorized as exploratory or confirmatory based on the strength of their design and evidence. After 77,914 records were screened, 52 articles were eligible for this review, and 24 articles (representing 19 studies) with a low risk of bias were accepted. Our findings are based on exploratory studies of predominantly male football players at the high school, collegiate, and professional levels. Most athletes recover within days to a few weeks, and American and Australian professional football players return to play quickly after mild traumatic brain injury. Delayed recovery appears more likely in high school athletes, in those with a history of previous concussion, and in those with a higher number and duration of postconcussion symptoms.

    Conclusions

    The evidence concerning sports concussion course and prognosis is very preliminary, and there is no evidence on the effect of return-to-play guidelines on prognosis. Our findings have implications for further research. Well-designed, confirmatory studies are urgently needed to understand the consequences of sport concussion, including recurrent concussion, across different athletic populations and sports.

  • 15. Cancelliere, Carol
    et al.
    Kristman, Vicki L
    Cassidy, J David
    Hincapié, Cesar A
    Coté, Pierre
    Boyle, Eleanor
    Carroll, Linda J
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Nygren-de Boussard, Catharina
    Borg, Jörgen
    Systematic review of return to work after mild traumatic brain injury: results of the international collaboration on mild traumatic brain injury prognosis2014Inngår i: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 95, nr 3, Suppl, S201-S209 s.Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Objective

    To synthesize the best available evidence on return to work (RTW) after mild traumatic brain injury (MTBI).

    Data Sources

    MEDLINE and other databases were searched (2001–2012) with terms including “craniocerebral trauma” and “employment.” Reference lists of eligible articles were also searched.

    Study Selection

    Controlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to assess RTW or employment outcomes in at least 30 MTBI cases.

    Data Extraction

    Eligible studies were critically appraised using a modification of the Scottish Intercollegiate Guidelines Network criteria. Two reviewers independently reviewed and extracted data from accepted studies into evidence tables.

    Data Synthesis

    Evidence was synthesized qualitatively according to modified Scottish Intercollegiate Guidelines Network criteria and prioritized according to design as exploratory or confirmatory. After 77,914 records were screened, 299 articles were found eligible and reviewed; 101 (34%) of these with a low risk of bias were accepted as scientifically admissible, and 4 of these had RTW or employment outcomes. This evidence is preliminary and suggests that most workers RTW within 3 to 6 months after MTBI; MTBI is not a significant risk factor for long-term work disability; and predictors of delayed RTW include a lower level of education (<11y of formal education), nausea or vomiting on hospital admission, extracranial injuries, severe head/bodily pain early after injury, and limited job independence and decision-making latitude.

    Conclusions

    Our findings are based on preliminary evidence with varied patient characteristics and MTBI definitions, thus limiting firm conclusions. More well-designed studies are required to understand RTW and sustained employment after MTBI in the longer term (≥2y post-MTBI).

  • 16. Crenshaw, Albert
    et al.
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Lyskov, Eugene
    A gender comparison of electromyography (EMG) during repetitive arm work with and without mental stress2013Inngår i: The FASEB Journal, ISSN 0892-6638, E-ISSN 1530-6860, Vol. 27, 1152.21- s.Artikkel i tidsskrift (Annet vitenskapelig)
  • 17. Crenshaw, Albert G
    et al.
    Elcadi, Guilherme H
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Hellström, Fredrik
    Mathiassen, Svend Erik
    Reliability of near-infrared spectroscopy for measuring forearm and shoulder oxygenation in healthy males and females2012Inngår i: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 112, nr 7, 2703-2715 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study determined the day-to-day reliability of NIRS-derived oxygenation responses (a dagger StO(2)%) for isometric contractions and for cuff occlusion. Twenty-four subjects (12 males and 12 females) were tested for 2 days (4-6 days interval). Variables generated were: (1) a dagger StO(2)% for isometric contractions (10, 30, 50 and 70% MVC) for descending trapezius (TD) and extensor carpi radialis (ECR) muscles; (2) slope changes in total haemoglobin (HbTslope) and deoxyhaemoglobin (HHbslope) for the ECR using upper arm venous (VO, 50 mmHg) and arterial occlusion (AO, 250 mmHg); (3) recovery slopes (Rslope) for oxygen saturation (StO(2)) following isometric contractions and AO. For each variable, an intraclass correlation (ICC) was calculated to assess the ability to differentiate between subjects, and limits of agreement (LOA) were computed to assess day-to-day consistency of the measurement. ICCs for Delta StO(2)% were lowest at 10% MVC for both ECR (0.58) and TD (0.55), and highest at 30% MVC for ECR (0.95) and at 70% MVC for TD (0.79). For both muscles, LOA for Delta StO(2)% was lowest at 10% and highest at 50 and 70% MVC. ICC for HbTslope was 0.17. For HHbslope ICC was higher for AO (0.83) than for VO (0.73), and LOA was lower for AO. For the ECR Rslope ICCs ranged from 0.88 to 0.90 for contraction, but was lower for AO (0.33); LOA was lowest at 70% MVC. For trapezius Rslope ICCs ranged from 0.63 to 0.73 and LOA was lowest at 30% MVC. For this study, establishing reliability data for the ECR and TD and including variables commonly reported are expected to have meaning for future NIRS studies of work-related upper-extremity pain as well as for other NIRS research and clinical applications.

  • 18. Divanoglou, A
    et al.
    Westgren, N
    Bjelak, S
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Medical conditions and outcomes at 1 year after acute traumatic spinal cord injury in a Greek and a Swedish region: a prospective, population-based study2010Inngår i: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 48, nr 6, 470-476 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    STUDY DESIGN: Prospective, population-based study. This paper is part of the Stockholm Thessaloniki Acute Traumatic Spinal Cord Injury Study (STATSCIS).

    OBJECTIVES: To evaluate and compare outcomes, length of stay (LOS), associated conditions and medical complications at 1-year post-trauma.

    SETTINGS: The Greater Thessaloniki region, Greece, and the Greater Stockholm region, Sweden. While Stockholm follows a SCI system of care, Thessaloniki follows a fragmented 'non-system' approach.

    SUBJECTS: Out of the 87 cases in Thessaloniki and the 49 cases in Stockholm who comprised the study population of STATSCIS, 75 and 42 cases respectively were successfully followed-up during the first year post-trauma.

