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  • 1.
    Bring, Annika
    et al.
    Uppsala Universitet, Sweden.
    Åsenlöf, Pernilla
    Uppsala Universitet, Sweden.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    What is the comparative effectiveness of current standard treatment, against an individually tailored behavioural programme delivered either on the Internet or face-to-face for people with acute whiplash associated disorder?: A randomized controlled trial2016In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 30, no 5, p. 441-453Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the comparative effectiveness of current standard treatment, against an individually tailored behavioural programme delivered via the Internet or face-to-face for people with acute whiplash associated disorders.

    DESIGN: A multicentre, randomized, three-group design, with concealed allocation.

    SUBJECTS AND SETTINGS: A total of 55 participants (37 female), age 18-65, with acute Whiplash Associated Disorder (Grade I-II), recruited at two emergency clinics in Sweden.

    INTERVENTIONS: Before randomization all participants received standard self-care instructions. The Internet and face-to-face groups followed a seven-week behavioural programme involving individual tailoring, via email (Internet group), or in sessions at a physical therapy unit (face-to-face group). The control group only received the self-care instructions.

    MAIN MEASURES: Pain-related disability, pain intensity, self-efficacy in daily activities, catastrophizing and fear of movement/(re)injury. Assessments were performed at baseline (2-4 weeks postinjury) and at three, six and 12 months postintervention.

    RESULTS: Both the Internet (n = 16) and face-to-face (n = 14) group showed a larger decrease in pain-related disability than the control group (n = 16); -12 and -11, respectively, compared with -5 in the control group at 12-months follow-up. Significant differences between the groups in overall treatment effect were shown in all outcomes except pain intensity. All groups improved significantly over time in all outcomes, except for fear of movement/(re)injury and catastrophizing in the control group.

    CONCLUSION: An individually tailored behavioural programme improved biopsychosocial factors in patients with whiplash associated disorders up to 12 months after treatment. Internet-delivered intervention was as effective as clinic-based face-to-face therapy sessions.

  • 2.
    Emilson, C.
    et al.
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Demmelmaier, I.
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Bergman, S.
    Research and Development Center Spenshult, Halmstad, Sweden.
    Lindberg, P.
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Denison, Eva
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Åsenlöf, P.
    Department of Public Health, and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    A 10-year follow-up of tailored behavioural treatment and exercise-based physiotherapy for persistent musculoskeletal pain2017In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 31, no 2, p. 186-196Article in journal (Refereed)
    Abstract [en]

    Objective: To study the long-term outcomes of two interventions targeting patients with sub-acute and persistent pain in a primary care physiotherapy setting. Design: A 10-year follow-up of a two-armed randomised controlled trial, initially including 97 participants. Interventions: Tailored behavioural medicine treatment, applied in a physiotherapy context (experimental condition), and exercise-based physiotherapy (control condition). Main measures: Pain-related disability was the primary outcome. The maximum pain intensity, pain control, fear of movement, sickness-related absence (register data) and perceived benefit and confidence in coping with future pain problems were the secondary outcomes. Results: Forty-three (44%) participants responded to the follow-up survey, 20 in the tailored behavioural medicine treatment group and 23 in the exercise-based physiotherapy group. The groups did not differ in terms of the change in the scores for the primary outcome (p=0.17) of pain-related disability between the experimental group (median: 2.5, Q1-Q3: -2.5-14.25), and the control group (median: 0, Q1-Q3: -5-6). Further, there were also no significant differences found for the secondary outcomes except for sickness-related absence, where the exercise-based physiotherapy group had more days of sickness-related absence three months before treatment (p= 0.02), and at the 10-year follow-up (p=0.03). Discussion: The beneficial effects favouring tailored behavioural medicine treatment that observed post-treatment and at the two-year follow-up were not maintained 10 years after treatment.

