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  • 1.
    Emilson, Christina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
    Long-term perspectives on musculoskeletal pain: Health care utilization and integration of behavioral medicine treatment into physical therapy2017Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    There are currently no effective methods for treating and preventing chronic pain. The aim of this thesis was to study prognostic factors for health care utilization, and the long-term outcomes of tailored behavioral medicine treatment for patients with musculoskeletal pain. Another aim was to increase knowledge about physical therapists’ assessment and analysis of patients’ pain conditions and to investigate the potential of subgrouping patients based on prognostic factors.

    Methods: In Study I, a prospective population-based cohort was followed over 21 years. Data from three measure points were analyzed: 1995 (n=2425), 2007 (n=1582) and 2016 (n=1184). Study II was a 10-year follow-up of randomized controlled trial (n=97), comparing tailored behavioral medicine treatment and exercise-based physical therapy. In Study III, a descriptive and explorative design was applied, using data from video-recordings of 12 physical therapists. In study IV, assignment to three subgroups based on the Örebro Musculoskeletal Pain Screening Questionnaire was validated against reference instruments, and the stability between two points of measurement was investigated in patients (n=40) who were seeking primary health care due to musculoskeletal pain.

    Results: Chronic pain, female gender and high age predict high health care utilization over 21 years, and a trajectory of stable high health care utilization over the entire period. The differences between groups in favor for tailored behavioral medicine treatment reported at post-treatment and after two years, were not maintained at the 10-year follow-up. A majority of the physical therapists assessed factors for poor prognosis. The analyses were mainly based on biomedical assessments and none of the physical therapists included behavioral factors. Subgroup assignment according to the Örebro Musculoskeletal Pain Screening Questionnaire appears to be valid and stable over time.

    Conclusion: Prognostic factors such as chronic pain and female gender need to be considered when allocating health care resources and planning treatment to improve long-term outcomes. The treatment should also be tailored based on individual functional behavioral analyses of key behaviors and on patient´s biomedical and psychosocial condition, including strategies for maintenance of behavioral changes. Evidence-based methods for integrating behavioral medicine treatment into physical therapy need to be further evaluated and improved. 

    Delarbeten
    1. Association between health care utilization and musculoskeletal pain. A 21-year follow-up of a population cohort
    Öppna denna publikation i ny flik eller fönster >>Association between health care utilization and musculoskeletal pain. A 21-year follow-up of a population cohort
    (Engelska)Ingår i: Artikel i tidskrift (Refereegranskat) Submitted
    Abstract [en]

    Background: Few studies have reported the long-term impact of pain on health care utilization. The aim of this study was to describe and predict health care utilization associated with chronic pain in a 21-year follow-up of a population cohort and to identify and describe different trajectories over time.                                                                              Methods: A prospective cohort design was used that included five measurement time points. A representative sample of 3928 subjects (age 20-74) from the south of Sweden was selected. Data were collected by self-reported questionnaires, and the response rate was n=2425 (62%). Three time points of 1995, 2007 and 2016 were included in the study. The associations between baseline variables and health care utilization in 2016 were calculated based on logistic regression analysis. Different trajectories for health care utilization were compared and described.                                                             Results: The response rate in 2016 was n=1184 (63%) of the eligible participants. Predictors for high health care utilization at the 21-year follow-up was chronic widespread pain (OR: 3.2, CI: 1.9-5.1), chronic regional pain (OR:1.8, CI: 1.2-2.6), female gender and high age. Trajectory for high health care utilization over the entire period was characterized by high prevalence of chronic pain at baseline and female gender.                                                                                                                     Conclusions: Chronic pain, which may reflect poorer general health, had implications in health care utilization over a 21-year period. A stable high health care utilization trajectory was identified among a small group of the general population characterized by chronic widespread pain and female gender, indicating that treatment of this group has not been successful.

    Nyckelord
    Musculoskeletal pain, health care utilization, chronic pain, pain prevalence
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Forskningsämne
    Medicinsk vetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-328402 (URN)
    Tillgänglig från: 2017-08-22 Skapad: 2017-08-22 Senast uppdaterad: 2017-08-23
    2. A 10-year follow-up of tailored behavioural medicine treatment and exercise-based physiotherapy in persistent musculoskeletal pain
    Öppna denna publikation i ny flik eller fönster >>A 10-year follow-up of tailored behavioural medicine treatment and exercise-based physiotherapy in persistent musculoskeletal pain
    Visa övriga...
    2017 (Engelska)Ingår i: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 31, nr 2, s. 186-196Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Objective: To study the long-term outcomes of two interventions targeting patients with sub-acute and persistent pain in a primary care physiotherapy setting.

