Background: Few studies have investigated prognostic factors for patients with sciatica, especial... more Background: Few studies have investigated prognostic factors for patients with sciatica, especially for patients treated without surgery. The aim of this study was to identify factors associated with non-success after 1 and 2 years of follow-up and to test the prognostic value of surgical treatment for sciatica. Methods: The study was a prospective multicentre observational study including 466 patients with sciatica and lumbar disc herniation. Potential prognostic factors were sociodemographic characteristics, back pain history, kinesiophobia, emotional distress, pain, comorbidity and clinical examination findings. Study participation did not alter treatment considerations for the patients in the clinics. Patients reported on the questionnaires if surgery of the disc herniation had been performed. Uni-and multivariate logistic regression analyses were used to evaluate factors associated with non-success, defined as Maine-Seattle Back Questionnaire score of ≥5 (0-12) (primary outcome) and Sciatica Bothersomeness Index ≥7 (0-24) (secondary outcome). Results: Rates of non-success were at 1 and 2 years 44% and 39% for the main outcome and 47% and 42% for the secondary outcome. Approximately 1/3 of the patients were treated surgically. For the main outcome variable, in the final multivariate model non-success at 1 year was significantly associated with being male (OR 1.70 [95% CI; 1.06 − 2.73]), smoker (2.06 [1.31 − 3.25]), more back pain (1.0 [1.01 − 1.02]), more comorbid subjective health complaints (1.09 [1.03 − 1.15]), reduced tendon reflex (1.62 [1.03 − 2.56]), and not treated surgically (2.97 [1.75 − 5.04]). Further, factors significantly associated with non-success at 2 years were duration of back problems > 1 year (1.92 [1.11 − 3.32]), duration of sciatica > 3 months (2.30 [1.40 − 3.80]), more comorbid subjective health complaints (1.10 [1.03 − 1.17]) and kinesiophobia (1.04 [1.00 − 1.08]). For the secondary outcome variable, in the final multivariate model, more comorbid subjective health complaints, more back pain, muscular weakness at clinical examination, and not treated surgically, were independent prognostic factors for non-success at both 1 and 2 years. Conclusions: The results indicate that the prognosis for sciatica referred to secondary care is not that good and only slightly better after surgery and that comorbidity should be assessed in patients with sciatica. This calls for a broader assessment of patients with sciatica than the traditional clinical assessment in which mainly the physical symptoms and signs are investigated.
Background: Obesity is one of the most important risk factors for osteoarthritis (OA) in knee(s).... more Background: Obesity is one of the most important risk factors for osteoarthritis (OA) in knee(s). However, the relationship between obesity and OA in hand(s) and hip(s) remains controversial and needs further investigation. The purpose of this study was to investigate the impact of obesity on incident osteoarthritis (OA) in hip, knee, and hand in a general population followed in 10 years. Methods: A total of 1854 people aged 24-76 years in 1994 participated in a Norwegian study on musculoskeletal pain in both 1994 and 2004. Participants with OA or rheumatoid arthritis in 1994 and those above 74 years in 1994 were excluded, leaving n = 1675 for the analyses. The main outcome measure was OA diagnosis at follow-up based on self-report. Obesity was defined by a body mass index (BMI) of 30 and above. Results: At 10-years follow-up the incidence rates were 5.8% (CI 4.3-7.3) for hip OA, 7.3% (CI 5.7-9.0) for knee OA, and 5.6% (CI 4.2-7.1) for hand OA. When adjusting for age, gender, work status and leisure time activities, a high BMI (> 30) was significantly associated with knee OA (OR 2.81; 95%CI 1.32-5.96), and a dose-response relationship was found for this association. Obesity was also significantly associated with hand OA (OR 2.59; 1.08-6.19), but not with hip OA (OR 1.11; 0.41-2.97). There was no statistically significant interaction effect between BMI and gender, age or any of the other confounding variables. Conclusion: A high BMI was significantly associated with knee OA and hand OA, but not with hip OA.