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  • 3.
    Nilsagård, Y
    et al.
    Örebro universitet.
    Lundholm, C
    Karolinska Institutet.
    Denison, Eva
    Mälardalen University, School of Health, Care and Social Welfare.
    Gunnarsson, L-G
    Örebro universitetssjukhus.
    Predicting accidental falls in people with multiple sclerosis: a longitudinal study2009In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 23, no 3, p. 259-269Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate accidental falls and near fall incidents in people with multiple sclerosis with respect to clinical variables and the predictive values of four tests. Design: A longitudinal, multi-centred cohort study with prospectively collected falls. Procedures: Self-reported incidents during the three months following a standardized test procedure. Subjects: Seventy-six people with multiple sclerosis and an Expanded Disability Status Scale score between 3.5 and 6.0. Main outcome measures: Berg Balance Scale, Timed Up and Go cognitive, Four Square Step Test (FSST) and 12-item Multiple Sclerosis Walking Scale. Results: Forty-eight people (63%) registered 270 falls. Most falls occurred indoors during activities of daily life. We found a correlation of r(s) = 0.57 between near falls and falls, and of r(s) = 0.82 between registered and retrospectively recalled falls. Fallers and non-fallers differed significantly regarding Expanded Disability Status Score (odds ratio (OR) 1.99, 95% confidence interval (0) 1.22; 3.40), spasticity (OR 1.14, CI 1.02; 1.31), proprioception (OR 2.50, CI 1.36; 5.12) and use of walking aids (OR 2.27, Cl 1.23; 4.37). Reported use of walking aids both indoors and outdoors increased the odds of falling fivefold while disturbed proprioception increased the odds 2.5-15.6 times depending on severity. The odds of falling were doubled for each degree of increased Expanded Disability Status Score and more than doubled for each degree of increased spasticity. The Berg Balance Scale, use of walking aids and Timed Up and Go cognitive best identified fallers (73-94%) and proprioception, Expanded Disability Status Score, 12-item Multiple Sclerosis Walking Scale and Four Square Step Test best identified non-fallers (75-93%). Conclusions: In clinical practice, looking at the use of walking aids, investigating proprioception and spasticity, rating Expanded Disability Status Score and using Berg Balance Scale or Timed Up and Go cognitive all contribute when identifying fallers

  • 4.
    Rodby-Bousquet, Elisabet
    et al.
    Lund University.
    Augustson, Atli
    Rehabilitation Centre of Excellence, Kópavogur, Iceland.
    Jonsdottir, Gudny
    Rehabilitation Centre of Excellence, Kópavogur, Iceland.
    Czuba, Tomasz
    Lund university.
    Johansson, Ann-Christin
    Uppsala University.
    Hägglund, Gunnar
    Lund University, Skåne University Hospital, Lund, Sweden.
    Interrater reliability and construct validity of the posture and postural ability scale in adults with cerebral pulsy in supine, prone, siting and standing position2014In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 28, no 1, p. 82-90Article in journal (Other academic)
    Abstract [en]

    Objective To evaluate reliability, internal consistency and construct validity of the Posture and Postural Ability Scale for adults with cerebral palsy. Design Psychometric evaluation of a clinical assessment tool. Setting Rehabilitation Centres in Sweden and Iceland. Subjects Thirty adults with cerebral palsy aged 19-22 years, six people at each level I-V of the Gross Motor Function Classification System. Main measures The Posture and Postural Ability Scale contains a 7-point ordinal scale for postural ability in supine, prone, sitting, and standing and items for assessment of posture. Posture and postural ability was rated from photos and videos by three independent assessors. Interrater reliability was calculated using weighted Kappa. Internal consistency was analysed with Cronbach’s alpha if item deleted and corrected item-total correlation. Construct validity was evaluated based on known groups, using Jonckheere Terpstra for averaged values of the three raters relative to the Gross Motor Function Classification System. Results There was an excellent interrater reliability (kappa=0.85-0.99) and a high internal consistency (alpha=0.96-0.97, item-total correlation=0.60-0.91). Median values differed (p<0.02) between known groups represented by the levels of gross motor function, showing construct validity for all items. Conclusion The Posture and Postural Ability scale showed an excellent interrater reliability for experienced raters, a high internal consistency and construct validity. It can detect postural asymmetries in adults with cerebral palsy at all levels of gross motor function.