    RESULTS: Significantly superior outcomes (that is, survival with neurological recovery, functional ability and discharge to home) and shorter LOS for initially motor complete cases occurred in Stockholm. Management routines known to increase long-term morbidity, for example, long-term tracheostomy and indwelling urethral catheters were significantly more common in Thessaloniki. Major medical complications, that is, multiple pressure ulcers, heterotopic ossification and bacteremia/sepsis were more frequent in Thessaloniki.

    CONCLUSIONS: Our findings show how two rather similar cohorts of TSCI manifest large discrepancies in terms of 1-year outcomes and complications, depending on the type of management they receive. As the major difference between regions was the presence or absence of a SCI system of care, rather than differences in availability of modern medicine, the mere presence of the latter does not seem to be sufficient to guarantee adequate outcomes. This study provides strong evidence as to the urgent need of implementing a SCI system of care in Greece.

  • 19.
    Divanoglou, Anestis
    et al.
    Division of Neuro-rehabilitation, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
    Seiger, A
    Division of Neuro-rehabilitation, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
    Richard, Levi
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Division of Neuro-rehabilitation, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
    Acute management of traumatic spinal cord injury in a Greek and a Swedish region: a prospective, population-based study.2010Inngår i: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 48, nr 6, 477-482 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    STUDY DESIGN: Prospective, population-based study. This paper is part of the Stockholm Thessaloniki Acute Traumatic Spinal Cord Injury Study (STATSCIS). OBJECTIVES: To characterize patient populations and to compare acute management after traumatic spinal cord injury (TSCI). SETTINGS: The Greater Thessaloniki region in Greece and the Greater Stockholm region in Sweden. METHODS: Inception cohorts with acute TSCI that were hospitalized during the study period, that is September 2006 to October 2007, were identified. Overall, 81 out of 87 cases consented to inclusion in Thessaloniki and 47 out of 49 in Stockholm. Data from Thessaloniki were collected through physical examinations, medical record reviews and communication with TSCI cases and medical teams. Data from Stockholm were retrieved from the Nordic Spinal Cord Injury Registry. RESULTS: There were no significant differences between study groups with regard to core clinical characteristics. In contrast, there were significant differences in (1) transfer logistics from the scene of trauma to a tertiary-level hospital (number of intermediate admissions, modes of transportation and duration of transfer) and (2) acute key therapeutic interventions, that is, the use of mechanical ventilation (49% in Thessaloniki versus 20% in Stockholm), and performance of tracheostomy (36% in Thessaloniki versus 15% in Stockholm); spinal surgery was performed significantly more often and earlier in Stockholm than in Thessaloniki. CONCLUSIONS: Despite largely similar core clinical characteristics, Stockholm and Thessaloniki cases underwent significantly different acute management, most probably to be attributed to adaptations to the differing regional approaches of care one following a systematic approach of SCI care and the other not.

  • 20.
    Divanoglou, Anestis
    et al.
    Karolinska Inst, Div Neurorehabil, Stockholm.
    Westgren, Ninni
    Karolinska Inst, Div Neurorehabil, Stockholm ; Karolinska Univ Hosp, Spinalis SCI Rehabil Unit, Stockholm.
    Seiger, Åke
    Karolinska Inst, Div Neurorehabil, Stockholm.
    Hulting, Claes
    Karolinska Inst, Div Neurorehabil, Stockholm ; Karolinska Univ Hosp, Spinalis SCI Rehabil Unit, Stockholm.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Karolinska Inst, Div Neurorehabil, Stockholm ; Rehab Stn Stockholm, Stockholm, Sweden.
    Late mortality during the first year after acute traumatic spinal cord injury: a prospective, population-based study2010Inngår i: Journal of Spinal Cord Medicine (JSCM), ISSN 1079-0268, Vol. 33, nr 2, 117-127 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Little is known about the possible impact of the system of care on mortality during the first year after acute traumatic spinal cord injury (TSCI).

    OBJECTIVE: To evaluate late mortality (i.e., >7 days after trauma) during the first year after acute TSCI in 2 European Union (EU) regions, Thessaloniki in Greece and Stockholm in Sweden.

    METHODS: This paper is part of the Stockholm Thessaloniki Acute Traumatic Spinal Cord Injury Study (STATSCIS), which is a prospective, population-based study. Incidence cohorts of TSCI cases were identified and followed up in both study regions through STATSCIS. Data from Thessaloniki region were collected through physical examination, medical records review, and interviews with TSCI individuals and the medical teams. Data from Stockholm were retrieved mainly from the Nordic Spinal Cord Injury Registry, as well as from direct contact with all intensive care facilities of the region.

    RESULTS: The annual case mortality rate after acute TSCI was nearly 20% in Thessaloniki and 0% in Stockholm. The mean time of survival after trauma for the 12 mortality cases of Thessaloniki was 47 days (median = 24, SD +/- 67, range = 8-228). Factors associated with mortality were higher age and presence of comorbid spinal disorders but also the inefficient transfer logistics, initially missed spinal instability, and unsuccessfully treated complications.

    CONCLUSIONS: The annual case mortality rate in Thessaloniki was dramatically higher than in Stockholm. The different approaches to care, one systematic and the other not, is postulated to be an important factor leading to such major discrepancies between the outcomes of these 2 EU regions.

  • 21.
    Ejelöv, Marina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Bergström, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Mattsson, Monica
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    “Many obstacles along the way”: follow-up of rehabilitation plans after multimodal pain rehabilitation2016Inngår i: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, Vol. 18, nr 1, 18-26 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to explore the content of rehabilitation plans after multimodal rehabilitation (MMR) for chronic pain patients, focusing on occupation-oriented measures. A secondary aim was to study how the individual rehabilitation plans had been carried out and implemented during 1 year after MMR. A multiple methods approach with quantitative and qualitative data was used. The quantitative part was descriptive and examined whether the rehabilitation plans were carried out, the number of recommendations in each plan and the type of measures suggested. The qualitative part constituted a content analysis of interviews. Vocational rehabilitation was the second most common recommendation for the whole group. The analysis of the interviews resulted in seven categories divided into two main categories: impeding factors and facilitating factors for rehabilitation. The compliance of professionals and external parties with the patients’ rehabilitation plans, and the patients’ positive experience of their change in behaviour, contributed to the completion of the rehabilitation plans. In conclusion, lack of follow-up from the professionals and negative bodily signals inhibited the completion of rehabilitation. Flexibility on the part of professionals and external actors regarding patients’ rehabilitation plans as well as their own positive experiences of striving for change facilitated rehabilitation.