Objectives: To assess validity, reliability, responsiveness and interpretability of the revised O... more Objectives: To assess validity, reliability, responsiveness and interpretability of the revised OsteoArthritis Quality Indicator (OA-QI) questionnaire version 2 (v2) assessing patientreported quality of osteoarthritis care. Methods: The OA-QI v2 (16 items, score range 0-100 (100=best score)) was included in a longitudinal cohort study. Attendees of a 4.5 hour osteoarthritis patient education programme at Diakonhjemmet Hospital, Norway, completed the OA-QI at four time points: two weeks before, immediately before, immediately after, and three months after the programme. Testretest reliability and measurement error over a two-week time period were assessed in those that had not seen health professionals in the interim. Construct validity and responsiveness were assessed with predefined hypotheses. Floor and ceiling effects, smallest detectable change (SDC 95%) and minimal important change (MIC) were assessed to evaluate interpretability. Results: The intraclass correlation coefficient for all 16 items was 0.89. For single items the test-retest kappa estimates ranged 0.38-0.85 and percent agreement 69-92%. Construct validity was acceptable with all six predefined hypotheses confirmed. Responsiveness was acceptable with 33 of 48 and three of four predefined hypotheses confirmed for single items and all items, respectively. There were no floor or ceiling effects. The SDC 95% was 29.1 and 3.0 at the individual and group levels, respectively. MIC was 20.4. Conclusions: The OA-QI v2 had higher reliability estimates compared to v1, showed acceptable validity, and is the recommended version for future use. The results of responsiveness testing further support the use of the OA-QI v2 as an outcome measure in studies aiming to improve osteoarthritis care.
Objective: To describe and compare patients with neck and back pain treated by physiotherapists i... more Objective: To describe and compare patients with neck and back pain treated by physiotherapists in primary healthcare (PHC) and in departments for physical medicine and rehabilitation in specialist healthcare (SHC) in Norway.Design: Cross-sectional study using data from the FYSIOPRIM database in PHC and the Norwegian Neck and Back Registry in SHC. Neck and back pain patients in the period 2014–18 aged ≥ 18 years were included. Demographics, lifestyle and clinical factors were investigated.Results: A total of 8,125 patients were included: 584 in PHC and 7,541 in SHC. Mean age was 47.1 and 45.5 years, respectively, with more females in PHC (72% vs 56%). Low levels of education and physical activity, high workload and receiving social benefits were associated with treatment in SHC. Treatment in SHC was most common from 3 to 12 months’ pain duration. Higher pain intensity and lower health-related quality of life were found in patients treated in SHC, no differences were found for psycho...
Individuals with persistent low back pain commonly have a broad range of other health concerns in... more Individuals with persistent low back pain commonly have a broad range of other health concerns including co-occurring musculoskeletal pain, which significantly affect their quality of life, symptom severity, and treatment outcomes. The purpose of this review is to get a better understanding of prevalence and patterns of co-occurring musculoskeletal pain complaints in those with persistent low back pain and its potential association with age, sex, and back-related disability as it might affect prognosis and management. This systematic review protocol has been designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. We will perform a comprehensive search, with no date limit, in the following bibliographic databases: MEDLINE and Embase (via Ovid), CINAHL, and Scopus for citation tracking, based on the following domains: back pain, co-occurring musculoskeletal pain, combined with a focus group that emphasizes study design. Appropriate paper...
In a cross-sectional postal questionnaire study we compared individuals with localized low back p... more In a cross-sectional postal questionnaire study we compared individuals with localized low back pain (LBP) with individuals with LBP as part of widespread musculoskeletal pain, according to demographic and lifestyle characteristics and functional ability. All the inhabitants in Ullensaker
Background Individuals with persistent low back pain commonly have a broad range of other health ... more Background Individuals with persistent low back pain commonly have a broad range of other health concerns including co-occurring musculoskeletal pain, which significantly affect their quality of life, symptom severity, and treatment outcomes. The purpose of this review is to get a better understanding of prevalence and patterns of co-occurring musculoskeletal pain complaints in those with persistent low back pain and its potential association with age, sex, and back-related disability as it might affect prognosis and management. Methods This systematic review protocol has been designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. We will perform a comprehensive search, with no date limit, in the following bibliographic databases: MEDLINE and Embase (via Ovid), CINAHL, and Scopus for citation tracking, based on the following domains: back pain, co-occurring musculoskeletal pain, combined with a focus group that emphasizes study design...
