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  • 1.
    Engquist, Markus
    et al.
    Ryhov Hospital, Jönköping, Sweden.
    Löfgren, Håkan
    Ryhov Hospital, Jönköping, Sweden.
    Öberg, Birgitta
    Linkoping University, Linköping, Sweden.
    Holtz, Anders
    Uppsala University Hospital, Uppsala, Sweden.
    Peolsson, Anneli
    Linkoping University, Linköping, Sweden.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Vavruch, Ludek
    Spine Center Goteborg, Gothenburg, Sweden.
    Lind, Bengt
    Spine Center Goteborg, Gothenburg, Sweden.
    Factors affecting the outcome of surgical versus nonsurgical treatment of cervical radiculopathy: A randomized, controlled study2015In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 40, no 20, p. 1553-1563Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN: Prospective randomized controlled trial.

    OBJECTIVE: To analyze factors that may influence the outcome of anterior cervical decompression and fusion (ACDF) followed by physiotherapy versus physiotherapy alone for treatment of patients with cervical radiculopathy.

    SUMMARY OF BACKGROUND DATA: An understanding of patient-related factors affecting the outcome of ACDF is important for preoperative patient selection. No previous prospective, randomized study of treatment effect modifiers relating to outcome of ACDF compared with physiotherapy has been carried out.

    METHODS: Sixty patients with cervical radiculopathy were randomized to ACDF followed by physiotherapy or physiotherapy alone. Data for possible modifiers of treatment outcome at one year, such as sex, age, duration of pain, pain intensity, disability (Neck Disability Index, NDI), patient expectations of treatment, anxiety due to neck/arm pain, distress (Distress And Risk Assessment Method, DRAM), self efficacy (Self Efficacy Scale, SES) health status (EQ-5D) and MRI findings were collected. A multivariate analysis was performed to find treatment effect modifiers affecting the outcome regarding arm/ neck pain intensity and NDI.

    RESULTS: Factors that significantly altered the treatment effect between treatment groups in favor of surgery were: duration of neck pain < 12 months (p = 0.007), duration of arm pain < 12 months (p = 0.01) and female sex (p = 0.007) (outcome: arm pain), low EQ-5D index (outcome: neck pain, p = 0.02), high levels of anxiety due to neck/arm pain (outcome: neck pain, p = 0.02 and NDI, p = 0.02), low SES score (p = 0.05) and high DRAM score (p = 0.04). (outcome: NDI). No factors were found to be associated with better outcome with physiotherapy alone.

    CONCLUSIONS: In this prospective, randomized study of patients with cervical radiculopathy, short duration of pain, female sex, low health quality, high levels of anxiety due to neck/arm pain, low self efficacy and a high level of distress before treatment were associated with better outcome from surgery. No factors were found to be associated with better outcome from physiotherapy alone.

  • 2.
    Kyhlbäck, Maria
    et al.
    Akademiska Sjukhuset Uppsala.
    Kjellby-Wendt, Gunilla
    Sahlgrenaka Akademin.
    Abbott, Allan
    Karolinska Institutet.
    Millisdotter, Monica
    Lunds Universitetssjukhus.
    Grönlund, Per
    Östersunds sjukgymnastik.
    Johansson, Mia
    Umeå Universitetssjukhus.
    Johansson, Ann-Christin
    Mälardalen University, School of Health, Care and Social Welfare.
    Postoperativ rehabilitering vid ländryggsdiskbråck2011In: Fysioterapi, ISSN 1653-5804, no 1, p. 32-37Article in journal (Other academic)
    Abstract [sv]

