Background: Pelvic girdle pain is prevalent during pregnancy, and women affected report weight-be... more Background: Pelvic girdle pain is prevalent during pregnancy, and women affected report weight-bearing activities to be their main disability. The Stork test is a commonly used single-leg-stance test. As clinicians report specific movement patterns in those with pelvic girdle pain, we aimed to investigate the influence of both pregnancy and pelvic girdle pain on performance of the Stork test. Methods: In this cross-sectional study, 25 pregnant women with pelvic girdle pain, 23 asymptomatic pregnant and 24 asymptomatic non-pregnant women underwent three-dimensional kinematic analysis of the Stork test. Linear mixed models were used to investigate between-group differences in trunk, pelvic and hip kinematics during neutral stance, weight shift, leg lift and single leg stance. Findings: Few and small significant between-group differences were found. Pregnant women with pelvic girdle pain had significantly less hip adduction during single leg stance compared to asymptomatic pregnant women (estimated marginal means (95% confidence intervals)-1.1°(−2.4°, 0.3°) and 1.0°(−0.4°, 2.4°), respectively; P = 0.03). Asymptomatic pregnant women had significantly less hip internal rotation compared to non-pregnant women 4.1°(1.6°, 6.7°) and 7.9°(5.4°, 10.4°), respectively (P = 0.04) and greater peak hip flexion angle of the lifted leg in single leg stance 80.4°(77.0°, 83.9°) and 74.1°(70.8°, 77.5°), respectively (P = 0.01). Variation in key kinematic variables was large across participants in all three groups. Interpretation: Our findings indicate that trunk, pelvic and hip movements during the Stork test are not specific to pregnancy and/or pelvic girdle pain in the 2nd trimester. Instead, movement strategies appear unique to each individual.
Background: Walking difficulties are common among pregnant women with pelvic girdle pain. This cr... more Background: Walking difficulties are common among pregnant women with pelvic girdle pain. This cross-sectional study investigated the influence of pelvic girdle pain, pregnancy and speed on spatiotemporal and trunk, pelvic and hip kinematics during gait in the 2nd trimester of pregnancy. Methods: Three-dimensional gait analysis at self-selected speed was performed in 25 pregnant women with pelvic girdle pain, 24 asymptomatic pregnant and 24 nonpregnant women. Linear mixed models were used to investigate between-group differences in gait variables. Adjustment for gait speed was included in the analysis. Correlations between speed and fear of movement, disability and pain were examined using Spearman correlation coefficient (r s). Findings: Pregnant women with pelvic girdle pain walked 18% slower (estimated marginal means (95% confidence intervals) 1.18 (1.22, 1.24) meter/s) compared to asymptomatic pregnant women (1.44 (1.38, 1.50) meter/s) (P < 0.001). Moreover, with longer double limb support (5%, P = 0.04), shorter contralateral step length (3%, P = 0.03) and more restricted pelvic and hip kinematics (0.001 ≤ P ≤ 0.01) adjusted for speed. Only stance, double limb support and thoracic rotation (0.001 ≤ P ≤ 0.04) differed between asymptomatic pregnant and non-pregnant women. Speed was negatively correlated with fear of movement (r s = −0.63, P = 0.01) and disability (r s = −0.46, P = 0.03) in the pelvic girdle pain group. Interpretation: Gait is primarily influenced by pelvic girdle pain and less by pregnancy. Pregnant women with pelvic girdle pain walked slower and with a more rigid gait pattern compared to asymptomatic pregnant women, presumably related to altered load transfer. Our results may assist clinical evaluation of pelvic girdle pain, as well as direct future research.
