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  • 1. Al-Ani, Amer N.
    et al.
    Flodin, Lena
    Söderqvist, Anita
    Ackermann, Paul
    Samnegård, Eva
    Dalén, Nils
    Sääf, Maria
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Hedström, Margareta
    Does Rehabilitation Matter in Patients With Femoral Neck Fracture and Cognitive Impairment?: A Prospective Study of 246 Patients2010In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 91, no 1, p. 51-57Article in journal (Refereed)
    Abstract [en]

    Objective: To identify factors associated with preserved walking ability and Katz activities of daily living (ADLs) index at 4-month and 12-month follow-up in cognitively impaired patients with femoral neck fracture. Design: Population-based cohort study. Setting: A multicenter study of the Stockholm Hip Fracture Group including 4 university hospitals. Participants: Consecutive patients (N=246) with femoral neck fracture, older than 65 years (mean, 84y; 72% women) with cognitive impairment (known dementia or low [0-2 points] score) in Short Portable Mental Status Questionnaire [0-10 points]) and able to walk before the fracture. Interventions: Not applicable. Main Outcome Measure: Walking ability and ADLs index at 4-month and 12-month follow-up. Results: Significant predictors of preserved walking ability at 12-month follow-up were discharge to rehabilitation unit (odds ratio [OR]=2.83: confidence interval [CI], 1.1-7.26; P=.03) and walking ability before the fracture (OR=8.98; Cl, 3.52-22.93; P<.001), while type of surgery was not (P=.197). Analyses were adjusted for age, sex, American Society of Anesthesiologists score, fracture type, and surgical method. Corresponding predictors of preserved Katz ADLs index at 12-month follow-up, after adjustment for age and sex, were discharge to rehabilitation unit (OR=5.33; Cl, 1.44-19.65: P=.012) and ADLs index before fracture (OR=2.5; Cl. 1.8-3.5: P<.001), while type of surgery was not (P=.376). Conclusions: Discharge to rehabilitation unit, a factor we can influence, was associated with preserved walking ability and ADLs index in cognitively impaired patients with hip fracture.

  • 2.
    Anens, Elisabeth
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Exploratory Study of Physical Activity in Persons With Charcot-Marie-Tooth Disease2015In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 96, no 2, p. 260-268Article in journal (Refereed)
    Abstract [en]

    Objectives: To explore and describe the perceived facilitators and barriers to physical activity, and to examine the physical activity correlates in people with Charcot-Marie-Tooth (CMT) disease. Design: Cross-sectional survey study. Setting: Community-living subjects. Participants: Swedish people with CMT disease (N=44; men, 54.5%; median age, 59.5y [interquartile range, 45.3-64.8y]). Interventions: Not applicable. Main Outcome Measures: The survey included open-ended questions and standardized self-reported scales measuring physical activity, fatigue, activity limitation, self-efficacy for physical activity, fall-related self-efficacy, social support, and enjoyment of physical activity. Physical activity was measured by the Physical Activity Disability Survey-Revised. Results: Qualitative content analysis revealed that personal factors such as fatigue, poor balance, muscle weakness, and pain were important barriers for physical activity behavior. Facilitators of physical activity were self-efficacy for physical activity, activity-related factors, and assistive devices. Multiple regression analysis showed that self-efficacy for physical activity (beta=.41) and fatigue (beta=-.30) explained 31.8% of the variation in physical activity (F-2,F-40=10.78, P=.000). Conclusions: Despite the well-known benefits of physical activity, physical activity in people with CMT disease is very sparsely studied. These new results contribute to the understanding of factors important for physical activity behavior in people with CMT disease and can guide health professionals to facilitate physical activity behavior in this group of patients. (C) 2015 by the American Congress of Rehabilitation Medicine

  • 3.
    Arnadottir, Solveig A
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Gunnarsdottir, Elin D
    Fisher, Anne G
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Application of rasch analysis to examine psychometric aspects of the activities-specific balance confidence scale when used in a new cultural context2010In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 91, no 1, p. 156-163Article in journal (Refereed)
    Abstract [en]

    Arnadottir SA, Lundin-Olsson L, Gunnarsdottir ED, Fisher AG. Application of Rasch analysis to examine psychometric aspects of the Activities-Specific Balance Confidence Scale when used in a new cultural context. OBJECTIVE: To investigate by using Rasch analysis the psychometric properties of the Activities-Specific Balance Confidence (ABC) Scale when applied in a new Icelandic context. DESIGN: Cross-sectional, population-based, random selection from the Icelandic National Registry. SETTING: Community-based. PARTICIPANTS: Icelanders (N=183), 65 to 88 years old, and 48% women. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: ABC, an instrument used to evaluate how confident older people are in maintaining balance and remaining steady when moving through the environment. An Icelandic translation of the ABC (ABC-ICE) scale was evaluated by implementing Rasch rating scale analysis to transform ordinal ABC-ICE scores into interval measures and evaluating aspects of validity and reliability of the scale. RESULTS: Participants were not able to differentiate reliably between the 11 rating scale categories of the ABC-ICE. Additionally, 3 items failed to show acceptable goodness of fit to the ABC-ICE rating scale model. By collapsing categories and creating a new 5-category scale, only 1 item misfit. Removing that item resulted in a modified version of ABC-ICE with 5 categories and 15 items. Both item goodness-of-fit statistics and principal components analysis supported unidimensionality of the modified ABC-ICE. The ABC-ICE measures reliably separated the sample into at least 4 statistically distinct strata of balance confidence. Finally, the hierarchical order of item difficulties was consistent with theoretic expectations, and the items were reasonably well targeted to the balance confidence of the persons tested. CONCLUSIONS: Rasch analysis indicated a need to modify the ABC-ICE to improve its psychometric properties. Further studies are needed to determine if similar analyses of other versions of the ABC, including the original one, will yield similar results.

  • 4.
    Barnett, Cleveland T.
    et al.
    Nottingham Trent University, Nottingham, U.K. .
    Vanicek, Natalie
    University of Hull, Hull, U.K. .
    Rusaw, David
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Do predictive relationships exist between postural control and falls efficacy in unilateral transtibial prosthesis users?2018In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 99, no 11, p. 2271-2278Article in journal (Refereed)
    Abstract [en]

    Objective

    To assess whether variables from a postural control test relate to and predict falls efficacy in prosthesis users.

    Design

    Twelve-month within and between subjects repeated measures design. Participants performed the Limits of Stability (LOS) test protocol at study baseline and at 6-month follow-up. Participants also completed the Falls Efficacy Scale-International (FES-I) questionnaire, reflecting the fear of falling, and reported the number of falls monthly between study baseline and 6-month follow-up, and additionally at 9- and 12-month follow-ups.

    Setting

    University biomechanics laboratories.

    Participants

    A group of active unilateral transtibial prosthesis users of primarily traumatic etiology (PROS) (n=12) with at least one year of prosthetic experience and age and gender matched control participants (CON) (n=12).

    Interventions

    Not applicable.

    Main Outcome Measure(s)

    Postural control variables derived from centre of pressure data obtained during the LOS test, which was performed on and reported by the Neurocom Pro Balance Master, namely; reaction time (RT), movement velocity (MVL), endpoint (EPE) and maximum (MXE) excursion and directional control (DCL). Number of falls and total FES-I scores.

    Results

    During the study period, the PROS group had higher FES-I scores (U = 33.5, p =0.02), but experienced a similar number of falls, compared to the CON group. Increased FES-I score were associated with decreased EPE (R=-0.73, p=0.02), MXE (R=-0.83, p<0.01) and MVL (R=-0.7, p=0.03) in the PROS group, and DCL (R=-0.82, p<0.01) in the CON group, all in the backwards direction.

    Conclusions

    Study baseline measures of postural control, in the backwards direction only, are related to and potentially predictive of subsequent 6-month FES-I scores in relatively mobile and experienced prosthesis users.

  • 5. Berg, H.E
    et al.
    Berggren, G
    Tesch, P.A
    Dynamic neck strength training effect on pain and function1994In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 75, no 6, p. 661-665Article in journal (Refereed)
  • 6.
    Bernspång, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Fisher, Anne G.
    Department of Occupational Therapy, College of Applied Human Sciences, Colorado State University.
    Differences between persons with right or left cerebral vascular accident on the Assessment of Motor and Process Skills1995In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 76, no 12, p. 1144-1151Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Persons with right and left cerebral vascular accident (RCVA and LCVA) differ in terms of discrete impairments, but there is limited information with regard to how such impairments translate into differences in disability. The following hypotheses were tested: (1) persons with stroke have lower instrumental or domestic activities of daily living (IADL) ability than do matched nondisabled controls, (2) persons with RCVA do not differ from persons with LCVA in IADL ability, and (3) persons with RCVA and LCVA differ in specific motor and process skills that affect IADL performance.

    DESIGN: Descriptive comparison.

    SETTING: Subjects were tested in settings where rehabilitation services were received (home or clinic).

    SUBJECTS: 71 persons with RCVA, 76 persons with LCVA, and 83 community-living nondisabled individuals drawn from the Assessment of Motor and Process Skills (AMPS) database, matched for age, gender, and number of tasks performed.

    MAIN OUTCOME MEASURE: AMPS, designed to measure type and severity of impairments manifested in the context of IADL performance. The AMPS was administered to all subjects in accordance with standardized testing procedures.

    RESULTS: The two stroke groups did not differ significantly in IADL ability, but both stroke groups had significantly lower IADL performance than did the nondisabled subjects. On the AMPS motor scale, persons with RCVA demonstrated greater impairment in pacing, transporting, and coordinating two body parts. Persons with LCVA demonstrated greater impairments in calibrating movements. No differences were found between the two groups in AMPS process skills.

    CONCLUSIONS: Persons with RCVA and LCVA have hemisphere-specific differences in motor impairments, but do not differ significantly in IADL ability.

  • 7.
    Björklund, Martin
    et al.
    Centre for Musculoskeletal Research, National Institute for Working Life, Umeå Sweden.
    Hamberg, Jern
    Stiftelsen Alfta Kurhem, Alfta Rehab Center, Alfta, Sweden.
    Crenshaw, Albert G.
    Centre for Musculoskeletal Research, National Institute for Working Life, Umeå Sweden.
    Sensory adaptation after a 2-week stretching regimen of the rectus femoris muscle2001In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 82, no 9, p. 1245-1250Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study the effects of a muscle stretching regimen for the rectus femoris muscle on subjective stretch sensation and range of motion (ROM). DESIGN: A 2 x 2 crossover design comprising 2 treatments and 2 intervention periods.

