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  • 1.
    Aasa, Björn
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi. Norrlandsklinikens hälsocentral, Umeå, Sweden.
    Berglund, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Michaelson, Peter
    Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi.
    Aasa, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Individualized low-load motor control exercises and education versus a high-load lifting exercise and education to improve activity, pain intensity, and physical performance in patients with low back pain: a randomized controlled trial2015Inngår i: Journal of Orthopaedic and Sports Physical Therapy, ISSN 0190-6011, E-ISSN 1938-1344, Vol. 45, nr 2, 77-85 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Study Design Randomized controlled trial. Background Low back pain is a common disorder. Patients with low back pain frequently have aberrant and pain-provocative movement patterns that often are addressed with motor control exercises. Objective To compare the effects of low-load motor control (LMC) exercise and those of a high-load lifting (HLL) exercise. Methods Seventy participants with recurrent low back pain, who were diagnosed with nociceptive mechanical pain as their dominating pain pattern, were randomized to either LMC or HLL exercise treatments. Participants were offered 12 treatment sessions over an 8-week period. All participants were also provided with education regarding pain mechanisms. Methods Participants were assessed prior to and following treatment. The primary outcome measures were activity (the Patient-Specific Functional Scale) and average pain intensity over the last 7 days (visual analog scale). The secondary outcome measure was a physical performance test battery that included 1 strength, 3 endurance, and 7 movement control tests for the lumbopelvic region. Results Both interventions resulted in significant within-group improvements in pain intensity, strength, and endurance. The LMC group showed significantly greater improvement on the Patient-Specific Functional Scale (4.2 points) compared with the HLL group (2.5 points) (P<.001). There were no significant between-group differences in pain intensity (P = .505), strength, and 1 of the 3 endurance tests. However, the LMC group showed an increase (from 2.9 to 5.9) on the movement control test subscale, whereas the HLL group showed no change (from 3.9 to 3.1) (P<.001). Conclusion An LMC intervention may result in superior outcomes in activity, movement control, and muscle endurance compared to an HLL intervention, but not in pain intensity, strength, or endurance.

  • 2.
    Aasa, Björn
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Hellqvist, Jonas
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Berglund, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Michaelson, Peter
    Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi.
    Aasa, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    A characterisation of pain, disability, kinesiophobia and physical capacity in patients with predominantly peripherally mediated mechanical low back pain2011Konferansepaper (Fagfellevurdert)
  • 3.
    Aasa, Björn
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi. Norrlandskliniken, Umeå.
    Lundström, Lena
    Pain Rehabilitation, Norrlands University Hospital, Umeå.
    Papacosta, Daniel
    Norrlandskliniken, Umeå.
    Sandlund, Jonas
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Aasa, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Do we see the same movement impairments?: the inter-rater reliability of movement tests for experienced and novice physiotherapists2014Inngår i: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, Vol. 16, nr 16, 173-182 s., 3Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Study design: Inter-rater reliability study. Background: Physiotherapists (PTs) use clinical tests including movement tests to identify faulty movement patterns. Aims: To investigate the inter-rater-reliability of active movement tests in the cervical spine, shoulder joint and scapulo-thoracic joint, and to describe the reasons for judgment of a positive test. Methodology: Four PTs, two experienced and two recently educated (novice), rated performance of five movement tests for 36 participants. Twenty-one of the participants were patients under treatment because of neck and/or shoulder problems, while 15 participants declared no problem from this region of the body. All tests were video recorded and the ratings were done by observing the video recordings. First, the PTs judged the tests as negative (the movement being ideally performed) or positive (the movement not being ideally performed). Then, the PTs described why the movements that they judged positive were not being ideally performed, using a predefined protocol, which represented different movement quality aspects. The inter-rater reliability was calculated for each test using Kappa statistics between the two experienced and the two novice PTs, respectively, and between each of the experienced and each of the novice PTs. Major findings: The experienced PTs had a higher inter-rater reliability than the novice PTs. The reasons for considering a movement test being positive differed highly between the (novice) PTs. Principal conclusion: This study supports previous studies concluding that the observation of active movement tests is reliable when assessed by experienced PTs. Novice PTs might benefit from further supervision.

  • 4.
    Aasa, Ulrika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Berglund, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Aasa, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Krafttag ska stoppa styrkelyftarnas skador2015Annet (Annet (populærvitenskap, debatt, mm))
  • 5.
    Aasa, Ulrika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Lundell, Sara
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Aasa, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi. Norrlandskliniken, Umeå, Sweden.
    Westerståhl, Maria
    Institutionen för laboratoriemedicin, Karolinska institutet.
    Physical Activity Might Be of Greater Importance for Good Spinal Control Than If You Have Had Pain or Not: A Longitudinal Study2015Inngår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 40, nr 24, 1926-1933 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    STUDY DESIGN: Longitudinal design. A cohort followed in 3 waves of data collection.

    OBJECTIVE: The aim of the study was to describe the relationships between the performance of 2 tests of spinal control at the age of 52 years and low back pain, physical activity level, and fitness earlier in life, as well as to describe the cross-sectional relationships between these measures.

    SUMMARY OF BACKGROUND DATA: Altered spinal control has been linked to pain; however, other stimuli may also lead to inability to control the movements of the spine.

    METHODS: Participants answered questions about physical activity and low back pain, and performed physical fitness tests at the age of 16, 34, and 52 years. The fitness test battery included tests of endurance in the back and abdominal muscles, a submaximal bicycle ergometer test to estimate maximal oxygen uptake, and measurements of hip flexion, thoracic spine flexibility, and anthropometrics. Two tests were aggregated to a physical fitness index. At the age of 52, also 2 tests of spinal control, the standing Waiter's bow (WB) and the supine double leg lower (LL) were performed.

    RESULTS: Logistic regression analyses showed that higher back muscle endurance at the age of 34 years could positively predict WB performance at 52 years and higher physical fitness at the age of 34 could positively predict LL performance at 52 years. Regarding cross-sectional relationships, an inability to perform the WB correctly was associated with lower physical fitness, flexibility and physical activity, and larger waist circumference. An inability to correctly perform the LL was associated with lower physical fitness. One-year prevalence of pain was not significantly associated with WB or LL test performance.

    CONCLUSION: An active life resulting in higher physical fitness is related to better spinal control in middle-aged men and women. This further strengthens the importance of physical activity throughout the life span.

    LEVEL OF EVIDENCE: 3.

  • 6. Afif, Haitham
    et al.
    Mukka, Sebastian
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi. Sundsvall Hospital.
    Sjödén, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi. Sundsvall Hospital.
    Sayed-Noor, Arkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi. Sundsvall Hospital.
    Do bisphosphonate-related atypical femoral fractures and osteonecrosis of the jaw affect the same group of patients?: a pilot study2014Inngår i: Orthopedic Reviews, ISSN 2035-8237, E-ISSN 2035-8164, Vol. 6, 5067Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Bisphosphonates (BPs) are commonly used drugs in clinical practice. In this pilot study, we investigated whether bisphosphonate-related atypical femoral fractures (AFF) and osteonecrosis of the jaw (ONJ) occurred simultaneously in the same group of patients. Six ONJ patients were examined by an orthopedic surgeon and 5 AFF patients were examined by a dentist to look for manifestations of simultaneous occurrence of AFF in ONJ patients and vice versa. The required radiological investigations and previous medical and dental records were available. No simultaneous occurrence of AFF and ONJ was found in the examined patients. In this pilot study with limited sample size, no manifestations of simultaneous occurrence of AFF and ONJ were found. This could be an indication that these complications have different pathophysiologies and affect different subgroups of patients on long-term BP treatment.

  • 7. Agren, Per-Henrik
    et al.
    Tullberg, Tycho
    Mukka, Sebastian
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Wretenberg, Per
    Sayed-Noor, Arkan S.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Post-traumatic in situ fusion after calcaneal fractures: A retrospective study with 7-28 years follow-up2015Inngår i: Foot and Ankle Surgery, ISSN 1268-7731, E-ISSN 1460-9584, Vol. 21, nr 1, 56-59 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: In situ fusion as salvage operation after calcaneal fractures has been used. In this retrospective investigation, a group of in situ fused patients is analyzed with long-term follow-up.

    Methods: Twenty-nine patients with in situ single or multiple fusions performed between 1970 and 1990 were included. In 1998 these patients were examined with plain radiographs and computerized tomography (CT) scan of the affected foot. Also, a visual analogue score (VAS) for calcaneal fractures, short form health survey (SF-36), Olerud Molander score and American Orthopaedic Foot and Ankle society (AOFAS) hindfoot score were evaluated.