Background: The Timed Up and Go (TUG) test, a standardized functional mobility test, has been pro... more Background: The Timed Up and Go (TUG) test, a standardized functional mobility test, has been proposed as a physical performance-based measure in pregnant women with pelvic girdle pain (PGP). Objectives: This cross-sectional study aimed to investigate physical function by the use of TUG in pregnant women with PGP compared to asymptomatic pregnant and non-pregnant women, and to identify factors associated with increased TUG. Methods: In total, 25 pregnant women with PGP, 24 asymptomatic pregnant and 25 asymptomatic non-pregnant women participated. One-way analysis of variance was used to explore difference in TUG between the groups and multiple linear regression analyses to explore associations between TUG and potential explanatory variables. Results: The time on TUG varied among pregnant women with PGP, and was significantly higher (mean (95% CI) 6.9 (6.5, 7.3) seconds) than for asymptomatic pregnant (5.8 (5.5, 6.0), p < 0.001) and non-pregnant (5.5 (5.4, 5.6), p < 0.001) women. In the total study sample, group, increased BMI and sick leave were significantly associated with increased TUG (p-values≤0.02). In pregnant women with PGP, pain intensity was the only significant clinical factor associated with increased TUG (p = 0.002). Conclusion: Pregnant women with PGP used longer time and showed larger variation in TUG than asymptomatic pregnant and non-pregnant women, this underpins that TUG targets activities relevant to PGP. Our results provide new knowledge about factors influencing TUG time. Importantly, multivariable analyses suggest that pain intensity should be considered when interpreting TUG time in pregnant women with PGP. 2001), has previously been recommended to evaluate function in PGP patients (Vleeming et al., 2008). Later, the self-reported Pelvic Girdle Questionnaire (PGQ) including activities, participation and bodily symptoms was developed (Stuge et al., 2011). However, both the ASLR and PGQ capture the patient's perception of their performance or condition. As self-reported functioning is not always indicative of the actual performance (Terwee et al., 2006b), performance-based measures assist in determining the extent of disability. Recently, Evensen and colleagues (2015, 2016) proposed the Timed Up and Go (TUG) test (Podsiadlo and Richardson, 1991) undertaken at maximum speed as a reliable and valid weight-bearing physical performance-based measure for pregnant women with PGP. The TUG is a standardized, timed, functional mobility test (Podsiadlo and
Acupuncture in medicine : journal of the British Medical Acupuncture Society, 2014
Pattern differentiation and diagnosis are fundamental principles of Traditional Chinese Medicine ... more Pattern differentiation and diagnosis are fundamental principles of Traditional Chinese Medicine (TCM). Studies have shown low inter-rater reliability in TCM pattern diagnoses. This variability may originate from both the identification and the interpretation of symptoms and signs. To examine the inter-rater reliability in TCM pattern diagnoses made in the style of Maciocia for 25 case histories by eight acupuncturists and to explore the impact of demographic factors on the diagnostic conclusion. Further, the association between the diagnosis and the presence of symptoms was examined for a single TCM diagnosis. Eight acupuncturists independently diagnosed 25 women (15 fertile, 10 infertile) based on written case histories. Descriptive statistics, logistic regression and inter-rater reliability (κ) were used. Poor inter-rater reliability on TCM patterns (κ<0.20) and large variation in the number of TCM pattern diagnoses were found. Sex, duration of practice and education had a hig...
Assessment of everyday functioning in children may depend to a considerable extent on the framewo... more Assessment of everyday functioning in children may depend to a considerable extent on the framework used to conceptualise functioning and disability. The Pediatric Evaluation of Disability Inventory (PEDI) has incorporated the mediating role of the environment on disability, using different measurement scales. The construction of the Functional Skills scales, which measure capability, and the Caregiver Assistance scales, which measure performance, was based on the Nagi disablement scheme. The International Classification of Functioning, Disability and Health (ICF) represents a new framework of functioning and disability that could be used to compare the measurement constructs and the content of different outcome measurements. To examine the conceptual basis and the content of the PEDI using the ICF. Phrases that describe the conceptual basis of the PEDI scales and of the ICF classifications were systematically collected and compared. Two researchers classified the item content of the Functional Skills scales independently before consensus was reached. The analyses indicate that the conceptual basis of the PEDI scales to a large extent match the ICF concepts of activity, participation and environmental factors. Both the PEDI and the ICF use the constructs of capacity and performance, but differ in how to operationalise these constructs. The classification of the Functional Skills scales shows that the PEDI primarily is a measure of activities and participation. The frequently use of environmental codes to classify the context of the requested functions demonstrates that the PEDI has incorporated the environment into the assessment. Our analyses indicate that the ICF could serve as a conceptual framework to clarify the measurement construct of the PEDI scales, and as taxonomy to describe and clarify the item content of the Functional Skills scales. Both as framework and taxonomy the ICF showed limitations in covering functioning in early childhood.
