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Berglund, L., Aasa, B., Michaelson, P. & Aasa, U. (2018). Sagittal lumbo-pelvic alignment in patients with low back pain and the effects of a high-load lifting exercise and individualized low-load motor control exercises: a randomized controlled trial (ed.). The spine journal, 18(3), 399-406
Open this publication in new window or tab >>Sagittal lumbo-pelvic alignment in patients with low back pain and the effects of a high-load lifting exercise and individualized low-load motor control exercises: a randomized controlled trial
2018 (English)In: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632, Vol. 18, no 3, p. 399-406Article in journal (Refereed) Published
Abstract [en]

Background Context

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

Purpose

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

Study Design

This study is a secondary analysis of a randomized controlled trial evaluating the effects of HLL and LMC.

Patient Sample

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

Outcome measures

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

Methods

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

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

This study was supported by two grants from Visare Norr (12000 US dollars) and Norrbotten County Council (13000 US dollars). The supporting organizations were not involved in the collection of data, analysis, interpretation or drafting of the manuscript.

Results

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

Conclusions

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

Place, publisher, year, edition, pages
Elsevier, 2018
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:ltu:diva-60947 (URN)10.1016/j.spinee.2017.07.178 (DOI)000427617300003 ()28757287 (PubMedID)
Note

Validerad;2018;Nivå 2;2018-03-16 (andbra)

Available from: 2016-12-06 Created: 2016-12-06 Last updated: 2018-04-06Bibliographically approved
Calner, T., Nordin, C., Eriksson, M. K., Nyberg, L., Gard, G. & Michaelson, P. (2017). Effects of a self-guided, web-based activity programme for patients with persistent musculoskeletal pain in primary healthcare: A randomized controlled trial (ed.). European Journal of Pain, 21(6), 1110-1120
Open this publication in new window or tab >>Effects of a self-guided, web-based activity programme for patients with persistent musculoskeletal pain in primary healthcare: A randomized controlled trial
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2017 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 21, no 6, p. 1110-1120Article in journal (Refereed) Published
Abstract [en]

BACKGROUNDWeb-based interventions for pain management are increasingly used with possible benefits, but never used in addition to multimodal rehabilitation (MMR). MMR is recommended treatment for persistent pain in Sweden. The aim was to evaluate the effects of a self-guided, web-based programme added to MMR for work ability, pain, disability and health-related quality of life.METHODSWe included 99 participants with persistent musculoskeletal pain in a randomized study with two intervention arms: (1) MMR and web-based intervention, and (2) MMR. Data was collected at baseline, 4 and 12 months. Outcome measures were work ability, working percentage, average pain intensity, pain-related disability, and health-related quality of life.RESULTSThere were no significant effects of adding the web-based intervention to MMR regarding any of the outcome variables.CONCLUSIONSThis trial provides no support for adding a self-guided, web-based activity programme to MMR for patients with persistent musculoskeletal pain.SIGNIFICANCEThe comprehensive self-guided, web-based programme for activity, Web-BCPA, added to multimodal treatment in primary health care had no effect on work ability, pain, disability or health-related quality of life. Future web-based interventions should be tailored to patients' individual needs and expectations

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:ltu:diva-60945 (URN)10.1002/ejp.1012 (DOI)000403249400015 ()28464364 (PubMedID)2-s2.0-85018759209 (Scopus ID)
Note

Validerad; 2017; Nivå 2; 2017-06-15 (inah)

Available from: 2016-12-06 Created: 2016-12-06 Last updated: 2018-09-13Bibliographically approved
Berglund, L., Aasa, B., Michaelson, P. & Aasa, U. (2017). Effects of low-load motor control exercises and a high-load lifting exercise on lumbar multifidus thickness: a randomized controlled trial (ed.). Spine, 42(15), E876-E882
Open this publication in new window or tab >>Effects of low-load motor control exercises and a high-load lifting exercise on lumbar multifidus thickness: a randomized controlled trial
2017 (English)In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 42, no 15, p. E876-E882Article in journal (Refereed) Published
Abstract [en]

STUDY DESIGN:Randomized controlled trial.

OBJECTIVE:

The aim of this study was to compare the effects of low-load motor control (LMC) exercises and a high-load lifting (HLL) exercise, on lumbar multifidus (LM) thickness on either side of the spine and whether the effects were affected by pain intensity or change in pain intensity.

SUMMARY OF BACKGROUND DATA:

There is evidence that patients with low back pain (LBP) may have a decreased size of the LM muscles with an asymmetry between sides in the lower back. It has also been shown that LMC training can affect this asymmetry. It is, however, not known whether a high-load exercise has the same effect.

