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  • 1.
    Abzhandadze, Tamar
    et al.
    Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Lundström, Erik
    Department of Medical Sciences, Neurology, Akademiska Sjukhuset, Uppsala, Sweden.
    Buvarp, Dongni
    Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Quinn, Terence J.
    Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
    Sunnerhagen, Katharina S.
    Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Neurocare, Rehabilitation Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Development of a Swedish short version of the montreal cognitive assessment for cognitive screening in patients with stroke2023In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 55, article id jrm4442Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The primary objective was to develop a Swedish short version of the Montreal Cognitive Assessment (s-MoCA-SWE) for use  with patients with stroke. Secondary objectives were to identify an optimal cut-off value for the s-MoCA-SWE to screen for cognitive impairment and to compare its sensitivity with that of previously developed short forms of the Montreal Cognitive Assessment.

    DESIGN: Cross-sectional study.

    SUBJECTS/PATIENTS: Patients admitted to stroke and rehabilitation units in hospitals across Sweden.

    METHODS: Cognition was screened using the Montreal Cognitive Assessment. Working versions of the s-MoCA-SWE were developed using supervised and unsupervised algorithms.

    RESULTS: Data from 3,276 patients were analysed (40% female, mean age 71.5 years, 56% minor stroke at admission). The suggested s-MoCA-SWE comprised delayed recall, visuospatial/executive function, serial 7, fluency, and abstraction. The aggregated scores ranged from 0 to 16. A threshold for impaired cognition ≤ 12 had a sensitivity of 97.41 (95% confidence interval, 96.64-98.03) and positive predictive value of 90.30 (95% confidence interval 89.23-91.27). The s-MoCA-SWE had a higher absolute sensitivity than that of other short forms.

    CONCLUSION: The s-MoCA-SWE (threshold ≤ 12) can detect post-stroke cognitive issues. The high sensitivity makes it a potentially useful "rule-out" tool that may eliminate severe cognitive impairment in people with stoke.

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  • 2.
    Ahlgren, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Waling, Kerstin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Kadi, Fawzi
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Djupsjöbacka, Mats
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Centre for Musculoskeletal Research, National Institute for Working Life, Umeå , Sweden.
    Thornell, Lars-Eric
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Sundelin, Gunnevi
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Effects on physical performance and pain from three dynamic training programs for women with work-related trapezius myalgia2001In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 33, no 4, p. 162-9Article in journal (Refereed)
    Abstract [en]

    To compare training programs for women with trapezius myalgia regarding physical performance and pain, 102 women were randomized to strength, endurance, co-ordination and non-training groups. Before and after the intervention, static strength and dynamic muscular endurance in shoulder muscles were measured on a Cybex II dynamometer. Muscle activity in shoulder muscles was monitored via surface EMG. The signal amplitude ratio between the active and passive phase of repeated contractions indicated the ability to relax. Pain at present, pain in general and pain at worst were measured on visual analogue scales. After training, within group comparisons showed that the training groups rated less pain, and in the strength training group ratings of pain at worst differed from the non-training group. Using the non-training group as a reference, static strength increased in the strength and endurance training groups and muscular endurance in all training groups. The study indicates that regular exercises with strength, endurance or co-ordination training of neck/shoulder muscles might alleviate pain for women with work-related trapezius myalgia.

  • 3.
    Andersson, Jenni
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Sörlin, Ann
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Magaard, Gustaf
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Hu, Xiao-Lei
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Long-term perceived disabilities up to 10 years after transient ischaemic attack2021In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 53, no 3, article id jrm00167Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The long-term impact of transient ischaemic attack is largely unknown.

    OBJECTIVES: To assess the long-term perceived impact of transient ischaemic attack and explore the influence of sex and age on these perceptions; and to evaluate the relationships between activities of daily living, participation and overall recovery, and the other domains of the Stroke Impact Scale 3.0 (SIS).

    METHODS: A retrospective study among adult community-dwelling individuals from 6 months up to 10 years after onset of transient ischaemic attack. A total of 299 survivors of transient ischaemic attack responded to the SIS.

    RESULTS: Most self-reported disabilities involved emotion, strength, and participation domains of SIS and remained stable until 10 years post-transient ischaemic attack. Women reported significantly more disabilities for emotion and hand function. Elderly subjects (age > 65 years) reported more disabilities for strength, mobility, hand function, activities of daily living/instrumental activities of daily living, and participation. The activities of daily living/instrumental activities of daily living, participation, and overall recovery demonstrated significant, although low-to-moderate, associations with other SIS domains after transient ischaemic attack.

    CONCLUSION: The broadly perceived disabilities were demonstrated consistently and played a significant meaningful role in everyday life and recovery among community-dwelling individuals up to 10 years after a transient ischaemic attack. These findings indicate the need for long-term multi-professional follow-up with holistic rehabilitation to improve overall recovery among survivors of transient ischaemic attack.

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  • 4.
    Andersson, Sofi A.
    et al.
    The Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; The Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Danielsson, Anna
    The Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; The Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ohlsson, Fredrik
    Umeå University, Faculty of Science and Technology, Department of Mathematics and Mathematical Statistics. The RISE, Unit Sensor System, Gothenburg, Sweden.
    Wipenmyr, Jan
    The RISE, Unit Sensor System, Gothenburg, Sweden.
    Alt Murphy, Margit
    The Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; The Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Arm impairment and walking speed explain real-life activity of the affected Arm and leg after stroke2021In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 53, no 6, article id jrm00210Article in journal (Refereed)
    Abstract [en]

    Objective: To determine to what extent accelerometer-based arm, leg and trunk activity is associated with sensorimotor impairments, walking capacity and other factors in subacute stroke.

    Design: Cross-sectional study.

    Patients: Twenty-six individuals with stroke (mean age 55.4 years, severe to mild motor impairment).

    Methods: Data on daytime activity were collected over a period of 4 days from accelerometers placed on the wrists, ankles and trunk. A forward stepwise linear regression was used to determine associations between free-living activity, clinical and demographic variables.

    Results: Arm motor impairment (Fugl-Meyer Assessment) and walking speed explained more than 60% of the variance in daytime activity of the more-affected arm, while walking speed alone explained 60% of the more-affected leg activity. Activity of the less-affected arm and leg was associated with arm motor impairment (R2=0.40) and independence in walking (R2=0.59). Arm activity ratio was associated with arm impairment (R2=0.63) and leg activity ratio with leg impairment (R2=0.38) and walking speed (R2=0.27). Walking-related variables explained approximately 30% of the variance in trunk activity.

    Conclusion: Accelerometer-based free-living activity is dependent on motor impairment and walking capacity. The most relevant activity data were obtained from more-affected limbs. Motor impairment and walking speed can provide some information about real-life daytime activity levels.