Table S3. Adjusted multilevel logistic regression showing the effects of each prognostic indicato... more Table S3. Adjusted multilevel logistic regression showing the effects of each prognostic indicator on treatment success (based on P ≤ 0.05 from the univariate analysis). (PDF 96 kb)
Brief overview of The SAMBA/ActiveA physiotherapist workshop training package and the patient man... more Brief overview of The SAMBA/ActiveA physiotherapist workshop training package and the patient management programme. This file contains an overview of the SAMBA/ActiveA physiotherapist workshop training package and the patient management program, which is illustrated in a model. Exercises for improving neuromuscular control, muscle strength and range of motion are illustrated. (DOCX 832kb)
Introduction Traumatic injuries constitute a major cause of mortality and morbidity. Still, the p... more Introduction Traumatic injuries constitute a major cause of mortality and morbidity. Still, the public health burden of trauma in Norway has not been characterised using nationwide registry data. More knowledge is warranted on trauma risk factors and the long-term outcomes following trauma. The Injury Prevention and long-term Outcomes following Trauma project will establish a comprehensive research database. The Norwegian National Trauma Registry (NTR) will be merged with several data sources to pursue the following three main research topics: (1) the public health burden of trauma to society (eg, excess mortality and disability-adjusted life-years (DALYs)), (2) trauma aetiology (eg, socioeconomic factors, comorbidity and drug use) and (3) trauma survivorship (eg, survival, drug use, use of welfare benefits, work ability, education and income). Methods and analysis The NTR (n≈27 000 trauma patients, 2015–2018) will be coupled with the data from Statistics Norway, the Norwegian Patie...
Objectives The Fibromyalgia Survey Diagnostic Criteria-2016 (FSD-2016 criteria) were recently rec... more Objectives The Fibromyalgia Survey Diagnostic Criteria-2016 (FSD-2016 criteria) were recently recommended for both clinical and research purposes. The present study aims to examine whether there is concordance between clinician-based and FSD-2016 criteria-based diagnoses of FM, and secondly, to examine how the illness severity and physical function relate to the criteria-based diagnosis among patients referred to a rheumatism hospital. Methods Participants with a clinician-based diagnosis of FM were included consecutively when referred to a patient education programme for patients with FM. Illness severity was assessed with the Fibromyalgia Survey Questionnaire (FSQ). Based on the FSQ, the fulfilment of the FSD-2016 criteria was evaluated. Physical function was assessed using the Fibromyalgia Impact Questionnaire (FIQ) function scale and self-reported employment status. Results The sample included 130 patients (84% women) from 20 to 66 years of age. Eighty-nine per cent met the FSD-...
Background: Lateral epicondylitis or tennis elbow is a frequent condition with long-lasting sympt... more Background: Lateral epicondylitis or tennis elbow is a frequent condition with long-lasting symptoms. In order to identify predictors for treatment success and pain in lateral epicondylitis, we used data from a randomized controlled trial. This trial investigated the efficacy of physiotherapy alone or combined with corticosteroid injection for acute lateral epicondylitis in general practice. Methods: The outcomes treatment success and pain score on VAS were assessed at 6, 12, 26 and 52 weeks. We ran a univariate binary logistic regression with generalized estimating equations (GEE) and subsequently an adjusted multilevel logistic regression to analyze the association between potential prognostic indicators and the outcome success/ no success. To assess the changes in pain score we used a two-level multilevel linear regression (MLR) followed by an adjusted MLR model with random effects. Results: The most consistent predictor for reduced treatment success at all time points was a high Pain Free Function Index score signifying more pain on everyday activities. Being on paid sick-leave and having a recurring complaint increased short term treatment success but gave decreased long-term treatment success. The patients reporting symptoms after engaging in probable overuse in an unusual activity, tended towards increased treatment success at all time-points, but significant only at 12 weeks. The most consistent predictor of increased pain at all time points was a higher overall complaints score at baseline. Conclusions: Our results suggest that in treating acute lateral epicondylitis, a consideration of baseline pain, a registration of the patient's overall complaint on a VAS scale and an assessment of the patient's perceived performance in everyday activities with the Pain Free Function Index can be useful in identifying patients that will have a more protracted and serious condition.
