Gymnastik- och idrottshögskolan, GIH

AIM: Recurrent pain of unknown origin is a major problem in children. The aim of the present review was to examine the hypothesis of negative stress as an aetiology of recurrent pain from different aspects.

METHODS AND RESULTS: Epidemiological studies, clinical experience and hormonal data give support for such a hypothesis. Negative stress as a tentative aetiology for recurrent pain is reviewed. Stress, muscular tension, the startle reaction and its tentative relation to pain is illuminated. Deviations of hormonal secretion supporting a stress aetiology is mentioned. The role of central sensitization for recurrent pain is discussed. Possible aetiological implications of recurrent pain as a local symptom or a general disorder are presented. Brain changes due to stress is shortly reviewed. Stress and pain in the clinic are highlighted. The importance of biological, psychological and social factors, as well as genetic elements, are-Ddiscussed.

CONCLUSION: Stress elicits neurobiological mechanisms. They may lead to many neurophysiological deviances. Increase of muscle tension and neuromuscular excitability and enhanced startle reaction may be of importance for recurring pain. The identification of stress as a primary cause of recurrent pain can have huge implications for understanding signs and treatment in clinical practice. This article is protected by copyright. All rights reserved.

OBJECTIVE: Compare the long-term effects of two different individualised physical activity interventions in hip or knee osteoarthritis patients.

DESIGN: Randomised, assessor-blinded, controlled trial.

SETTING: Primary care.

SUBJECTS: Patients with clinically verified hip or knee osteoarthritis, <150 min/week with moderate or vigorous physical activity, aged 40-74.

INTERVENTION: The advice group (n = 69) received a 1-h information and goalsetting session for individualised physical activity. The prescription group (n = 72) received information, goalsetting, individualised written prescription, self-monitoring, and four follow-ups.

MAIN MEASURES: Physical activity, physical function, pain and quality of life at baseline, 6, 12 and 24 months.

RESULTS: There were only minor differences in outcomes between the two groups. For self-reported physical activity, the advice group had improved from a mean of 102 (95% CI 74-130) minutes/week at baseline to 214 (95% CI 183-245) minutes/week at 24 months, while the prescription group had improved from 130 (95% CI 103-157) to 176 (95% CI 145-207) minutes/week (p = 0.01 between groups). Number of steps/day decreased by -514 (95% CI -567-462) steps from baseline to 24 months in the advice group, and the decrease in the prescription group was -852 (95% CI -900-804) steps (p = 0.415 between groups). Pain (HOOS/KOOS) in the advice group had improved by 7.9 points (95% CI 7.5-8.2) and in the prescription group by 14.7 points (95% CI 14.3-15.1) from baseline to 24 months (p = 0.024 between groups).

CONCLUSIONS: There is no evidence that individualised physical activity on prescription differs from individualised advice in improving long-term effects in patients with hip or knee osteoarthritis.

OBJECTIVE: To compare the responsiveness of two unilateral lower-limb performance-based tests, the one-leg rise test and the maximal step-up test, with the bilateral 30-second chair-stand test and the self-reported measure of physical function (HOOS/KOOS). Specific aims were to evaluate responsiveness, floor/ceiling effect and association between the instruments.

METHOD: Data was included from 111 participants, mean age 61.3 years (8.3), with clinically verified hip or knee osteoarthritis, who reported less than 150 minutes/week of moderate or vigorous intensity physical activity. Responsiveness, how well the instruments captured improvements, was measured as Cohen's standardised mean difference for effect size, and was assessed from baseline to 12 months following a physical activity intervention. Other assessments were floor and ceiling effects, and correlations between tests.

RESULTS: The maximal step-up test had an effect size of 0.57 (95% CI 0.37, 0.77), the 30-second chair-stand 0.48 (95% CI 0.29, 0.68) and the one-leg rise test 0.12 (95% CI 0.60, 0.31). The one-leg rise test had a floor effect as 72% of the participants scored zero at baseline and 63% at 12 months. The correlation between performance-based tests and questionnaires was considered to be minor (r = 0.188 to 0.226) (p = 0.018 to 0.048).

CONCLUSION: The unilateral maximal step-up test seems more responsive to change in physical function compared to the bilateral 30-second chair-stand test, although the tests did not differ statistically in effect size. The maximal step-up test provides specific information about each leg for the individual and allows for comparison between the legs.

BACKGROUND: Young adults with mobility disability (MD) are less likely to engage in regular physical activity (PA) compared with their able-bodied peers and inactive adults with a MD are more likely to report one or more chronic diseases compared to those who are physically active. Despite the vast amount of research published in the field of PA interventions over the past decades, little attention has been focused on interventions aiming to increase PA among individuals with MD. Thus, we propose to compare the effects of an eHealth program compared to a usual care supervised health program on levels of PA and other health behaviors.

METHODS: The current intervention will use a randomized controlled trial (RCT) design with two treatment groups (an eHealth program and a usual care supervised health program) in young adults with newly acquired MD. In total, 110 young adults (aged 18-40 years) with a MD, acquired within the past 3 years, will be recruited to participate in a 12-week intervention. The primary study outcome is accelerometer-measured time spent in moderate to vigorous PA. Secondary outcomes includes health-related quality of life, depression, stress, fitness, body composition, diet, musculoskeletal pain, motivation to exercise and work ability.

DISCUSSION: There is a lack of RCTs investigating effective ways to increase levels of PA in young adults with MD. Increased levels of PA among this physically inactive population have the potential to substantially improve health-related outcomes, possibly more so than in the general population. The trial will put strong emphasis on optimizing exercise adherence and investigating feasibility in the two treatment programs. The Ethical Review Board (EPN) at Karolinska Institutet has approved the study (2017/1206-31/1).

TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number (ISRCTN), reference number ISRCTN22387524 . Prospectively registered February 4, 2018.

ABSTRACT

Purpose and research questions

The objective of this study was to evaluate the muscle activity in three shoulder muscles: Upper Trapezius (UT), Serratus Anterior (SA) and Lower Trapezius (LT) during six different shoulder stabilization exercises in healthy individuals. The purpose was also to investigate whether specific shoulder stabilization exercises in slings increase the activation, in predominantly SA and LT, while the activity in UT is still low, compared to exercises performed on firm ground, and to evaluate possible side differences between left and right shoulder muscles. The research questions were: Are specific sling based exercises more effective regarding activation of SA and NT compared to exercises performed on firm ground? Will the sling exercises in the study show less activation in UT compared to exercises performed on firm ground? Is there a side difference in muscle activation during the six exercises?

Method

Ten healthy people (mean 36 years) took part in this study. The activity of three muscles (UT, SA, LT) were registered bilaterally using electromyography (EMG) during six different shoulder stabilizing exercises. Three of the exercises were conducted in redcord slings and three exercises were performed on firm ground. To compare the EMG-activity during exercises the activity was normalized to percent of maximal voluntary contraction (MVC) for each muscle and side.

Results

The sling-exercises were not significantly more effective regarding SA activation than exercises on firm ground. UT activity was significantly lower in the sling exercises (leaning forward during abduction, UA) (p<0.001) compared to protraction in supine (PRO) (p<0.001) and push up plus (PUP) (p<0.001). Mean values of EMG activity for each muscle were: UT: from 0.3% of MVC for leaning forward (UF) to 4.0% of MVC at the push-up plus with slings (PuPR), SA: lowest value 3.7% (UF) and the highest value 43.9% (PUP). LT: lowest value -1.5% (PUP) and the highest value of 9.7 % (UF).

Conclusion

Based on the results from this study it is recommended that healthy people, who specifically want to increase the muscle activation in SA, can perform the following exercises; PUP, WS or PuPR. If the person additionally wants to do an exercise with low activation in LT, while the activation level in SA is still high, the exercise PUP is recommended.

Syfte och frågeställningar

Huvudsyftet med denna studie var att se om ett vertikalhopp eller ett trippelhopp uppvisade större känslighet att identifiera skillnader mellan opererat och icke-opererat ben i jämförelse med ett horisontalhopp hos individer som genomgått främre korsbands(ACL)-rekonstruktion.

Studien syftade även till att undersöka om individens kön påverkade resultatet och om prestationen på de olika hoppen hade ett samband med isokinetisk benstyrka respektive det knäspecifika instrumentet KOOS, The Knee injury and Osteoarthritis Outcome Score.

Metod

17 försökspersoner, 9 män och 8 kvinnor (medelålder 28 år) deltog i studien. De hade alla genomgått primär unilateral ACL-rekonstruktion i genomsnitt 7 månader tidigare. Vid ett och samma mättillfälle utfördes ett isokinetiskt styrketest samt tre funktionella hopp: vertikalhopp (”Jump and Reach”), trippelhopp samt horisontalhopp. KOOS fylldes i av försökspersonerna runt samma tidpunkt (nätbaserat frågeformulär för utvärdering av patientens upplevelse av sitt knä och knärelaterade besvär).