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  • 5.
    Awad, Amar
    et al.
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology.
    Levi, Richard
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Lindgren, Lenita
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Hultling, Claes
    Department of Neurobiology, Care Sciences and Society (Neurorehabilitation), Karolinska Institute, Stockholm, Sweden.
    Westling, Göran
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology.
    Nyberg, Lars
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Eriksson, Johan
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Preserved somatosensory conduction in a patient with complete cervical spinal cord injury2015In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, no 5, p. 426-431Article in journal (Refereed)
    Abstract [en]

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

  • 6.
    Björck van Dijken, Christina
    et al.
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Orthopaedics. Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Physiotherapy.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation.
    Hildingsson, Christer
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Orthopaedics.
    Low back pain, lifestyle factors and physical activity: a population-based study.2008In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, no 10, p. 864-869Article in journal (Refereed)
    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.

  • 7.
    Brogårdh, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Johansson, Fredrik W
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Nygren, Frida
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Sjölund, Bengt H
    Mode of hand training determines cortical reorganisation: A randomized controlled study in healthy adults2010In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, no 8, p. 789-794Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate two commonly used forms of hand training with respect to influence on dexterity and cortical reorganization.

    Subjects: Thirty healthy volunteers (mean age 24.2 years).

    Methods: The subjects were randomized to 25 min of shaping exercises or general activity training of the non-dominant hand. The dexterity and the cortical motor maps (number of excitable positions) of the abductor pollicis brevis muscle were evaluated pre- and post-training by the Purdue Peg Board test and transcranial magnetic stimulation, respectively.

    Results: After shaping exercises the dexterity increased significantly (p ≤ 0.005) for both hands, mostly so in the non-dominant hand. The cortical motor map of the abductor pollicis brevis muscle shifted forwardly into the pre-motor area without expanding. After general activity training, no significant improvements in dexterity were found for the non-dominant hand. The cortical motor map of the non-dominant abductor pollicis brevis muscle expanded significantly (p = 0.03) in the posterior (sensory) direction.

    Conclusion: These results indicate that shaping exercises, but not general activity training, increase dexterity of the trained non-dominant hand in parallel with a shift of location of active transcranial magnetic stimulation positions. Shifts of active cortical areas might be important for the interpretation of brain plasticity in common behavioural tasks.

  • 8.
    Brogårdh, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Department of Rehabilitation, Lund University Hospital, Lund.
    Vestling, Monika
    Sjölund, Bengt H
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. 3Rehabilitation and Research Centre for Torture Victims, Copenhagen and University of Southern Denmark, Odense, Denmark.
    Shortened constraint-induced movement therapy in subacute stroke - no effect of using a restraint: a randomized controlled study with independent observers2009In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 41, no 4, p. 231-236Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

  • 9.
    Brycke, Sara
    et al.
    Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden.
    Bråndal, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Brogårdh, Christina
    Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden; Department of Health Sciences, Lund University, Lund, Sweden.
    Implementation of evidence-based interventions according to the Swedish national guidelines for strokecare: a nationwide survey among physiotherapists2024In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 56, article id jrm18444Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate (i) to what extent physiotherapists (PTs) working in stroke rehabilitation in various parts of the stroke care chain have implemented interventions according to the national guidelines for stroke (NGS), (ii) facilita-ting and hindering factors for the implementation, and (iii) differences between various care settings.

    Design: A cross-sectional study.

    Subjects: 148 PTs working in stroke rehabilitation in various parts of the care chain in Sweden.

    Methods: Data were collected by a web-based survey.

    Results: Task-specific training for walking (80–98%), impaired motor function (64–100%) and fall prevention (73–92%) were most implemented. Factors that facilitated implementation were: important to comply with the NGS, that PTs had confidence to per-form the interventions, and that interventions were clearly described. Limited time, lack of resources, no clear goals or routines at the workplace hindered the implementation. Significant differences (p < 0.05) between the settings existed. Municipal and primary care reported most challenges in implementing the NGS and providing evidence-based interventions.

    Conclusion: Most interventions, with high priority according to NGS, are provided by PTs working in stroke rehabilitation, although differences in various parts of the care chain exist. Knowledge, time, education and supportive management are important factors when implementing evidence-based interventions.

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  • 10. Cnossen, Maryse C.
    et al.
    Lingsma, Hester F.
    Tenovuo, Olli
    Maas, Andrew I. R.
    Menon, David
    Steyerberg, Ewout W.
    Ribbers, Gerard M.
    Polinder, Suzanne
    Brorsson, Camilla (Contributor)
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Rehabilitation after traumatic brain injury: A survey in 70 European neurotrauma centres participating in the CENTER-TBI study2017In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, no 5, p. 395-401Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe variation in structural and process characteristics of acute in-hospital rehabilitation and referral to post-acute care for patients with traumatic brain injury across Europe.

    DESIGN: Survey study, of neurotrauma centres.

    METHODS: A 14-item survey about in-hospital rehabilitation and referral to post-acute care was sent to 71 neurotrauma centres participating in a European multicentre study (CENTER-TBI). The questionnaire was developed based on literature and expert opinion and was pilot-tested before sending out to the centres.

    RESULTS: Seventy (99%) centres in 20 countries completed the survey. The included centres were predominately academic level I trauma centres. Among the 70 centres, a multidisciplinary rehabilitation team can be consulted at 41% (n = 29) of the intensive care units and 49% (n = 34) of the wards. Only 13 (19%) centres used rehabilitation guidelines in patients with traumatic brain injury. Age was reported as a major determinant of referral decisions in 32 (46%) centres, with younger patients usually referred to specialized rehabilitation centres, and patients ≥ 65 years also referred to nursing homes or local hospitals.

    CONCLUSION: Substantial variation exists in structural and process characteristics of in-hospital acute rehabilitation and referral to post-acute rehabilitation facilities among neurotrauma centres across Europe.

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  • 11. Enthoven, Paul
    et al.
    Molander, Peter
    Oberg, Birgitta
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Department of Clinical Sciences, Karolinska Institutet and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden.
    Stenberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Gerdle, Bjorn
    DO PAIN CHARACTERISTICS GUIDE SELECTION FOR MULTIMODAL PAIN REHABILITATION?2017In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, no 2, p. 161-169Article in journal (Refereed)
    Abstract [en]

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

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  • 12.
    Fahlström, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Bränström, Harriet
    Kinesiophobia in patients with chronic muskuloskeletal pain - differences between men and women2008In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081Article in journal (Refereed)
  • 13. Feldthusen, Caroline
    et al.
    Grimby-Ekman, Anna
    Forsblad-d'Elia, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Jacobsson, Lennart
    Mannerkorpi, Kaisa
    Explanatory factors and predictors of fatigue in persons with rheumatoid arthritis: a longitudinal study2016In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 48, no 5, p. 469-476Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the impact of disease-related aspects on long-term variations in fatigue in persons with rheumatoid arthritis.

    DESIGN: Observational longitudinal study.

