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  • 1.
    Cronström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Health Sciences, Lund University, Lund, Sweden.
    Ageberg, Eva
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Does sensorimotor function predict graft rupture, contra-lateral injury or failure to return to sports after ACL reconstruction?: A protocol for the STOP Graft Rupture study2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, article id e042031Article in journal (Refereed)
    Abstract [en]

    Introduction: People with anterior cruciate ligament (ACL) reconstruction (ACLR) are at high risk of sustaining a graft rupture and/or contra-lateral ACL injury. The main factors that may predispose individuals for subsequent ACL injuries are, however, not established. To reduce the risk of reinjuries, it is of particular interest to identify modifiable risk-factors, for instance, those related to sensorimotor control which are responsive to training. The aim of the current study protocol is to present the design of our prospective cohort study STOP Graft Rupture investigating sensorimotor function as predictors for graft rupture, contra-lateral ACL injury and/or failure to return to sport (RTS) within 3 years following ACLR.

    Methods and analysis: We aim to recruit 200 individuals (15–35 years, ~50% women) with ACLR from Norrland University Hospital, Umeå and Lund University Hospital, Lund, Sweden. Participants will be assessed with a comprehensive test battery for sensorimotor muscle function, including hop performance, muscle strength, muscle activation, hip and ankle range of motion and postural orientation as well as patient-reported function 1 year after ACLR (baseline). For a subgroup of individuals (Umeå cohort), 3D kinematics and joint position sense will also be evaluated. At follow-up (≥3 years post-ACLR), the participants will be asked to answer questions related to new ACL injuries to either knee and about RTS. Separate logistic regression models, adjusting for possible confounders, will be used to evaluate the influence of the different sensorimotor predictors on the prospective outcomes (graft rupture, contra-lateral ACL injury, RTS).

    Ethics and dissemination: This study was approved by the Swedish Ethical Review Board (Dnr 2016/319 and Dnr 2019-04037). The results will be published in international peer-reviewed scientific journals and presented at clinical and scientific congresses.

    Trial registration number: NCT04162613.

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  • 2.
    Cronström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Ageberg, Eva
    Lund University, Lund, Sweden.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Patient-reported function and psychological aspects, but not objectively assessed physical function, may impact return to sport within one year following anterior cruciate ligament reconstruction2021Conference paper (Refereed)
  • 3.
    Cronström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Health Sciences, Lund University, Lund, Sweden.
    Ageberg, Eva
    Department of Health Sciences, Lund University, Lund, Sweden.
    Zeraidi, Erika
    Department of Health Sciences, Lund University, Lund, Sweden.
    Larsson, Julia
    Department of Health Sciences, Lund University, Lund, Sweden.
    Nae, Jenny
    Department of Health Sciences, Lund University, Lund, Sweden.
    Associations between postural orientation errors in patients undergoing rehabilitation for ACL reconstruction and future patient-reported outcomes: an explorative study2023In: JSAMS plus (Journal of Science and Medicine in Sport plus), ISSN 2772-6967, Vol. 2, article id 100039Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate associations between postural orientation errors (POEs) in patients undergoing rehabilitation for anterior cruciate ligament reconstruction (ACLR) and patient-reported outcomes (PROMs) at 2-year follow-up.

    Design: Prospective cohort study.

    Methods: Fifty-three participants (mean (SD) 27 (6.5) years, 24 women), (mean (range) 7 (4–10) months post ACLR) were included. At baseline, all participants were visually assessed for POEs using a validated test battery. The POE subscales Activities of Daily Living and Sport were used in the analysis. At 2-years, the following PROMs were collected: Global knee function, Knee injury and Osteoarthritis Outcome Score, ACL Quality of Life (QoL), Knee Self-Efficacy Scale (K-SES), and ACL Return-to-Sport after Injury scale.

    Results: Twenty-one participants answered the questionnaires at 2 years (7 women and 14 men). Worse baseline POE Sport was associated with worse scores on K-SES (rs ​= ​–0.435, p ​≤ ​0.049) and ACL-QoL (rs ​= ​−0.467 to −0.576, p ​≤ ​0.038) at follow-up. No statistically significant associations were observed between POEs and the other PROMs.

    Conclusion: Postural orientation during the rehabilitation phase may be important for future knee self-efficacy and knee-related QoL after ACLR. Given the small population and low response rate, this result needs to be confirmed in future research.

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  • 4.
    Cronström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia; Department of Health Sciences, Lund University, Lund, Sweden.
    Cole, Michael H.
    Chalkley, Daniel
    Van Andel, Steven
    Pepping, Gert-Jan
    Creaby, Mark W.
    Acute effect of traditional and adaptive metronomes on gait variability in older individuals with a history of falls2022In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 34, no 6, p. 1349-1356Article in journal (Refereed)
    Abstract [en]

    Background: Metronome cueing has been shown to reduce gait variability and thereby potentially reduce falls risk in individuals with Parkinson's disease. It is unclear however, if metronome cueing has a similar effect in healthy older adults with a history of falls.

    Aim: To investigate whether a traditional and/or an adaptive metronome, based on an individual's gait pattern, were effective in reducing gait variability in older adults with a history of falls.

    Methods: Twenty older adults (15 women, 71 ± 4.9 years) with a history of falls were included in this cross-over study. Participants received two types of cueing (adaptive and traditional metronome) 1 week apart. The variability of the participants' stride time, stride length, walking speed and duration of double leg support were recorded during three walking conditions (baseline, during feedback and post-feedback gait). Repeated-measures ANOVA was used to assess the possible effects of the two cueing strategies on gait variables.

