The extent and depth of traumatic brain injury (TBI) remains a major determining factor together with the type of structural insult and its location, whether mild, moderate or severe, as well as the distribution and magnitude of inflammation and loss of cerebrovascular integrity, and the eventual efficacy of intervention. The influence of exercise intervention in TBI is multiple, ranging from anti-apoptotic effects to the augmentation of neuroplasticity. Physical exercise diminishes cerebral inflammation by elevating factors and agents involved in immunomodulatory function, and buttresses glial cell, cerebrovascular, and blood-brain barrier intactness. It provides unique non-pharmacologic intervention that incorporate different physical activity regimes, whether dynamic or static, endurance or resistance. Physical training regimes ought necessarily to be adapted to the specific demands of diagnosis, type and degree of injury and prognosis for individuals who have suffered TBI. © 2012 John Wiley & Sons A/S.

There is evidence that a knee flexor exercise, the Nordic hamstring exercise (NHE), prevents hamstring injuries. The purpose of this study was therefore to develop, and to determine the reliability of, a novel NHE test device and, further, to determine the effectiveness of a 10-week low volume NHE program on NHE performance. Twenty female football (soccer) players, aged 16–30 years, participated in this study. From a kneeling position on the device, with the ankles secured under a heavy lifting sling, participants leaned forward in a controlled manner as far as possible (eccentric phase) and then returned to the starting position (concentric phase). A tape measure documented the forward distance achieved by the participants in cm. Participants completed three separate occasions to evaluate test-retest reliability. Additionally, 14 players performed a low volume (1 set of 5 repetitions) NHE program once weekly for 10 weeks. No significant test-retest differences in NHE performance were observed. The intra-class correlation coefficient was 0.95 and the coefficient of variation was 3.54% between tests. Mean improvement in the NHE performance test by the players following training was 22% (8.7 cm), p = 0.005. Our test device reliably measured NHE performance and is easy to perform in any setting. Further, NHE performance was improved by a 10-week low volume NHE program. This suggests that even a small dose (1 set of 5 repetitions once weekly) of the NHE may enhance NHE performance.

Aim:  The overall aim of this thesis was to explore the development of a video-supported interactive learning model for movement awareness among nursing students.

Methods:  Study I was a cross-sectional survey regarding prevalence and impact of musculoskeletal symptoms (MSS) among nursing students. In the remaining three studies a learning model was developed and explored; II - the inter-personal interaction (qualitative content analysis), III - the students’ experiences of using the learning model (phenomenological hermeneutics), IV - the students’ learning processes (hermeneutic approach).

Results: 143 of the 224 respondents in study I reported MSS during the previous 12 months and of those 91 reported impact on physical daily life activities. The odds ratio for reporting MSS study year 3 was 4.7 (95% CI: 2.1 – 10.7). Study II shows that the students’ movement awareness and self-analysis developed when encountering their own movement through video feedback. Studies III and IV show that the facilitator’s reflective and responsive approach appears to be essential in creating interaction and a permitting learning atmosphere. The students became emotionally and cognitively challenged and personally engaged, were motivated to change by discovering details in their movements and gained a greater understanding of the relationship between their own movements and current or risk for future MSS. They also experienced emotional, cognitive and bodily confusion, which was interpreted as a necessary step in the changing process.

Conclusion: MSS among nursing students appears to be a problem and education regarding ergonomic movements and principles is suggested to be emphasized in the nursing curriculum. The video-supported learning model enabled encountering and discovering one’s own body and movement in different ways, which facilitated reflection and motivation for change, which was supported by the facilitator’s reflective approach. The learning model, which could contribute to multifactorial ergonomic interventions, could also support movement awareness and learning in practical learning situations within education and rehabilitation. Further research needs to study the model in different contexts and in relation to MSS prevention.

Aim: To explore the long-term learning process in movement awareness development supported by a video-based learning model.

Participants: Eleven undergraduate nursing students.

Method: The students participated in learning sessions comprising video modelling, video feedback and reflective enquiry with a focus on inter-personal interaction. Each student participated in three individual video sessions during a four-month period. Three individual interviews were carried out, the last one 12–18 months after the final session. Visual, verbal and written material were collected from the video sessions, individual interviews and diaries, and interpreted within a hermeneutical approach.

Results: The learning process was described in three themes: motivation for change, exploring alternative perspectives and movement changes through challenges.

Conclusions: The video-based learning model implies a challenging experience on a personal level that supports motivation and a deep approach to learning. It adds a powerful base for reflection, which encourages student-centred active learning. The facilitator’s reflective approach is essential to allow the student to explore her/his own movement, in contrast to delivering instructions. The learning model may be valuable in the physiotherapist’s clinical work in facilitating patients’ movement awareness in the process of movement improvements.

Health care staff and students have a great risk of developing musculoskeletal symptoms. One cause of this is heavy load-related work activities such as manual handling, in which the quality of individual work technique may play a major role. Preventive interventions and well-defined educational strategies to support movement awareness and long-lasting movement changes need to be developed. The aim of the present study was to explore nursing students’ experiences of a newly developed interactive learning model for movement awareness. The learning model, which is based on a life-world perspective with focus on inter-personal interaction, has been used with eleven undergraduate students from the second and final year. Each student participated in three individual video-sessions with a facilitator. Two individual interviews were carried out with each student during the learning process and one interview 12-18 months after the last session. The interviews were audio-recorded and transcribed verbatim and a phenomenological hermeneutic method inspired by Paul Ricoeur and described by Lindseth & Norberg was used to interpret the interviews and diary notes. The interpretation resulted in three key themes and nine sub-themes. The key themes were; Obtaining better preconditions for bodily awareness, Experiencing changes in one’s own movement and Experiencing challenges in the learning process. The interactive learning model entails a powerful and challenging experience that develops movement awareness. The experience of meaningfulness and usefulness emerges increasingly and alternates with a feeling of discomfort. The learning model may contribute to the body of knowledge of well-defined educational strategies in movement awareness and learning in for example preventive interventions and ergonomic education. It may also be valuable in other practical learning situations where movement awareness is required.