Purpose. The study describes use of assistive devices and other environmental modifications, and ... more Purpose. The study describes use of assistive devices and other environmental modifications, and their impact on everyday activities and care in young children with cerebral palsy (CP). Method. Ninety-five children (55 boys, 40 girls; mean age 58 months, SD 18 months) and their parents were studied using a cross-sectional design. The Pediatric Evaluation of Disability Inventory (PEDI) was applied to assess daily activities using the three measurement scales: functional skills, caregiver assistance, and modifications of the environment. Use of modifications was described related to the five severity levels of the Gross Motor Function Classifications System (GMFCS). Impact was rated on the Caregiver Assistance scale of the PEDI and on a five-point Likert scale. Results. Out of the 1075 provided environmental modifications, 980 were in regular use to support mobility, self-care and social function among 84 children. The number increased with GMFCS levels; children at levels IV and V used 80% of the modifications, with large variations between the children at same level. Adaptations of housing and transportation facilitated effective use of assistive devices. Half of the parents rated the modifications to have moderate to very large effect on the child's mobility, 25% on self-care skills, and 20% on social function. Furthermore, 65% reported that the modifications lightened the caregiving for mobility, 75% for self-care and 25% for social function. Functional independence and care demands often benefited from different types of modifications. Conclusion. The variations in use and benefits of environmental modifications indicate need of comprehensive assistive technology assessments, including child factors, family factors, technology factors and service system factors.
Everyday functioning is described in 95 children with cerebral palsy (CP; 55 males and 40 females... more Everyday functioning is described in 95 children with cerebral palsy (CP; 55 males and 40 females; mean age 58 months, SD 18 months, range 25 to 87 months) using the three scales of the Pediatric Evaluation of Disability Inventory (PEDI): Functional Skills, Caregiver Assistance, and Modifications of the Environment. Types of CP in the children were hemiplegia, (n=19), spastic/ataxic diplegia, (n=44), spastic quadriplegia, (n=16), dyskinetic, (n=9), and mixed (n=7). Symptoms were grouped by severity according to the Gross Motor Function Classification System (GMFCS): 23% were classified at level I, 21% at level II, 10% at level III, 23% at level IV, and 23% level V. A large variability in functioning in mobility, self-care, and social function was seen because of the heterogeneity of children with CP. Limitations in achievement of activities, need for assistance, and use of assistive devices increased progressively with GMFCS level. Furthermore, these children differed to a great extent from the normative sample of the PEDI. Stepwise regression analysis showed that the GMFCS was a good predictor of everyday functioning with age and learning problems as significantly contributing factors, particularly in self-care and social function. In conclusion, the three scales of the PEDI represent different but strongly related aspects of everyday functioning in young children with CP.