Resultat

Vertikalhoppet uppvisade en högre sensitivitet i jämförelse med horisontalhoppet vid test 7 månader efter ACL-rekonstruktion.

Gällande de absoluta värdena (opererat ben) uppvisade både vertikalhoppet som trippelhoppet ett statistiskt samband med explosiv quadricepsstyrka (240grader/sekund), r=0,75 respektive r=0,73.

Inget samband kunde ses mellan hopp och resultatet på KOOS.

Inga könsskillnader hittades.

Slutsats

Resultaten visar att vertikalhoppet är ett mer sensitivt test för att identifiera funktionella nedsättningar i ACL-rekonstruerat knä i jämförelse med horisontalhoppet som ofta används som ”gold standard” i forskning och i den kliniska vardagen.

En enkel och billig testmetod för vertikalhoppet, ”Jump and Reach” som användes i denna studie visar liknande resultat på sensitiviteten i jämförelse med datoriserade mätmetoder som är dyra och ofta inte tillgängliga i sjukgymnastens kliniska vardag.

Aim

The purpose of the present study was to find out whether there were any correlations between anterior knee laxity, measured with KT-1000 arthrometer, and the subscales "function in sport and recreation" and "quality of life" according to Knee injury and Osteoarthritis Outcome Score (KOOS) after an anterior cruciate ligament (ACL) reconstruction. Another purpose was to study whether there was a gender difference with respect to these parameters.

Method

This study was based on prospectively collected data from the Swedish ACL-register and the Capio Artro Clinic IT-register of patients who have undergone ACL reconstruction with hamstrings graft. The patients (18-35 years) who were operated on by those orthopedic surgeons who had performed the highest number of ACL reconstructions during 2010 and 2011 were consecutively selected. This material was represented by 427 patients. After the inclusion-and exclusion criteria 100 patients finally remained as participants of the study. A power analysis showed a need for a total of 58 patients, 29 men and 29 women. An even distribution between men and women was randomly performed by lottery draw. The patients were evaluated with the KT-1000 as well as with KOOS subscales "function in sports and recreation" and "quality of life" 6-8 months after surgery.

Results

The results showed that anterior knee laxity, measured with KT-1000, was reduced in the operated knee and "function in sports and recreation" as well as "quality of life" according to KOOS was improved 6-8 months post-operatively. No significant differences were noted between men and women concerning all studied parameters. No correlations were shown between anterior knee laxity and "function in sports and recreation" as well as "quality of life".

Conclusion

No significant differences in terms of gender were found in any of the studied parameters 6-8 months after ACL reconstruction. No correlations were shown between anterior knee laxity and "function in sports and recreation" and "quality of life" according to KOOS.

New methods to screen for and identify early-stage dementia disorders are highly sought after. The purpose of this pilot study is to develop a study protocol for a dual-task test aimed at aiding the early detection of dementia disorders. We used the Timed Up-and-Go (TUG) test, which is a mobility task involving starting in a sitting position, standing up, walking three meters to cross a line on the floor, turning around, walking back and sitting down again. We combined TUG with the verbal task of naming different animals. Pilot study participants were 43 individuals with and without established dementia diagnoses who attended a clinic for memory assessment. Video-recorded test performances were systematically analysed. Deviant test performances concerning the interplay between test administration and participants' responses to the assessment instructions were revealed and led to refinements being made to the final study protocol. Exploration of the dual-task test outcome measures in a sub-sample of 22 persons, ten with and twelve without dementia, indicated that step-length and number of named animals after the turning point of the dual-task test might constitute appropriate measures for examining this kind of sample. We concluded that the refined study protocol is feasible for testing individuals undergoing initial memory assessments and healthy controls. Follow-up studies with larger samples are being carried out and will bring new knowledge to this area of research. It may also provide an opportunity for further studies exploring possibilities for broad clinical implementation.

Background The objective of this study was to provide preliminary measures of the distance between the supraspinatus, infraspinatus, and subscapularis footprints and the acromion, coracoacromial ligament, and coracoid process, during dynamic arm elevations through the entire range-of-motion.

BACKGROUND: The spasticity could lead to decreased functional capacity and changes in musculoskeletal tissue.

OBJECTIVE: To compare the Achilles tendon properties between the affected and contralateral limbs of participants with spasticity due to stroke and the healthy subjects.

METHODS: Fifteen individuals with ankle spasticity due to stroke and 15 healthy subjects were recruited. Maximal isometric ankle joint torque was obtained with an isokinetic dynamometer, and an ultrasound was used to determine tendon length, tendon cross-sectional area, and the medial gastrocnemius myotendinous junction displacement. The Achilles tendon strength, displacement, stress, strain, stiffness, and Young's modulus were obtained during a maximum voluntary isometric plantarflexion contraction.

RESULTS: There were no differences between Achilles tendon length among participants. Both limbs of participants with stroke showed reduced tendon cross-sectional area (~18%) compared to healthy limb. The affected limb showed decreased tendon strength (686 ± 293.3 N), displacement (10.6 ± 1.7 mm), Young's modulus values (849 ± 235.6 MPa), and lower stiffness (196.6 ± 67.6 N/mm) compared to the contralateral limb (strength, 1357.1 ± 294.8 N; displacement, 15.2 ± 5.5 mm; Young's modulus, 1431.8 ± 301.9 MPa; stiffness, 337.5 ± 98.1 N/mm) and to the healthy limb. The contralateral limb also showed decreased tendon strength (~26.2%) and stiffness (~21.5%) compared to the healthy group.

CONCLUSION: There is a decrement in Achilles tendon morphological and mechanical properties of the affected limb in individuals with spasticity due to stroke. The contralateral limb had a thinner tendon more compliant likely to physical activity reduction.

Abstract

Purpose:

The purpose of the study was to examine what treatment strategy physiotherapists within Stockholm County choose for patients diagnosed with chronic midportion Achilles tendinosis.

Method:

A web questionnaire was designed and sent out to a total of 2,267 physiotherapists through e-mail within Stockholm County, which were found in the Electronic Catalog. The questionnaire is not validity or reliability tested. The questionnaire was self-designed and based on the purpose of the study. To increase the internal validity a pilot study was conducted. The survey was performed from 14-02-05 to 14-02-19. All variables from the data were summarized in tables as numbers of observations and percent. Correlation analyzes were made in standardized cross tables where the statistical analysis was performed by Fisher's exact test.

Results:

A total of 49 percent of physiotherapists responded to the survey. 36 percent of the physiotherapists responded that they treat chronic midportion achillestendinosis. Eccentric training (64%), eccentric/concentric training (20%) and shock wave therapy (5%) were the treatment methods that the majority of physiotherapists indicated as first choice. There was a significant difference in first choice of treatment depending on how long the physiotherapists been clinical active. There was no difference between physiotherapists with a speciality and those without regarding first choice of treatment.The majority of respondents indicated that they treat from six to 10 weeks before they change the treatment strategy. Stretching, acupuncture and taping were the three treatment methods that most of the respondents selected as parallel treatments. The most common combination of first choice and parallel treatment was eccentric training with the parallel treatments; stretching, acupuncture and taping. 56 percent of the physiotherapists indicated that they always evaluate pain during treatment and the majority of these allowed continued physical activity, exercise and sport during the treatment period.

Conclusion:

The result of the study demonstrates that within Stockholm County physiotherapistst follow evidence based medicine regarding first hand choice of treatment for patients with chronic midportion Achilles tendinosis. The result shows that there is a difference in first choice of treatment depending on how long the physiotherapist have been clinical active. No difference was detected regarding physiotherapists with a speciality and those without and first choice of treatment. The majority of physiotherapists treat from six to 10 weeks before they change the treatment strategy. The most applied parallel methods is stretching, acupuncture and taping. Little more than half of the physiotherapists always evaluate pain and allows physical activity, exercise and sport during the treatment period.

Aim

The aim of the study was to investigate the experience of physical activity among people with intestinal stoma. The research questions were:

• What is the level of physical activity among people with intestinal stoma?
• Do people with intestinal stoma experience a change in physical activity after surgery?
• What factors affect physical activity in people who have intestinal stoma?
• What kind of information and follow-up on physical activity do people receive who have had intestinal stoma surgery?

Method

To answer the aim and research questions, a qualitative method of semi-structured interviews have been conducted. 12 people with intestinal stoma participated in the study and were recruited from three hospitals in Stockholm County using a non-random sample with astrategic selection. The participants were between 30 and 84 years old and were operated for at least three months before the time of the interview. The interviews were transcribed and then analysed by an inductive content analysis according to Graneheim and Lundman (2004).

