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  • 1.
    Enthoven, Paul
    et al.
    Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, Linkoping, Sweden.
    Peolsson, Anneli
    Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, Linkoping, Sweden.
    Landen Ludvigsson, Maria
    Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, Linkoping, Sweden;Linkoping Univ, Dept Rehabil, Motala, Sweden;Linkoping Univ, Dept Med & Hlth Sci, Motala, Sweden.
    Wibault, Johanna
    Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, Motala, Sweden;Linkoping Univ, Dept Act & Hlth, Linkoping, Sweden.
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, Linkoping, Sweden.
    Oberg, Birgitta
    Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, Linkoping, Sweden.
    Validity, internal consistency and self-rated change of the patient enablement instrument in patients with chronic musculoskeletal pain2019In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 51, no 8, p. 587-597Article in journal (Refereed)
    Abstract [en]

    Objective: Patient enablement reflects patient's understanding of and coping with illness. The aim of this study was to investigate the content validity, construct validity, internal consistency and selfrated change (SRC) of the Patient Enablement Instrument (PEI) in patients with whiplash-associated disorders, cervical radiculopathy and mixed chronic pain treated in different settings.

    Design: Psychometric analyses. Participants: Patients with disabling non-malignant chronic musculoskeletal pain.

    Methods: Participants answered questionnaires on disability (Neck Disability Index (NDI) or Functional Rating Index (FRI)), anxiety/depression (Hospital Anxiety and Depression Scale; HADS) and general health (EuroQol; EQ-5D). Content validity, construct validity (confirmatory factor analysis), internal consistency and cut-off for SRC were investigated for the PEI after treatment. The SRC value was the receiver operating characteristic (ROC) curve optimal cut-off point.

    Results: After treatment all items were completed by 516 patients (mean standard deviation (SD) age 45.1 years (SD 10.1), women 75% (n=385)). The 1-factor PEI model had approximate fit to the data. The internal consistency Cronbach's alpha was between 0.878 and 0.929 for the 3 groups. Correlations between the PEI and the NDI/FRI, HADS and EQ-5D were fair to good. The SRCROC for whiplash-associated disorders, cervical radiculopathy and mixed chronic pain groups was 5, 6 and 4 points in the PEI, respectively.

    Conclusion: The PEI showed fair content validity, construct validity and internal consistency. However, the scale needs further development to improve measurement of change.

  • 2.
    Landén Ludvigsson, Maria
    et al.
    Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, 58183 Linköping, Sweden.;Cty Council Ostergotland, Dept Rehabil & Med, Rehab Vast..
    Peolsson, Anneli
    Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, 58183 Linköping, Sweden.
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, 58183 Linköping, Sweden.
    Dedering, Åsa
    Karolinska Univ Hosp, Allied Hlth Professionals Funct, Huddinge, Sweden.;Karolinska Inst, Div Physiotherapy, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden..
    Johansson, Gun
    Karolinska Inst, Inst Environm Med, Unit Occupat Med, Stockholm, Sweden..
    Bernfort, Lars
    Linkoping Univ, Dept Med & Hlth Sci, Div Hlth Care Anal, Linkoping, Sweden..
    Cost-effectiveness of neck-specific exercise with or without a behavioral approach versus physical activity prescription in the treatment of chronic whiplash-associated disorders: Analyses of a randomized clinical trial2017In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 96, no 25, article id e7274Article in journal (Refereed)
    Abstract [en]

    Background: Fifty percent of people injured by whiplash still report neck pain after 1 year and costs associated with whiplash associated disorders (WAD) are mostly attributed to health service and sick-leave costs in chronic conditions. With increasing health care expenditures the economic impact of interventions needs to be considered.

    Objective: To analyze the cost-effectiveness of physiotherapist-led neck-specific exercise without (NSE) or with a behavioral approach (NSEB), or prescription of physical activity (PPA) in chronic WAD, grade 2 to 3.

    Methods: This is a secondary cost-effectiveness analysis of a multicenter randomized clinical trial of 216 participants with chronic WAD grade 2 to 3. The interventions were physiotherapist-led neck-specific exercise without or with a behavioral approach, or prescription of physical activity for 12 weeks. Incremental cost-effectiveness ratios (ICERs) were determined after 1 year and bootstrapped cost-effectiveness planes and sensitivity analyses of physiotherapy visits were performed. Health care and production loss costs were included and quality-adjusted life years (QALYs) were estimated, using the Euroqol-5D questionnaire. Comparisons with the Short Form-6D, and neck disability index (NDI) were also made.