Archives of Pediatrics & Adolescent Medicine, 2007
Participants: One hundred twenty children aged 7 to 12 years with complex CHD and 387 healthy sch... more Participants: One hundred twenty children aged 7 to 12 years with complex CHD and 387 healthy schoolchildren in the same age range (control group). Interventions: All children with CHD were surgically treated with multiple corrections within the first year of life. Main Outcome Measures: Movement Assessment Battery for Children, grip strength, quadriceps muscle strength, and balance. Results: Compared with the control group, children with CHD had a risk of having any degree of impaired motor competence of 5.8 (95% confidence interval, 3.8-8.8). The risk for having severe motor problems was 11.0 (95% confidence interval, 5.4-22.5). There were highly significant differences between the groups for manual dexterity, ball skills, grip strength, quadriceps muscle strength, and static and dynamic balance (P Ͻ.001). Conclusions: Children with CHD have a risk of severe motor problems 11-fold that of schoolchildren without any known heart failure. This suggests that primary health care providers should screen the motor competence in children with CHD at an early age to initiate therapeutic actions for children who show incipient motor problems. Optimal rehabilitative, social, and environmental support may improve the children's motor competence and prevent future health problems.
Background Acupuncture is rooted in traditional Chinese medicine (TCM) and emphasises individuali... more Background Acupuncture is rooted in traditional Chinese medicine (TCM) and emphasises individualised treatment according to TCM patterns. Eight TCM patterns are regarded as typical for female infertility. There are no empirical data comparing these patterns in fertile and infertile women. Objective To identify and compare the TCM patterns and recommended acupuncture points in infertile and fertile women. The hypothesis that infertile and fertile women should differ in occurrence of TCM patterns described as typical for infertility was examined. Methods A cross-sectional study examined the distribution of TCM patterns and acupuncture points among 24 infertile and 24 fertile women. TCM patterns and points proposed by two acupuncturists were analysed. The odds ratio was used as the effect measure. Results Three patterns were found in more than 92% of the women. Five patterns occurred more frequently among infertile (p≤0.03), and four among fertile (p≤0.02) women. Only three of the eigh...
To provide normative age- and gender-associated values on muscular strength, power and endurance ... more To provide normative age- and gender-associated values on muscular strength, power and endurance and to establish a reference database on healthy school children aged 7 to 12 years. In addition, associations between some simple functional tests and the more sophisticated isokinetic strength measures were investigated. Three hundred seventy-six children, 191 girls and 185 boys, performed different muscle-strength tests like knee flexion/extension, handgrip, back extension and vertical jump. There was a significant and linear increase in strength with no gender differences from 7 up to 11 years of age. There was a large variability within each age group, indicating that a normative sample of muscle-strength measurements includes a wide range of values for each age group. The relationship between hand- grip strength and observed quadriceps strength was high (r = 0.84) and the correlation between vertical jump and relative quadriceps strength was moderate (r = 0.50). All the different strength measures showed almost the same pattern, indicating increased absolute strength values with increasing age and no significant gender differences except for flexion at the age of 11 and 12 years . The association between grip strength, vertical jump and quadriceps strength measured isokinetically was moderate to strong. The back muscle endurance test (The Biering-Sørensen test) showed a great roof effect and should not be included in a test battery for school children.
We determined the repeatability and correlations between force, endurance and muscle activity dur... more We determined the repeatability and correlations between force, endurance and muscle activity during isometric contractions over three years. Twenty-six subjects, with and without complaints of the shoulder and neck, performed standardized maximal and submaximal shoulder-abduction contractions and wrist extension-contractions at yearly intervals from 1997 to 1999. Peak forces developed during maximal contraction and the endurance times of submaximal contractions during shoulder abduction and wrist extension were measured. Electromyography (EMG) of muscle activity was recorded bilaterally from the upper trapezius, middle deltoid, and forearm extensor muscles. Root mean square EMG amplitudes were calculated. We found statistically significant associations between peak forces developed during wrist extension and shoulder abduction, and between endurance times of submaximal wrist extension and shoulder abduction. No statistically significant changes in peak force and EMG peak were found over the measurement years. The responses were not statistically significantly influenced by gender, or neck and shoulder pain. However, we observed considerable intra-individual variation in the inter-year measurements particularly for the responses to submaximal contraction. Such large variations represent a challenge when attempting to use the responses to interpret the effects of therapies.
in 2013. Julsvoll received the Norwegian Musculosceletal Research Award 2014 for her research on ... more in 2013. Julsvoll received the Norwegian Musculosceletal Research Award 2014 for her research on temporomandibular disorders and have presented her research results both at international and national congresses. Julsvoll works at Hans & Olaf Physical therapy clinic, Oslo. She collaborates with other physical therapists and with dentists, oral surgeons and maxillo-facial radiologists. She is also responsible for specialization courses for physiotherapists, manual therapists and chiropractors in Norway and has given support to the Norwegian guidelines for patients with TMD, published by the Norwegian Directorate for Health.