    METHODS: Sixty-five persons with rheumatoid arthritis, age range 20-65 years, were invited to a clinical examination at 4 time-points during the 4 seasons. Outcome measures were: general fatigue rated on visual analogue scale (0-100) and aspects of fatigue assessed by the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire. Disease-related variables were: disease activity (erythrocyte sedimentation rate), pain threshold (pressure algometer), physical capacity (six-minute walk test), pain (visual analogue scale (0-100)), depressive mood (Hospital Anxiety and Depression scale, depression subscale), personal factors (age, sex, body mass index) and season. Multivariable regression analysis, linear mixed effects models were applied.

    RESULTS: The strongest explanatory factors for all fatigue outcomes, when recorded at the same time-point as fatigue, were pain threshold and depressive mood. Self-reported pain was an explanatory factor for physical aspects of fatigue and body mass index contributed to explaining the consequences of fatigue on everyday living. For predicting later fatigue pain threshold and depressive mood were the strongest predictors.

    CONCLUSION: Pain threshold and depressive mood were the most important factors for fatigue in persons with rheumatoid arthritis.

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  • 14. Fischer, Marcelo Rivano
    et al.
    Schult, Marie-Louise
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Karolinska Institutet, Department of Clinical Sciences, Division of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden.
    Ekholm, Jan
    Persson, Elisabeth B.
    Lofgren, Monika
    Variability in patient characteristics and service provision of interdisciplinary pain rehabilitation: a study using the Swedish national quality registry for pain rehabilitation2020In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 52, no 11, article id jrm00128Article in journal (Refereed)
    Abstract [en]

    Objective: To describe the organization, content and dosage of interdisciplinary pain rehabilitation, and the differences in degree of severity of problems of patients admitted to clinical units reporting to a Swedish national quality pain registry, grouped according to unit size and possible affiliation with a university hospital.

    Methods: Reports from 31 out of 39 clinical units in Sweden, on inclusion processes, organization, content and dosage of interdisciplinary pain rehabilitation, and patient-reported data from a Swedish national quality pain registry at assessment for interdisciplinary pain rehabilitation were analysed.

    Results: the number of patients treated annually at each unit ranged from 3 to 340. In 17 units, teams comprised 5 professionals. Dosage of interdisciplinary pain rehabilitation ranged from 20-180 h per patient in total. Patients at the university-hospital units scored the highest levels of symptoms and lowest levels of health related quality of life. Units used similar sets of inclusion criteria, and several treatments, such as education, self-training and psychological interventions, were used by most units.

    Conclusion: When interpreting outcome data from registries, aspects other than rehabilitation out-comes must be considered. The interpretation of outcomes from quality registries would be facilitated if data, in addition to assessments and patient reported outcomes, also includes standardized descriptions of the reporting clinical units.

  • 15.
    Fjellman-Wiklund, Anncristine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Stenlund, Therese
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Steinholtz, Katarina
    The Stress Clinic, University Hospital of Umeå.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Take charge: Patients' experiences during participation in a rehabilitation programme for burnout2010In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, no 5, p. 475-481Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to explore the experiences of patients with burnout during a rehabilitation programme.

    Patients and methods: Eighteen patients with burnout were interviewed at the end of a one-year rehabilitation programme. The programme consisted of 2 groups, one with a focus on cognitively-oriented behavioural rehabilitation and Qigong and 1 with a focus on Qigong alone. The interviews were analysed using the grounded theory method.

    Results: One core category, Take Charge, and 6 categories emerged. The core category represents a beneficial recovery process that helped the patients to take control of their lives. The common starting point for the process is presented in the 3 categories of Good encounters, Affirmation and Group cohesiveness. The categories were basic conditions for continuing development during rehabilitation. In the categories Get to know myself, How can I be the one I want to be? and Choice of track, the more group-specific tools are included, through which the patients adopted a new way of behaving.

    Conclusion: Patients in both groups experienced group participation as being beneficial for recovery and regaining control of their lives, although in somewhat different way. An experience of affirmation and support from health professionals and group participants is of importance for behavioural change

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  • 16.
    Flank, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Boström, Carina
    Lewis, John E.
    Levi, Richard
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Wahman, Kerstin
    Self-reported physical activity and risk markers for cardiovascular disease after spinal cord injury2014In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, no 9, p. 886-890Article in journal (Refereed)
    Abstract [en]

    Objective:

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

    Design:

    Descriptive, cross-sectional study.

    Subjects:

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

    Methods:

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

    Results:

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

    Conclusion:

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

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  • 17.
    Flank, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Wahman, Kerstin
    Levi, Richard
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Prevalence of risk factors for cardiovascular disease stratified by body mass index categories in patients with wheelchair-dependent paraplegia after spinal cord injury2012In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, no 5, p. 440-443Article in journal (Refereed)
    Abstract [en]

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

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  • 18.
    Gantschnig, Brigitte E
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Page, Julie
    Fisher, Anne G
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Cross-regional validity of the assessment of motor and process skills for use in Middle Europe2012In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, no 2, p. 151-157Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate cross-regional validity of the Assessment of Motor and Process Skills (AMPS) with a specific focus on valid use with Middle Europeans.

    Design: Descriptive cross-regional validation study. Participants: A total of 1346 participants from Middle Europe and 144,143 participants from North America, UK/Ireland, the Nordic Countries, other Europe, Australia/New Zealand and Asia, between the ages of 3 and 103 years, in good health and with a variety of diagnoses, were selected from the AMPS database.

    Methods: Many-facet Rasch analysis was used to analyse participant raw data, and effect sizes were used to evaluate for differential item functioning. Evaluation for differential test functioning was also implemented.

    Results: None of the 20 activity of daily living process items, and only one of the activity of daily living motor items demonstrated differential item functioning. The activity of daily living motor item Aligns exceeded the significant effect size criterion of +/- 0.55 logit, but the significant differential item functioning did not lead to differential test functioning (i.e. all measures fell within the 95% confidence bands).

    Conclusion: This study provides further evidence of validity of the AMPS when used to evaluate quality of activity of daily living tasks performance across world regions. The AMPS measures can be used as objective indices of activity of daily living ability in rehabilitation settings and in international collaborative research related to activity of daily living task performance.

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  • 19.
    Glavare, Maria
    et al.
    Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Karolinska Institutet, Department of Clinical Sciences, Division of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Löfgren, Monika
    Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden; Karolinska Institutet, Department of Clinical Sciences, Division of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden.
    Virtual reality exercises in an interdisciplinary rehabilitation programme for persons with chronic neck pain: A feasibility study2021In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 4, article id 1000067Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the feasibility of a virtual reality exercise intervention within an interdisciplinary rehabilitation programme for persons with chronic neck pain. The effects of the intervention on symptom severity, variables related to chronic neck pain, and patients' experience of exercises were assessed.