Niels Gunnar Juel er spesialist i fysikalsk medisin og rehabilitering og overlege ved Oslo univer... more Niels Gunnar Juel er spesialist i fysikalsk medisin og rehabilitering og overlege ved Oslo universitetssykehus. Han er dr.philos., laerebokforfatter og lektor ved Avdeling for allmennmedisin, Universitetet i Oslo. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. STEIN JARLE PEDERSEN Stein Jarle Pedersen er spesialist i allmennmedisin, stipendiat ved Institutt for helse og samfunn, Universitetet i Oslo, og fastlege ved Ankerløkka Legesenter i Fredrikstad. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. KAIA BECK ENGEBRETSEN Kaia Beck Engebretsen er ph.d., spesialfysioterapeut og klinisk spesialist ved Oslo universitetssykehus. Hun forsker på og arbeider med skulderplager. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. KJETIL GUNDRO BRURBERG Kjetil Gundro Brurberg er ph.d. og seniorforsker ved Folkehelseinstituttet. Han er metodeekspert innen systematiske oversikter og retningslinjer. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. OLE MARIUS EKEBERG Ole Marius Ekeberg er ph.d., spesialist i fysikalsk medisin og rehabilitering og overlege ved seksjon Fysikalsk medisin og rehabilitering, Helse Fonna. Han forsker på skulderplager. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. SILJE ENDRESEN REME Silje Endresen Reme er psykologspesialist ved Avdeling for smertebehandling, Oslo universitetssykehus, og professor ved Psykologisk Institutt, Universitetet i Oslo. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. JENS IVAR BROX Jens Ivar Brox er spesialist i fysikalsk medisin og rehabilitering, professor ved Universitetet i Oslo og leder av Nakke-og ryggpoliklinikken, Oslo universitetssykehus. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. BÅRD NATVIG Bård Natvig er professor ved Avdeling for allmennmedisin, Universitetet i Oslo. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. 18. Helsebiblioteket. Retningslinje for skulderplager i primaerhelsetjenesten. https://www.helsebiblioteket.no/retningslinjer/skulderplager-i-primaerhelsetjenesten (22.3.2019).
Background Little is known about the prognostic factors for work-related outcomes of sciatica cau... more Background Little is known about the prognostic factors for work-related outcomes of sciatica caused by disc herniation. Objectives To identify prognostic factors for return to work (RTW) during a 2-year follow-up among sciatica patients referred to secondary care. Methods The setting was a multicenter prospective cohort study including 466 patients. Study participation did not involve any specific type of intervention. In patients with severe symptoms, surgery was performed at the discretion of each center. Administrative data from the National Sickness Benefit Register were accessed for 227 patients. Two patient samples were used. Sample (A) comprised patients who at the time of inclusion in the cohort reported being on partial sick leave or complete sick leave, or were undergoing rehabilitation because of back pain/sciatica. Sample (B) comprised patients who, according to the sickness benefit register, at the time of inclusion received sickness benefits or rehabilitation allowances because of back pain/sciatica. In sample (A), the outcome was self-reported return to full-time work at the 2-year follow-up. In sample (B), the outcome was time to first sustained RTW, defined as the first period of >60 days without receiving benefits from the register. Analyses were performed by multivariate logistic regression and Cox proportional hazard modeling. Results One-fourth of the patients were still out of work at the 2-year follow-up. In sample A (n=237), younger age, better general health, lower baseline sciatica bothersomeness, less fear avoidance–work, and a negative straight-leg-raising test result were significantly associated with a higher probability of RTW at the 2-year follow-up. Surgery was not significantly associated with the outcome. In sample B (n=125), a previous history of sciatica, duration of the current sciatica episode >3 months, and greater sciatica bothersomeness, fear avoidance–work, and back pain were significantly associated with a longer time to sustained RTW. Surgery was negatively associated with time to sustained RTW both in univariate (hazard ratio,HR 0.60; 95% confidence interval (CI) 0.39, 0.93; p=0.02) and in multivariate analysis (HR 0.49; 95% CI 0.31, 0.79; p=0.003). Conclusions The baseline factors associated with RTW identified in multivariate analysis were age, general health, previous history of sciatica, duration of the current episode, baseline sciatica bothersomeness, fear avoidance–work, back pain, and the straight-leg-raising test result. Surgical treatment was associated with slower RTW. Disclosure of Interest None Declared