  • 22.
    Eklund, Fredrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Neovius, Martin
    Svensson, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Variation in fracture rates by country may not be explained by differences in bone mass2009Inngår i: Calcified Tissue International, ISSN 0171-967X, E-ISSN 1432-0827, Vol. 85, nr 1, 10-16 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    It is unclear whether the high fracture incidence in Sweden compared with other countries is related to low bone mass. We present and compare bone mineral density (BMD, g/cm(2)) at the femoral neck in a mainly osteoporotic referral population consisting of 2,031 men and 6,932 women with that of previous population-based cohorts. BMD measurements were collected at a single study center in Sweden, and data on validated hip fractures were collected from the corresponding health-care district and the cohort investigated. The BMD values of our cohort were similar to those of population-based cohorts from other countries. In contrast, the total incidence of hip fractures in 80-year-old women and men in the health-care district where our BMD measurements were performed was high (1.8% and 0.9%, respectively). The correlation between age and BMD was more negative in men aged 20-49 years than in women of the same age group (-0.011 vs. -0.006 g/cm(2) yearly, P < 0.001). In contrast, at 50-80 years of age, more negative regression coefficients were seen in women (-0.007 vs. -0.004 g/cm(2) yearly, P < 0.001 for comparison). In conclusion, a low BMD may not be the key factor explaining Sweden's comparatively high fracture incidence. In our cross-sectional data, age trends in BMD at the femoral neck differ between men and women. It would be highly interesting to further study the underlying causes of the global variations in fracture incidence rates.

  • 23.
    Eklund, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    On vocational rehabilitation in northern Sweden: with focus on life satisfaction and outcome prediction1991Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    A consecutive series of 149 subjects with complete or partial vocational disability due to somatic ill-health were investigated at admission for vocational rehabilitation and two years later. Subjects filled in checklists which encompassed 5 socio-demographic, 5 psycho-social and 9 life satisfaction items. Moreover, 5 dimensions of "handicap" were assessed.

    At admission subjects were physically examined. In this diagnostically mixed sample 80 of them had non-specific locomotor dysfunction with pain ("algia"). In this sub-sample 23 symptoms (yes/no alternatives) and 24 signs (present/not present) were registered.

    At the two-year follow-up actual source and level of income were registered and 126 subjects reported their levels of life satisfaction. A reference population including 163 employed subjects was used for comparisons of levels of life satisfaction.At admission satisfaction with life as a whole (level of happiness) and with 6/8 domain specific life satisfaction items were significantly lower for the vocational rehabilitation clients than for the references. Psycho-socio-demographic items formed 5 factors, two were socio-demographic and three psycho-social characteristics. Only few were "handicapped" concerning orientation, mobility and self-care, while the majority were financially and/or occupationally "handicapped".

    At the two-year follow-up 91% of the partly and 67% of those who at admission were completely vocationally disabled were undergoing education or were gainfully employed, giving a success rate of 77%. Moreover, return to work from unemployment resulted in significantly increased income. Successful rehabilitation resulted in normalization of the majority of life satisfaction domains. This was particularly true for overall vocational satisfaction. Level of happiness was increased but not up to the level of the references. At follow-up the level of or change in (admission/follow-up computations) vocational satisfaction were major predictors for level of or change in happiness. Hence, successful vocational rehabilitation led to increased social well-being.

    For the total sample major predictors of outcome were: Level of experienced health and belief in vocational return. It is suggested that these two variables arc useful instruments for vocational rehabilitation decision making. In the algic sub-sample signs and symptoms were - statistically - combined into 8 meaningful entities, characterizing regional, postural and relational syndromes. Whereas these may not necessarily be generalizable they may be of clinical descriptory value. However, only one of them contributed to outcome prediction; the major predictors for those algic subjects being belief in vocational return and sex.

  • 24.
    Elcadi, Guilherme H
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Forsman, Mikael
    Public Health Sciences, Karolinska Institute, Centre for Musculoskeletal Research, University of Gävle.
    Aasa, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Crenshaw, Albert G
    Department of Occupational and Public Health , University of Gävle.
    Shoulder and forearm oxygenation and myoelectric activity in patients with work related muscle pain and healthy subjects2013Inngår i: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 113, nr 5, 1103-1115 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We tested hypotheses of (i) reduced oxygen usage, oxygen recovery, blood flow and oxygen consumption; and (ii) increased muscle activity for patients diagnosed with work related muscle pain in comparison to healthy controls. Oxygenation was measured with near infrared spectroscopy (NIRS), and muscle activity with EMG for the extensor carpi radialis (ECR) and trapezius descendens (TD) muscles. Eighteen patients with diffuse neck-shoulder-arm pain and seventeen controls (matched in age and sex) were equipped with NIRS and EMG probes. After determining an individual’s maximum voluntary contraction (MVC) force, short term (20 sec) isometric contractions for the ECR and TD of 10%, 30%, 50% and 70% MVC generated ∆StO2% and StO2% recovery (Rslope) from NIRS, and RMS%max from EMG signals. In addition, upper arm venous (VO) and arterial (AO) occlusions generated slopes of total hemoglobin (HbTslope) and deoxyhemoglobin (HHbslope) for the resting ECR as surrogates of blood flow and oxygen consumption, respectively. Mixed Model analyses, t-tests, and Mann-Whitney test were used to assess differences between groups. There was no significant difference in MVC between groups for either muscle. Also, ∆StO2%, Rslope for either muscle, and ECR-HbTslope were not different between groups, thus our hypotheses of reduced oxygen use, recovery, and blood flow for patients were not confirmed. However, patients had a significantly lower ECR-HHbslope confirming our hypothesis of reduced consumption. Further, there was no difference in RMS%max during contractions meaning that the hypothesis of increased activity for patients was not confirmed. When taking into account the number of NIRS variables studied, differences we found between our patient group and healthy controls (i.e. in forearm oxygen consumption and shoulder oxygen saturation level) may be considered modest. Overall our findings may have been impacted by the fact that our patients and controls were similar in muscle strength, which is in contrast to previous studies.