    Results: The plain radiographs and CT scan showed severe remaining deformities in these patients. The outcome parameters were generally poor and correlated to the degree of remaining deformity.

    Conclusions: Simple in situ fusion, without consideration of the deformity at hand, after a calcaneal fracture is not an adequate treatment and generally associated with poor outcome. (C) 2014 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  • 8.
    Ahlgren, Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Kalciumbrist - osteoporos: parathyreoideaes roll vid adaptionen till lågt kalciumintag hos vuxna råttor1975Doktoravhandling, med artikler (Annet vitenskapelig)
  • 9.
    Andersson, Camilla
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Hospital-acquired hip fractures Aspects on hospital-acquired hip fractures in Umeå, 2002-20142017Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 10.
    Andersson, Petter
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Evaluation of sonication in suspected prosthetic joint infection after hip replacement surgery2017Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 11.
    Aspenberg, Per
    et al.
    Department of Orthopaedics, IKE, Faculty of Health Sciences, Linköping.
    Nilsson, Kjell G
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Fixed or loose?: Dichotomy in RSA data for cemented cups.2008Inngår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 79, nr 4, 467-473 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and purpose: Roentgen stereometric analysis (RSA) cannot discern whether a single prosthesis is fixed or migrating below the detection level. Samples of patients usually show migration values that appear to be continuously distributed. Is there such continuity, or is there a dichotomy between stable and migrating prostheses? The hypothesis of a dichotomy has, to our knowledge, not been tested. We present an exploratory evaluation of such a dichotomy using a mixture distribution algorithm.

    Methods: We analyzed the migration (as determined by RSA) of 147 cemented acetabular cups of 7 different designs by using a new set of algorithms for frequency distribution analysis called Rmix.

    Results: We first analyzed a migration vector, regardless of direction. After 2 years there was a significant dichotomy between 2 lognormal subgroups within the sample. Although some types of cups were over‐represented in one of the subgroups, neither cup design, sex, nor operating department could explain the dichotomy into two groups, which appears to reflect the existence of two basically different types of behavior of the cups. We next analyzed the migration along the 3 axes in space, and found a similar dichotomy. During the second year, around 80% of the patients belonged to a distinct, normally distributed subgroup with a mean not different from 0 mm and a small variation. The remainder differed significantly from this subgroup and showed migration.

    Interpretation: There is a dichotomy in migration pattern. During the second postoperative year, most cups belonged to a subpopulation that appeared stable. The remainder is probably at risk of loosening. For a single type of prosthesis, the relative size of the stable subgroup may be a good index of the expected performance. The possibility of detecting subgroups within a seemingly continuous sample might be useful in many fields of medicine.

  • 12.
    Asplund, Kjell
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Castrén, Maaret
    Ehrenberg, Anna
    Farrokhnia, Nasim
    Göransson, Katarina
    Jonsson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Lind, Lars
    Marké, Lars-Åke
    Norlund, Anders
    Oredsson, Sven
    Syversson, Anneth
    Säwe, Juliette
    Triage och flödesprocesser på akutmottagningen. En systematisk litteraturöversikt.2010Rapport (Annet vitenskapelig)
  • 13. Benetou, V
    et al.
    Orfanos, P
    Pettersson-Kymmer, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap.
    Bergström, Ulrica
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Svensson, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Johansson, Ingegerd
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Kariologi.
    Berrino, F
    Tumino, R
    Borch, K B
    Lund, E
    Peeters, P H M
    Grote, V
    Li, K
    Altzibar, J M
    Key, T
    Boeing, H
    von Ruesten, A
    Norat, T
    Wark, P A
    Riboli, E
    Trichopoulou, A
    Mediterranean diet and incidence of hip fractures in a European cohort2013Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 24, nr 5, 1587-1598 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Prevention of hip fractures is of critical public health importance. In a cohort of adults from eight European countries, evidence was found that increased adherence to Mediterranean diet, measured by a 10-unit dietary score, is associated with reduced hip fracture incidence, particularly among men. INTRODUCTION: Evidence on the role of dietary patterns on hip fracture incidence is scarce. We explored the association of adherence to Mediterranean diet (MD) with hip fracture incidence in a cohort from eight European countries. METHODS: A total of 188,795 eligible participants (48,814 men and 139,981 women) in the European Prospective Investigation into Cancer and nutrition study with mean age 48.6 years (±10.8) were followed for a median of 9 years, and 802 incident hip fractures were recorded. Diet was assessed at baseline through validated dietary instruments. Adherence to MD was evaluated by a MD score (MDs), on a 10-point scale, in which monounsaturated were substituted with unsaturated lipids. Association with hip fracture incidence was assessed through Cox regression with adjustment for potential confounders. RESULTS: Increased adherence to MD was associated with a 7 % decrease in hip fracture incidence [hazard ratio (HR) per 1-unit increase in the MDs 0.93; 95 % confidence interval (95 % CI) = 0.89-0.98]. This association was more evident among men and somewhat stronger among older individuals. Using increments close to one standard deviation of daily intake, in the overall sample, high vegetable (HR = 0.86; 95 % CI = 0.79-0.94) and high fruit (HR = 0.89; 95 % CI = 0.82-0.97) intake was associated with decreased hip fracture incidence, whereas high meat intake (HR = 1.18; 95 % CI = 1.06-1.31) with increased incidence. Excessive ethanol consumption (HR high versus moderate = 1.74; 95 % CI = 1.32-2.31) was also a risk factor. CONCLUSIONS: In a prospective study of adults, increased adherence to MD appears to protect against hip fracture occurrence, particularly among men.

  • 14.
    Berglund, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Deadlift training for patients with mechanical low back pain: a comparison of the effects of a high-load lifting exercise and individualized low-load motor control exercises2016Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Disability due to low back pain is common. While evidence exist that exercise is effective in reducing pain and disability, it is still largely undetermined which kind of exercises that are most effective. The overall aim of this thesis was to evaluate and compare the effects of a high-load lifting exercise and individualized low-load motor control exercises for patients with nociceptive mechanical low back pain. A secondary aim was to evaluate which patients benefit from training with a high-load lifting exercise.

    All four papers in this thesis were based on a randomized controlled trial including 70 participants with nociceptive mechanical low back pain as their dominating pain pattern. Participants were randomized into training with either a high-load lifting exercise (HLL), the deadlift, (n=35) or individualized low-load motor control exercises (LMC) (n=35). Both interventions included aspects of pain education. All participants were offered twelve sessions during an eight week period. The effects of the interventions were evaluated directly after and twelve months after the end of the intervention period. Outcome measures were pain intensity, activity, disability, physical performance, lumbo-pelvic alignment and lumbar multifidus muscle thickness.

    There was a significant between-group effect in favour of the LMC intervention regarding improvements in activity, movement control tests and some tests of trunk muscle endurance. For pain intensity there were no significant differences between groups. A majority of participants in both intervention groups showed clinically meaningful improvements from baseline to two and twelve month follow-up regarding pain intensity and activity. There were no significant differences between HLL and LMC regarding the effect on lumbo-pelvic alignment or lumbar multifidus thickness. The participants who benefit the most from the HLL intervention were those with a low pain intensity and high performance in the Biering-Sørensen test at baseline.

    The results of this thesis showed that the HLL intervention was not more effective than the LMC intervention. The LMC was in fact more effective in improving activity, performance in movement control tests and some tests of trunk muscle endurance, compared to the HLL intervention.

    The results imply that the deadlift, when combined with education, could be considered as an exercise to produce clinically relevant improvements on pain intensity in patients who prefer a high-load exercise. However, before considering deadlift training, the results suggest that pain intensity and performance in the Biering-Sørensen test should be evaluated.

  • 15.
    Berglund, Lars
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Aasa, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Aasa, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Michaelson, Peter
    Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi.
    Styrketräning som behandling vid långvariga ländryggsbesvär2017Inngår i: Fysioterapi, ISSN 1653-5804, nr 4, 8 s.28-33 s.Artikkel, forskningsoversikt (Annet vitenskapelig)
    Abstract [sv]

    Fysisk träning är viktigt för en god hälsa och fungerar även som behandlingsform vid många sjukdomar, så även ländryggsbesvär. Styrketräning har visat sig vara en mer effektiv träningsform än till exempel aerob träning vid behandling av långvariga ländryggsbesvär. I dagsläget finns det ingen konsensus kring vilket det mest effektiva styrketräningsupplägget kan vara. Den vanligaste designen av styrketräningsprogram vid ländryggsbesvär tycks vara ett upplägg med syftet att förbättra styrkan/uthålligheten av ryggsträckarmuskulaturen och därigenom uppnå smärtlindring och funktionsförbättring. I en studie från Umeå universitet och Luleå tekniska universitet har träning av marklyft för patienter med långvariga ländryggsbesvär utvärderats. Marklyftsträningen förväntades öka deltagarnas bålstyrka samtidigt som den fokuserade på förbättring av rörelsekontroll kring såväl höft som ländrygg. När den åtta veckor långa träningsperioden var slut, visade det sig att gruppen som tränat marklyft hade ökat sin bålstyrka, minskat smärta, ökat funktionsförmåga och hälsorelaterad livskvalitet i samma omfattning som gruppen som tränade individanpassad träning av rörelsekontroll. Men de hade inte förbättrats lika mycket gällande rörelsekontroll eller vardagsfunktion. Vidare forskning pågår vid Umeå universitet om skador i samband med tung styrketräning samt lyftteknikens betydelse för skador och besvär vid tung styrketräning.

