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  • 1.
    Blauwet, Cheri A.
    et al.
    Medical Committee, International Paralympic Committee, Bonn, Germany; and Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Derman, Wayne
    Medical Committee, International Paralympic Committee, Bonn, Germany; Institute for Sport and Exercise Medicine, Division of Orthopaedics, Stellenbosch University, South Africa; and International Olympic Committee (IOC) Research Centre, South Africa.
    Idrisova, Guzel
    Medical Committee, International Paralympic Committee, Bonn, Germany; and Lesgaft National State University of Physical Education, Sport and Health, St. Petersburg, Russia; National Paralympic Committee of Russia, Moscow, Russia.
    Kissick, James
    Medical Committee, International Paralympic Committee, Bonn, Germany; and Department of Family Medicine, University of Ottawa, Ottawa, Canada; Carleton University Sport Medicine Clinic, Ottawa, Canada.
    Stomphorst, Jaap
    Medical Committee, International Paralympic Committee, Bonn, Germany; and Sports Medicine Department, Isala Klinieken, Zwolle, The Netherlands.
    Wosornu, Yetsa Tuakli
    Medical Committee, International Paralympic Committee, Bonn, Germany; and Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
    Vliet, Peter van der
    Medical Committee and Medical and Scientific Department, International Paralympic Committee, Bonn.
    Webborn, Nick
    Medical Committee, International Paralympic Committee, Bonn, Germany; and School of Sport and Service Management, University of Brighton, East Sussex, United Kingdom.
    The Road to Rio: Medical and Scientific Perspectives on the 2016 Paralympic Games2016Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 8, nr 8, s. 798-801Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In August and September of this year, the world will turn its attention to Rio de Janeiro, Brazil, for the 2016 Summer Olympic and Paralympic Games. Of interest to physiatrists, the Paralympic Games will take place from September 7 to 18, with an estimated total of 4 billion viewers. In the United States, for the first time in history, the Summer Games will be broadcast over a total of 66 hours on NBCUniversal. The Paralympic Games represent the pinnacle of elite sport for athletes with disabilities while also changing perceptions around the importance of grassroots sport and physical activity opportunities for the disability community more broadly.It is no secret that the planning and preparation for the Rio Games has brought with it a number of challenges—the Zika virus, water quality, construction delays, and the oft-tenuous state of the Brazilian political system, to name a few. In some respects, these challenges are important as they stimulate discourse about the future of the Olympic and Paralympic Movement. In Paralympic sport, some of our current and most salient challenges are rooted in principles of sports medicine and science, as outlined herein. Because it is imperative to uphold the highest standards of athlete health and safety at the Games, this presents an unparalleled opportunity for the voice of physiatrists to come to the fore. As experts in disability and functional performance, neurologic and musculoskeletal rehabilitation, and sports medicine, we uniquely are suited to make an important and timely impact on Paralympic sport. Here, we provide a snapshot of what to watch out for in Rio.

  • 2.
    Brogårdh, Christina
    et al.
    Lund University Hospital, Skåne University Hospital, Lund, Institutionen för hälsa, vård och samhälle, Lunds universitet, Department of Health Sciences, Lund University, Department of Rehabilitation Medicine, Skåne University Hospital.
    Flansbjer, Ulla-Britt
    Lunds universitet, Lund University, Department of Rehabilitation Medicine, Skåne University Hospital.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Determinants of falls and fear of falling in ambulatory persons with late effects of polio2017Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 9, nr 5, s. 455-463Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BackgroundFalls and fear of falling (FOF) are common in persons with late effects of polio but there is limited knowledge of associated factors.ObjectiveTo determine how knee muscle strength, dynamic balance and gait performance (adjusted for gender, age and BMI) are associated with falls and FOF in persons with late effects of polio.DesignA cross-sectional study.SettingA university hospital outpatient clinic.ParticipantsEighty-one ambulatory persons with verified late effects of polio (43 men; mean age 67 years).Main Outcome MeasurementsNumber of falls the past year, Falls Efficacy Scale –International (FES-I) to assess FOF, a Biodex dynamometer to measure knee muscle strength, the Timed Up and Go (TUG) test to assess dynamic balance and the Six Minute Walk test (6MWT) to assess gait performance. Univariate and multivariate logistic regression analyses were used for falls (categorical data) and linear regression analyses for FOF (continuous data) as dependent variables.ResultsFifty-nine % reported at least one fall during the past year and 79% experienced FOF. Reduced knee muscle strength in the more affected limb and gait performance were determinants of falls. An increase of 10 Nm in knee flexor and knee extensor strength reduced the OR between 0.70 and 0.83 (P=.01), and an increase of 100 meter in 6MWT reduced the OR to 0.41 (P=.001). All factors were determinants of FOF; reduced knee muscle strength in the more and less affected limbs explained 17% to 25% of the variance in FOF, dynamic balance 30% and gait performance 41%. Gender, age and BMI only marginally influenced the results.ConclusionsReduced gait performance, knee muscle strength and dynamic balance are to a varying degree determinants of falls and FOF in ambulatory persons with late effects of polio. Future studies need to evaluate if rehabilitation programs targeting these factors can reduce falls and FOF in this population. 