  • 25.
    Elcadi, Guilherme H
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Forsman, Mikael
    Public Health Sciences, Karolinska Institute, Centre for Musculoskeletal Research, University of Gävle.
    Hallman, David
    Department of Occupational and Public Health, University of Gävle .
    Aasa, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Crenshaw, Albert G
    Department of Occupational and Public Health, University of Gävle .
    No differences in oxygenation in the forearm and shoulder of patients with work-related muscle pain and healthy subjects during a low-load sustained contractionManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    A frequently ascribed symptom associated to work-related muscle pain (WRMP) is muscle fatigue. Studies investigating oxygenation and hemodynamics in association to fatigue development in the muscles of patients with WRMP are sparse. Inadequate oxygen consumption and/or inadequate blood supply can influence the ability of the muscles to withstand fatigue. In this study we applied near-infrared spectroscopy (NIRS) and electromyography (EMG) to investigate oxygenation, hemodynamics and muscle activity in the extensor carpi radialis (ECR) and trapezius (TD) muscles of patients with WRMP and healthy controls. Eighteen patients with diffuse neck-shoulder-arm pain and 17 controls (matched in age and sex) were equipped with NIRS and EMG probes. After determination of maximal voluntary contraction (MVC) a sustained contraction of 15% MVC was performed with a cutoff for the maximum time of 12 min. Variables generated were StO2% and HbT from NIRS and RMS%max and MPF from EMG during the contraction. T tests and Mann-Whitney tests were used for analyzes of differences in MVC and endurance times. Full factorial repeated measures analyses of variance (ANOVA) were used to assess differences between patients and controls in NIRS and EMG parameters over time. Results showed no differences in MVC between patients and controls. We found, however, a shorter endurance time for patients compared to controls. There were no significant differences in StO2%, HbT, RMS and MPF responses during contraction between groups for the ECR. For the TD there was a group effect for StO2% with patients showing a lower level at rest and throughout the contraction. For the ECR and TD oxygenation, hemodynamics, RMS and MPF there were no straightforward differences between patients and controls that could explain the differences in endurance time. Therefore, we conclude that the shorter endurance time seen in the present study was not measurable by physiological indicators investigated in this group of patients.

  • 26.
    Elcadi, Guilherme H
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Högskolan Gävle.
    Forsman, Mikael
    Högskolan Gävle; Karolinska institutet Stockholm.
    Hallman, David M
    Högskolan Gävle.
    Aasa, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Fahlstrom, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Crenshaw, Albert G
    Högskolan Gävle.
    Oxygenation and hemodynamics do not underlie early muscle fatigue for patients with work-related muscle pain.2014Inngår i: PLoS ONE, ISSN 1932-6203, Vol. 9, nr 4, e95582Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Patients suffering from work-related muscle pain (WRMP) fatigue earlier during exercise than healthy controls. Inadequate oxygen consumption and/or inadequate blood supply can influence the ability of the muscles to withstand fatigue. However, it remains unknown if oxygenation and hemodynamics are associated with early fatigue in muscles of WRMP patients. In the present study we applied near-infrared spectroscopy (NIRS) on the extensor carpi radialis (ECR) and trapezius (TD) muscles of patients with WRMP (n = 18) and healthy controls (n = 17). Our objective was to determine if there were group differences in endurance times for a low-level contraction of 15% maximal voluntary contraction (MVC)--sustained for 12-13 min, and to see if these differences were associated with differences in muscle oxygenation and hemodynamics. At baseline, oxygen saturation (StO2%) was similar between groups for the ECR, but StO2% was significantly lower for TD for the WRMP patients (76%) compared to controls (85%) (P<0.01). Also, baseline ECR blood flow was similar in the two groups. For both muscles there were a larger number of patients, compared to controls, that did not maintain the 15% MVC for the allotted time. Consequently, the endurance times were significantly shorter for the WRMP patients than controls (medians, ECR: 347 s vs. 582 s; TD: 430 s vs. 723 s respectively). Responses in StO2% during the contractions were not significantly different between groups for either muscle, i.e. no apparent difference in oxygen consumption. Overall, we interpret our findings to indicate that the early fatigue for our WRMP patients was not associated with muscle oxygenation and hemodynamics.

  • 27.
    Elmqvist, Lars-Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Chronic anterior cruciate ligament tear: knee function and knee extensor muscle size, morphology and function before and after surgical reconstruction1988Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Knee function was evaluated by knee score, activity level, clinical findings and performance tests, muscle size by computerized tomography (CT), morphology by light (LM) and electron microscopy (EM), muscle function by electromyography (EMG) and isokinetic performance in 29 patients with chronic anterior cruciate ligament (ACL) tear. Preoperatively CT disclosed a significant mean atrophy of the quadriceps and nonsignificant changes of the other muscle areas of the injured leg. Morphology of m vastus lateralis of the injured leg was normal in more than half of the biopsies preoperatively, the rest showed signs of nonoptimal activation. Significant decreases in all isokinetic parameters were noticed together with significantly decreased EMG of the quadriceps muscle of the injured leg.

    Âfter surgical reconstruction the knees were immobilized in a cast for 6 weeks at either 30° or 70° of knee flexion. After cast removal CT showed significant decreases of all areas which also remained after training. The 30° group showed larger fibres (intracellular oedema) and more frequent morphological abnormalities than the 70° group. Fourteen weeks postoperatively the patients were allocated to either a combination of isometric and progressive resistance training or isokinetic training for 6 weeks. CT showed slightly larger areas at 20 weeks postoperatively than at 6 weeks. Morphological abnormalities were still prominent at 20 weeks postoperatively. Maximum isokinetic knee extensor mechanical output and endurance were markedly decreased at 14 weeks postoperatively but both improved progressively during the one year rehabilitation, mostly during the intensive 6 week training period but irrespective of training programme used. Fatiguability/endurance level improved over the preoperative level. Muscular work/integrated EMG was stable while EMG/t increased indicating neuromuscular relearning.

    The clinical result at 28 months foliowup was excellent or good in 93% of the patients and clinical stability improved in 66%. Independent upon primary knee immobilization angle or training programmes no differences could be demonstrated with respect to stability, range of motion, function or isokinetic mechanical output. Isokinetic performance was still significantly lower in the injured compared to the noninjured leg and not significantly different from the preoperative values. Morphology, only 6 cases, showed abnormalities similar to preoperative findings.

    In conclusion, the reason for the decreased maximum and total knee extensor performance in these patients with ACL tears is suggested to be nonoptimal activation of normal functioning muscle fibres depending on changes in knee joint receptor afferent inflow. No differences concerning the markedly improved postoperative clinical result could be seen between the different treatment modalities used. A nonoptimal muscular activation might explain the still decreased isokinetic performance present at followup.