IRAF is an instrument developed to support education, communication and assessment within the field of safe and gentle person transfers. IRAF encompasses both the level of independence and the qualitative aspects of the movement performance to clarify the individual’s need of support in daily life transfers to guide how to provide safe and adequate support, i.e., in what way, how much and in what stage of the transfer. Additionally, the aim is to create a common language for person transfers among patients, healthcare providers, family care givers, and teachers within different contexts, such as hospitals, rehabilitation centres, home care and educational institutions. The IRAF is today a paper-based instrument and is currently under development in a digital format.

The purpose of IRAF is to provide structure for and facilitate the analysis and assessment of an individual’s mobility in physical activities in daily living to enhance understanding and communication of an individual’s level of independence(LI) and the quality of movement performance (MP). 

Nursing education should prepare students for a lifelong professional career including managing clinical physical demands. Musculoskeletal symptoms, such as bodily pain, have been reported among nurses and nursing students but less is known about the impact of symptoms in daily activities. The aim was to explore the prevalence of self-reported musculoskeletal symptoms and their impact on general physical activity among nursing students. This cross-sectional study was based on a questionnaire to all undergraduate nursing students at one university. The prevalence of symptoms and physical impact during past 3 and 12 months was calculated for each study year. Odds ratio was analysed with logistic regression. Of 348 students 224 responded, 84% women, mean age 24.6 years (range 20-46). Of those 143 (64%) reporting symptoms during the past 12 months, 91 (64%) reported impact on physical activities. Most commonly reported were everyday activities such as transportations and prolonged sitting. The odds ratio for reporting symptoms was 1.8 for year 2 (95% CI: 0.9-3.5), and 4.7 for year 3 (95% CI: 2.1-10.7). The prevalence of musculoskeletal symptoms was high among nursing students and higher the final study year and not only resulted in discomfort but had an impact on the students' general physical activities.

The aim of this study is to describe an interactive model developed for movement awareness in a practical learning situation and to explore the use of video-based digital feedback and reflective enquiry in this model among nursing students. Sixteen students participated in individual interactive video sessions with a facilitator, who encouraged the students to reflect upon their own movements. Qualitative analysis showed that movement patterns were visualized, and that movement awareness and self-analysis were gradually developed. Encountering one’s own movement and reflecting on one’s own experiences appear to support motivation for movement changes.

There is a call to action for physiotherapists worldwide to contribute to the transition towards 'sustainable health'. In this paper, we build upon the current definition of 'sustainable health' and also on 'sustainable physical activity' to introduce and theoretically substantiate the concept of sustainable human movements, and suggest a definition thereof. Sustainable human movements will be described as a threshold concept with three aligned critical concepts; (i) movement control, including forces as causes of emerging movements, (ii) movement quality, referring to how movements are performed in terms of optimisation, and (iii) physical literacy, including motivation, confidence and physical competence. A deep understanding of these concepts, combined with a collaboration and learning approach applied together with the patient, is proposed to enable a sustainable human movement approach to permeate physiotherapy theory and practice. To facilitate this, a generic and easily accessible tool has recently been developed. It combines support for structured observational movement analysis and pedagogical support for creating a mutual and extended understanding of a patient's lived experience. This encourages the patient to become actively involved and take responsibility for promoting his/her 'sustainable health'. The aims of this paper are to a) suggest a theoretical framework for and definition of the concept sustainable human movements, and b) introduce a clinical tool that ultimately aims at promoting sustainable movements and health.

Background: To my knowledge, no previous studies have examined the appearance of injury in young floorball players. Aim: To investigate the occurrence of overuse injuries in lower extremity (LE) in floorball players aged 15 or younger, with respect to frequency, location, and consequence of injury. Method: Fifty-seven players participated (mean age 11±2 years). A modified version of Oslo Sports Trauma Research Center Overuse Injury Questionnaire was submitted every fourth week during four months in order to record the occurrence of overuse injuries in LE. Result: A total of 42 overuse injuries in 42% (24/57) of the cohort were found. The average monthly prevalence for all players, in any anatomical area, was 28% (95% confidence interval 18%-38%). The most common location of injuries was the knee (43%), followed by the foot (40%). A weak positive and significant correlation (rs = 0.276, p = 0.038 ) between overuse injuries and age was found. Conclusion: The present study shows, in accordance with other recent studies on children and adolescents, that overuse injuries seems to be a common problem for young floorball players.

Abstract

Investigation physical activity in a population gives descriptive data and the

result serves as a measuring instrument for how future interventions ought to

be designed. The purpose of this study was to see whether any associations

existed between three examination instruments for physical activity that are

used with children with overweight. Method: The participants were

measured, weighed, estimated their physical activity (questionnaire), testing

their physical performance (six-minute walking test) and their physical

activity was measured (accelerometer). Results: Eight girls, aged 7-13, body

mass index of 26 ± 3.7, participated. The majority of the children estimated

to be physically active for 30-60 min/day, during weekdays and weekends,

but seen as a group the estimation was significantly lower on the weekend.

Their physical performance showed a significantly lower value than the

predicted value. The children performed on average for 67 ± 24 min / day

during the week and significantly less (31 ± 29.7 min / day) on weekends. A

significant association existed between performed physical activity during

weekdays and the performance test. A formula for how this relationship

could be calculated was designed. Conclusion: Despite low numbers of

participants the result of the study could indicate that 6MWT can be used not

only for assessing the performance but also to calculate the executed amount

of activity during weekdays.

OBJECTIVE: To describe and identify the explanatory factors of variation in current and maintained health-enhancing physical activity (HEPA) in persons with rheumatoid arthritis (RA).

METHODS: In this cross-sectional study, current HEPA was assessed with the International Physical Activity Questionnaire and maintained HEPA with the Exercise Stage Assessment Instrument, the latter explicitly focusing on both aerobic physical activity and muscle strength training. Sociodemographic, disease-related, and psychosocial data were retrieved from the Swedish Rheumatology Quality (SRQ) registers and a postal questionnaire. The explained variations in the respective HEPA behaviors were analyzed with logistic regression.