Background: Fatigue is a common symptom in patients with sarcoidosis. Despite lacking evidence on... more Background: Fatigue is a common symptom in patients with sarcoidosis. Despite lacking evidence on whether high-intensity interval training (HIIT) will aggravate fatigue, moderate-intensity exercise is often recommended. This study aimed to investigate whether a single session of HIIT would affect fatigue differently from a single session of moderate-intensity continuous training (MICT). Methods: Forty-one patients with pulmonary sarcoidosis were recruited to a cross-over study. All patients completed one treadmill session of HIIT (85% of peak heart rate (HRpeak)) and one of MICT (70% of HRpeak). Fatigue was assessed with the Visual Analogue Scale 0–100 mm, before (T0), after (T1), and 24 hours after (T2) each exercise session. Paired sample t-test was used to compare changes in fatigue from T0 to T1 and from T0 to T2 between HIIT and MICT. Results: No statistically significant difference in fatigue levels was found between HIIT and MICT, either at T1 (3.6 (13.5) and 1.4 (13.5)) or a...
Objectives Shoulder pain is a prevalent problem and has a considerable impact on the use of prima... more Objectives Shoulder pain is a prevalent problem and has a considerable impact on the use of primary and specialist health care in Norway. It is important to improve short-term recovery and reduce long-term consequences regarding pain and disability, the high costs of treatment and the amount of sick-leave. Treatment for non-specific shoulder pain is mainly non-operative. The aims of this study were to investigate if there are differences in main characteristics, pain and disability (SPADI-score) and psycho-social factors between patients in primary and specialist health care. Methods This cross-sectional study included patients consulting physiotherapy in primary health care and patients at an outpatient clinic in specialist health care. Well-known and tested questionnaires for these populations were used and variables were divided into clinical, sociodemographic, psycho-social, and shoulder pain and disability. Descriptive statistics were applied. Two-sample t-test and linear regre...
Background: Fatigue is a common symptom in patients with sarcoidosis. Despite lacking evidence on... more Background: Fatigue is a common symptom in patients with sarcoidosis. Despite lacking evidence on whether high-intensity interval training (HIIT) will aggravate fatigue, moderate-intensity exercise is often recommended. This study aimed to investigate whether a single session of HIIT would affect fatigue differently from a single session of moderate-intensity continuous training (MICT). Methods: Forty-one patients with pulmonary sarcoidosis were recruited to a cross-over study. All patients completed one treadmill session of HIIT (85% of peak heart rate (HRpeak)) and one of MICT (70% of HRpeak). Fatigue was assessed with the Visual Analogue Scale 0-100 mm, before (T0), after (T1), and 24 hours after (T2) each exercise session. Paired sample t-test was used to compare changes in fatigue from T0 to T1 and from T0 to T2 between HIIT and MICT. Results: No statistically significant difference in fatigue levels was found between HIIT and MICT, either at T1 (3.6 (13.5) and 1.4 (13.5)) or at T2 (8.2 (17.0) and 2.1 (17.1)). Conclusions: A single session of HIIT did not affect fatigue differently than a single session of MICT. These preliminary findings support the need for further research on the long-term effect of HIIT on fatigue in patients with sarcoidosis.