  • 28.
    Engman-Bredvik, Sofie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Carballeira Suarez, Nivia
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Nilsson, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Multi-family therapy in anorexia nervosa: a qualitative study of parental experiences2016Inngår i: Eating Disorders, ISSN 1064-0266, E-ISSN 1532-530X, Vol. 24, nr 2, 186-197 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This qualitative study from northern Sweden investigated experiences of multi-family therapy (MFT) in 12 parents of children with anorexia nervosa (AN). The main reported benefit was the opportunity to talk to others in a similar situation, thereby sharing experiences and struggles. MFT resulted in new perspectives and insights that improved family dynamics and enabled new constructive behaviors. In conclusion, MFT seems to be a useful therapeutic modality in the treatment of AN in a northern European setting.

  • 29. Enthoven, Paul
    et al.
    Molander, Peter
    Oberg, Birgitta
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Department of Clinical Sciences, Karolinska Institutet and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden.
    Stenberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Gerdle, Bjorn
    DO PAIN CHARACTERISTICS GUIDE SELECTION FOR MULTIMODAL PAIN REHABILITATION?2017Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, nr 2, 161-169 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To determine whether self-reported pain measures are associated with selection for multimodal or multidisciplinary rehabilitation (MMR) and whether this selection is influenced by sex. Design: Cross-sectional cohort study. Subjects: A total of 1,226 women and 464 men with chronic pain conditions from 2 university hospitals. Methods: Drawing from the Swedish Quality Registry for Pain Rehabilitation (SQRP), data on pain, psychological symptoms, function, health, and activity/participation were collected. Multiple logistic regression was used to investigate association of pain measures with selection for MMR (no/yes) after multidisciplinary assessment. Covariates were: age, educational level, anxiety, depression, working status, and several pain measures. Results: High pain intensity in the previous week (odds ratio (OR) 0.92; 95% confidence interval (CI) 0.86-0.99) and high pain severity (Multidimensional Pain Inventory) (OR 0.83; 95% CI 0.74-0.95) were negatively associated with selection for MMR, whereas higher number of pain quadrants was positively associated with selection for MMR. Similar results were obtained for women, but none of the measures was predictive for men. Conclusion: This practice-based study showed that higher scores on self-reported pain were not associated with selection for MMR, and in women there was a negative association for higher pain intensity and pain severity. Thus, other factors than pain determine whether patients are selected for MMR.

  • 30.
    Fahlström, M
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Fahlström, P G
    Lorentzon, Ronny
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Henriksson-Larsén, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Positive short-term subjective effect of sports drink supplementation during recovery.2006Inngår i: J Sports Med Phys Fitness, ISSN 0022-4707, Vol. 46, nr 4, 578-84 s.Artikkel i tidsskrift (Fagfellevurdert)
  • 31.
    Fahlström, M
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Fahlström, P G
    Lorentzon, Ronny
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Henriksson-Larsén, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Positive short-term subjective effect of sports drink supplementation during recovery.2006Inngår i: J Sports Med Phys Fitness, ISSN 0022-4707, Vol. 46, nr 4, 578-84 s.Artikkel i tidsskrift (Fagfellevurdert)
  • 32.
    Fahlström, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Alfredson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Ultrasound and Doppler findings in the Achilles tendon among middle-aged recreational floor-ball players in direct relation to a match.2010Inngår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 44, nr 2, 140-143 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: In this study, structure, blood flow and thickness in the Achilles tendon related to tendon-loading activity were investigated. DESIGN: Examination by ultrasound (US) and colour Doppler (CD) immediately before and after 1 h of floor-ball matchplay. SETTING: Sports Medicine Unit, Umeå University, Sweden. PARTICIPANTS: 36 Achilles tendons in 18 middle-aged (mean 39 years) recreational male floor-ball players. MAIN OUTCOME MEASUREMENTS: Structure and high blood flow (HBF)/neovessels (NV) in the tendons were registered. Tendon thickness was measured 3 and 4.5 cm above the upper calcaneus and at the thickest part of the tendon. RESULTS: The US examination showed that 11/36 tendons (30.5%) in nine individuals had structural changes before and after the floor-ball match. In 7/36 tendons (five with structural changes), there were HBF/NV before, and after, the match. In six of these seven tendons, the blood flow was higher after than before the match. In three more tendons (two with structural changes), there were HBF/NV after, but not before, the match. After the match, mean tendon thickness had decreased significantly in both normal tendons and tendons with structural changes at the 3-cm level (6.0 (1.0) mm to 5.8 (0.9) mm; p<0.019), at the 4.5-cm level (5.7 (1.1) mm to 5.5 (1.0) mm; p<0.044), and at the thickest part (6.6 (1.1) mm to 6.3 (1.2) mm; p<0.000). CONCLUSIONS: In about 1/3 of the tendons, there were structural changes, about half of those tendons also had HBF/NV, which was higher after, than before, the match. Mean tendon thickness in both normal tendons and tendons with structural changes had decreased significantly after a 1-h floor-ball match.

  • 33.
    Fahlström, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Lorentzon, Ronny
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Acute Achilles tendon rupture in badminton players1998Inngår i: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 26, nr 3, 467-470 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    All patients with badminton-related acute Achilles tendon ruptures registered during 1990 to 1994 at the University Hospital of Umeå were retrospectively followed up using a questionnaire. Thirty-one patients (mean age, 36.0 years), 27 men and 4 women, were included. Thirty patients (97%) described themselves as recreational players or beginners. The majority of the injuries (29 of 31, 94%) happened at the middle or end of the planned game. Previous local symptoms had been noticed by five patients (16%). Long-term results showed that patients treated with surgery had a significantly shorter sick leave absence than patients treated without surgery (50 versus 75 days). There was no obvious selection favoring any treatment modality. None of the surgically treated patients had reruptures, but two reruptures occurred in the nonsurgically treated group. There seemed to be fewer remaining symptoms and a higher sports activity level after the injury in the surgically treated group. Our results indicate that local muscle fatigue may interfere with strength and coordination. Preventive measures such as specific treatment of minor injuries and adequate training of strength, endurance, and coordination are important. Our findings also indicate that surgical treatment and careful postoperative rehabilitation is of great importance among badminton players of any age or sports level with Achilles tendon rupture.