  • 5.
    Söderlund, Anne
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Lindberg, Per
    Uppsala University.
    Whiplash-associated disorders--predicting disability from a process-oriented perspective of coping2003In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 17, no 1, p. 101-107Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe the coping process over time for patients with whiplash-associated disorders (WAD). DESIGN: The study was conducted by following patients prospectively for 12 months. SETTINGS: The orthopaedic clinic at a university hospital. SUBJECTS: Fifty-three patients out of 59 had complete data-sets. MAIN OUTCOME MEASURES: Two measures were used: the Pain Disability Index (PDI) and the Coping Strategies Questionnaire (CSQ). RESULTS: The results showed that the proportion of variance in disability shared with coping increased over time. CONCLUSION: The importance of coping as an explanatory factor for disability increased during the one year follow-up. Thus, coping has a crucial role for disability. The possibility of a positive long-term outcome could therefore be improved by teaching patients to use active and adaptive coping strategies shortly after an accident.

  • 6.
    Söderlund, Anne
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Olerud, C
    Uppsala Science Park, Uppsala, Sweden.
    Lindberg, P
    Uppsala Science Park, Uppsala, Sweden.
    Acute whiplash-associated disorders (WAD): the effects of early mobilization and prognostic factors in long-term symptomatology.2000In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 14, no 5, p. 457-467Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To compare two different home exercise programmes for patients with acute whiplash-associated disorders (WAD). A further aim was to describe the initial prognostic variables related to self-reported pain at six months follow-up. DESIGN: A randomized treatment study with a follow-up period of six months. SETTINGS: The study was undertaken in an orthopaedic clinic at a university hospital. SUBJECTS: A total of 59 symptomatic (neck pain, stiffness, etc.) patients with acute whiplash injury. INTERVENTIONS: Patients were randomized to a regular treatment group (RT group) and an additional-exercise treatment group (AT group). MAIN OUTCOME MEASURES: Pain Disability Index (PDI), Self-Efficacy Scale (SES), Coping Strategies Questionnaire (CSQ), neck range of motion (ROM), head posture, kinaesthetic sensibility, visual analogue scale (VAS). RESULTS: Patients given an additional exercise did not improve more than patients with regular treatment. Only one CSQ item, 'Ability to decrease pain', showed a significant difference between the groups in its pattern of change over time: the AT group had a significant increase between three and six months whilst values in the RT group decreased. Nonsymptomatic patients at six months follow-up were characterized by initially better self-efficacy, lower disability and significantly different patterns in the use of 'behavioural coping strategies' when compared with symptomatic patients. The nonsymptomatic patients also reported more frequent training than symptomatic patients, i.e. they complied better with the treatment regime. CONCLUSION: This home exercise programme, including training of neck and shoulder ROM, relaxation and general advice seems to be sufficient treatment for acute WAD patients when used on a daily basis. Additionally, patients reporting low self-efficacy and high disability levels may profit from more attention initially, as these psychological factors are significant predictors of pain at long-term follow-up.

  • 7.
    Åsenlöf, Pernilla
    et al.
    Uppsala University, Uppsala, Sweden.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala University, Uppsala, Sweden.
    A further investigation of the importance of pain cognition and behaviour in pain rehabilitation: longitudinal data suggest disability and fear of movement are most important2010In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 24, no 5, p. 422-430Article in journal (Refereed)
    Abstract [en]

    Background: Tailored treatments are topical in pain rehabilitation. One key issue for correlational studies is the identification of factors having a potential causal impact on essential treatment outcomes.

    Objective: To study associations between pain beliefs and disability with regard to the amount and time-frame of available data.

    Design: A prospective, correlational design.

    Subjects and setting: Ninety-two patients consulting physical therapists in primary care for persistent musculoskeletal pain.

    Main measures: The Pain Disability Index, the Self-Efficacy Scale and the Tampa Scale of Kinesiophobia.

    Results: Functional self-efficacy and fear of movement/(re) injury explained variance in pain-related disability pretreatment (adj R(2) = 0.41). Self-efficacy was the most salient predictor. Adding data from immediately post treatment decreased explained variance (adj R(2) = 0.25). Functional self-efficacy and fear of movement/ (re)injury lost their significant contribution in favour of pain-related disability at baseline. Change scores in functional self-efficacy and fear of movement/(re) injury accounted for a modest share of explained variance in change scores of disability (adj R(2) = 0.11). Fear of movement/(re) injury but not functional self-efficacy was related to a reliable change in pain-related disability.

    Conclusions: Longitudinal data suggest that pretreatment levels of pain-related disability and changes in fear of movement/(re) injury are most important to immediate treatment outcomes and individual reliable change. Disability and elevated fear of movement/(re) injury should therefore be addressed in tailored pain treatments. A "

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