    Methods: Nine women and 3 men participated in a 6-week virtual reality exercise intervention during an interdisciplinary rehabilitation programme. Symptom severity was rated before and after each session of virtual reality exercise, using questionnaires before and after the interdisciplinary rehabilitation programme, and questions about participants' experiences.Results: Neck pain symptoms increased temporarily during the exercises, but no lasting deterioration was found after the interdisciplinary rehabilitation programme. Depression, pain interference, pain control, sleep and kinesiophobia improved significantly after the programme. Participants experienced that the virtual reality exercises increased motivation to exercise and provided a focus other than pain. However, the equipment was heavy; and exercising was tiring and reminded them of their challenges.

    Conclusion: This study indicates that virtual reality exercises as part of an interdisciplinary rehabilitation programme are feasible and safe for patients with chronic neck pain. Pain symptoms may increase temporarily during the exercises. Virtual reality exercises may support participants by increasing motivation to exercise and providing helpful feedback. Further research into the added value of virtual reality exercises in an interdisciplinary rehabilitation programme for patients with chronic neck pain is warranted.

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  • 20. Godbolt, Alison K
    et al.
    DeBoussard, Catharine Nygren
    Stenberg, Maud
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Lindgren, Marie
    Ulfarsson, Trandur
    Borg, Jörgen
    Disorders of consciousness after severe traumatic brain injury: a Swedish-Icelandic study of incidence, outcomes and implications for optimizing care pathways2013In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, no 8, p. 741-748Article in journal (Refereed)
    Abstract [en]

    Background: Very severe traumatic brain injury may cause disorders of consciousness in the form of coma, unresponsive wakefulness syndrome (also known as vegetative state) or minimally conscious state. Previous studies of outcome for these patients largely pre-date the 2002 definition of minimally conscious state.

    Objectives: To establish the numbers of patients with disorder of consciousness at 3 weeks, 3 months and 1 year after severe traumatic brain injury, and to relate conscious state 3 weeks after injury to outcomes at 1 year.

    Design: Multi-centre, prospective, observational study of severe traumatic brain injury.

    Inclusion criteria: Lowest (non-sedated) Glasgow Coma Scale 3-8 during the first 24 h; requirement for neurosurgical intensive care; age 18-65 years; alive 3 weeks after injury. Diagnosis of coma, unresponsive wakefulness syndrome, minimally conscious state or emerged from minimally conscious state was based on clinical and Coma Recovery Scale Revised assessments 3 weeks, 3 months and 1 year after injury. One-year outcome was measured with Glasgow Outcome Scale Extended (GOSE).

    Results: A total of 103 patients was included in the study. Of these, 81% were followed up to 1 year (76% alive, 5% dead). Three weeks after injury 36 were in coma, unresponsive wakefulness syndrome or minimally conscious state and 11 were anaesthetized. Numbers of patients who had emerged from minimally conscious state 1 year after injury, according to status at 3 weeks were: coma (0/6), unresponsive wakefulness syndrome (9/17), minimally conscious state (13/13), anaesthetized (9/11). Outcome at 1 year was good (GOSE>4) for half of patients in minimally conscious state or anaesthetized at 3 weeks, but for none of the patients in coma or unresponsive wakefulness syndrome. These differences in outcome were not revealed by prognostic predictions based on acute data.

    Conclusion: Patients in minimally conscious state or anaesthetized 3 weeks after injury have a better prognosis than patients in coma or unresponsive wakefulness syndrome, which could not be explained by acute prognostic models.

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  • 21.
    Gunnarsson, Stina
    et al.
    Department of Rehabilitation Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Lemming, Dag
    Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Alehagen, Siw
    Division of Nursing Sciences and Reproductive Health and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Linköping, Sweden.
    Bergenheim, Tommy
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Neurosciences.
    Gerdle, Björn
    Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Samuelsson, Kersti
    Department of Rehabilitation Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Patients' expectations before initiation of intrathecal baclofen treatment: a longitudinal study with 1-year follow-up2023In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 55, article id jrm00371Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate patients' expectations, met/unmet expectations and satisfaction with intrathecal baclofen treatment in relation to effect on spasticity, pain intensity, sleep quality, occupational performance, well-being and self-efficacy.

    Design: A prospective longitudinal study with follow-up at 1 year.

    Patients: Consecutive patients, age ≥ 18 years with a disabling spasticity of cerebral or spinal origin selected for intrathecal baclofen treatment at 2 university hospitals in Sweden were included. From August 2016 to June 2019, 35 patients began intrathecal baclofen treatment; 29 patients were included and completed the study.

    Methods: Baseline and 1-year follow-up included assessment of spasticity by physiotherapists, a semi-structured interview regarding occupational performance using the Canadian Occupational Performance Measure and a questionnaire.

    Results: Overall satisfaction with treatment and satisfaction with occupational performance were reported as moderate. Important variables that explained satisfaction with occupational performance were improvements in performance, expectations and performance before treatment. Patients had higher expectations compared with the 1-year outcomes regarding occupational performance, spasticity, pain intensity and sleep quality, although improvements were reported.

    Conclusion: A thorough discussion of goal setting with intrathecal baclofen treatment before implantation is necessary to give patients individual and realistic expectations.

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  • 22.
    Gustafsson, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Strahle, Stefan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Parkinsons Disease: A population-based investigation of life satisfaction and employment2015In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, no 1, p. 45-51Article in journal (Refereed)
    Abstract [en]

    Objective:

    To investigate relationships between individuals' socioeconomic situations and quality of life in working-aged subjects with Parkinson's disease.

    Methods:

    A population-based cohort comprising 1,432 people with Parkinson's disease and 1,135 matched controls, who responded to a questionnaire. Logistic regression analysis was performed to identify factors associated with life satisfaction and likelihood of employment.

    Results:

    In multivariate analyses, Parkinson's disease was associated with an increased risk of dissatisfaction with life (odds ratio (OR) = 5.4, 95% confidence interval (95% CI) = 4.2-7.1) and reduced likelihood of employment (OR = 0.30, 95% CI = 0.25-0.37). Employers' support was associated with greater likelihood of employment (p < 0.001). Twenty-four percent of people with Parkinson's disease for ≥ 10 years remained employed and 6% worked full-time. People with Parkinson's disease also more frequently experienced work demands that exceeded their capacity; this factor and unemployment independently correlated with greater risk of dissatisfaction with life (both p < 0.05).

    Conclusion:

    People with Parkinson's disease have an increased risk of dissatisfaction with life. Employment situation is important for general life satisfaction among working-aged individuals. People with Parkinson's disease appear to find it difficult to meet the challenge of achieving a balanced employment situation.