  • 34.
    Fahlström, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Lorentzon, Ronny
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Acute badminton injuries1998Inngår i: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 8, nr 3, 145-148 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    During 1990-1994, 1.2% of all sports injuries that required emergency care at the University Hospital of Umeå were caused by badminton. In 90.7% of the cases the patients described themselves as recreational players or beginners. There were 51.3% minor injuries (AIS 1) and 48.7% moderate injuries (AIS 2). The lower extremities were affected in 92.3% of the cases. Achilles tendon ruptures (34.6%) and ankle sprains and fractures (29.5%) were the most frequent. By the time of the follow-up (10-69 months), 52.6% of the players still had symptoms from the injuries and 39.5% had not been able to return to playing badminton. Our data indicate the importance of adequate treatment and rehabilitation after acute badminton injuries.

  • 35.
    Fahlström, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Bränström, Harriet
    Kinesiophobia in patients with chronic muskuloskeletal pain - differences between men and women2008Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977Artikkel i tidsskrift (Fagfellevurdert)
  • 36.
    Fahlström, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Jonsson, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Lorentzon, Ronny
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Alfredson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Chronic Achilles tendon pain treated with eccentric calf-muscle training2003Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 11, nr 5, 327-333 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Injuries involving the Achilles tendon and manifested as chronic tendon pain are common, especially among recreational athletes. In a pilot study on a small group of patients with chronic painful midportion Achilles tendinosis, eccentric calf-muscle training was shown to give good clinical results. The aim of this prospective study was to investigate if the previously achieved good clinical results could be reproduced in a larger group of patients, and also to investigate the effects of eccentric calf-muscle training in patients with chronic insertional Achilles tendon pain. Seventy-eight consecutive patients, having chronic painful Achilles tendinosis at the mid-portion (2–6 cm level) in a total of 101 tendons (55 unilateral and 23 bilateral), and thirty consecutive patients with chronic insertional Achilles tendon pain in 31 tendons (29 unilateral and one bilateral) were treated with eccentric calf-muscle training for 12 weeks. Most patients were recreational athletes. Evaluation of the amount of tendon pain during activity was recorded on a visual analogue scale (VAS), before and after treatment. In 90 of the 101 Achilles tendons (89%) with chronic painful mid-portion Achilles tendinosis, treatment was satisfactory and the patients were back on their reinjury activity level after the 12-week training regimen. In these patients, the amount of pain during activity, registered on the VAS-scale (mean±SD), decreased ignificantly from 66.8±19.4 to 10.2±13.7. On the contrary, in only ten of the tendons (32%) with chronic insertional Achilles tendon pain was treatment satisfactory, with a significant decrease on the VAS-scale (mean±SD), from 68.3±7.0 to 13.3±13.2. Our conclusion is that treatment with eccentric calf-muscle training produced good clinical results in patients with chronic painful mid-portion Achilles tendinosis, but not in patients withchronic insertional Achilles tendon pain.

  • 37.
    Fahlström, Martin
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Lorentzon, Ronny
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Alfredson, Håkan
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Painful conditions in the Achilles tendon region: a common problem in middle-aged competitive badminton players.2002Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 10, nr 1, 57-60 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Overuse injuries are the most frequent type in badminton, generally localized in the legs. An earlier study found 32% of young Swedish elite badminton players to have experienced disabling pain in the Achilles tendon region during the previous 5 years. The present investigation examined the prevalence and characteristics of painful conditions in the Achilles tendon region in 32 middle-aged competitive badminton players by means of questionnaire and physiotherapist's examination. Pain in the Achilles tendon region was reported by 44%, either presently or during the past 5 years, generally localized in the middle portion of the tendon. Symptoms had lasted 2 weeks-1 year (96 days). On the competition days 22% of the reported pain currently in the region. Age was found to be correlated to Achilles tendon pain, but there was no relationship between symptoms of pain and body mass index, gender, training quantity, or years of playing badminton. In conclusion, Achilles tendon pain seems to be relatively common among Swedish middle-aged competitive badminton players, particularly in the older ones.

  • 38.
    Fahlström, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Lorentzon, Ronny
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Alfredson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Painful conditions in the Achilles tendon region in elite badminton players.2002Inngår i: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 30, nr 1, 51-54 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The purpose of this study was to investigate the prevalence and characteristics of painful conditions in the Achilles tendon region in elite badminton players. The study group consisted of 66 players in the Swedish elite division (highest level) in badminton, 41 men (mean age, 24.4 years) and 25 women (mean age, 21.9 years). Twenty-one players (32%) reported the occurrence of a disabling painful condition in the Achilles tendon region during the previous 5 years, and 11 players (17%) had an ongoing painful condition. A majority of the painful conditions (12 of 21, or 57%) were described as involving the midportion of the Achilles tendon. The players who had a painful condition reported a significantly higher weekly training load as measured by the number of hours spent in total training, badminton training, and endurance and strength training. There were no differences in age, sex, and body mass index between the players with and without painful conditions in the Achilles tendon region.

  • 39.
    Fahlström, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Söderman, Kerstin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Decreased shoulder function and pain common in recreational badminton players.2007Inngår i: Scand J Med Sci Sports, ISSN 0905-7188, Vol. 17, nr 3, 246-51 s.Artikkel i tidsskrift (Fagfellevurdert)
  • 40.
    Fahlström, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Yeap, Joo Seng
    Alfredson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Söderman, Kerstin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Shoulder pain -- a common problem in world-class badminton players.2006Inngår i: Scandinavian journal of medicine & science in sports, ISSN 0905-7188, Vol. 16, nr 3, 168-73 s.Artikkel i tidsskrift (Fagfellevurdert)
  • 41.
    Flank, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Spinal cord injuries in Sweden: studies on clinical follow-ups2016Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    A spinal cord injury is a serious medical condition, often caused by a physical trauma. An injury to the spinal cord affects the neurotransmission between the brain and spinal cord segments below the level of injury. The SCI causes a loss of motor function, sensory function and autonomic regulation of the body, temporary or permanent. Significantly improved acute care, primary comprehensive rehabilitation and life-long structured follow-up has led to persons with spinal cord injury (SCI) living longer than ever before. However, increased long-time survival has allowed secondary conditions to emerge, like diabetes mellitus and where cardiovascular disease (CVD) now is the most common cause of death among SCI patients. Other possible CVD-related comorbidities in this patient group have been reported to be pain and mood disturbances. There is still lack of, and need for more knowledge in the field of CVD-related screening and prevention after SCI.

    The overall aim of this thesis was to contribute to a scientific ground regarding the need for CVD-related screening and prevention after SCI.