    Bakgrund och syfte:Under 2008 har en grupp sjukgymnaster tagit fram nationella behandlingsriktlinjer för patienter som genomgått diskbråcksoperation. Syftet var att dessa skulle baseras på vetenskaplig evidens och klinisk erfarenhet.Metoder:Litteratursökning gjordes i sju olika databaser, sökningen omfattade randomiserade, kontrollerade studier under tidsperioden 1990-2008. Inkluderade studier granskades utifrån ett modifierat kvalitetsindex enligt SBU (Statens Beredning för medicinsk Utvärdering). För bevisvärdering av studieresultat användes SBU:s gradering högt, medelhögt och lågt bevisvärde. Evidensgrad för olika sjukgymnastiska metoder som förekom i de inkluderade studierna kategoriserades i enlighet med SBU:s nivåer för vetenskaplig evidens; starkt vetenskapligt underlag, måttligt starkt vetenskapligt underlag, begränsat vetenskapligt underlag och otillräckligt vetenskapligt underlag. Resultat:Sexton artiklar som uppfyllde kriterierna för granskning inkluderades i granskningen.Baserat på dessa studier finns måttligt stark evidens för att aktiv träning som inkluderar ett mer aktivt förhållningssätt är mer effektiv på kort sikt än mer försiktig/passiv träning och förhållningssätt (< 6 månader efter operation). Det finns ett starkt vetenskapligt stöd för att den aktiva träningen inte påverkar smärta och funktion på lång sikt (ett år efter operation), liksom att tidig, aktiv träning inte ökar komplikationsrisken efter operation. Det vetenskapliga stödet är begränsat vad gäller de positiva effekterna av enbart råd om fysisk aktivitet, motsägande beträffande effekten av övervakad träning jämfört med hemträning och otillräckligt beträffande effekten av beteendemedicinskt inriktad träning.Konklusion:Sjukgymnastiken efter diskbråcksoperation bör ha ett aktivt förhållningssätt inkluderande tidig, aktiv träning för att förbättra patienternas ryggfunktion och höja aktivitetsgraden efter operation.

  • 3.
    Rahme, Hans
    et al.
    University Hospital, Uppsala, Sweden.
    Vikerfors, Ola
    Central Hospital, Västerås, Sweden.
    Ludvigsson, Lena
    Central Hospital, Västerås, Sweden.
    Elvén, Maria
    Central Hospital, Västerås, Sweden.
    Michaëlsson, K
    University Hospital, Uppsala, Sweden.
    Loss of external rotation after opern Bankart repair: an important prognostic factor for patient satisfaction2010In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 18, p. 404-408Article in journal (Refereed)
    Abstract [en]

    The repair of the capsuloligamentous complex during shoulder stabilisation procedures can be followed by a persistent restricted capacity of external rotation. The prognostic importance of this loss in external rotation for patient satisfaction has not previously been evaluated. We therefore followed 68 consecutive patients operated for recurrent traumatic unidirectional anterior instability of the glenohumeral joint to assess the association between loss of external rotation and patient satisfaction. All patients underwent open Bankart repair. Two independent observers carried out a follow-up (5 years on average) after surgery. At follow-up, recurrent dislocation had developed in four of the 68 patients (6%). The median pre-operative Rowe score was 65 (range 42-87), which can be compared with 92 (range 46-100) at the follow-up. Three patients rated their outcome as poor, 13 as fair, 23 as good and 29 as excellent. There was a five-fold increased risk for a poor or fair outcome among patients with loss of external rotation in 0° of abduction (age- and gender-adjusted odds ratio [OR] 5.3; 95% confidence interval [CI] 1.3-22.0, P = 0.0007). A linear association between the degree of loss in external rotation and patient dissatisfaction was found. The risk of being dissatisfied, independent of recurrent dislocation, occasional pain, positive apprehension test, age and gender, more than doubled (OR 2.6; 95% CI 1.4-4.8, P = 0.002) for every 10° of post-operative loss of external rotation. Loss of external rotation almost explained all of the variation in patient satisfaction with a population attributable risk of 0.85 (95% CI 0.20-0.94). We conclude that open Bankart repair with a modified Rowe procedure is an excellent surgical option regarding stability, but restriction in external rotation reduces the likelihood of a satisfied patient.

  • 4.
    Stenvall, M.
    et al.
    Umeå University, Sweden.
    Elinge, E.
    Umeå University, Sweden.
    von Heideken Wågert, Petra
    Umeå University, Sweden.
    Lundström, M.
    Umeå University, Sweden.
    Gustafson, Y.
    Umeå University, Sweden.
    Nyberg, L.
    Umeå University, Sweden.
    Having had a hip fracture – association with dependency among the oldest old2005In: Age and ageing, ISSN 0002-0729, Vol. 34, no 3, p. 294-297Article in journal (Refereed)
1 - 4 of 4
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