Results

The content analysis resulted in three main categories; the time before surgery, the time after the operation as well as information. The main results were 1) the participants had a high level of physical activity after the surgery. 2) The physical activity level of the participants was the same or slightly higher after the surgery. However some participants had made changes in their activity or the environment of where the activity took place. 3) The participants did not see the stoma as a barrier to physical activity more than in certain specific environments. Physical activity could however be affected by other illness- and surgery-related causes. 4)The participants had received information regarding physical activity in the direct postoperative stage but experienced a lack of information and follow-up at a later stage after surgery.

Conclusions

The results of the study indicate that a stoma does not need be a barrier for physical activity. Furthermore, the results show the importance of information and follow-up for people with stoma in order for them to be able to return to their preoperative level of physical activity.

Abstract

Aim: The aim of this study was to investigate if patients with chronic obstructive lung disease after seven weeks of pulmonary rehabilitation increased their activity in daily life and their physical activity level and relate this to increase in quality of life and physical capacity.

The questions asked was if seven weeks of pulmonary rehabilitation could lead to an increase in physical activity level measured with accelerometer and if physical capacity and performance would increase measured with 6-minutes walking distance? Can this also lead to a change in ADL and quality of life measured with the Eq5d-questionaire and decrease the patient’s perceived inconvenience in COPD measured with CCQ?

Method: The study is a quantitative prospective study. There were 25 participants in the study. Men and women in the ages 45-90 years, all diagnosed with COPD stage 1-4. All patients participated in a multidisciplinary rehabilitation during seven weeks including information about COPD and fitness- and strength training during 12 occasions. The participants were evaluated with accelerometer- a device that measures movement in three dimensions, 6-minutes walking distance, CCQ-chronic COPD questionnaire and Eq5d- health barometer (0-100mm). All evaluation was made before and after participating in pulmonary rehabilitation. Measurements with the accelerometers was made one week before the rehabilitation started and one week after it finished.

Results: No significant improvements were found regarding physical activity level, step counts/day (N.S p=0.330), sedentary time (N.S p=0.055), periods of sedentary bouts (N.S p=0.875). Physical capacity and performance measured with 6-minutes walking distance showed a significant increase, on average 60 meters (p=0.0002). ADL and quality of life measured with Eq5d health barometer showed a significant improvement in average 56 mm before to 64 mm after participating in pulmonary rehabilitation (p=0.022) and the patients evaluated their perceived inconvenience 0.29 points less, from 2.32 to 2.03 points of a maximum score of 6.0 (p=0.046).

Conclusions: After participating in pulmonary rehabilitation for 7 weeks the study could show a significant increase regarding walking distance and less perceived inconvenience from breathlessness at physical demanding activity. The patients increased their mental wellbeing but showed no significant increase regarding activity level or step counts/day, although a tendency that the patient were less sedentary could be seen.

PURPOSE: To investigate the association between common measures of trunk and lower extremity range of motion (ROM), strength, the results of one-leg jump tests at baseline and the incidence of subsequent substantial knee injuries in adolescent female football players.

METHODS: Players were assessed at baseline regarding (1) ROM of trunk, hip, and ankle; (2) trunk, hip, and knee strength; and (3) one-leg jump tests. Players were prospectively monitored weekly for 1 year regarding knee injuries and the volume of matches and training. Hazard rate ratios (HRRs) and 95% confidence intervals (CIs) were calculated with Cox regression for the association between the baseline tests and the incidence of substantial knee injury (moderate/severe reduction in training volume or performance, or complete inability to participate in football). Exposures were categorized in tertiles (high, medium and low values). The highest tertile was used as reference.

RESULTS: 376 players were included without substantial knee injury at baseline (mean age, 13.9 ± 1.1 years), and 71 (19%) reported at least one substantial knee injury during the follow-up. Several associations were found; the strongest was that players in the lowest tertile of knee extension strength had a higher incidence of knee injuries than players in the highest tertile (HRR, 2.28; 95% CI, 1.20-4.38). Players in the lowest tertile of trunk rotation ROM in lunge position half-kneeling (HRR, 0.50; 95% CI, 0.27-0.94) had lower incidence of knee injuries than players in the highest tertile.

CONCLUSIONS: Poor knee strength and high trunk ROM were associated with an increased incidence of substantial knee injury in adolescent female football players. Therefore, knee-strengthening exercises during season may be recommended.

LEVEL OF EVIDENCE: Level II.

BACKGROUND: Most individuals with alcohol use disorder (AUD) do not seek treatment. Stigma and the desire to self-manage the problem are likely explanations. Exercise is an emerging treatment option but studies in non-treatment seeking individuals are lacking. We compared the effects of aerobic exercise, yoga, and treatment as usual (phone-based support) on alcohol consumption in non-treatment seeking adults with AUD.

METHODS: Three-group parallel, single blind, randomized controlled trial. 140 physically inactive adults aged 18-75 diagnosed with AUD were included in this community-based trial. Participants were randomized to either aerobic exercise (n = 49), yoga (n = 46) or treatment as usual (n = 45) for 12-weeks. The primary study outcome was weekly alcohol consumption at week 13 (Timeline Follow-back).

RESULTS: A significant decrease in weekly alcohol consumption was seen in all three groups: aerobic exercise (mean ∆ = - 5.0, 95% C = - 10.3, - 3.5), yoga group (mean ∆ = - 6.9, 95% CI = - 10.3, - 3.5) and TAU (mean ∆ = - 6.6, 95% CI = - 8.8, - 4.4). The between group changes were not statistically significant at follow-up. Per-protocol analyzes showed that the mean number of drinks per week reduced more in both TAU (mean ∆ = - 7.1, 95% CI = - 10.6, - 3.7) and yoga (mean ∆ = - 8.7, 95% CI = - 13.2, - 4.1) compared to aerobic exercise (mean ∆ = - 1.7, 95% CI = - 4.4, 1. 0), [F(2, 55) = 4.9, p = 0.011].

CONCLUSIONS: Participation in a 12-week stand-alone exercise program was associated with clinically meaningful reductions in alcohol consumption comparable to usual care (phone counseling) by an alcohol treatment specialist.

Background: Shoulder injuries are common in sport. In particular there is a clear relationship between shoulder injuries and sports that includes hand- and arm movements over the head, for example handball. In handball, the shoulder joints are exposed to hard physical contact as well as high loads during repetitive throwing which puts high demands on the structures inside and surrounding the shoulder joint. The prevalence of current or previous shoulder injuries is reported to be between 58 to 75 % in studies of handball players.

Aim: The purpose of this study was to investigate how a preventive training program aimed at risk factors for shoulder injuries in the shoulder joint, performed during eight weeks in the final stage of competitive season, affected the prevalence of overuse injuries in the shoulder joint for elite handball players in Sweden.

 How is the prevalence of overuse injuries and severe overuse injuries in the shoulder joints of elite Swedish handball players affected by the implementation of an eight-week preventive training program?

Method: The study was of a quasi-experimental design which consisted of six measurements taken during eight weeks. Nine elite handball teams active in the middle regions of Sweden were recruited, from which 110 of the 162 available players were included. Exclusions during and after the study period reduced the number of players. The teams were divided into an intervention (n = 48) or control group (n = 32) through stratified sampling, with mean age (± SD) 22.0 (3.3) and 21.9 (4.0), respectively. The intervention group was assigned a preventive exercise program consisting of three exercises with the purpose of improving riskfactors for shoulder injuries for overhead athletes. The control group was not assigned any intervention. The training program was evaluated by analyzing the prevalence of overuse and severe overuse symptoms in the shoulder measured with a modified version of The Oslo Sports Trauma Research Centre Overuse Injury Questionnaire.

Results: A total of 455 overuse symptoms were reported by 42 players (53 %) of which 95 symptoms in 18 players (23 %) were severe. The prevalence of overuse injuries decreased in both the intervention and the control group from 42 % (95 % CI 28-56 %) to 25 % (95 % CI 13-37 %) and 53 % (95 % CI 36-70 %) to 31 % (95 % CI 15-47 %), respectively. The prevalence of severe overuse injuries decreased in both the intervention and the control group from 15 % (95 % CI 5-25 %) to 6 % (95 % CI -1-13 %) and 19 % (95 % CI 5-32 %) to 13 % (95 % CI 1-24 %), respectively. There was no significant difference between the groups regarding prevalence after the intervention of eight weeks. Severity score consistently decreased with a significant difference over time (p = 0.001) for both groups, with a slightly greater improvement in the control group. There was a tendency towarda difference between the groups (p = 0.064) regarding the severity score.