    Results: The 1-year follow-up was completed by 170 participants (79%). Both physiotherapist-led groups improved in health related quality of life. The intervention cost alone, per quality-adjusted life year (QALY) gain in the NSE group was US$12,067. A trend for higher QALY gains were observed in the NSEB group but the costs were also higher. The ICERs varied depending on questionnaire used, but the addition of a behavioral approach to neck-specific exercise alone was not cost-effective from a societal perspective (ICER primary outcome $127,800 [95% confidence interval [CI], 37,816-711,302]). The sensitivity analyses confirmed the results. The prescription of physical activity did not result in any QALY gain and the societal costs were not lower.

    Conclusion: Neck-specific exercise was cost-effective from a societal perspective in the treatment of chronic WAD compared with the other exercise interventions. ICERS varied depending on health-related quality of life questionnaires used, but the addition of a behavioral approach was not cost-effective from a societal perspective. The prescription of physical activity did not result in any QALY gain and was thus not considered a relevant option.

  • 3. Landén Ludvigsson, Maria
    et al.
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Peolsson, Anneli
    The effect of three exercise approaches on health-related quality of life, and factors associated with its improvement in chronic whiplash-associated disorders: analysis of a randomized controlled trial.2019In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 28, no 2, p. 357-368Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim was to evaluate whether neck-specific exercise, with (NSEB) or without (NSE) a behavioural approach, improves health-related quality of life (HRQoL) compared to physical activity prescription (PPA) in chronic whiplash-associated disorders (WAD) grades 2 and 3. A secondary aim was to identify factors associated with HRQoL and HRQoL improvement following exercise interventions.

    METHODS: This is a secondary analysis of a multicentre randomized clinical trial. Participants (n = 216) with chronic WAD grades 2 and 3 were randomized to 12 weeks of PPA or physiotherapist-led NSE or NSEB. The EQ-5D 3L/EQ-VAS and SF-36v2 physical (PCS) and mental (MCS) component summaries were collected together with several neck-related and psychosocial outcomes at baseline, after 3, 6 and 12 months, and were analysed with linear mixed models (all time points) and multivariate linear regressions (baseline, 6 months).

    RESULTS: NSE/NSEB resulted in better outcomes than PPA (EQ-VAS and SF-36 PCS, both groups, p < 0.01) but not in a higher EQ-5D score. Improvement over time was seen in EQ-5D/EQ-VAS for the NSEB group (p < 0.01), and for NSE/NSEB as measured with the PCS (p < 0.01). Factors associated with baseline HRQoL and change to 6 months in HRQoL (R2 = 0.38-0.59) were both neck-related and psychosocial (e.g. depression, work ability).

    CONCLUSION: Neck-specific exercise, particularly with a behavioural approach, may have a more positive impact on HRQoL than physical activity prescription in chronic WAD grades 2 and 3. HRQoL is however complex, and other factors also need to be considered. Factors associated with HRQL and improvements in HRQoL following exercise are multidimensional.

    TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, No. NCT01528579.

  • 4.
    Landén Ludvigsson, Maria
    et al.
    Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, S-58183 Linkoping, Sweden;Linkoping Univ, Dept Rehabil, Ostergotland Cty Council, Rehab Vast, Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, S-58183 Linkoping, Sweden.
    Widh, Simon
    Linkoping Univ, Dept Med & Hlth Sci, Cty Council Ostergotland, Rorelse Halsa, Linkoping, Sweden.
    Peolsson, Anneli
    Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, S-58183 Linkoping, Sweden.
    Exercise, headache, and factors associated with headache in chronic whiplash: Analysis of a randomized clinical trial2019In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 98, no 48, article id e18130Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Almost 40% of individuals with chronic whiplash-associated disorders (WAD) report headache after 5 years, making it one of the most common persistent symptoms besides neck pain, but randomized treatment studies are lacking. This study aimed to evaluate the effect of 3 different exercise approaches on headache in chronic WAD grades 2 and 3, and to identify potential factors associated with such headache, and whether they differ depending on 3 different aspects of such headache (current headache, maximum headache, or headache bothersomeness).