    In Paper I and Paper II, patients with wheelchair-dependent post-traumatic SCI (paraplegia) were assessed. The results in paper I showed that 80% of the examined patients had at least one cardiovascular disease risk marker irrespective of body mass index (BMI). Dyslipidemia was common for both men and women at all BMI categories. The study also showed a high prevalence of hypertension, especially in men. Paper II showed a low frequency of self-reported physical activity, where only one out of 5 persons reported undertaking physical activity >30 min/day. The physically active had lower diastolic blood pressure but no significant difference in blood lipids.

    In paper III and IV, patients with SCI (tetraplegia and paraplegia) participated in the studies. Eighty-one percent of the patients had dyslipidemia, where also a majority of the patients with normal abdominal clinical measures had dyslipidemia. Self-reported physical activity >30min/day was reported by one third of the patients. No differences were found between physically active and not physically active patients when it came to blood glucose, serum lipid values and clinical measures (paper III). Pain was common in the patient group, however, most often on a mild to moderate level. Anxiety and depression was less common than reported in other studies (paper IV).

  • 42.
    Flank, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Boström, Carina
    Lewis, John E.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Wahman, Kerstin
    Self-reported physical activity and risk markers for cardiovascular disease after spinal cord injury2014Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, nr 9, 886-890 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective:

    To examine whether self-reported physical activity of a moderate/vigorous intensity influences risk markers for cardiovascular disease in persons with paraplegia due to spinal cord injury.

    Design:

    Descriptive, cross-sectional study.

    Subjects:

    A total of 134 wheelchair-dependent individuals (103 men, 31 women) with chronic (>= 1 year) post-traumatic spinal cord injury with paraplegia.

    Methods:

    Cardiovascular disease markers (hypertension, blood glucose and a blood lipid panel) were analysed and related to physical activity.

    Results:

    One out of 5 persons reported undertaking physical activity >= 30 min/day. Persons who were physically active >= 30 min/day were significantly younger than inactive persons. Systolic and diastolic blood pressures were lower in the physically active group. When adjusting for age, the association between systolic blood pressure and physical activity disappeared. Physical activity >= 30 min/day had a tendency to positively influence body mass index and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio. Men had significantly higher systolic and diastolic blood pressures than women, lower high-density lipoprotein cholesterol, higher low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio and higher triglycerides. No other significant differences between men and women were found.

    Conclusion:

    Self-reported physical activity >= 30 min/day in persons with spinal cord injury positively influenced diastolic blood pressure. No other reductions in cardiovascular disease risk markers were seen after controlling for age. These results indicate a positive effect of physical activity, but it cannot be concluded that recommendations about physical activity in cardiovascular disease prevention for the general population apply to wheelchair-dependent persons with spinal cord injury.

  • 43.
    Flank, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Ramnemark, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Wahman, Kerstin
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Dyslipidemia is common after spinal cord injury - independent of clinical measures2015Inngår i: Jacobs Journal of Physical Rehabilitation Medicine, ISSN 2469-3103, Vol. 1, nr 1Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To survey the incidence of clinical risk markers and its correlation with established clinical measurements for cardiovascular disease (CVD) in a heterogeneous spinal cord injured (SCI) patient population.

    Design: Descriptive, cross-sectional study.

    Subjects: 78 patients with SCI, at different injury and functional level.

    Methods: Anthropometric data, blood pressure, a blood lipid panel, blood glucose and a questionnaire were analyzed.

    Results: Eighty-one percent of all patients had dyslipidemia (DL) and a majority of the patients with abdominal measures below the recommended cut-off levels had DL. Self-reported physical activity above the cut-off level was reported by 32.1%of the patients. There were no differences in clinical measures, serum lipid values and blood glucose between physically active and not active patients. No differences were seen between men/women, tetraplegia/paraplegia and wheelchair dependent/not wheelchair dependent patients.

    Conclusion: DL is common and seems to be not treated or undertreated in the studied SCI patient group with different neurological lesion and functional levels. General anthropometric clinical measures do not seem to be valid for evaluating risk for CVD in this patient group.

  • 44.
    Flank, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Ramnemark, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Wahman, Kerstin
    Department of Neurobiology, Care Sciences and Society, Division of Neurodegeneration, Section Neurorehabilitation, Karolinska Institutet, Sweden; Rehab Station, Stockholm/Spinalis R&D Unit, Sweden.
    Martin, Fahlström
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Pain, anxiety and depression in spinal cord injured patients2017Inngår i: Jacobs Journal of Physical Rehabilitation Medicine, ISSN 2469-3103, Vol. 3, nr 1, 028Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To assess the prevalence of pain, anxiety and depression in a sample of chronic SCI patients in Northern Sweden. Design: Descriptive, cross-sectional study. Setting: Specialist Clinic at a University Hospital. Participants: 78 patients with chronic spinal cord injury, at different injury and functional level. Outcome measures: Patients registered presented pain above, at or below injury level on a Visual Analogue Scale (VAS). Patients currently on pain medication were also registered as having pain. Depression and anxiety were assessed by the Hospital Anxiety and Depression Rating Scale (HADS). Results: Out of 78 patients, 58 (74%) indicated current presence of pain or were on continuous pain medication. Pain above injury level was present in 32% of the patients, with a mean VAS of 15.9±20.1, range 0-60mm. Pain at injury level were present in 24% of the patients, mean VAS 11.0±17.0, range 0-50mm and 58% had pain below injury level with a mean VAS 31.4±22.3, range 0-80mm. Clinically significant psychological disorders were reported in 4 patients (5%) for both anxiety and depression. Conclusions: Pain is very common in persons with chronic SCI, but, at least in a drug-treated population, the pain is at a mild or moderate level. Anxiety and depression were found much less common than reported in other studies. Medication effects have been considered. Even in a presumably well-medicated and well-rehabilitated population, there is still a need for further optimization of pain management, including both pharmacological and non-pharmacological methods.

  • 45.
    Flank, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Wahman, Kerstin
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Prevalence of risk factors for cardiovascular disease stratified by body mass index categories in patients with wheelchair-dependent paraplegia after spinal cord injury2012Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, nr 5, 440-443 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To assess risk factors for cardiovascular disease at different body mass index values in persons with wheelchair-dependent paraplegia after spinal cord injuries. Design: Cross-sectional study. Subjects: A total of 135 individuals, age range 18-79 years, with chronic (>= 1 year) post-traumatic paraplegia. Methods: Body mass index was stratified into 6 categorical groups. Cardiovascular disease risk factors for hypertension, diabetes mellitus and a serum lipid profile were analysed and reported by body mass index category. Results: More than 80% of the examined participants had at least one cardiovascular disease risk factor irrespective of body mass index level. Hypertension was highly prevalent, especially in men. Dyslipidaemia was common at all body mass index categories in both men and women. Conclusion: Higher body mass index values tended to associate with more hypertension and diabetes mellitus, whereas dyslipidaemia was prevalent across all body mass index categories. Studies that intervene to reduce weight and or percentage body fat should be performed to determine the effect on reducing modifiable cardiovascular disease risk factors.