  • 16.
    Berglund, Lars
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Aasa, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Hellqvist, Jonas
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Michaelson, Peter
    Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi .
    Aasa, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Which patients with low back pain benefit from deadlift training?2015Inngår i: Journal of Strength and Conditioning Research, ISSN 1064-8011, E-ISSN 1533-4287, Vol. 29, nr 7, 1803-1811 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Recent studies have indicated that the deadlift exercise may be effective in decreasing pain intensity and increasing activity for most, but not all, patients with a dominating mechanical low back pain pattern. This study aimed to evaluate which individual factors measured at baseline could predict activity, disability, and pain intensity in patients with mechanical low back pain after an 8-week training period involving the deadlift as a rehabilitative exercise. Thirty-five participants performed deadlift training under the supervision of a physical therapist with powerlifting experience. Measures of pain-related fear of movement, hip and trunk muscle endurance and lumbopelvic movement control were collected at baseline. Measures of activity, disability and pain intensity were collected at baseline and at follow-up. Linear regression analyses were used to create models to predict activity, disability and pain intensity at follow-up. Results showed that participants with less disability, less pain intensity and higher performance on the Biering-Sørensen test, which tests the endurance of hip and back extensor muscles, at baseline benefit from deadlift training. The Biering-Sørensen test was the strongest predictor since it was included in all predictive models. Pain intensity was the next best predictor as it was included in two predictive models. Thus, for strength and conditioning professionals who use the deadlift as a rehabilitative exercise for individuals with mechanical low back pain, it is important to ensure that clients have sufficient back extensor strength and endurance and a sufficiently low pain intensity level to benefit from training involving the deadlift exercise.

  • 17.
    Berglund, Lars
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Aasa, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi. Norrlandskliniken Hlth Care Ctr, Umea, Sweden.
    Michaelson, Peter
    Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi .
    Aasa, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Idrottsmedicin.
    Effects of Low-Load Motor Control Exercises and a High-Load Lifting Exercise on Lumbar Multifidus Thickness: A Randomized Controlled Trial2017Inngår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 42, nr 15, E876-E882 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Study Design. Randomized controlled trial.Objective. The aim of this study was to compare the effects of low-load motor control (LMC) exercises and a high-load lifting (HLL) exercise, on lumbar multifidus (LM) thickness on either side of the spine and whether the effects were affected by pain intensity or change in pain intensity. Summary of Background Data. There is evidence that patients with low back pain (LBP) may have a decreased size of the LM muscles with an asymmetry between sides in the lower back. It has also been shown that LMC training can affect this asymmetry. It is, however, not known whether a high-load exercise has the same effect. Methods. Sixty-five participants diagnosed with nociceptive mechanical LBP were included and randomized into LMC exercises or a HLL exercise, the deadlift. The LM thickness was measured using rehabilitative ultrasound imaging (RUSI), at baseline and after a 2-month training period. Results. There were no differences between interventions regarding effect on LM muscle thickness. However, the analysis showed a significant effect for asymmetry. The thickness of the LM muscle on the small side increased significantly compared with the large side in both intervention groups, without influence of pain at baseline, or change in pain intensity.Conclusion. At baseline, there was a difference in thickness of the LM muscles between sides. It seems that exercises focusing on spinal alignment may increase the thickness of the LM muscles on the small side, irrespective of exercise load. The increase in LM thickness does not appear to be mediated by either current pain intensity or the magnitude of change in pain intensity.

  • 18.
    Berglund, Lars
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Aasa, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Michaelson, Peter
    Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi .
    Aasa, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Sagittal lumbo-pelvic alignment in patients with low back pain and the effects of a high-load lifting exercise and individualized low-load motor control exercises - a randomized controlled trial.2017Inngår i: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Context

    Assessment of posture and lumbo-pelvic alignment is often a main focus in the classification and treatment of patients with low back pain. However, little is known regarding the effects of motor control interventions on objective measures of lumbo-pelvic alignment.

    Purpose

    The primary aim of this study was to describe the variation of sagittal lumbo-pelvic alignment in patients with nociceptive mechanical low back pain. The secondary aim was to compare the effects of a high-load lifting exercise (HLL) and low-load motor control exercises (LMC) on change in lumbo-pelvic alignment with a special emphasis on patients with high and low degrees of lumbar lordosis (lu) and sacral angle (sa).

    Study Design

    This study is a secondary analysis of a randomized controlled trial evaluating the effects of HLL and LMC. Patient Sample Patients from the primary study, i.e. patients categorized with nociceptive mechanical low back pain, who agreed to participate in the radiographic examination were included (n=66).

    Outcome measures

    Lateral plain radiographic images were used to evaluate lumbo-pelvic alignment regarding lumbar lordosis and sacral angle as outcomes with posterior bend as an explanatory variable.

    Methods

    The participants were recruited to the study from two occupational health care facilities. They were randomized to either the HLL or LMC intervention group and offered 12 supervised exercise sessions. Outcome measures were collected at baseline and at the end of intervention period 2 months after baseline. Between and within group analyses of intervention groups and sub-groups based on the distribution of the baseline values for lumbar lordosis and sacral angle respectively, (LOW, MID, HIGH), were performed using both parametric and non-parametric statistics. This study was supported by two grants from Visare Norr (12000 US dollars) and Norrbotten County Council (13000 US dollars). The supporting organizations were not involved in the collection of data, analysis, interpretation or drafting of the manuscript.

    Results

    The ranges of values for the present sample for lumbar lordosis were 26.9-91.6° (M=59.0°, SD=11.5°) and for sacral angle were 18.2-72.1° (M=42.0°, SD=9.6°). There were no significant differences between the intervention groups in the percent change of either outcome measure. Neither did any outcome change significantly over time within the intervention groups. In the sub-groups, based on the distribution of respective baseline values, LOWlu showed significantly increased lumbar lordosis, whereas HIGHsa, showed significantly decreased sacral angle following intervention.

    Conclusions

    This study describes the wide distribution of values for lumbo-pelvic alignment for patients with nociceptive mechanical low back pain. Further research is needed to investigate sub-groups of other types of low back pain and contrast findings to those presented in this study. Our results also suggest that re-training of lumbo-pelvic alignment could be possible for patients with low back pain.

  • 19.
    Berglund, Lars
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Aasa, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Michaelson, Peter
    Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi .
    Aasa, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Sagittal lumbo-pelvic alignment in patients with low back pain and the effects of a high-load lifting exercise and individualized low-load motor control exercises – a randomized controlled trialManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Background Context

    Assessment of posture and alignment is often a main focus in the classification and treatment for patients with low back pain. However, there is much not known regarding the effects of motor control interventions on objective measures of lumbo-pelvic alignment.

    Purpose

    The primary aim of this study was to describe the variation of sagittal lumbo-pelvic alignment in patients with nociceptive mechanical low back pain. The secondary aim was to compare the effects of low-load motor control exercises and a high-load lifting exercise on change in alignment with a special emphasis on patients with high and low degrees of lumbar lordosis and sacral angle.

    Study Design

    This study is a secondary analysis of a randomized controlled trial evaluating the effects of a high-load lifting exercise (HLL) and low-load motor control training (LMC).

    Patient Sample

    Patients from the primary study, i.e. patients with a dominating pattern of nociceptive mechanical low back pain, who agreed to participate in the radiographic examination were included (n=66).

    Outcome measures

    Lateral plain radiographic images were used to evaluate lumbo-pelvic alignment regarding lumbar lordosis and sacral angle as outcomes and posterior bend as an explanatory variable.

    Methods

    The participants were recruited from two occupational health care facilities. They were randomized to LMC or HLL intervention group and offered 12 sessions of exercise with an instructor. Outcome measures were collected at baseline at the end of intervention period 2 months after baseline.

    Between and within group analyses of intervention groups and sub-groups based on the distribution of the baseline values for lumbar lordosis and sacral angle respectively, (LOW, MID, HIGH), were performed using both parametric and non-parametric tests.