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  • 23. Gustafsson, Monika
    et al.
    Ekholm, Jan
    Öhman, Ann
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    From shame to respect: musculoskeletal pain patients' experience of a rehabilitation programme, a qualitative study2004In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 36, no 3, p. 97-103Article in journal (Refereed)
    Abstract [en]

    Objective: This study aimed to describe and analyse how participants with fibromyalgia or chronic, widespread, musculoskeletal pain, 1 year after completion, experienced a rehabilitation programme; and what knowledge and strategies they had gained.

    Design, methods and subjects: Semi-structured interviews with 16 female patients were analysed using the grounded theory method of constant comparison.

    Results: One core category, from shame to respect, and 4 categories, developing body awareness/knowledge, setting limits, changing self-image and negative counterbalancing factors, and hopelessness and frustration over one's employment situation emerged from the data. The core category represents a process where the informants changed emotionally. Three categories were identified as important for starting and maintaining the process, one category affected the process negatively.

    Conclusion: The rehabilitation programme started the process of change, from shame to respect. The informants learned new strategies for handling their pain and other symptoms; they improved their self-image and communication in their social environment.

  • 24.
    Heiden, Marina
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational Medicine.
    Lyskov, Eugene
    Nakata, Minori
    Sahlin, Karin
    Sahlin, Tore
    Barnekow-Bergkvist, Margareta
    Evaluation of cognitive behavioural training and physical activity for patients with stress-related illnesses: a randomized controlled study.2007In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 39, no 5, p. 366-373Article in journal (Refereed)
  • 25. Hållstam, Andrea
    et al.
    Stålnacke, Britt Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Svensen, Christer
    Löfgren, Monika
    "Change is possible": patients' experience of a multimodal chronic pain rehabilitation programme2015In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, no 3, p. 242-248Article in journal (Refereed)
    Abstract [en]

    Objective: To explore patients' experiences of activity, participation and quality of life one year after a rehabilitation programme for chronic pain, and to determine the impact of the programme on their current life situation. Design: Qualitative study with emergent design. Subjects and methods: The 14 informants were patients with chronic pain who had participated in rehabilitation at a pain clinic. Individual semi-structured interviews were analysed with inductive, qualitative content analysis. Results: The core theme "Change is possible" and the themes "A life ruled by pain" (the situation before rehabilitation), "The penny's dropped" (experience during rehabilitation) and "Live a life, not only survive" (the situation at the time of the interviews) emerged from the data. These themes represent a process through which, during and after rehabilitation, the informants integrated earlier disabling symptoms into a functioning lifestyle. Conclusion: Individuals living with disabling chronic pain can create a better life by integrating their illness. A prerequisite is that healthcare professionals empower patients to develop the strength to take responsibility for their daily lives. This process is facilitated by skills to reduce pain and handle life, plus support from significant others.

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  • 26. Johansson, Sverker
    et al.
    Ytterberg, Charlotte
    Back, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Widen Holmqvist, Lotta
    von Koch, Lena
    The Swedish occupational fatigue inventory in people with multiple sclerosis2008In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, no 9, p. 737-743Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the applicability of the Swedish Occupational Fatigue Inventory and its ability to identify different dimensions of fatigue in people with multiple sclerosis with varying, degrees of disease severity, and the correlation of each of its 5 dimensions with the Fatigue Severity Scale.

    Design: An observational. prospective study.

    Subjects: Two hundred and nineteen outpatients: 59.5% had mild. 170%, moderate and 23.5% severe disease severity; 83%, received immunomodulatory treatment.

    Methods: Both questionnaires were administered at inclusion, and at 12 and 24 months. Analyses of internal consistency. item-total correlation, factor analysis and tests of correlations were performed.

    Results: The instrument was completed by 97% of subjects. Internal consistency was satisfactory in the dimensions Lack of energy, Lack of motivation and Sleepiness, but not in Physical exertion and Physical discomfort. Factor analysis revealed that all but 3 items (2 in Physical exertion, 1 in Physical discomfort) loaded satisfactorily in 5 dimensions. Correlations between the dimensions and the Fatigue Severity Scale were low, except for a moderate correlation found for Lack of energy.

    Conclusion: The dimensions Lack of energy, Lack of motivation and Sleepiness appear applicable for use in people with multiple sclerosis. Further development of the physical dimensions and studies on the instrument's capacity to measure changes are needed.

  • 27.
    Larsson Lund, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Lexell, Jan
    A positive turning point in life: How persons with late effects of polio experience the influence of an interdisciplinary rehabilitation programme2010In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, no 6, p. 559-565Article in journal (Refereed)
    Abstract [en]

    Objective: To describe and enhance our understanding of how persons with late effects of polio experience the influence of an interdisciplinary rehabilitation programme. Participants: Twelve persons with clinically verified late effects of polio who had participated in an individualized, goal-oriented, comprehensive interdisciplinary rehabilitation programme. Methods: Qualitative research interviews analysed using the constant comparative method of grounded theory. Results: The rehabilitation programme was experienced as a turning point in the participants' lives. Before rehabilitation they felt they were on a downward slope without control. Rehabilitation was the start of a process of change whereby they acquired new skills, which, over time, contributed to a different but good life. After approximately a year, they had a sense of control and had accepted life with late effects of polio. They had also established new habits, taken on a changed valued self and could look to the future with confidence. Conclusion: This qualitative study has shown that persons with late effects of polio can benefit from an individualized, goal-oriented, comprehensive interdisciplinary rehabilitation programme and experience positive changes in their management of daily activities and in their view of their late effects of polio, their future and their self.

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  • 28.
    Larsson Lund, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Lexell, Jan
    Perceived participation in life situations in persons with late effects of polio2008In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, no 8, p. 659-664Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate how persons with late effects of polio perceive their participation and problems with participation in life situations and to determine the association between perceived problems with participation and sex, age, marital status, use of mobility aids and access to instrumental support.

    Design: Cross-sectional.

    Subjects: A total of 160 persons with prior polio 6-30 months after an individualized, goal-oriented, comprehensive inter-disciplinary rehabilitation programme.

    Methods: All subjects answered the Swedish version of the Impact on Participation and Autonomy Questionnaire.

    Results: A majority of the respondents perceived their participation as sufficient in most activities and 65% of the respondents perceived no severe problems with participation. The remaining 35% perceived 1-6 severe problems with participation. All 5 domains of participation were positively correlated with the 9 items for problem experience. Most restrictions in participation were reported in the domains of Family role, Autonomy outdoors, and Work and education. Insufficient instrumental support was most strongly associated with the perception of severe problems with participation.

    Conclusion: Rehabilitation programmes for persons with late effects of polio need to focus on areas of participation that are perceived as a problem by these persons and to promote access to a supportive environment to enhance their participation.