    METHODS: This was an analysis of a randomized clinical trial of people with chronic WAD and headache (n = 188), who were randomized to either 12 weeks of neck-specific exercise without (NSE) or with a behavioral approach (NSEB) or physical activity prescription (PPA). Data were collected at baseline and at 3, 6, and 12 months. Physical and psychosocial factors were tested for association with headache. Multivariate regression models and linear mixed models were used.

    RESULTS: The NSE/NSEB groups reported reduced headache both over time and compared to PPA. Up to 51% (NSE) and 61% (NSEB) reported at least 50% reduction in their headache at 12 months. The PPA group was not improved over time. Neck pain and dizziness were associated with headache regardless of aspect of headache. The only associated psychosocial factor was anxiety, which was associated with headache bothersomeness. Other factors were mainly physical, and up to 51% of the variance was explained.

    CONCLUSION: Headache in chronic WAD, may be reduced with neck-specific exercise with or without a behavioral approach. Chronic headache was associated with neck pain and dizziness regardless of aspect tested. Other factors associated with headache in chronic WAD were mainly physical rather than psychosocial.

    TRIAL REGISTRATION NUMBER: Clinical Trials.gov, no: NCT015285.

  • 5.
    Liew, Bernard X. W.
    et al.
    Univ Birmingham, Ctr Precis Rehabil Spinal Pain CPR Spine, Sch Sport Exercise & Rehabil Sci, Coll Life & Environm Sci, Birmingham B15 2TT, W Midlands, England.
    Scutari, Marco
    Univ Oxford, Dept Stat, Oxford, England.
    Peolsson, Anneli
    Linkoping Univ, Div Physiotherapy, Dept Med & Hlth Sci, Linkoping, Sweden.
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Div Physiotherapy, Dept Med & Hlth Sci, Linkoping, Sweden.
    Ludvigsson, Maria L.
    Linkoping Univ, Div Physiotherapy, Dept Med & Hlth Sci, Linkoping, Sweden;Cty Council Ostergotland, Rehab Vast, Dept Rehabil, Motala, Sweden;Cty Council Ostergotland, Rehab Vast, Dept Med & Hlth, Motala, Sweden.
    Falla, Deborah
    Univ Birmingham, Ctr Precis Rehabil Spinal Pain CPR Spine, Sch Sport Exercise & Rehabil Sci, Coll Life & Environm Sci, Birmingham B15 2TT, W Midlands, England.
    Investigating the Causal Mechanisms of Symptom Recovery in Chronic Whiplash-associated Disorders Using Bayesian Networks2019In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 35, no 8, p. 647-655Article in journal (Refereed)
    Abstract [en]

    Objectives: The present study's objective was to understand the causal mechanisms underpinning the recovery of individuals with whiplash-associated disorders (WAD). We applied Bayesian Networks (BN) to answer 2 study aims: (1) to identify the causal mechanism(s) of recovery underpinning neck-specific exercise (NSE), and (2) quantify if the cyclical pathway of the fear-avoidance model (FAM) is supported by the present data.

    Materials and Methods: We analyzed a prospective cohort data set of 216 individuals with chronic WAD. Fifteen variables were used to build a BN model: treatment group (NSE with or without a behavioral approach, or general physical activity), muscle endurance, range of motion, hand strength, neck proprioception, pain catastrophizing, fear, anxiety, depression, self-efficacy, perceived work ability, disability, pain intensity, sex, and follow-up time.

    Results: The BN model showed that neck pain reduction rate was greater after NSE compared with physical activity prescription (beta=0.59 points per month [P<0.001]) only in the presence of 2 mediators: global neck muscle endurance and perceived work ability. We also found the following pathway of variables that constituted the FAM: anxiety, followed by depressive symptoms, fear, catastrophizing, self-efficacy, and consequently pain.

    Conclusions: We uncovered 2 mediators that explained the mechanisms of effect behind NSE, and proposed an alternative FAM pathway. The present study is the first to apply BN modelling to understand the causal mechanisms of recovery in WAD. In doing so, it is anticipated that such analytical methods could increase the precision of treatment of individuals with chronic WAD.