    SETTING: A military base in Sweden.

    PARTICIPANTS: A volunteer sample of 29 male military conscripts divided into 2 groups, with each group subjected to both experimental and control treatments at different time periods.

    INTERVENTION: Two weeks of supervised stretching (4 times/wk) of the rectus femoris muscle (experimental treatment) and the calf muscles (control treatment).

    MAIN OUTCOME MEASURES: Subjective rating of the stretch sensation for the anterior aspect of the thigh determined on a category ratio scale. Passive knee flexion ROM determined on each test with the same applied torque, specific for each subject.

    RESULTS: An additive analysis of variance revealed that the stretch sensation after the experimental treatment was decreased, compared with the control treatment (p <.01). The knee flexion, however, remained the same regardless of the treatment.

    CONCLUSION: Sensory adaptation seems to be an important mechanistic factor in the effect stretching has on ROM changes. The lack of change in knee flexion suggests that the stretching, as performed in this study, did not influence stiffness of the rectus femoris muscle. Sensory adaptation may also be an underlying mechanism in the alleviating effect of stretching when applied to tired, tender, and painful muscles.

  • 8.
    Björklund, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Hamberg, Jern
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Crenshaw, Albert G
    Sensory adaptation after a 2-week stretching regimen of the rectus femoris muscle2001In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 82, no 9, p. 1245-1250Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study the effects of a muscle stretching regimen for the rectus femoris muscle on subjective stretch sensation and range of motion (ROM). DESIGN: A 2 x 2 crossover design comprising 2 treatments and 2 intervention periods. SETTING: A military base in Sweden. PARTICIPANTS: A volunteer sample of 29 male military conscripts divided into 2 groups, with each group subjected to both experimental and control treatments at different time periods. INTERVENTION: Two weeks of supervised stretching (4 times/wk) of the rectus femoris muscle (experimental treatment) and the calf muscles (control treatment). MAIN OUTCOME MEASURES: Subjective rating of the stretch sensation for the anterior aspect of the thigh determined on a category ratio scale. Passive knee flexion ROM determined on each test with the same applied torque, specific for each subject. RESULTS: An additive analysis of variance revealed that the stretch sensation after the experimental treatment was decreased, compared with the control treatment (p <.01). The knee flexion, however, remained the same regardless of the treatment. CONCLUSION: Sensory adaptation seems to be an important mechanistic factor in the effect stretching has on ROM changes. The lack of change in knee flexion suggests that the stretching, as performed in this study, did not influence stiffness of the rectus femoris muscle. Sensory adaptation may also be an underlying mechanism in the alleviating effect of stretching when applied to tired, tender, and painful muscles.

  • 9.
    Brodtkorb, Thor-Henrik
    et al.
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Henriksson, Martin
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Arts and Sciences.
    Johannesen-Munk, Kasper
    Thidell, Fredrik
    Cost-effectiveness of C-Leg compared to non microprocessor controlled knees: a modeling approach2008In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 89, no 1, p. 24-30Article in journal (Refereed)
    Abstract [en]

    Objective: To estimate the costs and health outcomes of C-Leg and non–microprocessor-controlled (NMC) knees using a decision-analytic model.

    Design: Data on costs, rates and duration of problems, knee survival, and health-related quality of life were obtained from interviews with patients and prosthetists with experience of both C-Leg and NMC knees. Interview data were assessed in a decision-analytic Markov model to estimate cost-effectiveness from a health care perspective.

    Setting: Outpatient.

    Participants: A population sample of 20 patients currently using the C-Leg and prior experience of nonmicroprocessor knees, and 5 prosthetists.

    Interventions: Not applicable.

    Main Outcome Measure: Incremental cost per quality-adjusted life year (QALY).

    Results: The mean incremental cost (in 2006 Euros) and QALYs for the C-Leg was €7657 and 2.38, respectively, yielding a cost per QALY gained of €3218.

    Conclusions: It is important to provide decision-makers with relevant information on costs and health outcomes of different treatment strategies on actual decision problems despite limited evidence. The results of the study, taking into account both costs and a broadly defined health outcome in terms of QALY, show that given existing albeit limited evidence the C-Leg appears to yield positive health outcomes at an acceptable cost.

  • 10.
    Brodtkorb, Thor-Henrik
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Rehabilitation.
    Henriksson, Martin
    Johannesen-Munk, Kasper
    Jönköping University, School of Health Science, HHJ, Dep. of Rehabilitation.
    Thidell, Fredrik
    Jönköping University, School of Health Science, HHJ, Dep. of Rehabilitation.
    Cost-effectiveness of C-leg compared with non-microprocessor-controlled knees: a modeling approach.2008In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 89, no 1, p. 24-30Article in journal (Refereed)
  • 11.
    Brodtkorb, Thor-Henrik
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Henriksson, Martin
    AstraZeneca.
    Munk Johannesen, Kasper
    CPO, England .
    Letter: Cost-Effectiveness of Microprocessor-Controlled Prosthetic Knees Response2010In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 91, no 4, p. 664-664Article in journal (Other academic)
    Abstract [en]

    n/a

  • 12.
    Brogårdh, Christina
    et al.
    Skåne University Hospital, Lund.
    Flansbjer, Ulla-Britt
    Lund University.
    Lexell, Jan
    Luleå University of Technology, Department of Health Sciences, Medical Science.
    No effects of whole-body vibration training on muscle strength and gait performance in persons with late effects of polio: a pilot study2010In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 91, no 9, p. 1474-1477Article in journal (Refereed)
    Abstract [en]

    ObjectiveTo evaluate the feasibility and possible effects of whole-body vibration (WBV) training on muscle strength and gait performance in people with late effects of polio.DesignA case-controlled pilot study with assessments before and after training.SettingA university hospital rehabilitation department.ParticipantsPeople (N=5; 3 men, 2 women; mean age, 64±6.7y; range, 55-71y) with clinically and electrophysiologically verified late effects of polio.InterventionsAll participants underwent 10 sessions of supervised WBV training (standing with knees flexed 40°-55° up to 60 seconds per repetition and 10 repetitions per session twice weekly for 5 weeks).Main Outcome MeasuresIsokinetic and isometric knee muscle strength (dynamometer), and gait performance (Timed Up & Go, Comfortable Gait Speed, Fast Gait Speed, and six-minute walk tests).ResultsAll participants completed the 5 weeks of WBV training, with no discernible discomfort. No significant changes in knee muscle strength or gait performance were found after the WBV training period.ConclusionsThis pilot study did not show any significant improvements in knee muscle strength and gait performance following a standard protocol of WBV training. Thus, the results do not lend support to WBV training for people with late effects of polio.

  • 13.
    Brogårdh, Christina
    et al.
    Lund University Hospital.
    Lexell, Jan
    Luleå University of Technology, Department of Health Sciences, Medical Science.
    A 1-year follow-up after shortened constraint-induced movement therapy with and without mitt poststroke2010In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 91, no 3, p. 460-464Article in journal (Refereed)
    Abstract [en]

    ObjectiveTo explore the long-term benefits of shortened constraint-induced movement therapy (CIMT) in the subacute phase poststroke.DesignA 1-year follow-up after shortened CIMT (3h training/d for 2wk) where the participants had been randomized to a mitt group or a nonmitt group.SettingA university hospital rehabilitation department.ParticipantsPoststroke patients (N=20, 15 men, 5 women; mean age 58.8y; on average 14.8mo poststroke) with mild to moderate impairments of hand function.InterventionsNot applicable.Main Outcome MeasuresThe Sollerman hand function test, the modified Motor Assessment Scale, and the Motor Activity Log test. Assessments were made by blinded observers.ResultsOne year after shortened CIMT, participants within both the mitt group and the nonmitt group showed statistically significant improvements in arm and hand motor performance and on self-reported motor ability compared with before and after treatment. No significant differences between the groups were found in any measure at any time.ConclusionsShortened CIMT seems to be beneficial up to 1 year after training, but the restraint may not enhance upper motor function. To determine which components of CIMT are most effective, larger randomized studies are needed.

  • 14. Broström, Eva
    et al.
    Nordlund Ekblom, Maria M
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Laboratory for Biomechanics and Motor Control.
    Cresswell, Andrew G
    Plantar- and dorsiflexor strength in prepubertal girls with juvenile idiopathic arthritis.2004In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 85, no 8, p. 1224-30Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To compare lower-leg strength of young girls with polyarticular juvenile idiopathic arthritis (JIA) with that of healthy, age-matched controls. DESIGN: Isometric and isokinetic strength tests of the plantar- and dorsiflexors. All strength measures were made at an ankle angle of 90 degrees. Isokinetic plantar- and dorsiflexor measures were made at 15 degrees/s during shortening (concentric) and lengthening (eccentric) actions. SETTING: Strength testing laboratory. PARTICIPANTS: Ten prepubertal girls diagnosed with JIA and 10 healthy girls. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Isometric and isokinetic plantar- and dorsiflexor strength. RESULTS: Isometric plantar- and dorsiflexion torques were significantly lower (48% and 38% respectively; P<.05) for the children with JIA than for the controls. The JIA group also produced lower shortening plantarflexion torques (52%, P<.05). Lengthening plantarflexor torques did not differ significantly between the 2 groups (P<.05). Controls were stronger than the JIA group for both shortening and lengthening maximal dorsiflexor actions (P<.05). All children were 4 to 5 times stronger in plantarflexion than in dorsiflexion. CONCLUSIONS: Girls with JIA had significantly less plantar- and dorsiflexor strength than age-matched, healthy peers. The reduced strength of children with JIA is likely to affect function in daily activities and probably contributes to reduced levels of physical activity.

  • 15. Cancelliere, Carol
    et al.
    Hincapié, Cesar A
    Keightley, Michelle
    Godbolt, Alison K
    Coté, Pierre
    Kristman, Vicki L
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Caroll, Linda J
    Hung, Ryan
    Borg, Jörgen
    Nygren-de Boussard, Chatarina
    Coronado, Victor G
    Donovan, James
    Cassidy, J David
    Systematic review of prognosis and return to play after sport concussion: results of the international collaboration on mild traumatic brain injury prognosis2014In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 95, no 3, Suppl, p. S210-S229Article, review/survey (Refereed)
    Abstract [en]

    Objective

    To synthesize the best available evidence on prognosis after sport concussion.