Conclusions: The results of this study show that the prevalence of severe overuse injuries in the shoulder joint of elite handball players in Sweden might be reduced to some extent by performing a preventive exercise program two or more times per week for eight weeks. The prevalence of severe symptoms of overload injury decreased to a slightly lower value for the intervention group. The difference of prevalence of overuse injuries within the intervention group, stratified by the number of executed preventive exercise programs (<2 and ≥2), was significant (p = 0.044). Severity score decreased in both groups during the study. However, there was a tendency to a significant difference between the groups (p = 0.064), where the control group improved slightly more in spite of a higher value when measured at week 8. Shoulder injury and dysfunctions of overhead athletes can be caused by various factors, which means that the riskfactors for each of these conditions may vary. It is therefore important to highlight that the effects of a training program may be different at the individual level compared with the results at group level.

Aim: The purpose of this study was to investigate how physiotherapists in Sweden rehabilitate patients who has undergone an anterior cruciate ligament reconstruction. Further, the purpose was to investigate whether there are differences in the practical implementation of rehabilitation depending on clinical characteristics among the physiotherapists.

Method: The study was a descriptive, quantitative cross-sectional study with a qualitative component, where open-response questions were analyzed by using a qualitative content analysis. A survey was developed together with an expert group and was then sent to physiotherapists in Sweden with experience of anterior cruciate ligament rehabilitation. In order to find out possible differences in the practice of the rehabilitation depending clinical characteristics among the physiotherapists, the Chi-square test was used.

Results: The survey was answered by 146 physiotherapists. The practice mainly differs in terms of recommendations regarding gym-based training during the initial phase of rehabilitation, and regarding when balance-, coordination- and sport-specific training should be implemented. There are also different opinions concerning how, and when, exercises in open kinetic chain should be initiated. Physiotherapists treating higher volumes of anterior cruciate ligament reconstructions per year, and physiotherapists with specialist certification, appears to have more frequent visits from patients and use reliable and valid objective strength measures in a greater extent compared to physiotherapists treating lower volumes of patients and physiotherapists without specialist certification. 

Conclusion: The results of the present study show that physiotherapists in Sweden to a great extent practice rehabilitation after an anterior cruciate ligament reconstruction in a similar way. Although certain parts of the practical implementation differ among physiotherapists. These results indicate that the rehabilitation after an anterior cruciate ligament reconstruction is complex, and therefore varies among individuals. 

BACKGROUND: Chronic low back pain (CLBP) is an important cause for reduced daily physical activity (PA) and loss of quality of life, especially in women. In Suriname, a middle-income country in South America, the relationship between PA and CLBP is still unknown.

AIMS: To assess the level of PA in women with CLBP of different ethnicity, and to identify whether fear avoidance beliefs (FAB), disability, co-occurring musculoskeletal pain sites and various sociodemographic and lifestyle factors were associated with self-reported PA.

METHODS: A cross-sectional community-based house-to-house survey was conducted between April 2016 and July 2017. The survey followed the Community Oriented Program for Control of Rheumatic Diseases methodology. Selection criteria were being female of Asian-Surinamese, African-Surinamese or of Mixed ethnicity and aged 18 or older, living in an urban area, and reporting CLBP. Data was collected on PA, FAB, disability, co-occurring musculoskeletal pain sites, CLBP intensity and sociodemographic and lifestyle factors.

RESULTS: Urban adult women with current CLBP (N = 210) were selected. Nearly 57% of the population met the WHO recommendation on PA, with work-related PA as the largest contributor to total self-reported PA. Most women showed low FAB scores (FABQ-Work ≤34 (96.2%) and FABQ-PA ≤14 (57.6%)) and low disability levels (Oswestry Disability Index ≤20 (62.4%)). An inverse association between total PA and FABQ-Work (OR = 0.132, CI: 0.023; 0.750) was found. In contrast, total PA had a significant, positive association with disability (OR = 2.154, CI: 1.044; 4.447) and workload (OR = 2.224, CI: 1.561; 3.167). All other variables showed no association with total PA.

CONCLUSION: This was the first study in Suriname reporting that 43.3% of urban adult women with CLBP were physically inactive. Total self-reported PA is influenced by FABQ-Work, average to heavy workload and moderate to severe disability. In this study, PA-Work was the major contributor to total PA. Therefore, future longitudinal studies should evaluate different types and aspects of PA in relation to CLBP management.

Objectives: The aims were to determine, for the first time, the prevalence of low back pain (LBP) in urban and rural communities and to assess back beliefs and treatment-seeking behaviour in Suriname, a multi-ethnic country in the Caribbean community.

Methods: A cross-sectional community-based survey using the Community Oriented Program for the Control of Rheumatic Diseases methodology was performed between April 2016 and July 2017. Information was collected on LBP prevalence and LBP-related treatment seeking, beliefs about LBP [Back Beliefs Questionnaire (BBQ)], level of disability (Oswestry Disability Index) and the risk of developing persistent disabling pain (Start Back Screening Tool).

Results: A total of 541 out of 2902 individuals reported current acute or chronic LBP. It was more prevalent in urban (20.2%) than in rural (13.7%) communities, especially in females and older adults (>55 years of age). Individuals from rural areas [median BBQ = 18.00 (14.00-22.00)] had significantly more negative beliefs than the urban population [median BBQ = 25.00 (19.00-31.00); P < 0.001]. Maroons displayed more negative beliefs than Creole (P = 0.040), Hindustani (P < 0.001), Javanese (P < 0.001) and mixed ethnicity (P < 0.001) groups. At least 75% of the LBP population sought care, especially from a western health-care practitioner. Seeking treatment and having a higher risk of developing persistent disabling pain was significantly associated with more disability (P < 0.001). Age ≥45 years (P < 0.001), Indigenous ethnicity (P < 0.05) and functional disability (P < 0.001) were factors influencing treatment seeking.

Conclusion: Low back pain is a prevalent health problem in the Surinamese urban community, especially in older adults and among females. Most individuals experiencing LBP visited a western health-care practitioner and had more negative beliefs compared with other communities.

STUDY DESIGN: Descriptive.

OBJECTIVE: The present aim was to define accelerometer cut-point values for wrist-worn accelerometers to identify absolute- and relative-intensity physical activity (PA) levels in people with motor-complete paraplegics (PP) and tetraplegics (TP).

SETTINGS: Rehabilitation facility in Sweden.

METHODS: The participants were 26 (19 men, 7 women) with C5-C8, AIS A and B (TP) and 37 (27 men, 10 women) with T7-T12 (PP), AIS A and B. Wrist-worn accelerometer recordings (Actigraph GT3X+) were taken during seven standardized activities. Oxygen consumption was measured, as well as at-rest and peak effort, with indirect calorimetry. Accelerometer cut-points for absolute and relative intensities were defined using ROC-curve analyses.

RESULTS: The ROC-curve analyses for accelerometer cut-points revealed good-to-excellent accuracy (AUC >0.8), defining cut-points for absolute intensity (2, 3, 4, 5, 6, 7 METs for PP and 2 to 6 METs for TP) and relative intensity (30, 40, 50, 60, 70, and 80% for PP and 40-80% for TP). The cut-points for moderate-to-vigorous physical activity was defined as ≥9515 vector magnitude counts per minute (VMC) for PP and ≥4887 VMC/min for TP.

CONCLUSION: This study presents cut-points for wrist-worn accelerometers in both PP and TP, which could be used in clinical practice to describe physical activity patterns and time spent at different intensity levels.

STUDY DESIGN: Cross-sectional.

OBJECTIVES: This study aimed to describe and compare VO2 and energy expenditure at rest (REE) and during standardized sedentary, non-exercise physical activity, and exercise activities, in people with motor-complete tetraplegia (C5-C8). Further, REE and energy expenditure (EE) for the different activities were compared to data from a reference group of people with motor-complete paraplegia (T7-T12).

SETTING: Sweden.

METHODS: The sample of people with motor-complete tetraplegia consisted of 26 adults (seven women) with SCI, C5-C8 AIS A-B. REE and EE for the different activities were measured with indirect calorimetry. The results were further compared to people with motor-complete paraplegia.

RESULTS: Resting VO2 was 2.57 ml O2 kg-1 min-1, 2.54 for men and 2.60 for women. The VO2 or activity energy expenditure related to body weight increased three to four times during non-exercise physical activity compared to sedentary activities for the people with motor-complete tetraplegia, and up to six times during exercise activity. No significant differences were seen in resting or sedentary activity VO2 between the people with motor-complete tetraplegia and those with motor-complete paraplegia. Activities of daily life revealed no or small differences in VO2, except for setting a table, while the people with tetraplegia had ∼50% lower VO2 during exercise activities.

