Aim: Study the psychometric properties of the Swedish version of the Injustice Experience Questionnaire (IEQ-S) among patients with chronic pain referred to Swedish specialist care.

Method: This study was part of a feasibility study for a cohort exploring patients with chronic, non-malignant pain. Sixty-five participants, referred to Pain Center at Uppsala University hospital, with a pain duration over three months at the time of referral, were consecutively sampled. The participants completed the IEQ-S to prepare for their clinical visit and again within six weeks to examine the stability reliability. The Work Ability Index was completed for a concurrent criterion validity analysis.

Results: The correlation coefficient between the IEQ-S and WAI (n = 57) was r_S = - 0.47, p = < 0.01. The internal consistency reliability for the full IEQ-S was Cronbach’s alpha = 0.94 (n = 64). The stability reliability was calculated using an Intraclass Correlation Coefficient = 0.80 (n = 55), with a 95 % confidence interval ranging between 0.69-0.88. The median total score for IEQ-S measured at admission = 27.0 (n = 64), 25^th percentile = 15.3, 75^th percentile = 37.8, range = 3-48 points. The mean = 26.2, standard deviation = 13.3. Thirty out of 64 participants (46.9 %) had a total score > 30.

Conclusion: This study has contributed with new information about the psychometric properties of the IEQ-S, for patients with chronic pain referred to specialist care in Sweden. The internal consistency of the IEQ-S was high (1), and the stability reliability satisfactory (3). There was a moderate (4), negative, significant relationship between IEQ-S and WAI, high levels of perceived injustice were associated with low work ability in this study. The results support the use of the IEQ-S as an adjunct tool to assess patients with chronic pain referred to specialist care in Sweden, however further research is desirable. This study has also given an insight into how injustice is perceived among patients with chronic pain, however this should be studied in a larger sample.

Objectives

The use of the Injustice Experience Questionnaire (IEQ) in psychological assessment of individuals with chronic pain is supported by research. The psychometric properties of the Swedish version, the IEQ-S, has not yet been evaluated. Hence, the aim was to investigate structural validity, and concurrent criterion validity of the IEQ-S against the Work Ability Index (WAI), the Pain Catastrophizing Scale (PCS-SW), the Patient Health Questionnaire 9-item depression module (PHQ-9), and the Generalized anxiety disorder 7-item scale (GAD-7). Internal consistency and test-retest reliability were also studied.

Methods

Sixty-five participants, referred to a University hospital, with a pain duration over three months were consecutively sampled. They completed the IEQ-S at admission and again within six weeks. A confirmatory factor analysis was performed for the study of structural validity. Concurrent criterion validity was evaluated using Spearman’s correlation coefficient. Internal consistency reliability for the full IEQ-S was calculated using the Cronbach’s alpha. Test-retest reliability was calculated using an Intraclass Correlation Coefficient (ICC).

Results

The median total score (0–48, where high scores indicate high levels of injustice) at admission (test 1) was 27.0 (n=64), 25th percentile=15.3, 75th percentile=37.8, range=3–48 points. A one-factor model was supported with item-loadings between 0.67–0.92. Spearman’s correlation coefficient between the IEQ-S and the WAI (n=56) was r _S =−0.46; the PCS-SW (n=63) was r _S =0.68, the PHQ-9 (n=64) was r _S =0.50 and the GAD-7 (n=64) was r _S =0.57, p<0.01. Cronbach’s alpha was 0.94 (n=64). The ICC was 0.80 (n=55), with a 95% confidence interval, ranging between 0.69–0.88.

Conclusions

Our study supported structural validity and concurrent criterion validity of the IEQ-S against other measures of psychological constructs and work ability. It also supported the internal consistency reliability of the IEQ-S and the test-retest reliability with a retest interval up to six weeks, was good. These findings support the use of the IEQ-S as an adjunct tool to assess appraisals of injustice in patients with chronic pain who are referred to tertiary care in Sweden. The added value might be identification of those who are at risk for slow or no improvement in their pain condition over time, and sick-leave, but this has to be confirmed in future studies.

Abstract

Background

Regular physical activity is an important part of a woman’s health. There are no Swedish guidelines regarding physical activity during the postpartum period which leads to limited knowledge in healthcare. This lack of knowledge shows a need to examine postpartum women´s personal experience of information regarding physical activity and exercise after childbirth.

Objectives

To investigate postpartum women’s experience of information regarding physical activity and exercise after childbirth. 

Method

A quality descriptive study design was used. Six semi-structured interviews with postpartum women were conducted and analysed with a quality content analysis. 

Results

The analysis revealed six categories and nine subcategories regarding the informants’ experiences. The informants experienced insufficient information regarding physical activity and exercise after childbirth. All the informants described the information as general and desired to obtain personalized advice regarding physical activity and exercise.

Conclusion

Women experience lack of information after childbirth. There is no guidance on how physical activity and exercise should be performed. Individualized information regarding physical activity and exercise could contribute to better health for the postpartum woman. 

Background The functional impact of breathlessness is assessed using the modified Medical Research Council (mMRC) scale for chronic respiratory disease and with the New York Heart Association Functional Classification (NYHA) scale for heart failure. We evaluated agreement between the scales and their concurrent validity with other clinically relevant patient-reported outcomes in cardiorespiratory disease. Methods Outpatients with stable chronic respiratory disease or heart failure were recruited. Agreement between the mMRC and NYHA scales was analysed using Cramer's V and Kendall's tau B tests. Concurrent validity was evaluated using correlations with clinically relevant measures of breathlessness, anxiety, depression, and health-related quality of life. Analyses were conducted for all participants and separately in chronic obstructive pulmonary disease (COPD) and heart failure. Results In a total of 182 participants with cardiorespiratory disease, the agreement between the mMRC and NYHA scales was moderate (Cramer's V: 0.46; Kendall's tau B: 0.57) with similar results for COPD (Cramer's V: 0.46; Kendall's tau B: 0.66) and heart failure (Cramer's V: 0.46; Kendall's tau B: 0.67). In the total population, the scales correlated in similar ways to other patient-reported outcomes. Conclusion In outpatients with cardiorespiratory disease, the mMRC and NYHA scales show moderate to strong correlations and similar associations with other patient-reported outcomes. This supports that the scales are comparable when assessing the impact of breathlessness on function and patient-reported outcomes.

Background: Cystic fibrosis affects the pulmonary function and health related quality of life (HRQoL). The treatment is physically and mentally demanding, and a time-consuming part is chest physiotherapy, which contains airway clearance techniques (ACT). Study purpose: investigate the effects of exercise on pulmonary function and HRQoL, and provide a basis for future research regarding whether exercise could substitute for chest physiotherapy. 

Method: Systematic review. Search conducted in PubMed and Cochrane; eight studies included. Three examined aerobic exercise, one weight training, three a combination of aerobic- and weight training, one aerobic- and weight training divided in two intervention groups. Assessment of study quality was made with PEDro-scale. Strength of evidence assessed by GRADEstud. 

Results: Studies were divided into three categories based on exercise form. Contradicting results regarding the effects of exercise on pulmonary function and HRQoL were found in all categories. Four studies presented significant effects on pulmonary function measures, two showed significant effects on HRQoL. Strength of evidence: limited for aerobic training, insufficient for both weight training and a combination of aerobic- and weight training. 

Conclusion: This review presented contradicting results which eventuated in low strength of evidence, therefor no definite conclusions can be made regarding the effect of exercise on pulmonary function and HRQoL. 

Background: Parkinson’s disease (PD) is a chronic progressive neurodegenerative disease with both motor and non-motor symptoms. Depression is a common non-motor symptom in PD. According to research, physical activity (PA) has a positive effect on depression; however, strong evidence supporting the relation between them is lacking.

Purpose: The purpose of this study was to examine the relation between PA and depression in patients with PD. 

Method: Fifty-eight participants were recruited to this cross-sectional study. The International Physical Activity Questionnaire modified for the elderly was used to measure PA, presented in low, moderate and high physical activity levels and MET-minutes/week. Montegomery-Åstrand Depression Rating Scale was used to assess depression and was presented in total score. The questionnaires were formed into a survey from which the data was collected. Spearman’s rank correlation was used to calculate the relation. 