Background and aims: Matrix metalloproteinase 9 (MMP9) is an enzyme that may affect degradation o... more Background and aims: Matrix metalloproteinase 9 (MMP9) is an enzyme that may affect degradation of several extracellular matrix (ECM) components in the pelvic ligaments during pregnancy. Previous studies indicate that genetic variations in the gene encoding MMP9 may affect the enzymatic activity. One such genetic variant is a single nucleotide polymorphism (SNP), rs17576 A>G. In this study we investigated whether the MMP9 SNP rs17576 A>G may be associated with increased lumbopelvic pain in 838 pregnant woman. The study was registered with ClinicalTrials.gov (NCT 00476567) on May 21, 2007. Methods: Lumbopelvic pain-intensity was measured by visual analog scale (VAS) at two time points during pregnancy, T1 (18–22 weeks), T2 (32–36 weeks) and 3 months after delivery. Blood samples were collected at each point and SNP genotyping was carried out using predesigned TaqMan SNP genotyping assays. Results: The results showed a significant association between the number of G alleles and ...
OBJECTIVE: To investigate the associations between cardiorespiratory fitness (CRF) and level of c... more OBJECTIVE: To investigate the associations between cardiorespiratory fitness (CRF) and level of cardiovascular (CV) risk factors in patients with ankylosing spondylitis (AS) and controls. METHODS: In a cross sectional comparative study CRF was measured with a maximal treadmill test for estimation of peak oxygen uptake. Metabolic syndrome (MS), body composition, traditional CV risk factors and inflammatory markers were assessed. Multivariable linear regression models were used to study the associations between CRF and CV risk factors. All models were adjusted for age, gender and smoking, and adjusted for inflammation when C-reactive protein (CRP) or sedimentation rate (SR) were not already included as dependent variables. RESULTS: 126 patients (mean age 47.9 (SD 10.8)) and 111 controls (mean age 52.1 (SD 11.1)) were included. For patients and controls there were significant inverse associations between CRF and body mass index, waist circumference, triglycerides, CRP and SR (p=<0.0...
Background: Pelvic girdle pain is prevalent during pregnancy, and women affected report weight-be... more Background: Pelvic girdle pain is prevalent during pregnancy, and women affected report weight-bearing activities to be their main disability. The Stork test is a commonly used single-leg-stance test. As clinicians report specific movement patterns in those with pelvic girdle pain, we aimed to investigate the influence of both pregnancy and pelvic girdle pain on performance of the Stork test. Methods: In this cross-sectional study, 25 pregnant women with pelvic girdle pain, 23 asymptomatic pregnant and 24 asymptomatic non-pregnant women underwent three-dimensional kinematic analysis of the Stork test. Linear mixed models were used to investigate between-group differences in trunk, pelvic and hip kinematics during neutral stance, weight shift, leg lift and single leg stance. Findings: Few and small significant between-group differences were found. Pregnant women with pelvic girdle pain had significantly less hip adduction during single leg stance compared to asymptomatic pregnant women (estimated marginal means (95% confidence intervals)-1.1°(−2.4°, 0.3°) and 1.0°(−0.4°, 2.4°), respectively; P = 0.03). Asymptomatic pregnant women had significantly less hip internal rotation compared to non-pregnant women 4.1°(1.6°, 6.7°) and 7.9°(5.4°, 10.4°), respectively (P = 0.04) and greater peak hip flexion angle of the lifted leg in single leg stance 80.4°(77.0°, 83.9°) and 74.1°(70.8°, 77.5°), respectively (P = 0.01). Variation in key kinematic variables was large across participants in all three groups. Interpretation: Our findings indicate that trunk, pelvic and hip movements during the Stork test are not specific to pregnancy and/or pelvic girdle pain in the 2nd trimester. Instead, movement strategies appear unique to each individual.
