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  • 1.
    Blomgren, Johannes
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Strandell, Erika
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Jull, Gwendolen
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation. Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, Australia.
    Vikman, Irene
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Röijezon, Ulrik
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Effects of deep cervical flexor training on impaired physiological functions associated with chronic neck pain: a systematic review2018In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 19, article id 415Article in journal (Refereed)
    Abstract [en]

    Background:Neck pain is a major health issue with high rates of recurrence. It presents with a variety ofaltered sensorimotor functions. Exercise is a cornerstone of rehabilitation and many training methods areused. Exercise is evaluated in most randomized controlled trials on its pain relieving effects. No review hasassessed the effect of exercise on the altered physiological functions or determined if there are differentialeffects of particular training methods. This review investigated the effects of deep cervical flexor (DCF)training, a training method commonly used for patients with neck pain, and compared it to other trainingmethodsornotrainingonoutcomesofcervicalneuromuscular function, muscle size, kinematics and kinetics.Methods:Web of Science, Scopus, CINAHL, PubMed were searched from inception until January 2018. Twelverandomized controlled trials were included that compared DCF training as sole intervention to other trainingor no interventions in persons with neck pain. The Cochrane Risk of Bias tool was used to assess the methodquality. All outcome measures were analysed descriptively and meta-analyses were performed for measuresevaluated in three or more studies.Results:DCF training was compared to cervical endurance, strength, proprioception and mobility training,muscle stretching, and no intervention control groups. Physiological outcome measures includedneuromuscular co-ordination (craniocervical flexion test), functional tasks, muscle fatigability, muscle size,kinematics (joint position sense, posture and range of motion) and kinetics (strength, endurance andcontraction accuracy). Strong evidence was found for effectiveness of DCF training on neuromuscularcoordination, but it had no or small effects on strength and endurance at higher loads. DCF trainingimproved head and cervical posture, while evidence was limited or contradictory for other measures.Conclusions:DCF training can successfully address impaired neuromuscular coordination, but not cervicalflexor strength and endurance at higher contraction intensities. A multimodal training regime is proposedwhen the aim is to specifically address various impaired physiological functions associated with neck pain

  • 2.
    Gemark Simonsen, Jenny
    et al.
    Division of Occupational and Environmental Medicine, Lund University.
    Gard, Gunvor
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Swedish Sonographers' perceptions of ergonomic problems at work and their suggestions for improvement2016In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 17, no 1, article id 391Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Sonographers' perceptions of ergonomic and work-related pain problems at work have so far mostly been researched in quantitative studies by questionnaires. There is a need of experience-based research to deepen the knowledge about how sonographers perceive ergonomic problems at work. Therefore, the aim of this qualitative study was to describe sonographers' perceptions of ergonomic problems at work, and their suggestions for improvement strategies.

    METHODS:

    Twenty-two female sonographers were individually interviewed regarding different aspects of their physical working environment. Content analysis was applied.

    RESULTS:

    The sonographers perceived different ergonomic problems in their working environment, but to offer patient comfort and to obtain the best possible images were often prioritized over working posture. Echocardiography was considered demanding as the examination is performed with little variation in posture. Ergonomic improvements included reducing the manual handling of the transducer, optimizing the adjustability of equipment, and taking the patient's physique and health into account. As some examinations were perceived to be more ergonomically demanding, variation between examinations was suggested, however, this requires broader skills.

    CONCLUSION:

    Sonography, especially echocardiography is ergonomically demanding but the improvement strategies suggested were perceived useful and applicable.

  • 3.
    Josefsson, Kristina Areskoug
    et al.
    Department of Health Sciences, Division of Physiotherapy, Lund University.
    Ekdahl, Charlotte
    Department of Health Sciences, Division of Physiotherapy, Lund University.
    Jakobsson, Ulf
    Center for Primary Health Care Research, Lund University, CRC, 20205, Malmö.
    Gard, Gunvor
    Swedish version of the multi dimensional health assessment questionnaire: translation and psychometric evaluation2013In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 14, article id 178Article in journal (Refereed)
    Abstract [en]