  • 3.
    Brogårdh, Christina
    et al.
    Lund University Hospital, Skåne University Hospital, Lund, Institutionen för hälsa, vård och samhälle, Lunds universitet, Department of Health Sciences, Lund University, Department of Rehabilitation Medicine, Skåne University Hospital.
    Flansbjer, Ulla-Britt
    Lunds universitet, Lund University, Department of Rehabilitation Medicine, Skåne University Hospital, Department of Health Sciences, Lund University.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Muscle Weakness and Perceived Disability of Upper Limbs in Persons With Late Effects of Polio2016Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 8, nr 9, s. 825-832Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Muscle weakness in one or both upper limbs is common in persons with previous polio, but there is very limited knowledge how it influences daily life. Objective: To assess muscle weakness and self-perceived disability of the upper limbs in persons with late effects of polio and evaluate their association. Design: Cross-sectional study. Settings: University hospital outpatient clinic. Participants: Twenty-eight persons (mean age 67, SD 16 years) with late effects of polio in their upper limbs. Main Outcome Measures: A fixed dynamometer (Biodex System 3 PRO dynamometer (Biodex Medical Systems Inc., Shirley, NY) was used to measure isometric shoulder abduction and elbow flexion, as well as isokinetic concentric elbow flexion and extension. A hand-held dynamometer (Grippit, Hägersten, Sweden) was used to measure isometric grip strength. The Disabilities of Arm, Shoulder and Hand (DASH) questionnaire was used to assess self-perceived disability of the upper limbs. The relationships between the measures were analyzed with the Spearman rank correlation coefficients (rho). Results: The participants were 20%-31% weaker in their more-affected upper limb compared with their less-affected limb. The DASH score was on average 33.5 (SD 18.6), indicating a mild-to-moderate disability of their upper limbs. Changing a lightbulb overhead, carrying a heavy object, and performing recreational activities that required muscle force with the arms were perceived as most difficult. The correlations (rho) between the muscle strength measurements and DASH scores ranged from -0.46 (95% confidence interval [95% CI] -0.10 to -0.71) to -0.61 (95% CI -0.31 to -0.80) for the more affected upper limb, and from -0.54 (95% CI -0.21 to -0.76) to -0.68 (95% CI -0.41 to -0.84) for the less affected upper limb (P < .05-.01). Conclusions: Persons with previous polio and muscle weakness in their upper limbs perceive difficulties to use their arms in daily life, especially when performing activities above their head and strenuous household or leisure activities. The fair-to-moderate correlations of muscle strength with self-perceived disability imply that the weakness can only partially explain the perceived disabilities of arm, shoulder and hand. Other factors are therefore important to consider in the rehabilitation of persons with late effects of polio and upper limb disability. © 2016 American Academy of Physical Medicine and Rehabilitation.