Background: Few studies have investigated prognostic factors for patients with sciatica, especial... more Background: Few studies have investigated prognostic factors for patients with sciatica, especially for patients treated without surgery. The aim of this study was to identify factors associated with non-success after 1 and 2 years of follow-up and to test the prognostic value of surgical treatment for sciatica. Methods: The study was a prospective multicentre observational study including 466 patients with sciatica and lumbar disc herniation. Potential prognostic factors were sociodemographic characteristics, back pain history, kinesiophobia, emotional distress, pain, comorbidity and clinical examination findings. Study participation did not alter treatment considerations for the patients in the clinics. Patients reported on the questionnaires if surgery of the disc herniation had been performed. Uni-and multivariate logistic regression analyses were used to evaluate factors associated with non-success, defined as Maine-Seattle Back Questionnaire score of ≥5 (0-12) (primary outcome) and Sciatica Bothersomeness Index ≥7 (0-24) (secondary outcome). Results: Rates of non-success were at 1 and 2 years 44% and 39% for the main outcome and 47% and 42% for the secondary outcome. Approximately 1/3 of the patients were treated surgically. For the main outcome variable, in the final multivariate model non-success at 1 year was significantly associated with being male (OR 1.70 [95% CI; 1.06 − 2.73]), smoker (2.06 [1.31 − 3.25]), more back pain (1.0 [1.01 − 1.02]), more comorbid subjective health complaints (1.09 [1.03 − 1.15]), reduced tendon reflex (1.62 [1.03 − 2.56]), and not treated surgically (2.97 [1.75 − 5.04]). Further, factors significantly associated with non-success at 2 years were duration of back problems > 1 year (1.92 [1.11 − 3.32]), duration of sciatica > 3 months (2.30 [1.40 − 3.80]), more comorbid subjective health complaints (1.10 [1.03 − 1.17]) and kinesiophobia (1.04 [1.00 − 1.08]). For the secondary outcome variable, in the final multivariate model, more comorbid subjective health complaints, more back pain, muscular weakness at clinical examination, and not treated surgically, were independent prognostic factors for non-success at both 1 and 2 years. Conclusions: The results indicate that the prognosis for sciatica referred to secondary care is not that good and only slightly better after surgery and that comorbidity should be assessed in patients with sciatica. This calls for a broader assessment of patients with sciatica than the traditional clinical assessment in which mainly the physical symptoms and signs are investigated.
Background: Obesity is one of the most important risk factors for osteoarthritis (OA) in knee(s).... more Background: Obesity is one of the most important risk factors for osteoarthritis (OA) in knee(s). However, the relationship between obesity and OA in hand(s) and hip(s) remains controversial and needs further investigation. The purpose of this study was to investigate the impact of obesity on incident osteoarthritis (OA) in hip, knee, and hand in a general population followed in 10 years. Methods: A total of 1854 people aged 24-76 years in 1994 participated in a Norwegian study on musculoskeletal pain in both 1994 and 2004. Participants with OA or rheumatoid arthritis in 1994 and those above 74 years in 1994 were excluded, leaving n = 1675 for the analyses. The main outcome measure was OA diagnosis at follow-up based on self-report. Obesity was defined by a body mass index (BMI) of 30 and above. Results: At 10-years follow-up the incidence rates were 5.8% (CI 4.3-7.3) for hip OA, 7.3% (CI 5.7-9.0) for knee OA, and 5.6% (CI 4.2-7.1) for hand OA. When adjusting for age, gender, work status and leisure time activities, a high BMI (> 30) was significantly associated with knee OA (OR 2.81; 95%CI 1.32-5.96), and a dose-response relationship was found for this association. Obesity was also significantly associated with hand OA (OR 2.59; 1.08-6.19), but not with hip OA (OR 1.11; 0.41-2.97). There was no statistically significant interaction effect between BMI and gender, age or any of the other confounding variables. Conclusion: A high BMI was significantly associated with knee OA and hand OA, but not with hip OA.