    BackgroundHealth assessment measurements for patients with Rheumatoid arthritis (RA) have to be meaningful, valid and relevant. A commonly used questionnaire for patients with RA is the Stanford Health Assessment Questionnaire Disability Index (HAQ), which has been available in Swedish since 1988. The HAQ has been revised and improved several times and the latest version is the Multi Dimensional Health Assessment Questionnaire (MDHAQ). The aim of this study was to translate the MDHAQ to Swedish conditions and to test the validity and reliability of this version for persons with RA. MethodsTranslation and adaption of the MDHAQ were performed according to guidelines by Guillemin et al. The translated version was tested for face validity and test-retest in a group of 30 patients with RA. Content validity, criterion validity and internal consistency were tested in a larger study group of 83 patients with RA. Reliability was tested with test-retest and Cronbach´s alpha for internal consistency. Two aspects of validity were explored: content and criterion validity. Content validity was tested with a content validity index. Criterion validity was tested with concurrent validity by exploring the correlation between the MDHAQ-S and the AIMS2-SF. Floor and ceiling effects were explored. ResultsTest-retest with intra-class correlation coefficient (ICC) gave a coefficient of 0.85 for physical function and 0.79 for psychological properties. Reliability test with Cronbach´s alpha gave an alpha of 0.65 for the psychological dimension and an alpha of 0.88 for the physical dimension of the MDHAQ-S. The average sum of the content validity index for each item was of the MDHAQ-S was 0.94. The MDHAQ-S had mainly a moderate correlation with the AIMS2-SF, except for the social dimension of the AIMS2-SF, which had a very low correlation with the MDHAQ-S. ConclusionsThe MDHAQ-S was considered to be reliable and valid, but further research is needed concerning sensitivity to change.

  • 4.
    Josefsson, Kristina Areskoug
    et al.
    Department of Health Sciences, Health Sciences Center, Lund University.
    Gard, Gunvor
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Women's experiences of sexual health when living with Rheumatoid Arthritis: an explorative qualitative study2010In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 11, p. 240-247Article in journal (Refereed)
    Abstract [en]

    Background: The ICF core sets for patients with Rheumatoid Arthritis (RA) acknowledge sexual function and intimate relationships as important since the patients' sexual health can be affected by the disease. About 36-70% of all RA-patients experience a reduced sexual health, and their perceived problems are directly or indirectly caused by their disease. Physiotherapy is often used as non-pharmacological treatment for RA. Mobility treatment, pain reduction, and physical activities are often included in physiotherapy for patients with RA. The aim of the study was to explore sexual health in relation to physiotherapy in women living with RA. Method: An explorative qualitative interview study with a phenomenological approach was performed. The study consisted of ten interviews with women with RA. The analysis was performed according to Giorgi. Results: The main theme that emerged in the material was that the body and the total life situation affected sexual health. Three categories were included in the theme: 1) sexual health - physical and psychological dimensions, 2) Impacts of RA, and 3) Possibilities to increase sexual health - does physiotherapy make a difference?. Conclusions: Sexual health was affected by RA in different ways for the informants. Possibilities to improve sexual health were improved partner communication and physiotherapy. Physiotherapy can play an active role in improving sexual health for patients with RA

  • 5.
    Larsson, Agneta
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Karlqvist, Lena
    Department of Health Sciences, Mid Sweden University, Östersund.
    Gard, Gunvor
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Effects of work ability and health promoting interventions for women with musculoskeletal symptoms: a 9-month prospective study2008In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 9Article in journal (Refereed)
    Abstract [en]

    Women working in the public human service sector in 'overstrained' situations run the risk of musculoskeletal symptoms and long-term sick leave. In order to maintain the level of health and work ability and strengthen the potential resources for health, it is important that employees gain greater control over decisions and actions affecting their health - a process associated with the concept of self-efficacy. The aim of this study was to describe the effects of a self-efficacy intervention and an ergonomic education intervention for women with musculoskeletal symptoms, employed in the public sector. MethodsThe design of the study was a 9-month prospective study describing the effects of two interventions, a comprehensive self-efficacy intervention (n = 21) and an ergonomic education intervention (n = 21). Data were obtained by a self-report questionnaire on health- and work ability-related factors at baseline, and at ten weeks and nine months follow-up. Within-group differences over time were analysed. ResultsOver the time period studied there were small magnitudes of improvements within each group. Within the self-efficacy intervention group positive effects in perceived work ability were shown. The ergonomic education group showed increased positive beliefs about future work ability and a more frequent use of pain coping strategies. ConclusionBoth interventions showed positive effects on women with musculoskeletal symptoms, but in different ways. Future research in this area should tailor interventions to participants' motivation and readiness to change.