  • 29.
    Larsson Lund, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Nordlund, Anders
    Nygård, Louise
    Lexell, Jan
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Perceptions of participation and predictors of perceived problems with participation in persons with spinal cord injury2005In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 37, no 1, p. 3-8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe how persons with spinal cord injury perceived their participation in life situations and to determine the relationship between their participation and perceived problems therewith. The purpose was also to evaluate the influence of age, sex, level of injury, time since injury, marital status and access to social support on perceived problems with participation. DESIGN: Cross-sectional. SUBJECTS: One hundred sixty-one persons with spinal cord injury. METHODS: A postal questionnaire including socio-demographic characteristics and a Swedish version of the Impact on Participation and Autonomy questionnaire. RESULTS: A majority of the respondents perceived their participation as sufficient in most activities addressed. Still, a majority of the respondents perceived one or more severe problems with their participation. Access to social support was the most influencing variable in predicting perceived severe problems with participation as compared with certain personal and health-related factors. CONCLUSION: The results suggest that it is important to consider access to social support along with other factors in the person-environment interaction and their influence on severe problems with participation in enhancing clients' participation in rehabilitation.

  • 30.
    Lindström, Britta
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Röding, Jenny
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Sundelin, Gunnevi
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Positive attitudes to work and preserved high level of motor performance are important factors for return to work in younger persons after stroke: A national survey2009In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 41, p. 714-718Article in journal (Refereed)
  • 31.
    Merrick, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Sundelin, Gunnevi
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    An observational study of two rehabilitation strategies for patients with chronic pain, focusing on sick leave at one-year follow-up2013In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, no 10, p. 1049-1057Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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  • 32.
    Merrick, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Sundelin, Gunnevi
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    One-year follow-up of two different rehabilitation strategies for patients with chronic pain2012In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, no 9, p. 764-773Article in journal (Refereed)
    Abstract [en]

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

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  • 33. Michaelson, Peter
    et al.
    Holmberg, David
    Aasa, Björn
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Aasa, Ulrika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    High load lifting exercise and low load motor control exercises as interventions for patients with mechanical low back pain: a randomized controlled trial with 24-month follow-up2016In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 48, no 5, p. 456-463Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to compare the effects of a high load lifting exercise with low load motor control exercises on pain intensity, disability and health-related quality of life for patients with mechanical low back pain. Design: A randomized controlled trial. Subjects: Patients with mechanical low back pain as their dominating pain mechanism. Methods: The intervention programme consisted of a high load lifting exercise, while the control group received low load motor control exercises over 8 weeks (12 sessions) with pain education included in both intervention arms. The primary outcome was pain intensity and disability, and the secondary outcome was health-related quality of life. Results: Each intervention arm included 35 participants, analysed following 2-, 12- and 24-month follow-up. There was no significant difference between the high load lifting and low load motor control interventions for the primary or secondary outcome measures. Between 50% and 80% of participants reported a decrease in perceived pain intensity and disability for both short-and long-term follow-up. Conclusion: No difference was observed between the high low load lifting and low load motor control interventions. Both interventions included retraining of movement patterns and pain education, which might explain the positive results over time.

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  • 34.
    Michaelson, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Michaelson, M
    Jaric, S
    Latash, ML
    Sjölander, P
    Djupsjöbacka, M
    Vertical posture and head stability in patients with chronic neck pain.2003In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 35, no 5, p. 229-235Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate postural performance and head stabilization of patients with chronic neck pain. DESIGN: A single-blind comparative group study. SUBJECTS: Patients with work-related chronic neck pain (n = 9), with chronic whiplash associated disorders (n = 9) and healthy subjects (n = 16). METHODS: During quiet standing in different conditions (e.g. 1 and 2 feet standing, tandem standing, and open and closed eyes) the sway areas and the ability to maintain the postures were measured. The maximal peak-to-peak displacement of the centre of pressure and the head translation were analysed during predictable and unpredictable postural perturbations. RESULTS: Patients with chronic neck pain, in particular those with whiplash-associated disorders, showed larger sway areas and reduced ability to successfully execute more challenging balance tasks. They also displayed larger sway areas and reduced head stability during perturbations. CONCLUSION: The results show that disturbances of postural control in chronic neck pain are dependent on the aetiology, and that it is possible to quantify characteristic postural disturbances in different neck pain conditions. It is suggested that the dissimilarities in postural performance are a reflection of different degrees of disturbances of the proprioceptive input to the central nervous system and/or of the central processing of such input.

  • 35.
    Molander, Peter
    et al.
    Pain and Rehabilitation Centre and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Novo, Mehmed
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Ringqvist, Åsa
    Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden.
    Hållstam, Andrea
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Hesser, Hugo
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; School of Behavioural, Social and Legal Sciences, Center for Health and Medical Psychology, Örebro University, Sweden.
    Löfgren, Monika
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Gerdle, Björn
    Pain and Rehabilitation Centre and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Interdisciplinary pain rehabilitation for patients with Ehlers-Danlos syndrome and hypermobility spectrum disorders2024In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 56, article id jrm12431Article in journal (Refereed)
    Abstract [en]

    Objective: Chronic pain is a common manifestation of Ehlers-Danlos syndrome and hypermobility spectrum disorders; thus it is often suggested that patients undergo generic interdisciplinary pain rehabilitation, despite there being little evidence to support this decision. The aim of this study is to examine the effectiveness of standard rehabilitation programmes for chronic pain on patients with Ehlers-Danlos syndrome and hypermobility spectrum disorders, compared with patients with other chronic pain disorders.

    Subjects: Data, collected between 2008 and 2016, were extracted from a Swedish national registry. The patient data comprised of 406 cases with Ehlers-Danlos syndrome or hypermobility spectrum disorders, 784 cases with a whiplash-related diagnosis, 3713 cases with diagnoses relating to spinal pain, and 2880 cases of fibromyalgia.

    Methods: The differences between groups on key outcome measures from pre-to 1-year follow-up after interdisciplinary pain rehabilitation were analysed using linear mixed effects models. Sensitivity analysis in the form of pattern-mixture modelling was conducted to discern the impact of missing data.

    Results: No significant differences were found in improvements from pre-to 1-year follow-up for patients with Ehlers-Danlos syndrome or hypermobility spectrum disorder compared with other diagnostic groups regarding measures of health-related quality of life, mental health, or fatigue. At follow-up, differences in pain interference (d = –0.34 (95% confidence interval [95% CI] –0.5 to –0.18)), aver-age pain (d = 0.22 (95% CI 0.11–0.62)) and physical functioning (d = 2.19 (95% CI 1.61–2.77)) were detected for the group with spinal-related diagnoses in relation to those with EDS/HSD, largely due to pre-treatment group differences. Sensitivity analysis found little evidence for missing data influencing the results.

    Conclusion: This study suggests that patients with Ehlers-Danlos syndrome/hypermobility spectrum disorders may benefit from inclusion in an interdisciplinary pain rehabilitation programme.