  • 4.
    Brogårdh, Christina
    et al.
    Department of Health Sciences, Lund University.
    flansbjer, Ulla-Britt
    Department of Health Sciences, Lund University.
    Lexell, Jan
    Self-reported walking ability in persons with chronic stroke and the relationship with gait performance tests2012Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 4, nr 10, s. 734-738Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To assess self-reported walking ability in individuals with chronic stroke and to determine the relationship with gait performance tests. Design: Descriptive analysis of a convenience sample. Setting: A university hospital rehabilitation medicine clinic. Participants: Fifty ambulatory community-dwelling poststroke individuals (mean age, 64 years [range, 44-74 years] and mean time since stroke onset 42 months [range, 6-101 months]). Main Outcome Measures: The Walking Impact Scale (the Walk-12) to assess self-reported walking ability, and the Timed "Up & Go" test, 10-m Comfortable Gait Speed and Fast Gait Speed tests, and 6-Minute Walk Test to assess gait performance. Results: A majority of the participants (94%) reported limitations in their walking ability. The most common limitations were related to standing or walking, walking speed and distance, effort, and gait quality aspects. The ability to run was reported as most affected, whereas the need for support indoors or outdoors was least affected. Significant correlations (. P < .01) were found between the Walk-12 and the 4 gait performance tests (ρ = -0.60 to 0.60). Conclusions: Persons with chronic stroke perceive limitations in their walking ability. The relationship between the Walk-12 and the 4 gait performance tests indicates that self-reports and quantitative assessments are associated. Because the Walk-12 reflects broader dimensions than the gait performance tests, it can be a complementary tool when walking ability in persons with chronic stroke is evaluated.

  • 5.
    Brogårdh, Christina
    et al.
    Department of Rehabilitation Medicine, Skåne University Hospital.
    Lexell, Jan
    Effects of cardiorespiratory fitness and muscle-resistance training after stroke2012Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 4, nr 11, s. 901-907Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Stroke is a leading cause of long-term disability. The physical and cognitive impairments after an ischemic or hemorrhagic stroke often lead to activity limitations and participation restrictions. Many persons after stroke have a sedentary lifestyle, are physically inactive, and have a low fitness level. Physical fitness training is known to be beneficial for persons with a number of comorbid conditions or risk factors for stroke. Although exercise and physical activity are considered valuable, the evidence of their benefits after stroke is still insufficient. In this review, we summarize published randomized controlled trials regarding the effects of cardiorespiratory fitness and muscle-resistance training after stroke on physical function, activity, participation, life satisfaction, and mood. We discuss various barriers that can impede the ability to perform exercise, and the importance of reducing these barriers to increase physical fitness levels after the completion of usual stroke rehabilitation, thereby enhancing leisure, well-being, and participation in society

  • 6.
    Brogårdh, Christina
    et al.
    Department of Health Sciences, Lund University.
    Lexell, Jan
    Lundgren-Nilsson, Åsa
    Rehabilitation Medicine, Sahlgrenska Academy at Göteborg University.
    Construct Validity of a New Rating Scale for Self-Reported Impairments in Persons With Late Effects of Polio2013Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To evaluate the construct validity of a new rating scale for self-reported impairments in persons with late effects of polio. Design: Psychometric analysis of data on self-perceived impairments in persons with prior polio. Participants: Two hundred and seventy-three persons with prior polio (119 men and 154 women; mean age, 63.5 years). Method: Rasch analysis of a 13-item rating scale with 5 response categories, in which the participants rated how much they have been bothered by various post-polio-related impairments during the past 2 weeks. Results: The initial analysis showed disordered categories, misfit with some of the items, multidimensionality, and local dependency. After adjustment of the categories, which resulted in a 4-category rating scale, fit to the model was achieved, but the scale still showed signs of multidimensionality. Analyses of local dependency revealed correlations among some of the items, which resulted in a 5 testlet solution, which gave fit to the model and unidimensionality. Conclusion: After adjustment of the categories and local dependency, this new rating scale, Self-Reported Impairments in Persons With Late Effects of Polio, can be considered as unidimensional. The good psychometric properties implies that the Self-Reported Impairments in Persons With Late Effects of Polio scale could be a useful rating scale that would increase our understanding of the impairments that persons with late effects of polio can experience. With further refinements, this scale may assist in the planning and evaluation of appropriate rehabilitation interventions.