    Data Sources

    MEDLINE and other databases were searched (2001–2012) with terms including “craniocerebral trauma” and “sports.” Reference lists of eligible articles were also searched.

    Study Selection

    Randomized controlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to have a minimum of 30 concussion cases.

    Data Extraction

    Eligible studies were critically appraised using a modification of the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Two reviewers independently reviewed and extracted data from accepted studies into evidence tables.

    Data Synthesis

    Evidence was synthesized qualitatively according to modified SIGN criteria, and studies were categorized as exploratory or confirmatory based on the strength of their design and evidence. After 77,914 records were screened, 52 articles were eligible for this review, and 24 articles (representing 19 studies) with a low risk of bias were accepted. Our findings are based on exploratory studies of predominantly male football players at the high school, collegiate, and professional levels. Most athletes recover within days to a few weeks, and American and Australian professional football players return to play quickly after mild traumatic brain injury. Delayed recovery appears more likely in high school athletes, in those with a history of previous concussion, and in those with a higher number and duration of postconcussion symptoms.

    Conclusions

    The evidence concerning sports concussion course and prognosis is very preliminary, and there is no evidence on the effect of return-to-play guidelines on prognosis. Our findings have implications for further research. Well-designed, confirmatory studies are urgently needed to understand the consequences of sport concussion, including recurrent concussion, across different athletic populations and sports.

  • 16. Cancelliere, Carol
    et al.
    Kristman, Vicki L
    Cassidy, J David
    Hincapié, Cesar A
    Coté, Pierre
    Boyle, Eleanor
    Carroll, Linda J
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Nygren-de Boussard, Catharina
    Borg, Jörgen
    Systematic review of return to work after mild traumatic brain injury: results of the international collaboration on mild traumatic brain injury prognosis2014In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 95, no 3, Suppl, p. S201-S209Article, review/survey (Refereed)
    Abstract [en]

    Objective

    To synthesize the best available evidence on return to work (RTW) after mild traumatic brain injury (MTBI).

    Data Sources

    MEDLINE and other databases were searched (2001–2012) with terms including “craniocerebral trauma” and “employment.” Reference lists of eligible articles were also searched.

    Study Selection

    Controlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to assess RTW or employment outcomes in at least 30 MTBI cases.

    Data Extraction

    Eligible studies were critically appraised using a modification of the Scottish Intercollegiate Guidelines Network criteria. Two reviewers independently reviewed and extracted data from accepted studies into evidence tables.

    Data Synthesis

    Evidence was synthesized qualitatively according to modified Scottish Intercollegiate Guidelines Network criteria and prioritized according to design as exploratory or confirmatory. After 77,914 records were screened, 299 articles were found eligible and reviewed; 101 (34%) of these with a low risk of bias were accepted as scientifically admissible, and 4 of these had RTW or employment outcomes. This evidence is preliminary and suggests that most workers RTW within 3 to 6 months after MTBI; MTBI is not a significant risk factor for long-term work disability; and predictors of delayed RTW include a lower level of education (<11y of formal education), nausea or vomiting on hospital admission, extracranial injuries, severe head/bodily pain early after injury, and limited job independence and decision-making latitude.

    Conclusions

    Our findings are based on preliminary evidence with varied patient characteristics and MTBI definitions, thus limiting firm conclusions. More well-designed studies are required to understand RTW and sustained employment after MTBI in the longer term (≥2y post-MTBI).

  • 17.
    Dedering, Asa
    et al.
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Cleland, Joshua A.
    Franklin Pierce Univ, NH USA.
    Halvorsen, Marie
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Svensson, Mikael A.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Kierkegaard, Marie
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    The Effects of Neck-Specific Training Versus Prescribed Physical Activity on Pain and Disability in Patients With Cervical Radiculopathy: A Randomized Controlled Trial2018In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 99, no 12, p. 2447-2456Article in journal (Refereed)
    Abstract [en]

    Objective: To compare the effects of a neck-specific training program to prescribed physical activity with both groups receiving a cognitive behavioral approach, on pain and disability in patients with cervical radiculopathy (CR). Design: Parallel-group randomized clinical trial with follow-up at 3, 6, 12, and 24 months. Setting: Recruitment and assessments of participants were performed at a university hospital. Interventions were performed in primary care setting at outpatient physiotherapy clinics. Participants: Patients (N=144) with CR were recruited to participate in this clinical trial. Interventions: Patients were randomly assigned to 3 months of either of a neck-specific training program or prescribed physical activity. Main Outcome Measures: Primary outcomes included self-rated neck and arm pain as collected by the visual analog scale (VAS). Secondary outcomes were self-rated headache measured with the VAS, the Neck Disability Index, the EuroQol 5D, the Fear Avoidance Beliefs Questionnaire, and the Hospital Anxiety and Depression Scale. Assessments were performed at baseline and at 3-, 6-, 12-, and 24-month follow-up periods. Results: Intention-to-treat and per-protocol analyses showed no significant interaction (group x time) or group effects. There were, however, significant time effects indicating improvement over time for both groups for all outcomes except for levels of depression. Conclusions: The study revealed that neck-specific training as well as prescribed physical activity both including additional cognitive behavioral approach decreased the pain in patients with CR, that is, participants improved regardless of the intervention received. There is a lack of consensus of how to best manage individuals with CR. However, our findings suggest that CR has a natural favorable long-term outcome when patients are prescribed neck-specific training and exercise in combination with a behavioral approach. (C) 2018 by the American Congress of Rehabilitation Medicine

  • 18.
    Elmgren Frykberg, Gunilla
    et al.
    Department of Neuroscience, Rehabilitation Medicine, Uppsala University.
    Åberg, Anna Cristina
    Department of Public Health and Caring Sciences/Geriatrics, Uppsala University; Swedish School of Sport and Health Sciences, Stockholm, Sweden.
    Halvorsen, Kjartan
    Department of Information Technology, Division of Systems and Control, Uppsala University; School of Technology and Health, the Royal Institute of Technology, Stockholm, Sweden.
    Borg, Jörgen
    Department of Neuroscience/Rehabilitation Medicine, Uppsala University, Uppsala, Sweden.
    Hirschfeld, Helga
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy.
    Temporal coordination of the sit-to-walk task in subjects with stroke and in controls2009In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 90, no 6, p. 1009-1017Article in journal (Refereed)
    Abstract [en]

    Objectives: To explore events and describe phases for temporal coordination of the sit-to-walk (STW) task, within a semistandardized set up, in subjects with stroke and matched controls. In addition, to assess variability of STW phase duration and to compare the relative duration of STW phases between the 2 groups.

    Design: Cross-sectional.

    Setting: Research laboratory.

    Participants: A convenience sample of persons with hemiparesis (n=10; age 50–67y), more than 6 months after stroke and 10 controls matched for sex, age, height, and body mass index.

    Interventions: Not applicable.

    Main Outcome Measures: Relative duration of STW phases, SE of measurement in percentage of the mean, and intraclass correlation coefficients (ICCs).

    Results: Four STW phases were defined: rise preparation, transition, primary gait initiation, and secondary gait initiation. The subjects with stroke needed 54% more time to complete the STW task than the controls did. ICCs ranged from .38 to .66 and .22 to .57 in the stroke and control groups, respectively. SEs of measurement in percentage of the mean values were high, particularly in the transition phase: 54.1% (stroke) and 50.4% (controls). The generalized linear model demonstrated that the relative duration of the transition phase was significantly longer in the stroke group.

    Conclusions: The present results extend existing knowledge by presenting 4 new phases of temporal coordination of STW, within a semistandardized set-up, in persons with stroke and in controls. The high degree of variability regarding relative STW phase duration was probably a result of both the semistandardized set up and biological variability. The significant difference in the transition phase across the 2 groups requires further study.

  • 19.
    Elmgren Frykberg, Gunilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine.
    Åberg, Anna Cristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Halvorsen, Kjartan
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Automatic control.
    Borg, Jörgen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine.
    Hirschfeld, Helga
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy.
    Temporal coordination of the sit-to-walk task in subjects with stroke and in controls2009In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 90, no 6, p. 1009-1017Article in journal (Refereed)
    Abstract [en]

    Objectives: To explore events and describe phases for temporal coordination of the sit-to-walk (STW) task, within a semistandardized set up, in subjects with stroke and matched controls. In addition, to assess variability of STW phase duration and to compare the relative duration of STW phases between the 2 groups.

    Design: Cross-sectional.

    Setting: Research laboratory.

    Participants: A convenience sample of persons with hemiparesis (n=10; age 50–67y), more than 6 months after stroke and 10 controls matched for sex, age, height, and body mass index.

    Interventions: Not applicable.

    Main Outcome Measures: Relative duration of STW phases, SE of measurement in percentage of the mean, and intraclass correlation coefficients (ICCs).

    Results: Four STW phases were defined: rise preparation, transition, primary gait initiation, and secondary gait initiation. The subjects with stroke needed 54% more time to complete the STW task than the controls did. ICCs ranged from .38 to .66 and .22 to .57 in the stroke and control groups, respectively. SEs of measurement in percentage of the mean values were high, particularly in the transition phase: 54.1% (stroke) and 50.4% (controls). The generalized linear model demonstrated that the relative duration of the transition phase was significantly longer in the stroke group.

    Conclusions: The present results extend existing knowledge by presenting 4 new phases of temporal coordination of STW, within a semistandardized set-up, in persons with stroke and in controls. The high degree of variability regarding relative STW phase duration was probably a result of both the semistandardized set up and biological variability. The significant difference in the transition phase across the 2 groups requires further study.

  • 20. Elmståhl, Sölve
    et al.
    Malmberg, Bo
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Annerstedt, Lena
    Caregiver's Burden of Patients 3 Years After Stroke Assessed by a Novel Caregiver Burden Scale1996In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 77, no 2, p. 177-82Article in journal (Refereed)
  • 21.
    Emtner, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Finne, Merja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Stålenheim, Gunnemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    A 3-year follow-up of asthmatic patients participating in a 10-week rehabilitation program with emphasis on physical training1998In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 79, no 5, p. 539-544Article in journal (Refereed)
    Abstract [en]

    Objective: To determine if asthmatic patients who had participated in a 10-week rehabilitation program with emphasis on physical training (1) continued with physical training, (2) maintained their improved cardiovascular condition and lung function, and (3) retained their good asthma control through the following 3 years.