    This study was supported by two grants from Visare Norr and Norrbotten County Council.

    Results

    The lumbar lordosis and sacral angle in the present sample had a wide distribution, while the mean values for lumbar lordosis was 59.0, SD 11.5 degrees and for sacral angle 42.0, SD 9.6 degrees. There were no difference between groups in the percent change in either outcome measure. Neither did any outcome change significantly over time within the intervention groups. In the sub-groups based on the distribution of baseline values for lumbar lordosis and sacral angle respectively, the sub-group LOWlu representing low baseline values of lumbar lordosis increased their lumbar lordosis significantly. The sub-group HIGHsa, representing high baseline values for sacral angle, decreased their sacral angle significantly following intervention.

    Conclusions

    This study is the first to describe the wide distribution of values for lumbo-pelvic alignment for patients with nociceptive mechanical low back pain. There is however further need to investigate other types of low back pain in order to contrast these findings to other sub-groups of low back pain. The results also suggest that re-training of lumbo-pelvic alignment could be possible for patients with low back pain.

  • 20.
    Berglund, Lars
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Aasa, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Michaelson, Peter
    Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi .
    Aasa, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    The effects of low-load motor control exercises and a high-load lifting exercise on lumbar multifidus thickness – a randomized controlled trialManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Study Design

    Randomized controlled trial

    Objective

    The aim of this study was to compare the effects of low-load motor control exercises and a high-load lifting exercise on lumbar multifidus thickness among patients with nociceptive mechanical low back pain.

    Summary of Background Data

    There is evidence that patients with low back pain may have a decreased size of the lumbar multifidus muscles with an asymmetry between left/right sides in the lower back. It has also been shown that low-load motor control training can affect this asymmetry; essentially, it is effective in equalizing side differences in lumbar multifidus muscle size. It is, however, not known whether a high-load exercise has the same effect.

    Methods

    Sixty-five participants diagnosed with nociceptive mechanical low back pain were included and randomized into low-load motor control exercises or a high-load lifting exercise, the deadlift. The lumbar multifidus thickness at the fifth lumbar vertebra was measured, using rehabilitative ultrasound imaging, at baseline and after a 2-month training period.

    Results

    There were no differences between interventions regarding effect on lumbar multifidus muscle thickness. However, the linear mixed model analysis showed a significant effect for asymmetry. The thickness of the lumbar multifidus muscle on the small side increased significantly compared to the large side in both intervention groups.

    Conclusions

    There was a difference in thickness of the lumbar multifidus muscles between sides. It seems that exercises focusing on spinal alignment may increase the thickness of the lumbar multifidus muscles on the small side, irrespective of exercise load.

  • 21.
    Berglund, Lars
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Hellqvist, Jonas
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Aasa, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Holmberg, David
    Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi.
    Michaelson, Peter
    Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi.
    Aasa, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Which patients with persistent mechanical low back pain will respond to high load motor control training?2011Konferansepaper (Fagfellevurdert)
  • 22.
    Berglund, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Long-term results of patients <65 years of age undergoing Total Knee Arthroplasty with Trabecular Metal Implant2016Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 23.
    Bergström, Ulrica
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Ortopedi.
    Fragility fractures in fragile people: epidemiology of the age quake2009Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Osteoporosis-related fracture is already today a major public health problem and the number of hip fractures is expected to double to 2030. Sweden has one of the highest hip fracture incidences worldwide. This may be explained by several factors: e.g. age, genetic, climatologic, geographic and a relative vitamin D deficiency, secondary to the limited sunlight exposure especially during winter months. Intrinsic and extrinsic factors contribute to a fracture, although a prior low energy fracture is one of the strongest predictors for a subsequent one and this should be a target for secondary fracture prevention in an orthopaedic setting.

    Since 1993 all injured patients admitted to the emergency floor and all in-hospital fractures at Umeå University Hospital, Sweden, were registered according to the Injury Data Base, former EHLASS. There were 31,173 fracture events (one or more fractures at the same time), of which 13,931 were in patients’ ≥ 50 years old. The fracture database was co analyzed with the Northern Sweden Health and Disease Study cohort in a nested case-control study for investigations of associations between osteoporotic fracture and serum markers, lifestyle data, nutrition etc. We found that there were differences in fracture pattern depending on age and sex. Both injury mechanism and fracture site were strongly dependent of age. The most severe fragility fracture, hip fracture, had a decreasing incidence. However, the incidence curve was right-shifting leading to an increase, both in numbers and in incidence of hip fractures among the oldest female. To identify people at high risk for fractures, re-fracture patients are useful. No less than 21% of the fracture patients had suffered more than one fracture event, accounting for 38% of all fracture events. The total risk ratio for a subsequent fracture was 2.2 (2.1-2.3 95% CI). In males the highest risk for re fracture was in the age cohort 70-79 years (RR 2.7, 2.3-3.2 95% CI), in females > 90 years (RR 3.9, 3.2-4.8 95% CI). Another possible risk factor in this subarctic population is the lack of sunlight, leading to a vitamin D deficit. The overall adjusted risk of sustaining a hip fracture in this population was 2.7 (95%CI:1.3-5.4) in subjects with a serum 25 hydroxyvitamin D below 50 nmol/l. The association was, however, different according to age at baseline. Thus in subjects aged 60 years and above at baseline, the adjusted odds ratio of sustaining a hip fracture was 6.2 (1.2-32.5 95%CI) for the group of individuals with a serum 25OHD below 50 nmol/l, whereas no significant association was found in the youngest age group.

    In the next 30 years the ongoing demographic changes will accelerate. The World War II baby boomers will cause an age quake. We can already see signs heralding a new fracture pattern: an increasing cohort of mobile but fragile elderly, with considerable co-morbidity is now at risk for fragility fractures. In fracture patients, clinical information is sufficient to pinpoint patients with a high risk for re-fractures. It is therefore clinically important to use the information provided by the fracture event. We suggest that trauma units and primary care units should screen for risk factors and inform patients about the treatment options, and to organize fracture liaison services. This seems to be especially cost-efficient for our oldest and frailest patients. Secondary prophylaxis and follow-up treatment after cardiovascular disorders are now a matter of course worldwide, but the screening for risk factors, in order to prevent a second fracture, is often neglected. This is one of the most important issues of fracture care in the future in order to improve general health.

  • 24.
    Bergström, Ulrica
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Jonsson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Svensson, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Fracture mechanisms and fracture pattern in men and women aged 50 years and older: a study of a 12-year population-based injury register, Umeå, Sweden2008Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 19, nr 9, 1267-1273 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Summary: In a study of a 12-year population-based injury register, Umeå, Sweden, we analyzed the fracture mechanisms and fracture pattern in men and women 50 years and older. Low-energy trauma was responsible for the major and costliest part of the fracture panorama, but the pattern differs between age groups.

    Introduction: Osteoporosis-related fracture is a major health problem: the number of hip fractures is expected to double to 2030. While osteoporosis is one of many risk factors, trauma is almost always involved. Therefore, we analyzed injury mechanisms in patients aged over 50.

    Methods: We registered injury mechanism, cause, diagnosis in all trauma patients at Umeå University hospital, Sweden. This population-based register (1993–2004) comprises a total of 113,668 injuries (29,189 fractures). Patients ≥50 years contributed to 13,279 fractures.

    Results: Low-energy trauma (fall <1 m) caused 53% of all fractures ≥50 years and older. In those over 75 low-energy trauma caused >80%. The seasonal variation of fractures was maximally 25%. With increasing age, proximal fractures became more common, in both upper and lower extremities. Proximal locations predominate in older age groups.

    Conclusions: Low-energy trauma was responsible for the largest and costliest part of the fracture panorama. In fact, almost all fractures in middle-aged and old people were caused by low-energy mechanisms; thus, most fractures in these patients have a fragility component, and the contribution of osteoporosis-related fractures is more important than previously thought. A better understanding of injury mechanisms also in low-energy trauma is a prerequisite for preventive interventions.