  • 7.
    Ekstrand, Elisabeth
    et al.
    Department of Health Sciences, Lund University.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Brogårdh, Christina
    Lund University Hospital, Skåne University Hospital, Lund, Institutionen för hälsa, vård och samhälle, Lunds universitet, Department of Health Sciences, Lund University, Department of Rehabilitation Medicine, Skåne University Hospital.
    Test-Retest Reliability and Convergent Validity of Three Manual Dexterity Measures in Persons With Chronic Stroke2016Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 8, nr 10, s. 935-943Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Decreased manual dexterity is common in persons after stroke. Different measures are used to assess manual dexterity, but a lack of knowledge exists about their reliability and how they are related. Objective: To evaluate the test-retest reliability and convergent validity of 3 manual dexterity measures after stroke. Design: A test-retest design. Setting: University Hospital. Participants: Forty-five persons (mean age 65 years) with mild-to-moderate impairments in the upper extremity at least 6 months after stroke. Main Outcome Measures: Manual dexterity was assessed on 2 occasions, 1 week apart using the Box and Block Test (BBT), the Nine-Hole Peg Test (NHPT), and the modified Sollerman Hand Function Test (mSHFT). The reliability of the BBT and NHPT was evaluated with the intraclass correlation coefficient together with systematic and random measurement errors. Reliability of the mSHFT was evaluated with the Kappa coefficient and the Svensson rank-invariant method (percent agreement and systematic and random disagreements). Convergent validity of the total scores was evaluated with the Spearman rank correlation coefficients (rho). Results: The intraclass correlation coefficient for the BBT and the NHPT ranged from 0.83 to 0.99. Significant systematic measurement errors were found for both tests and hands. The Kappa coefficient for the total sum score of the mSHFT was 0.95 for the more affected hand and 0.59 for the less affected hand. One of the 3 items showed systematic disagreements for both hands. The convergent validity (rho) for the more affected hand ranged from 0.41 (BBT versus mSHFT) to -0.68 (NHPT versus mSHFT). Conclusion: The test-retest reliability of the BBT, NHPT and mSHFT was high but all measures showed learning effects. The relationships between the 3 measures indicate that they partly complement one another. The BBT may be preferred for persons with moderate impairments of the upper extremity and the NHPT and the mSHFT for persons with milder impairments. As the mSHFT has the advantage of reflecting activities in daily life it may be a suitable alternative to the NHPT.

  • 8.
    Flansbjer, Ulla-Britt
    et al.
    Department of Clinical Sciences, Division of Rehabilitation Medicine, Lund university.
    Lexell, Jan
    Reliability of Gait Performance Tests in Individuals With Late Effects of Polio2010Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 2, nr 2, s. 125-131, 167Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    To assess the reliability of 4 gait performance tests in individuals with late effects of polio. DESIGN: An intrarater (between occasions) test-retest reliability study. SETTINGS: University hospital. PARTICIPANTS: Thirty men and women (mean age 63 +/- 6.4 years) with clinically and electrophysiologically verified late effects of polio. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: The Timed "Up & Go" test, the Comfortable and the Fast Gait Speed tests, and the 6-Minute Walk test were assessed 7 days apart. Reliability was evaluated with the intraclass correlation coefficient (ICC(2,1)), the mean difference between the test sessions (d), and the 95% confidence intervals for d, the standard error of measurement (SEM and SEM%), the smallest real difference (SRD and SRD%) and the Bland & Altman graphs. RESULTS: Test-retest agreements were high (ICC(2,1) 0.82-0.97) and measurement errors generally small. The standard error of measurement (SEM%), representing the smallest change that indicates a real (clinical) improvement for a group of individuals, was small (4%-7%). The smallest real difference (SRD%), representing the smallest change that indicates a real (clinical) improvement for a single individual also was small (12%-21%). CONCLUSION: These commonly used gait performance tests are highly reliable and can be recommended to evaluate improvements in various aspects of gait performance in groups of individuals as well as single individuals with late effects of polio.