RESULTS: In all, 3,152 (58.5%) of 5,391 persons identified as eligible from the SRQ registers responded to the questionnaire. Current HEPA was reported by 69%, and maintained HEPA by 11% of the respondents. The most salient and consistent factors explaining variation in both current and maintained HEPA were self-efficacy, social support, and outcome expectations related to physical activity.

CONCLUSION: To our knowledge, this is the first study exploring maintained physical activity in a large well-defined sample of persons with RA. Our results indicate that a minority perform maintained HEPA, including both aerobic physical activity and muscle strength training, and that psychosocial factors are the most salient and consistent in the explanation of HEPA variation.

Bakgrund: Trochanterrelaterad smärta anses bero på en bursit eller tendinopati i musklerna gluteus medius eller minimus. Smärtan uppstår när gluteal muskulatur pressas samman mot trochanter major av tractus iliotibialis när höften förs i en adduktion. Konservativ behandling är den primära behandlingsformen. Syfte: Syftet med studien var att genomföra en litteraturöversikt av aktuell litteratur (från 2018 och framåt) som undersökte konservativ behandling vid trochanterrelaterad smärta. Denna studie riktade in sig på interventionerna träning, inflammationsdämpande kortisoninjektion och stötvågsbehandling.Metod: Litteratursökningen genomfördes primärt i två elektroniska databaser: PubMed och Cochrane Library och kompletterades med sökningar i Google sholar samt skolans bibliotek. Sökorden togs fram via MeSH-termer (Medical Subject Headings) från Karolinska Institutet samt fritext. Sju studier mötte inklusionskriterierna och kvalitetsgranskades enligt en utvald mall för randomiserade studier. Evidensgradering utfördes på varje enskild originalstudie enligt en evidensmall. Resultat: Samtliga behandlingsformer; träning, kortisoninjektion och stötvågsbehandling, har visat på signifikanta skillnader i minskad smärta mellan grupperna utvärderat med NRS (Numeric rating scale) eller VAS (Visuell analog skala) och kortisoninjektioner och stötvågsbehandling har även visat på signifikanta minskningar i smärta inom grupperna. VISA-G (Victorian Institute of Sport Assessment – gluteal) uppvisar två signifikanta skillnader i ökad funktion i vardagen och ökad effektstorlek där träning och stötvågsbehandling har högre värde jämfört med kortisoninjektion. En signifikant skillnad i ökad livskvalitet ses hos deltagare som fått stötvågsbehandling. Evidensstyrkan uppmättes till måttligt stark. Konklusion: En oklarhet råder kring vilken behandlingsmetod som har den mest effektiva behandlingsstrategin. Forskningen visar på att en intervention, oavsett om den är aktiv eller placebo, är mer fördelaktig för personer med trochanterrelaterad smärta jämfört med vila. 

Abstract

Background: Instrumented testing of anterior posterior knee laxity has become an objective valuable tool in combination with clinical tests in evaluation and diagnosis of ACL injuries. The Rolimeter is an instrument that quantifies anterior knee laxity and has in previous studies showed satisfactory results regarding intra and inter tester reliability in subjects without injuries or with chronic ACL deficiency.

Objective: To test the reliability of the Rolimeter in the acute phase following a substantial knee trauma. The repeatability of the test procedure was also investigated.

Methods: Totally 15 subjects with acute knee trauma were examined by one single observer at three different times with the Rolimeter using maximum force. Both injured and non injured knees were examined and anterior posterior displacement was recorded. Endpoint examination was used as “golden standard” in data analysis.

Results: Strong significant correlations were found for the Rolimeter scores of knee laxity between baseline and endpoint for both injured (r= 0,928, p< 0,01) and non injured knees (r= 0,987, p < 0,01). Mean differences in anterior laxity were small with no significant differences between readings. High repeatability was found in repeated measurements with no significant change over time for the non injured knees.

Conclusion: The study implicates that the Rolimeter produces reliable quantification of anterior knee laxity in repeated measurements even in the acute phase following knee trauma. In combination with manual tests the Rolimeter seems to be a valuable instrument in diagnosing ACL injuries.

Key words: Anterior cruciate ligament, Arthrometer, Hemarthrosis, Instability, Instrumented testing, Knee joint instability

High Velocity Manipulation of the cervical spine is a manual treatment technique against pain in foremost the neck, shoulders. The technique has according to multiple sources been connected to the risk of injury to the blood vessels that supply the brain with blood, with among others stroke as a consequence.  Other sources have on the other hand shown it the technique to be safe to perform.

This literature study has compiled and evaluated research that in various ways tries to find out if said connection is causal The method used was to evaluate articles through a pre-made form from SBU, and then to sort them according to relevance to see if the connection is causal or not.

The result showed that the question is too complex to be answered in a single study, and that more research is needed to answer the question in full. This is due to the fact that there are multiple mechanisms behinds this form om injury, that the risk seems to exists in certain groups, and that some of these are not yet identifiable.

On the other hand there is a high probability that the technique might act as an activating factor in these groups. Because of this there can be said that a risk exists with the technique in practice, no matter if there is a casual connection between the technique and stroke in itself or not.

Under de senaste åren har man uppmärksammat vårdgivares bemötande till patienter i vården. Syfte: Syftet med denna studie var att undersöka patienters upplevelse av sjukgymnastens bemötande vid ett förstagångsbesök. Metod: En kvalitativ ansats valdes för studien. Tre män och sju kvinnor intervjuades enligt en semistrukturerad intervjuguide. Texten analyserades utifrån kvalitativ manifest innehållsanalys. Resultat: Analysen resulterade i åtta kategorier som beskrev patientens upplevelse av sjukgymnastens bemötande vid ett förstagångsbesök. De intervjuade uppfattade sjukgymnastens uppriktighet i att vilja förstå varför patienten sökte. Tillvägagångssättet var genomgående att sjukgymnasten ställde frågor i kombination med en undersökning. I samtalet upplevde patienten sjukgymnastens särskilda intresse av att få en förståelse för individen och få en helhetsbild. Patienterna kände att de blev tagna på allvar och ansåg att sjukgymnastens fullständiga uppmärksamhet var riktad mot patienten som noggrant hann beskriva sina symtom i kombination med att sjukgymnasten kom fram till en funktionsdiagnos med fortsatt behandlingsstrategi. Sammanfattning: Resultatet av studien visade på många förhållanden som ledde fram till ett bra möte. Samspelet mellan patient och sjukgymnast byggde på att sjukgymnasten visade ett intresse, hade empati och gav motivation samt lyssnade till patientens berättelse. 