Objectives: To assess validity, reliability, responsiveness and interpretability of the revised O... more Objectives: To assess validity, reliability, responsiveness and interpretability of the revised OsteoArthritis Quality Indicator (OA-QI) questionnaire version 2 (v2) assessing patientreported quality of osteoarthritis care. Methods: The OA-QI v2 (16 items, score range 0-100 (100=best score)) was included in a longitudinal cohort study. Attendees of a 4.5 hour osteoarthritis patient education programme at Diakonhjemmet Hospital, Norway, completed the OA-QI at four time points: two weeks before, immediately before, immediately after, and three months after the programme. Testretest reliability and measurement error over a two-week time period were assessed in those that had not seen health professionals in the interim. Construct validity and responsiveness were assessed with predefined hypotheses. Floor and ceiling effects, smallest detectable change (SDC 95%) and minimal important change (MIC) were assessed to evaluate interpretability. Results: The intraclass correlation coefficient for all 16 items was 0.89. For single items the test-retest kappa estimates ranged 0.38-0.85 and percent agreement 69-92%. Construct validity was acceptable with all six predefined hypotheses confirmed. Responsiveness was acceptable with 33 of 48 and three of four predefined hypotheses confirmed for single items and all items, respectively. There were no floor or ceiling effects. The SDC 95% was 29.1 and 3.0 at the individual and group levels, respectively. MIC was 20.4. Conclusions: The OA-QI v2 had higher reliability estimates compared to v1, showed acceptable validity, and is the recommended version for future use. The results of responsiveness testing further support the use of the OA-QI v2 as an outcome measure in studies aiming to improve osteoarthritis care.
Objective: To describe and compare patients with neck and back pain treated by physiotherapists i... more Objective: To describe and compare patients with neck and back pain treated by physiotherapists in primary healthcare (PHC) and in departments for physical medicine and rehabilitation in specialist healthcare (SHC) in Norway.Design: Cross-sectional study using data from the FYSIOPRIM database in PHC and the Norwegian Neck and Back Registry in SHC. Neck and back pain patients in the period 2014–18 aged ≥ 18 years were included. Demographics, lifestyle and clinical factors were investigated.Results: A total of 8,125 patients were included: 584 in PHC and 7,541 in SHC. Mean age was 47.1 and 45.5 years, respectively, with more females in PHC (72% vs 56%). Low levels of education and physical activity, high workload and receiving social benefits were associated with treatment in SHC. Treatment in SHC was most common from 3 to 12 months’ pain duration. Higher pain intensity and lower health-related quality of life were found in patients treated in SHC, no differences were found for psycho...
Individuals with persistent low back pain commonly have a broad range of other health concerns in... more Individuals with persistent low back pain commonly have a broad range of other health concerns including co-occurring musculoskeletal pain, which significantly affect their quality of life, symptom severity, and treatment outcomes. The purpose of this review is to get a better understanding of prevalence and patterns of co-occurring musculoskeletal pain complaints in those with persistent low back pain and its potential association with age, sex, and back-related disability as it might affect prognosis and management. This systematic review protocol has been designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. We will perform a comprehensive search, with no date limit, in the following bibliographic databases: MEDLINE and Embase (via Ovid), CINAHL, and Scopus for citation tracking, based on the following domains: back pain, co-occurring musculoskeletal pain, combined with a focus group that emphasizes study design. Appropriate paper...
In a cross-sectional postal questionnaire study we compared individuals with localized low back p... more In a cross-sectional postal questionnaire study we compared individuals with localized low back pain (LBP) with individuals with LBP as part of widespread musculoskeletal pain, according to demographic and lifestyle characteristics and functional ability. All the inhabitants in Ullensaker
Background Individuals with persistent low back pain commonly have a broad range of other health ... more Background Individuals with persistent low back pain commonly have a broad range of other health concerns including co-occurring musculoskeletal pain, which significantly affect their quality of life, symptom severity, and treatment outcomes. The purpose of this review is to get a better understanding of prevalence and patterns of co-occurring musculoskeletal pain complaints in those with persistent low back pain and its potential association with age, sex, and back-related disability as it might affect prognosis and management. Methods This systematic review protocol has been designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. We will perform a comprehensive search, with no date limit, in the following bibliographic databases: MEDLINE and Embase (via Ovid), CINAHL, and Scopus for citation tracking, based on the following domains: back pain, co-occurring musculoskeletal pain, combined with a focus group that emphasizes study design...