    Design: A descriptive 3-year follow-up study.

    Patients and Setting: A convenience sample of 58 patients who had previously undergone a 10-week outpatient rehabilitation program were followed up 6 months and 1, 1.5, 2, and 3 years after the start of the program at a lung clinic in a university hospital.

    Main Outcome Measures: A training log was kept by each patient to record frequency, intensity, and mode of training. Physical condition was evaluated with a submaximal 6-minute ergometry test and a 12-minute walking test, respiratory function with static and dynamic spirometry, and bronchial hyperreactivity with a metacholine provocation test. Asthma symptoms and asthma control were measured with a study-specific questionnaire.

    Results: Thirty-nine subjects (68%) exercised regularly during all 3 years. The cardiovascular condition and lung function values remained almost unchanged in all 58 patients. There was a significant decrease in number of emergency room visits the year after the 10-week rehabilitation program compared to the year before. It remained stable throughout the following 2 years. There was also a decrease in asthma symptoms in all patients, but the decrease was significant only in a subgroup of 26 patients, who exercised one or two times a week.

    Conclusions: It is possible for asthmatic subjects to exercise at a moderate intensity level on a long-term basis without deleterious effects. Moreover, the high compliance rate might indicate that inactive asthmatic patients who are taught how to exercise choose to continue to be physically active.

  • 22.
    Feldthusen, C.
    et al.
    University of Gothenburg, Sweden.
    Dean, Elizabeth
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. University of British Columbia, Vancouver, BC, Canada; .
    Forsblad-D'Elia, H.
    Umeå University, Umeå, Sweden.
    Mannerkorpi, K.
    University of Gothenburg, Sweden.
    Effects of person-centered physical therapy on fatigue-related variables in persons with rheumatoid arthritis: A randomized controlled trial2016In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 97, no 1, p. 26-36Article in journal (Refereed)
    Abstract [en]

    Objective To examine effects of person-centered physical therapy on fatigue and related variables in persons with rheumatoid arthritis (RA). Design Randomized controlled trial. Setting Hospital outpatient rheumatology clinic. Participants Persons with RA aged 20 to 65 years (N=70): intervention group (n=36) and reference group (n=34). Interventions The 12-week intervention, with 6-month follow-up, focused on partnership between participant and physical therapist and tailored health-enhancing physical activity and balancing life activities. The reference group continued with regular activities; both groups received usual health care. Main Outcome Measures Primary outcome was general fatigue (visual analog scale). Secondary outcomes included multidimensional fatigue (Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire) and fatigue-related variables (ie, disease, health, function). Results At posttest, general fatigue improved more in the intervention group than the reference group (P=.042). Improvement in median general fatigue reached minimal clinically important differences between and within groups at posttest and follow-up. Improvement was also observed for anxiety (P=.0099), and trends toward improvements were observed for most multidimensional aspects of fatigue (P=.023-.048), leg strength/endurance (P=.024), and physical activity (P=.023). Compared with the reference group at follow-up, the intervention group improvement was observed for leg strength/endurance (P=.001), and the trends toward improvements persisted for physical (P=.041) and living-related (P=.031) aspects of fatigue, physical activity (P=.019), anxiety (P=.015), self-rated health (P=.010), and self-efficacy (P=.046). Conclusions Person-centered physical therapy focused on health-enhancing physical activity and balancing life activities showed significant benefits on fatigue in persons with RA. 

  • 23. Feldthusen, Caroline
    et al.
    Dean, Elizabeth
    Forsblad-d'Elia, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Mannerkorpi, Kaisa
    Effects of Person-Centered Physical Therapy on Fatigue-Related Variables in Persons With Rheumatoid Arthritis: A Randomized Controlled Trial2016In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 97, no 1, p. 26-36Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To examine effects of person-centered physical therapy on fatigue and related variables in persons with rheumatoid arthritis (RA).

    DESIGN: Randomized controlled trial.

    SETTING: Hospital outpatient rheumatology clinic.

    PARTICIPANTS: Persons with RA aged 20-65y (n=70); intervention-group (n=36) and reference-group (n=34).

    INTERVENTION: The 12-week intervention, with 6-month follow-up, focused on partnership between participant and physical therapist, and tailored health-enhancing physical activity and balancing life activities. The reference-group continued with regular activities; both groups received usual healthcare.

    MAIN OUTCOME MEASURES: Primary outcome was general fatigue (Visual Analogue Scale, VAS). Secondary outcomes included multidimensional fatigue (Bristol Rheumatoid Arthritis Fatigue - Multi-Dimensional Questionnaire, BRAF-MDQ), and fatigue-related variables, i.e., disease, health and function.

    RESULTS: At posttest, general fatigue improved more in the intervention-group than reference-group (p=0.042). Improvement in median general fatigue reached minimal clinically important difference between and within groups at posttest and follow-up. Improvement was also observed for anxiety (p=0.0099) and trends toward improvements was observed for most multidimensional aspects of fatigue (p=0.023-p=0.048), leg strength/endurance (p=0.024) and physical activity (p=0.023). Compared with the reference-group at follow-up, intervention-group improvement was observed for leg strength/endurance (p=0.001) and the trends toward improvements persisted for physical (p=0.041) and living-related (p=0.031) aspects of fatigue, physical activity (p=0.019) and anxiety (p=0.015) and self-rated health (p=0.010) and self-efficacy (p=0.046).

    CONCLUSIONS: Person-centered physical therapy focused on health-enhancing physical activity and balancing life activities, showed significant benefits on fatigue in persons with RA.

  • 24. Frykberg, Gunilla E.
    et al.
    Aberg, Anna Cristina
    Halvorsen, Kjartan
    KTH, School of Technology and Health (STH), Medical Engineering.
    Borg, Jorgen
    Hirschfeld, Helga
    Temporal Coordination of the Sit-to-Walk Task in Subjects With Stroke and in Controls2009In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 90, no 6, p. 1009-1017Article in journal (Refereed)
    Abstract [en]

    Objectives: To explore events and describe phases for temporal coordination of the sit-to-walk (STW) task, within a semi standardized set up, in subjects with stroke and matched controls. In addition, to assess variability of STW phase duration and to compare the relative duration of STW phases between the 2 groups. Design: Cross-sectional. Setting: Research laboratory. Participants: A convenience sample of persons with hemiparesis (n=10; age 50-67y) more than 6 months after stroke and 10 controls matched for sex, age, height, and body mass index. Interventions: Not applicable. Main Outcome Measures: Relative duration of STW phases, SE of measurement in percentage of the mean, and intraclass correlation coefficients (ICCs). Results: Four STW phases were defined: rise preparation, transition, primary gait initiation, and secondary gait initiation. The Subjects with stroke needed 54% more time to complete the STW task than the controls did. ICCs ranged from .38 to .66 and .22 to .57 in the stroke and control groups, respectively. SEs of measurement in percentage of the mean values were high, particularly in the transition phase: 54.1% (stroke) and 50.4% (controls). The generalized linear model demonstrated that the relative duration of the transition phase was significantly longer in the stroke group. Conclusions: The present results extend existing knowledge by presenting 4 new phases of temporal coordination of STW, within a semistandardized set-up, in persons with stroke and in controls. The high degree of variability regarding relative STW phase duration was probably a result of both the semistandardized Set up and biological variability. The significant difference in the transition phase across the 2 groups requires further study.

  • 25.
    Godbolt, Alison K.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine.
    Stenson, Staffan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine.
    Winberg, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine.
    Frykberg, Gunilla E.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine.
    Tengvar, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine.
    Disorders of Consciousness: Recommendations Are Welcome but Further Guidance is Needed2011In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 92, no 7, p. 1181-1181Article in journal (Refereed)
  • 26.
    Hamberg, Jern
    et al.
    Stiftelsen Alfta Kurhem, Alfta Rehab Center, Alfta, Sweden.
    Björklund, Martin
    Centre for Musculoskeletal Research, National Institute for Working Life, Umeå Sweden.
    Nordgren, Bengt
    Sahlstedt, Bo
    Stretchability of the rectus femoris muscle: Investigation of validity and intratester reliability of two methods including x-ray analysis of pelvic tilt1993In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 74, no 3, p. 263-270Article in journal (Refereed)
    Abstract [en]

    Validity and intratester reliability of two test methods designed to identify stretchability of the rectus femoris muscle (RFM) was investigated, combined with x-ray analysis of pelvic tilt in the sagittal plane. The first method is commonly used in clinical practice. The second is a new technique supposed to tilt the pelvis posteriorly and thus further separate the origin and insertion of the muscle. Investigation of validity and intratester reliability of the two methods was made by testing and retesting a random sample of 71 persons. The tests were performed with an equipment that automatically recorded the angle of knee flexion from a previously determined applied torque, indicating the end point of motion for that particular subject. Angle of knee flexion and subjective estimation of pain sensation due to stretch were recorded at each measurement. The pelvic tilt-analysis consisted of test-retest reliability of x-ray measurements, comparison be- tween the methods in both starting and final position, and x-ray and electronic goniometer measurements. All applied torques were measured with a strain gauge. Two out of three criteria of validity favored the new method and the third pointed out the two methods as equal. The two methods as well as the x-ray measurements showed high reliability, and the hypothesis of a more posterior tilted pelvis in the new method was confirmed. The electronic goniometer was less sensitive than x-ray, but proposed to analyse pelvic tilt clinically. Methodology procedures for joint angle measurements are discussed.

  • 27. Hamberg, Jern
    et al.
    Björklund, Martin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Nordgren, Bengt
    Sahlstedt, Bo
    Stretchability of the rectus femoris muscle: investigation of validity and intratester reliability of two methods including x-ray analysis of pelvic tilt.1993In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 74, no 3, p. 263-270Article in journal (Refereed)
    Abstract [en]

    Validity and intratester reliability of two test methods designed to identify stretchability of the rectus femoris muscle (RFM) was investigated, combined with x-ray analysis of pelvic tilt in the sagittal plane. The first method is commonly used in clinical practice. The second is a new technique supposed to tilt the pelvis posteriorly and thus further separate the origin and insertion of the muscle. Investigation of validity and intratester reliability of the two methods was made by testing and retesting a random sample of 71 persons. The tests were performed with an equipment that automatically recorded the angle of knee flexion from a previously determined applied torque, indicating the end point of motion for that particular subject. Angle of knee flexion and subjective estimation of pain sensation due to stretch were recorded at each measurement. The pelvic tilt-analysis consisted of test-retest reliability of x-ray measurements, comparison between the methods in both starting and final position, and x-ray and electronic goniometer measurements. All applied torques were measured with a strain gauge. Two out of three criteria of validity favored the new method and the third pointed out the two methods as equal. The two methods as well as the x-ray measurements showed high reliability, and the hypothesis of a more posterior tilted pelvis in the new method was confirmed. The electronic goniometer was less sensitive than x-ray, but proposed to analyse pelvic tilt clinically. Methodology procedures for joint angle measurements are discussed.