  • 6.
    Lo, Hiu Kwan
    et al.
    Univ Queensland, Div Physiotherapy, Sch Hlth & Rehabil Sci, Brisbane, Qld, Australia.
    Johnston, Venerina
    Univ Queensland, Div Physiotherapy, Sch Hlth & Rehabil Sci, Brisbane, Qld, Australia; Univ Queensland, Recover Injury Res Ctr, Brisbane, Qld, Australia.
    Landén Ludvigsson, Maria
    Linköping Univ, Dept Med & Hlth Sci, Div Physiotherapy, Linköping, Sweden; Cty Council Östergötland, Rehab Vast, Motala, Sweden; Linköping Univ, Dept Rehabil, Linköping, Sweden; Linköping Univ, Dept Med & Hlth Sci, Linköping, Sweden.
    Peterson, Gunnel
    Linköping Univ, Dept Med & Hlth Sci, Div Physiotherapy, Linköping, Sweden.
    Overmeer, Thomas
    Mälardalen Univ, Sch Hlth Care & Social Welf, Physiotherapy Dept, Västerås, Sweden; Örebro Univ, Ctr Hlth & Med Psychol, Örebro, Sweden.
    David, Michael
    Univ Queensland, Sch Publ Hlth, Brisbane, Qld, Australia; Univ Newcastle, Sch Med & Publ Hlth, Newcastle, NSW, Australia.
    Peolsson, Anneli
    Linköping Univ, Dept Med & Hlth Sci, Div Physiotherapy, Linköping, Sweden.
    Factors associated with work ability following exercise interventions for people with chronic whiplash-associated disorders: Secondary analysis of a randomized controlled trial2018In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50, no 9, p. 828-836Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the efficacy of exercise interventions and factors associated with changes in work ability for people with chronic whiplash-associated disorders.

    Design: Secondary analysis of a single-blind, randomized multi-centre controlled trial.

    Setting: Interventions were conducted in Swedish primary care settings.

    Patients: A total of 165 individuals with chronic whiplash-associated disorders grade II–III.

    Methods: Participants were randomly allocated to neck-specific exercise, neck-specific exercise with a behavioural approach, or prescribed physical activity interventions. Work ability was evaluated with the Work Ability Index at baseline, 3, 6 and 12 months.

    Results: The neck-specific exercise with a behavioural approach intervention significantly improved work ability compared with the prescribed physical activity intervention (3 months, p = 0.03; 6 months, p = 0.01; 12 months, p = 0.01), and neck-specific exercise at 12 months (p = 0.01). Neck-specific exercise was better than the prescribed physical activity intervention at 6 months (p = 0.05). An increase in work ability from baseline to one year for the neck-specific exercise with a behavioural approach group (p < 0.01) was the only significant within-group difference. Higher self-rated physical demands at work, greater disability, greater depression and poorer financial situation were associated with poorer work ability (p < 0.01).

    Conclusion: This study found that neck-specific exercise with a behavioural approach intervention was better at improving self-reported work ability than neck-specific exercise or prescribed physical activity. Improvement in work ability is associated with a variety of factors.

  • 7.
    Ludvigsson, Maria Landen
    et al.
    Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, Linkoping, Sweden;Linkoping Univ, Dept Rehabil, Cty Council Ostergotland, Rehab Vast, Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, Linkoping, Sweden .
    Peolsson, Anneli
    Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, Linkoping, Sweden.
    Neck-specific exercise may reduce radiating pain and signs of neurological deficits in chronic whiplash: Analyses of a randomized clinical trial2018In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, article id 12409Article in journal (Refereed)
    Abstract [en]

    Up to 90% of people with neurological deficits following a whiplash injury do not recover and cervical muscle dysfunction is common. The aim of this multicentre, randomized controlled trial was to examine whether two versions of neck-specific exercise or prescription of physical activity (PPA) can improve radiating arm pain and clinical signs that can be associated with neurological deficits in people with chronic whiplash associated disorders (WAD). Participants with chronic WAD, arm symptoms and signs associated with neurological deficits (n = 171) were randomized to: 12 weeks of neck-specific exercise without (NSE) or with a behavioural approach (NSEB), or PPA. Pain/bothersomeness frequency, six measures of arm pain/paraesthesia (VAS scales), and four clinical neurological tests were evaluated after 3 months. The NSE group reported the lowest frequency and lowest levels of arm pain, the highest proportion of participants with at least 50% pain reduction and the highest proportion of normal arm muscle force. The NSEB group reported increased normal tendon reflexes. No improvements were recorded for the PPA group. Neck-specific exercise may improve arm pain and decrease signs of neurological deficits, but the addition of a behavioural approach does not seem to be of additional benefit.

