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  • 1.
    Aasa, Björn
    et al.
    Department of Orthopaedics, Surgical and Perioperative Sciences, Umeå University, Norrlandsklinikens hälsocentral, Umeå.
    Berglund, Lars
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Aasa, Ulrika
    Umeå University, Department of Community Medicine and Rehabilitation.
    Individualized Low-Load Motor Control Exercises and Education Versus a High-Load Lifting Exercise and Education to Improve Activity, Pain Intensity, and Physical Performance in Patients With Low Back Pain: A Randomized Controlled Trial2015In: Journal of Orthopaedic and Sports Physical Therapy, ISSN 0190-6011, E-ISSN 1938-1344, Vol. 45, no 2, p. 77-85Article in journal (Refereed)
    Abstract [en]

    Study DesignRandomized controlled trial. BackgroundLow back pain is a common disorder. Patients with low back pain frequently have aberrant and pain-provocative movement patterns that often are addressed with motor control exercises. ObjectiveTo compare the effects of low-load motor control (LMC) exercise and those of a high-load lifting (HLL) exercise. MethodsSeventy participants with recurrent low back pain, who were diagnosed with nociceptive mechanical pain as their dominating pain pattern, were randomized to either LMC or HLL exercise treatments. Participants were offered 12 treatment sessions over an 8-week period. All participants were also provided with education regarding pain mechanisms. MethodsParticipants were assessed prior to and following treatment. The primary outcome measures were activity (the Patient-Specific Functional Scale) and average pain intensity over the last 7 days (visual analog scale). The secondary outcome measure was a physical performance test battery that included 1 strength, 3 endurance, and 7 movement control tests for the lumbopelvic region. ResultsBoth interventions resulted in significant within-group improvements in pain intensity, strength, and endurance. The LMC group showed significantly greater improvement on the Patient-Specific Functional Scale (4.2 points) compared with the HLL group (2.5 points) (P<.001). There were no significant between-group differences in pain intensity (P = .505), strength, and 1 of the 3 endurance tests. However, the LMC group showed an increase (from 2.9 to 5.9) on the movement control test subscale, whereas the HLL group showed no change (from 3.9 to 3.1) (P<.001). ConclusionAn LMC intervention may result in superior outcomes in activity, movement control, and muscle endurance compared to an HLL intervention, but not in pain intensity, strength, or endurance. Registered at ClinicalTrials.gov (NCT01061632).

  • 2.
    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.

  • 3.
    Aasa, Björn
    et al.
    Department of Orthopaedics, Surgical and Perioperative Sciences, Umeå University, Norrlandsklinikens hälsocentral, Umeå.
    Sandlund, Jonas
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Aasa, Ulrika
    Umeå University, Department of Community Medicine and Rehabilitation.
    Low- versus high-load motor control exercise to reduce disability in patients with persistent peripherally mediated mechanical low back pain2012In: Rendez vous of hands and minds: 10th International Federation of Orthopaedic Manipulative Physical Therapists’ World conference, Quebec,  1-5 Oct 2012, 2012, no 2Conference paper (Refereed)
  • 4.
    Aasa, Ulrika
    et al.
    Umeå University, Department of Community Medicine and Rehabilitation.
    Aasa, Björn
    Department of Orthopaedics, Surgical and Perioperative Sciences, Umeå University, Norrlandsklinikens hälsocentral, Umeå.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Sandlund, Jonas
    Effects of low- and high-load motor control exercises on lumbar curvature during stance in patients with low back pain2012In: Rendez vous of hands and minds: 10th International Federation of Orthopaedic Manipulative Physical Therapists’ World conference, Quebec,  1-5 Oct 2012, 2012, no 2Conference paper (Refereed)
  • 5.
    Berglund, Lars
    et al.
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University.
    Aasa, Björn
    Norrlandsklinikens hälsocentral, Umeå.
    Hellqvist, Jonas
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Aasa, Ulrika
    Department of Community Medicine and Rehabilitation, Umeå University.
    Which patients with low back pain benefit from deadlift training?2015In: Journal of Strength and Conditioning Research, ISSN 1064-8011, E-ISSN 1533-4287, Vol. 29, no 7, p. 1803-1811Article in journal (Refereed)
    Abstract [en]