  • 46.
    Flodgren, Gerd
    et al.
    Centre for Musculoskeletal Research, University of Gävle, Sweden.
    Crenshaw, AG
    Centre for Musculoskeletal Research, University of Gävle, Sweden.
    Gref, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Klinisk fysiologi.
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Changes in interstitial noradrenaline, trapezius muscle activity and oxygen saturation during low-load work and recovery2009Inngår i: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 107, nr 1, 31-42 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Both physical as well as mental demands result in an increased activity in the sympathetic nervous system (SNS) with changes in blood-pressure and heart-rate. Through local release of catecholamines, e.g. noradrenaline (NAd) SNS exerts various actions at the muscle level. The aims of this study were to investigate the effects of low-load repetitive work alone and in combination with mental demands on local muscle interstitial noradrenaline concentration [NAd]i, muscle activity and oxygenation, assessed with microdialysis, surface electromyography, and near-infrared spectroscopy, respectively. Healthy females (n = 15) were exposed to (1) 30 min repetitive work (RW) and (2) 30 min repetitive work with superimposed mental load (RWML) on two different occasions. Muscle [NAd]i and muscle activity increased significantly in response to RW, but did not increase further during RWML. For RW, [NAd]i was found to be inversely correlated to muscle activity. Oxygenation decreased significantly during work, independently of occasion. Our findings indicate that low-load work causes significantly increased trapezius muscle [NAd]i in healthy females, and short periods of superimposed mental load do not add to this increase and further, that both muscle activity and oxygenation were unaffected by the superimposed mental load.

  • 47.
    Flodgren, Gerd
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Hellström, FB
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Crenshaw, AG
    Effects of 30 versus 60 minutes of low-load work on intramuscular lactate, pyruvate, glutamate, prostaglandin E2 and oxygenation in the trapezius muscle of healthy females2006Inngår i: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 97, nr 5, 557-565 s.Artikkel i tidsskrift (Fagfellevurdert)
  • 48.
    Flodgren, Gerd M
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Crenshaw, Albert G
    Hellström, Fredrik
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Combining microdialysis and near-infrared spectroscopy for studying effects of low-load repetitive work on the intramuscular chemistry in trapezius myalgia.2010Inngår i: Journal of Biomedicine and Biotechnology, ISSN 1110-7243, E-ISSN 1110-7251, Vol. 2010, 513803- s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Epidemiological research provides strong evidence for a link between repetitive work (RW) and the development of chronic trapezius myalgia (TM). The aims were to further elucidate if an accumulation of sensitising substances or impaired oxygenation is evident in painful muscles during RW. Females with TM (n = 14) were studied during rest, 30 minutes RW and 60 minutes recovery. Microdialysate samples were obtained to determine changes in intramuscular microdialysate (IMMD) [glutamate], [PGE(2)], [lactate], and [pyruvate] (i.e., [concentration]) relative to work. Muscle oxygenation (%StO(2)) was assessed using near-infrared spectroscopy. During work, all investigated substances, except PGE(2), increased significantly: [glutamate] (54%, P < .0001), [lactate] (26%, P < .005), [pyruvate] (19%, P < .0001), while the %StO(2) decreased (P < .05). During recovery [PGE(2)] decreased (P < .005), [lactate] remained increased (P < .001), [pyruvate] increased progressively (P < .0001), and %StO(2) had returned to baseline. Changes in substance concentrations and oxygenation in response to work indicate normal increase in metabolism but no ongoing inflammation in subjects with TM.

  • 49. Gerdle, Bjorn
    et al.
    Molander, Peter
    Stenberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Stalnacke, Britt-Marie
    Enthoven, Paul
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden.
    Weak outcome predictors of multimodal rehabilitation at one-year follow-up in patients with chronic pain-a practice based evidence study from two SQRP centres2016Inngår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 17, 490Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: For patients with chronic pain, the heterogeneity of clinical presentations makes it difficult to identify patients who would benefit from multimodal rehabilitation programs (MMRP). Yet, there is limited knowledge regarding the predictors of MMRP’s outcomes. This study identifies predictors of outcome of MMRPs at a 12-month follow-up (FU-12) based on data from the Swedish Quality Registry for Pain Rehabilitation (SQRP).

    Methods: Patients with chronic pain from two clinical departments in Sweden completed the SQRP questionnaires—background, pain characteristics, psychological symptoms, function, activity/participation, health and quality of life—on three occasions: 1) during their first visit; 2) immediately after the completion of their MMRP; and 3) 12 months after completing the MMRP (n = 227). During the FU-12, the patients also retrospectively reported their global impressions of any changes in their perception of pain and their ability to handle their life situation in general.

    Results: Significant improvements were found for pain, psychological symptoms, activity/participation, health, and quality of life aspects with low/medium strong effects.

    A general pattern was observed from the analyses of the changes from baseline to FU-12; the largest improvements in outcomes were significantly associated with poor situations according to their respective baseline scores. Although significant regressors of the investigated outcomes were found, the significant predictors were weak and explained a minor part of the variation in outcomes (15–25%). At the FU-12, 53.6% of the patients reported that their pain had decreased and 80.1% reported that their life situation in general had improved. These improvements were associated with high education, low pain intensity, high health level, and work importance (only pain perception). The explained variations were low (9–11%).

    Conclusions: Representing patients in real-world clinical settings, this study confirmed systematic reviews that outcomes of MMRP are associated with broad positive effects. A mix of background and baseline variables influenced the outcomes investigated, but the explained variations in outcomes were low. There is still a need to develop standardized and relatively simple outcomes that can be used to evaluate MMRP in trials, in clinical evaluations at group level, and for individual patients.

  • 50. Gerdle, Björn
    et al.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Rudling, Karin
    Jansen, Gunilla Brodda
    Fischer, Marcelo Rivano
    Do not compare apples and pears in the evaluation of the rehabilitation guarantee.2014Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, nr 47, 2111-2 s.Artikkel i tidsskrift (Fagfellevurdert)
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