  • 8.
    Peolsson, Anneli
    et al.
    Linkoping Univ, Dept Med & Hlth Sci, Physiotherapy, Linkoping, Sweden;Linkoping Univ, Ctr Med Image Sci & Visualizat CMIV, Linkoping, Sweden.
    Karlsson, Anette
    Linkoping Univ, Ctr Med Image Sci & Visualizat CMIV, Linkoping, Sweden;Linkoping Univ, Dept Biomed Engn, Linkoping, Sweden.
    Ghafouri, Bijar
    Linkoping Univ, Pain & Rehabil Ctr, Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, Rehabil Med, Linkoping, Sweden.
    Ebbers, Tino
    Linkoping Univ, Ctr Med Image Sci & Visualizat CMIV, Linkoping, Sweden;Linkoping Univ, Div Cardiovasc Med, Dept Med & Hlth Sci, Linkoping, Sweden.
    Engstrom, Maria
    Linkoping Univ, Ctr Med Image Sci & Visualizat CMIV, Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, Radiol Sci, Linkoping, Sweden.
    Jonsson, Margaretha
    Linkoping Univ, Dept Med & Hlth Sci, Physiotherapy, Linkoping, Sweden;Herrgardets Vardcentral, Vasteras, Region Vastmanl, Sweden.
    Wahlen, Karin
    Linkoping Univ, Pain & Rehabil Ctr, Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, Rehabil Med, Linkoping, Sweden.
    Romu, Thobias
    Linkoping Univ, Ctr Med Image Sci & Visualizat CMIV, Linkoping, Sweden;Linkoping Univ, Dept Biomed Engn, Linkoping, Sweden.
    Borga, Magnus
    Linkoping Univ, Ctr Med Image Sci & Visualizat CMIV, Linkoping, Sweden;Linkoping Univ, Dept Biomed Engn, Linkoping, Sweden.
    Kristjansson, Eythor
    Univ Iceland, Landspitali Univ Hosp, Reykjavik, Iceland.
    Bahat, Hilla Sarig
    Univ Haifa, Dept Phys Therapy, Haifa, Israel.
    German, Dmitry
    Univ Haifa, Dept Phys Therapy, Haifa, Israel.
    Zsigmond, Peter
    Linkoping Univ, Dept Neurosurg & Clin & Expt Med, Linkoping, Sweden.
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Dept Med & Hlth Sci, Physiotherapy, Linkoping, Sweden.
    Pathophysiology behind prolonged whiplash associated disorders: study protocol for an experimental study2019In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 20, article id 51Article in journal (Refereed)
    Abstract [en]

    BackgroundThere is insufficient knowledge of pathophysiological parameters to understand the mechanism behind prolonged whiplash associated disorders (WAD), and it is not known whether or not changes can be restored by rehabilitation. The aims of the projects are to investigate imaging and molecular biomarkers, cervical kinaesthesia, postural sway and the association with pain, disability and other outcomes in individuals with longstanding WAD, before and after a neck-specific exercise intervention. Another aim is to compare individuals with WAD with healthy controls.MethodsParticipants are a sub-group (n=30) of individuals recruited from an ongoing randomized controlled study (RCT). Measurements in this experimental prospective study will be carried out at baseline (before intervention) and at a three month follow-up (end of physiotherapy intervention), and will include muscle structure and inflammation using magnetic resonance imaging (MRI), brain structure and function related to pain using functional MRI (fMRI), muscle function using ultrasonography, biomarkers using samples of blood and saliva, cervical kinaesthesia using the butterfly test and static balance test using an iPhone app. Association with other measures (self-reported and clinical measures) obtained in the RCT (e.g. background data, pain, disability, satisfaction with care, work ability, quality of life) may be investigated. Healthy volunteers matched for age and gender will be recruited as controls (n=30).DiscussionThe study results may contribute to the development of improved diagnostics and improved rehabilitation methods for WAD.Trial registrationClinicaltrial.gov Protocol ID: NCT03664934, initial release 09/11/2018.

