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  • 1.
    Aasa, Björn
    et al.
    Norrlandsklinikens hälsocentral, Umeå.
    Hellqvist, Jonas
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Berglund, Lars
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehab. peter.michaelson@ltu.se .
    Aasa, Ulrika
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    A characterisation of pain, disability, kinesiophobia and physical capacity in patients with predominantly peripherally mediated mechanical low back pain2011In: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 97, no Suppl. 1Article in journal (Refereed)
    Abstract [en]

    Purpose: The specific objectives were to: 1) describe the level of pain intensity, disability, activity limitation, kinesiophobia and physical capacity in patients with predominantly peripherally mediated mechanical back pain, and 2) investigate whether differences between these patients in physical and psychosocial factors can be distinguished when the patients are further sub-grouped.Relevance: To improve assessment among patients with chronic low back pain (CLBP) it is important to investigate the prevalence of physical and psychosocial features in homogenous sub-groups.Participants: Seventy-one patients with CLBP, 20-60 years old, with peripherally mediated mechanical pain at the the moment for the study, were included and each patient was sub-classified into one of five sub-groups based on their pain behaviour and functional movement pattern (flexion n=20, flexion/lateral shift, n=11, active extension n=23 , passive extension n=8, and multidirectional pattern n=9).Methods: Data on pain intensity (Visual Analogue Scale), disability (the Roland and Morris Questionnaire), activity limitation (the Patient Specific Functional Scale), kinesiophobia (the Tampa Scale of Kinesiophobia) and physical capacity (lifting capacity and trunk extensor endurance) was collected.Analysis: Mean and standard deviation for parametric and median and interquartile range for non-parametric data were used for descriptive statistics. One-way ANOVA for normally distributed data and Kruskal-Wallis for non-normally distributed data were used for analyses of differences between the sub-groups. The subjects were also divided into two age-groups (20-40 and 41-60 years) and measures of physical capacity were compared to women and men at the ages of 34 and 50, respectively, in the general Swedish population using one sample T-test.Results: The patients reported low to moderate pain intensity (3.1/10±2.4), disability (RMDQ (7.27/24 ±4.2) and kinesiophobia (33.4/68 ±7) and these levels were lower than reported levels in other studies including more heterogenous groups of patients with CLBP. The patiens reported activity limitations (PSFS 13/30±23). Lifting capacity and trunk extensor endurance were significantly lower than in the general population in the youngest age-group. No significant differences in pain intensity, disability, kinesiophobia or physical capacity were found between the sub-groups.Conclusions: This research highlights that patients with predominantly peripherally mediated mechanical back pain may differ from other sub-groups of patients with CLBP (e.g., patients with central sensitization as dominating pain mechanism) regarding physical and psychosocial factors. The individual variation in pain intensity, disability, kinesiophbia and physical capacity among the patients indicates the importance to assess these factors in every patient. Due to the fact that there were few patients in the sub-groups, further research is necessary to explore whether there are differences, that we were not able to disingjish, between patients with different movement patterns.