    Design: A 10-year follow-up of a two-armed randomised controlled trial, initially including 97 participants.

    Interventions: Tailored behavioural medicine treatment, applied in a physiotherapy context (experimental condition), and exercise-based physiotherapy (control condition). Main measures: Pain-related disability was the primary outcome. The maximum pain intensity, pain control, fear of movement, sickness-related absence (register data) and perceived benefit and confidence in coping with future pain problems were the secondary outcomes.

    Results: Forty-three (44%) participants responded to the follow-up survey, 20 in the tailored behavioural medicine treatment group and 23 in the exercise-based physiotherapy group. The groups did not differ in terms of the change in the scores for the primary outcome (p=0.17) of pain-related disability between the experimental group (median: 2.5, Q1-Q3: -2.5-14.25), and the control group (median: 0, Q1-Q3: -5-6). Further, there were also no significant differences found for the secondary outcomes except for sickness-related absence, where the exercise-based physiotherapy group had more days of sickness-related absence three months before treatment (p= 0.02), and at the 10-year follow-up (p=0.03).

    Discussion: The beneficial effects favouring tailored behavioural medicine treatment that observed post-treatment and at the two-year follow-up were not maintained 10 years after treatment.

    Nyckelord
    Chronic pain, behavioural medicine, primary care, physical exercise, long-term compliance
    Nationell ämneskategori
    Sjukgymnastik
    Identifikatorer
    urn:nbn:se:uu:diva-281461 (URN)10.1177/0269215516639356 (DOI)000394758500005 ()27009057 (PubMedID)
    Forskningsfinansiär
    Reumatikerförbundet
    Tillgänglig från: 2016-03-24 Skapad: 2016-03-24 Senast uppdaterad: 2017-08-22Bibliografiskt granskad
    3. Physical Therapists' Assessments, Analyses And Use Of Behavioral Change Techniques In Initial Consultations On Musculoskeletal Pain: Direct Observations In Primary Health Care
    Öppna denna publikation i ny flik eller fönster >>Physical Therapists' Assessments, Analyses And Use Of Behavioral Change Techniques In Initial Consultations On Musculoskeletal Pain: Direct Observations In Primary Health Care
    Visa övriga...
    2016 (Engelska)Ingår i: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, s. S187-S187Artikel i tidskrift, Meeting abstract (Refereegranskat) Published
    Nationell ämneskategori
    Sjukgymnastik
    Identifikatorer
    urn:nbn:se:uu:diva-313852 (URN)000388943400587 ()
    Tillgänglig från: 2017-01-26 Skapad: 2017-01-25 Senast uppdaterad: 2017-11-29Bibliografiskt granskad
    4. Concurrent validity and stability of subgroup assignment based on three levels of pain condition severity in patients with musculoskeletal pain
    Öppna denna publikation i ny flik eller fönster >>Concurrent validity and stability of subgroup assignment based on three levels of pain condition severity in patients with musculoskeletal pain
    Visa övriga...
    (Engelska)Ingår i: Artikel i tidskrift (Refereegranskat) Submitted
    Abstract [en]

    Pain screening instruments have been used to identify risk factors for poor prognosis and are recommended for the stratification of treatment for musculoskeletal pain. The aim of this study was to investigate the concurrent validity of subgroup assignment based on the Örebro Musculoskeletal Pain Screening Questionnaire compared with reference instruments: The Pain Disability Index, the Tampa Scale for Kinesiophobia, and the Pain Catastrophizing Scale. A secondary aim was to investigate the stability of the subgroup assignment over a defined period of time. Participants (n=40) aged 18-65 years were recruited from five primary health care centers in Sweden. Data were collected using self-reported questionnaires. The subgroups based on the Örebro Musculoskeletal Pain Screening Questionnaire were predefined to low, moderate or high pain condition severity. The reference instrument data were dichotomized into low or high level based on previously used cut-off scores. Concurrent validity was analyzed with Fisher´s exact test. Stability was calculated using quadraticweighted kappa analysis. The results indicated acceptable psychometric properties of the subgroup assignment based on the Örebro Musculoskeletal Pain Screening Questionnaire regarding concurrent validity, and the stability over two to three weeks. To further increase validity, it is suggested that subgroup assignment is complemented with other measures assessing e.g. pain catastrophizing. In conclusion, assignment to subgroups with low, moderate and high pain condition severities based on the Örebro Musculoskeletal Pain Screening Questionnaire, could be used as a valid base for stratified treatment for patients with musculoskeletal pain.   