METHODS:

Sixty-five participants diagnosed with nociceptive mechanical LBP were included and randomized into LMC exercises or a HLL exercise, the deadlift. The LM thickness was measured using rehabilitative ultrasound imaging (RUSI), at baseline and after a 2-month training period.

RESULTS:

There were no differences between interventions regarding effect on LM muscle thickness. However, the analysis showed a significant effect for asymmetry. The thickness of the LM muscle on the small side increased significantly compared with the large side in both intervention groups, without influence of pain at baseline, or change in pain intensity.

CONCLUSION:

At baseline, there was a difference in thickness of the LM muscles between sides. It seems that exercises focusing on spinal alignment may increase the thickness of the LM muscles on the small side, irrespective of exercise load. The increase in LM thickness does not appear to be mediated by either current pain intensity or the magnitude of change in pain intensity.

Place, publisher, year, edition, pages
Wolters Kluwer, 2017
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:ltu:diva-60433 (URN)10.1097/BRS.0000000000001989 (DOI)000406277300001 ()27870804 (PubMedID)2-s2.0-84996721427 (Scopus ID)
Note

Validerad;2017;Nivå 2;2017-08-10 (rokbeg)

Available from: 2016-11-15 Created: 2016-11-15 Last updated: 2018-07-10Bibliographically approved
Calner, T., Isaksson, G. & Michaelson, P. (2017). I know what I want but I’m not sure how to get it: expectations of physiotherapy treatment of persons with persistent pain (ed.). Physiotherapy Theory and Practice, 33(3), 198-205
Open this publication in new window or tab >>I know what I want but I’m not sure how to get it: expectations of physiotherapy treatment of persons with persistent pain
2017 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 33, no 3, p. 198-205Article in journal (Refereed) Published
Abstract [en]

Expectations of physiotherapy treatment of patients with persistent pain have been shown to influence treatment outcome and patient satisfaction, yet this is mostly explored and described in retrospective. The aim of the study was to explore and describe the expectations people with persistent pain have prior to physiotherapy treatment. Ten participants with persistent musculoskeletal pain from the back, neck, or shoulders were included in the study. Data were collected by interviews using a semi-structured interview guide and were analyzed with qualitative content analysis. The analysis resulted in one main category: “The multifaceted picture of expectations” and four categories: 1) Standing in the doorway: curious and uncertain; 2) Looking for respect, confirmation and knowledge; 3) Expecting treatment, regular training, and follow up; and 4) Having dreams, being realistic, or feeling resigned. The main category and the categories describe a multifaceted picture of the participants’ expectations, gradually developed and eventually encompassing several aspects: good dialog and communication, the need to be confirmed as individuals, and getting an explanation for the pain. The results also show that the participants expected tailored training with frequent follow-ups and their expectations of outcome ranged from hope of the best possible results to realistic or resigned regarding pain relief and activity levels.

Place, publisher, year, edition, pages
Taylor & Francis, 2017
National Category
Physiotherapy Occupational Therapy
Research subject
Physiotherapy; Occupational therapy
Identifiers
urn:nbn:se:ltu:diva-60434 (URN)10.1080/09593985.2017.1283000 (DOI)000399482200003 ()28339337 (PubMedID)2-s2.0-85012914555 (Scopus ID)
Note

Validerad; 2017; Nivå 2; 2017-03-27 (rokbeg)

Available from: 2016-11-15 Created: 2016-11-15 Last updated: 2018-11-15Bibliographically approved
Nordin, C., Michaelson, P., Eriksson, M. K. & Gard, G. (2017). It's about me: patients’ Experiences of Patient Participation in the Web Behavior Change Program for Activity in Combination With Multimodal Pain Rehabilitation. Journal of Medical Internet Research, 19(1), 62-72, Article ID e22.
Open this publication in new window or tab >>It's about me: patients’ Experiences of Patient Participation in the Web Behavior Change Program for Activity in Combination With Multimodal Pain Rehabilitation
2017 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 19, no 1, p. 62-72, article id e22Article in journal (Refereed) Published
Abstract [en]

Background

Patients’ participation in their health care is recognized as a key component in high-quality health care. Persons with persistent pain are recommended treatments with a cognitive approach from a biopsychosocial explanation of pain, in which a patient’s active participation in their rehabilitation is in focus. Web-based interventions for pain management have the potential to increase patient participation by enabling persons to play a more active role in rehabilitation. However, little is known about patients’ experiences of patient participation in Web-based interventions in clinical practice.

Objective

The objective of our study was to explore patients’ experiences of patient participation in a Web Behavior Change Program for Activity (Web-BCPA) in combination with multimodal rehabilitation (MMR) among patients with persistent pain in primary health care.

Methods

Qualitative interviews were conducted with 15 women and 4 men, with a mean age of 45 years. Data were analyzed with qualitative content analysis.