  • 25.
    Bergström, Ulrica
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Jonsson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Pettersson, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk farmakologi.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Svensson, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    The hip fracture incidence curve is shifting to the right: a forecast of the age-quake2009Inngår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 80, nr 5, 520-524 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background The number of hip fractures has doubled in the last 30–40 years in many countries. Age-adjusted incidence has been reported to be decreasing in Europe and North America, but is there a decreasing trend in all age groups? Patients and methods This population-based study included all hip-fracture patients over 50 years of age (a total of 2,919 individuals, 31% of whom were men) admitted to Umeå University Hospital, Sweden, from 1993 through 2005. Results The incidence of hip fracture declined between the periods 1993–1996 and 2001–2005: from 706 to 625 hip fractures per 105 women and from 390 to 317 hip fractures per 105 men. However, there was a 114% increase in the number of fractures in women aged 90 or older (12 and 25 hip fractures/year, respectively, in the two time periods). For the period 2001–05, women ≥ 90 years of age accounted for almost the same numbers of hip fractures as women aged 75–79 (27 fractures/year). The rate increased during this period, from 2,700 per 105 women to 3,900 per 105 women > 90 years. In men there were declining trends for both relative and absolute numbers. Interpretation Although age-adjusted incidence declined in the population > 50 years of age, absolute fracture rate and incidence increased in the very old. Women over 90 now have the same absolute number of hip fractures every year as women aged 75–79 years. There was a right-shift in hip fracture distribution towards the oldest old, probably due to an increased number of octo/nonagenarians, a new population of particularly frail old people that hardly existed earlier. Better health among septuagenarians may also have delayed the age at which fractures occurred. This changing pattern will strain orthopedic and geriatric resources even more.

  • 26.
    Bjerke, Joakim
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik. Department of Physiotherapy, School of Health Education & Social Work, Sør-Trøndelag University College, Trondheim, Norway.
    Öhberg, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Nilsson, Kjell G
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Foss, Olav A
    Orthopaedic Research Centre, Trondheim University Hospital, Trondheim, Norway.
    Stensdotter, Ann-Katrin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik. Department of Physiotherapy, School of Health Education & Social Work, Sør-Trøndelag University College, Trondheim, Norway.
    Peak knee flexion angles during stair descent in TKA patients2014Inngår i: The Journal of Arthroplasty, ISSN 0883-5403, E-ISSN 1532-8406, Vol. 29, nr 4, 707-711 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Reduced peak knee flexion during stair descent (PKSD) is demonstrated in subjects with total knee arthroplasty (TKA), but the underlying factors are not well studied. 3D gait patterns during stair descent, peak passive knee flexion (PPKF), quadriceps strength, pain, proprioception, demographics, and anthropometrics were assessed in 23 unilateral TKA-subjects ~ 19 months post-operatively, and in 23 controls. PKSD, PPKF and quadriceps strength were reduced in the TKA-side, but also in the contralateral side. A multiple regression analysis identified PPKF as the only predictor (57%) to explain the relationship with PKSD. PPKF was, however sufficient for normal PKSD. Deficits in quadriceps strength in TKA-group suggest that strength is also contributing to smaller PKSD. Increased hip adduction at PKSD may indicate both compensatory strategy and reduced hip strength.

  • 27.
    Bjerke, Joakim
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Department of Physiotherapy, School of Health Education & Social Work, Sør-Trøndelag University College, Trondheim, Norway.
    Öhberg, Fredrik
    Department of Biomedical Engineering & Informatics, Umeå University Hospital, Umeå, Sweden.
    Nilsson, Kjell G
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Stensdotter, Ann-Katrin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Department of Physiotherapy, School of Health Education & Social Work, Sør-Trøndelag University College, Trondheim, Norway.
    Compensatory strategies for muscle weakness during stair ascent in subjects with total knee arthroplasty2014Inngår i: The Journal of Arthroplasty, ISSN 0883-5403, E-ISSN 1532-8406, Vol. 29, nr 7, 1499-1502 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Subjects with total knee arthroplasty (TKA) exhibit decreased quadriceps and hamstring strength. This may bring about greater relative effort or compensatory strategies to reduce knee joint moments in daily activities. To study gait and map out the resource capacity, knee muscle strength was assessed by maximal voluntary concentric contractions, and whole body kinematics and root mean square (RMS) electromyography (EMG) of vastus lateralis and semitendinosus were recorded during stair ascent in 23 unilateral TKA-subjects ~19months post-operation, and in 23 healthy controls. Muscle strength and gait velocity were lower in the TKA group, but no significant group differences were found in RMS EMG or forward trunk lean. The results suggest that reduced walking velocity sufficiently compensated for reduced knee muscle strength.

  • 28.
    Bjerke, Joakim
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Department of Physiotherapy, Faculty of Health and Social Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
    Öhberg, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Nilsson, Kjell G
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Stensdotter, Ann-Katrin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. epartment of Physiotherapy, Faculty of Health and Social Sciences, Norwegian University of Science and Technology, Trondheim, Norway .
    Walking on a compliant surface does not enhance kinematic gait asymmetries after unilateral total knee arthroplasty2016Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 24, nr 8, 2606-2613 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: To investigate gait asymmetries and the effect of walking on compliant surfaces in individuals with unilateral total knee arthroplasty (TKA), hypothesizing that asymmetries would increase as an effect of the compliant surface.

    METHODS: Individuals with unilateral TKA ~19 months post-operative (n = 23, median age 59 years) recruited from one orthopaedic clinic and age- and gender-matched healthy individuals without knee complaints (n = 23, median age 56 years) walked at comfortable speed on a hard surface and on a compliant surface. 3D kinematic analyses were made for knee and hip angles in sagittal and frontal planes, stance time, step length, and gait velocity.

    RESULTS: Shorter stance time (p < 0.01) and less peak knee flexion (p < 0.001) at weight bearing acceptance was found in the prosthetic side compared with the contralateral side. Larger knee (p < 0.01) and hip (p < 0.001) adduction was found compared with healthy controls. Neither asymmetries between the prosthetic and the contralateral side nor differences compared with healthy controls were enhanced when walking on compliant surfaces compared with hard surfaces.

    CONCLUSION: The TKA group adapted their gait to compliant surfaces similarly to healthy controls. Gait asymmetries in the TKA group observed on hard surface were not enhanced, and adduction in hip and knee joints did not increase further as an effect of walking on compliant surfaces. Thus, unfavourable knee joint loading did not increase when walking on a compliant surface. This implies that recommendations for walking on soft surfaces to reduce knee joint loading are not counteracted by increased gait asymmetries and unfavourable joint loading configurations.

    LEVEL OF EVIDENCE: III.

  • 29.
    Björck van Dijken, Christina
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Ortopedi. Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Sjukgymnastik.
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering.
    Hildingsson, Christer
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Ortopedi.
    Low back pain, lifestyle factors and physical activity: a population-based study.2008Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, Vol. 40, nr 10, 864-869 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective and designThe prevalence of low back pain was assessed in relation to physical activity, for both work and leisure activities, in a randomly selected population in the northern part of Sweden. Additionally, the associations between age, sex, level of education, lifestyle factors, demographic characteristics, and low back pain were evaluated. Subjects: A total of 5798 subjects aged 25–79 years were selected randomly from a geographically well-defined area in northern Sweden. Methods: Additional questions concerning people's experience of low back pain were added to the questionnaire of the World Health Organization MONICA (MONItoring of trends and determinants in CArdiovascular disease) health survey with the aim of investigating prevalence rates and factors associated with low back pain. Results: Forty-one percent of the participants reported having low back pain (of these 55% were women and 45% men). The prevalence rate was highest in the age group 55–64 years. Chronic low back pain was the most frequent occurring problem. Of those with low back pain, 43% of the women and 37% of the men reported having continuous low back pain for more than 6 months. Individuals with low back pain often experienced a more physically heavy workload at work and lower physical activity during leisure time, and they were also more likely to have been smokers, have had higher body mass index, lived in smaller communities, and were less educated than people without low back pain. Conclusion: Low back pain seems to be associated with physical activity at work and in leisure time, certain lifestyle factors and demographic characteristics.

  • 30. Borgström, Fredrik
    et al.
    Zethraeus, Niklas
    Johnell, Olof
    Lidgren, Lars
    Ponzer, Sari
    Svensson, Olle
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Ortopedi.
    Abdon, Peter
    Ornstein, Ewald
    Lunsjö, Karl
    Thorngren, Karl Göran
    Sernbo, Ingemar
    Rehnberg, Clas
    Jönsson, Bengt
    Costs and quality of life associated with osteoporosis-related fractures in Sweden.2006Inngår i: Osteoporos International, ISSN 0937-941X, Vol. 17, nr 5, 637-50 s.Artikkel i tidsskrift (Fagfellevurdert)
  • 31.
    Borota, Ljubisa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Jonasson, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Agolli, Armend
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Spontaneous resorption of intradural lumbar disc fragments2008Inngår i: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632, Vol. 8, nr 2, 397-403 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background context: Intradural disc herniation is relatively rare complication of the spinal degenerative process that occurs most frequently in the lumbar part of the spine. Both myelographic and magnetic resonance features of this entity have been described, and the mechanism of intradural herniation has already been proposed and generally accepted. In this article, we present a case of spontaneous resorption of an intradural, fragmented intervertebral disc. Spontaneous resorption of intradural disc fragments has not been previously reported.