  • 9.
    Peolsson, Anneli
    et al.
    Linköping University, Physiotherapy, Department of Medical and Health Sciences.
    Landén Ludvigsson, Maria
    Linköping University, Physiotherapy, Department of Medical and Health Sciences; Linköping University, ehab Väst, County Council of Östergötland, Department of Rehabilitation and Department of Medical and Health Sciences .
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linköping University, Physiotherapy, Department of Medical and Health Sciences.
    Neck-specific exercises with internet-based support compared to neck-specific exercises at a physiotherapy clinic for chronic whiplash-associated disorders: study protocol of a randomized controlled multicentre trial.2017In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 18, article id 524Article in journal (Refereed)
    Abstract [en]

    Background:Globally, neck pain is the fourth most common condition associated with longer periods of living withdisability. Annually, approximately 0.3% of the population of Western countries undergo whiplash trauma, and half ofthose individuals will develop chronic problems with highcosts for the individual and society. Evidence for chronicwhiplash-associated disorders (WAD) treatment is scarce, though neck-specific training at a physiotherapy clinic twice aweek for 12 weeks has demonstrated good results. More efficient, flexible rehabilitation with reduced waiting times andlower costs is needed, ideally replacing lengthy on-site treatment series by healthcare providers. Internet-based care hasbeen shown to be a viable alternative for a variety of diseases and interventions, but studies are lacking on Internet-basedinterventions for individuals with chronic neck problems. The aim of the trial described here is to compare the effects ofan Internet-based neck-specific exerciseprogrammetothesameexercisesperformed at a physiotherapy clinic in regardsto self-reported and clinical measures, as well as cost-effectiveness.

    Methods:This prospective, randomized controlled trial will involve 140 participants. Measurements will be made atbaseline, 3 months (end of treatment), and 15 months (12 months after end of intervention) and will include ratings ofpain, disability, satisfaction with care, work ability, quality of life, and cost-effectiveness.

    Discussion:The study results may contribute to the development of a more effective rehabilitation, flexible and equalcare, shorter waiting times, increased availability, and lower costs for healthcare and society.

    Trial registration:ClinicalTrials.gov Protocol ID: NCT03022812, initial release 12/20/2016.

  • 10.
    Peolsson, Anneli
    et al.
    Linkoping Univ, Dept Med & Hlth Sci, Physiotherapy, Linkoping, Sweden.
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Dept Med & Hlth Sci, Physiotherapy, Linkoping, Sweden.
    Hermansen, Anna
    Linkoping Univ, Dept Med & Hlth Sci, Physiotherapy, Linkoping, Sweden.
    Ludvigsson, Maria Landen
    Linkoping Univ, Dept Med & Hlth Sci, Physiotherapy, Linkoping, Sweden;Reg Council Ostergotland, Rehab Vast, Dept Rehabil, Linkoping, Sweden;Reg Council Ostergotland, Rehab Vast, Dept Med & Hlth Sci, Linkoping, Sweden.
    Dedering, Åsa
    Univ Hosp, Allied Hlth Profess Funct Occupat Therapy & Physi, Stockholm, Sweden;Karolinska Inst, Div Physiotherapy, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.
    Löfgren, Hakan
    Ryhov Hosp, Neuroorthoped Ctr, Jonkoping, Sweden.
    Physiotherapy after anterior cervical spine surgery for cervical disc disease: study protocol of a prospective randomised study to compare internet-based neck-specific exercise with prescribed physical activity2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 2, article id e027387Article in journal (Refereed)
    Abstract [en]