    Results: Compared with the baseline condition, participants had significantly increased stride time variability during feedback (F (2) = 9.83, p < 0.001) and decreased double leg support time variability post-feedback (F (2) 3.69, p = 0.034). Increased stride time variability was observed with the adaptive metronome in comparison to the traditional metronome.

    Conclusion: Metronome cueing strategies may reduce double leg support variability in older adults with a history of falls but seem to increase stride time variability. Further studies are needed to investigate if metronome cueing is more beneficial for individuals with greater baseline gait variability than those included in the current study.

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  • 5.
    Cronström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Health Sciences, Lund University, Lund, Sweden.
    Creaby, Mark W.
    Ageberg, Eva
    Do knee abduction kinematics and kinetics predict future anterior cruciate ligament injury risk?: A systematic review and meta-analysis of prospective studies2020In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 21, no 1, article id 563Article, review/survey (Refereed)
    Abstract [en]

    Background: To systematically review the association between knee abduction kinematics and kinetics during weight-bearing activities at baseline and the risk of future anterior cruciate ligament (ACL) injury.

    Methods: Systematic review and meta-analysis according to PRISMA guidelines. A search in the databases MEDLINE (PubMed), CINAHL, EMBASE and Scopus was performed. Inclusion criteria were prospective studies including people of any age, assessing baseline knee abduction kinematics and/or kinetics during any weight-bearing activity for the lower extremity in individuals sustaining a future ACL injury and in those who did not.

    Results: Nine articles were included in this review. Neither 3D knee abduction angle at initial contact (Mean diff: -1.68, 95%CI: − 4.49 to 1.14, ACL injury n = 66, controls n = 1369), peak 3D knee abduction angle (Mean diff: -2.17, 95%CI: − 7.22 to 2.89, ACL injury n = 25, controls n = 563), 2D peak knee abduction angle (Mean diff: -3.25, 95%CI: − 9.86 to 3.36, ACL injury n = 8, controls n = 302), 2D medial knee displacement (cm; Mean diff:: -0.19, 95%CI: − 0,96 to 0.38, ACL injury n = 72, controls n = 967) or peak knee abduction moment (Mean diff:-10.61, 95%CI: - 26.73 to 5.50, ACL injury n = 54, controls n = 1330) predicted future ACL injury.

    Conclusion: Contrary to clinical opinion, our findings indicate that knee abduction kinematics and kinetics during weight-bearing activities may not be risk factors for future ACL injury. Knee abduction of greater magnitude than that observed in the included studies as well as factors other than knee abduction angle or moment, as possible screening measures for knee injury risk should be evaluated in future studies.

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  • 6.
    Cronström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Ageberg, Eva
    Lund University, Lund, Sweden.
    Are objectively assessed physical function or patient-reported outcomes associated with psychological readiness to sport at one year post anterior cruciate ligament reconstruction?2021Conference paper (Refereed)
  • 7.
    Cronström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Health Sciences, Lund University, Lund, Sweden.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Thorborg, Kristian
    Department of Health Sciences, Lund University, Lund, Sweden; Department of Orthopaedic Surgery, Copenhagen University Hospital, Copenhagen, Denmark.
    Ageberg, Eva
    Department of Health Sciences, Lund University, Lund, Sweden.
    Factors associated with sports function and psychological readiness to return to sports at 12 months after anterior cruciate ligament reconstruction: a cross-sectional study2023In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 51, no 12, p. 3112-3120Article in journal (Refereed)
    Abstract [en]

    Background: Sports function and psychological readiness to return to sports (RTS) are important outcomes when evaluating rehabilitation after anterior cruciate ligament reconstruction (ACLR). It is, however, unclear which specific factors contribute most to these outcomes.

    Purpose: To determine associations between demographic characteristics, objective measurements of physical function, patient-reported outcome measure scores, sports-related function assessed with the Knee injury and Osteoarthritis Outcome Score (KOOS) Sport and Recreation subscale, and psychological readiness to RTS assessed with the Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) scale at 1 year after ACLR.

    Study Design: Cross-sectional study; Level of evidence, 3. Methods: At a mean of 12.5 ± 2.0 months after ACLR, 143 participants (50.3% female), with a mean age of 25.0 ± 5.7 years, were assessed for demographic characteristics, physical factors (hop performance, muscle strength, ankle and hip range of motion), and psychological factors (KOOS Pain and Symptoms subscales, Perceived Stress Scale, fear of reinjury) as well as the KOOS Sport and Recreation subscale and ACL-RSI scale. Backward linear regression models were used to evaluate factors associated with sports function and psychological readiness to RTS.

    Results: Lower isokinetic knee extension peak torque (limb symmetry index) (B = 18.38 [95% CI, 3.01-33.75]), lower preinjury activity level (B = 2.00 [95% CI, 0.87-3.14]), greater knee pain (B = 0.90 [95% CI, 0.70-1.10]), shorter time between injury and reconstruction (B = 0.16 [95% CI, 0.05-0.26]), and greater fear of reinjury (B = 0.11 [95% CI, 0.01-0.20]) were associated with a worse KOOS Sport and Recreation subscore (R2 = 0.683). A shorter hop distance (B = 0.15 [95% CI, 0.00-0.29]) was associated with a lower ACL-RSI score (R2 = 0.245).

    Conclusion: A combination of knee muscle strength, activity level, knee pain, timing of surgery, and fear of reinjury accounted for approximately 70% of the variation in sports function at 1 year after ACLR. In contrast, there was only 1 weak association between physical function and psychological readiness to RTS at this time point. Thus, factors associated with current sports function are much better known than features related to psychological readiness to RTS.