  • 2.
    Berglund, Lars
    et al.
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hellqvist, Jonas
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Aasa, Björn
    Norrlandsklinikens hälsocentral, Umeå.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehab. peter.michaelson@ltu.se .
    Holmberg, David
    Cederkliniken Primary Health Care Centre.
    Aasa, Ulrika
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Which patients with persistent mechanical low back pain will respond to high load motor control training?2011In: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 97, no Suppl. 1Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to explore variables influencing success or failure of eight weeks of high load motor control training with the conventional deadlift exercise.Relevance: Researching viable exercises for rehabilitation of specific sub-groups of persistent low back pain is relevant for physical therapists in order to develop tailored treatment regimes for patients with persistent low back pain. This study contributes to this research by exploring which variables characterize the ideal patient for the conventional deadlift exercise.Participants: Thirty-five patients with persistent mechanical low back pain were recruited consecutively from two occupational health care services in Umeå, Sweden . Inclusion and exclusion criteria were designed to include patients with persistent mechanical low back pain.Methods: The study design was a prospective cohort study. The intervention consisted of eight weeks of training with the conventional deadlift exercise. To discriminate between patients with a successful or failed outcome of treatment, change in the patient-specific functional scale was used and a cut-off at 50 % improvement was set. Possible predictive variables collected at baseline included physical activity level, pain intensity (Visual Analogue Scale), activity limitation (the Roland and Morris Disability Questionnaire and the Patient-Specific Functional Scale), kinesiophobia (Tampa Scale of Kinesiophobia), specific anamnestic questions regarding patients' history and symptoms of low back pain, test of active movement control of the low back, trunk muscle endurance(Prone bridge test, Side-bridge test, Biering-Sörensen test) and lift strength (static two-hand lift test), two-point discrimination of the low back and ultrasound imaging of the mm. multifidi.Analysis: Student´s T-test for normally distributed continuous data, Mann Whitney for non-normally distributed continuous data and chi-square tests or Fisher´s Exact tests for categorical variables were used for analyses of differences between the success and the failure group.Results: No significant differences between groups were found in background, anamnestic or physical performance variables. After eight weeks of training, 15 patients (43 %) were categorized as treatment success and 20 patients (57 %) were categorized as treatment failure according to the cut-off set for the PSFS. The patients reported difficulty in performing a wide variation of activities, ranging from not being able to sit for longer than 15 minutes, to stand upright and watch their children play football games, and to not being able to run long distances, play football or perform different lifting tasks.Conclusions: We conclude that the conventional deadlift exercise may be considered a possible exercise to improve patients' activity limitations, if administered by a therapist experienced in resistance training and analyzing movement patterns. However, further research is needed to explore which variables can define patients in the successful and in the failure group, respectively.Implications: The results of this study imply that the conventional deadlift exercise can be used in treatment of patients with mechanical low back pain in order to increase activity limitation. However, it is still unclear on what grounds treatment with the conventional deadlift exercise is indicated to achieve these results.

  • 3. Gard, Gunvor
    Increased focus on values: a tool in stress prevention?2003In: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 89, no 5, p. 282-9Article in journal (Refereed)
    Abstract [en]

    Background and purpose: Can an increased focus on values in working life be a factor in stress prevention? Values are defined as the shared principles which guide behaviour in an organisation. The purpose of this study was to describe how patients with musculoskeletal pain perceive the importance of values in relation to coping with daily stress and in relation to health. Methods: Patients receiving physiotherapy for various musculoskeletal disorders at three primary healthcare centres in the north of Sweden participated in the study, in total 95 patients. They answered a questionnaire covering values, work situation, coping behaviour and health and the relationship between these aspects. Results: All patients perceived that it was important to have values to follow at work, such as doing one's best, setting priorities, following one's priorities and having open and direct communication with others. A significant positive relationship was shown between having motivating values and low emotion-focused strategies, in this case behavioural and cognitive coping strategies. A positive relationship was also shown between having motivating values and low occurrence of symptoms (good perceived health). Conclusion: Values and effective coping strategies may be motivating factors preserving health

  • 4. Gard, Gunvor
    et al.
    Gyllensten, Amanda Lundvik
    University of Lund, Department of Physical Therapy.
    Salford, Eva
    University of Lund, Department of Physical Therapy.
    Ekdahl, Charlotte
    University of Lund, Department of Physical Therapy.
    Physical therapists' emotional expressions in interviews about factors important for interaction with patients2002In: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 86, no 5, p. 229-40Article in journal (Refereed)
    Abstract [en]

    Interactions: between patients and physiotherapists have been studied by various researchers. Some results indicate that physiotherapists have an awareness of underlying emotions, but often respond only on an intellectual level. It seems that verbally expressed emotions may be important for interaction between physiotherapists and patients during treatment. Aim: The aim of this study was to investigate how many and what verbally expressed emotions physiotherapists state during interviews between physiotherapists and patients. Method: The study was a qualitative case study with cross-case analysis according to Shepard et al (1993) and Merriam (1988). Ten informants participated, all of them 'experts in interaction with patients', women, Swedish-speaking, and with at least five years' experience in primary health care. The physiotherapists' emotions were categorised according to Tomkins (1984) and Izard (1977) in the categories of interest/excitement, surprise/startle, enjoyment/joy, sadness, anger/rage, fear/terror, shame/humiliation, contempt and disgust. Results: Positive emotions such as interest and joy were expressed most often in the interviews, in situations where physiotherapy had been successful, as joyful contacts with colleagues, or in situations where humour was used as a therapeutic instrument. Surprise, sadness and anger were expressed more seldom and contempt or disgust were not expressed at all in the interviews. Conclusion: Verbal expressions of emotions in treatment situations in physiotherapy practice should be promoted more emphatically. This may start a reflective process in both patients and physiotherapists and deepen the understanding of the interaction.