    Introduction Patients suffering from remaining disability after anterior cervical decompression and fusion (ACDF) surgery for cervical disc disease may be prescribed physical activity (PPA) or neck-specific exercises (NSEs). Currently, we lack data for the success of either approach. There is also a knowledge gap concerning the use of internet-based care for cervical disc disease. The scarcity of these data, and the high proportion of patients with various degrees of incapacity following ACDF, warrant increased efforts to investigate and improve cost-effective rehabilitation. The objective is to compare the effectiveness of a structured, internet-based NSE programme, versus PPA following ACDF surgery. Methods and analysis This is a prospective, randomised, multicentre study that includes 140 patients with remaining disability (>= 30% on the Neck Disability Index, NDI) following ACDF for radiculopathy due to cervical disc disease. Patient recruitment occurs following attendance at routine clinical appointments, scheduled at 3 months postsurgery. Patients are then randomised to one of two groups (70 patients/group) for a 3-month treatment programme/period of either internet-based NSE or PPA. Questionnaires on background data, pain and discomfort, physical and mental capacity, satisfaction with care, and health and workplace factors are completed, along with physical measures of neck-related function conducted by independent test leaders blinded to randomisation. Measures are collected at inclusion, after the 3-month treatments (end of treatment) and at a 2-year follow-up. Radiography will be completed at the 2-year follow-up. Preoperative data will be collected from the Swedish Spine Registry. Data on healthcare consumption, drug use and sick leave will be requested from the relevant national registers. Ethical considerations This study was approved by the Regional Ethical Review Board in Linkoping Ref. 2016/283-31 and 2017/91-32. The scientists are independent with no commercial ties. Patients are recruited after providing written informed consent. Patient data are presented at group level such that no connection to any individual can be made. All data are anonymised when reported, and subject to the Swedish Official Secrets Health Acts. The test leaders are independent and blinded for randomisation. Exercises, both general and neck-specific, have been used extensively in clinical practice and we anticipate no harm from their implementation other than a risk of muscle soreness. Both randomisation groups will receive care that is expected to relieve pain, although the group receiving NSE is expected to demonstrate a greater and more cost-effective improvement versu s the PPA group. Any significant harm or unintended effects in each group will be collected by the test leaders. All questionnaires and test materials are coded by the research group, with code lists stored in locked, fireproof file cabinets, housed at the university in a room with controlled (card-based) access. Only individuals in receipt of a unique website address posted by the researchers can access the programme; patients can neither communicate with each other nor with caregivers via the programme. Study participation might lead to improved rehabilitation versus non-participation, and might therefore be of benefit. The results of this study should also contribute to more effective and flexible rehabilitation, shorter waiting times, lower costs and the possibility to implement our findings on a wider level. Dissemination If effective, the protocols used in this study can be implemented in existing healthcare structures. The results of the study will be presented in scientific journals and popular science magazines of relevance to health. The findings will also be presented at local, regional, national and international conferences and meetings, as well as in the education of university students and at public lectures. Information about the results will be communicated to the general population in cooperation with patient organisations and the media.

  • 11.
    Peterson, Gunnel
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linköping Univ, Dept Med & Hlth Sci, Linköping, Sweden.
    Nilsson, David
    Umea Univ, Dept Chem, Computat Life Sci Cluster CLiC, Umea, Sweden.
    Trygg, Johan
    Umea Univ, Dept Chem, Computat Life Sci Cluster CLiC, Umea, Sweden.
    Peolsson, Anneli
    Linköping Univ, Dept Med & Hlth Sci, Linköping, Sweden.
    Neck-specific exercise improves impaired interactions between ventral neck muscles in chronic whiplash: A randomized controlled ultrasound study2018In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, article id 9649Article in journal (Refereed)
    Abstract [en]

    Chronic pain and disability is common in whiplash-associated disorders (WAD), leading to personal suffering, sick leave, and social cost. The cervical spine is heavily dependent on muscular support and whiplash injury can cause damage to the neck muscles, but diagnostic tools to measure neck muscle impairment and evaluate exercise interventions are lacking. Therefore, the present study investigated ventral neck muscle interactions in 26 individuals with chronic WAD randomized to neck-specific exercise (NSE) or remaining on a waiting list (WL) in 3 months. We performed real-time, non-invasive ultrasound measurements with speckle tracking analysis and calculated the deformation area and deformation rate in three ventral neck muscles. Multivariate statistics were used to analyse interactions between the muscles. After 3 months of NSE, significant improvements were observed in neck muscle interactions and pain intensity in the NSE group compared to the WL group. Thus, this study demonstrates that non-invasive ultrasound can be a diagnostic tool for muscle impairment and used to evaluate exercise interventions in WAD and stands to make a breakthrough for better management in chronic WAD.