CONCLUSIONS: Non-exercise physical activities of daily life may be significant for increasing total daily EE in people with motor-complete tetraplegia. This might act to motivate the individual, and might be clinically important when designing adapted lifestyle intervention programs for the target group.

Syfte och frågeställningar:

Syftet med studien var att undersöka vad som motiverar idrottare med en främre korsbandsskada till rehabilitering. Ytterligare ett delsyfte var att undersöka vad som motiverar dessa idrottare till fysisk aktivitet.

1. Hur ser skillnaderna ut mellan inre och yttre motivation för rehabilitering, fysisk aktivitet och totalt (rehabilitering + fysisk aktivitet)?
2. Hur ser sambanden ut mellan rehabilitering och fysisk aktivitet för inre och yttre motivation?
3. Hur ser förekomsten av amotivation ut?

Metod:

För insamling av data valdes en kvantitativ metod i form av en enkät. Enkäten konstruerades efter befintliga motivations- och rehabiliteringsenkäter. Inre och yttre motivation samt amotivation undersöktes. Olika sjukgymnastkliniker, läkarmottagningar och idrottskadecenter kontaktades runt om i Stockholm. Sjukgymnasterna på respektive klinik delade ut enkäterna till deltagarna under deras rehabiliteringssessioner. Enkäten fanns även som nätversion och delades bland annat ut via Gymnastik- och idrottshögskolans interna e-post, olika idrottsforum och dylikt. Totalt deltog 47 personer i studien. För de jämförande analyserna användes t-test och för sambandsanalyserna Pearsons korrelationskoefficient.

Resultat:

En skillnad mellan den sammanlagda inre och yttre motivationen kunde ses för rehabiliterig, fysisk aktivitet och totalt (rehabiliterig + fysisk aktivitet) (p < 0,05). Sambandet mellan rehabilitering och fysisk aktivitet för den sammanlagda inre motivationen var lågt (r = 0,24). Sambandet mellan rehabilitering och fysisk aktivitet för den sammanlagda yttre motivationen var högt (r = 0,66). Det mest frekventa svaret för amotovation var 1 (stämmer inte alls) på samtliga frågor.

Slutsats:

Den vanligast förekommande motivationstypen vid rehabilitering och fysisk aktivitet var den inre motivationen. Den yttre motivationen var delvis förekommande. Amotivation förekom i mycket låg omfattning. Dock är studiens resultat inte generaliserbara till andra populationer och studien borde därför göras om och då i en större omfattning. En mer utvecklad och förbättrad kartläggning av i vilken omfattning de olika motivationstyperna förekommer hos rehabiliterande idrottsutövare skulle öppna möjligheter till en ökad möjlighet till motivation hos skadade individer och hjälpa dem att återigen bli fysiskt aktiva.

Aim

- The purpose of this systematic review was to compile research evaluating the effect of eccentric training and compared with alternative therapy, on pain and function in patients with chronic patellar tendinopathy.

Method

- Search of the literature was done in PubMed, Web of Science, Cinahl and AMED. 12 articles were selected for review using the PEDro scale. Points assessment were traded with SBU template probative value of evidence level and summarized in tabular form.

Results

- The results of this study showed that eccentric training reduces pain and increases function of patients with patellar tendinopathy. Compared to other treatments eccentric training is as effective as surgery, Heavy Slow Resistance and more effective than cortisone injection at long term follow-up. Also more effective than friction and ultrasound. One article had high quality and the rest medium quality.

Conclusions

-Current research provides an indication that eccentric exercise results in a decrease in pain and improved function in patients with patellar tendinopathy, however, the use of other therapies has proven to give the same effect and can be used if there is a possibility to. To ensure efficacy against other treatments more studies with high quality comparing the same methods are needed. In the current situation there are too few studies that actually compare the same things which make it difficult to say with certainty that eccentric training is better than any other treatment.

Aim

The aim of this study was to evaluate the activity recorded with electromyography (EMG) fine-wire electrodes, in transversus abdominis (TrA) and rectus abdominis (RA) while performing various stabilization exercises, and to investigate how the level of activation was affected by specific instructions

Method

Ten physically active women (27.1 ± 5.5year, 1.74 ± 0.05 m, 67.1 ± 8.6 kg) performed six different stabilization exercises (four lying supine with bent knees and hips and two in four point kneeling). They performed two sets of exercises, the first without and the second with specific instructions. The specific instruction was “abdominal hollowing to activate” TrA. The fine-wire electrodes were inserted bilateral into TrA and RA with an injection needle with guidance from an ultrasound. EMG was recorded during the middle second (while the subjects were asked to withhold the final position) and data was normalized to maximal voluntary contraction (MVC) and value at rest.

Results

The effects from instructions were significant while looking upon muscle and exercise (p<0,05). All exercises but exercise number 4 (unilateral bridgening) were significant effected by instructions in TrA, but none of the exercises were effected in RA (p>0,05). The mean of the activity in TrA varied without instructions between 2,9% (± 4,4) to 39,5 % (± 20,0) and with instructions 15,2 % (± 14,7) to 45,6 % (± 23,5). In RA the mean of the activity varied without instructions between 0,3% (± 0,8) to 9,8 % (± 27,4) and with instructions between 2.4 % (± 2,9) to 11,3% (± 28,5).

Conclusion

It is possible to selectively increase the activity in TrA in the majority of selected stabilization exercises with supine position with bent knees and hips, and in four point kneeling.

BACKGROUND: Regular exercise has been shown to have beneficial health effects in cancer survivors, including improving quality of life and other important health outcomes. However, providing people with cancer with easily accessible, high-quality exercise support and programs is a challenge. Therefore, there is a need to develop easily accessible exercise programs that draw upon the current evidence. Supervised, distance-based exercise programs have the benefit of reaching out to many people whilst providing the support of an exercise professional. The aim of the EX-MED Cancer Sweden trial is to examine the effectiveness of a supervised, distance-based exercise program, in people previously treated for breast, prostate, or colorectal cancer, on health-related quality of life (HRQoL), as well as other physiological and patient-reported health outcomes.

METHODS: The EX-MED Cancer Sweden trial is a prospective randomised controlled trial including 200 people that have completed curative treatment for breast, prostate, or colorectal cancer. Participants are randomly allocated to an exercise group or a routine care control group. The exercise group will participate in a supervised, distanced-based exercise program delivered by a personal trainer who has undertaken specialised exercise oncology education modules. The intervention consists of a combination of resistance and aerobic exercises with participants completing two 60-min sessions per week for 12 weeks. The primary outcome is HRQoL (EORTC QLQ-C30) assessed at baseline, 3- (end of intervention and primary endpoint) and 6-months post-baseline. Secondary outcomes are physiological (cardiorespiratory fitness, muscle strength, physical function, body composition) and patient-reported outcomes (cancer-related symptoms, fatigue, self-reported physical activity), and self-efficacy of exercise. Furthermore, the trial will explore and describe the experiences of participation in the exercise intervention.

DISCUSSION: The EX-MED Cancer Sweden trial will provide evidence regarding the effectiveness of a supervised, distance-based exercise program for survivors of breast, prostate, and colorectal cancer. If successful, it will contribute to the implementation of flexible and effective exercise programs as part of the standard of care for people following cancer treatment, which is likely to contribute to a reduction in the burden of cancer on the individual, health care system and society.

CLINICALTRIALS: gov NCT05064670. Registered on October 1, 2021.

Abstract

Purpose and research questions: The purpose of the study was to a) evaluate the inter-rater reliability of common clinical tests: Neer sign (NS), Hawkins-Kennedy Test (HKT) and Jobe Test (JT), and b) compare the results from NS, HKT and JT with the results obtained from musculoskeletal ultrasound measure in patients with sub-acromial pain. The research questions were: How is the inter-rater reliability for NS, HKT and JT? Which sensitivity and specificity has each of the clinical test (NS, HKT and JT), respectively, and used as a battery of tests, to diagnose sub-acromial shoulder pain using musculoskeletal ultrasound measure as the reference method? How well correlates a positive impingement test with an abnormally low distance between humerus and acromion? Is there a difference between the distance of acromio-humeral space (AHD) between people with and without shoulder impingement?

Methods: 18 people (fp) with shoulder problems (mean age 54 years, median duration of symptoms 2,25 months) were consecutively recruited. Subjects were examined by two physiotherapists during one day using the tests NS, HKT and JT. Ultrasound examination was performed within eight days and was used as the reference method to calculate sensitivity and specificity for the clinical tests. AHD was measured using ultrasound and the correlation between a positive impingement test and an abnormally low AHD between people with and without impingement was calculated.