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  • 8.
    Cronström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Health Sciences, Lund University, Sweden.
    Ingelsrud, Lina H.
    Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Denmark.
    Nero, Håkan
    Department of Clinical Sciences Lund, Orthopedics, Lund University, Sweden.
    Lohmander, L. Stefan
    Department of Clinical Sciences Lund, Orthopedics, Lund University, Sweden; Arthro Therapeutics AB, Malmö, Sweden.
    Ignjatovic, Majda Misini
    Arthro Therapeutics AB, Malmö, Sweden.
    Dahlberg, Leif E.
    Department of Clinical Sciences Lund, Orthopedics, Lund University, Sweden; Arthro Therapeutics AB, Malmö, Sweden.
    Kiadaliri, Ali
    Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Orthopedics, Lund University, Sweden; Arthro Therapeutics AB, Malmö, Sweden.
    Interpretation threshold values for patient-reported outcomes in patients participating in a digitally delivered first-line treatment program for hip or knee osteoarthritis2023In: Osteoarthritis and Cartilage Open, ISSN 2665-9131, Vol. 5, no 3, article id 100375Article in journal (Refereed)
    Abstract [en]

    Objective: Establish proportions of patients reporting important improvement, acceptable symptoms and treatment failure and define interpretation threshold values for pain, patient-reported function and quality-of-life after participating in digital first-line treatment including education and exercise for hip and knee osteoarthritis (OA).

    Methods: Observational study. Responses to the pain Numeric Rating Scale (NRS, 0-10 best to worst), Knee injury and Osteoarthritis Outcome Score 12 (KOOS-12) and Hip disability and Osteoarthritis Outcome Score 12 (HOOS-12, both 0-100 worst to best) were obtained for 4383 (2987) and 20341 (1264) participants with knee (hip) OA at 3 and 12 months post intervention.. Threshold values for Minimal Important Change (MIC), Patient Acceptable Symptom State (PASS) and Treatment Failure (TF) were estimated using anchor-based predictive modeling.

    Results: 70–85% reported an important improvement in pain, function and quality of life after 3 and 12 months follow-up. 42% (3 months) and 51% (12 months) considered their current state as satisfactory, whereas 2-4% considered treatment failed. MIC values were -1 (NRS) and 0-4 (KOOS/HOOS-12) across follow-ups and joint affected. PASS threshold value for NRS was 3, and 53–73 for the KOOS/HOOS-12 subscales Corresponding values for TF were 5 (NRS) and 34–55 (KOOS/HOOS-12). Patients with more severe pain at baseline had higher MIC scores and accepted poorer outcomes at follow-ups.

    Conclusion: Threshold estimates aid in the interpretation of outcomes after first-line OA interventions assessed with NRS Pain and KOOS/HOOS-12. Baseline pain severity is important to consider when interpreting threshold values after first-line interventions in these patients.

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  • 9.
    Cronström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Orthopaedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Health Sciences, Lund University, Lund, Sweden.
    Nero, H.
    Orthopaedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
    Lohmander, L.S.
    Orthopaedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
    Dahlberg, L.E.
    Orthopaedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
    On the waiting list for joint replacement for knee osteoarthritis: are first-line treatment recommendations implemented?2020In: Osteoarthritis and Cartilage Open, ISSN 2665-9131, Vol. 2, no 2, article id 100056Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate to what extent individuals participated in guideline-based first-line treatments before being assigned to a wait list for knee replacement for osteoarthritis (OA), and to what extent they were recommended such treatments once on the list. Factors associated with participation in first-line management were also investigated.

    Design: All patients on the waiting list ≥ three months for knee replacement due to knee OA (n = 229) at a public hospital in Sweden were invited to participate in this cross-sectional survey study. 136 individuals (mean age 70 ± 9 years, 59% women) answered self-reported questionnaires including demographics, physical activity level, knee function and treatments before and during their time on the waiting list.

    Results: Before being referred to the waiting list, 40% had participated in guideline-based OA management (Better management of patients with OsteoArthritis (BOA)), 53% in physiotherapy, 67% in either BOA or physiotherapy whilst 23% of those overweight (BMI≥25) had received weight-management advice. Women had participated in BOA and physiotherapy twice as often as men (51% vs. 25%, p = 0.002 and 66% vs. 34%, p < 0.001) prior to waiting list referral. During their time on the waiting list, only 10% were recommended BOA, 30% physiotherapy and 15% weight-management. 38% of the patients that had never participated in BOA indicated that they were interested in participating while waiting for their knee replacement.

    Conclusion: Our results suggest that recommended treatment guidelines for OA may not be adequately implemented in Swedish health-care. Further exploration of implementation barriers and lack of equality of care appears warranted.

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  • 10.
    Cronström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Health Sciences, Lund University, Lund, Sweden.
    Risberg, May Arna
    Englund, Martin
    Tidérius, Carl-Johan
    Önnerfjord, Patrik
    Struglics, André
    Svensson, Jonas
    Peterson, Pernilla
    Månsson, Sven
    Ageberg, Eva
    Is good muscle function a protective factor for early signs of knee osteoarthritis after anterior cruciate ligament reconstruction? The SHIELD cohort study protocol2020In: Osteoarthritis and Cartilage Open, ISSN 2665-9131, Vol. 2, no 4, article id 100102Article in journal (Refereed)
    Abstract [en]

    Introduction: Knee injury history and increased joint load, respectively, are major risk factors for the development of knee osteoarthritis (OA). Lower extremity muscle function, such as knee muscle strength, influence joint load and may be important for the onset of knee OA. However, the role of muscle function as a possible modifiable protective mechanism for the development of OA after anterior cruciate ligament reconstruction (ACLR) is not clear.