Results

One theme, “It’s about me,” and 4 categories, “Take part in a flexible framework of own priority,” “Acquire knowledge and insights,” “Ways toward change,” and “Personal and environmental conditions influencing participation,” were developed. Patient participation was depicted as being confirmed in an individualized and structured rehabilitation framework of one’s own choice. Being confirmed was fundamental to patient participation in the interaction with the Web-BCPA and with the health care professionals in MMR. To acquire knowledge and insights about pain and their life situation, through self-reflection in the solitary work in the Web-BCPA and through feedback from the health care professionals in MMR, was experienced as patient participation by the participants. Patient participation was described as structured ways to reach their goals of behavior change, which included analyzing resources and restrictions, problem solving, and evaluation. The individual’s emotional and cognitive resources and restrictions, as well as health care professionals and significant others’ attitudes and behavior influenced patient participation in the rehabilitation. To some extent there were experiences of restrained patient participation through the great content of the Web-BCPA.

Conclusions

Patient participation was satisfactory in the Web-BCPA in combination with MMR. The combined treatment was experienced to increase patient participation in the rehabilitation. Being confirmed through self-identification and finding the content of the Web-BCPA trustworthy was emphasized. Patient participation was experienced as a learning process leading to new knowledge and insights. Higher user control regarding the timing of the Web-BCPA and therapist guidance of the content may further increase patient participation in the combined treatment.

National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:ltu:diva-60937 (URN)10.2196/jmir.5970 (DOI)000392330900005 ()28100440 (PubMedID)2-s2.0-85012895275 (Scopus ID)
Note

Validerad; 2017; Nivå 2; 2017-04-06 (rokbeg)

Available from: 2016-12-06 Created: 2016-12-06 Last updated: 2018-07-10Bibliographically approved
Åsenlöf, P., Michaelson, P., Grahn, B., Bergman, S., Axelson, S., Gyllenswärd, H. & Bergström, G. (2016). A systematic review of randomized controlled trials studying the preventive effects of physical exercise, manual and behavioural treatments in acute low back pain and neck pain. Paper presented at International Congress of Behavioral Medicine, Melbourne, 7-10 December 2016. International Journal of Behavioral Medicine, 23(Suppl. 1), S187
Open this publication in new window or tab >>A systematic review of randomized controlled trials studying the preventive effects of physical exercise, manual and behavioural treatments in acute low back pain and neck pain
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2016 (English)In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, no Suppl. 1, p. S187-Article in journal, Meeting abstract (Refereed) Published
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:ltu:diva-61363 (URN)10.1007/s12529-016-9586-3 (DOI)000388943400588 ()
Conference
International Congress of Behavioral Medicine, Melbourne, 7-10 December 2016
Available from: 2017-01-10 Created: 2017-01-10 Last updated: 2017-11-29Bibliographically approved
Michaelson, P., Holmberg, D., Aasa, B. & Aasa, U. (2016). Deadlift versus low load motor control for patients with mechanical low back pain (ed.). Paper presented at IFOMPT Conference : 04/07/2016 - 08/07/2016. Manual Therapy, 25, e78
Open this publication in new window or tab >>Deadlift versus low load motor control for patients with mechanical low back pain
2016 (English)In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 25, p. e78-Article in journal, Meeting abstract (Refereed) Published
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:ltu:diva-61276 (URN)10.1016/j.math.2016.05.126 (DOI)
Conference
IFOMPT Conference : 04/07/2016 - 08/07/2016
Note

Godkänd; 2016; 20160815 (andbra)

Available from: 2016-12-29 Created: 2016-12-29 Last updated: 2017-11-24Bibliographically approved
Nordin, C., Michaelson, P., Gard, G. & Eriksson, M. K. (2016). Effects of the Web Behavior Change Program for Activity and Multimodal Pain Rehabilitation: Randomized Controlled Trial. Journal of Medical Internet Research, 18(10), 24-41, Article ID 265.
Open this publication in new window or tab >>Effects of the Web Behavior Change Program for Activity and Multimodal Pain Rehabilitation: Randomized Controlled Trial
2016 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 18, no 10, p. 24-41, article id 265Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Web-based interventions with a focus on behavior change have been used for pain management, but studies of Web-based interventions integrated in clinical practice are lacking. To emphasize the development of cognitive skills and behavior, and to increase activity and self-care in rehabilitation, the Web Behavior Change Program for Activity (Web-BCPA) was developed and added to multimodal pain rehabilitation (MMR).

OBJECTIVE:

The objective of our study was to evaluate the effects of MMR in combination with the Web-BCPA compared with MMR among persons with persistent musculoskeletal pain in primary health care on pain intensity, self-efficacy, and copying, as part of a larger collection of data. Web-BCPA adherence and feasibility, as well as treatment satisfaction, were also investigated.