    Nyckelord
    Musculoskeletal pain, psychological factors, stratified care, screening instruments, primary care
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Forskningsämne
    Medicinsk vetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-328403 (URN)
    Tillgänglig från: 2017-08-22 Skapad: 2017-08-22 Senast uppdaterad: 2017-08-23Bibliografiskt granskad
  • 2.
    Emilson, Christina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Demmelmaier, Ingrid
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Bergman, S.
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Publ Hlth & Community Med, Gothenburg, Sweden.
    Pettersson, S.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Physiotherapy, Stockholm, Sweden.
    Åsenlöf, Pernilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Concurrent Validity and Stability of Subgroup Assignment to Three Levels of Pain Condition Severity in Patients With Musculoskeletal Pain2018Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, s. 1835-1835Artikel i tidskrift (Övrigt vetenskapligt)
  • 3.
    Emilson, Christina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Demmelmaier, Ingrid
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Bergman, Stefan
    Res & Dev Ctr Spenshult, Halmstad, Sweden.; Univ Gothenburg, Dept Publ Hlth & Community Med, Gothenburg, Sweden..
    Lindberg, Per
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Denison, Eva
    Malardalen Univ, Sch Hlth Care & Social Welf, Vasteras, Sweden..
    Åsenlöf, Pernilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    A 10-year follow-up of tailored behavioural medicine treatment and exercise-based physiotherapy in persistent musculoskeletal pain2017Ingår i: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 31, nr 2, s. 186-196Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To study the long-term outcomes of two interventions targeting patients with sub-acute and persistent pain in a primary care physiotherapy setting.

    Design: A 10-year follow-up of a two-armed randomised controlled trial, initially including 97 participants.

    Interventions: Tailored behavioural medicine treatment, applied in a physiotherapy context (experimental condition), and exercise-based physiotherapy (control condition). Main measures: Pain-related disability was the primary outcome. The maximum pain intensity, pain control, fear of movement, sickness-related absence (register data) and perceived benefit and confidence in coping with future pain problems were the secondary outcomes.

    Results: Forty-three (44%) participants responded to the follow-up survey, 20 in the tailored behavioural medicine treatment group and 23 in the exercise-based physiotherapy group. The groups did not differ in terms of the change in the scores for the primary outcome (p=0.17) of pain-related disability between the experimental group (median: 2.5, Q1-Q3: -2.5-14.25), and the control group (median: 0, Q1-Q3: -5-6). Further, there were also no significant differences found for the secondary outcomes except for sickness-related absence, where the exercise-based physiotherapy group had more days of sickness-related absence three months before treatment (p= 0.02), and at the 10-year follow-up (p=0.03).

    Discussion: The beneficial effects favouring tailored behavioural medicine treatment that observed post-treatment and at the two-year follow-up were not maintained 10 years after treatment.

  • 4.
    Emilson, Christina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Demmelmaier, Ingrid
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Livsstil och rehabilitering vid långvarig sjukdom.
    Bergman, Stefan
    Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa, Göteborgs universitet.
    Pettersson, Susanne
    Department of Rheumatology, Karolinska university hospital.
    Åsenlöf, Pernilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Concurrent validity and stability of subgroup assignment based on three levels of pain condition severity in patients with musculoskeletal painIngår i: Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Pain screening instruments have been used to identify risk factors for poor prognosis and are recommended for the stratification of treatment for musculoskeletal pain. The aim of this study was to investigate the concurrent validity of subgroup assignment based on the Örebro Musculoskeletal Pain Screening Questionnaire compared with reference instruments: The Pain Disability Index, the Tampa Scale for Kinesiophobia, and the Pain Catastrophizing Scale. A secondary aim was to investigate the stability of the subgroup assignment over a defined period of time. Participants (n=40) aged 18-65 years were recruited from five primary health care centers in Sweden. Data were collected using self-reported questionnaires. The subgroups based on the Örebro Musculoskeletal Pain Screening Questionnaire were predefined to low, moderate or high pain condition severity. The reference instrument data were dichotomized into low or high level based on previously used cut-off scores. Concurrent validity was analyzed with Fisher´s exact test. Stability was calculated using quadraticweighted kappa analysis. The results indicated acceptable psychometric properties of the subgroup assignment based on the Örebro Musculoskeletal Pain Screening Questionnaire regarding concurrent validity, and the stability over two to three weeks. To further increase validity, it is suggested that subgroup assignment is complemented with other measures assessing e.g. pain catastrophizing. In conclusion, assignment to subgroups with low, moderate and high pain condition severities based on the Örebro Musculoskeletal Pain Screening Questionnaire, could be used as a valid base for stratified treatment for patients with musculoskeletal pain.   