Results: Among the participants, 15 (26%) had a low level of PA, 18 (31%) moderate and 25 (43%) high level of PA. Further, 15 (26%) were non-depressed, 27 (47%) had mild depression, 14 (24%) moderate and 2 (3%) severe depression. Evaluating the relation using the two different presentations of PA along with depression scores, results showed r= -0.2 (p= 0.26) and r= -0.15 (p= 0.26), respectively.

Conclusion: The result showed a weak negative relation, but the probability of the result being due to coincidence is high. To ensure the relation between PA and depression in patients with PD, further studies are needed in the future.

Background

Traumatic spinal cord injury (TSCI) is one of the most crippling conditions concerning the impact on the patient’s private lives. The role and experiences of physiotherapists concerning the treatment given to TSCI-patients are vital for the success of functional goals and reintegration into society. Despite this, there are no studies published exploring the physiotherapeutic experiences of the health care given to TSCI-patients in South Africa.

Aim

The purpose was to capture the experiences of physical therapists regarding the health care provided to victims of traumatic spinal cord injuries in Cape Town, South Africa.

Method

The study had a qualitative and exploratory research design with four semi-structured interviews. To process the data, a qualitative inductive content analysis was used.

Results

The results were divided into four categories and fourteen subcategories. They had examples of experienced facilitators and barriers in the rehabilitation and reintegration of TSCI-patients in South Africa, as well as their emotional responses. They additionally had experiences regarding the physiotherapeutic rehabilitation process, in terms of team based care, acute care, assessment and discharge.

Conclusion

The participants experienced a discrepancy between the in-patient health care and the health care of TSCI-victims post-discharge. Despite best efforts of patients and physiotherapists and other caregivers, societal, financial and educational factors outside the immediate control of patients often hinder successful rehabilitation and reintegration into society

Background It is recommended that patients with coronary artery disease undergo cardiac rehabilitation and regular physical exercise as part of the treatment. These patients are often physically and psychologically affected by their disease which can make a health change challenging. Self-efficacy is an important concept in the area of health behaviour change and has been shown to strongly predict physical activity among these patients. Heart rehabilitation has been shown to positively impact said self-efficacy, but there is a lack of evidence regarding whether and if so what type of exercise that most influences it, and if there are any gender differences in this concern.

Purpose The aim of the study was to investigate the physical capacity, self-efficacy for physical activity and the potential correlation between these variables among patients who had undergone a 12-week heart rehabilitation, plus any correlation between these variables. Furthermore, the possible gender differences regarding said questions were examined. 

Method Data regarding upper and lower extremity strength as well as aerobic capacity and self-efficacy score for 56 patients who had recently undergone cardiac rehabilitation and who participated in an ongoing research project was compiled and analysed.

Results Men had higher physical capacity than women, but women rated their self-efficacy slightly higher. There was a significant correlation (p <0.001) between women's self-efficacy and strength, and a correlation was seen between self-efficacy and strength for men (p = 0.0501). 

Conclusion The results of this study show that strength is clearly more closely linked to self-efficacy than aerobic capacity among individuals after completing cardiac rehabilitation, and especially among females. This may indicate that more focus could be needed to be directed towards strength training in cardiac rehabilitation.

PURPOSE: The purpose was to evaluate the psychometric properties of physical activity measures in persons with multiple sclerosis (PwMS).

METHODS: Adults with multiple sclerosis were recruited, n = 30 (validation) and n = 57 (test-retest). Steps measured with PiezoRX, Yamax SW200 and ActiGraph GT9X Link (AGlink) and time in different positions measured with AGlink were validated against data from video analysis. Psychometric properties of the Physical Activity and Disability Survey - Revised Swedish version (PADS-R(Sw)) was evaluated.

RESULTS: The most valid measures were AGlink using the low-frequency extension filter, and PiezoRX with median absolute percentage errors (MeAPEs) of 0.9-3.1% and 1.3-3.3%. The MeAPEs were higher for Yamax SW200 (2.9-21.0%), AGlink display (3.6-44.8%) and AGlink normal filter (8.9-48.9%), indicating low validity. AGlink was not valid in measurements of sitting (MeAPE 12.0-12.5%) or lying (MeAPE 31.0-41.7%). The correlation between PADS-R(Sw) and AGlink steps was r = 0.492 (p = .009). The relative reliability of PADS-R(Sw) was ICC_2,1 0.85 (CI 0.76-0.91), and absolute reliability was SEM 0.54.

CONCLUSION: AGlink and PiezoRX were valid measures of steps in PwMS. The questionnaire PADS-R(Sw) was valid, with high relative reliability, but its absolute reliability was unsatisfactory.

Deadlift is an exercise that proves to effectively train the hip extensors amongst other muscle groups, which is one of the most important muscle groups for performing a vertical jump. Despite this connection, no studies have been made on the correlation between deadlifts and vertical jumps, contrary to the numerous studies made regarding the correlation between squat and vertical jump. The purpose of this study was to examine the possible correlation between deadlifts, vertical jumps as well as BMI (Body Mass Index) amongst healthy physiotherapy students (n=15) at Uppsala University. This to assess the use of deadlift as an alternative training method to improve a person’s vertical jump ability. Vertical jumps were measured with an electronic jump mat and deadlifts were measured with 1RM-test. BMI was calculated using the person’s height and weight. The variables were then compiled and calculated using Pearson's correlation coefficient.

The results presented no correlation between vertical jumps and deadlifts (p = 0,773, r = 0,083), and a weak negative correlation between BMI and vertical jumps (p = 0,514, r = -0,188). A very strong positive correlation between BMI and deadlifts (p = 0,013, r = 0,721) was detected, whereas participants with higher BMI lifted more in deadlift. The conclusion of this study dictates that deadlift should not be recommended as an alternative exercise to improve vertical jump ability. However, more studies with larger populations are needed to scrutinize clinical applications.

Introduction: Healthcare professionals', especially physiotherapists' role as promoters, preventers and rehabilitators play a significant role in prevention of falls. The purpose of this study was to gain knowledge on the risk factors which are associated with fall-related injuries among community dwelling men and women, based on Social Cognitive Theory (SCT) concepts. Patients and methods: The study includes 13,151 people who responded to a postal survey questionnaire in 2017. The random sample consisted of men and women aged 70 years and older. Multivariate regression models were used to explore associations between theory-based risk factors and fall-related injuries. Results: A total of 16% (1951 people) reported a fall-related injury during the past 12 months. For men, a total of seven risk factors were associated with fall-related injury: age, pain (neck/shoulder), incontinence, depression, help in daily living, education and sedentary behaviour. For women, a total of nine risk factors were associated with fall-related injury: age, pain (extremities and neck/shoulder), tiredness, incontinence, appetite, economy, accommodation and participation in social activities. Conclusions: This study identified risk factors from all aspects of the SCT, serving as a clinically useful theory in addition to traditional fall preventive actions. Gender differences should be considered when designing fall prevention strategies.

Globally, falls and fall-related injuries constitute a severe threat to public health at all ages. New approaches are warranted since existing knowledge and actions have failed to reduce the incidence of falls and fall-related injuries, both at work and during leisure time. The purpose of this quasi-experimental study was to investigate the impact of a 10-week supervised judo-inspired exercise program, Judo4Balance, provided in a workplace setting among men and women targeting: physical functions, activity level, fall-related self-efficacy, and techniques for safe landing when falling. A total of 79 adults from seven different workplaces in Sweden, mean age 45 years (18-68), participated in the program. The study was conducted from May 2018 to June 2019. The 10-week exercise program performed in a workplace setting improved physical and psychological functions, as well as techniques for falling safely, factors of great importance to prevent falls and fall-related injuries among men and women. Therefore, it is suggested that the judo-inspired exercise program may be an effective tool in the quest to promote health and prevention of risk factors for falls and fall-related injuries among those of working age.