    Recent studies have indicated that the deadlift exercise may be effective in decreasing pain intensity and increasing activity for most, but not all, patients with a dominating mechanical low back pain pattern. This study aimed to evaluate which individual factors measured at baseline could predict activity, disability, and pain intensity in patients with mechanical low back pain after an 8-week training period involving the deadlift as a rehabilitative exercise. Thirty-five participants performed deadlift training under the supervision of a physical therapist with powerlifting experience. Measures of pain-related fear of movement, hip and trunk muscle endurance and lumbopelvic movement control were collected at baseline. Measures of activity, disability and pain intensity were collected at baseline and at follow-up. Linear regression analyses were used to create models to predict activity, disability and pain intensity at follow-up. Results showed that participants with less disability, less pain intensity and higher performance on the Biering-Sørensen test, which tests the endurance of hip and back extensor muscles, at baseline benefit from deadlift training. The Biering-Sørensen test was the strongest predictor since it was included in all predictive models. Pain intensity was the next best predictor as it was included in two predictive models. Thus, for strength and conditioning professionals who use the deadlift as a rehabilitative exercise for individuals with mechanical low back pain, it is important to ensure that clients have sufficient back extensor strength and endurance and a sufficiently low pain intensity level to benefit from training involving the deadlift exercise.

  • 6.
    Berglund, Lars
    et al.
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University.
    Aasa, Björn
    Norrlandsklinikens hälsocentral, Umeå.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Aasa, Ulrika
    Department of Community Medicine and Rehabilitation, Umeå University.
    Effects of low-load motor control exercises and a high-load lifting exercise on lumbar multifidus thickness: a randomized controlled trial2017In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 42, no 15, p. E876-E882Article in journal (Refereed)
    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.

  • 7.
    Berglund, Lars
    et al.
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University.
    Aasa, Björn
    Norrlandsklinikens hälsocentral, Umeå.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Aasa, Ulrika
    Department of Community Medicine and Rehabilitation, Umeå University.
    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 trial2018In: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632, Vol. 18, no 3, p. 399-406Article in journal (Refereed)
    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.

  • 8.
    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.

  • 9.
    Calner, Tommy
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Isaksson, Gunilla
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Experiences of physiotherapy treatment of persons with persistent musculoskeletal painManuscript (preprint) (Other academic)
    Abstract [en]

    The aim of this study was to explore and describe experiences of physiotherapy treatment of people with persistent musculoskeletal pain. Eleven 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 analysed with qualitative content analysis. The analysis resulted in one main category “Towards acceptance and management of pain” which was formulated and built up by the four categories “Establishing and maintaining alliance”, “Being active, taking initiative and facing challenge”, “Appreciating guidance, incentive and a sounding board” and “Acquired knowledge and developed awareness”. The main category and the categories describe how the participants used knowledge, awareness, movements and exercises learned from the physiotherapy treatment to develop strategies to manage pain and the process of acceptance. A trustful alliance with the physiotherapist and a continuous dialogue was important. The participants were actively involved in the process when exercises, activities and other treatment modalities were individualized. This was rewarding but also an effort and a challenge. The physiotherapist’s initiatives and actions were considered important as incentive and support.

  • 10.
    Calner, Tommy
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Isaksson, Gunilla
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    “I know what I want but I’m not sure how to get it”: Expectations of physiotherapy treatment of persons with persistent pain2016In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 25, p. e142-e143Article in journal (Refereed)
  • 11.
    Calner, Tommy
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Isaksson, Gunilla
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    I know what I want but I’m not sure how to get it: expectations of physiotherapy treatment of persons with persistent pain2017In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 33, no 3, p. 198-205Article in journal (Refereed)
    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.

  • 12.
    Calner, Tommy
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Nordin, Catharina
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Eriksson, Margareta K.
    Department of Public Health, Norrbotten County Council, Luleå.
    Nyberg, Lars
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Gard, Gunvor
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Effects of a self-guided, web-based activity programme for patients with persistent musculoskeletal pain in primary healthcare: A randomized controlled trial2017In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 21, no 6, p. 1110-1120Article in journal (Refereed)
    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

  • 13.
    Calner, Tommy
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Nordin, Catharina
    Department of Primary health care, Norrbotten County Council .
    Gard, Gunvor
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Nyberg, Lars
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Physiotherapy in combination with personalized counseling and a web-based programme for persistent pain: an early stage evaluationManuscript (preprint) (Other academic)
    Abstract [en]

    Objective

    We evaluated first a self-managed web-based programme for activity compared to waiting list for persons with persistent musculoskeletal pain suited for primary health care. Thereafter, we evaluated the effects and process of a novel multimodal treatment intervention combining the web programme with counselling and physiotherapy. 