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  • 36.
    Nordgren, Camilla
    et al.
    Neurotec Department, Karolinska Institutet, Stockholm, Sweden and Spinalis SCI Research Unit, Karolinska Institutet, Stockholm, Sweden.
    Richard, Levi
    Neurotec Department, Karolinska Institutet, Stockholm, Sweden and Spinalis SCI Research Unit, Karolinska Institutet, Stockholm, Sweden and Frösunda Center Research Unit, Karolinska Institutet, Stockholm, Sweden.
    Ljunggren, Gunnar
    Neurotec Department, Karolinska Institutet, Stockholm, Sweden.
    Seiger, Åke
    Neurotec Department, Karolinska Institutet, Stockholm, Sweden and Spinalis SCI Research Unit, Karolinska Institutet, Stockholm, Sweden and Frösunda Center Research Unit, Karolinska Institutet, Stockholm, Sweden.
    Societal services after traumatic spinal cord injury in Sweden2003In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 35, no 3, p. 121-126Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Societal services after traumatic spinal cord injury in Sweden were investigated, including self-rated levels of satisfaction with the application process and resource allocation.

    DESIGN: Survey of an incidence population.

    SUBJECTS: Thirty-four persons of a total regional incidence population (n = 48) with traumatic spinal cord injury.

    METHODS: Structured interviews using a standardized questionnaire.

    RESULTS: About 25 separate services were identified being available for persons with traumatic spinal cord injury. The average number of applications per person was 5 (range 0-11). The most common service was "transportation service". Of the applications, 17% were partially or totally rejected. Most subjects received information about available services from a social worker. For 13 available services at least 1 subject claimed ignorance about its existence.

    CONCLUSIONS: In Sweden, significant resources are allocated for allowing independence and financial compensation for individuals with traumatic spinal cord injury. However, this support system sometimes also results in frustration and disappointment. Insufficient information and co-ordination are reported as weaknesses. The persons' efforts to acquire knowledge of how the system works take time which could be better used for rehabilitation and full integration into the community.

  • 37. Nordin, Catharina
    et al.
    Gard, Gunvor
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Being in an exchange process: experiences of patient participation in multimodal pain rehabilitation2013In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, no 6, p. 580-586Article in journal (Refereed)
    Abstract [en]

    Objective: To explore primary healthcare patients' experiences of patients participation in multimodal pain rehabilitation.

    Patients and methods: A total of 17 patients who had completed multimodal rehabilitation for persistent pain were interviewed. The interviews were analysed using qualitative content analysis.

    Results: One theme, Being in an exchange process, and 4 categories emerged. The theme depicted patient participation as a continuous exchange of emotions, thoughts and knowledge. The category Fruitful encounters represented the basic prerequisites for patient participation through dialogue and platforms to meet. Patients' emotional and cognitive resources and restrictions, as well as knowledge gaps, were conditions influencing patient participation in the category Inequality in co-operation. Mutual trust and respect were crucial conditions in patient's personal relationships with the health professionals, forming the category Confidence-inspiring alliance. In the category Competent health professionals, the health professionals' expertise, empathy and personal qualities, were emphasized to favour patient participation.

    Conclusion: Patient participation can be understood as complex and individualized. A confidence-inspiring alliance enables a trusting relationship to be formed between patients and health professionals. Patients emphasized that health professionals need to play an active role in building common ground in the interaction. Understanding each patient's needs in the participation process may favour patient participation.

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  • 38.
    Nyberg, Andre
    et al.
    Heart and Lung Institute, University of Laval, Quebec, Canada.
    Saey, Didier
    Martin, Mickaël
    Maltais, François
    Test-re-test reliability of quadriceps muscle strength measures in people with more severe chronic obstructive pulmonary disease2018In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50, no 8, p. 759-764Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the interday test-retest reliability of volitional and non-volitional measurements of isometric quadriceps strength using a strain-gauge in people with severe to very severe chronic obstructive pulmonary disease.

    DESIGN: Cross-sectional study. Volitional quadriceps measurements consisted of isometric maximal voluntary contractions. Non-volitional measurements were obtained during magnetic potentiated twitch stimulations of the femoral nerve.

    SETTING: Research centre laboratory.

    PARTICIPANTS: Twenty-four individuals with severe to very severe chronic obstructive pulmonary disease (percentage of predicted forced expiratory volume in 1 s, 37% predicted).

    RESULTS: Maximal voluntary contractions and potentiated twitch stimulations measures demonstrated excellent interday test-retest relative reliability (ICC 0.97 and 0.80, respectively), while absolute reliability measures were different between techniques (SEM 1.4 kg, CV 3.2%, MDC 3.9 kg vs SEM 1.5 kg, CV 12.2%, MDC 4.2 kg for maximal voluntary contractions and potentiated twitch stimulations, respectively).

    CONCLUSION: The results supports that maximal voluntary contraction and potentiated twitch stimulation measurements of isometric quadriceps strength are reliable in people with severe to very severe chronic obstructive pulmonary disease as evident excellent relative reliability using both techniques, although the former technique appears to have better absolute reliability.

  • 39.
    Nyberg, Vanja E.
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Novo, Mehmed
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Sjölund, Bengt H.
    Changes in multidimensional pain inventory profile after a pain rehabilitation programme indicate the risk of receiving sick leave benefits one year later2014In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, no 10, p. 1006-1013Article in journal (Refereed)
    Abstract [en]

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

  • 40.
    Nyberg, Vanja E
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Sanne, Harald
    Primary Health Care Service, Occupational Rehab Center, Gothenburg.
    Sjölund, Bengt H
    Dep of Public Health, University of Southern Denmark, Odense.
    Swedish quality registry for pain rehabilitation:: purpose, design, implementation and characteristics of referred patients2011In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 43, no 1, p. 50-57Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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  • 41. Näslund, Annika
    et al.
    Sundelin, Gunnevi
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hirschfeld, Helga
    Reach performance and postural adjustments during standing in children with severe spastic diplegia using dynamic ankle-foot orthoses.2007In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 39, no 9, p. 715-23Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the co-ordination between reaching, ground reaction forces and muscle activity in standing children with severe spastic diplegia wearing dynamic ankle-foot orthoses compared with typically developing children. DESIGN: Clinical experimental study. SUBJECTS: Six children with spastic diplegia (Gross Motor Function Classification System level III-IV) and 6 controls. METHODS: Ground reaction forces (AMTI force plates), ankle muscle activity (electromyography and displacement of the hand (ELITE systems) were investigated while reaching for an object. RESULTS: For the children with severe spastic diplegia who were wearing dynamic ankle-foot orthoses, co-ordination between upward and forward reach velocity differed regarding the temporal sequencing and amplitude of velocity peaks. During reaching, these children lacked interplay of pushing force beneath the reach leg and braking force beneath the non-reach leg and co-ordinated ankle muscle activity, compared with controls. CONCLUSION: The results suggest differences in reach performance and postural adjustments for balance control during a reaching movement in standing between children with spastic diplegia Gross Motor Function Classification System level III-IV, wearing dynamic ankle-foot orthoses compared with typically developing children.