  • 28.
    Hu, Xiaolei
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Heyn, Patricia C.
    Schwartz, Jaclyn
    Roberts, Pamela
    What is mild stroke?2017In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 98, no 11, p. 2347-2349Article, review/survey (Refereed)
  • 29.
    Hu, Xiaolei
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Heyn, Patricia C.
    Schwartz, Jaclyn
    Roberts, Pamela
    What Is Mild Stroke?2017In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 98, no 11, p. 2347-2349Article in journal (Refereed)
  • 30. Hung, Ryan
    et al.
    Carroll, Linda J
    Cancelliere, Carol
    Coté, Pierre
    Rumney, Peter
    Keightley, Michelle
    Donovan, James
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Cassidy, J David
    Systematic Review of the Clinical Course, Natural History, and Prognosis for Pediatric Mild Traumatic Brain Injury: Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis2014In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 95, no 3, Suppl, p. S174-S191Article, review/survey (Refereed)
    Abstract [en]

    Objective

    To synthesize the best available evidence on prognosis after pediatric mild traumatic brain injury (MTBI).

    Data Sources

    We searched MEDLINE, Embase, PsycINFO, CINAHL, and SPORTDiscus (2001–2012), as well as reference lists of eligible articles, and relevant systematic reviews and meta-analyses.

    Study Selection

    Controlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to have a minimum of 30 MTBI pediatric cases. After 77,914 records were screened for the entire review, 299 studies were eligible and assessed for scientific rigor.

    Data Extraction

    Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Two reviewers independently reviewed each study and extracted data from accepted articles into evidence tables.

    Data Synthesis

    Evidence from 25 accepted articles was synthesized qualitatively according to SIGN criteria, and prognostic information was prioritized according to design as exploratory or confirmatory. Most studies show that postconcussion symptoms and cognitive deficits resolve over time. Limited evidence suggests that postconcussion symptoms may persist in those with lower cognitive ability and intracranial pathology on neuroimaging. Preliminary evidence suggests that the risk of epilepsy is increased for up to 10 years after MTBI; however, there is insufficient high-quality evidence at this time to support this link.

    Conclusions

    Common post-MTBI symptoms and deficits in children are not specific to MTBI and appear to resolve with time; however, limited evidence suggests that children with intracranial pathology on imaging may experience persisting symptoms or deficits. Well-designed, long-term studies are needed to confirm these findings.

  • 31.
    Jarl, Gustav M.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Heinemann, Allen W
    Rehabilitation Institute of Chicago, Chicago IL, United States; Feinberg School of Medicine, Northwestern University, Chicago IL, United States.
    Lindner, Helen Y
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hermansson, Liselotte M N
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Cross-cultural validity and differential item functioning of the Orthotics and Prosthetics Users’ Survey with Swedish and American users of lower-limb prosthesis2015In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 96, no 9, p. 1615-1626Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the cross-cultural validity of the Orthotics and Prosthetics Users’ Survey (OPUS), to evaluate differential item functioning (DIF) related to country, sex, age, amputation level, and amputated side (unilateral, bilateral), and to determine known-group validity of the OPUS.

    Design: Survey.

    Setting: Outpatient clinics.

    Participants: The sample (NZ321) consisted of Swedish (nZ195) and U.S. (nZ126) adults using lower-limb prostheses.

    Interventions: Not applicable.

    Main Outcome Measures: Four OPUS modules were used: lower extremity functional status, client satisfaction with device (CSD), client satisfaction with services (CSS), and health-related quality of life. Rasch analysis was used to calculate measures for persons and items.

    Results: The cross-cultural validity was satisfactory. Many items demonstrated DIF related to country and demographic characteristics, but the impact on mean person measures was negligible. The rating scales of CSD and CSS needed adjustments, and the unidimensionality of CSD and CSS was weak. The differences between the mean measures of known patient groups were statistically significant for 2 out of 6 comparisons.

    Conclusions: This study supports the validity of OPUS measure comparisons between Sweden and the United States and between subgroups with different demographic characteristics. Some of the country-related DIF may reflect the different health care financing systems. The findings demonstrate that the OPUS can discriminate between certain patient groups. The results also challenge some of our preconceptions about persons with bilateral amputation, indicating that we might know these persons less well than we think.

  • 32.
    Kennedy, Paul
    et al.
    University of Oxford, Oxford Doctoral Course in Clinical Psychology and Stoke Mandeville Hospital, The National Spinal Injuries Centre, Department of Clinical Psychology.
    Lude, Peter
    Swiss Paraplegic Centre, Nottwil and Zurich University of Applied Sciences, School of Applied Psychology.
    Elfström, Magnus
    Mälardalen University, School of Sustainable Development of Society and Technology.
    Smithson, Emily
    Stoke Mandeville Hospital, The National Spinal Injuries Centre, Department of Clinical Psychology.
    Psychological contributions to functional independence: A longitudinal investigation of spinal cord injury rehabilitation2011In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 92, no 4, p. 597-602Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the contribution of pre-rehabilitation appraisals of spinal cord injury and patient’s coping strategies to the variance in functional independence post discharge.

    Design: Longitudinal, cohort study. Patients sustaining a spinal cord injury aged 16 or above were recruited from English and German speaking specialist spinal injuries centres. Measures of appraisals, coping strategies, mood and functional independence were administered on commencing active rehabilitation (12 weeks post injury) and following hospital discharge (1 year post injury).

    Setting: Specialist spinal cord injury rehabilitation centres in England,Germany,Switzerland andIreland.

    Participants: One hundred and twenty seven patients completed questionnaires at both time points. Sample age ranged between 17.5 and 64.5 with a mean age of 39.3. Demographic and injury characteristics were similar to those reported in international statistics databases.

    Interventions: Not Applicable

    Main Outcome Measure:  Functional Independence Measure (FIM; motor subscale).

    Results: Injury characteristics, age, gender, current depression and the utilization of the coping strategy ‘social reliance’ at twelve weeks post injury explained 33.5% of the variance in motor FIM at one year post injury. Strong relationships were found between appraisals, coping styles, mood and functional outcomes.

    Conclusion: The coping strategy ‘Social Reliance’ was found to contribute significantly when explaining the variance in functional outcomes. Suggestions are made to assess appraisals and coping strategies early in rehabilitation in order to provide effective interventions and additional support to those scoring highly on negative coping styles. Further research would be recommended to provide support for the relationship between dependent coping strategies and functional outcomes.

  • 33. Kim, Sonya
    et al.
    Mortera, Marianne
    Hoffecker, Lilian
    Herrold, Amy
    King, Laurie
    Terhorst, Lauren
    Hu, Xiaolei
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Shilpa, Krishnan
    Machtinger, Joseph
    Heyn, Patricia
    An Umbrella Review of Systematic Reviews of Pharmacological Treatments Post-TBI2017In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 98, no 10, p. 142-Article in journal (Refereed)
  • 34. Lexell, Jan
    et al.
    Flansbjer, Ulla-Britt
    Department of Rehabilitation, Lund University Hospital, Sweden.
    Downham, David
    Department of Rehabilitation, Lund University Hospital, Sweden.
    Knee muscle strength, gait performance, and perceived participation after stroke2006In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 87, no 7, p. 974-80Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess the relation between knee muscle strength, gait performance, and perceived participation in subjects with chronic mild to moderate poststroke hemiparesis. DESIGN: Descriptive analysis of convenience sample. SETTING: University hospital. PARTICIPANTS: Fifty men and women (mean age, 58+/-6.4y) 6 to 46 months poststroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Isokinetic concentric knee extension and flexion strength was measured at 60 degrees /s. Gait performance was assessed by Timed Up & Go, comfortable and fast gait speed, stair climbing ascend and descend, and 6-minute walk test. Perceived participation was assessed with the Stroke Impact Scale. RESULTS: There was a significant correlation (P < .01) between knee muscle strength and gait performance for the paretic but not for the nonparetic lower limb. Strength for the paretic limb explained 34% to 50% of the variance in gait performance; the addition of strength for the nonparetic limb explained at most a further 11% of the variance in gait performance. There was a significant correlation (P < .01) between gait performance and perceived participation; gait performance explained 28% to 40% of the variance in perceived participation. CONCLUSIONS: Knee muscle strength is a moderate to strong predictor of walking ability in individuals with chronic mild to moderate poststroke hemiparesis. Walking ability influences perceived participation, but the strengths of the relations indicate that other factors are also important

  • 35.
    Luker, Julie
    et al.
    University of Melbourne, Australia; University of S Australia, Australia.
    Lynch, Elizabeth
    University of S Australia, Australia.
    Bernhardsson, Susanne
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. University of S Australia, Australia; Narhalsan Hono Ockero Rehabil, Sweden.
    Bennett, Leanne
    University of S Australia, Australia.
    Bernhardt, Julie
    University of Melbourne, Australia.
    Stroke Survivors Experiences of Physical Rehabilitation: A Systematic Review of Qualitative Studies2015In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 96, no 9, p. 1698-1708Article, review/survey (Refereed)
    Abstract [en]