     

    Design

    A weekly comparison of measures of outcome data between those using the self-managed web-based programme to those on a waiting list. After that a Single Subject Experimental Design (SSED) evaluation of the multimodal intervention, structured interviews and log data.

     

    Setting

    Clinical setting in primary health care.

     

    Subjects

    Ten participants with persistent musculoskeletal pain.

     

    Intervention

    First, only a self-managed web-based programme for activity. Thereafter a multimodal intervention combining the web programme with counselling and physiotherapy.

     

    Main measures

    Effect measures were work ability, pain intensity, disability and self-efficacy. Process evaluation by interviews of the participants and log data of usage of the modalities.

     

    Results

    There were no conclusive effects of the self-managed web-based programme as compared to waiting list. The SSED analyses of the multi-modal showed promising short-term results regarding disability and pain intensity, but no conclusive results for work ability or self-efficacy. The multimodal intervention process seemed successfully implemented, and the importance of physiotherapy and to some extent counselling was emphasized by the participants.

     

    Conclusion

    For persons with persistent musculoskeletal pain, the newly designed multimodal intervention in primary care seemed feasible and showed some promising short-terms effects, while the implementation of a self-managed web-based programme as a single intervention seemed without effect. 

  • 14.
    Gard, Gunvor
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Nyberg, Lars
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Eriksson, Margareta K.
    Department of Public Health, Norrbotten County Council, Luleå.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehab. peter.michaelson@ltu.se .
    Nordin, Catharina
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Calner, Tommy
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Multimodal pain rehabilitation (MMR) with additional tailored web-based pain rehabilitation: an RCT study2014Conference paper (Other academic)
  • 15.
    Holmberg, David
    et al.
    Cederkliniken Primary Health Care Centre.
    Crantz, Henrik
    Fristaden Primary Health Care Centre.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Treating persistent low back pain with deadlift training: a single subject experimental design with a 15-month follow-up2012In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 14, no 2, p. 61-70Article in journal (Refereed)
    Abstract [en]

    Low back pain (LBP) is a common disorder in the western world. Persistent LBP can be caused by pathological changes in the discs and disturbed neuromuscular activation, which can cause hypotrophy of the strong type 2 muscle fibers of the extensors. Deadlift (DL) is an exercise that may address all these pathological transformations. The aim of the study was to investigate the effect of DL training on patients with persistent LBP. A single subject experimental design with an AB-design and multiple baselines was applied in this pilot study. Two patients with discogenic LBP and one with arthrogenic LBP were treated with DL training over 8–10 weeks. A follow-up was performed at 15 months. The subjects with discogenic LBP showed positive response to DL training regarding pain intensity and functional status, but the exercise did not affect their mental health. The subject with arthrogenic LBP did not seem to have positive effect from DL training. As a result of this pilot study, the authors hypothesize that DL training may be a successful treatment for subjects with LBP of discogenic origin.

  • 16.
    Linder, Martin
    et al.
    Ystad Rehab Center.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Röijezon, Ulrik
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Laterality judgments in people with low back pain-a cross-sectional observational and test-retest reliability study2016In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 21, p. 128-133Article in journal (Refereed)
    Abstract [en]

    BackgroundDisruption of cortical representation, or body schema, has been indicated as a factor in the persistence and recurrence of LBP. This has been observed through impaired laterality judgment ability and it has been suggested that this ability is affected in a spatial rather than anatomical manner.ObjectivesWe compared laterality judgment performance of foot and trunk movements between people with LBP with or without leg pain and healthy controls, and investigated associations between test performance and pain. We also assessed the test-retest reliability of the Recognise OnlineTM software when used in a clinical and a home setting.DesignCross-sectional observational and test-retest study.MethodsThirty individuals with LBP and 30 healthy controls performed judgment tests of foot and trunk laterality once supervised in a clinic and twice at home.ResultsNo statistically significant group differences were found. LBP intensity was negatively related to trunk laterality accuracy (p=0.019). Intraclass correlation values ranged from 0.51-0.91. Reaction time improved significantly between test occasions while accuracy did not.ConclusionsLaterality judgments were not impaired in subjects with LBP compared to controls. Further research may clarify the relationship between pain mechanisms in LBP and laterality judgment ability. Reliability values were mostly acceptable, with wide and low confidence intervals, suggesting test retest reliability for Recognise OnlineTM could be questioned in this trial. A significant learning effect was observed which should be considered in clinical and research application of the test.