    Purpose: To discuss a possible mechanism of spontaneous resorption of the subdural disc fragments.

    Study design: Case report and literature review.

    Methods: Radiological follow-up of a 46-year-old man with the intradural herniation of disc fragments.

    Conclusion: The reaction generated by the meninges might lead to the complete resorption of intrathecally localized disc fragments.

  • 32.
    Borssén, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Foot lesions in diabetic patients aged 15-20 years: a population-based study1996Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Foot problems are not only the most common but in general also the most severe of the diabetic complications. The age group 15-50 yrs in this study was chosen because these patients were considered to be at their most active age and were felt to require optimal foot function.

    380 patients (96 %) participated, 78 % with Type 1, 20 % Type 2 and 1 % with secondary diabetes mellitus (DM) and 100 healthy controls. Only six patients had signs of peripheral ischaemia but half of the patients had deformities such as fallen forefoot arches and hammer toes. With sensory thresholds and clinical signs it was demonstrated that age, duration of DM and tall stature are major risk factors for diabetic neuropathy. Gender differences depend on differences in height. Dorsiflexion of the toes against resistance was used to test the function and volume of m.extensor digitorum brevis. When compared with measurements of sensory thresholds for vibration, perception and pain, it was found to be a valuable test for screening of distal motor neuropathy.

    To prevent worsening of foot deformities 266 patients with Type 1 DM were followed for 3 years. Those with the most pronounced deformities were fitted with custom-made insoles and had repeated examinations. Improvement was more common in patients with insoles compared to patients without insoles.

    Bone mineral density (BMD) was measured in nine patients with osteopathy in their feet and 18 controls. BMD was lower in L2-L3, but not in the proximal femur, implying osteopenia being a possible risk factor for distal osteopathy.

    Plaster cast treatment was used in 33 diabetic patients with severe foot ulcers who were selected because previous conservative treatment had been unsuccessful and they had been judged unsuitable for vascular surgery. The lesions healed in 19 patients.

    In conclusion, the main findings demonstrate the need for an increased awareness of early preventive foot care in young and middle-aged diabetic patients.

  • 33.
    Bovinder Ylitalo, Erik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Thysell, Elin
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Jernberg, Emma
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Lundholm, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Crnalic, Sead
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Egevad, Lars
    Stattin, Pär
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Widmark, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Bergh, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Wikström, Pernilla
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Subgroups of castration-resistant prostate cancer bone metastases defined through an inverse relationship between androgen receptor activity and immune response2017Inngår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 71, nr 5, 776-787 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Novel therapies for men with castration-resistant prostate cancer (CRPC) are needed, particularly for cancers not driven by androgen receptor (AR) activation. Objectives: To identify molecular subgroups of PC bone metastases of relevance for therapy.

    Design, setting, and participants: Fresh-frozen bone metastasis samples from men with CRPC (n = 40), treatment-naïve PC (n = 8), or other malignancies (n = 12) were characterized using whole-genome expression profiling, multivariate principal component analysis (PCA), and functional enrichment analysis. Expression profiles were verified by reverse transcription–polymerase chain reaction (RT-PCR) in an extended set of bone metastases (n = 77) and compared to levels in malignant and adjacent benign prostate tissue from patients with localized disease (n = 12). Selected proteins were evaluated using immunohistochemistry. A cohort of PC patients (n = 284) diagnosed at transurethral resection with long follow-up was used for prognostic evaluation.

    Results and limitations: The majority of CRPC bone metastases (80%) was defined as AR-driven based on PCA analysis and high expression of the AR, AR co-regulators (FOXA1, HOXB13), and AR-regulated genes (KLK2, KLK3, NKX3.1, STEAP2, TMPRSS2); 20% were non–AR-driven. Functional enrichment analysis indicated high metabolic activity and low immune responses in AR-driven metastases. Accordingly, infiltration of CD3+ and CD68+ cells was lower in AR-driven than in non–AR-driven metastases, and tumor cell HLA class I ABC immunoreactivity was inversely correlated with nuclear AR immunoreactivity. RT-PCR analysis showed low MHC class I expression (HLA-A, TAP1, and PSMB9 mRNA) in PC bone metastases compared to benign and malignant prostate tissue and bone metastases of other origins. In primary PC, low HLA class I ABC immunoreactivity was associated with high Gleason score, bone metastasis, and short cancer-specific survival. Limitations include the limited number of patients studied and the single metastasis sample studied per patient.

    Conclusions: Most CRPC bone metastases show high AR and metabolic activities and low immune responses. A subgroup instead shows low AR and metabolic activities, but high immune responses. Targeted therapy for these groups should be explored. Patient summary: We studied heterogeneities at a molecular level in bone metastasis samples obtained from men with castration-resistant prostate cancer. We found differences of possible importance for therapy selection in individual patients.

  • 34.
    Brax-Olofsson, Lisbeth
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Svensson, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Lorentzon, Ronny
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Lindström, Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Alfredson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Periosteal transplantation to the rabbit patella.2007Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 15, nr 5, 560-563 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Autologous periosteal transplantation (without chondrocyte cell transplantation) for treating traumatic articular cartilage defects of the patella gives pain relief in uncontrolled clinical studies. To study the whole transplanted area macroscopically and microscopically, animal studies are motivated. In this pilot study, we reproduce the surgical technique for periosteum transplantation on human patella to a rabbit model. A full-thickness cartilage defect of the whole patella was created in eight adult female rabbits. The defect was treated with autologous periosteal transplantation. After surgery, the rabbits were allowed free activity. This is the difference compared to the treatment in humans, where our group uses CPM for 5 days and non-weight-bearing for 12 weeks. After 21 weeks, there was a diffuse synovitis in all transplanted knees, and in five of eight knees there were signs of osteoarthritis in the patello-femoral joint. Histologically, in three animals, small islands of hyaline cartilage surrounded by fibrocartilage were seen in the transplanted area. In the other five animals, fibrocartilage was the predominant tissue. In contrast to previous experimental studies using a rabbit model, we did not achieve hyaline cartilage resurfacing.

  • 35. Brodda Jansen, Gunilla
    et al.
    Edlund, Curt
    Grane, Per
    Hildingsson, Christer
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Ortopedi.
    Whiplash injuries: Diagnosis and early management2008Inngår i: European Spine Journal, Vol. 17, nr Suppl 3Artikkel i tidsskrift (Fagfellevurdert)
  • 36. Brodén, Cyrus
    et al.
    Mukka, Sebastian
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi. Department of Orthopedics, Sundsvall Hospital, Sundsvall.
    Muren, Olle
    Eisler, Thomas
    Boden, Henrik
    Stark, André
    Sköldenberg, Olof
    High risk of early periprosthetic fractures after primary hip arthroplasty in elderly patients using a cemented, tapered, polished stem: an observational, prospective cohort study on 1,403 hips with 47 fractures after mean follow-up time of 4 years2015Inngår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 86, nr 2, 169-174 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and purpose - Postoperative periprosthetic femoral fracture (PPF) after hip arthroplasty is associated with considerable morbidity and mortality. We assessed the incidence and characteristics of periprosthetic fractures in a consecutive cohort of elderly patients treated with a cemented, collarless, polished and tapered femoral stem (CPT). Patients and methods - In this single-center prospective cohort study, we included 1,403 hips in 1,357 patients (mean age 82 (range 52-102) years, 72% women) with primary osteoarthritis (OA) or a femoral neck fracture (FNF) as indication for surgery (367 hips and 1,036 hips, respectively). 64% of patients were ASA class 3 or 4. Hip-related complications and need for repeat surgery were assessed at a mean follow-up time of 4 (1-7) years. A Cox regression analysis was used to evaluate risk factors associated with PPF. Results - 47 hips (3.3%) sustained a periprosthetic fracture at median 7 (2-79) months postoperatively; 41 were comminute Vancouver B2 or complex C-type fractures. The fracture rate was 3.8% for FNF patients and 2.2% for OA patients (hazard ratio (HR) = 4; 95% CI: 1.3-12). Patients > 80 years of age also had a higher risk of fracture (HR = 2; 95% CI: 1.1-4.5). Interpretation - We found a high incidence of early PPF associated with the CPT stem in this old and frail patient group. A possible explanation may be that the polished tapered stem acts as a wedge, splitting the femur after a direct hip contusion. Our results should be confirmed in larger, registry-based studies, but we advise caution when using this stem for this particular patient group.