  • 12.
    Peterson, Gunnel
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Fac Hlth Sci, Dept Med & Hlth Sci, Div Physiotherapy, Linkoping, Sweden.
    O'Leary, Shaun
    Univ Queensland, Sch Hlth & Rehabil Sci, Brisbane, Qld, Australia;Queensland Hlth, Physiotherapy Dept, Royal Brisbane & Womens Hosp, Herston, Qld, Australia.
    Nilsson, David
    Umea Univ, Dept Chem, Computat Life Sci Cluster CLiC, Umea, Sweden.
    Moodie, Katherine
    Univ Queensland, Sch Hlth & Rehabil Sci, Brisbane, Qld, Australia.
    Tucker, Kylie
    Univ Queensland, Sch Hlth & Rehabil Sci, Brisbane, Qld, Australia;Univ Queensland, Sch Biomed Sci, Brisbane, Qld, Australia.
    Trygg, Johan
    Umea Univ, Dept Chem, Computat Life Sci Cluster CLiC, Umea, Sweden.
    Peolsson, Anneli
    Linkoping Univ, Fac Hlth Sci, Dept Med & Hlth Sci, Div Physiotherapy, Linkoping, Sweden.
    Ultrasound imaging of dorsal neck muscles with speckle tracking analyses - the relationship between muscle deformation and force2019In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, article id 13688Article in journal (Refereed)
    Abstract [en]

    The development of methods of non-invasive measurement of neck muscle function remains a priority in the clinical sciences. In this study, dorsal neck muscle deformation vs time curves (deformation area) were evaluated against incremental force, recorded from non-invasive real-time ultrasound measurement. The results revealed subject-specific moderate to strong linear or non-linear relationships between deformation and force. Test-retest variability showed strong reliability for all five neck muscles summed together and fair to good reliability for the five muscles evaluated separately. Multivariate statistics were used to analyse the interactions between the dorsal neck muscles during different percentages of maximal voluntary contraction (MVC). Low force (10-20% MVC) was related to muscle shortening; higher force (40-80% MVC) showed combination of shortening and elongation deformation in the muscle interactions. The muscle interactions during isometric MVC test were subject-specific, with different combinations and deformations of the five neck muscles. Force >= 40% MVC were associated with a forward movement of the cervical spine that affected the ultrasound measurement of the dorsal neck muscles. Ultrasound with speckle-tracking analyses may be best used to detect low levels (<40% MVC) of neck muscle activity.

  • 13. Rahnama, Leila
    et al.
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden.
    Kazemnejad, Anoshirvan
    Trygg, Johan
    Peolsson, Anneli
    Alterations in the Mechanical Response of Deep Dorsal Neck Muscles in Individuals Experiencing Whiplash-Associated Disorders Compared to Healthy Controls: An Ultrasound Study2018In: American Journal of Physical Medicine & Rehabilitation, ISSN 0894-9115, E-ISSN 1537-7385, Vol. 97, no 2, p. 75-82Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to investigate and compare the mechanical responses of dorsal neck muscles in individuals with whiplash-associated disorders (WAD) versus healthy individuals.

    DESIGN: This study included 36 individuals with WAD (26 women and 10 men) and 36 healthy controls (26 women and 10 men). Ultrasound imaging with speckle tracking was used to measure deformation and deformation rate in five dorsal neck muscles during a neck extension task.

    RESULTS: Compared with controls, individuals with WAD showed higher deformations of the semispinalis cervicis (P = 0.02) and multifidus (P = 0.002) muscles and higher deformation rates (P = 0.03 and 0.0001, respectively). Among individuals with WAD, multifidus deformation and deformation rate were significantly associated with pain, disability, and fatigue (r = 0.31-0.46, P = 0.0001-0.01).

    CONCLUSIONS: These findings indicate that the mechanical responses of the deep dorsal neck muscles differ between individuals with WAD and healthy controls, possibly reflecting that these muscles use altered strategies while performing a neck extension task. This finding provides new insight into neck muscles pathology in patients with chronic WAD and may help improve rehabilitation programs.

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