  • 17.
    Michaelson, Magdalena
    et al.
    Södra Lapplands forskningsenhet, Vilhelmina.
    Michaelson, Peter
    Jämförelse mellan closed kinetic chain exercise och open kinetic chain exercise: en litterturstudie1999Report (Other academic)
  • 18.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Aktivitet: Patienters erfarenheter av tidigt insatt rehabilitering vid Sunderby sjukhus efter whiplashtrauma: en enkätstudie2008Conference paper (Other (popular science, discussion, etc.))
  • 19. Michaelson, Peter
    Sensorimotor characteristics in chronic neck pain: possible pathophysiological mechanisms and implications for rehabilitation2004Doctoral thesis, comprehensive summary (Other academic)
  • 20.
    Michaelson, Peter
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Holmberg, D.
    Cederkliniken Primary health care center, Department of Research, The Norrbotten County Council, Luleå.
    Aasa, Björn
    Department of Orthopaedics, Surgical and Perioperative Sciences, Umeå University.
    Aasa, Ulrika
    Umeå University, Department of Community Medicine and Rehabilitation, Division of Physiotherapy.
    Proprioception in musculoskeletal rehabilitation2016In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 25, p. e78-Article in journal (Refereed)
  • 21.
    Michaelson, Peter
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Holmberg, David
    Cederkliniken Primary Health Care Centre.
    Aasa, Björn
    Norrlandsklinikens hälsocentral, Umeå.
    Aasa, Ulrika
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Deadlift versus low load motor control for patients with mechanical low back pain2016In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 25, p. e78-Article in journal (Refereed)
  • 22.
    Michaelson, Peter
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Holmberg, David
    Cederkliniken Primary Health Care Centre.
    Aasa, Björn
    Department of Orthopaedics, Surgical and Perioperative Sciences, Umeå University.
    Aasa, Ulrika
    Umeå University, Department of Community Medicine and Rehabilitation, Division of Physiotherapy.
    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-up2016In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 48, no 5, p. 456-463Article in journal (Refereed)
    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

  • 23. Michaelson, Peter
    et al.
    Michaelson, Magdalena
    Södra Lapplands forskningsenhet, Vilhelmina.
    Jaric, Slobodan
    University of Gävle, Centre of Musculoskeletal Research.
    Latash, Mark L.
    Pennsylvania State University, Department of Kinesiology.
    Sjölander, Per
    Södra Lapplands forskningsenhet, Vilhelmina.
    Djupsjöbacka, Mats
    University of Gävle, Centre of Musculoskeletal Research.
    Head stability and vertica lposture in patients with whiplash associated disorders and work related neck pain2004In: Proceedings of the 8th International Federation of Orthopaedic Manipulative therapists' Conference, IFOMT , 2004Conference paper (Other academic)
  • 24. Michaelson, Peter
    et al.
    Michaelson, Magdalena
    Southern Lapland Research Department, Vilhelmina.
    Jaric, Slobodan
    University of Gävle, Centre of Musculoskeletal Research.
    Latash, Mark L.
    Pennsylvania State University, Department of Kinesiology.
    Sjölander, Per
    Southern Lapland Research Department, Vilhelmina.
    Djupsjöbacka, Mats
    University of Gävle, Centre of Musculoskeletal Research.
    Vertical posture and head stability in patients with chronic neck pain2003In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 35, no 5, p. 229-35Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate postural performance and head stabilization of patients with chronic neck pain. DESIGN: A single-blind comparative group study. SUBJECTS: Patients with work-related chronic neck pain (n = 9), with chronic whiplash associated disorders (n = 9) and healthy subjects (n = 16). METHODS: During quiet standing in different conditions (e.g. 1 and 2 feet standing, tandem standing, and open and closed eyes) the sway areas and the ability to maintain the postures were measured. The maximal peak-to-peak displacement of the centre of pressure and the head translation were analysed during predictable and unpredictable postural perturbations. RESULTS: Patients with chronic neck pain, in particular those with whiplash-associated disorders, showed larger sway areas and reduced ability to successfully execute more challenging balance tasks. They also displayed larger sway areas and reduced head stability during perturbations. CONCLUSION: The results show that disturbances of postural control in chronic neck pain are dependent on the aetiology, and that it is possible to quantify characteristic postural disturbances in different neck pain conditions. It is suggested that the dissimilarities in postural performance are a reflection of different degrees of disturbances of the proprioceptive input to the central nervous system and/or of the central processing of such input.