  • 6.
    Larsson, Agneta
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Karlqvist, Lena
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Westerberg, Mats
    Luleå University of Technology, Department of Business Administration, Technology and Social Sciences, Innovation and Design.
    Gard, Gunvor
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Identifying work ability promoting factors for home care aides and assistant nurses2012In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 13, no 1Article in journal (Refereed)
    Abstract [en]

    In workplace health promotion, all potential resources needs to be taken into consideration, not only factors relating to the absence of injury and the physical health of the workers, but also psychological aspects. A dynamic balance between the resources of the individual employees and the demands of work is an important prerequisite. In the home care services, there is a noticeable trend towards increased psychosocial strain on employees at work. There are a high frequency of work-related musculoskeletal disorders and injuries, and a low prevalence of sustainable work ability. The aim of this research was to identify factors promoting work ability and self-efficacy in care aides and assistant nurses within home care services.This study is based on cross-sectional data collected in a municipality in northern Sweden. Care aides (n = 58) and assistant nurses (n = 79) replied to a self-administered questionnaire (response rate 46%). Hierarchical multiple regression analyses were performed to assess the influence of several independent variables on self-efficacy (model 1) and work ability (model 2) for care aides and assistant nurses separately.Perceptions of personal safety, self-efficacy and musculoskeletal wellbeing contributed to work ability for assistant nurses (R2adj of 0.36, p < 0.001), while for care aides, the safety climate, seniority and age contributed to work ability (R2adj of 0.29, p = 0.001). Self-efficacy was associated with the safety climate and the physical demands of the job in both professions (R2adj of 0.24, p = 0.003 for care aides), and also by sex and age for the assistant nurses (R2adj of 0.31, p < 0.001).The intermediate factors contributed differently to work ability in the two professions. Self-efficacy, personal safety and musculoskeletal wellbeing were important for the assistant nurses, while the work ability of the care aides was associated with the safety climate, but also with the non-changeable factors age and seniority. All these factors are important to acknowledge in practice and in further research. Proactive workplace interventions need to focus on potentially modifiable factors such as self-efficacy, safety climate, physical job demands and musculoskeletal wellbeing.

  • 7.
    Mannerkorpi, Kaisa
    et al.
    Department of Rheumatology and Inflammation Research, Institute of Medicine, University of Gothenburg.
    Gard, Gunvor
    Hinders for continued work among persons with fibromyalgia2012In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 13, p. 96-Article in journal (Refereed)
    Abstract [en]

    Background Work disability is common among women with fibromyalgia (FM). The aim of the study was to investigate what health problems and work-related difficulties lead to hinders for continued work among women with FM. Methods A qualitative interview study. Twenty-seven gainfully employed women with FM participated in five focus group interviews. Their median age was 52 years, ranging from 33 to 62. The transcribed interviews were analyzed by content analysis. Results Health problems and work-related demands were identified. Limited physical capacity, increased stress and an increased need of rest were the major health problems, while physical, psychosocial and work organizational demands were the main work-related problems. Personal factors and factors related to family influenced the strategies used to manage the imbalance between the health problems and work-related demands. Conclusions Limited physical capacity and an increased need of rest made it difficult for these women to manage the physical, psychosocial and organizational work demands. Adjustment of the work tasks and work environment were the main factors influencing whether the women with FM could work or not.

  • 8.
    Post Sennehed, Charlotte
    et al.
    Department of Clinical Sciences Lund, Lund University, Orthopedics.
    Gard, Gunvor
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Holmberg, Sara A.C.
    Department of Research and Development, Region Kronoberg.
    Stigmar, Kjerstin G.E.
    bEpidemiology and Register Centre South, Region Skåne, Lund.
    Forsbrand, Malin
    Department of Clinical Sciences Lund, Lund University, Orthopedics, Lund.
    Grahn, Birgitta E.M.
    Department of Clinical Sciences Lund, Lund University, Orthopedics, Lund.
    "Blue flags", development of a short clinical questionnaire on work-related psychosocial risk factors: A validation study in primary care2017In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 18, no 1, article id 318Article in journal (Refereed)
    Abstract [en]