Introduction: Increased physical exercise is linked to enhanced brain health and reduced dementia risk. Exercise intervention studies usually are conducted at facilities in groups under trainer supervision. To improve scalability, accessibility, and engagement, programs may need to be structured such that individuals can execute and adjust routines in their own homes.

Methods: One hundred eighty-three healthy older adults from two sites (the United States and Sweden) were screened. One hundred fifty-six subjects (mean age 73.2), randomly assigned to one of four interventions (PACE-Yourself physical exercise program, mindfulness meditation, or Cogmed® adaptive or nonadaptive computerized working memory training) began the study. All interventions were structurally similar: occurring in subjects' homes using interactive, web-based software, over five weeks, ∼175 minutes/week. In the PACE-Yourself program, video segments presented aerobic exercises at different pace and intensity (P&I). The program paused frequently, allowing subjects to indicate whether P&I was "too easy," "too hard," or "somewhat hard." P&I of the subsequent exercise set was adjusted, allowing subjects to exercise at a perceived exertion level of "somewhat hard." Program completion was defined as finishing ≥60% of sessions.

Results: A high percentage of participants in all groups completed the program, although the number (86%) was slightly lower in the PACE-Yourself group than the other three. Excluding dropouts, the PACE-Yourself group had a lower adherence rate of 93%, compared with the other three (∼98%). Over the five weeks, PACE-Yourself participants increased exercising at the highest intensity level, consistent with augmented aerobic activity over time. The number of exercise sessions completed predicted the postintervention versus preintervention increase in self-reported level of physical activity.

Discussion: This study supports the feasibility of a home-based, subject-controlled, exercise program in which P&I is regulated via real-time participant feedback, which may promote self-efficacy. Further study is needed to determine if similar results are found over longer periods and in more diverse populations.

Studier har visat att det är viktigt att ge kvinnor evidensbaserad information och råd kring träning och graviditet. Syftetmed studien var att undersöka frågeställningen: Upplever kvinnor efter sin förlossning att de fick kunskap under sin graviditet kring fysisk aktivitet och träning? Metodensom användes var en enkätundersökning och ett av inklutionskriterierna var att man skulle ha fött sitt barn inom de senaste 24 månaderna. Resultatetav studien baserades på 360 enkätsvar vilka visade 70 % av de svarande anser att de inte fått tillräcklig information om träning under graviditeten. Av de svarande som ansåg sig fått tillräckligt med kunskap om fysisk aktivitet under graviditeten fick 39 % den informationen från en fysioterapeut, flest av alternativen. 52 % av de svarande bedömde sin kunskap om träning och graviditet som låg under graviditeten. Enkätresultaten visade också att 86 % av de svarande som bedömde sig ha hög eller mycket hög kunskap om gravidträning under graviditeten gjorde en förändring i sin träning. Det var sex procentenheter högre än resultatet bland alla respondenter. Slutsatsenav studien visade indikationer på att de kvinnor som träffat en fysioterapeut under sin graviditet i högre grad verkar uppleva att de fått information om hur de bör träna under graviditeten. Det bör undersökas genom vidare studier.

Bakgrund: Att skapa bra förutsättningar och ta hand om idrottstalanger är angeläget i många länder, så också i Sverige. Ett led i att skapa möjligheter för våra idrottsungdomar har varit satsningen på idrottsgymnasier.

Syfte: Syftet med den här studien var att undersöka om de friidrottsungdomar som presterar bäst vid antagningstester till Friidrottsgymnasiet i Växjö även är de friidrottare som presterar bäst resultat som seniorer. 

Material och metod: Totalt 207 friidrottare, i 15 års ålder, (100 flickor och 107 pojkar) som utfört ansökningstesterna till FIG Växjö och presterat ett friidrottsresultat som senior ingick i studien. Följande antagningstester ingick:30 meter flygande(snabbhet), kulkast framåt (explosivitet) samt plinthopp, 90 sekunder (styrkeuthållighet). Antagningstesterna jämfördes med friidrottarens bästa prestation utförd som senior. En jämförelse gjordes även grengruppsvis. Resultatet visade en ganska stark korrelation för flickor mellan 5 av de 15 undersökta sambanden. Sprint/häckgruppens friidrottsresultat korrelerade med flygande30 meter samt kulkast framåt (r= 0,6, p<0,05). Hoppgruppens resultat korrelerade med plinthopp samt flygande30 meter (r=0,5, p<0,05). Medel/långdistansgruppens resultat korrelerade med kulkast framåt (r=0,5, p<0,05). För pojkar sågs endast en ganska stark korrelation, sprintgruppen korrelerade med kulkast framåt(r=0,5, p<0,05).  

Slutsats: De fysiska tester som använts i denna studie bör inte vara helt avgörande vid en antagning till ett friidrottsgymnasium, framförallt inte när det gäller pojkar.