  • 37.
    Brännström, André
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Idrottsmedicin.
    Yu, Ji-Guo
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Idrottsmedicin.
    Jonsson, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Åkerfeldt, Torbjörn
    Stridsberg, Mats
    Svensson, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Idrottsmedicin.
    Vitamin D in relation to bone health and muscle function in young female soccer players2017Inngår i: European Journal of Sport Science, ISSN 1746-1391, E-ISSN 1536-7290, Vol. 17, nr 2, 249-256 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The present work investigated serum vitamin D (25(OH)D) status in relation to bone and muscle qualities and functions in 19 female soccer players (13–16 years) resident at northern latitude with very low sun exposure (∼32–36 h/month) during winter season (late January to early March). Serum 25(OH)D, parathyroid hormone and bone turnover markers osteocalcin (OC) and beta carboxy-terminal collagen cross-links (β-Ctx), as well as body composition and muscle performance were examined. Hormones were tested using routine laboratory methods. Fat mass, lean mass, and bone mineral density in whole body, as well as femur and lumbar spine were evaluated with dual-energy X-ray absorptiometry. Muscle performance was assessed through isokinetic knee extension and flexion, countermovement jump, and sprint running. 25(OH)D was low (50.5 ± 12.8 nmol l−1), whereas the values of bone turnover markers were markedly high (OC: 59.4 ± 18.6 μg l−1; β-Ctx: 1075 ± 408 ng l−1). All bone and muscle measurements were normal or above normal. 25(OH) D was not significantly correlated with most of the parameters of bone and muscle quality or function, except the knee extension time to peak torque (r = −0.50, p = .03). In conclusion, the level of vitamin D is markedly low in adolescent female soccer players during the winter in Sweden. However, vitamin D levels did not significantly correlate with measures of bone and muscle except a moderate correlation in time to peak torque in the knee extensors. The practical implication of low vitamin D levels in young growing female athletes remains unclear.

  • 38.
    Bäckman, Mikaela
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Valideringsstudie av reoperationer i Svenska Frakturregistret Sunderby och Piteå Älvdals Sjukhus under 20142015Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 39.
    Börsbo, Johannes
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Prediktiva värdet av Sernbo score för mortalitet vid behandling med höftprotes vid felställd lårbenshalsfraktur2016Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 40. Callary, Stuart A
    et al.
    Campbell, David G
    Mercer, Graham E
    Nilsson, Kjell G
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Field, John R
    The 6-Year Migration Characteristics of a Hydroxyapatite-Coated Femoral Stem A Radiostereometric Analysis Study2012Inngår i: The Journal of Arthroplasty, ISSN 0883-5403, E-ISSN 1532-8406, Vol. 27, nr 7, 1344-1348 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A prospective cohort of 30 patients undergoing primary total hip arthroplasty for treatment of osteoarthritis was enrolled in a study to characterize the migration behavior of a clinically successful cementless stem. At 6 years, the mean subsidence of the stem was 0.63 mm (range, -0.33 to 3.68 mm); the mean rotation into retroversion was 1.41° (range, -1.33° to 7.48°). No stems had additional subsidence of more than 0.25 mm between 6 months and 6 years. The resultant mean subsidence between 2 and 6 years was 0.03 mm, which is below the limit measurable by radiostereometric analysis. The data demonstrate that subsidence of this cementless stem occurs within the first 6 months, after which there is persistent stabilization.

  • 41. Callary, Stuart A.
    et al.
    Campbell, David G.
    Mercer, Graham
    Nilsson, Kjell G.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Field, John R.
    Wear of a 5 Megarad Cross-linked Polyethylene Liner: A 6-year RSA Study2013Inngår i: Clinical Orthopaedics and Related Research, ISSN 0009-921X, E-ISSN 1528-1132, Vol. 471, nr 7, 2238-2244 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    One cross-linked polyethylene (XLPE) liner is manufactured using a lower dose of radiation, 5 Mrad, which may result in less cross-linking. The reported in vivo wear rate of this XLPE liner in patients undergoing THA has varied, and has included some patients in each reported cohort who had greater than 0.1 mm/year of wear, which is an historical threshold for osteolysis. Previous studies have measured wear on plain radiographs, an approach that has limited sensitivity. We therefore measured the amount and direction of wear at 6 years using Radiostereometric analysis (RSA) in patients who had THAs that included a cross-linked polyethylene liner manufactured using 5 Mrad radiation. We prospectively reviewed wear in 30 patients who underwent primary THAs with the same design of cross-linked acetabular liner and a 28-mm articulation. Tantalum markers were inserted during surgery and all patients had RSA radiographic examinations at 1 week, 6 months, 1, 2, and 6 years postoperatively. The mean proximal, two-dimensional (2-D) and three-dimensional (3-D) wear rates calculated between 1 year and 6 years were 0.014, 0.014, and 0.018 mm/per year, respectively. The direction of the head penetration recorded between 1 week and 6 years was in a proximal direction for all patients, proximolateral for 16 of 24 patients, and proximomedial for eight of 24 patients. The proximal, 2-D and 3-D wear of a XLPE liner produced using 5 Mrad of radiation was low but measurable by RSA after 6 years. No patients had proximal 2-D or 3-D wear rates exceeding 0.1 mm/year. Further followup is needed to evaluate the effect of XLPE wear particles on the development of long-term osteolysis.

  • 42. Campbell, David
    et al.
    Mercer, Graham
    Nilsson, Kjell G
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Wells, Vanessa
    Field, John R
    Callary, Stuart A
    Early migration characteristics of a hydroxyapatite-coated femoral stem: an RSA study.2011Inngår i: International Orthopaedics, ISSN 0341-2695, E-ISSN 1432-5195, Vol. 35, nr 4, 483-488 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Measurement of early stem subsidence can be used to predict the likelihood of long-term femoral component loosening and clinical failure. Data that examines the early migration pattern of clinically proven stems will provide clinicians with useful baseline data with which to compare new stem designs. This study was performed to evaluate the early migration pattern of a hydroxyapatite-coated press-fit femoral component that has been in use for over ten years. We enrolled 30 patients who underwent THA for osteoarthritis. The median age was 70 years (range, 55-80 years). Patients were clinically assessed using the Harris hip score. Radiostereometric analysis was used to evaluate stem migration at three to four days, six months, one year and two years. We observed a mean subsidence of 0.73 mm at six months, 0.62 mm at one year and 0.58 mm at two years and a mean retroversion of 1.82° at six months, 1.90° at one year and 1.59° at two years. This data suggests that subsidence is confined to the first six months after which there was no further subsidence. The results from this study can be compared with those from novel cementless stem designs to help predict the long-term outcome one may expect from new cementless stem designs.

  • 43.
    Campbell, David
    et al.
    Orthopaedic Unit, Repatriation General Hospital, Daws Road, Daw Park, SA 5041 Australia.
    Mercer, Graham
    Orthopaedic Unit, Repatriation General Hospital, Daws Road, Daw Park, SA 5041 Australia.
    Nilsson, Kjell Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Callary, Stuart A.
    Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA Australia .
    Case report: Cementless stem stabilization after intraoperative fracture: A radiostereometric analysis2010Inngår i: Clinical Orthopaedics and Related Research, ISSN 0009-921X, E-ISSN 1528-1132, Vol. 468, nr 3, 898-901 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We present the case of a patient with intraoperative femoral fracture during THA, which was repaired using cerclage fixation and insertion of an hydroxyapatite-coated cementless stem. The patient was evaluated postoperatively using radiostereometry during a 2-year course, and despite a large amount of subsidence and rotation, stabilization occurred and was maintained by 6 months. By evaluating the pattern of stem migration after intraoperative fracture, this case shows, even in the presence of instability, a successful clinical outcome can be achieved using an hydroxyapatite-coated cementless stem.

  • 44. Campbell, David
    et al.
    Mercer, Graham
    Nilsson, Kjell Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Wells, Vanessa
    Field, John R.
    Callary, Stuart A.
    Wear of a highly cross-linked polyethylene liner: a prliminary RSA study2010Inngår i: European Journal of Orthopaedic Surgery & Traumatology, ISSN 1633-8065, E-ISSN 1432-1068, Vol. 20, nr 1, 23-27 s.Artikkel i tidsskrift (Fagfellevurdert)
  • 45. Chammout, Ghazi Khalil
    et al.
    Mukka, Sebastian Simon
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Carlsson, Thomas
    Danderyds sjukhus.
    Neander, Gustaf Fredrik
    Stark, André Wilhelm Helge
    Sköldenberg, Olof Gustaf
    Total hip replacement versus open reduction and internal fixation of displaced femoral neck fractures: a randomized long-term follow-up study2012Inngår i: Journal of Bone and Joint Surgery. American volume, ISSN 0021-9355, E-ISSN 1535-1386, Vol. 94, nr 21, 1921-1928 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Clinical trials with short and intermediate-term follow-up have demonstrated superior results for total hip replacement as compared with internal fixation with regard to hip function and the need for secondary surgery in elderly patients with a displaced intracapsular femoral neck fracture. The aim of the present study was to compare the results of total hip replacement with those of internal fixation over a long-term follow-up period of seventeen years.