METHODS:

A total of 109 participants, mean age 43 (SD 11) years, with persistent pain in the back, neck, shoulder, and/or generalized pain were recruited to a randomized controlled trial with two intervention arms: (1) MMR+WEB (n=60) and (2) MMR (n=49). Participants in the MMR+WEB group self-guided through the eight modules of the Web-BCPA: pain, activity, behavior, stress and thoughts, sleep and negative thoughts, communication and self-esteem, solutions, and maintenance and progress. Data were collected with a questionnaire at baseline and at 4 and 12 months. Outcome measures were pain intensity (Visual Analog Scale), self-efficacy to control pain and to control other symptoms (Arthritis Self-Efficacy Scale), general self-efficacy (General Self-Efficacy Scale), and coping (two-item Coping Strategies Questionnaire; CSQ). Web-BCPA adherence was measured as minutes spent in the program. Satisfaction and Web-BCPA feasibility were assessed by a set of items.

RESULTS:

Of 109 participants, 99 received the allocated intervention (MMR+WEB: n=55; MMR: n=44); 88 of 99 (82%) completed the baseline and follow-up questionnaires. Intention-to-treat analyses were performed with a sample size of 99. The MMR+WEB intervention was effective over time (time*group) compared to MMR for the two-item CSQ catastrophizing subscale (P=.003), with an effect size of 0.61 (Cohen d) at 12 months. There were no significant between-group differences over time (time*group) regarding pain intensity, self-efficacy (pain, other symptoms, and general), or regarding six subscales of the two-item CSQ. Improvements over time (time) for the whole study group were found regarding mean (P<.001) and maximum (P=.002) pain intensity. The mean time spent in the Web-based program was 304 minutes (range 0-1142). Participants rated the items of Web-BCPA feasibility between 68/100 and 90/100. Participants in the MMR+WEB group were more satisfied with their MMR at 4 months (P<.001) and at 12 months (P=.003).

CONCLUSIONS:

Adding a self-guided Web-based intervention with a focus on behavioral change for activity to MMR can reduce catastrophizing and increase satisfaction with MMR. Patients in MMR may need more supportive coaching to increase adherence in the Web-BCPA to find it valuable.

National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:ltu:diva-59603 (URN)10.2196/jmir.5634 (DOI)000387985700002 ()27707686 (PubMedID)2-s2.0-84994475068 (Scopus ID)
Note

Validerad; 2016; Nivå 2; 2016-10-10 (andbra)

Available from: 2016-10-10 Created: 2016-10-10 Last updated: 2018-07-10Bibliographically approved
Michaelson, P., Holmberg, D., Aasa, B. & Aasa, U. (2016). 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-up (ed.). Journal of Rehabilitation Medicine, 48(5), 456-463
Open this publication in new window or tab >>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-up
2016 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 48, no 5, p. 456-463Article in journal (Refereed) Published
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

National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:ltu:diva-13271 (URN)10.2340/16501977-2091 (DOI)000375753300007 ()27097785 (PubMedID)2-s2.0-84964575172 (Scopus ID)c77c6615-68f7-4ba6-b634-f0b84c3f3c8f (Local ID)c77c6615-68f7-4ba6-b634-f0b84c3f3c8f (Archive number)c77c6615-68f7-4ba6-b634-f0b84c3f3c8f (OAI)
Note

Validerad; 2016; Nivå 2; 20160421 (andbra)

Available from: 2016-09-29 Created: 2016-09-29 Last updated: 2018-07-10Bibliographically approved
Calner, T., Isaksson, G. & Michaelson, P. (2016). “I know what I want but I’m not sure how to get it”: Expectations of physiotherapy treatment of persons with persistent pain (ed.). Paper presented at IFOMPT Conference : 04/07/2016 - 08/07/2016. Manual Therapy, 25, e142-e143
Open this publication in new window or tab >>“I know what I want but I’m not sure how to get it”: Expectations of physiotherapy treatment of persons with persistent pain
2016 (English)In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 25, p. e142-e143Article in journal, Meeting abstract (Refereed) Published
National Category
Physiotherapy Occupational Therapy
Research subject
Physiotherapy; Occupational therapy
Identifiers
urn:nbn:se:ltu:diva-30538 (URN)10.1016/j.math.2016.05.274 (DOI)46366356-e3cf-4b77-89ab-86ae8ff10f86 (Local ID)46366356-e3cf-4b77-89ab-86ae8ff10f86 (Archive number)46366356-e3cf-4b77-89ab-86ae8ff10f86 (OAI)
Conference
IFOMPT Conference : 04/07/2016 - 08/07/2016
Note

Godkänd; 2016; 20160815 (andbra)

Available from: 2016-09-30 Created: 2016-09-30 Last updated: 2018-02-01Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-0112-4657

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