This study investigates the effectiveness of two fall prevention exercise interventions targeting physical performance, activity level, fall-related self-efficacy, health-related quality of life, and falls: the Otago Exercise Programme (OEP) with and the OEP without behavior change support. In this randomized controlled trial (RCT), 175 participants were randomised into two intervention groups and one control group. A total of 124 community-dwelling older adults over the age of 75 who needed walking aids or home support participated in the two-year follow-up. The OEP with and the OEP without support for behavior change displayed no long-term benefits on physical performance, fall-related self-efficacy, health-related quality of life, and falls compared to a control group. Although no significant differences were detected between the groups, the results implied the control group's physical activity level decreased compared to the intervention groups at two-year follow up.

Abstract

Background/problem definition: Mental illness, such as anxiety, is a health problem affecting about 10-20% of adolescents worldwide. Studies have found a person’s physical fitness to be associated with their mental health, but most studies have been done in the western world and few have investigated sub-Saharan African (SSA) countries. It has also been found that SSA countries’ guidelines regarding physical activity are few and incomplete, although the importance of it is well known.

Aim: To investigate to what extent physical fitness: grip strength (GS), 20 meter shuttle run test (20MSRT), body mass index (BMI) and waist circumference (WC) correlate to self-assessed anxiety in South African students at the UWC.

Methods: The study had a quantitative, cross-sectional and correlational research design with a non-randomized convenience sampling. The physical fitness data were collected through a hydraulic grip strength dynamometer, 20MSRT and by measuring anthropometric measurements in order to calculate BMI and WC. An electronic version of the GAD-7 form was used for self-assessed anxiety.

Results: The results showed a significant positive correlation between BMI and levels of anxiety in women, but not in men. The correlation of anxiety related to WC, GS and 20MSRT showed no significance for the whole sample or related to gender, respectively.

Conclusion: No significant correlation could be determined between physical fitness and anxiety. Severe anxiety affected 25% of the population, supporting previous research indicating that students are a group prone to anxiety.

Background: Carpal tunnel syndrome is the most common type of peripheral neuropathy caused by compression of the median nerve in the carpal tunnel. The condition is characterized by night time tingling and pain in the hand and fingers. 

Objective: The purpose of this study was to investigate the effects and evidence of neural mobilization as a treatment for carpal tunnel syndrome. 

Methods: Searches were made in the databases PubMed, PEDro, CINAHL, AMED and Scopus to try and find randomized controlled trials that investigated neural mobilization as treatment for carpal tunnel syndrome. All of the included articles were appraised by the PEDro-scale and the level of evidence was graded using GRADEstud. 

Results: Nine studies were included in this review. In all of the included studies a positive effect could be seen by neural mobilization on symptoms and/or function with a significant difference between groups in seven out of the nine studies. Six out of the nine studies had high quality and three had low quality according to the PEDro-scale. The grading of evidence showed that neural mobilization as treatment for carpal tunnel syndrome has a moderately high level of evidence (+++). Few studies with few participants resulted in one point deduction for lack of precision.

Conclusion: Neural mobilization could have positive effects on symptoms and function in patients with carpal tunnel syndrome and has a moderately high level of evidence according to GRADEstud. Neural mobilization may have positive effects long term and could reduce need for surgery but more high quality research is needed to confirm this.

Key words: Carpal tunnel syndrome, CTS, neural mobilization, nerve gliding.

Background:Low back pain (LBP) is a common cause of disability and 60-80% of adults have experienced LBP at some point in their lives. Physical activity (PA) has good evidence to prevent LBP from becoming chronic, reduce pain and increase function. Physical therapy students learn of the importance of PA in both prevention and treatment. But do we live as we learn?

Objective:To investigate the prevalence of LBP, average amount of PA and differences regarding the amount and intensity of PA amongst physical therapy students with and without LBP in Sweden. The study has also examined gender differences in the prevalence of LBP.

Method:A cross-sectional study with quantitative, comparative and non-experimental design. A web survey was distributed to all physiotherapy programs in Sweden. Out of an estimated 1,700 students, 252 responded. Respondents submitted background information and estimated for the last seven days their LBP from 1-10 according to Numeric Rating Scale (NRS) and their amount of PA at different intensities according to International Physical Activity Questionnaire Short Form (IPAQ-SF).

Results:The prevalence of LBP was 60%. 58% of men and 60% of women estimated LBP in the last seven days. The majority of the participants’ PA was classified as high. The results showed no significant difference in PA between the groups.

Conclusion:No statistic differences regarding prevalence of LBP could be seen between the sexes. No significant difference regarding amount or intensity of PA was found between the groups with and without LBP. Further research is needed.

Background Patients with neurological diseases are often in need of rehabilitative medical care in order to sustain body-function and manage activities in daily life. In some cases, rehabilitation in a warm climate is offered to patients within this group. The rehabilitation period often includes multidisciplinary medical care and will go on for 3-4 weeks. Physiotherapy is commonly a central part of the period. There is limited knowledge in regard to the experiences of receiving physiotherapy during a rehabilitation period in a warm climate and its effects.

Purpose/Aim of the study The aim of the present study was to explore and describe experiences of receiving physiotherapy during a rehabilitation stay in a warm climate among patients with neurological diseases.

Design & Method This study had a qualitative and exploratory design were data was collected through five semi-structured interviews. To analyze the data a qualitative, inductive approach was used.

Result The result of this study suggest that physiotherapy was a central part of the rehabilitation stay and that intensive and individually designed exercise programs were beneficial. Patient-centered care was described as important to the result of the stay. Factors such as the warm climate, social support and being away from one’s daily environment were reported to be crucial in regard to the total rehabilitation experience. An enhanced level of motivation to physical activity was described as an important effect of receiving medical care in a warm climate.

Conclusion Social support, a warm climate and responsive health care professionals contributed to a positive experience of receiving physiotherapy as a part of a rehabilitation stay. Experiences of enhanced motivation towards physical activity and more positive health outcomes suggest that a rehabilitation stay in a warm climate could be considered as a medical care complement. 

Background: Anterior cruciate ligament (ACL) injuries are common in young female soccer players. There is evidence that neuromuscular training can reduce the risk of ACL injury with 64–88 %. Knee control is a neuromuscular training programme that was implemented in the national education for soccer coaches in 2010.

Aim: The aim of the study was to examine how well girl soccer teams, ages 12–17, follow the existing recommendations regarding knee control training to prevent ACL injuries and if adherence was higher in teams where the coach was educated later than 2010.

Method: The study design was a quantitative, non experimental cross-sectional study. A self-composed questionnaire was answered through e-mail by 33 coaches for girl soccer teams. Participants were a random sample of a larger population with a geographical spread across Sweden.

Results: The result of the study was that four (12 %) coaches were placed in the category Following the recommendations fully, 21 (64 %) coaches in the category Following the recommendations partly and eight coaches in the category Do not follow recommendations. A difference in adherence to the programme Knee control could not be seen based on if the coach had completed the national education for soccer coaches later than 2010 or lacked this education.

Conclusion: The conclusion of the study was that the majority of coaches for girl soccer teams, ages 12–17, followed the recommendations partly for performance of the programme Knee control. No difference could be seen in adherence to the programme Knee control based on the coach’s education.

BACKGROUND: Heart rate variability (HRV) has been found reduced in patients with schizophrenia and depression. However, there is a lack of knowledge on how demographic, lifestyle, and pharmacological factors contribute to the reduction in HRV in these patients.

METHODS: We recruited 37 patients with schizophrenia, 43 patients with unipolar depression, and 64 healthy controls. A combined chest-worn HRV and accelerometer device was used in an ambulatory measurement. Age, sex, anticholinergic burden of medication, nicotine use, body mass index, and ongoing physical activity were assessed in multiple regression models regarding their influence on HRV, measured as the standard deviation of all the RR intervals (SDNN).

RESULTS: In the fully adjusted model, schizophrenia (β = -0.23, P = 0.019), depression (β = -0.18, P = 0.028), age (β = -0.34, P < 0.000), ongoing physical activity (β = -0.23, P = 0.001), and anticholinergic burden (β = -0.19, P = 0.025) influenced SDNN negatively. Sex, nicotine use, and BMI had negligible effects on SDNN.