    Methods: We enrolled 100 patients who had sustained a femoral neck fracture in a single-center, randomized controlled trial; all patients had had a healthy hip before the injury. The study group included seventy-nine women and twenty-one men with a mean age of seventy-eight years (range, sixty-five to ninety years). The subjects were randomly assigned to either total hip replacement (the arthroplasty group) (n = 43) or internal fixation (the control group) (n = 57). The primary end point was hip function, evaluated with use of the Harris hip score. Secondary end points included mortality, reoperations, gait speed, and activities of daily life. Follow-up evaluations were performed at threemonths and at one, two, four, eleven, and seventeen years.

    Results: The Harris hip score was higher in the total hip arthroplasty group, with a mean difference of 14.7 points (95% confidence interval, 9.2 to 20.1 points; p < 0.001 [analysis of covariance]) during the study period. We found no difference in mortality between the two groups. Four patients (9%) in the total hip replacement group and twenty-two patients (39%) in the internal fixation group had undergone a major reoperation (relative risk, 0.24; 95% confidence interval, 0.09 to 0.64). The overall reoperation rate was 23% (ten of forty-three) in the total hip replacement group and 53% (thirty of fifty-seven) in the internal fixation group (relative risk, 0.44; 95% confidence interval, 0.24 to 0.80). The results related to gait speed and activities of daily living favored the arthroplasty group during the first year.

    Conclusions: Over a period of seventeen years in a group of healthy, elderly patients with a displaced femoral neck fracture, total hip replacement provided better hip function and significantly fewer reoperations compared with internal fixation without increasing mortality.

  • 46. Conaway, H Herschel
    et al.
    Persson, Emma
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral cellbiologi.
    Halén, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral cellbiologi.
    Granholm, Susanne
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral cellbiologi.
    Svensson, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Pettersson, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk farmakologi.
    Lie, Anita
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral cellbiologi.
    Lerner, Ulf H
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral cellbiologi.
    Retinoids inhibit differentiation of hematopoietic osteoclast progenitors2009Inngår i: The FASEB Journal, ISSN 0892-6638, E-ISSN 1530-6860, Vol. 23, nr 10, 3526-3538 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Whether vitamin A promotes skeletal fragility, has no effect on fracture rate, or protects against bone loss is unclear. In the present study, effects of retinoids on osteoclast differentiation in cultured mouse bone marrow cells (BMCs), bone marrow macrophages (BMMs), spleen cells, and RAW264.7 cells were evaluated by analyzing osteoclast formation and expression of genes important in signal transduction and osteoclast function. All-trans-retinoic acid (ATRA) did not stimulate osteoclastogenesis in BMCs, but inhibited hormone and RANKL-induced gene expression and formation of osteoclasts. In BMMs, spleen cells, and RAW264.7 cells, osteoclast differentiation and formation stimulated by M-CSF/RANKL were inhibited (IC(50) = 0.3 nM) by ATRA. The effect was exerted at an early step of RANKL-induced differentiation. ATRA also abolished increases of the transcription factors c-Fos and NFAT2 stimulated by RANKL and suppressed down-regulation of the antiosteoclastogenic transcription factor MafB. By comparing effects of several compounds structurally related to ATRA, as well as by using receptor antagonists, evaluation pointed to inhibition being mediated by RARalpha, with no involvement of PPARbeta/delta. The results suggest that activation of RARalpha by retinoids in myeloid hematopoietic precursor cells decreases osteoclast formation by altering expression of the transcription factors c-Fos, NFAT2, and MafB.

  • 47. Conaway, Herschel H
    et al.
    Persson, Emma
    Halén, Marie
    Granholm, Susanne
    Svensson, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Pettersson, Ulrika
    Lie, Anita
    Lerner, Ulf H
    Retinoids inhibit differentiation of hematopoetic osteoclast progenitors2009Inngår i: The FASEB Journal, ISSN 0892-6638, E-ISSN 1530-6860, Vol. 23, nr 10, 3526-3538 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Whether vitamin A promotes skeletal fragility, has no effect on fracture rate, or protects against bone loss is unclear. In the present study, effects of retinoids on osteoclast differentiation in cultured mouse bone marrow cells (BMCs), bone marrow macrophages (BMMs), spleen cells, and RAW264.7 cells were evaluated by analyzing osteoclast formation and expression of genes important in signal transduction and osteoclast function. All-trans-retinoic acid (ATRA) did not stimulate osteoclastogenesis in BMCs, but inhibited hormone and RANKL-induced gene expression and formation of osteoclasts. In BMMs, spleen cells, and RAW264.7 cells, osteoclast differentiation and formation stimulated by M-CSF/RANKL were inhibited (IC(50) = 0.3 nM) by ATRA. The effect was exerted at an early step of RANKL-induced differentiation. ATRA also abolished increases of the transcription factors c-Fos and NFAT2 stimulated by RANKL and suppressed down-regulation of the antiosteoclastogenic transcription factor MafB. By comparing effects of several compounds structurally related to ATRA, as well as by using receptor antagonists, evaluation pointed to inhibition being mediated by RARalpha, with no involvement of PPARbeta/delta. The results suggest that activation of RARalpha by retinoids in myeloid hematopoietic precursor cells decreases osteoclast formation by altering expression of the transcription factors c-Fos, NFAT2, and MafB.

  • 48.
    Crnalic, Sead
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Characterization of Prostate Cancer Bone Metastases According to Expression Levels of Steroidogenic Enzymes and Androgen Receptor Splice Variants2013Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, nr 11, e77407Artikkel i tidsskrift (Fagfellevurdert)
  • 49.
    Crnalic, Sead
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Metastatic spinal cord compression in prostate cancer: clinical and morphological studies2012Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Background: Bone metastases occur in most patients with advanced hormone-refractory prostate cancer causing pain, pathologic fractures, and spinal cord compression. Few studies specifically address surgical treatment of metastatic spinal cord compression (MSCC) in prostate cancer. Criteria for identifying patients who may benefit from surgery are poorly defined. Most of the current knowledge regarding tumor biology in prostate cancer is based on studies of primary tumors or soft tissue metastases. The mechanisms regulating growth of bone metastases are not fully established.

    Aims: a) to evaluate outcome after surgery for MSCC in prostate cancer and to identify prognostic factors for survival and functional recovery; b) to evaluate current practice for referral of prostate cancer patients with MSCC; c) to analyze expression of androgen receptor (AR), cell proliferation, apoptosis, and prostate-specific antigen (PSA) in bone metastases with regard to survival after surgery for complications of bone metastases.

    Patients and Methods: We retrospectively evaluated the hospital records of 68 consecutive patients operated for metastatic spinal cord compression. Tumor tissue from bone metastases was obtained on spinal surgery (54 patients), fracture surgery (4 patients) and biopsy (2 patients), and analyzed by immunohistochemistry.

    Results:

    Study I: Mortality and complication rate after surgery was high. Patients with hormone-naïve disease and those with hormone-refractory disease with good performance status and without visceral metastases had more favorable survival. The ability to walk after surgery was related to better survival.

    Study II: A new score for prognosis of survival after surgery for spinal cord compression includes: hormone status of prostate cancer, Karnofsky performance status, evidence of visceral metastasis, and preoperative serum PSA. The score is simple, tumor specific, and easy to apply in clinical practice.

    Study III: Our results suggest that delays in diagnosis and treatment may have negative impact on functional outcome. Pretreatment ability to walk, hormone status of prostate cancer, and time from loss of ambulation influenced neurological recovery after surgery for spinal cord compression.

    Study IV: High nuclear AR immunostaining in bone metastases and high preoperative serum PSA were associated with a poor outcome after metastasis surgery in patients with hormone-refractory prostate cancer. Short-term effect of castration therapy disclosed that nuclear AR immunostaining was decreased and apoptosis was increased, but cell proliferation remained largely unaffected.

    Conclusion:  Prostate cancer patients with metastatic spinal cord compression represent a heterogeneous group. We identified prognostic factors for survival and functional outcome, which may help clinicians in making decisions about treatment. Our results also implicate the need for development of local and regional guidelines for treatment of patients with spinal cord compression, as well as the importance of information to patients at risk.

  • 50.
    Crnalic, Sead
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Metastatic spinal cord compression must not be missed. Increased awareness of early symptoms enables fast treatment2014Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, nr 7, 276-277 s.Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
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