  • 25.
    Michaelson, Peter
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Sjölander, Per
    Södra Lapplands forskningsenhet, Vilhelmina.
    Djupsjöbacka, Mats
    University of Gävle, Centre of Musculoskeletal Research.
    Jaric, Slobodan
    University of Gävle, Centre of Musculoskeletal Research.
    Preprioception and kinematics in chronic neck pain: a comparison of whiplash- and work-related pain2003In: Abstract of the 4th Conference on progress in motor control: Motor control and Learning over the Life Span, 2003Conference paper (Other academic)
  • 26. Michaelson, Peter
    et al.
    Sjölander, Per
    Södra Lapplands forskningsenhet, Vilhelmina.
    Johansson, Håkan
    Södra Lapplands forskningsenhet, Vilhelmina.
    Factors predicting pain reduction in chronic back and neck pain after multimodal treatment2004In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 20, no 6, p. 447-54Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To determine whether treatment related pain reduction on the short- and long-term is predicted by different baseline variables, and with different accuracy, in patients with chronic low back pain as compared with those with chronic neck pain. DESIGN AND METHODS: A single blinded prospective cohort study based on patients with chronic musculoskeletal pain in the lower back (N = 167) or the neck (N = 136) who completed a 4-week multimodal rehabilitation program. At admission, each patient was evaluated on 17 potential predictors, including pain characteristics and physical, sociodemographic, and psychosocial-behavioral variables. Changes in self-reported pain intensity in the lower back or the neck between the pretreatment evaluation and those performed immediately after, and 12 months after the rehabilitation program, were assessed. RESULTS: Logistic regression models revealed that change in pain intensity could be predicted with good specificity but with poor sensitivity both for patients with chronic low back pain and chronic neck pain. Significant predictors among the neck pain patients were high endurance, low age, high pain intensity, few other symptoms, low need of being social, to do things with others, and to be helped, along with optimistic attitudes on how the pain will interfere with daily life. Among the low back pain patients, high pain intensity, low levels of pain severity, and high affective distress were important predictors. Variables such as sex, sick leave history, working status, accident, pain duration, and depressive symptoms demonstrated no predictive value. Short- and long-term pain outcome was equally predictable and predicted by almost the same variables. CONCLUSIONS: Patients who reported unchanged or increased pain after multimodal treatment could be predicted with good accuracy, whereas those who reported decreased pain were more difficult to identify. Treatment-related pain alteration in chronic low back pain seems to be predicted by partly different variables than in chronic neck pain

  • 27. Michaelson, Peter
    et al.
    Sjölander, Per
    Södra Lapplands forskningsenhet, Vilhelmina.
    Johansson, Håkan
    Södra Lapplands forskningsenhet, Vilhelmina.
    Faktorer som förutsäger smärtreduktion efter multimodal behandling av kronisk smärta i nacke och ländrygg2003In: Med forskning som drivkraft, 2003Conference paper (Other academic)
  • 28.
    Mikaelsson, Katarina
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Eliasson, Kristina
    Luleå tekniska universitet.
    Lysholm, Jack
    Department of Orthopaedics, Surgical and Perioperative Sciences, Umeå University.
    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.
    Physical capacity in physically active and non-active adolescents2011In: Journal of Public Health, ISSN 1741-3842, E-ISSN 1741-3850, Vol. 19, no 2, p. 131-138Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to investigate differences in physical capacity between physically active and non-active men and women among graduates from upper secondary school. Subject and methods: Research participants were graduates (38 women and 61 men) from upper secondary school. Physical activity was determined using the International Physical Activity Questionnaire, and participants were dichotomously characterized as being physically active or physically non-active according to the recommendations of the World Health Organization (WHO). Aerobic capacity was measured using the Åstrand cycle ergometer test. Participants also underwent tests of muscular strength and balance. Results: Maximum oxygen uptake differed significantly between physically active and non-active men (mean ± SD 3.6 ± 0.7 vs 3.0 ± 0.6 l/kg, p = 0.002) and women (3.0 ± 0.6 vs 2.5 ± 0.3 l/kg, p = 0.016). There was a difference among physically active and non-active men regarding push-ups (37.1 ± 9.0 vs 28.5 ± 7.0, p < 0.001) and sit-ups (59.2 ± 30.2 vs 39.6 ± 19.4, p = 0.010). No significant differences were found regarding vertical jump or grip strength among men, any of the muscle strength measurements among women, and balance (in any sex). Conclusion: Activity levels had impact on aerobic capacity in both sexes, but did not seem to have the same impact on muscular strength and balance, especially in women