Results: Inter-rater reliability was moderate for NS (k = 0,47) and good for HKT (k = 0,61) and JT (k = 0,67). The sensitivity of the battery of shoulder impingement tests was high (0,92) but with low specificity (0,40). JT was the only test that had both high sensitivity (0,83) and high specificity (0,80). There was no covariance between an abnormally low AHD and a positive impingement test, however, there was a significant difference of the percentage of the AHD in people with impingement compared to people without.

Conclusion: NS, HKT and JT had moderate to good inter-rater reliability but low diagnostic accuracy. The clinical tests may be useful methods as a battery of tests in detecting shoulder impingement if the specificity can be improved. JT was the test with best diagnostic accuracy.

Background: To be physical active is important. The risk to sustain a knee injury during physical activity is dependent on the choice of activity and the number of hours the activity is exercised. Activities and sports that includes acceleration, deceleration, pivoting, jump and landing brings more load to the knee joint. In evaluation of a knee injury it is today common to use different kinds of patient-reported outcomes, PRO. Tegner Activity Scale, TAS, is one of the most common questionnaire about sport participation today. Several of today common activities and sports are missing in TAS. Also some of the activities and sports with high incidence of knee injury is missing. Today there is no knee related activity scale that includes the activities and sports with the highest incidence of knee injury and the most common exerted activities and sports in Sweden. The need for a new knee related activity scale is big.

Aim: The aim of this study was to develop a new content valid knee related activity scale in PRO form.

Method: The study was conducted in two steps. First a new knee related activity scale with TAS as basis was made. TAS was then compared with statistics over participation in activities/sports from Riksidrotts Förbundet, RF, and from The Swedish National Knee Ligament Register. This to ensure that the most common activities and the activities with high risk for knee injury was in the new scale. Experts: trainers, actives and physiotherapists, with experience from each of the specific activities and sports were then asked to place their specific activity/sport in the new scale based on their belief of load to the knee joint.

Results: The experts response was analysed, the activity scale was corrected and then the new scale, Knee Activity Scale, KAS, was completed. KAS contains 50 activities/sports compared with 22 in TAS. The division in competitive and recreational level from TAS was removed as well as the work-related activities. Four activities/sports was found on a higher level in KAS compered to TAS.

Conclusion: A new knee related activity scale in PRO form was designed.

Aims

The aim of this study was to conclude what effects, both positive and negative, physical activity can have for people in rehabilitation. The following questions were used: What background have the different pain states? What form of physical activity and the duration, frequency and intensity of use? How are the people in question affected by the physical activity on the pain state - positive / negative effects?

Methods

The study is based on five interviews with women in rehabilitation, in the form of physiotherapy. I thought, this way could help me to find out however people can be affected, positively or negatively, by physical activity at various physical pain. The answers from the interviews was then compiled and compared with previous researched and other material. Literature studies have also derived background information and for increased knowledge in the subject.

Results

The results showed that the interviewed women who go to rehabilitation, feel improved physical capacity and decreased pain during exercise, irrespective of the different painstates and painfactors for each interviewee. The current pain permits are one workrelated injury, accident injury, sports injury, overworked and congenital disabilities. All interviewees are in rehabilitation for an indefinite period of time - it depends on how their body continues to respond to exercise and how you feel effects of endurance training. Everyone feel, so far, that the exercise has positive effects, provided that you only train your own potential and that you are not training too hard, resulting in a backlash of negative effects. Interviewees also shared that they experience positive effects in maintenance training – if they train regularly on a comfortable level and not take long breaks in their training. Training paus demonstrated a perceived increased pain and less mobility, than in training periods.

Conclusion

Physical activity in rehabilitation showed positive effects as long workout was individualized and look at the prevailing pain. Regularity train in combination with a moderate level of frequency, duration and intensity revealed optimal positive effects.

Vi har nöjet att publicera kapitel 2.8 Fysisk aktivitet vid depression ur  Fysisk aktivitet i sjukdomsprevention och sjukdomsbehandling, FYSS 2017  med tillstånd av Yrkesföreningar för Fysisk Aktivitet (YFA). Detta kapitel samt  ytterligare drygt 30 kapitel ur FYSS 2017 kan laddas ner från www.fyss.se.  Samtliga 53 kapitel är samlade i boken FYSS 2017 utgiven av Läkartidningen förlag AB.

SAMMANFATTANDE REKOMMENDATION •  Personer med depression bör rekommenderas aerob eller muskelstärkande fysisk aktivitet för att minska depressiva symtom. Måttligt starkt vetenskapligt underlag (evidensstyrka +++). •  Fysisk aktivitet reducerar depressiva symtom i liknande grad som antidepressiva läkemedel eller KBT vid lindrig och måttlig depression. Måttligt starkt vetenskapligt underlag (evidensstyrka +++). •  Om enbart muskelstärkande fysisk aktivitet väljs i syfte att behandla depression, bör den kompletteras med aerob fysisk aktivitet för att minska risken för kardiovaskulär sjukdom, eftersom denna risk är förhöjd vid depression.

Aim

The aim of the study was to determine inter- and intra-rater reliability of the total score from the functional movement screening test - 9+ screening battery, among a group young female soccer players.

Method

Twelve healthy female soccer players (13-14 years) participated in the study. The tests were conducted on two occasions separated by seven days. The screening battery included eleven functional movement tests and three clearing exams. The performance was evaluated by six physical therapists with little experience in this specific test battery.

Results

The mean score of the group was 17.2 ± 1.3 (95 % CI; 14.4–19.9) for test occasion 1 and 17.4 ± 1.8 (95 % CI; 13.4–21.5) for test occasion 2 out of a total of 33 points. However, there were no participants that reached 22 points (67 %), i.e. the predetermined limit proposed to indicate a risk of injury. There was no significant difference (p=0.54) of the inter-rater reliability between test occasion 1 and 2 in the total score of the entire screening battery. A significant difference was observed in the scoring between the physical therapists (p = 0.002), where rater 1 (p = 0.007) and rater 2 (p = 0.003) scored higher values ​​in comparison to rater 4. Intra class correlation (ICC) for inter-rater reliability for test occasion 1 and 2 was 0.68. The mean ICC for inter-rater reliability for all physical therapists was 0.60, and ICC ranged from 0.43-0.67 (p = 0.16-0.65).

Conclusions

This study shows that the 9+ screening battery is moderately reliable when screening young female soccer players for both inter-and intra-rater reliability in regards to the results for the entire test battery. The low total score of the group also shows that it is extremely important to find those athletes from this population who, through functional movement analysis, are detected to have an increased risk of injury. Preventative measures may help potential injuries to be avoided.

Background

Regular physical activity is beneficial for cognitive performance in older age. A single bout of aerobic physical exercise can transiently improve cognitive performance. Researchers have advanced improvements in cerebral circulation as a mediator of long-term effects of aerobic physical exercise on cognition, but the immediate effects of exercise on cognition and cerebral perfusion are not well characterized and the effects in older adults are largely unknown.

Methods

Forty-nine older adults were randomized to a 30-minutes aerobic exercise at moderate intensity or relaxation. Groups were matched on age and cardiovascular fitness (VO2 max). Average Grey Matter Blood Flow (GMBF), measured by a pulsed arterial-spin labelling (pASL) magnetic resonance imaging (MRI) acquisition, and working memory performance, measured by figurative n-back tasks with increasing loads were assessed before and 7 minutes after exercising/resting.

Results

Accuracy on the n-back task increased from before to after exercising/resting regardless of the type of activity. GMBF decreased after exercise, relative to the control (resting) group. In the exercise group, higher n-back performance after exercise was associated with lower GMBF in the right hippocampus, left medial frontal cortex and right orbitofrontal cortex, and higher cardiovascular fitness was associated with lower GMBF.

Conclusion

The decrease of GMBF reported in younger adults shortly after exercise also occurs in older adults and relates to cardiovascular fitness, potentially supporting the link between cardiovascular fitness and cerebrovascular reactivity in older age.