Table S3. Adjusted multilevel logistic regression showing the effects of each prognostic indicato... more Table S3. Adjusted multilevel logistic regression showing the effects of each prognostic indicator on treatment success (based on P ≤ 0.05 from the univariate analysis). (PDF 96 kb)
Brief overview of The SAMBA/ActiveA physiotherapist workshop training package and the patient man... more Brief overview of The SAMBA/ActiveA physiotherapist workshop training package and the patient management programme. This file contains an overview of the SAMBA/ActiveA physiotherapist workshop training package and the patient management program, which is illustrated in a model. Exercises for improving neuromuscular control, muscle strength and range of motion are illustrated. (DOCX 832kb)
Introduction Traumatic injuries constitute a major cause of mortality and morbidity. Still, the p... more Introduction Traumatic injuries constitute a major cause of mortality and morbidity. Still, the public health burden of trauma in Norway has not been characterised using nationwide registry data. More knowledge is warranted on trauma risk factors and the long-term outcomes following trauma. The Injury Prevention and long-term Outcomes following Trauma project will establish a comprehensive research database. The Norwegian National Trauma Registry (NTR) will be merged with several data sources to pursue the following three main research topics: (1) the public health burden of trauma to society (eg, excess mortality and disability-adjusted life-years (DALYs)), (2) trauma aetiology (eg, socioeconomic factors, comorbidity and drug use) and (3) trauma survivorship (eg, survival, drug use, use of welfare benefits, work ability, education and income). Methods and analysis The NTR (n≈27 000 trauma patients, 2015–2018) will be coupled with the data from Statistics Norway, the Norwegian Patie...
Objectives The Fibromyalgia Survey Diagnostic Criteria-2016 (FSD-2016 criteria) were recently rec... more Objectives The Fibromyalgia Survey Diagnostic Criteria-2016 (FSD-2016 criteria) were recently recommended for both clinical and research purposes. The present study aims to examine whether there is concordance between clinician-based and FSD-2016 criteria-based diagnoses of FM, and secondly, to examine how the illness severity and physical function relate to the criteria-based diagnosis among patients referred to a rheumatism hospital. Methods Participants with a clinician-based diagnosis of FM were included consecutively when referred to a patient education programme for patients with FM. Illness severity was assessed with the Fibromyalgia Survey Questionnaire (FSQ). Based on the FSQ, the fulfilment of the FSD-2016 criteria was evaluated. Physical function was assessed using the Fibromyalgia Impact Questionnaire (FIQ) function scale and self-reported employment status. Results The sample included 130 patients (84% women) from 20 to 66 years of age. Eighty-nine per cent met the FSD-...
Background: Lateral epicondylitis or tennis elbow is a frequent condition with long-lasting sympt... more Background: Lateral epicondylitis or tennis elbow is a frequent condition with long-lasting symptoms. In order to identify predictors for treatment success and pain in lateral epicondylitis, we used data from a randomized controlled trial. This trial investigated the efficacy of physiotherapy alone or combined with corticosteroid injection for acute lateral epicondylitis in general practice. Methods: The outcomes treatment success and pain score on VAS were assessed at 6, 12, 26 and 52 weeks. We ran a univariate binary logistic regression with generalized estimating equations (GEE) and subsequently an adjusted multilevel logistic regression to analyze the association between potential prognostic indicators and the outcome success/ no success. To assess the changes in pain score we used a two-level multilevel linear regression (MLR) followed by an adjusted MLR model with random effects. Results: The most consistent predictor for reduced treatment success at all time points was a high Pain Free Function Index score signifying more pain on everyday activities. Being on paid sick-leave and having a recurring complaint increased short term treatment success but gave decreased long-term treatment success. The patients reporting symptoms after engaging in probable overuse in an unusual activity, tended towards increased treatment success at all time-points, but significant only at 12 weeks. The most consistent predictor of increased pain at all time points was a higher overall complaints score at baseline. Conclusions: Our results suggest that in treating acute lateral epicondylitis, a consideration of baseline pain, a registration of the patient's overall complaint on a VAS scale and an assessment of the patient's perceived performance in everyday activities with the Pain Free Function Index can be useful in identifying patients that will have a more protracted and serious condition.