  • 29.
    Mikaelsson, Katarina
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Lysholm, Jack
    Nyberg, Lars
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Medical Science.
    The relationship between the physical capacity and physical activity of adolescents2012In: Gazzetta Medica Italiana, ISSN 0393-3660, E-ISSN 1827-1812, Vol. 171, no 5, p. 639-651Article in journal (Refereed)
    Abstract [en]

    Aim. Physical activity and physical capacity are important health related parameters for all age-groups. Yet, little is known about the relationship between physical activity and physical capacity amongst adolescents about to leave compulsory education. The aim of the study was to investigate how physical capacities are related to self-reported energy expenditure on physical activities at different levels of physical activity and amount of time spent sitting among graduates of upper secondary school. Methods. In total, 99 third grade students participated from upper secondary school. Levels of physical activity and the amount of time spent sitting were assessed using the International Physical Activity Questionnaire (IPAQ). The energy expenditure was calculated based on the activity determined by the IPAQ. The participants’ physical capacity was tested using VO2max, muscle strength and balance measures. The relationship between physical activity and physical capacity was addressed using linear regression models. Results. There was significant relationship between Total METs and aerobic capacity (R2 = 0.15), push-ups (R2 = 0.08) and sit-ups (R2 = 0.07). A stronger significant relationship was revealed for activity performed on Vigorous activity METs for aerobic capacity (R2 = 0.23), push-ups (R2 = 0.18) and sit-ups (R2 = 0.10). The regression analyses for Moderate activity METs, Walking activity METs and time spent Sitting showed no significant relationship to any measures of physical capacity. Conclusion. For adolescents, the intensity of physical activity is of importance for achieving high aerobic capacity, and the amount of time spent sitting does not influence physical capacity.

  • 30.
    Mikaelsson, Katarina
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Aktivitet: Fysisk aktivitet och sittande hos gymnasieungdomar i Norrbotten2012Conference paper (Other (popular science, discussion, etc.))
  • 31.
    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.

  • 32.
    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.

  • 33.
    Nordin, Catharina
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab. Department of Primary Health Care, Region Norrbotten, Piteå.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Eriksson, Margareta K.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab. Department of Public Health, Norrbotten County Council, Luleå.
    Gard, Gunvor
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    It's about me: patients’ Experiences of Patient Participation in the Web Behavior Change Program for Activity in Combination With Multimodal Pain Rehabilitation2017In: 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)
    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.

  • 34.
    Nordin, Catharina
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab. Department of Primary Health Care, Norrbotten County Council.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Gard, Gunvor
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Eriksson, Margareta K.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab. Department of Primary Health Care, Norrbotten County Council.
    Effects of the Web Behavior Change Program for Activity and Multimodal Pain Rehabilitation: Randomized Controlled Trial2016In: 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)
    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.

  • 35.
    Sjölander, Per
    et al.
    Södra Lapplands forskningsenhet, Vilhelmina.
    Michaelson, Peter
    Prediction of treatment outcome based on psychosocial characteristics of patients with musculoskeletal pain2000Conference paper (Other academic)
  • 36.
    Sjölander, Per
    et al.
    Södra Lapplands forskningsenhet, Vilhelmina.
    Michaelson, Peter
    Djupsjöbacka, Mats
    University of Gävle, Centre of Musculoskeletal Research.
    Sensorimotor control and kinematics during neck rotations in patients with whiplash associated disorders and work-related neck pain2004In: Proceedings of the 8th International Federation of Orthopaedic Manupulative Therapists' Conference, IFOMT , 2004Conference paper (Other academic)
  • 37.
    Sjölander, Per
    et al.
    Southern Lapland Research Department, Vilhelmina.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Jaric, Slobodan
    University of Gävle, Centre of Musculoskeletal Research.
    Djupsjöbacka, Mats
    University of Gävle, Centre of Musculoskeletal Research.
    Sensorimotor disturbances in chronic neck pain: range of motion, peak velocity, smoothness of movement, and repositioning acuity2008In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 13, no 2, p. 122-131Article in journal (Refereed)
    Abstract [en]