Bakgrund: Subacromiellt smärtsyndrom och rotatorcuffrelaterade besvär behandlas vanligtvis med rehabilitering i from av fysisk träning. Forskning visar mer och mer på positiv effekt av motorsimulering (MI) vid både träning och rehabilitering i from av bland annat ökad styrka och rörlighet. Området är dock inte tillräckligt utforskat och det saknas forskning på just SAPS och rotatorcuffproblematik.Syfte: Syftet med studien var att undersöka om ett tillägg av mental träning genom MI vid rehabilitering av SAPS eller rotatorcuffrelaterade besvär kan bidra till ytterligare effekt i form av minskad smärta och förbättrad upplevd funktionsnivå.Metod: Studien utfördes som en experimentell studie med interventionsgrupp (n=10) som utförde fysisk rehabilitering och MI samt referensgrupp (n=11) som utförde fysisk rehabilitering under 8 veckor. Upplevd funktion och smärta undersöktes med WORC och NRS vid rehabiliteringsperiodens start, efter 4 veckor och efter 8 veckor. Data analyserades med Mann-Whitney U test och ANOVA repeated measures. WORC analyserades i sin helhet samt dess delområden och smärtan utifrån NRS och WORC:s två frågor om smärtaResultat: Det noterades inga signifikanta skillnader mellan grupperna vid någon tidpunkt. För interventionsgruppen förelåg en signifikant förbättring på WORC:s totala poäng samt delområdena Fysisk, Arbete och Livsstil samt för smärtskattning VAS skarp smärta. För referensgruppen förelåg en signifikant förbättring för WORC:s delområden Fysiska, Arbete och Känslor samt NRS och smärtskattning VAS skarp smärta.Slutsats: Resultatet visar tendenser till att MI kan ha effekt som komplement till fysisk rehabilitering vid SAPS eller rotatorcuffsrelaterade besvär vad gäller upplevd funktion men inte för smärtminskning. Detta innebär att MI skulle kunna vara ett alternativ vid behandling av dessa besvär. Denna studie genomfördes som en pilotstudie med ett relativt lågt deltagarantal vilket gör att resultaten bör tolkas med försiktighet.

BACKGROUND: Individuals with knee and hip osteoarthritis (OA) are less physically active than people in general, and many of these individuals have adopted a sedentary lifestyle. In this study we evaluate the outcome of education and supervised exercise on the level of physical activity in individuals with knee or hip OA. We also evaluate the effect on pain, quality of life and self-efficacy.

METHODS: Of the 264 included individuals with knee or hip OA, 195 were allocated to the intervention group. The intervention group received education and supervised exercise that comprised information delivered by a physiotherapist and individually adapted exercises. The reference group consisted of 69 individuals with knee or hip OA awaiting joint replacement and receiving standard care. The primary outcome was physical activity (as measured with an accelerometer). The secondary outcomes were pain (Visual Analog Scale), quality of life (EQ-5D), and self-efficacy (Arthritis Self-Efficacy Scale, pain and other symptoms subscales). Participants in both groups were evaluated at baseline and after 3 months. The intervention group was also evaluated after 12 months.

RESULTS: No differences were found in the number of minutes spent in sedentary or in physical activity between the intervention and reference groups when comparing the baseline and 3 month follow-up. However, there was a significant difference in mean change (mean diff; 95% CI; significance) between the intervention group and reference group favoring the intervention group with regard to pain (13; 7 to 19; p < 0.001), quality of life (- 0.17; - 0.24 to - 0.10; p < 0.001), self-efficacy/other symptoms (- 5; - 10 to - 0.3; p < 0.04), and self-efficacy/pain (- 7; - 13 to - 2; p < 0.01). Improvements in pain and quality of life in the intervention group persisted at the 12-month follow-up.

CONCLUSIONS: Participation in an education and exercise program following the Swedish BOA program neither decreased the average amount of sedentary time nor increased the level of physical activity. However, participation in such a program resulted in decreased pain, increased quality of life, and increased self-efficacy.

TRIAL REGISTRATION: The trial is registered with ClinicalTrials.gov. Registration number: NCT02022566 . Retrospectively registered 12/18/2013.

Bakgrund

Hälso- och sjukvården står inför stora utmaningar, och digitaliseringen anses vara ett av de viktigaste verktygen för att möta dessa. Telerehabilitering i form av egenmonitorering och distansbehandlingar är viktiga inslag i den digitala transformationen, inte minst vad gäller att hantera kroniska besvär. När vi nu övergår till mer digitala behandlingsupplägg används även utvärderingsinstrument i en mer digital kontext. För att bibehålla vårdens kvalitet är det väsentligt att kontrollera dessa med avseende på tillförlitlighet.  

Syfte

Syftet med denna studie var att undersöka det självrapporterade 30 sekunder Chair Stand Test (30s CST) som används i Joint Academys digitala behandling. Syftet var att kontrollera testets tillförlitlighet och om huruvida det självrapporterade testet är likvärdigt ett traditionellt 30s CST.  

Material och metod

Studien genomfördes i två delmoment, där samtidig validitet respektive stabilitet (test-retest reliabilitet) bedömdes. För att bedöma samtidig validitet studerades inter-rater reliabilitet och samstämmighet mellan det traditionella 30s CST och det självrapporterade testet. Det självrapporterade testets stabilitet bedömdes genom att studera test-retest reliabilitet och samstämmighet mellan upprepade mätningar. Data analyserades med Inter-Class Correlation Coefficient (ICC), Bland Almandiagram med tillhörande Limits of Agreement (LoA) och intervall för Minimal Clinically Important Difference (MCID). 

Resultat 

Inter-rater reliabilitet bedömdes god till utmärkt (ICC=0.930 95% CI 0.636 - 0.979). Undersökning av samstämmighet mellan traditionellt och självrapporterat test visade en medelskillnad på -1.5 uppresningar, vilken tillsammans med 95% konfidensintervall hamnade innanför intervallet för MCID. Test-retest reliabiliteten bedömdes god till utmärkt (ICC=0.923, 95% CI 0.828 - 0.962). Bland Altmandiagrammet för samstämmighet mellan upprepade mätningar visade en medelskillnad på -1.2 uppresningar vilken även den hamnade innanför MCID. Utöver detta observerades stora individuella skillnader. 

Slutsats 

Det självrapporterade funktionstestet kan anses likvärdigt ett traditionellt 30s CST vid mätning av fysisk funktion. Det digitala och självrapporterade 30s CST bör vid kliniska bedömningar, precis som det traditionella 30s CST, användas tillsammans med annan relevant information som exempelvis smärtskattning.