CONCLUSIONS: We show for the first time that a quantified score of anticholinergic burden of medication has a negative relationship to HRV in patients with schizophrenia or depression, but that the diagnoses themselves still exhibit an effect on HRV.

Introduction: Running economy (RE) is known to be a strong indicator for performance on long distance running. RE is improved by plyometric training through an increase in stiffness in the musculotendinous system. Stretch shorten cycle (SSC) is a function in the muscle where a contraction is preceded by a stretch or an eccentric action. Orienteering is an endurance sport where RE is important for performance. Purpose: The purpose of the study was to examine whether or not there is a correlation between jumping performance and performance on long distance running in young elite orienteers 16-19 years old. Methods: 34 young elite orienteers did drop jumps (DJ) and countermovement jumps (CMJ) on an ErgoJump Bosco System contact mat. In conjunction with the jumps time on a 5 or 7 km (for girls and boys respectively) running test was collected. Pearson's correlation test was then used to determine the correlation between jumping height and running velocity. Results: The jumping height of the CMJ was on average 30,46 cm and 28,24 cm for the DJ. The running velocity was on average 14,19 km/h. Pearson's correlation test for the correlation between DJ and running velocity was 0,463 and for the correlation between CMJ and running velocity it was 0,461. In both cases the significance was 0,006. Conclusions: There is a significant, moderate to strong correlation between jump height in DJ and CMJ and performance on long distance running on a running test in young elite orienteers.

Background

The World Health Organization (WHO) classifies intimate partner violence as a global health problem. Even if both men and women are affected, data from National Centre for Knowledge on Men’s Violence against Women (NCK) shows that almost three times more women than men have been affected. The Swedish health care needs to improve on how they work on finding these patients but there is little research of how physiotherapists work regarding this matter.

Objective

To explore how physiotherapists investigate and examine female patients who are or have been a victim of intimate partner violence.

Methods

This survey used a qualitative method with a semi structured interview guide. Six interviews were carried through with physiotherapists who worked in Uppsala’s primary care, either in public or private health centers.

Results

The survey showed various experiences within the partakers. None of the physiotherapists asked about intimate partner violence as a standardized question at all new visits. On the contrary, several informants expressed that they felt a need to create a relationship with the patients before asking such questions. The physiotherapist took different actions when detecting intimate partner violence; mainly referring the patients to a curator and/or giving information of the women’s peace line. All partakers felt the need of a deeper knowledge and understanding of this issue.

Conclusion

Physiotherapists need more awareness as well as practical and theoretical knowledge to be able to work more efficiently with women that are affected by intimate partner violence.

Background:Cases of stress-related disorders have increased in Sweden. Stress is related to several diseases and mental illness and could cause or aggravate pain. Meditation has previously shown positive effects on brain functioning and could reduce perceived stress. Problem: Few studies have examined the subjective experience of stress in association with meditation. To reduce and prevent stress is of interest from a physiotherapeutic perspective, as stress could deteriorate health conditions. Purpose:To examine if meditation during five weeks could reduce stress in a small number of meditation-practitioners with no or little experience. Method:Three participants assessed perceived stress using a modified version of the PSS-14 existing of three questions during baseline and intervention concerning the sensation of stress and anxiety, sources of irritation and the ability to control important things in life. The intervention included taking part of a beginners’ course in sitting meditation including four course meetings consisting of both theoretical and practical teachings and 45-60 minutes of meditation practice daily. Results:Perceived stress and anxiety were reduced, the ability to control irritations in life was improved and the feeling of being unable to control important things in life was reduced in all participants. No distinct differences were noted between assessments of all three aspects of stress in every individual separately. Conclusion: Meditation could havepositive effects on all three aspects of stress. Other methods such as multiple baseline design, longer baseline and strategies to identify external factors should have been used which might have produced more credible results. 

Abstract 

Background 

Chronic pain in children and adolescents is common and girls are more affected than boys. The pain effects the affected person widely which is often showed in the social life, in daily activities and in school.

Aim 

The aim of this study was to explore experiences of physiotherapeutic treatment among girls with chronic pain.

Methods

A qualitative study was made, and data were collected through semi structured interviews. Convenience sample was used to recruit informants. Data were analysed using a qualitative content analysis with an abductive approach.  

Results

Chronic pain in young girls caused both physical and psychological limitations. Positive experiences of the physiotherapeutic treatment included to feel involved in one’s own treatment and to be able to influence the outcome, while getting restrictions from the physiotherapist seemed limiting. The treatment contributed to a more positive attitude, an increased level of physical activity and an improved mental well-being. The informants had a positive attitude towards meeting a physiotherapist, even though some of them had seen limited results of the treatment. It was important that the physiotherapist showed an interest and communicated with the adolescent in the first place. 

Conclusion

Girls who live with chronic pain had experiences of both physical and psychological limitations. The positive effects of the physiotherapeutic treatment were described as an increased activity level and participation in social life. Even though some of the girls had seen limited results of the treatment, the physiotherapist’s commitment made a great impression on the informants.  

Background: Endometriosis is a disease that affects every tenth woman of reproductive age. Physiotherapy is recommended as part of a treatment because it can have a pain-relieving effect and increase quality of life. The literature does not present how women with endometriosis experience the physiotherapeutic treatment. Therefore, there is a need to investigate how physiotherapeutic treatment is experienced by women with endometriosis.

Objectives: Examine women's experiences of endometriosis and physiotherapeutic treatment in endometriosis. 

Method: The study was of qualitative design. Five semi-structured interviews were conducted with women aged 24–40 diagnosed with endometriosis. They were recruited through a Facebook group and an Instagram account. Convenience sampling was applied. Data processing was done with qualitative content analysis.

Results: Four main categories were formulated: Living with endometriosis, Importance of physiotherapist's knowledge, Creating a safe environment with the patient and Individual experience of the physiotherapeutic treatments. The categories highlight experiences of the impact of the disease, the physiotherapist's knowledge and the effect of treatment methods.

Conclusion: Endometriosis was described as constantly influencing the everyday lives of informants where physiotherapy has contributed to relief of symptoms by obtaining new knowledge and by individually tailored treatments. It was considered valuable for informants to be involved in the choice of treatment. Being heard and validated was perceived as important. Various experiences of the effect of TENS, acupuncture, physical activity and treatment of the pelvic floor emerged. To clarify what makes the treatment effective, more studies are needed.

Background: For people diagnosed with type 1 diabetes physical activity is important. It can improve glucose control over time. A need for further research about the support diabetics receive from healthcare professionals regarding physical activity has been expressed. There is also a need for investigating if diabetics experience fear of being physically active due to the risk of hypoglycemia. 

Purpose: The purpose of this qualitative study is to explore, through interviews, what support individuals with newly diagnosed type 1 diabetes receive from healthcare professionals regarding physical activity, and how they experience this support. The study will also illustrate what experiences people with type 1 diabetes have regarding fear of being physically active as well as what they believe can reduce that potential fear.

Method: The study used a qualitative descriptive design, and data collection was conducted through five semi-structured interviews. Qualitative content analysis was used to process the data.

Results: The interviewees’ experiences of the advice from healthcare professionals regarding physical activity was inconsistent. For those who have lived with diabetes for a shorter period of time, the advice was considered good but quite general. Those who have lived with their diabetes for a longer period of time thought that the advice was more individualized. More individualised advice was requested. None of the interviewees expressed specific fear of being physically active.

Conclusion: The advice diabetics receives from healthcare professionals is considered good but insufficient. In the future more support will be needed regarding physical activity in the form of exercise-specific advice and encouragement.

Abstract

Background: Older adults are a growing population in society as the life expectancy increases in Sweden. Many are physically inactive and are exposed to chronic diseases. This has resulted in a considerable load on healthcare which could be decreased if this group would increase their physical activity.