  • 5.
    Emilson, Christina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Åsenlöf, Pernilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Demmelmaier, Ingrid
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Livsstil och rehabilitering vid långvarig sjukdom.
    Bergman, Stefan
    Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa, Göteborgs universitet; Spenshult Research and Development Centre, Halmstad, Sweden.
    Association between health care utilization and musculoskeletal pain. A 21-year follow-up of a population cohortIngår i: Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Few studies have reported the long-term impact of pain on health care utilization. The aim of this study was to describe and predict health care utilization associated with chronic pain in a 21-year follow-up of a population cohort and to identify and describe different trajectories over time.                                                                              Methods: A prospective cohort design was used that included five measurement time points. A representative sample of 3928 subjects (age 20-74) from the south of Sweden was selected. Data were collected by self-reported questionnaires, and the response rate was n=2425 (62%). Three time points of 1995, 2007 and 2016 were included in the study. The associations between baseline variables and health care utilization in 2016 were calculated based on logistic regression analysis. Different trajectories for health care utilization were compared and described.                                                             Results: The response rate in 2016 was n=1184 (63%) of the eligible participants. Predictors for high health care utilization at the 21-year follow-up was chronic widespread pain (OR: 3.2, CI: 1.9-5.1), chronic regional pain (OR:1.8, CI: 1.2-2.6), female gender and high age. Trajectory for high health care utilization over the entire period was characterized by high prevalence of chronic pain at baseline and female gender.                                                                                                                     Conclusions: Chronic pain, which may reflect poorer general health, had implications in health care utilization over a 21-year period. A stable high health care utilization trajectory was identified among a small group of the general population characterized by chronic widespread pain and female gender, indicating that treatment of this group has not been successful.

  • 6.
    Emilson, Christina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Åsenlöf, Pernilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Pettersson, S.
    Karolinska Inst, Div Physiotherapy, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.;Karolinska Univ Hosp, Dept Rheumatol, Stockholm, Sweden..
    Bergman, S.
    Res & Dev Ctr Spenshult, Halmstad, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Publ Hlth & Community Med, Gothenburg, Sweden..
    Sandborgh, M.
    Malardalen Univ, Sch Hlth Care & Social Welf, Vasteras, Sweden..
    Martin, Cathrin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Demmelmaier, Ingrid
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Physical therapists' assessments, analyses and use of behavior change techniques in initial consultations on musculoskeletal pain: direct observations in primary health care2016Ingår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 17, artikel-id 316Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Behavioral medicine (BM) treatment is recommended to be implemented for pain management in physical therapy. Its implementation requires physical therapists (PTs), who are skilled at performing functional behavioral analyses based on physical, psychological and behavioral assessments. The purpose of the current study was to explore and describe PTs' assessments, analyses and their use of behavioral change techniques (BCTs) in initial consultations with patients who seek primary health care due to musculoskeletal pain. Methods: A descriptive and explorative research design was applied, using data from video recordings of 12 primary health care PTs. A deductive analysis was performed, based on a specific protocol with definitions of PTs' assessment of physical and psychological prognostic factors (red and yellow flags, respectively), analysis of the clinical problem, and use of BCTs. An additional inductive analysis was performed to identify and describe the variation in the PTs' clinical practice. Results: Red and yellow flags were assessed in a majority of the cases. Analyses were mainly based on biomedical assessments and none of the PTs performed functional behavioral analyses. All of the PTs used BCTs, mainly instruction and information, to facilitate physical activity and improved posture. The four most clinically relevant cases were selected to illustrate the variation in the PTs' clinical practice. The results are based on 12 experienced primary health care PTs in Sweden, limiting the generalizability to similar populations and settings. Conclusion: Red and yellow flags were assessed by PTs in the current study, but their interpretation and integration of the findings in analyses and treatment were incomplete, indicating a need of further strategies to implement behavioral medicine in Swedish primary health care physical therapy.