Background. Baduanjin exercise is considered to be beneficial to modulate the blood lipid metabolism. The purpose of the systematic review was to assess the potential efficacy and safety of Baduanjin exercise. Methods. MEDLINE, EMBASE, CBM, CNKI, VIP, Chinese Important Conference Papers Database, and Chinese Dissertation Database were searched for all prospective-controlled trials of Baduanjin exercise from their inception to December 31, 2011. Results. A total of 14 studies were included. Comparing with no treatment, Baduanjin exercise significantly reduced the levels of TC, TG, LDL-C in plasma, and elevated plasma HDL-C level for healthy participants, and the pooled MD (95% confidence interval, CI) was −0.58 mmol/L (−0.86, −0.30 mmol/L), −0.22 mmol/L (−0.31, −0.13 mmol/L), −0.35 mmol/L (−0.54, −0.17 mmol/L), 0.13 mmol/L (0.06, 0.21 mmol/L), respectively. Baduanjin exercise also obviously decreased the levels of TG, LDL-C in plasma comparing with no treatment for patients, and the pooled MD (95% CI) was −0.30 mmol/L (−0.40, −0.19 mmol/L), −0.38 mmol/L (−0.63, −0.13 mmol/L), but there was not obvious to decrease plasma TC level or elevate plasma HDL-C level in patients with the pooled MD (95%CI), −0.39 mmol/L (−1.09, 0.31 mmol/L) and 0.22 mmol/L (−0.11, 0.55 mmol/L), respectively. In addition, the obvious advantage was not observed to modulate the blood lipid metabolism in comparing Baduanjin exercise with other exercises, regardless for health participants or patients. Conclusion. Studies indicated that Baduanjin exercise could significantly decrease the levels of TC, TG, LDL-C levels in plasma and elevate plasma HDL-C level for the healthy people. It also was helpful that Baduanjin exercise modulated the blood lipid metabolism for patients. Moreover, the Baduanjin exercise did not have an obvious advantage on modulating the lipid metabolism comparing with other exercises. But the evidence was uncertain because of the small sample size and low-methodological quality

Background: Knee injuries are one of the most common injuries in a range of sports. In novice runners followed for one year, 32% of reported injuries were knee injuries. Iliotibial band syndrome, also known as runner's knee, is common in runners, cyclists and the military. There is a lack of consensus regarding pathology and etiology when it comes to iliotibial band syndrome and several explanatory models exist. Conservative treatment has been noted to achieve good effects, but with a varied time for return to normal activity level. Treatment can consist of both patient-controlled and therapist-dependent treatment. There is, however, a lack of evidence to determine which treatment type is the most effective to relieve symtoms and improve functional ability. Aim: The aim was to examine the effect of therapist-dependent and patient-controlled treatments on pain and function in patients with iliotibial band syndrome. Method: Data collection was carried out by searching the databases Pubmed, PEDro, Cinahl and ONE search via Linnaeus University's library during the period 220730 - 220808. Results: A total of six studies were included, the quality of which was assessed based on the PEDro scale. Therapist-dependent treatments significantly reduced pain. Patient-controlled treatments significantly reduced pain after the study period. Regarding function, both therapist-dependent and patient-controlled treatments had an effect. The patient-directed treatments showed a certain advantage regarding functional improvements compared to therapist-dependent treatment. Conclusion: The results indicate that both types of treatment have a good effect on pain. Regarding function, a rehabilitation protocol with successively increased load appears to provide a greater functional improvement.

Background Shoulder pain and injury is common in both the general population and among athletes. Overhead athletes, such as handball players, are at an even higher risk of shoulder injury. There is currently no consensus regarding how or if these injuries can be prevented. 

Purpose The aim of this review was to examine whether preventive training programs reduce acute and/or overuse injuries in overhead athletes. Another aim was to examine if training programs increase the strength of the rotator cuff in overhead athletes. 

Method Searches were made in PubMed, Cinahl, and Sport Discus in March and April 2021. Ten studies were included in the study. The PEDro-scale was used to assess methodological quality and GRADE was used to determine level of evidence. 

Results The methodological quality was “moderate to high” for five of the studies. The remaining five studies were of lower quality. The level of evidence was “limited” for prevention and “inadequate” for rotator cuff strength. 

Conclusion The evidence for prevention of shoulder injuries was “limited” and the evidence for rotator cuff strength was “inadequate”. A narrower focus on one sport might result in more robust evidence. 

Keywords overhead athlete, prevention, shoulder, strength

Background: Groin pain is common in different sports. It is seen especially among football players, but also hockey players commonly suffer from groin pain. There is currently no updated review regarding prevention and treatment of groin pain among athletes. 

Purpose: The purpose of this review was to compile the preventive protocols for groin pain in athletes as well as the conservative treatments used in rehabilitation. 

Method: Searches were made in PubMed, Cinahl and Sport Discus during February 2022. Ten studies were included in the study. GRADE was used to determine the level of evidence. The methodological quality was assessed by using the PEDro-scale.

Results: The methodological quality was considered “moderate to high” in all but one of the included studies. The evidence for prevention of groin pain was “moderate”, while the evidence for treatment of groin pain was “limited”.

Conclusion: Preventive programs for groin pain alone are few. No single treatment for groin pain can be presented. A higher number of studies including other sports than football could lead to a larger transferability. 

Keywords: rehabilitation, prevent, groin, injury

Background: Digital working methods and the use of digital tools are becoming increasingly common in healthcare. Increased digitization can improve the possibilities for more individualized and accessible care based on patient's needs. For the development and use of various digital tools to be effective, it is important that they are adapted to the existing user needs. Physiotherapists have an important role in healthcare to promote people's health and function both for a preventive and health-promoting purpose, as well as for a rehabilitative purpose in many different areas and patient groups. Literature review prior to this work showed that there is a lack of collective knowledge about physiotherapists' perception of working with digital tools in the rehabilitation of patients. In line with increased digitization in healthcare, attention needs to be paid to physiotherapists' perception of working with digital tools to ensure efficient working methods. 

Aim: To examine professional physiotherapists' perceptions of working with digital tools in the rehabilitation of adult patients. 

Method: A systematic qualitative review was conducted using structured searches in PubMed and CINAHL. Data were analyzed through thematic synthesis. 