    Methods and analysis: In this prospective cohort study, 100 patients (50% women, 18-35 years) with ACLR will be recruited from Skåne University Hospital, Sweden and Oslo University Hospital, Norway. They will be assessed with a comprehensive test battery of muscle function including muscle strength, muscle activation, hop performance, and postural orientation as well as patient-reported outcomes, one year (baseline) and three years (follow-up) after ACLR. Primary predictor will be knee extension strength, primary outcome will be patient-reported knee pain (Knee injury and Osteoarthritis Outcome Score, subscale pain) and secondary outcomes include compositional MRI (T2 mapping) and turnover of cartilage and bone biomarkers. Separate linear regression model will be used to elucidate the influence of each baseline muscle function variable on the outcomes at follow-up, adjusted for baseline values. Twenty non-injured individuals will also be assessed with MRI. This study is approved by The Regional Ethical Review Board in Lund (Sweden) and Oslo (Norway).

    Discussion: This study may have important clinical implications for using muscle function to screen for risk of early-onset knee OA and for optimizing exercise therapy after knee injury.

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  • 11.
    Cronström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Health Sciences, Lund University, Lund, Sweden.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Response to comment on: “return to sports: a risky business? a systematic review with meta-analysis of risk factors for graft rupture following acl reconstruction”2024In: Sports Medicine, ISSN 0112-1642, E-ISSN 1179-2035, Vol. 54, p. 779-780Article in journal (Refereed)
  • 12.
    Cronström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Department of Health Sciences, Lund University, Lund, Sweden.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Return to sports: a risky business? a systematic review with meta-analysis of risk factors for graft rupture following acl reconstruction2023In: Sports Medicine, ISSN 0112-1642, E-ISSN 1179-2035, Vol. 53, no 1, p. 91-110Article, review/survey (Refereed)
    Abstract [en]

    Background: The risk of sustaining a graft rupture after anterior cruciate ligament reconstruction (ACLR) is high. Contributing risk factors are, however, still not clearly identified.

    Objective: The aim of this systematic review was to identify and quantify risk factors for graft rupture after ACLR.

    Methods: A systematic review with meta-analysis (PROSPERO CRD42020140129) based on PRISMA guidelines was performed. MEDLINE, CINAHL and EMBASE were searched from inception to September 2021. Prospective and retrospective studies addressing risk factors for graft rupture after ACLR in males/females of all ages were considered. Meta-analyses using a random effect model (effect measure: odds ratio [OR] with 95% confidence interval [CI]) were performed. The GRADE tool was used to assess evidence quality.

    Results: Following full-text screening of 310 relevant papers, 117 were eventually included, incorporating up to 133,000 individuals in each meta-analysis. Higher Tegner activity level (≥ 7 vs < 7) at primary injury (OR 3.91, 95% CI 1.69–9.04), increased tibial slope (degrees) (OR 2.21, 95% CI 1.26–3.86), lower psychological readiness to return to sport (RTS) (OR 2.18, 95% CI 1.32–3.61), early surgery (< 12 vs ≥ 12 months) (OR 1.87, 95% CI 1.58–2.22), RTS (pre-injury level) (OR 1.87, 95% CI 1.21–2.91) and family history of ACL injury (OR 1.76, 95% CI 1.34–2.31) were all associated with increased odds of graft rupture. Higher age (OR 0.47, 95% CI 0.39–0.59), female sex (OR 0.88, 95% CI 0.79–0.98), fewer self-reported knee symptoms pre-reconstruction (OR 0.81, 95% CI 0.69–0.95) and concomitant cartilage injuries (OR 0.70, 95% CI 0.62–0.79) instead decreased the odds. Meta-analysis revealed no association between body mass index, smoking, joint laxity, RTS time, knee kinematics, muscle strength or hop performance and graft rupture.

    Conclusion: Conspicuous risk factors for graft rupture were mainly sports and hereditary related. Few studies investigated function-related modifiable factors or included sports exposure data.

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  • 13.
    Cronström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Health Sciences, Lund University, Lund, Sweden.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Risk factors for contra-lateral secondary anterior cruciate ligament injury: a systematic review with meta-analysis2021In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 55, no Suppl 1, p. A75-A76, article id 193Article in journal (Refereed)
    Abstract [en]

    Background: There is limited knowledge about which risk factors that contribute to the high numbers of contra-lateral anterior cruciate ligament (C-ACL) injury after primary ACL injury.

    Objective:  To systematically review intrinsic risk factors for sustaining a C-ACL injury.

    Design: A systematic review with meta-analysis according to the PRISMA guidelines. Four databases (MEDLINE, CINAHL, EMBASE, Sport Discus) were searched from inception to January 2020. Meta-analyses were performed and expressed as odds ratios (OR).

    Setting: The included studies describe a variety of sport settings and activity levels.

    Participants: The review comprises studies including males and/or females of any age with ACL injury.

    Assessment of Risk Factors: The review comprises longitudinal studies investigating any intrinsic risk factor for future C-ACL injury.

    Main Outcome Measurements: C-ACL injury

    Results: Thirty-five moderate-to-high quality studies were eligible for meta-analysis, including up to ~59 000 individuals. The following factors all independently increased the odds of sustaining a C-ACL: Returning to a high activity level (OR: 3.26, 95% CI: 2.10–5.06), BMI < 25 (OR: 2.73, 95% CI: 1.73–4.36), Age ≤ 18 years (OR: 2.42, 95% CI: 1.51–3.88), Family history of ACL injury (OR: 2.07, 95% CI: 1.54–2.80), Primary ACL reconstruction performed ≤ 3 months post injury (OR: 1.65, 95% CI: 1.32–2.06), Female sex (OR: 1.35, 95% CI: 1.14–1.61) and Concomitant meniscal injury (OR 1.21, 95% CI: 1.03–1.42). There were no associations between the odds of sustaining a C-ACL injury and Smoking status, Pre-injury activity level, Playing soccer compared to other sports or Timing of return to sport.