Dual-task paradigms can provide insights on the structures and mechanisms underlying information processing and hold diagnostic, prognostic, and rehabilitative value for populations with cognitive deficits such as in individuals with intellectual disability (ID). In this paradigm, two tasks are performed separately (single-task context) and concurrently (dual-task context). The change in performance from single- to dual-task context represents dual-task interference. Findings from dual-task studies have been largely inconsistent on whether individuals with ID present with dual-task-specific deficits. The current review aimed to map the published literature on dual-task methods and pattern of dual-task interference in individuals with ID. A scoping review based on Arksey and O'Malley's five-stage methodological framework was performed. Seventeen electronic databases and registries were searched to identify relevant studies, including gray literature. Charted data from included studies were analyzed quantitatively and qualitatively. PRISMA guidelines informed the reporting of this review. Twenty-two studies involving 1,102 participants (656 with ID and 446 without ID) met the review's inclusion criteria. Participants in the included studies were heterogeneous in sex, age (range 3-59 years), etiology and ID severity. Included studies characterized their ID-sample in different ways, most commonly using intelligence quotient (IQ) scores. Other measures of intellectual function (e.g., mental age, ID severity, verbal and/or visuospatial ability scores) were also used, either solely or in combination with IQ. Methods of dual-task testing varied across studies, particularly in relation to dual-task combinations, equation of single-task performance between groups, measurement and reporting of dual-task performance for each single-task, and task priority instructions. Thematic content of the included studies were: (1) structural interference to dual-tasking; (2) etiology-based differences in dual-tasking; (3) gait and balance dual-task performance; (4) testing executive function using dual-task paradigms; and (5) training effect on dual-task performance. Although the evidence consistently supported the intact dual-tasking ability of individuals with ID, the pattern of dual-task interference was inconsistent. Likewise, the evidence was inconclusive regarding dual-task deficit specific to individuals with ID because of heterogeneity in dual-task study designs among included studies.

Knee injuries are common among basketball players, leading to the most time away from training and competition. Previous studies have shown that poor frontal plane knee control, among other factors, can predict knee injuries in athletes. Women atlethes have shown to be more prone to knee injuries compared to male atlethes. The drop jump and single leg squat, measured with 3D-kinematics, are two different tests that in previous studies have been recommended to measure poor frontal plane knee control. Every year the Swedish Basketball Federation performs a screening battery of all the youth national team basketball players for the purpose of identifying players that are in the risk zone for injuries.

Aim: The aim of this study was to further investigate if a subjectively measured drop jump and single squat can predict future knee injuries in youth national team basketball players. Furthermore, the aim was to study whether Basketsmart, or other knee control exercises, reduce the risk of knee injuries, as well as, to determine the proportion of knee injuries between male and female basketball players.

Method: A questionnaire was sent to 96 male and female youth national team basketball players between the ages of 16 and 20 years old. All of these players had participated in the drop jump and single leg squat test in the spring of 2012. The aim of the questionnaire was to determine whether they had suffered any knee injuries during the 2012/2013 basketball season. The results of the questionnaire were compared to the test results from the drop jump and single leg squat. 57% of the athletes completed the questionnaire.

Results: A total of 20 knee injuries were identified in this study. 46% of the female and 35% of the male athletes suffered from a knee injury during the 2012/2013 basketball season. No significant difference was seen when comparing the results from the drop jump test to whether or not a knee injury occurred to the player. The single leg squat showed a significant difference in score between the athletes who suffered from a knee injury and those who did not. However, this difference only occurred in the right leg. Together, the two tests had a sensitivity of 53% and a specificity of 62%.

Conclusion: In summary, frontal plane knee control measured subjectively with a drop jump and single leg squat does not seem to have the ability to predict knee injuries in youth national team basketball players. Further studies are recommended to find reliable and valid testing methods to use in a medical clinic.

BACKGROUND: Generalised anxiety disorder (GAD) is a frequent and severe anxiety disorder among older adults. GAD increases the risk of developing other disorders such as depression and coronary heart disease. Older adults with GAD exhibit a poorer response to cognitive behaviour therapy (CBT) compared to younger patients with GAD. The normal age-related cognitive decline can be a contributor to reduced treatment efficacy. One strategy for improving treatment efficacy is to combine CBT with adjunctive interventions targeted at improving cognitive functions. Physical exercise is a viable intervention in this regard. Increased levels of brain-derived neurotrophic factor may mediate improvement in cognitive function. The present study aims to investigate the proposed effects and mechanisms related to concomitant physical exercise.

METHODS: The sample comprises 70 participants aged 60-75 years, who have GAD. Exclusion criteria comprise substance abuse and unstable medication; inability to participate in physical exercise; and conditions which precludes GAD as primary diagnosis. The interventions are individual treatment in the outpatient clinic at the local psychiatric hospital, with two experimental arms: (1) CBT + physical exercise and (2) CBT + telephone calls. The primary outcome measure is symptom reduction on the Penn State Worry Questionnaire. Other measures include questionnaires, clinical interviews, physiological, biological and neuropsychological tests. A subset of 40 participants will undergo magnetic resonance imaging (MRI). After inclusion, participants undergo baseline testing, and are subsequently randomized to a treatment condition. Participants attend five sessions of the add-on treatment in the pre-treatment phase, and move on to interim testing. After interim testing, participants attend 10 sessions of CBT in parallel with continued add-on treatment. Participants are tested post-intervention within 2 weeks of completing treatment, with follow-up testing 6 and 12 months later.

DISCUSSION: This study aims to develop better treatment for GAD in older adults. Enhancing treatment response will be valuable from both individual and societal perspectives, especially taking the aging of the general population into account.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT02690441 . Registered on 24 February 2016.

Background: Proprioception is vital for motor control and can be disturbed, for example, due to fatigue or injury. Clinical feasible, reliable and valid tests of shoulder proprioception are warranted. The aim was to investigate the effects of local fatigue on shoulder proprioception and the reliability of a feasible joint position sense test using an experimental repeated measures design. Method: Forty participants repeated a shoulder joint position sense test to assess test–retest reliability. The test was then utilized on a subgroup of handball players who were subjected to five bouts of a repeated throwing task with the dominant hand. The effect of local fatigue was investigated by comparing the fatigued with the non-fatigued shoulder. Results: There was a significant interaction for the arm × bout (p = 0.028, ηp2 = 0.20) and a significant effect for the arm (p = 0.034, ηp2 = 0.35) with a significant decrease in joint position sense for the throwing arm compared to the non-throwing arm. The intraclass correlation coefficient was 0.78 (95% CI = [0.57; 0.89]). The standard error of measurement between trials was 0.70° (range: 0.57°–0.90°). Discussion: The results indicate that repeated throwing to fatigue disturbs shoulder joint position sense. Assessment with the modified test showed acceptable reliability and can be a valuable assessment tool in the clinic. 

Aim

The aim of this study was to determine the feasibility of a high-intensive exercise intervention following a knee arthroplasty, and also to evaluate possible effects on self-selected walking speed, calf muscle strength and self-rated symptoms, pain, ADL function and quality of life after high-intensive calf muscle training in an early post-operative phase.

Method

Fifteen participants were randomized into an exercise group (n=7), who performed a home-exercise program, consisting of high-intensive calf muscle exercise, and into a control group (n=8) who performed the same rehabilitation program but without the high-intensive calf muscle training.

A test procedure was conducted after 3 and 12 weeks following the knee arthroplasty. Self-selected walking speed was measured by a 30 meter walking test, calf muscle endurance training was measured with a standardized one-leg heel-rise test, maximal isometric calf muscle strength was measured with an isometric dynamometer, and self-rated symptom, pain, ADL function and quality of life were evaluated with Knee injury Osteoarthritis Outcome Score (KOOS).

Results

There were problems with adherence to exercise regimes in both groups. The results of both groups demonstrated improved self-selected walking speed, calf muscle endurance and maximal isometric calf muscle strength over time. However, the exercise group increased self-selected walking speed more than the control group. The exercise group reported fewer disorders due to pain 12 weeks after surgery. The results of both groups showed improved self-rated symptoms, pain, ADL function and quality of life over time, however, the exercise group improved all these variables significantly, while the control group significantly improved the quality of life aspect.

Conclusions

Early initiated high-intensive calf-muscle training following a knee artroplasthy is feasible and may have positive effects on self-rated symptoms, pain, ADL function and quality of life. Also, self-selected walking speed increased more with early initiated high-intensive calf muscle training after nine weeks when compared to the same rehabilitation program without high-intensive calf muscle training. 

Objective: This study was to investigate alterations in contractile properties of the ankle plantar- and dorsiflexors in post-stroke individuals. The correlation between muscle architecture parameters and contractile properties was also evaluated.

Methods: Eight post-stroke individuals and eight age-matched healthy subjects participated in the study. Participants were instructed to perform maximal isometric contraction (MVC) of ankle plantar- and dorsiflexors at four ankle angles, and isokinetic concentric contraction at two angular velocities. B-mode ultrasound images of gastrocnemius medialis (GM) and tibialis anterior (TA) were collected simultaneously during the MVC and isokinetic measurements. Individualized torque-angle and torque-angular velocity relations were established by fitting the experimental data using a second-order polynomial and a rectangular hyperbola function, respectively. Muscle structure parameters, such as fascicle length, muscle thickness and pennation angle of the GM and TA muscles were quantified.