  • 9.
    Jörgensen, Sophie
    et al.
    Department of Health Sciences, PO Box 157, Lund University.
    Iwarsson, Susanne
    Department of Health Sciences, Lund University.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering. Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University.
    Secondary health conditions, activity limitations, and life satisfaction in older adults with long-term spinal cord injury2017Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 9, nr 4, s. 356-366Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Many individuals with a spinal cord injury (SCI) have lived several decades with their injury, leading to a need for a deeper understanding of factors associated with healthy aging in people with long-term SCI.

    Objectives

    To (1) describe secondary health conditions, activity limitations, and life satisfaction in older adults with long-term SCI, and to (2) investigate how sociodemographics, injury characteristics, and secondary health conditions are associated with their activity limitations and life satisfaction.

    Design

    Cross-sectional descriptive cohort study.

    Setting

    Home and community settings.

    Participants

    A total of 123 individuals (71% men, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D), mean age 63 years, mean time since injury 24 years.

    Methods

    Baseline data as part of the Swedish Aging with Spinal Cord Injury Study. Associations between variables were investigated with multivariable linear regression analyses.

    Main Outcome Measurements

    Bowel and bladder function, nociceptive and neuropathic pain, spasticity, the Spinal Cord Independence Measure, third version, and the Satisfaction With Life Scale.

    Results

    Bowel-related and bladder-related problems were reported by 32% and 44%, respectively, 66% reported moderate or severe nociceptive and/or neuropathic pain, and 44% reported spasticity. Activity limitations were moderate (mean Spinal Cord Independence Measure, third version, total score 65.2, range 8-100) where injury characteristics and spasticity explained 68% of the variance. Higher level and more severe SCI (based on the American Spinal Injury Association Impairment Scale) exhibited the strongest association with more activity limitations. Life satisfaction was rated just above the midpoint between satisfied and dissatisfied with life (mean Satisfaction With Life Scale total score 20.7, range 6-34). Marital status, vocational situation, bladder function and injury characteristics explained 38% of the variance, where having a partner showed the strongest association with greater life satisfaction. Activity limitations and life satisfaction were not associated with gender, age and time since injury.

    Conclusion

    Older adults with long-term SCI can maintain a relatively high level of physical independence and generally are satisfied with their lives, regardless of gender, age or time since injury. The associations demonstrate the importance of injury characteristics for the performance of daily activities and the social context for life satisfaction in older adults with long-term SCI.

    Level of Evidence

    III

  • 10.
    Laskowski, Edward R.
    et al.
    Mayo Clinic Sports Medicine Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic.
    Lexell, Jan
    Exercise and sports for health promotion, disease, and disability2012Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 4, nr 11, s. 795-796Artikkel i tidsskrift (Fagfellevurdert)
  • 11. Lexell, Jan
    What's on the Horizon: Defining Physiatry Through Rehabilitation Methodology2012Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 4, nr 5, s. 331-334Artikkel i tidsskrift (Annet vitenskapelig)
  • 12.
    Lindgren, Ingrid
    et al.
    Department of Neurology, Skåne University Hospital and Department of Health Sciences, Lund University.
    Lexell, Jan
    Jonsson, Ann Cathrin
    Department of Health Sciences, Lund University.
    Brogårdh, Christina
    Department of Rehabilitation Medicine, Skåne University Hospital.
    Left-Sided Hemiparesis, Pain Frequency, and Decreased Passive Shoulder Range of Abduction Are Predictors of Long-Lasting Poststroke Shoulder Pain2012Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 4, nr 8, s. 561-568Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To determine the proportion of persons with poststroke shoulder pain 4 months after onset of the stroke in whom long-lasting shoulder pain develops and to assess the extent to which age, side of paresis at stroke onset, pain frequency and pain intensity, passive shoulder range of motion, resistance to passive movements, motor function, and subluxation at 4 months after stroke predict shoulder pain 1 year later. Design: A prospective study. Setting: A university hospital outpatient clinical setting. Participants: Fifty-eight men and women with their first-ever stroke (mean age, 71 years) and affected sensory-motor function in the upper extremity at stroke onset who all reported shoulder pain in the affected side 4 months after onset of the stroke. Methods: At 4 and 16 months after having a stroke, the participants rated their selfperceived shoulder pain (frequency and intensity). Passive range of shoulder abduction and external rotation, resistance to passive movements in the elbow, and motor function in the shoulder were assessed by a physical therapist. Main Outcome Measurements: A question about pain frequency (constant, often, or occasional), the Visual Analogue Scale for Pain for self-perceived shoulder pain intensity, a goniometer for range of motion, the Modified Ashworth Scale for resistance to passive movements, and the Motor Assessment Scale for motor function. Results: Of the 58 participants who had shoulder pain 4 months after having a stroke, 42 (72%) still had pain at 16 months. The logistic regression indicated an association between shoulder pain at 16 months and left-sided hemiparesis at stroke onset (P= .01; odds ratio [OR] 10.47; 95% confidence interval [CI] 1.92-57.05), pain frequency (P = .02; OR 6.85; 95% CI 1.46-32.14), decreased passive abduction at 4 months (P = .05; OR 4.46; 95% CI 0.99-20.10), and age (P = .07; OR 1.05; 95% CI 1.0-1.12). Conclusions: A high proportion of persons with shoulder pain 4 months after having a stroke are at risk of having persistent shoulder pain 1 year later. Left-sided hemiparesis, pain reported frequently, and decreased passive shoulder range of abduction at 4 months are predictors of long-lasting poststroke shoulder pain and require increased attention in the rehabilitation setting.