    The purpose of this pilot study was to evaluate sensorimotor functions in patients with chronic neck pain with objective and quantitative methods. A group of 16 patients with chronic idiopathic neck pain of insidious onset or whiplash associated disorders (WAD) was compared to an equally sized group of healthy subjects. Kinematics were investigated during voluntary head rotations by measuring range of motion, variability of range of motion (ROM-Variability), peak velocity, and smoothness of movement (jerk index). Repositioning acuity after cervical rotations was evaluated by analysing constant and variable error (VE). In comparison to the healthy subjects, the patients showed significantly larger jerk index, ROM-Variability and VE. No statistically significant differences were found between insidious neck pain and WAD. It is concluded that jerky and irregular cervical movements and poor position sense acuity are characteristic sensorimotor symptoms in chronic neck pain. The observed individuality in sensorimotor disturbances emphasizes the importance of developing specific rehabilitation programs for specific dysfunctions, and of using objective and quantitative methods for evaluation of rehabilitation.

  • 38.
    Sviridova, Olga
    et al.
    Luleå University of Technology.
    Gard, Gunvor
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Predictors for return to work after multimodal rehabilitation in persons with persistent musculoskeletal pain2018In: Edorium Journal of Disability and Rehabilitation, ISSN 2456-8392, Vol. 4, no 1, article id 100038D05SO2018Article in journal (Refereed)
    Abstract [en]

    Aims: To identify factors explaining return to work (RTW) 12 months after a multimodal rehabilitation (MMR) intervention in the REHSAM II project.

    Methods: The present study is a secondary assessment of the data from the randomized controlled trial REHSAM II. A total of 97 participants with persistent musculoskeletal pain were randomly allocated to MMR + web-based education or only MMR. The subjects were followed from baseline to 12 months. The baseline variables from the outcome measures were used to identify predictors. The associations between the dependent variable (i.e., RTW) and independent variables (i.e., baseline variables) were analyzed with univariate and multiple logistic regression models.

    Results: The univariate regression analyses showed that pain and disability level, the capacity to perform a task in relation to pain, hospital and psychiatric care, medication for insomnia, catastrophizing, self-assessed work ability compared with lifetime best, satisfaction with life, ability for coping and controlling work situation, ability for coping with life outside work, and sense of responsibility for managing health condition were significantly associated with RTW. In the final multiple regression model, RTW was predicted by the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ score) (p=0.003, OR=0.961) and EuroQol (EQ-5D index) (p=0.017, OR=7.283)

  • 39.
    Åsenlöf, Pernilla
    et al.
    Department of Neuroscience, Physiotherapy, Uppsala University.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehab. peter.michaelson@ltu.se .
    Grahn, Birgitta
    Department of Orthopedics, Clinical Sciences, Lund University.
    Bergman, Stefan
    Research and Development Center Spenshult, Halmstad.
    Axelson, S.
    Swedish Agency for Health Technology Assessment and Assessment of Social Services.
    Gyllenswärd, Harald
    Swedish Agency for Health Technology Assessment and Assessment of Social Services.
    Bergström, Gunnar
    Institute of Environmental Medicine, Unit of Intervention & Implementation Research, Karolinska Institutet.
    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 pain2016In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, no Suppl. 1, p. S187-Article in journal (Refereed)
  • 40.
    Åsenlöf, Pernilla
    et al.
    Institutionen för neurovetenskap, Uppsala universitet.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Grahn, Birgitta
    Kronoberg occupational rehabilitation service, Växjö, Lunds universitet, Institutionen för rörelseorganens sjukdomar, Kronoberg county council, R&D centre, R&D Welfare of Southern Småland, FoU Välfärd, Kronoberg County.
    Bergman, Stefan
    Högskolan i Halmstad.
    Gyllensvärd, Harald
    SBU.
    Bergström, Gunnar
    Enheten för interventions och implementeringsforskning, Karolinska Institutet.
    Preventiva insatser vid akut smärta från rygg och nacke: Presentation av en SBU-rapport2016In: Fysioterapi, ISSN 1653-5804, no 5, p. 34-42Article in journal (Other academic)
1 - 40 of 40
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