  • 42. Peolsson, Anneli
    et al.
    Peolsson, Michael
    Umeå University, Faculty of Science and Technology, Department of Chemistry. Computational Life Science Cluster, Umeå University, Umeå.
    Jull, Gwendolen
    O'Leary, Shaun
    Is there a difference in the pattern of muscle activity when performing neck exercises with a guild board versus a pulley?2013In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, no 9, p. 900-905Article in journal (Refereed)
    Abstract [en]

    Objective: Guild boards and pulleys are apparatus commonly used to train cervical muscle function for their purported benefit in facilitating activity of the deeper muscle layers, although this effect has not been substantiated. The objective of this study was to compare the activity of the different layers of cervical muscles when performing exercise with these 2 types of apparatus.

    Subjects: A total of 19 healthy persons (mean age 28 years, (standard deviation 7 years).

    Design: Ultrasound measurements of muscle deformation and deformation rate were recorded from the dorsal and ventral neck muscle layers during extension and flexion exercises. Pulley exercises were performed in the upright sitting position against a standardized resistance (men 2 kg, women 1 kg) and guild board exercises at an angle of 45 degrees.

    Results: The dorsal muscles generally showed greater levels of deformation and deformation rate during exercise with the guild board compared with the pulley system (p<0.05), but with no significant differences in relative activity between the deep and superficial muscle layers (condition x muscle interaction (p>0.05)). No differences were observed for the ventral muscles between exercise methods (p>0.05).

    Conclusion: While both exercise methods appear to train cervical muscle function, neither appear to be more selective in facilitating deep cervical muscle activity, probably as they involve very similar cervical kinematics.

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  • 43.
    Persson, Ann L
    et al.
    Rehabilitation and Research Centre for Torture Victims (RCT), Copenhagen, Denmark.
    Westermark, Sofia
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Merrick, Daniel
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Sjölund, Bengt
    Rehabilitation and Research Centre for Torture Victims (RCT), Copenhagen, Denmark.
    Validity of electrical stimulus magnitude matching in chronic pain2009In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 41, no 11, p. 898-903Article in journal (Refereed)
    Abstract [en]

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

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

    Patients: Thirty-one patients with chronic musculoskeletal pain.

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

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

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

  • 44.
    Pietilä Holmner, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Enthoven, Paul
    Gerdle, Björn
    Molander, Peter
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Long-term outcomes of multimodal rehabilitation in primary care for patients with chronic pain2020In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 52, no 2, article id UNSP jrm00023Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the outcomes one year after multimodal rehabilitation programmes in primary care for patients with chronic pain, both as a whole and for men and women separately. A second aim was to identify predictive factors for not being on sickness absence at follow-up after one year.

    Methods: A prospective longitudinal cohort study of 234 patients, 34 men and 200 women, age range 18–65 years, who participated in multimodal rehabilitation programmes in primary care in 2 Swedish county councils. Pain, physical and emotional functioning, coping, health-related quality of life, work-related factors, sickness absence (sick leave, sickness compensation/disability pension) were evaluated prior to and one year after multimodal rehabilitation programmes.

    Results: Patients showed significant improvements at 1-year follow-up for all measures (all p ≤ 0.004) except satisfaction with vocation (p = 0.060). The proportion of patients on sick leave decreased significantly at follow-up (p = 0.027), while there was no significant difference regarding the proportion of patients on sickness compensation/disability pension (p = 0.087). Higher self-rated work ability was associated with not being on sickness absence at 1-year follow-up (odds ratio (OR) 1.19, 95% confidence interval (CI) 1.21–1.06, p = 0.005).

    Conclusion: This study indicates that multimodal rehabilitation programmes in primary care could be beneficial for patients with chronic pain, since the outcomes at 1-year follow-up for pain, physical and emotional functioning, coping, and health-related quality of life were positive. However, the effect sizes were small and thus further development of multimodal rehabilitation programmes is warranted in order to improve the outcomes.

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  • 45.
    Pietilä Holmner, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Enthoven, Paul
    Stenberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    "The acceptance" of living with chronic pain – an ongoing process: A qualitative study of patient experiences of multimodal rehabilitation in primary care2018In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50, no 1, p. 73-79Article in journal (Refereed)
    Abstract [en]

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

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

    METHODS: The interviews were analysed using qualitative content analysis.

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

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

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  • 46. Rivano Fischer, Marcelo
    et al.
    Persson, Elisabeth B.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Karolinska Institutet, Department of Clinical Sciences, Division of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden.
    Schult, Marie-Louise
    Lofgren, Monika
    Return to work after interdisciplinary pain rehabilitation: one- and two-year follow-up study based on the Swedish quality registry for pain rehabiliation2019In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 51, no 4, p. 281-289Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 47.
    Rudolfsson, Thomas
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Djupsjöbacka, Mats
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Björklund, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Effects of neck coordination exercise on sensorimotor function in chronic neck pain: A randomized controlled trial.2014In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, no 9, p. 908-914Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

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  • 48.
    Röding, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Glader, Eva-Lotta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Malm, Jan
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Neurology.
    Lindström, Britta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Life satisfaction in younger individuals after stroke: different predisposing factors among men and women2010In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, no 2, p. 155-161Article in journal (Refereed)
    Abstract [en]

    There were different factors for being satisfied with life as a whole between men and women, indicating a need for a more gender-specific rehabilitation than is currently used. The impact that deteriorated ability to concentrate has on life satisfaction is an important finding that needs to be considered in the rehabilitation process of younger patients after stroke.

  • 49.
    Sandlund, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Centre for Musculoskeletal Research, University of Gävle; Alfta Research Foundation, Alfta.
    Djupsjöbacka, Mats
    Centre for Musculoskeletal Research, University of Gävle.
    Ryhed, Bengt
    Alfta Research Foundation, Alfta.
    Hamberg, Jern
    Alfta Research Foundation, Alfta.
    Björklund, Martin
    Centre for Musculoskeletal Research, University of Gävle; Alfta Research Foundation, Alfta.
    Predictive and discriminative value of shoulder proprioception tests for patients with whiplash-associated disorders2006In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 38, no 1, p. 44-49Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

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  • 50.
    Sandlund, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Centre for Musculoskeletal Research, University of Gävle, Gävle; Alfta Research Foundation, Alfta, Sweden.
    Röijezon, Ulrik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Centre for Musculoskeletal Research, University of Gävle, Gävle; Alfta Research Foundation, Alfta, Sweden.
    Björklund, Martin
    Centre for Musculoskeletal Research, University of Gävle, Gävle; Alfta Research Foundation, Alfta, Sweden.
    Djupsjöbacka, Mats
    Centre for Musculoskeletal Research, University of Gävle, Gävle.
    Acuity of goal-directed arm movements to visible targets in chronic neck pain2008In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, no 5, p. 366-374Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

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