Results: A total of 9 articles were included in the literature review. Three overarching themes were identified; evidence and competence are perceived as fundamental, physiotherapy on the patient's terms and the physiotherapist of the future. 

Conclusion: Digital tools are perceived as a useful option in the rehabilitation of patients when it is based on the patient's individual conditions, requests and needs. When technology is adapted based on the individual, physiotherapists believe that it can contribute to a more efficient and person-centered approach with increased access to physiotherapy for more patients. It is considered important that the use of digital tools is based on research and evidence-based methods to ensure efficient and patient-safe ways of working. 

Objectives

To compile a battery of test including various aspects of physical fitness that could be used on the field and to assess whether any of these tests are associated with future traumatic knee injuries in youth female team sports athletes.

Design

Prospective cohort.

Setting

Sport setting.

Participants

Female athletes (n = 117, age 15–19 years), from Swedish sport high schools, active in soccer, handball, or floorball.

Main outcome measures

Differences in pre-injury tests values of 11 physical fitness tests in injured versus non-injured athletes, assessed as number of traumatic knee injuries over one season.

Results

28 athletes sustained 34 traumatic knee injuries. Athletes who sustained an injury had a shorter distance on the Yo-Yo IR1 test at baseline than those without an injury (mean difference −193 m, CI -293− −65 m). None of the other tests, assessed for muscular strength, endurance, power, flexibility and dynamic knee valgus, differed between injured and non-injured athletes.

Conclusions

Youth female athletes with lower intermittent endurance capacity, assessed with the Yo-Yo IR1, seemed to be at greater risk of traumatic knee injury. Neither hop performance, flexibility, dynamic knee valgus nor isolated strength tests at baseline could distinguish between injured and non-injured youth female athletes at follow-up.

Idag erbjuds idrottsutbildning på runt 200 skolor i Sverigeför elever som vill kombinera sina gymnasiestudier medelitsatsning inom sin idrott. Aktuell forskning visar enhög prevalens av skador hos unga elitsatsande idrottaresamt att skador är en av de vanligaste orsakerna till attunga slutar med sin idrott. Medicinskt stöd på idrotts-gymnasium kan minska konsekvenserna av att varaskadad samt förebygga nya skador och det är därförmotiverat att dessa skolor har tillgång till detta stöd.

The aim of the present study was to analyse and describe muscle function, quality of life and functional capacity before and after shoulder instability surgery. Twenty-six women aged 34 (± 14) years and 95 men aged 32 (± 10) years participated in this study. All patients were on the waiting list or had undergone shoulder instability surgery. The study was performed with a cross-sectional design and patients were examined pre-operatively, 6-month post-operatively or 7-year post-operatively. Handgrip strength measurement, active range of motion (AROM), isometric shoulder muscle strength measurement, health-related quality of life measured by Western Ontario Shoulder Instability Index (WOSI©) and shoulder function using the Constant Score were evaluated. The mean AROM in flexion for women in all groups ranged from 162° (± 16) to 169° (± 12), and for men from 157° (± 19) to 162° (± 12). The mean AROM in abduction ranged from 170° (± 25) to 177°(± 5) for women and from 177° (± 8) to 179° (± 24) for men. The mean AROM in external rotation ranged from 89° (± 14) to 95° (± 14) for women and from 83° (± 21) to 85° (± 12) for men. Men were significantly stronger and had a larger AROM on the non-injured side compared with the injured side, whereas differences were found between non-injured and injured side for women only in AROM. The scores from the WOSI© for all the patients were far from normative values suggesting that the patient's subjective experience does not fully reflect the physical examination. The results from the present study can guide the physiotherapist to give patients realistic expectations of shoulder function concerning AROM and muscle strength.

Background: Data on external stressors, such as social and environment variables and other "life events", and its relation to injury in youth athletic population are scarce. Investigating if external stressors is associated with injury risk may help coaches and other team staff to provide a more safe sport environment. The aim of the present study was to evaluate different aspects of external stressors and its potential association to traumatic knee injury in youth athletes.

Methods: This study comprised of youth female and male athletes from Swedish national sports high schools, aged 15–19 years, participating and competing in soccer, handball, or floorball. The athletes recorded any traumatic knee injury that had occurred during high-school in a web-based injury form. Data on external stressors and subjective perceived stress was also collected.

Results: The majority (60%) of stress factors noted was related to sport context. More athletes in the injured group of athletes reported life event stressor (p=0.001) and experienced stress more often (p=0.02) compared to the group of non-injured athletes. No differences between injured and non-injured athletes in terms of change of club, team coach, training protocol or game formation were noted (p>0.05). A weak correlation (r=0.20, p=0.02) was found between the number of stressors and injuries.

Conclusions: A high prevalence of external stressors are present in youth elite athletes with a majority of stress factors related to sport context. Life event stressors are present prior to injury and seem to be associated with traumatic knee injury to some degree.

Background: Balance Body Tape (BBT) is a recently developed taping-method with the aim to reduce pain and improve posture through change in movement behavior. However, the potential efects of a treatment with BBT are scarcely documented. Therefore, the aim with this study was to investigate the efect of a three-week Balance body tape-treatment on the intensity of perceived neck, shoulder and back pain and forward head posture.Methods: In this RCT study, subjects (n=26), who reported being university students or having a sedentary work and experiencing pain in neck, back or shoulders, were randomized to either an intervention (n=12) or control group (n=14). The intervention group received a three-week treatment with BBT, the control group received no treatment. A questionnaire regarding pain, including a Numeric Rating Scale (NRS) measuring pain intensity, and a Photographic posture analysis measurement (PPAM) regarding the craniovertebral (CV) angle were assessed before and after the intervention for both groups. Wilcoxon’s signed rank test and Mann-Whitney U test was used to assess intra- and between group diferences respectively. The relationship between pain intensity and CV angle was assessed using Spearman’s correlation.Results: No diference in demographic and physical characteristics between the groups were noted at baseline (p>0.05). Pain intensity at baseline was 5 for the intervention group and 4 for the control group (p=0.330). At follow up, the intervention group reported a lower score (NRS=2.5, p=0.003) whereas the control group had no signifcant diference in pain intensity (NRS=3, p=0.086). No signifcant change was found in the CV angle (p=0.058) and no correlation was found between NRS and the CV angle (r=0.102, p=0.619).Conclusion: A short treatment period with BBT may, compared to no treatment, have a small reducing efect on pain intensity in neck, back and/or shoulders. However, no efect was found on forward head posture in this study.Trial registration: Registered retrospectively on 08/11/2021. NCT05111704.Trial registration page link:

AbstractBackground Studies investigating ankle condition in subjects with chronic ankle instability (CAI) using an on-thefield test battery are scarce. Understanding which tests that are most challenging for these subjects has the potentialto set realistic goals in rehabilitation and return-to-sports criteria. Thus, the primary aim of this study was to investigateCAI subjects regarding strength, balance and functional performance with an easily used test battery that requiredminimal equipment.Methods This study was conducted with a cross-sectional design. A total of 20 CAI subjects, engaged in sports,and 15 healthy subjects serving as a control group, were tested for assessment of strength, balance and functionalperformance. A test battery was developed accordingly; isometric strength in inversion and eversion, the single legstance test (SLS), single leg hop for distance (SLHD) and side hop test. The limb symmetry index was calculated todetermine whether a side-to-side lower limb difference could be classified as normal or abnormal. The sensitivity ofthe test battery was also calculated.Results The subjects were 20% weaker on the injured side compared with the non-injured side in eversion (p<0.01)and 16% weaker in inversion (p<0.01) (Table 2). For the SLS test, the mean score of the injured side was 8 points(67%) higher (more foot lifts) compared to the non-injured side (p<0.01). The mean distance of the SLHD was 10 cm(9%) shorter for the injured side compare to the non-injured side (p=0.03). The mean number of side hop was 11repetitions (29%) fewer for the injured side compare to the non-injured side (p<0.01). Six of the 20 subjects obtainedabnormal LSI values in all five tests whereas none obtained normal values in all tests. The sensitivity of the test batterywas 100%.Conclusion Deficits in muscle strength, balance and functional performance appear to be present in CAI subjectswith the largest impairments in balance and side hop performance, which stresses the need for return to sport criteriafor this group of subjects.Trial registration Registered retrospectively on 24/01/2023. NCT05732168.

Objectives

To examine whether different vertical drop jump (VDJ) landing depth (small versus deep) and stance width (wide versus narrow) may alter movement biomechanics in female recreational athletes. The purpose was also to identify whether leg muscle strength is a predictive factor for knee control during a VDJ.

Design

Cross-sectional.

Setting

Biomechanics laboratory. Participants: Eighteen women aged between 18-30 years.

Main Outcome Measures

Three VDJ tests were used for biomechanical analysis: 1) small “bounce” jump (BJ), 2) deep “countermovement” jump with wide (CMJW) and 3) narrow foot position (CMJN). Subjects also performed an isometric knee-extension strength test, dichotomized to ‘weak’ versus ‘strong’ subjects according to median and quartiles.

Results

There were greater knee valgus angles during landing for both the CMJW and CMJN test compared to the BJ test (p≤0.05). Differences in knee valgus between weak and strong subjects were significant for the BJ test (p=0.044) but not for any of the other tests.

Conclusions

VDJ landing depth influences knee kinematics in women. Landing depth may therefore be considered when screening athletes using the VDJ test. Also, muscle strength seems to influence the amount of knee valgus angles, but the difference was not statistically significant (except for the BJ test) in this small cohort.

Syfte: Att med hjälp av videoanalys och programvaran Dartfish, undersöka eventuella skillnader i stödfasen på vinkeln mellan calcaneus och underlaget, hos personer med Pes planus och pes cavus, både efter en- och 45 minuters löpning på löpband.  Studiedesign: En experimentell studie. Metod: Trettiofyra personer vars fot/fötter uppmättes till pes cavus och pes planus enligt kriterierna för Medial Longitudinale Arch -angle, inkluderades i studien. Mätningarna gjordes på en stillbild med digital goniometer i programvaran Dartfish. Därefter mättes calcaneus vertikala mittlinje i förhållande till underlaget i stödfasen både efter 1 minut och 45 minuter, när försökspersonerna sprang barfota på ett löpband. Resultat: Båda fotvalvsgrupperna visade ett signifikant lägre värde, d vs ökad valgusriktning av calcaneus till underlaget, efter 45 minuter jämfört med 1 minuts löpning (p<0.05).

Konklusion: Både pes cavus och pes planus tenderar att inta en calcaneusställning mer åt valgus efter 45 minuters löpning. Det behövs fortsatt forskning för att klargöra förändringen av biomekaniken efter längre tids löpning. Studiens resultat antyder att framtida studier som undersöker sambandet mellan skador och abnormala fotrörelser under belastning  även bör undersöka efter längre tids löpning.

OBJECTIVE: The aim of this study was to perform a 5-year follow-up of a 7-week multidisciplinary rehabilitation program focusing on pain, physical disability, anxiety and depression as well as stress and sick leave and to compare the results from the baseline, a 2-year follow-up and this 5-year follow-up. PARTICIPANTS: Out of 60 participants of the original rehabilitation program 54 were followed-up after 5 years. METHODS: The rehabilitation program was individually adapted and consisted of physical activity in several forms as well as theoretical and practical education. At baseline (start of study) and 2 and 5 years after completion of the rehabilitation program all participants were evaluated in terms of sick leave, pain rating (Visual Analogue Scale), the Disability Rating Index, Hospital Anxiety and Depression Scale, and Stress Test. RESULTS: Between the start of the program and the 5-year follow-up pain rating (P < 0.017) and the rate of full-time sick leave (P < 0.0005) decreased. Physical disability, anxiety, depression and stress were maintained from the 2-year follow-up until the 5-year follow-up. CONCLUSIONS: The rehabilitation program seemed to have had an effect on the participant's ability to manage with symptoms long after the end of the rehabilitation program. Most participants had returned to work, and reported less pain. The improvements made in physical disability and mental health prior to the 2-year follow-up were maintained at the 5-year follow-up occasion.