Aim: The aim of this study was to explore factors that affects participation in physical activity for older adults that are exercising regularly at Träffpunkter and their experience of the exercise provided.

Method: A qualitative interview study was used. Participants were selected using a strategic sample procedure. A qualitative content analysis approach was used for data analysis.

Results: Individual factors such as negative feelings linked to physical activity and reduced bodily function, were mentioned as challenges to participation. Participants expressed that they need to be flexible to overcome barriers and that the society need to provide accessible and adjustable exercise. The motivators were similar for all participants such as the positive effects of exercise and they appreciated the adjustable training and the social climate at Träffpunkten.

Conclusion: Factors that affects participation in physical activity are factors relating to the individual such as negative feelings, physical limitations and flexibility. They interact with environmental factors such as facility- and exercise design and transportation. Träffpunkter are viewed to provide adjustable training and a positive social climate. A increased variety of exercise could motivate participation in physical activity. More research in the field is needed.

Background: The presence of mental illness, like depression, anxiety and stress (DAS), is common among young adults, especially among females. There is strong evidence of physical activity having a reducing effect on DAS. Furthermore, research shows variation in stress and psychosomatic disorders related to different programs in high school.

Purpose: To investigate possible correlations between level of physical activity and experienced DAS among 18-year olds, studying natural science programme. Also, to investigate possible gender differences regarding experienced DAS and self-reported level of physical activity.

Method: The study consisted of a quantitative, non-experimental cross section study with comparative design. For data collection, two self-administered forms (IPAQ-SF and DASS-21) were used. The implementation took place at four high schools that had natural science programs within Uppsala municipality. A total of 35 students from nine classes attended.

Results: All participants exceeded recommendations for physical activity. There was no significant difference between the sexes. Most of the participants showed none, or low levels of DAS. The results showed differences in level of anxiety, where females reported a higher level. A correlation between DAS and physical activity was detected among males and females together as a group, as well as among the males.

Conclusion: Most of the 18-year old males and females investigated within this study reported high levels of physical activity, and none or low levels of DAS. The females reported higher levels of anxiety. Among the females, no correlation was found between level of physical activity and perceived DAS, but a strong correlation was found among the males. These gender differences should be further investigated.

Abstract

Background

There is limited research and guidelines regarding physiotherapy as a treatment approach      for post-traumatic stress (PTS). Refugee experience of physiotherapy interventions is hoped                      to contribute to awareness of the subject and to give insight into this developing field of the         profession.

Purpose

The purpose of the study was to investigate and describe refugees experience of post-             traumatic stress physiotherapy. The study was interested in both refugee experience of          treatment itself and of possible effects.

Design and Method

Qualitative explorative design. The study was based on five semi-structured interviews. A        qualitative, content analysis was used to process the data.

Results         

The analysis showed that the refugees faced many physical and psychological barriers to         treatment, especially relating to pain and somatisation, however they were able to                    experience increased bodily comfort during treatment itself. The relationship to         physiotherapist, the psychological impact of the treatment environment and other social      factors were also described as important to experience.

Physiotherapy was described as positively affecting patient outcomes both in physical and mental health, despite certain uncontrollable/unmanageable symptoms making this difficult. The refugees were able to achieve generalisation of physiotherapy into their day-to-                     day life enabling them to self-manage to some extent and feel liberated from PTS symptoms.

Conclusion

The study agrees with the available literature on the effectiveness of treating refugee              patients suffering from post-traumatic stress with physiotherapy, not just to improve            physical health outcomes but even to give holistic improvements. 

Keywords

Post-traumatic stress, refugee, physiotherapy, experiences

Background.Low back pain is common among commercial flying pilots and may possibly be a reason for future long- term sick leave. Possible influencing factors are the number of working years and exercise habits. There are few studies researching commercial flying pilots.

Purpose.To describe the prevalence of low back pain among commercial flying pilots and to investigate the risk of long- term sick leave. Furthermore, identify differences in the incidence of low back pain among pilots who has worked <10 compared to >10 years, as well as to investigate the correlation between low back pain and self-assessed exercise habits.

Method.A cross-sectional study was conducted with a web survey. The survey initially consisted of self-designed questions followed by “Örebroformuläret kortversion” by Steven Linton.

Results.The study contained 73 respondents, which corresponded to a response rate of 30%. A total of 57.5% of the 73 respondents indicated that they had low back pain, of which the majority had been suffering for over a year.  The results showed that the pilots who had low back pain had no risk of long-term sick leave. There was a difference in the incidence of low back pain in those who worked over compared to under ten years (p=0.017). The correlation between exercise habits and the incidence of low back pain was not statistically significant (r=0.03), (p=0.08).

Conclusion.The prevalence of nonspecific low back pain in commercial flying pilots was high and seemed to increase with the number of working years. Further research needs to investigate which factors contribute to the high incidence of nonspecific low back pain.

Background Handgrip strength claims to reflect general strength and correlates with tests of strength, particularly to the lower extremity. Few studies examine correlations between Jamar and the upper body and mainly focus on populations with lower strength. Climbers were assumed to have higher levels of strength.

Purpose The purpose was to investigate grip strength, 1RM pull-up and 1RM leg extension in climbers in Uppsala and examine the relationship between grip strength and the 1RM tests to further evaluate grip strength as a measure of general strength.

Method The study is a descriptive cross-sectional study testing 25 climbers. Jamar, 3-5RM pull-up and 3-5RM leg extension are done in succession with protocols for standardisation and 1RM is calculated based on Epley's formula. The descriptive measurements are then analyzed and put in correlation. 

Results The relationship between 1RM pull-up and grip strength was moderately strong and statistically significant, r = 0.597 (p = 0.002). The relationship between 1RM leg extension and grip strength was moderately strong and statistically significant r = 0.446 (p = 0.026).

Conclusion Handgrip strength measured with Jamar in climbers doesn’t deviate from the general population. A moderately strong relationship was found between Jamar and the 1RM tests. Further studies should put Jamar in relation to different tests of muscle strength in populations with varying levels of strength to evaluate Jamar as a measure of general muscle strength. Protocols for standardization of Jamar needs to be further developed. 

Background: Eccentric exercise (ECC) has been the dominant treatment option for patellar tendinopathy (PT) in the last 15 years. It would be of value to clinicians to know about the short-term effect ECC has after a training period.

Objective: Systematically review individual articles and assess the certainty in the weighted result regarding the effect on function, pain, and the ability to participate in sport and physical activities that eccentric training has after a 12week period of training on athletes with PT.

Design: Systematic review of randomized controlled trials.                                          

Method: Searches were conducted in PubMed, CINAHL, PEDro and Cochrane Library. Seven studies were included and reviewed with the PEDro Scale. GRADE-stud was used to assess the certainty in the result. 

Results: Included studies quality varied between acceptable and high quality, according to the PEDro Scale. There were no differences between ECC and control treatments. When weighing the respective results of the studies, the certainty was considered moderately high (+++) according to GRADEstud, due to high coherence in all included studies, but a lack of precision.

Conclusion: ECC is not more effective than other control therapies studied. Therefore, this study cannot ensure that improvements that occur after 12 weeks are due to ECC. 

Background: The High Intensity Functional Exercise (HIFE) program has been shown to have good effect on physical function and ADL in elderly people living in nursing homes and dependent on assistance with activities in daily living (ADL). However, there is limited knowledge regarding physiotherapists' experiences of using HIFE in nursing homes. This study can help to understand how physiotherapists can perform high-quality training with this population. 

Aim: To investigate physiotherapists' experiences of HIFE with elderly people living in nursing homes. 

Methods: To achieve the objective of this study a qualitative design was chosen and five physiotherapists that have worked according to HIFE in nursing homes in Sweden were interviewed using a semi-structured approach. The interviews were analyzed using qualitative content analysis. 

Results: Based on the collated data, four categories were identified with a total of 17 subcategories: Successful implementation requires the commitment of many, Important to actively choose participants, Push the participants close to their limits and Effects of the training seen on many levels.