    Objective: To report and synthesize the perspectives, experiences, and preferences of stroke survivors undertaking inpatient physical rehabilitation through a systematic review of qualitative studies. Data Sources: MEDLINE, CINAHL, Embase, and PsycINFO were searched from database inception to February 2014. Reference lists of relevant publications were searched. All languages were included. Study Selection: Qualitative studies reporting stroke survivors experiences of inpatient stroke rehabilitation were selected independently by 2 reviewers. The search yielded 3039 records; 95 full-text publications were assessed for eligibility, and 32 documents (31 studies) were finally included. Comprehensiveness and explicit reporting were assessed independently by 2 reviewers using the consolidated criteria for reporting qualitative research framework. Discrepancies were resolved by consensus. Data Extraction: Data regarding characteristics of the included studies were extracted by 1 reviewer, tabled, and checked for accuracy by another reviewer. All text reported in studies results sections were entered into qualitative data management software for analysis. Data Synthesis: Extracted texts were inductively coded and analyzed in 3 phases using thematic synthesis. Nine interrelated analytical themes, with descriptive subthemes, were identified that related to issues of importance to stroke survivors: (1) physical activity is valued; (2) bored and alone; (3) patient-centered therapy; (4) recreation is also rehabilitation; (5) dependency and lack of control; (6) fostering autonomy; (7) power of communication and information; (8) motivation needs nurturing; and (9) fatigue can overwhelm. Conclusions: The thematic synthesis provides new insights into stroke survivors experiences of inpatient rehabilitation. Negative experiences were reported in all studies and include disempowerment, boredom, and frustration. Rehabilitation could be improved by increasing activity within formal therapy and in free time, fostering patients autonomy through genuinely patient-centered care, and more effective communication and information. Future stroke rehabilitation research should take into account the experiences and preferences of stroke survivors. (C) 2015 by the American Congress of Rehabilitation Medicine

  • 36. Lundqvist, Lars-Olov
    et al.
    Zetterlund, Christina
    Richter, Hans O.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Effects of Feldenkrais Method on Chronic Neck/Scapular Pain in People With Visual Impairment: A Randomized Controlled Trial With One-Year Follow-Up2014In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 95, no 9, p. 1656-1661Article in journal (Refereed)
    Abstract [en]

    Objective: To determine whether the Feldenkrais method is an effective intervention for chronic neck/scapular pain in patients with visual impairment. Design: Randomized controlled trial with an untreated control group. Setting: Low vision center. Participants: Patients (N=61) with visual impairment (mean, 53.3y) and nonspecific chronic (mean, 23.8y) neck/scapular pain. Interventions: Participants were randomly assigned to the Feldenkrais method group (n=30) or untreated control group (n=31). Patients in the treatment group underwent one 2-hour Feldenkrais method session per week for 12 consecutive weeks. Main Outcome Measures: Blind assessment of perceived pain (visual analog scale [VAS]) during physical therapist palpation of the left and right occipital, upper trapezius, and levator scapulae muscle areas; self-assessed degree of pain on the Visual, Musculoskeletal, and Balance Complaints questionnaire; and the Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain scale. Results: Patients undergoing FeldenIcrais method reported significantly less pain than the controls according to the VAS and Visual, Musculoskeletal, and Balance Complaints questionnaire ratings at posttreatment follow-up and 1-year follow-up. There were no significant differences regarding the Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain scale ratings. Conclusions: Feldenkrais method is an effective intervention for chronic neck/scapular pain in patients with visual impairment. 

  • 37.
    Lundqvist, Lars-Olov
    et al.
    Örebro University, School of Law, Psychology and Social Work. Örebro University Hospital. Centre for Rehabilitation Research, Örebro University Hospital, Örebro, Sweden.
    Zetterlund, Christina
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Rehabilitation Research, Örebro University Hospital, Örebro, Sweden; Low Vision Centre, Örebro County Council, Örebro, Sweden.
    Richter, Hans O.
    Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden.
    Effects of Feldenkrais Method on Chronic Neck/Scapular Pain in People With Visual Impairment: A Randomized Controlled Trial With One-Year Follow-Up2014In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 95, no 9, p. 1656-1661Article in journal (Refereed)
    Abstract [en]

    Objective: To determine whether the Feldenkrais method is an effective intervention for chronic neck/scapular pain in patients with visual impairment.

    Design: Randomized controlled trial with an untreated control group.

    Setting: Low vision center.

    Participants: Patients (N=61) with visual impairment (mean, 53.3y) and nonspecific chronic (mean, 23.8y) neck/scapular pain.

    Interventions: Participants were randomly assigned to the Feldenkrais method group (n=30) or untreated control group (n=31). Patients in the treatment group underwent one 2-hour Feldenkrais method session per week for 12 consecutive weeks.

    Main Outcome Measures: Blind assessment of perceived pain (visual analog scale [VAS]) during physical therapist palpation of the left and right occipital, upper trapezius, and levator scapulae muscle areas; self-assessed degree of pain on the Visual, Musculoskeletal, and Balance Complaints questionnaire; and the Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain scale.

    Results: Patients undergoing FeldenIcrais method reported significantly less pain than the controls according to the VAS and Visual, Musculoskeletal, and Balance Complaints questionnaire ratings at posttreatment follow-up and 1-year follow-up. There were no significant differences regarding the Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain scale ratings.

    Conclusions: Feldenkrais method is an effective intervention for chronic neck/scapular pain in patients with visual impairment. (c) 2014 by the American Congress of Rehabilitation Medicine

  • 38.
    Nilsagård, Ylva
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    von Koch, Lena Kristina
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden; Department of Neurology, Karolinska University Hospital, Solna, Sweden.
    Nilsson, Malin
    Rehabunit, Central Hospital Karlstad, Karlstad, Sweden.
    Forsberg, Anette
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Family Medicine Research Centre, Örebro County Council, Örebro, Sweden.
    Balance exercise program reduced falls in people with multiple sclerosis: a single-group, pretest-posttest trial2014In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 95, no 12, p. 2428-2434Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the effects of a balance exercise program on falls in people with mild to moderate multiple sclerosis (MS).

    Design: Multicenter, single-blinded, single-group, pretest-posttest trial.

    Setting: Seven rehabilitation units within 5 county councils.

    Participants: Community-dwelling adults with MS (NZ32) able to walk 100m but unable to maintain 30-second tandem stance with armsalongside the body.

    Intervention: Seven weeks of twice-weekly, physiotherapist-led 60-minute sessions of group-based balance exercise targeting core stability, dualtasking, and sensory strategies (CoDuSe).

    Main Outcome Measures: Primary outcomes: number of prospectively reported falls and proportion of participants classified as fallers during 7preintervention weeks, intervention period, and 7 postintervention weeks. Secondary outcomes: balance performance on the Berg Balance Scale,Four Square Step Test, sit-to-stand test, timed Up and Go test (alone and with cognitive component), and Functional Gait Assessment Scale;perceived limitations in walking on the 12-item MS Walking Scale; and balance confidence on the Activities-specific Balance Confidence Scalerated 7 weeks before intervention, directly after intervention, and 7 weeks later.

    Results: Number of falls (166 to 43;P.001) and proportion of fallers (17/32 to 10/32;P.039) decreased significantly between thepreintervention and postintervention periods. Balance performance improved significantly. No significant differences were detected forperceived limitations in walking, balance confidence, the timed Up and Go test, or sit-to-stand test.

    Conclusions: The CoDuSe program reduced falls and proportion of fallers and improved balance performance in people with mild to moderateMS but did not significantly alter perceived limitations in walking and balance confidence

  • 39.
    Nooijen, Carla F.
    et al.
    Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam, Rotterdam.
    van den Brand, I. L.
    Ter Horst, P.
    Wynants, M.
    Valent, L. J.
    Stam, H. J.
    van den Berg-Emons, R. J.
    Act-Active Research, Group
    Feasibility of Handcycle Training During Inpatient Rehabilitation in Persons With Spinal Cord Injury2015In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 96, no 9, p. 1654-7Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess the feasibility of a handcycle training program during inpatient rehabilitation and the changes in physical capacity in persons with subacute spinal cord injury (SCI). DESIGN: Before-after trial. SETTING: Rehabilitation centers. PARTICIPANTS: Persons with subacute SCI in regular rehabilitation (N=45). INTERVENTIONS: A structured handcycle interval training program during the last 8 weeks of inpatient rehabilitation. Training was scheduled 3 times per week (24 sessions total), with an intended frequency of >/=2 times per week. Intended intensity was a Borg score of 4 to 7 on a 10-point scale. MAIN OUTCOME MEASURES: Feasibility was assessed, and participant satisfaction was evaluated (n=30). A maximal handcycling test was performed 8 weeks prior to discharge and at discharge to determine peak power output and peak oxygen uptake (VO2peak) (n=23). RESULTS: Of the participants, 91% completed the handcycle training, and no adverse events were reported. Mean training frequency was 1.8+/-0.5 times per week, and mean Borg score was 6.2+/-1.4. Persons with complete lesions demonstrated lower training feasibility. Most participants were satisfied with the handcycle training. Peak power output and VO2peak improved significantly after the training period (P<.01) by 36.4% and 9.6%, respectively. CONCLUSIONS: Overall, handcycle training during inpatient rehabilitation in persons with SCI was feasible except for the training frequency. Persons with complete lesions likely need extra attention to benefit optimally from handcycling training. Because the improvements in physical capacity were larger than those known to occur in persons with paraplegia receiving regular rehabilitation, the results suggest that the addition of handcycle training may result in larger increases in physical capacity compared with regular rehabilitation only.

  • 40. Nygren-de Boussard, Catharina
    et al.
    Holm, Lena W
    Cancelliere, Carol
    Godbolt, Alison K
    Boyle, Eleanor
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Hincapié, Cesar A
    Cassidy, J David
    Borg, Jörgen
    Nonsurgical interventions after mild traumatic brain injury: a systematic review: Results on the international collaboration on mild traumatic brain injury prognosis2014In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 95, no 3, Suppl, p. S257-S264Article, review/survey (Refereed)
    Abstract [en]

    Objective

    To synthesize the best available evidence regarding the impact of nonsurgical interventions on persistent symptoms after mild traumatic brain injury (MTBI).

    Data Sources

    MEDLINE and other databases were searched (2001–2012) with terms including “rehabilitation.” Inclusion criteria were original, peer-reviewed research published in English and other languages. References were also identified from the bibliographies of eligible articles.

    Study Selection

    Controlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to have a minimum of 30 MTBI cases and assess nonsurgical interventions using clinically relevant outcomes such as self-rated recovery.

    Data Extraction

    Eligible studies were critically appraised using a modification of the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Two reviewers independently reviewed each study and extracted data from the admissible studies into evidence tables.