    Conclusions: Demographic factors such as female sex, young age and family history of ACL injury, as well as early reconstruction and returning to a high activity level all contribute to the risk of sustaining a C-ACL injury. Studies on modifiable sensorimotor risk factors are warranted.

  • 14.
    Cronström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Health Sciences, Lund University, Lund, Sweden.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Risk factors for graft rupture after anterior cruciate ligament reconstruction: a systematic review with meta-analysis2021In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 55, no Suppl 1, p. A76-A76, article id 194Article in journal (Refereed)
    Abstract [en]

    Background: Underlying factors contributing to increased risk of graft rupture after anterior cruciate ligament reconstruction (ACLR) are not well described.

    Objective: To systematically review intrinsic risk factors for sustaining a graft rupture.

    Design: A systematic review with meta-analysis according to the PRISMA guidelines. Four databases (MEDLINE, CINAHL, EMBASE, Sport Discus) were searched from inception to January 2020. Meta-analyses (random effect model) were performed and expressed as odds ratios (OR).

    Setting: The included studies describe a variety of sport settings and activity levels.

    Participants: The review comprises studies including males and/or females of any age who have had ACLR.

    Assessment of Risk Factors: All longitudinal studies investigating any intrinsic risk factor for future graft rupture were included.

    Main Outcome Measurements: Graft rupture.

    Results: Seventy-seven studies were eligible for meta-analysis. The following factors all independently increased the odds of sustaining a graft rupture after ACLR: Age ≤ 18 years (OR: 3.87, 95% CI: 2.32–6.46), higher pre-primary injury activity level (OR: 2.43, 95% CI: 1.56–3.82), family history of ACL injury (OR: 1.98, 95% CI: 1.50–2.62), returning to a high activity level (OR: 1.87, 95% CI: 1.11–3.15), and increased lateral tibial slope (OR: 1.64, 95% CI: 1.13–2,38). None of the following factors were found to be associated with future graft rupture; sex, smoking status, generalized joint laxity, timing of surgery or return to sport (RTS), playing soccer compared to other sports, hop performance at time of RTS or concomitant meniscal or collateral ligament injuries.

    Conclusions: Young age, family history of ACL injury, high tibial slope and previous and current high activity level should be considered when screening for increased risk of graft rupture following ACLR. Future studies on the possible role of sensorimotor factors, e.g., muscle activation and/or strength and proprioception for future graft ruptures are warranted.

  • 15.
    Cronström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Health Sciences, Lund University, Lund, Sweden.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Häger, Charlotte K.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Risk Factors for Contra-Lateral Secondary Anterior Cruciate Ligament Injury: A Systematic Review with Meta-Analysis2021In: Sports Medicine, ISSN 0112-1642, E-ISSN 1179-2035, Vol. 51, no 7, p. 1419-1438Article, review/survey (Refereed)
    Abstract [en]

    Background: The risk of sustaining a contra-lateral anterior cruciate ligament (C-ACL) injury after primary unilateral ACL injury is high. C-ACL injury often contributes to a further decline in function and quality of life, including failure to return to sport. There is, however, very limited knowledge about which risk factors that contribute to C-ACL injury.

    Objective: To systematically review instrinsic risk factors for sustaining a C-ACL injury.

    Methods: A systematic review with meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four databases (MEDLINE, CINAHL, EMBASE, Sport Discus) were searched from inception to January 2020. Inclusion criteria were prospective or retrospective studies investigating any intrinsic risk factor for future C-ACL injury. Meta-analysis was performed and expressed as odds ratios (OR) if two or more articles assessed the same risk factor.

    Results: 44 moderate-to-high quality studies were eventually included in this review, whereof 35 studies were eligible for meta-analysis, including up to 59 000 individuals. We identified seven factors independently increasing the odds of sustaining a C-ACL injury (in order of highest to lowest OR): (1) returning to a high activity level (OR 3.26, 95% CI 2.10–5.06); (2) Body Mass Index < 25 (OR 2.73, 95% CI 1.73–4.36); (3) age ≤ 18 years (OR 2.42, 95% CI 1.51–3.88); (4) family history of ACL injury (OR 2.07, 95% CI 1.54–2.80); (5) primary ACL reconstruction performed ≤ 3 months post injury (OR 1.65, 95% CI: 1.32–2.06); (6) female sex (OR 1.35, 95% CI 1.14–1.61); and (7) concomitant meniscal injury (OR 1.21, 95% CI 1.03–1.42). The following two factors were associated with decreased odds of a subsequent C-ACL injury: 1) decreased intercondylar notch width/width of the distal femur ratio (OR 0.43, 95% CI 0.25–0.69) and 2) concomitant cartilage injury (OR 0.83, 95% CI 0.69–1.00). There were no associations between the odds of sustaining a C-ACL injury and smoking status, pre-injury activity level, playing soccer compared to other sports or timing of return to sport. No studies of neuromuscular function in relation to risk of C-ACL injury were eligible for meta-analysis according to our criteria.

    Conclusion: his review provides evidence that demographic factors such as female sex, young age (≤ 18 years) and family history of ACL injury, as well as early reconstruction and returning to a high activity level increase the risk of C-ACL injury. Given the lack of studies related to neuromuscular factors that may be modifiable by training, future studies are warranted that investigate the possible role of factors such as dynamic knee stability and alignment, muscle activation and/or strength and proprioception as well as sport-specific training prior to return-to-sport for C-ACL injuries.