  • 5. Gard, Gunvor
    et al.
    Larsson, Ingalill
    Lund University Hospital, Department of Health Sciences, Division of Physiotherapy.
    Conceptions of physiotherapy knowledge among Swedish physiotherapists: a phenomenographic study2006In: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 92, no 2, p. 110-115Article in journal (Refereed)
    Abstract [en]

    Objectives and design Knowledge in physiotherapy is based on both scientific evidence and clinical practice. Different perspectives of knowledge generate different implications for theory development. The aim of this qualitative, phenomenographic study was to describe physiotherapists’ conceptions of physiotherapy knowledge. Intervention and participants Open, semi-structured interviews were conducted with 10 physiotherapists working in different sectors of physiotherapy. The transcribed material was analysed according to phenomenographic analysis. Results The physiotherapists’ conceptions of various aspects of physiotherapy knowledge are described by four qualitatively different categories: (a) interaction, i.e. the ability to create opportunities for patients and develop patients’ competencies, equally influenced by both theoretical and practical knowledge, with a patient-oriented perspective conceiving the physiotherapist as a coach; (b) personal competencies, i.e. the ability to provide good therapy influenced more by practical knowledge oriented towards the physiotherapist; (c) professional demands, i.e. the ability to be professional according to rules and scientifically proven interventions, influenced more by theoretical knowledge oriented towards the physiotherapist; and (d) scientific areas, i.e. the ability to use different knowledge, as an expert, in the interaction with the patient, strongly influenced by theoretical knowledge and oriented towards the patient. Conclusions The results can contribute to physiotherapy students’ understanding of the multi-dimensional nature of physiotherapy. The paradigm of physiotherapy must be studied further in order to understand and explain its complexity

  • 6. Gard, Gunvor
    et al.
    Sundén, Bente Thrane
    Lund University, Department of Physical Therapy.
    Life-views of physiotherapy students compared to medical and nursing student2000In: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 86, no 11, p. 576-582Article in journal (Refereed)
    Abstract [en]

    A life-view is an overall view of man and the world, forming a central value system and giving expression to a fundamental attitude. Research has shown that life-views are established early in childhood, are influenced by social environment and are relatively constant over time. An individual's view of life determines the response to reality and influences decision-making and treatment of other people. The aim of this study was to compare life-views and ethical standpoints of physiotherapy, nursing and medical students at the beginning of their professional education. All physiotherapy students beginning their education at Lund University during 1996 to 1998 answered a questionnaire developed by Josephsson (1994), in total 187 students. The life-views of the physiotherapy students were compared with those of 385 medical students from the Karolinska Institute in Stockholm and 36 student nurses from Lulea University who answered the same questionnaire, which required them to indicate their agreement or otherwise with statements reflecting different life-views. The result showed that all student groups had high or moderate levels of agreement with the sentences reflecting a religious and evolutionary life-view and low agreement with a scientific life-view in Josephsson's terms. When comparing the groups, medical students had the lowest and nursing students the highest agreement with the religious life-view. Physiotherapy students had the highest agreement with the evolutionary life-view. No significant differences were noted between physiotherapy and nursing students in religious, scientific or evolutionary life-views. Women had higher agreements than men with the religious life-view. Men had higher agreements than women with the scientific and evolutionary life-view. No significant differences were noted in life-views between younger and older students within any student group. All student groups were patient-centred in their opinions on clinical ethical questions