    Data Synthesis

    The evidence was synthesized qualitatively according to the modified SIGN criteria. Recommendations were linked to the evidence tables using a best-evidence synthesis. After 77,914 records were screened, only 2 of 7 studies related to nonsurgical interventions were found to have a low risk of bias. One studied the effect of a scheduled telephone intervention offering counseling and education on outcome and found a significantly better outcome for symptoms (6.6 difference in adjusted mean symptom score; 95% confidence interval, 1.2–12.0), but no difference in general health outcome at 6 months after MTBI. The other was a randomized controlled trial of the effectiveness of 6 days of bed rest on posttraumatic complaints 6 months postinjury, compared with no bed rest, and found no effect.

    Conclusions

    Some evidence suggests that early, reassuring educational information is beneficial after MTBI. Well-designed intervention studies are required to develop effective treatments and improve outcomes for adults and children at risk for persistent symptoms after MTBI.

  • 41.
    Peolsson, Anneli
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Landén Ludvigsson, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Rehabilitation in Motala.
    Tigerfors, Ann-Marie
    Previa Occupat Health Care AB, Sweden.
    Peterson, Gunnel
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Uppsala University, Sweden.
    Effects of Neck-Specific Exercises Compared to Waiting List for Individuals With Chronic Whiplash-Associated Disorders: A Prospective, Randomized Controlled Study2016In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 97, no 2, p. 189-195Article in journal (Refereed)
    Abstract [en]

    Objective: To determine whether 3 months of neck-specific exercises (NSEs) could benefit individuals with chronic whiplash-associated disorder (WAD) who were on a waiting list (WL) for treatment. Design: A prospective, randomized controlled study. Setting: Primary health care. Participants: Individuals (N=41; 31 women, 10 men; mean age +/- SD, 38 +/- 11.2y) with chronic (6-36mo) WAD, grades 2 and 3, were analyzed. Interventions: Patients were randomly assigned to NSEs or no treatment for 3 months. Main Outcome Measures: Neck-specific disability (Neck Disability Index [NDI]), neck pain (visual analog scale), general pain-related disability (Pain Disability Index [PDI]), self-perceived performance ability (Self-Efficacy Scale [SES]), and health-related quality of life (EuroQol 5 dimensions [EQ-5D]) were measured. Results: NSEs significantly improved the NDI, SES, and EQ-5D compared with WL (P&lt;.01). There was significant improvement (P&lt;.0001) over time in all outcomes for NSEs, and apart from the PDI, significant worsening (P=.002-.0002) over time for the untreated group. Conclusions: NSEs were more beneficial than no intervention while on a WL for individuals with chronic WAD. (C) 2016 by the American Congress of Rehabilitation Medicine

  • 42.
    Peolsson, Anneli
    et al.
    Linkoping Univ, Div Physiotherapy, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden..
    Ludvigsson, Maria Landén
    Linkoping Univ, Div Physiotherapy, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden.;Cty Council Ostergotland, Rehab Vast, Motala, Sweden..
    Tigerfors, Ann-Marie
    Previa Occupat Hlth Care AB, Gavle, Sweden..
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Div Physiotherapy, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden..
    Effects of Neck-Specific Exercises Compared to Waiting List for Individuals With Chronic Whiplash-Associated Disorders: A Prospective, Randomized Controlled Study2016In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 97, no 2, p. 189-195Article in journal (Refereed)
    Abstract [en]

    Objective: To determine whether 3 months of neck-specific exercises (NSEs) could benefit individuals with chronic whiplash-associated disorder (WAD) who were on a waiting list (WL) for treatment. Design: A prospective, randomized controlled study. Setting: Primary health care. Participants: Individuals (N=41; 31 women, 10 men; mean age +/- SD, 38 +/- 11.2y) with chronic (6-36mo) WAD, grades 2 and 3, were analyzed. Interventions: Patients were randomly assigned to NSEs or no treatment for 3 months. Main Outcome Measures: Neck-specific disability (Neck Disability Index [NDI]), neck pain (visual analog scale), general pain-related disability (Pain Disability Index [PDI]), self-perceived performance ability (Self-Efficacy Scale [SES]), and health-related quality of life (EuroQol 5 dimensions [EQ-5D]) were measured. Results: NSEs significantly improved the NDI, SES, and EQ-5D compared with WL (P<.01). There was significant improvement (P<.0001) over time in all outcomes for NSEs, and apart from the PDI, significant worsening (P=.002-.0002) over time for the untreated group. Conclusions: NSEs were more beneficial than no intervention while on a WL for individuals with chronic WAD.

  • 43. Ploutz-Snyder, L.L
    et al.
    Tesch, P.A
    Dudley, G.A
    Increased vulnerability to exercise-induced dysfunction and muscle injury after concentric training1998In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 79, no 1, p. 58-61Article in journal (Refereed)
  • 44. Ploutz-Snyder, L.L
    et al.
    Tesch, P.A
    Hather, B.M
    Dudley, G.A
    Vulnerability to dysfunction and muscle injury after unloading1996In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 77, no 8, p. 773-777Article in journal (Refereed)
  • 45.
    Postema, Sietke
    et al.
    University Medical Center Groningen, Department of Rehabilitation Medicine, University of Groningen, Groningen, the Netherlands.
    Bongers, Raoul M.
    University Medical Center Groningen, Center of Human Movement Sciences, University of Groningen, Groningen, the Netherlands.
    Brouwers, Michel A. H.
    Rehabilitation Center De Hoogstraat Revalidatie, Utrecht, the Netherlands.
    Burger, Helena
    Institute for Rehabilitation, University of Ljubljana, Ljubljana, Slovenia; Medical Faculty, University of Ljubjama, Ljubjama, Slovenia.
    Hermansson, Liselotte M. N.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Prosthetics and Orthotics, Region Örebro County, Örebro, Sweden.
    Reneman, Michiel F.
    Department of Rehabilitation Medicine, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, the Netherlands.
    Dijkstra, Pieter U.
    Department of Rehabilitation Medicine, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, the Netherlands.
    van der Sluis, Corry K.
    University Medical Centre Groningen, Groningen, the Netherlands.
    Upper limb absence: predictors of work participation and work productivity2016In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 97, no 6, p. 892-899Article in journal (Refereed)
    Abstract [en]

    Objective: to analyze work participation, work productivity and contributing factors, as well as physical work demands, in individuals with an upper limb defect (ULD).

    Design: cross-sectional study: postal survey (response rate: 53%).

    Setting: patients of twelve rehabilitation centers and orthopedic workshops in the Netherlands.

    Participants: 207 individuals with unilateral transversal upper limb reduction deficiency (ULRD) or amputation (ULA), at or proximal to the carpal level, between the ages of 18 and 65 years, and a convenience sample of 90 controls (matched on age and gender).

    Interventions: not applicable.

    Main outcome measures: employment status, self-reported work productivity and self-reported upper extremity work demands.

    Results: 74% of individuals with ULRD and 57% of the individuals with ULA were employed. Males, using a prosthesis, with medium or higher level of education and good general health were most often employed. Work productivity was similar to the control group. Higher work productivity was related to predominantly mentally demanding type of work and less MSC related pain. Upper extremity work demands were higher in individuals with ULD with predominantly mentally demanding work, compared to controls with this type of work.

    Conclusions: the outcome of work participation of individuals with ULRD is comparable to the general population in the Netherlands. Individuals with ULA had lower rates of employment. Work productivity was not associated to one-handedness.

  • 46.
    Postema, Sietke G.
    et al.
    Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
    Bongers, Raoul M.
    Center of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
    Brouwers, Michael A.
    Rehabilitation Center De Hoogstraat Revalidatie, Utrecht, The Netherlands.
    Burger, Helena
    University Rehabiltiation Institute, Ljubljana, Slovenia; Medical Faculty, University of Ljubljama, Ljubljana, Slovenia.
    Norling-Hermansson, Liselotte M.
    Örebro University, School of Health Sciences. Department of Prosthetics and Orthotics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Reneman, Michiel F.
    Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
    Dijkstra, Pieter U.
    Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
    van der Sluis, Corry K.
    Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
    Musculoskeletal Complaints in Transverse Upper Limb Reduction Deficiency and Amputation in The Netherlands: Prevalence, Predictors, and Effect on Health2016In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 97, no 7, p. 1137-1145Article in journal (Refereed)
    Abstract [en]

    Objective: (1) To determine the prevalence of musculoskeletal complaints (MSCs) in individuals with upper limb absence in The Netherlands, (2) to assess the health status of individuals with upper limb absence in general and in relation to the presence of MSCs, and (3) to explore the predictors of development of MSCs and MSC-related disability in this population.

    Design: Cross-sectional study: national survey.

    Setting: Twelve rehabilitation centers and orthopedic workshops.

    Partiscipants: Individuals (n=263; mean age, 50.7±16.7y; 60% men) ≥18 years old, with transverse upper limb reduction deficiency (42%) or amputation (58%) at or proximal to the carpal level (response, 45%) and 108 individuals without upper limb reduction deficiency or amputation (n=108; mean age, 50.6±15.7y; 65% men) (N=371).

    Interventions: Not applicable.

    Main outcome measures: Point and year prevalence of MSCs, MSC-related disability (Pain Disability Index), and general health perception and mental health (RAND-36 subscales).

    Results: Point and year prevalence of MSCs were almost twice as high in individuals with upper limb absence (57% and 65%, respectively) compared with individuals without upper limb absence (27% and 34%, respectively) and were most often located in the nonaffected limb and upper back/neck. MSCs were associated with decreased general health perception and mental health and higher perceived upper extremity work demands. Prosthesis use was not related to presence of MSCs. Clinically relevant predictors of MSCs were middle age, being divorced/widowed, and lower mental health. Individuals with upper limb absence experienced more MSC-related disability than individuals without upper limb absence. Higher age, more pain, lower general and mental health, and not using a prosthesis were related to higher disability.

    Conclusions: Presence of MSCs is a frequent problem in individuals with upper limb absence and is associated with decreased general and mental health. Mental health and physical work demands should be taken into account when assessing such a patient. Clinicians should note that MSC-related disability increases with age.

  • 47.
    Sandberg, Klas
    et al.
    Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Department of Rehabilitation in Norrköping. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping. Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy.
    Kleist, Marie
    Linköping University, Department of Medical and Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Department of Rehabilitation in Norrköping. Linköping University, Faculty of Medicine and Health Sciences.
    Falk, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. Region Östergötland, Heart and Medicine Center, Department of Dermatology and Venerology.
    Enthoven, Paul
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Effects of Twice-Weekly Intense Aerobic Exercise inQ1 Early Subacute Stroke: A Randomized Controlled Trial2016In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 97, no 8, p. 1244-1253Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To examine the effects of 12 weeks of twice-weekly intensive aerobic exercise on physical function and quality of life after subacute stroke.