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  • 16. Dell'Isola, Andrea
    et al.
    Jönsson, Thèrèse
    Rolfson, Ola
    Cronström, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Department of Health Sciences, Lund University, Lund, Sweden.
    Englund, Martin
    Dahlberg, Leif
    Willingness to Undergo Joint Surgery Following a First-Line Intervention for Osteoarthritis: Data From the Better Management of People With Osteoarthritis Register2021In: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 73, no 6, p. 818-827Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to assess the proportion of participants reconsidering their willingness to undergo surgery after three and 12 months. Secondary aims are to analyse and compare the characteristics of people willing and unwilling to undergo joint surgery for osteoarthritis (OA) before a first-line intervention; to study the association between pain intensity, walking difficulties, self-efficacy and fear of movement with the willingness to undergo surgery.

    DESIGN: This is an observational study based on Swedish register data. We included 30,578 people with knee or hip OA who participated in a first-line intervention including education and exercise.

    RESULTS: People willing to undergo surgery at baseline showed a higher proportion of men (40% vs 27%) and more severe symptoms and disability. Respectively, 45% and 30% of the people with knee and hip OA who were willing to undergo surgery at baseline became unwilling after the intervention. At the end of the study period (12 months), 35% and 19% of those with knee and hip OA, respectively, who were willing to undergo surgery at baseline became unwilling. High pain intensity, walking difficulties, and fear of movement were associated with higher odds of being willing to undergo surgery at both follow-ups while increased self-efficacy showed the opposite association.

    CONCLUSIONS: A first-line intervention for OA is associated with reduced willingness to undergo surgery with a greater proportion among knee OA than hip OA people. Due to its temporal variability, willingness to undergo surgery should be used with care to deem surgery eligibility.

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  • 17.
    Dell’Isola, Andrea
    et al.
    Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopedics, Lund University, Sweden.
    Nero, Håkan
    Department of Clinical Sciences Lund, Orthopedics, Lund University, Sweden; Joint Academy®, Malmö, Sweden.
    Dahlberg, Leif E.
    Department of Clinical Sciences Lund, Orthopedics, Lund University, Sweden; Joint Academy®, Malmö, Sweden.
    Ignjatovic, Majda Misini
    Joint Academy®, Malmö, Sweden.
    Lohmander, L. Stefan
    Department of Clinical Sciences Lund, Orthopedics, Lund University, Sweden; Joint Academy®, Malmö, Sweden.
    Cronström, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Health Sciences, Lund University, Lund, Sweden.
    Kiadaliri, Ali
    Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopedics, Lund University, Sweden; Joint Academy®, Malmö, Sweden.
    Within-person change in patient-reported outcomes and their association with the wish to undergo joint surgery during a digital first-line intervention for osteoarthritis2023In: Osteoarthritis and Cartilage, ISSN 1063-4584, E-ISSN 1522-9653Article in journal (Refereed)
    Abstract [en]

    Aim: To study the association between within-person changes in patient-reported outcomes (PROMs) and wish for joint surgery during participation in a digital first-line intervention comprising exercise and education for knee/hip osteoarthritis (OA).

    Methods: Retrospective observational registry study. Participants enrolled between 01/06/2018 and 30/10/2021 with follow-up data at 3 months (n=13,961). We used asymmetric fixed effect (conditional) logistic regressions to study the association between change in wish to undergo surgery at last available time point (3,6,9 or 12 months) and improvement or worsening of PROMs pain (0-10), quality of life (EQ5D-5L, 0.243-0.976), overall health (0-10), activity impairment (0-10), walking difficulties (yes/no), fear of movement (yes/no) and Knee/Hip injury and Osteoarthritis Outcome Score 12 Items (KOOS-12/HOOS-12, 0-100) function and quality of life (QoL) subscales.

    Results: The proportion of participants wishing to undergo surgery declined by 2% (95% CI 1.9, 3.0), from 15.7% at the baseline to 13.3% at 3 months. Generally, improvements in PROMs were associated with reduced likelihood of wishing for surgery while worsening was associated with increased likelihood. For pain, activity impairment EQ-5D and KOOS/HOOS QoL, a worsening led to a change in the probability of wish for surgery of larger absolute magnitude than an improvement in the same PROM.

    Conclusions: Within-person improvements in PROMs are associated with reduced wish for surgery, while worsenings with an increased wish for surgery. Larger improvements in PROMs may be needed to match the magnitude of the change in wish for surgery associated with a worsening in the same PROM.

  • 18.
    Ivarsson, Angelica
    et al.
    Department of Health Sciences, Lund University, Lund, Sweden.
    Cronström, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Health Sciences, Lund University, Lund, Sweden.
    Agreement between isokinetic dynamometer and hand-held isometric dynamometer as measures to detect lower limb asymmetry in muscle torque after anterior cruciate ligament reconstruction2022In: International Journal of Sports Physical Therapy, E-ISSN 2159-2896, Vol. 17, no 7, p. 1307-1317Article in journal (Refereed)
    Abstract [en]

    Background: Two commonly used instruments to assess muscle strength after anterior cruciate ligament reconstruction are the isokinetic dynamometer, which measures isokinetic torque and the hand-held dynamometer, which measures isometric torque. Isokinetic dynamometers are considered superior to other instruments but may not be commonly used in clinical settings. Hand-held dynamometers are small, portable, and more clinically applicable devices.

    Purpose: The purpose of this study was to assess agreement between a hand-held dynamometer and an isokinetic dynamometer, used to assess lower limb symmetry in knee muscle torque one year after anterior cruciate ligament (ACL) reconstruction.