  • 7.
    Mikaelsson, Katarina
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Nyberg, Lars
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehab. peter.michaelson@ltu.se .
    Inactivity in adolescents, what are the effects on physical capacity?2011In: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 97, no Suppl. 1Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of the study was to investigate the effect of physical activity on physical capacity among graduates from upper secondary school.Relevance: Physical activity and physical fitness are important health related parameters, which both have declined the last decades. Adolescents who are about to leave compulsory school and physical education are supposed to peak regarding physical capacity. Therefore it is interesting to investigate the effect physical inactivity (according to WHO-recommendation) have on physical performance.Participants: The participants where third grade students (38 female and 61 male) from upper secondary school (18 - 20 years).Methods: International Physical Activity Questionnaire (IPAQ) was used to estimate the level of physical activity. The participants were divided, in accordance with World Health Organizations recommendations for physical activity, to A) physically inactive or B) physically active. Physical fitness was tested using the Åstrand bicycle test and functional tests of muscular strength and balance.Analysis: By Student's independent t-test, separate for females and males, differences in aerobic capacity, push-ups, grip strength, vertical jump height, sit-ups and balance, between physically inactive and active were tested.Results: Maximum oxygen uptake differed significantly between physically inactive and active males (mean ± SD: 3.0 ± 0.6 l/kg, vs. 3.6 ± 0.7 p = 0.002) and females (2.5± 0.3 l/kg, vs. 3.0 ± 0.6 p = 0.016). There was a difference among physically inactive and active males regarding push-ups (28.5 ± 7.0 vs. 37.1 ± 9.0, p < 0.001) and sit-ups (39.6 ± 19.4 vs. 59.2 ± 30.2, p = 0.010). No significant differences were found regarding vertical jump or grip strength among males, any of the muscle strength measurements among females, and balance (in any sex).Conclusions: The level of physical activity was related to aerobic capacity in both sexes, but did not seem to have the same impact on muscular fitness and balance, especially concerning the females. Since aerobic capacity is an important parameter in preventing future health problems, it is crucial to engage all adolescents in physical activity.Implications: According to this study physical activity have positive effects on aerobic capacity, without similar trend in muscle strength. Addressing strength training, as complement to aerobic training should be recommended regardless of level of physical activity performed. Therefore we see a future need for promoting and designing detailed guidelines regarding strength training for children and adolescents.

  • 8.
    Mikaelsson, Katarina
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Nyberg, Lars
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehab. peter.michaelson@ltu.se .
    Is self-rated physical activity a good indicator of physical capacity and is time spent sitting negative for physical capacity?2011In: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 97, no Suppl. 1Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to relate levels of physical activity to physical capacity and to study whether time sitting influences physical capacity among students in upper secondary school.Relevance: Physical activity and physical fitness are important health related parameters. Modern living habits with increased time spent on sedentary behaviors like watching TV and computer gaming have a potential for a negative influence. This calls for reliable and cost-effective measures of physical activities as indicators of physical capacity as tools for identifying people with an inactive lifestyle.Participants: Research participants where 99 third grade students (38 female, 61 male) from upper secondary school in Sweden (18-20 years).Methods: Levels of physical activity was established using the International Physical Activity Questionnaire (IPAQ) and determined for both 1) Level of activity (Total, Vigorous, Moderate, Walking), 2) IPAQ-classification Amount of activity (High, Medium, Low) and 3) Time sitting. Physical fitness was measured using the Åstrand bicycle test and functional tests of muscular strength.Analysis: The relation between 1) Level of activity, 2) IPAQ- amount of activity and 3) Time sitting and physical capacity was investigated by separate linear regression analyses.Results: There were a relation between Total level of activity and A) aerobic capacity (l/min2) (R2 = 0.1, p = 0.001), B) push-ups (R2 = 0.05, p = 0.011), and C) sit-ups (R2 = 0.046, p = 0.016), while other measure of physical capacity was non significant. An identical pattern was reveled for activity performed on Vigorous level with A) aerobic capacity (l/min2) (R2 = 0.2, p < 0.000), B) push-ups (R2 = 0.16, p < 0.000) and C) sit-ups (R2 = 0.082, p = 0.023). For activity on Moderate level the only significant relation was with aerobic capacity (R2 = 0.033, p = 0.033). For Walking no relation was significant. Regarding the IPAQ-classification of High-, Medium, and Low physical activity, no relation with any measures of physical capacity was found. Further, surprisingly, no relation was found between Time sitting and any measures of physical capacity.Conclusions: The results imply that the intensity of physical activity is of importance for achieving high aerobic capacity, while the amount of activity is not. Further, our results indicate that time sitting is not related to physical capacity.Implications: The self-rated questionnaire IPAQ can be questioned for use as a direct indicator of health parameters as physical capacity. Further, it seems that the intensity of activity is of importance for physical performance.

  • 9.
    Olsson, Lillemor Lundin
    et al.
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering. Sjukgymnastik.
    Pohl, Petra
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering. Sjukgymnastik.
    Sandlund, Marlene
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering. Sjukgymnastik.
    Ahlgren, Christina
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering. Sjukgymnastik.
    Bergvall-Kåreborn, Birgitta
    Luleå University of Technology, Department of Computer Science, Electrical and Space Engineering, Computer Science.
    Melander-Wikman, Anita
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Fall risk awareness in older community-dwelling people in northern Sweden: A qualitative study with focus groups2015In: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 101, no Suppl. 1, p. e1217-Article in journal (Refereed)
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