    DESIGN:

    Randomized controlled trial.

    SETTING:

    Ambulatory care.

    PARTICIPANTS:

    Patients (N=56; 28 women) aged ≥50 years who had a mild stroke (98% ischemic) and were discharged to independent living and enrolled 20 days (median) after stroke onset.

    INTERVENTIONS:

    Sixty minutes of group aerobic exercise, including 2 sets of 8 minutes of exercise with intensity up to exertion level 14 or 15 of 20 on the Borg rating of perceived exertion scale, twice weekly for 12 weeks (n=29). The nonintervention group (n=27) received no organized rehabilitation or scheduled physical exercise.

    MAIN OUTCOME MEASURES:

    Primary outcome measures included aerobic capacity on the standard ergometer exercise stress test (peak work rate) and walking distance on the 6-minute walk test (6MWT). Secondary outcome measures included maximum walking speed for 10m, balance on the timed Up and Go (TUG) test and single leg stance (SLS), health-related quality of life on the European Quality of Life Scale (EQ-5D), and participation and recovery after stroke on the Stroke Impact Scale (SIS) version 2.0 domains 8 and 9. Participants were evaluated pre- and postintervention. Patient-reported measures were also evaluated at 6-month follow-up.

    RESULTS:

    The following improved significantly more in the intervention group (pre- to postintervention): peak work rate (group × time interaction, P=.006), 6MWT (P=.011), maximum walking speed for 10m (P<.001), TUG test (P<.001), SLS right and left (eyes open) (P<.001 and P=.022, respectively), and SLS right (eyes closed) (P=.019). Aerobic exercise was associated with improved EQ-5D scores (visual analog scale, P=.008) and perceived recovery (SIS domain 9, P=.002). These patient-reported improvements persisted at 6-month follow-up.

    CONCLUSIONS:

    Intensive aerobic exercise twice weekly early in subacute mild stroke improved aerobic capacity, walking, balance, health-related quality of life, and patient-reported recovery.

  • 48.
    Scott Burns, Anthony
    et al.
    University of Toronto, Canada; University of Health Network Toronto Rehabil Institute, Canada.
    Lanig, Indira
    Northern Colorado Rehabil Hospital, CO USA.
    Grabljevec, Klemen
    University of Rehabil Institute, Slovenia.
    Wayne New, Peter
    Caulfield Hospital, Australia; Monash University, Australia.
    Bensmail, Djamel
    University of Versailles St Quentin, France.
    Ertzgaard, Per
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine.
    Vishwanath Nene, Anand
    Roessingh Centre Rehabil, Netherlands; Roessingh Research and Dev, Netherlands.
    Optimizing the Management of Disabling Spasticity Following Spinal Cord Damage: The Ability Network-An International Initiative2016In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 97, no 12, p. 2222-2228Article in journal (Refereed)
    Abstract [en]

    Optimizing the treatment of disabling spasticity in persons with spinal cord damage is hampered by a lack of consensus regarding the use of acceptable definitions of spasticity and disabling spasticity, and the relative absence of decision tools such as clinical guidelines and concise algorithms to support decision-making within the broader clinical community. Many people with spinal cord damage are managed outside specialist centers, and variations in practice result in unequal access to best practice despite equal`need. In order to address these issues, the Ability Network an international panel of clinical experts was initiated to develop management algorithms to guide and standardize the assessment, treatment, and evaluation of outcomes of persons with spinal cord damage and disabling spasticity. To achieve this, consensus was sought on common definitions through facilitated, in-person meetings. To guide patient selection, an in-depth review of the available tools was performed and expert consensus sought to develop an appropriate instrument. Literature reviews are guiding the selection and development of tools to evaluate treatment outcomes (body functions, activity, participation, quality of life) as perceived by people with spinal cord damage and disabling spasticity, and their caregivers and clinicians. Using this approach, the Ability Network aims to facilitate treatment decisions that take into account the following: the impact of disabling spasticity on health status, patient preferences, treatment goals, tolerance for adverse events, and in cases of totally dependent persons, caregiver burden. (C) 2016 by the American Congress of Rehabilitation Medicine

  • 49.
    Shaw, William S.
    et al.
    Liberty Mutual Research Institute for Safety, Hopkinton MA, USA; University of Massachusetts Medical School, Worcester MA, USA.
    Hartvigsen, Jan
    Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark.
    Woiszwillo, Mary J.
    Liberty Mutual Research Institute for Safety, Hopkinton MA, USA.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Reme, Silje E.
    Harvard School of Public Health, Boston MA, USA; Uni Research Health, Bergen, Norway.
    Psychological Distress in Acute Low Back Pain: A Review of Measurement Scales and Levels of Distress Reported in the First 2 Months After Pain Onset2016In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 97, no 9, p. 1573-1587Article in journal (Refereed)
    Abstract [en]

    Objective: To characterize the measurement scales and levels of psychological distress reported among published studies of acute low back pain (LBP) in the scientific literature.

    Data Sources: Peer-reviewed scientific literature found in 8 citation index search engines (CINAHL, Embase, MANTIS, PsycINFO, PubMed, Web of Science, AMED, and Academic Search Premier) for the period from January 1, 1966, to April 30, 2015, in English, Danish, Norwegian, and Swedish languages.

    Study Selection: Cross-sectional, case-control, cohort, or randomized controlled trials assessing psychological distress and including participants drawn from patients and workers (or an identifiable subset) with acute LBP (<8wk). Three researchers independently screened titles, abstracts, and full-length articles to identify peer-reviewed studies according to established eligibility criteria.

    Data Extraction: Descriptive data (study populations, definitions of LBP, distress measures) were systematically extracted and reviewed for risk of bias. Distress measures were described, and data were pooled in cases of identical measures. Reported levels of distress were contextualized using available population norms, clinical comparison groups, and established clinical cutoff scores.

    Data Synthesis: Of 10,876 unique records, 23 articles (17 studies) were included. The most common measures were the Beck Depression Inventory, the modified version of the Zung Self-Rated Depression Scale, the Center for Epidemiologic Studies-Depression Scale, and the Medical Outcomes Study 12-Item Short-Form Health Survey and Medical Outcomes Study 36-Item Short-Form Health Survey. Pooled results for these scales showed consistent elevations in depression, but not anxiety, and reduced mental health status in comparison with the general population.

    Conclusions: Based on the high consistency across studies using valid measures with a low to moderate risk of bias, there is strong evidence that psychological distress is elevated in acute LBP.

  • 50.
    Skillgate, Eva
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. Univ Hlth Network, Toronto Western Res Inst, Div Hlth Care & Outcomes Res, Toronto, ON, Canada.;Karolinska Inst, Inst Environm Med, Musculoskeletal & Sports Injury Epidemiol Ctr, Box 210, S-17177 Stockholm, Sweden.;Naprapathogskolan Scandinavian Coll Naprapath Man, Stockholm, Sweden..
    Cote, Pierre
    Univ Ontario, Inst Technol, Fac Hlth Sci, Oshawa, ON, Canada.;Univ Ontario, Inst Technol, Canadian Mem Chiropract Coll, Ctr Study Disabil Prevent & Rehabil, Oshawa, ON, Canada.;Univ Toronto, Dalla Lana Sch Publ Hlth, Div Epidemiol, Toronto, ON, Canada..
    Cassidy, J. David
    Univ Hlth Network, Toronto Western Res Inst, Div Hlth Care & Outcomes Res, Toronto, ON, Canada.;Univ Toronto, Dalla Lana Sch Publ Hlth, Div Epidemiol, Toronto, ON, Canada.;Univ Southern Denmark, Fac Hlth, Dept Sports Sci & Clin Biomech, Odense, Denmark..
    Boyle, Eleanor
    Univ Hlth Network, Toronto Western Res Inst, Div Hlth Care & Outcomes Res, Toronto, ON, Canada.;Univ Toronto, Dalla Lana Sch Publ Hlth, Div Epidemiol, Toronto, ON, Canada.;Univ Southern Denmark, Fac Hlth, Dept Sports Sci & Clin Biomech, Odense, Denmark..
    Carroll, Linda
    Univ Alberta, Sch Publ Hlth, Edmonton, AB, Canada.;Univ Alberta, Injury Prevent Ctr, Edmonton, AB, Canada..
    Holm, Lena W.
    Karolinska Inst, Inst Environm Med, Musculoskeletal & Sports Injury Epidemiol Ctr, Box 210, S-17177 Stockholm, Sweden.;Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada..
    Effect of Early Intensive Care on Recovery From Whiplash-Associated Disorders: Results of a Population-Based Cohort Study2016In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 97, no 5, p. 739-746Article in journal (Refereed)
    Abstract [en]

    Objective: To determine whether the results from previous research suggesting that early intensive health care delays recovery from whiplash associated disorders (WADs) were confounded by expectations of recovery and whether the association between early health care intensity and time to recovery varies across patterns of health care. Design: Population-based inception cohort. Setting: All adults (>= 18y) injured in motor vehicle collisions who received treatment from a regulated health professional or reported their injuries to the single provincially administered motor vehicle insurer. Participants: Participants with WAD (N=5204). Self-report visits to physicians, chiropractors, physiotherapists, massage therapists, and other professionals during the first 42 days postcollision were used to define health care intensity. Interventions: Not applicable. Main Outcome Measure: Self-perceived recovery. Results: Individuals with high utilization health care had slower recovery independent of expectation of recovery and other confounders. Compared with individuals who reported low utilization of physician services, recovery was slower for those with high health care utilization, regardless of the type of profession. For instance, those with high physician (hazard rate ratio [HRR] =.56; 95% confidence interval [CI],.42.75), physician and high physiotherapy utilization (BRR=.68; 95% CI,.61.77), physician and high chiropractor utilization (BRR=.74; 95% CI,.64.85), and physician and high massage therapy utilization (HRR=.78; 95% CI,.68.90) had significantly slower recovery. Conclusions: Our study adds to the existing evidence that early intensive care is associated with slower recovery from WAD, independent of expectation of recovery. The results have policy implications and suggest that the optimal management of WADs focuses on reassurance and education instead of intensive care.

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