Conclusion: All physiotherapists expressed a great need for HIFE in nursing homes. HIFE was considered suitable for many of the residents and made it possible to challenge the participants to a high intensity and thus saw a greater effect. In order to succeed, commitment is required from a number of people before, during and after the training period. 

Background: Studies have shown an association between level of physical activity (PA) and mental health during the COVID-19 pandemic. However, there is a lack of Swedish studies. Therefore, the aim of this study was to investigate the association between physical activity and mental health in Swedish adults during the COVID-19 pandemic between February and March 2021.

Methods: A survey consisting of the Swedish versions of GHQ-12 and IPAQ-SF was shared via Facebook and everyone between the ages of 18-65 and living in Sweden was eligible.

Results: There was 134 participants in the survey and 72 completed answers. The median for MET-minutes per week was 2269 with no difference between the sexes (p=0.07). In contrast, there was a difference in mental health between the sexes; 52% of the women reported a worse mental health compared to 29% of the males (p=0.003). A significantly larger proportion of males than females maintained their level of PA (p=0.003). There was a fair, significant correlation between PA and mental health (r=-0.35, p=0.0024) where a higher level of PA was associated with better mental health. Also, a change in the level of PA during the pandemic was associated with mental health (r=-0.42, p=0.0039) where a decrease in PA was associated with worse mental health.

Conclusion: This study demonstrates a correlation between physical activity and mental health during the COVID-19 pandemic in Sweden where a higher level of physical activity was associated with better mental health. However, further Swedish studies are needed to ensure these results.

Background Pelvic floor dysfunction (BBD) is common among people post partum, and it can affect the health-related quality of life (HRQoL). Physiotherapy for the pelvic floor can both ease symptoms and improve HRQoL.

Purpose To describe how people 1-5 years postpartum estimate their BBD and their HRQoL, and to investigate the correlation between BBD and HRQoL. To investigate how many of the participants that have received treatment from a physiotherapist.

Method In this cross-sectional study 205 people with BBD participated (mean age 33.56 years, SD=± 4.7). A web survey was published on four Facebook pages. Non-parametric statistics were used, and calculated with Spearman's correlation coefficient.

Results The median value for the participants' estimated BBD with PFDI-20 was 95. The highest of the participants' HRQoL measured with RAND-36 was the subscale physical function with a median value of 80 and the lowest was vitality with 35. The correlations between BBD and the various subscales for HRQoL varied between pain (r = -0.550) as the highest, and emotional role function (r = -0.358) as the lowest, and all correlations had p <0.001. The strongest negative correlation between sexual dysfunction and HRQoL was physical function (r = -0.517), and the weakest was vitality (r = -0.235). All correlations had p <0.001. Of all participants, 40% have seen a physiotherapist.

Conclusion The participants rated their BBD higher than an average population. The study shows a negative correlation between BBD measured with PFDI-20, a question about sexual dysfunction and estimated HRQoL measured with RAND-36. Despite perceived BBD, only half of the participants have received care for their problems.

Background: Frozen shoulder (FS) is a painful condition affecting 2-5% of the population and it affects the shoulder function. Currently there’s no consensus to which treatment is most effective in FS. However, proprioceptive neuromuscular facilitation (PNF) is assumed to bring pain relief and increase range of motion (ROM) and shoulder function. 

Objective: To review the evidence regarding the effect of PNF as treatment in patients with FS. It’s also to examine the quality of included studies and to study the effect of PNF on shoulder function and ROM. 

Method: A systematic review. The search was conducted in the databases of PubMed, Cochrane, Web of Science and Google scholar. The quality was assessed according to PEDro scale and the reliability with GRADEstud. 

Results: Eight studies were included with a total of 360 participants. The quality of the studies ranged between three to eight points according to PEDro scale. According to GRADEstud PNF received very low (+) evidence for shoulder function and low (++) evidence for ROM. The grading was based on four, high quality studies for both shoulder function and ROM. The included studies were conflicting regarding whether PNF had a significant, positive effect on shoulder function and ROM in FS.  

Conclusion: There’s very low (+) evidence that PNF would have an effect on shoulder function and low (++) evidence that PNF has an effect on ROM. In order to clarify the evidence there’s a need for future well-conducted studies with a similar approach. 

Background: Patellofemoral pain (PFP) is common in children and adolescents that are physically active, if untreated it may lead to persistent inconvenience and an abrupt end to adolescents involvement in sports. Individual physiotherapeutic treatment is commonly used in primary care to assess this problem. The purpose of this study was to investigate the concept individual physiotherapeutic treatment in PFP while assessing their evidence and to investigate the prevalence of PFP related to early sport specialisation.

Method: Systematic review. The search was conducted in databases PubMed and PEDro. Eight studier were included in the study. These studies were assessed to evidence quality according to PEDro-scale, SBUs regular- and modified GRADE. One study investigated the prevalence of PFS related to early sports specialization (ESS). Six studies investigated a multimodal treatment involving biopsychological factors. One study investigated the effect of knee- and hip-training with Theraband. 

Results: Early sport specialization increased the risk for PFP 1.5 times. Six studies showed promising results on factors as knee pain and self-assessed function within the population using a multimodal treatment, the combined evidence was estimated as insufficient. One study with high evidence concluded that knee- and hip-training with Theraband decreased knee pain and increased muscle strength. 

Conclusion: ESS is associated with an increased risk of developing PFP, this could be a factor that clinicians should be aware of when treating PFP. An intervention treating PFP should include musclestrenghtening and involve psycosocial factors, one method could be through patient education.

Exercise during cancer treatment improves cancer-related fatigue (CRF), but the importance of exercise intensity for CRF is unclear. We compared the effects of high- vs low-to-moderate-intensity exercise with or without additional behavior change support (BCS) on CRF in patients undergoing (neo-)adjuvant cancer treatment. This was a multicenter, 2x2 factorial design randomized controlled trial (Clinical Trials NCT02473003) in Sweden. Participants recently diagnosed with breast (n = 457), prostate (n = 97) or colorectal (n = 23) cancer undergoing (neo-)adjuvant treatment were randomized to high intensity (n = 144), low-to-moderate intensity (n = 144), high intensity with BCS (n = 144) or low-to-moderate intensity with BCS (n = 145). The 6-month exercise intervention included supervised resistance training and home-based endurance training. CRF was assessed by Multidimensional Fatigue Inventory (MFI, five subscales score range 4-20), and Functional Assessment of Chronic Illness Therapy-Fatigue scale (FACIT-F, score range 0-52). Multiple linear regression for main factorial effects was performed according to intention-to-treat, with post-intervention CRF as primary endpoint. Overall, 577 participants (mean age 58.7 years) were randomized. Participants randomized to high- vs low-to-moderate-intensity exercise had lower physical fatigue (MFI Physical Fatigue subscale; mean difference -1.05 [95% CI: -1.85, -0.25]), but the difference was not clinically important (ie <2). We found no differences in other CRF dimensions and no effect of additional BCS. There were few minor adverse events. For CRF, patients undergoing (neo-)adjuvant treatment for breast, prostate or colorectal cancer can safely exercise at high- or low-to-moderate intensity, according to their own preferences. Additional BCS does not provide extra benefit for CRF in supervised, well-controlled exercise interventions.

Background: Fibromyalgia is a chronic pain syndrome with a prevalence of around 4% for women and 1% for men. Physical exercise is recommended for patients as part of treatment. Earlier reviews indicate a lack of quality and heterogenity in intervention designs. There are uncertainties of which type of aerobic exercise has the biggest effect on pain.

Objective: This review aimed to summarize the scientific level of evidence concerning aerobic exercise on pain level for the fibromyalgia population.

Method: For this systematic review a structured litterature search was carried out in the databases PubMed and PEDro. Quality was assessed with the PEDro-scale and reliability was evaluated with GRADEstud.

Results: Nine RCT's including 529 subjects, with at least 5 points on the PEDro scale were included. The studies show a positive, clinically relevant effect on pain level, of aerobic training when compared to control groups (evidence: low) and similar effects on pain (evidence: moderately high) when compared to other training modality, low intensity aerobic exercise (evidence: low) or strength training (evidence: low). Heterogeneity in the studies reduces the level of evidence in all categories. 