  • 13.
    Persson, Elisabeth
    et al.
    Department of Health Sciences, Lund University; and Department of Rehabilitation Medicine, Skane University Hospital.
    Lexell, Jan
    Eklund, Mona
    Department of Health Sciences, Lund University.
    Rivano-Fischer, Marcelo
    Department of Health Sciences, Lund University; and Department of Rehabilitation Medicine, Skane University Hospital.
    Positive Effects of a Musculoskeletal Pain Rehabilitation Program Regardless of Pain Duration or Diagnosis2012Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 4, nr 5, s. 355-366Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To investigate how sociodemographic and clinical factors are associated with psychosocial functioning and disability at admission to a musculoskeletal pain rehabilitation program and at 1-year follow-up. Design: A cohort pre-post study. Setting: A University hospital specialized pain rehabilitation unit. Participants: Five hundred nine participants with musculoskeletal pain (neck disorders, 29%; fibromyalgia, 24%; low back pain, 24%; myalgia, 14%; and other pain diagnoses, 8%). Intervention: A 5-week outpatient, group-based, and goal-oriented comprehensive musculoskeletal interdisciplinary pain rehabilitation program based on cognitive behavioral principles. Main Outcome Measures: The Multidimensional Pain Inventory (MPI), the Disability Rating Index (DRI), and forms including sociodemographic factors (gender, age, ethnicity, marital status, educational level, and vocational situation) and clinical factors (pain duration and pain diagnoses). Data were analyzed with multivariate logistic regression. Results: At admission, factors associated with more positive scores on the MPI were being older than 40 years, being at work, being Nordic born, attainment of a higher educational level, and a diagnosis of fibromyalgia (compared with a neck disorder) (. P < .05). Being at work and a diagnosis of fibromyalgia (compared with low back pain) were associated with more positive scores on the DRI (. P < .05). On the basis of cut points for clinically important change on the MPI, participants rated themselves as most improved on the Affective Distress (52%), Life Control (49%), and Pain Severity (43%) subscales, and on the DRI index, the improvement rate was 22%. At the 1-year follow-up, neither sociodemographic nor clinical factors were associated with clinically important improvements of the MPI and the DRI, but younger age was related to deteriorations in pain severity. Conclusions: The lack of an association between sociodemographic and clinical factors and psychosocial functioning and disability at a 1-year follow-up after a musculoskeletal pain rehabilitation program suggests that the program was effective regardless of the participants' initial characteristics, except for age. The changes at the 1-year follow-up indicate that the program influenced the participants' psychosocial functioning more than their perception of disability.

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