Niels Gunnar Juel er spesialist i fysikalsk medisin og rehabilitering og overlege ved Oslo univer... more Niels Gunnar Juel er spesialist i fysikalsk medisin og rehabilitering og overlege ved Oslo universitetssykehus. Han er dr.philos., laerebokforfatter og lektor ved Avdeling for allmennmedisin, Universitetet i Oslo. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. STEIN JARLE PEDERSEN Stein Jarle Pedersen er spesialist i allmennmedisin, stipendiat ved Institutt for helse og samfunn, Universitetet i Oslo, og fastlege ved Ankerløkka Legesenter i Fredrikstad. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. KAIA BECK ENGEBRETSEN Kaia Beck Engebretsen er ph.d., spesialfysioterapeut og klinisk spesialist ved Oslo universitetssykehus. Hun forsker på og arbeider med skulderplager. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. KJETIL GUNDRO BRURBERG Kjetil Gundro Brurberg er ph.d. og seniorforsker ved Folkehelseinstituttet. Han er metodeekspert innen systematiske oversikter og retningslinjer. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. OLE MARIUS EKEBERG Ole Marius Ekeberg er ph.d., spesialist i fysikalsk medisin og rehabilitering og overlege ved seksjon Fysikalsk medisin og rehabilitering, Helse Fonna. Han forsker på skulderplager. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. SILJE ENDRESEN REME Silje Endresen Reme er psykologspesialist ved Avdeling for smertebehandling, Oslo universitetssykehus, og professor ved Psykologisk Institutt, Universitetet i Oslo. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. JENS IVAR BROX Jens Ivar Brox er spesialist i fysikalsk medisin og rehabilitering, professor ved Universitetet i Oslo og leder av Nakke-og ryggpoliklinikken, Oslo universitetssykehus. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. BÅRD NATVIG Bård Natvig er professor ved Avdeling for allmennmedisin, Universitetet i Oslo. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. 18. Helsebiblioteket. Retningslinje for skulderplager i primaerhelsetjenesten. https://www.helsebiblioteket.no/retningslinjer/skulderplager-i-primaerhelsetjenesten (22.3.2019).
Background Little is known about the prognostic factors for work-related outcomes of sciatica cau... more Background Little is known about the prognostic factors for work-related outcomes of sciatica caused by disc herniation. Objectives To identify prognostic factors for return to work (RTW) during a 2-year follow-up among sciatica patients referred to secondary care. Methods The setting was a multicenter prospective cohort study including 466 patients. Study participation did not involve any specific type of intervention. In patients with severe symptoms, surgery was performed at the discretion of each center. Administrative data from the National Sickness Benefit Register were accessed for 227 patients. Two patient samples were used. Sample (A) comprised patients who at the time of inclusion in the cohort reported being on partial sick leave or complete sick leave, or were undergoing rehabilitation because of back pain/sciatica. Sample (B) comprised patients who, according to the sickness benefit register, at the time of inclusion received sickness benefits or rehabilitation allowances because of back pain/sciatica. In sample (A), the outcome was self-reported return to full-time work at the 2-year follow-up. In sample (B), the outcome was time to first sustained RTW, defined as the first period of >60 days without receiving benefits from the register. Analyses were performed by multivariate logistic regression and Cox proportional hazard modeling. Results One-fourth of the patients were still out of work at the 2-year follow-up. In sample A (n=237), younger age, better general health, lower baseline sciatica bothersomeness, less fear avoidance–work, and a negative straight-leg-raising test result were significantly associated with a higher probability of RTW at the 2-year follow-up. Surgery was not significantly associated with the outcome. In sample B (n=125), a previous history of sciatica, duration of the current sciatica episode >3 months, and greater sciatica bothersomeness, fear avoidance–work, and back pain were significantly associated with a longer time to sustained RTW. Surgery was negatively associated with time to sustained RTW both in univariate (hazard ratio,HR 0.60; 95% confidence interval (CI) 0.39, 0.93; p=0.02) and in multivariate analysis (HR 0.49; 95% CI 0.31, 0.79; p=0.003). Conclusions The baseline factors associated with RTW identified in multivariate analysis were age, general health, previous history of sciatica, duration of the current episode, baseline sciatica bothersomeness, fear avoidance–work, back pain, and the straight-leg-raising test result. Surgical treatment was associated with slower RTW. Disclosure of Interest None Declared
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