    Study design: Cross-sectional measurement study

    Methods: Seventy-two participants who had undergone ACL reconstruction (35 men, 37 women; age= 25.8 ± 5.4 years) were included. Isokinetic muscle torque in knee flexion and extension was measured with an isokinetic dynamometer. Isometric flexion and extension knee muscle torque was measured with a hand-held dynamometer. Bland & Altman plots and Cohen’s Kappa coefficient were used to assess agreement between measurements obtained from the instruments.

    Result: Bland & Altman plots showed wide limits of agreement between the instruments for both flexion and extension limb symmetry index. Cohen´s Kappa coefficient revealed a poor to slight agreement between the extension limb symmetry index values (0.136) and a fair agreement for flexion limb symmetry index values (0.236). Cross-tabulations showed that the hand-held dynamometer detected a significantly larger number of participants with abnormal flexion torque limb symmetry index compared to the isokinetic dynamometer.

    Conclusion: The wide limits of agreements and Cohen’s Kappa coefficients values revealed insufficient agreement between the measurements taken with the two instruments, indicating that the instruments should not be used interchangeably. The hand-held dynamometer was more sensitive in detecting abnormal limb symmetry index in flexion torque, which promotes the option of use of hand-held dynamometers to detect differences between the injured and uninjured leg after ACL reconstruction.

    Level of evidence: 3b

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  • 19.
    Jönsson, Therese
    et al.
    Division of Sport Sciences, Department of Health Sciences, Lund University, Lund, Sweden.
    Dell’Isola, Andrea
    Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.
    Lohmander, Stefan L.
    Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden;Arthro Therapeutics, Malmö, Sweden.
    Wagner, Philippe
    Centre for Clinical Research, Uppsala University, Västerås, Sweden.
    Cronström, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Division of Sport Sciences, Department of Health Sciences, Lund University, Lund, Sweden;Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
    Comparison of face-to-face vs digital delivery of an osteoarthritis treatment program for hip or knee osteoarthritis2022In: JAMA Network Open, E-ISSN 2574-3805, Vol. 5, no 11, article id e2240126Article in journal (Refereed)
    Abstract [en]

    Importance: Digital care platforms have been introduced, but there is limited evidence for their efficacy compared with traditional face-to-face treatment modalities.

    Objective: To compare mean pain reduction among individuals with osteoarthritis (OA) of the knee or hip who underwent face-to-face vs digital first-line intervention.

    Design, setting, and participants: This registry-based cohort study included all persons with knee or hip osteoarthritis who participated in structured first-line treatment for osteoarthritis in a primary care setting in Sweden. Inclusion criteria were as follows: the treatment was delivered face-to-face or digitally between April 1, 2018, and December 31, 2019; patients provided 3-month follow-up data for pain; and patients had program adherence of at least 80%. Data analysis was conducted in March 2021.

    Exposures: Participants completed a 3-month intervention, including education and exercise for hip or knee osteoarthritis, with program adherence of 80% or higher, delivered face-to-face or by a digital application.

    Main outcomes and measures: Difference in change in joint pain (11-point numeric rating scale, with 0 indicating no pain and 10, the worst possible pain) between baseline and 3-month follow-up between the 2 intervention modalities. A minimal clinically important difference in pain change between groups was predefined as 1 point. Secondary outcomes were walking difficulties, health-related quality of life, willingness to undergo joint surgery, and fear avoidance behavior.

    Results: A total of 6946 participants (mean [SD] age, 67 [9] years; 4952 [71%] women; 4424 [64%] knee OA; 2504 [36%] hip OA) were included, with 4237 (61%) receiving face-to-face treatment and 2709 (39%) receiving digital treatment. Both the face-to-face (mean change, -1.10 [95% CI -1.17 to -1.02] points) and digital interventions (mean change, -1.87 [95% CI, -1.94 to -1.79] points) resulted in a clinically important pain reduction at 3 months. Participants in the digitally delivered intervention experienced a larger estimated improvement at 3 months (adjusted mean difference, -0.93 [95% CI, -1.04 to -0.81] points). Results of secondary outcomes were broadly consistent with main outcome.

    Conclusions and relevance: This Swedish national registry-based cohort study showed that people with knee or hip OA participating in first-line intervention experienced clinically relevant improvements in pain, whether delivered face-to-face or digitally. The increased benefit of digital delivery compared with face-to-face delivery was of uncertain clinical importance.

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  • 20.
    Kiadaliri, Ali
    et al.
    Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden; Arthro Therapeutics, Malmö, Sweden; Clinical Epidemiology Unit, Skåne University Hospital, Lund, Sweden.
    Cronström, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Health Sciences, Lund University, Lund, Sweden.
    Dahlberg, Leif E.
    Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden; Arthro Therapeutics, Malmö, Sweden.
    Lohmander, L. Stefan
    Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden; Arthro Therapeutics, Malmö, Sweden.
    Patient acceptable symptom state and treatment failure threshold values for work productivity and activity Impairment and EQ-5D-5L in osteoarthritis2024In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649Article in journal (Refereed)
    Abstract [en]

    Objective: To estimate patient acceptable symptom state (PASS) and treatment failure (TF) threshold values for Work Productivity and Activity Impairment (WPAI) measure and EQ-5D-5L among people with hip or knee osteoarthritis (OA) 3 and 12 months following participation in a digital self-management intervention (Joint Academy®).