    Background: Working conditions substantially influence health, work ability and sick leave. Useful instruments to help clinicians pay attention to working conditions are lacking in primary care (PC). The aim of this study was to test the validity of a short "Blue flags" questionnaire, which focuses on work-related psychosocial risk factors and any potential need for contacts and/or actions at the workplace. Methods: From the original"The General Nordic Questionnaire" (QPSNordic) the research group identified five content areas with a total of 51 items which were considered to be most relevant focusing on work-related psychosocial risk factors. Fourteen items were selected from the identified QPSNordic content areas and organised in a short questionnaire "Blue flags". These 14 items were validated towards the 51 QPSNordic items. Content validity was reviewed by a professional panel and a patient panel. Structural and concurrent validity were also tested within a randomised clinical trial. Results: The two panels (n = 111) considered the 14 psychosocial items to be relevant. A four-factor model was extracted with an explained variance of 25.2%, 14.9%, 10.9% and 8.3% respectively. All 14 items showed satisfactory loadings on all factors. Concerning concurrent validity the overall correlation was very strong rs = 0.87 (p < 0.001).). Correlations were moderately strong for factor one, rs = 0.62 (p < 0.001) and factor two, rs = 0.74 (p < 0.001). Factor three and factor four were weaker, bur still fair and significant at rs = 0.53 (p < 0.001) and rs = 0.41 (p < 0.001) respectively. The internal consistency of the whole "Blue flags" was good with Cronbach's alpha of 0.76. Conclusions: The content, structural and concurrent validity were satisfactory in this first step of development of the "Blue flags" questionnaire. In summary, the overall validity is considered acceptable. Testing in clinical contexts and in other patient populations is recommended to ensure predictive validity and usefulness.

  • 9. Röijezon, Ulrik
    et al.
    Djupsjöbacka, Mats
    Björklund, Martin
    Häger-Ross, Charlotte
    Grip, Helena
    Liebermann, Dario G
    Kinematics of fast cervical rotations in persons with chronic neck pain: a cross-sectional and reliability study2010In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 11, no 222Article in journal (Refereed)
  • 10.
    Röijezon, Ulrik
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Faleij, Ragnar
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Kravelis, Petros S.
    Laboratory of Knowledge and Intelligent Computing, Department of Computer Engineering, Technological Educational Institute of Epirus, Arta.
    Georgoulas, Georgios
    Luleå University of Technology, Department of Computer Science, Electrical and Space Engineering, Signals and Systems.
    Nikolakopoulos, George
    Luleå University of Technology, Department of Computer Science, Electrical and Space Engineering, Signals and Systems.
    A new clinical test for sensorimotor function of the hand: development and preliminary validation2017In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 18, no 1, article id 407Article in journal (Refereed)
    Abstract [en]

    Background

    Sensorimotor disturbances of the hand such as altered neuromuscular control and reduced proprioception have been reported for various musculoskeletal disorders. This can have major impact on daily activities such as dressing, cooking and manual work, especially when involving high demands on precision and therefore needs to be considered in the assessment and rehabilitation of hand disorders. There is however a lack of feasible and accurate objective methods for the assessment of movement behavior, including proprioception tests, of the hand in the clinic today. The objective of this observational cross- sectional study was to develop and conduct preliminary validation testing of a new method for clinical assessment of movement sense of the wrist using a laser pointer and an automatic scoring system of test results.

    Methods

    Fifty physiotherapists performed a tracking task with a hand-held laser pointer by following a zig-zag pattern as accurately as possible. The task was performed with left and right hand in both left and right directions, with three trials for each hand movement. Each trial was video recorded and analysed with a specifically tailored image processing pipeline for automatic quantification of the test. The main outcome variable was Acuity, calculated as the percent of the time the laser dot was on the target line during the trial.

    Results

    The results showed a significantly better Acuity for the dominant compared to non-dominant hand. Participants with right hand pain within the last 12 months had a significantly reduced acuity (p < 0.05), and although not significant there was also a similar trend for reduced Acuity also for participants with left hand pain. Furthermore, there was a clear negative correlation between Acuity and Speed indicating a speed-accuracy trade off commonly found in manual tasks. The repeatability of the test showed acceptable intra class correlation (ICC2.1) values (0.68-0.81) and standard error of measurement values ranging between 5.0–6.3 for Acuity.

    Conclusions

    The initial results suggest that the test may be a valid and feasible test for assessment of the movement sense of the hand. Future research should include assessments on different patient groups and reliability evaluations over time and between testers.

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