Conclusion: The populations are generally small and generally there is a large heterogenity in the interventions. No difference between aerobic training and other active interventions was observed in terms of pain reduction. It is not possible to conclude which modality of training is best for patients with fibromyalgia. To clarify evidence, there is a need for more studies with similar interventions.

Context. Breathlessness is a cardinal symptom in cardiorespiratory disease and consists of multiple dimensions that can be measured using the instruments Dyspnea-12 (D12) and the Multidimensional Dyspnea Profile (MDP). Objectives. The objective of the study is to determine the minimal clinically important differences (MCIDs) of all D12 and MDP summary and subdomain scores as well as the instruments' feasibility in patients with cardiorespiratory disease. Methods. Prospective multicenter cohort study of outpatients with diagnosed cardiorespiratory disease and breathlessness in daily life. D12 and MDP were assessed at baseline, after 30-90 minutes and two weeks. MCIDs were calculated using anchor-based and distributional methods for summary and subdomain scores. Feasibility was assessed as rate of missing data, help required, self-reported difficulty, and completion time. Results. A total 182 outpatients (53.3% women) were included; main diagnoses were chronic obstructive pulmonary disease (COPD; 25%), asthma (21%), heart failure (19%), and idiopathic pulmonary fibrosis (19%). Anchor-based MCIDs were for D12 total score 2.83 (95% CI 1.99-3.66); D12 physical 1.81 (1.29-2.34); D12 affective 1.07 (0.64-1.49); MDP A1 unpleasantness 0.82 (0.56-1.08); MDP perception 4.63 (3.21-6.05), and MDP emotional score 2.37 (1.10-3.64). The estimates were consistent with small-to-moderate effect sizes using distributional analysis, and MCIDs were similar between COPD and non-COPD patients. The instruments were generally feasible and quick to use. Conclusion. D12 and MDP are responsive to change and feasible for use for assessing multidimensional breathlessness in outpatients with cardiorespiratory disease. MCIDs were determined for use as endpoints in clinical trials. (C) 2020 The Authors. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.

Introduction Breathlessness is a cardinal symptom in cardiorespiratory disease. An instrument for measuring different aspects of breathlessness was recently developed, the Multidimensional Dyspnea Profile (MDP). This study aimed to validate the MDP in terms of the underlying factor structure, internal consistency, test-retest reliability and concurrent validity in Swedish outpatients with cardiorespiratory disease. Methods Outpatients with stable cardiorespiratory disease and breathlessness in daily life were recruited. Factor structure of MDP was analysed using confirmatory factor analysis; internal consistency was analysed using Cronbach's alpha; and test-retest reliability was analysed using intraclass correlation coefficients (ICCs) for patients with unchanged breathlessness between assessments (baseline, after 30-90 min and 2 weeks). Concurrent validity was evaluated using correlations with validated scales of breathlessness, anxiety, depression and health-related quality of life. Results In total, 182 outpatients with cardiorespiratory disease and breathlessness in daily life were included; 53.3% were women; main diagnoses were chronic obstructive pulmonary disease (24.7%), asthma (21.4%), heart failure (19.2%) and idiopathic pulmonary fibrosis (18.7%). The MDP total, immediate perception and emotional response scores, and individual item scores showed expected factor structure and acceptable measurement properties: internal consistency (Cronbach's alpha, range 0.80-0.93); test-retest reliability at 30-90 min and 2 weeks (ICC, range 0.67-0.91); and concurrent validity. There was no evidence of a learning effect. Findings were similar between diagnoses. Discussion MDP is a valid instrument for multidimensional measurement of breathlessness in Swedish outpatients across cardiorespiratory diseases.

Background: Dizziness is common among patients with first time stroke. It affects self-perceived health and is a risk factor for falls. Vestibular rehabilitation (VR) is effective for treating dizziness among various conditions, but the effect of dizziness with origin in the central nervous system is poorly studied.This pilot study of a randomized controlled trial aimed at investigating a vestibular rehabilitation programme among patients with first time stroke and concomitant dizziness. A second aim was to study the feasibility of performing the randomized controlled trial.

Methods: The participants were computer generated randomized to either an intervention or a control group. The intervention comprised of four different vestibular rehabilitation exercises, adapted for each patient and usual rehabilitation. The control group received usual rehabilitation without the vestibular rehabilitation exercises. Outcome measures used were The Activities-specific Balance Confidence Scale, the Berg Balance Scale, the Functional Gait Assessment Scale and the EuroQol-5D. Feasibility was studied in terms of recruitment, adherence and retention rates, also as the ability to collect primary and secondary outcomes as well as to find indications of treatment differences.

Results: Self-rated health improved for all participants. No other differences between baseline and follow-up were detected neither within nor between groups. Recruitment rate was 23%, adherence to the intervention 90%, retention rate 69% and ability to collect outcome measures 90%. No adverse events occurred.

Conclusion: Both the intervention and the control groups improved in self-perceived health. The measures of feasibility were satisfactory in this study, apart from a low recruitment rate.

Background: Previous knowledge about exercise is not a demand in the basic eligibility to attend the physiotherapy program. Previous studies show that there is a stereotypical idea of the physiotherapy profession and that exercise is a part of the profession. The physiotherapy program is also highlighted as a program which can be stressful.

Purpose: The purpose of the study was to investigate perceptions and experiences of non-formal expectations regarding exercise from teachers/course leaders and other students in a group of physiotherapy students at Uppsala university. The purpose was also to investigate how the non-formal expectations affected the students.

Method: Descriptive and qualitative design. Data was gathered through six semi-structured interviews with students from semester 5 attending the physiotherapy program at Uppsala university. The interviews were analyzed using qualitative content analysis.

Result: Students experienced non-formal expectations from teachers, other students and guest teachers. Some students did not experience any expectations. Students were affected positive, negative or not at all by these expectations. They also experienced stereotypical ideas towards how a physiotherapy student should behave. Students perceptions of stereotypical ideas changed over time.

Conclusion: The students experienced non-formal expectations regarding exercise from teachers, other students and guest teachers. These non-formal expectations affected the students differently, ranging from motivational to stressful while some did not experience any effect at all. The result of this study could contribute to the development of the program and treatment of the students.

Background and aims: Few studies have reported the long-term impact of chronic pain on health care utilization. The primary aim of this study was to investigate if chronic musculoskeletal pain was associated with health care utilization in the general population in a 21-year follow-up of a longitudinal cohort. The secondary aim was to identify and describe factors that characterize different long-term trajectories of health care utilization.

Methods: A prospective cohort design with a baseline sample of 2,425 subjects (aged 20-74). Data were collected by self-reported questionnaires, and three time points (1995, 2007, and 2016) were included in the present 21-year follow up study. Data on health care utilization were dichotomized at each time point to either high or low health care utilization. High utilization was defined as >5 consultations with at least one health care provider, or >= 1 consultation with at least 3 different health care providers during the last 12 months. Low health care utilization was defined as <= 5 consultations with one health care provider and <3 consultations with different health care providers. The associations between baseline variables and health care utilization in 2016 were analyzed by multiple logistic regression. Five different trajectories for health care utilization were identified by visual analysis, whereof four of clinical relevance were included in the analyses.

Results: Baseline predictors for high health care utilization at the 21-year follow-up in 2016 were chronic widespread pain (OR: 3.2, CI: 1.9 5.1), chronic regional pain (OR:1.8, CI: 1.2-2.6), female gender (OR: 2.0, CI: 1.4-3.0), and high age (OR: 1.6, CI:0.9-2.9). A stable high health care utilization trajectory group was characterized by high levels of health care utilization, and a high prevalence of chronic pain at baseline and female gender (n =23). A stable low health care utilization trajectory group (n=744) was characterized by low health care utilization, and low prevalence of chronic pain at baseline. The two remaining trajectories were: increasing trajectory group (n =108), characterized by increasing health care utilization, chronic pain at baseline and female gender, and decreasing trajectory group (n=107) characterized by decreasing health care utilization despite a stable high prevalence of chronic pain over time.