Results: Post-stroke subjects had significantly smaller ankle plantarflexor and dorsiflexor torques. The muscle structure parameters also showed a significant change in the stroke group, but no significant difference was observed in the TA muscle. A narrowed parabolic shape of the ankle PF torque-fiber length profile with a lower width span was also found in the stroke group.

Conclusion: This study showed that the contractile properties and architecture of ankle muscles in post-stroke individuals undergo considerable changes that may directly contribute to muscle weakness, decreased range of motion, and impaired motion function in individuals after stroke.

Objective: To compare the effects of yoga and aerobic exercise (AE) on wellbeing in physically inactive, but otherwise healthy older adults. A secondary objective was to assess and compare the frequency of adverse events associated with yoga and AE.

Design: Twelve-week, three-group, parallel randomized controlled trial with blinded follow-up assessment.

Interventions: Participants were supported to complete ≥ 3 Hatha yoga classes/week or ≥ 3 AE sessions/week. A wait-list control (WLC) group continued usual daily activities.

Main outcome measure: Change in wellbeing, assessed using the Satisfaction with Life Scale (SWLS) and Life Satisfaction Index-Z (LSI),at baseline and at 12-week follow up.

Results: In total, 82 adults (mean age 72.5 years, range 65-85, 77% female) were recruited. Of these, 27 were randomized to yoga, 29 to aerobic exercise and 26 to wait-list control. Medium-magnitude treatment effects (Hedges' g) were seen for yoga versus WLC and AE versus WLC(SWLS, g = 0.65 and 0.56; LSI, g = 0.54 and 0.54, respectively). In per-protocol analyses, larger effect sizes were found (SWLS, g = 0.72 and 0.66; LSI, g = 0.76 and 0.76, respectively). Adverse events were less frequent in the yoga group (6/27; 22%) compared to AE (10/27; 37%).

Conclusions: Among physically inactive older adults, participation in yoga or AE was associated with beneficial effects on subjective wellbeing when compared to a non-active control group. Yoga was associated with fewer injuries and may be especially suitable for older adults (DRKS 00015093).

PURPOSE: To compare the effects on verbal fluency of a supported yoga-based exercise intervention to an aerobic exercise intervention and a wait-list control group.

PARTICIPANTS AND METHODS: Eighty-two physically-inactive but otherwise healthy adults (mean age 72.5 years, range 65-85, 77% female) were recruited into a 12-week, three-group, parallel randomized controlled trial. Participants were supported to complete ≥3 Hatha yoga classes per/week or ≥3 structured aerobic exercise sessions/week. A wait-list control group continued usual daily activities only. Verbal fluency, including total-FAS, animals, and verbs, was assessed before and after interventions. Group effects were assessed using analysis of covariance (ANCOVA).

RESULTS: Twenty-seven participants were randomized to yoga, 29 to aerobic exercise and 26 to a waitlist. At 12-week follow-up, compared to baseline, there were increases in mean total-FAS in the yoga (+5.0 words, p=0.002) and aerobic exercise groups (+6.6 words, p=0.004). Mean total-FAS in the wait-list control group remained stable (-0.5 words, p=0.838). There were medium-magnitude estimated treatment effects on total-FAS for yoga versus wait-list control and aerobic exercise versus wait-list control: Hedges' g=0.51 (p=0.213) and 0.57 (p=0.098) respectively. In addition, small-to-medium magnitude estimated treatment effects were seen on animals and verbs for yoga versus wait-list control and aerobic exercise versus wait-list control: g=0.28 (p=0.155), 0.19 (p=0.766) and 0.50 (p=0.085), 0.59 (p=0.233) respectively.

CONCLUSION: Participation in yoga or aerobic exercise was associated with estimated improvements in verbal fluency compared to a non-active control group. Yoga and aerobic exercise may be promising approaches by which to promote cognitive function among older adults.

TRIAL REGISTRATION: DRKS00015093, U1111-1217-4248.

Aim

The aim of the present study was to evaluate thigh muscle strength and jump performance in one-leg hop for distance after anterior cruciate ligament (ACL) reconstruction using hamstring graft. A second aim was to find out whether there were any gender differences in this aspect. A third aim was to study if there was any correlation between thigh muscle strength and the one-leg hop test for distance.

Method

The study design of this investigation is a register study based on data from the Capio Artro Clinic IT-system. The study comprised 138 patients, 69 men and 69 women that had undergone an ACL reconstruction with hamstring graft during 2010 and 2011. The patients were evaluated 6-8 months postoperatively. Concentric and eccentric contractions of the knee extensors and knee flexors were measured using the Biodex dynamometer. Jump performance was evaluated with the one-leg hop test for distance.

Result

Significantly lower concentric muscle torques of the knee extensors and knee flexors were found at 90 deg/s and 240 deg/s as well as eccentric muscle torques of the knee extensors and knee flexors at 90 deg/s in the operated leg compared to the healthy leg (p<0.001). The result of the one-leg hop test for distance was significantly lower in the operated leg than the healthy leg (p<0.001). No significant side-to-side gender differences in muscle torques of the knee extensors and knee flexors or in terms of the one-leg hop test for distance regarding the operated and healthy leg were found. A moderately high correlation was found between thigh muscle torques and the one-leg hop test for distance.

Conclusions

A lower thigh muscle strength and performance of the one-leg hop for distance were found in the operated leg compared to the healthy leg 6-8 months after ACL reconstruction. No gender differences of thigh muscle strength and performance of the one-leg hop test for distance were found regarding the size of the side-to side differences between the operated and the healthy leg. A moderately high correlation was shown between thigh muscle strength and the one-leg hop test for distance.

Aim

The aim of this study was to map the injury panorama of traumatic injuries related to ice hockey in Sweden 2006-2011. In addition to that the aim was to compare whether there were any gender differences regarding traumatic ice hockey injuries.

Method

The present study was based on data from the Folksam insurance company between 2006 and 2011. The population consisted of ice hockey players in a club affiliated to the Swedish Ice Hockey Federation and that had sustained a traumatic injury related to ice hockey that resulted in medical care and then was reported to Folksam. The results are presented with descriptive statistics such as mean and standard deviation, median range and frequencies.

Results

The head was the most common injury localization followed by the upper extremity where the shoulder accounted for a high number of injuries. Fracture was the most common type of injury for both male and female players. Dental injuries were the second most common injury type. Injuries were most frequent in young players aged 10-24 years with a peak between 15-19 years of age. Female players suffered more contusion injuries, concussions and sprains than male players. Fractures to the upper extremity were the type of injury that to the highest extent led to permanent medical impairment.

Conclusion

Dental injuries constituted a great part of the injuries and have not decreased despite rules concerning dental protection. Fracture was the most frequent type of injury for both genders and was also the type of injury that led to the highest number of sports disability. Young players were more prone to injuries than older players. Concussion, contusions and distortions were more common in female than in male but there were no significant difference.

BACKGROUND: We study dual-task performance with marker-free video recordings of Timed Up-and-Go tests (TUG) and TUG combined with a cognitive/verbal task (TUG dual-task, TUGdt).

RESEARCH QUESTION: Can gait parameters be accurately estimated from video-recorded TUG tests by a new semi-automatic method aided by a technique for human 2D pose estimation based on deep learning?

METHODS: Thirty persons aged 60-85 years participated in the study, conducted in a laboratory environment. Data were collected by two synchronous video-cameras and a marker-based optoelectronic motion capture system as gold standard, to evaluate the gait parameters step length (SL), step width (SW), step duration (SD), single-stance duration (SSD) and double-stance duration (DSD). For reliability evaluations, data processing aided by a deep neural network model, involved three raters who conducted three repetitions of identifying anatomical keypoints in recordings of one randomly selected step from each of the participants. Validity was analysed using 95 % confidence intervals (CI) and p-values for method differences and Bland-Altman plots with limits of agreement. Inter- and intra-rater reliability were calculated as intraclass correlation coefficients (ICC) and standard errors of measurement. Smallest detectable change was calculated for inter-rater reliability.

RESULTS: Mean ddifferences between video and the motion capture system data for SW, DSD, and SSD were significant (p < 0.001). However, mean differences for all parameters were small (-6.4%-13.0% of motion capture system) indicating good validity. Concerning reliability, almost all 95 % CI of the ICC estimates exceeded 0.90, indicating excellent reliability. Only inter-rater reliability for SW (95 % CI = 0.892;0.973) and one rater's intra-rater reliability for SSD (95 % CI = 0.793;0.951) were lower, but still showed good to excellent reliability.

SIGNIFICANCE: The presented method for extraction of gait parameters from video appears suitable for valid and reliable quantification of gait. This opens up for analyses that may contribute to the knowledge of cognitive-motor interference in dual-task testing.