    Methods: Among the participants, we computed work and activity impairments scores (both 0–100, with a higher value reflecting higher impairment) and the Swedish hypothetical- (range: − 0.314 to 1) and experience-based (range: 0.243–0.976) EQ-5D-5L index scores (a higher score indicates better health status) at 3- (n = 14,607) and 12-month (n = 2707) follow-ups. Threshold values for PASS and TF were calculated using anchor-based adjusted predictive modeling. We also explored the baseline dependency of threshold values according to pain severity at baseline.

    Results: Around 42.0% and 48.3% of the participants rated their current state as acceptable, while 4.2% and 2.8% considered the treatment had failed at 3 and 12 months, respectively. The 3-month PASS/TF thresholds were 16/29 (work impairment), 26/50 (activity impairment), 0.92/0.77 (hypothetical EQ-5D-5L), and 0.87/0.77 (the experience-based EQ-5D-5L). The thresholds at 12 months were generally comparable to those estimated at 3 months. There were baseline dependencies in PASS/TF thresholds with participants with more severe baseline pain considering poorer (more severe) level of WPAI/EQ-5D-5L as satisfactory.

    Conclusion: PASS and TF threshold values for WPAI and EQ-5D-5L might be useful for meaningful interpretation of these measures among people with OA. The observed baseline dependency of estimated thresholds limits their generalizability and values should be applied with great caution in other settings/populations.

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  • 21.
    Nae, Jenny
    et al.
    Health Sciences, Lund University, Lund, Sweden.
    Creaby, Mark W.
    School of Exercise Science, Australian Catholic University, Queensland, Brisbane, Australia.
    Cronström, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Health Sciences, Lund University, Lund, Sweden.
    Ageberg, Eva
    Health Sciences, Lund University, Lund, Sweden.
    Sex differences in postural orientation errors and association with objective and patient-reported function in patients with ACL injury: An exploratory cross-sectional study2021In: BMJ Open Sport and Exercise Medicine, ISSN 2055-7647, Vol. 7, no 2, article id e001045Article in journal (Refereed)
    Abstract [en]

    Objectives: There is limited research on sex differences in postural orientation (ie, alignment between body segments) in people with knee injury measured with a clinically applicable method. An understanding of the relationship between postural orientation and physical function may help guide decision making in rehabilitation. The aims were to evaluate (1) sex differences in visual assessment of Postural Orientation Errors (POEs) and (2) the association between POEs and objective and patient-reported physical function, in men and women with anterior cruciate ligament reconstruction (ACLR).

    Methods: Twenty-four women and 29 men (mean 26.7 (SD 6.5) years) with ACLR were included. Six POEs (lower extremity and trunk) were scored from a video of five tasks with varying difficulty to compute POE scores (total and subscores). Objective physical function was evaluated with the single-leg hop for distance and side hop. Patient-reported physical function was evaluated using patient-reported outcome measures (PROMs).

    Results: Women had significantly more POEs than men (median difference 5.5-25, p≤0.028). More POEs were associated with shorter hop distance and fewer side hops in women (r s = -0.425 to -0.518, p<0.038), but not in men (r s <0.301, p>0.05). No associations were found between POE scores and PROMs, in either sex (r s < -0.246, p>0.05).

    Conclusions: Women with ACLR seem to have more POEs compared with men, indicating worse postural orientation. More POEs were associated with worse hop performance, suggesting that POE scores may be used as criteria for rehabilitation progression. The lack of associations between POE scores and PROMs indicate that these measures complement each other.

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  • 22.
    Nae, Jenny Älmqvist
    et al.
    Department of Health Sciences, Lund University, PO Box 157, Lund, Sweden.
    Cronström, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Association between sensorimotor function and visual assessment of postural orientation in patients with ACL injury2022In: Physical Therapy in Sport, ISSN 1466-853X, E-ISSN 1873-1600, Vol. 55, p. 160-167Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the association between sensorimotor function and visual assessment of postural orientation during execution of weight-bearing activities in patients with anterior cruciate ligament reconstruction (ACLR).

    Design: Cross-sectional study.

    Setting: Laboratory.

    Participants: Fifty-two individuals (23 women and 29 men, mean (SD) age 26.5 (6.4)) approximately 7 months after ACLR.

    Main outcome measures: Sensorimotor function (proprioception, ankle dorsiflexion range of motion, and isometric muscle strength of the hip, knee, and trunk) were recorded on the injured leg. Postural orientation errors (POEs) were visually scored from video-recordings of the injured leg during execution of 5 functional tasks, and POE subscales activities of daily living (ADL) and Sport, and Total POE score were used in the analysis.

    Results: Lower hip external rotation strength was associated with higher Total POE score (B = −24.4, p = 0.041) and higher POE subscale ADL score (B = −24.9, p = 0.03). No associations between sensorimotor function and POE subscale Sport were found.

    Conclusions: Decreased hip external rotation strength might contribute to higher scores on the POE subscale ADL and the Total POE score, in men and women following ACLR. Future studies will reveal if strengthening of hip external rotation strength improves postural orientation.

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  • 23.
    Nero, Håkan
    et al.
    med dr, leg fysioterapeut, Lunds universitet.
    Cronström, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Abbott, Allan
    med dr, leg fysioterapeut, Linköpings universitet.
    Svensk artrosbehandling är i framkant men underutnyttjad2021In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 118, article id 20205Article in journal (Refereed)
    Abstract [en]

    Osteoarthritis (OA) is a highly prevalent group of disorders and among the most common causes of chronic pain and disability globally. First-line evidence-based treatments for hip and knee OA, two of the most common variants, are available in Sweden with the potential for wide national reach through face-to-face and digital platforms. Research results suggest important reductions in symptoms in patients with knee or hip OA. Despite evidence, availability and low cost, first-line evidence-based treatments are not utilized to the full extent to reduce the burden of OA.

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