Conclusions: The results suggest that chronic pain is related to long-term health care utilization in the general population. Stable high health care utilization was identified among a group characterized by female gender and a report of chronic widespread pain.

Background: In Sweden, approximately 25 000–30 000 people suffer from a stroke every year. About a third of these get aphasia. Previous studies show communication problems between physical therapists and stroke patients with aphasia, which leads to difficulties in giving patients the opportunity to participate in their rehabilitation. There are few studies on how aphasia after stroke affects physiotherapeutic rehabilitation. 

Objectives: To investigate a group of physical therapists' experiences of how aphasia affects the physiotherapeutic rehabilitation process after stroke, and how they feel that these patients have opportunity to participate in the rehabilitation. 

Method: A qualitative design was used with a semi-structured interview guide followed by a qualitative content analysis. Six physical therapists in stroke care in three different regions, in inpatient and outpatient care were interviewed. 

Results: Six main categories emerged from the interviews: Aphasia makes it more difficult to communicate, strategies for better communication with aphasia patients, teamwork is important in the rehabilitation process of aphasia patients - especially with speech and language therapists, how aphasia affects physiotherapists' examination and treatment measures, aphasia contributes to poorer patient participation and requires strategies for increased participation, and emotions in meetings with aphasia patients. 

Conclusion: Aphasia is perceived to make it more difficult to communicate, which leads to difficulties in getting patients involved, even though the physical therapists together with the team use different strategies to improve communication and participation. Physiotherapeutic examinations are perceived as more difficult to carry out, but the exercise is not significantly affected by aphasia. 

Background: The mechanisms of EIB have been suggested to differ between adult athletes and the general population. In line with this, FeNO has been associated with EIB in the general population, but not in adult athletes. Respiratory resistance measured by forced oscillation technique is suggested to be a more sensitive measurement of airway obstruction than FEV1.Aim: To study the association between baseline FeNO and post-exercise changes in FEV1 and respiratory resistance in adolescents either attending a sports high school or from the general population.Methods: Study group A consisted of 148 adolescents, aged 13-15 years, from the general population. Study group B consisted of 98 adolescents, aged 15-17 years, attending sports high school. The subjects performed FeNO before and FEV1 and respiratory resistance measurements at 5 Hz (R5) before and after a standardised exercise test.Results: A positive EIB test (fall in FEV1 ≥10%) was found in 48 subjects in group A and in 24 subjects in group B. FeNO related to post-exercise fall in FEV1 as well as increase in R5 in group A (rho=-0.17, p=0.04 and rho=0.34, p&amp;lt;0.001, respectively). No such relation was found in group B (p&amp;gt;0.05). Elevated FeNO (&amp;gt;25 ppb) was associated with EIB in group A: odds ratio (OR) 2.6 (CI 95% 1.1, 6.2), but not in group B (OR 1.0, CI 95% 0.3, 3.2). The findings in group A were consistent after adjusting for age, gender and height (aOR 2.6 CI 95% 1.1, 6.6).Conclusion: EIB in adolescent athletes is not associated with FeNO in contrast to adolescents from the general population. This indicates that the mechanisms leading to EIB in adolescent athletes may differ from the general population.FootnotesCite this article as: European Respiratory Journal 2019; 54: Suppl. 63, PA4508.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).

Adult elite athletes have a higher prevalence of exercise-induced airway symptoms than the general population and it is more common among female athletes than male. Studies on the prevalence of these symptoms in early-career athletes are scarce.We studied the prevalence of exercise-induced wheeze and dyspnoea in high school athletes, over a two year period, by inviting a cohort (n=272) to answer a questionnaire at age 16 and again at age 18.At age 16 the prevalence of wheeze was 20.5% and dyspnoea 30.1%, and at age 18 the corresponding figures were; wheeze 18.2% and dyspnoea 21.8%. In comparison with 18-year-olds from the general population (1), the high school athletes reported more wheeze (18.2% vs 12.4% p=0.02).At age 16, more female athletes reported wheeze and dyspnea compared with males (29.5 vs 12.4% p=0.001 and 43.2 vs 16.8% p<0.001). Two years later, no gender difference was found regarding wheeze, but more females reported dyspnoea, compared with males (28.3 vs 16.5% p=0.02). The prevalence of dyspnoea among females did however decrease with age (43.2 vs 28.3% p=0.005). This was mainly due to less reported dyspnoea, over the two year period, in females with current asthma (86.4 vs 54.5% p=0.008). In male athletes, the prevalence of both symptoms was similar over time.High school athletes have a higher prevalence of exercise-induced wheeze compared with the general population. A larger proportion of female athletes report exercise-induced symptoms compared with their male peers but this difference seems to decrease with age.1. Johansson H, et al. Respir Med. 2019;154:76-81.FootnotesCite this article as: European Respiratory Journal 2020; 56: Suppl. 64, 1391.This abstract was presented at the 2020 ERS International Congress, in session “Respiratory viruses in the "pre COVID-19" era”.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).

OBJECTIVES: To study the prevalence of exercise-induced bronchoconstriction (EIB) and exercise-induced laryngeal obstruction (EILO) in adolescent athletes.

METHODS: All adolescents (n = 549) attending first year at a sports high school in 2016 and 2017, were invited to answer a questionnaire on respiratory symptoms. The 367 responding participants were divided into two groups based on whether they reported exercise-induced dyspnea (dyspnea group) or not (non-dyspnea group). Randomly selected participants in each group were invited to undergo two standardized exercise tests, an EIB test and a continuous laryngoscopy exercise (CLE) test, to investigate EILO.

RESULTS: In total, 98 participants completed an EIB test, 75 of whom also completed a CLE test. Positive EIB tests: eight of 41 in the dyspnea group and 16 of 57 in the non-dyspnea group. Positive CLE tests: five of 34 in the dyspnea group and three of 41 in the non-dyspnea group. The estimated prevalence of EIB was 23.1 % (95 % CI 14.5 - 33.8) and of EILO 8.1 % (95 % CI 2.5 - 18.5) in the whole study population. No differences in prevalence of EIB or EILO were found between the dyspnea and the non-dyspnea groups.

CONCLUSION: EIB was highly prevalent in this cohort of adolescent athletes. EILO was less prevalent, but represents an important differential diagnosis to EIB. Self-reported exercise-induced dyspnea is a weak indicator for both EIB and EILO and standardized testing should be provided.

Owners' ability to recognize signs of chronic pain in dogs undergoing pharmacologic and nonpharmacologic pain interventions during a period of physical rehabilitation is not known. This study aimed to compare dogs with and without chronic pain, and to assess the relationship between explanatory factors, including the probability of owners' response bias induced by pharmacologic and nonpharmacologic pain intervention, and chronic pain in dogs with osteoarthritis (OA). Seventy-one dogs with OA were included in this observational study. Owner-perceived pain interference was measured by Canine Brief Pain Inventory (CBPI) and owner-perceived pain behavior was assessed using Helsinki Chronic Pain Index. A dichotomous variable of Helsinki Chronic Pain Index was used in regression analysis to investigate the association between chronic pain and explanatory factors (body condition, anti-inflammatory medication, animal physiotherapy consultation once or more and owners' perception of pain interfering). Seventy-five percent of the dogs had ongoing anti-inflammatory medication, 51% of were overweight and 45% had a physiotherapy consultation. Higher levels of overt pain behaviors were reported in items addressing activities. Body condition, physiotherapy consultation and medication were not associated with chronic pain. Odds ratio (OR) and 95% confidence intervals of OR for the CBPI were 1.74 (1.23-2.47) and significantly associated with chronic pain. The adjusted OR of the CBPI did not differ from the crude OR. Owner-perceived pain behavior was not confounded by the dogs' medication. Results indicated that CBPI was not mediated by the medication. The CBPI pain interference score was not associated with response bias and may be used as clinical outcome measure of chronic pain and pain-related disability in dogs with OA along a period of physical rehabilitation comprising pharmacologic and nonpharmacologic pain interventions.