  • 7.
    Emilson, Christina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Åsenlöf, Pernilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Pettersson, S.
    Karolinska Inst, Div Physiotherapy, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.;Karolinska Univ Hosp, Dept Rheumatol, Stockholm, Sweden..
    Bergman, S.
    Res & Dev Ctr Spenshult, Halmstad, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Publ Hlth & Community Med, Gothenburg, Sweden..
    Sandborgh, M.
    Malardalen Univ, Sch Hlth Care & Social Welf, Vasteras, Sweden..
    Martin, Cathrin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Demmelmaier, Ingrid
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Physical Therapists' Assessments, Analyses And Use Of Behavioral Change Techniques In Initial Consultations On Musculoskeletal Pain: Direct Observations In Primary Health Care2016Ingår i: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, s. S187-S187Artikel i tidskrift (Refereegranskat)
  • 8. Munters, Li Alemo
    et al.
    Dastmalchi, Maryam
    Andgren, Vivianne
    Emilson, Christina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Sjukgymnastik.
    Bergegard, Jenny
    Regardt, Malin
    Johansson, Anna
    Tholander, Ingrid Orefelt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Hanna, Balsam
    Lidén, Maria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Reumatologi.
    Esbjornsson, Mona
    Alexanderson, Helene
    Improvement in Health and Possible Reduction in Disease Activity Using Endurance Exercise in Patients With Established Polymyositis and Dermatomyositis: A Multicenter Randomized Controlled Trial With a 1-Year Open Extension Followup2013Ingår i: Arthritis Care and Research, ISSN 0893-7524, E-ISSN 1529-0123, Vol. 65, nr 12, s. 1959-1968Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    ObjectiveTo determine the effects of a 12-week endurance exercise program on health, disability, VO2 max, and disease activity in a multicenter randomized controlled trial in patients with established polymyositis (PM) and dermatomyositis (DM), and to evaluate health and disability in a 1-year open extension study. MethodsPatients were randomized into a 12-week endurance exercise program group (EG; n = 11) or a control group (CG; n = 10). Assessments of health (Short Form 36 [SF-36]), muscle performance (5 voluntary repetition maximum [5 VRM]), activities of daily living (ADL), patient preference (McMaster Toronto Arthritis Patient Preference Disability Questionnaire), VO2 max, and disease activity (International Myositis Assessment and Clinical Studies criteria of improvement of the 6-item core set) were performed at 0 and 12 weeks. Disability assessments were performed again at 52 weeks in an open extension period. All assessments were performed by blinded observers. ResultsThe EG improved compared to the CG in SF-36 physical function and vitality (P = 0.010 and P = 0.046, respectively), ADL score (P = 0.035), 5 VRM (P = 0.026), and VO2 max (P = 0.010). More patients in the EG (7 of 11) were responders with reduced disease activity compared to none in the CG (P = 0.002). Correlations between VO2 max and SF-36 physical function were 0.90 and 0.91 at 0 and 12 weeks, respectively (P < 0.05). The EG improvement in 5 VRM was sustained up to 52 weeks compared to baseline (5.7 kg; P < 0.001), but not in ADL score or SF-36. ConclusionsEndurance exercise improves health and may reduce disease activity in patients with established PM/DM. This potentially could be mediated through improved aerobic fitness. The results also indicate sustained muscle strength up to 1 year after a supervised program.

  • 9.
    Åsenlöf, Pernilla
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Demmelmaier, Ingrid
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Emilson, Christina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Pettersson, Stefan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
    Bergman, S.
    Step-Up: An Innovative Stepped-Care Protocol for Tailored Behavioral Medicine Treatment in the Management of Musculoskeletal Pain in Primary Care2013Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, s. 1041-1041Artikel i tidskrift (Övrigt vetenskapligt)
  • 10.
    Åsenlöf, Pernilla
    et al.
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