Background: Walking difficulties are common among pregnant women with pelvic girdle pain. This cr... more Background: Walking difficulties are common among pregnant women with pelvic girdle pain. This cross-sectional study investigated the influence of pelvic girdle pain, pregnancy and speed on spatiotemporal and trunk, pelvic and hip kinematics during gait in the 2nd trimester of pregnancy. Methods: Three-dimensional gait analysis at self-selected speed was performed in 25 pregnant women with pelvic girdle pain, 24 asymptomatic pregnant and 24 nonpregnant women. Linear mixed models were used to investigate between-group differences in gait variables. Adjustment for gait speed was included in the analysis. Correlations between speed and fear of movement, disability and pain were examined using Spearman correlation coefficient (r s). Findings: Pregnant women with pelvic girdle pain walked 18% slower (estimated marginal means (95% confidence intervals) 1.18 (1.22, 1.24) meter/s) compared to asymptomatic pregnant women (1.44 (1.38, 1.50) meter/s) (P < 0.001). Moreover, with longer double limb support (5%, P = 0.04), shorter contralateral step length (3%, P = 0.03) and more restricted pelvic and hip kinematics (0.001 ≤ P ≤ 0.01) adjusted for speed. Only stance, double limb support and thoracic rotation (0.001 ≤ P ≤ 0.04) differed between asymptomatic pregnant and non-pregnant women. Speed was negatively correlated with fear of movement (r s = −0.63, P = 0.01) and disability (r s = −0.46, P = 0.03) in the pelvic girdle pain group. Interpretation: Gait is primarily influenced by pelvic girdle pain and less by pregnancy. Pregnant women with pelvic girdle pain walked slower and with a more rigid gait pattern compared to asymptomatic pregnant women, presumably related to altered load transfer. Our results may assist clinical evaluation of pelvic girdle pain, as well as direct future research.
Background: The Timed Up and Go (TUG) test, a standardized functional mobility test, has been pro... more Background: The Timed Up and Go (TUG) test, a standardized functional mobility test, has been proposed as a physical performance-based measure in pregnant women with pelvic girdle pain (PGP). Objectives: This cross-sectional study aimed to investigate physical function by the use of TUG in pregnant women with PGP compared to asymptomatic pregnant and non-pregnant women, and to identify factors associated with increased TUG. Methods: In total, 25 pregnant women with PGP, 24 asymptomatic pregnant and 25 asymptomatic non-pregnant women participated. One-way analysis of variance was used to explore difference in TUG between the groups and multiple linear regression analyses to explore associations between TUG and potential explanatory variables. Results: The time on TUG varied among pregnant women with PGP, and was significantly higher (mean (95% CI) 6.9 (6.5, 7.3) seconds) than for asymptomatic pregnant (5.8 (5.5, 6.0), p < 0.001) and non-pregnant (5.5 (5.4, 5.6), p < 0.001) women. In the total study sample, group, increased BMI and sick leave were significantly associated with increased TUG (p-values≤0.02). In pregnant women with PGP, pain intensity was the only significant clinical factor associated with increased TUG (p = 0.002). Conclusion: Pregnant women with PGP used longer time and showed larger variation in TUG than asymptomatic pregnant and non-pregnant women, this underpins that TUG targets activities relevant to PGP. Our results provide new knowledge about factors influencing TUG time. Importantly, multivariable analyses suggest that pain intensity should be considered when interpreting TUG time in pregnant women with PGP. 2001), has previously been recommended to evaluate function in PGP patients (Vleeming et al., 2008). Later, the self-reported Pelvic Girdle Questionnaire (PGQ) including activities, participation and bodily symptoms was developed (Stuge et al., 2011). However, both the ASLR and PGQ capture the patient's perception of their performance or condition. As self-reported functioning is not always indicative of the actual performance (Terwee et al., 2006b), performance-based measures assist in determining the extent of disability. Recently, Evensen and colleagues (2015, 2016) proposed the Timed Up and Go (TUG) test (Podsiadlo and Richardson, 1991) undertaken at maximum speed as a reliable and valid weight-bearing physical performance-based measure for pregnant women with PGP. The TUG is a standardized, timed, functional mobility test (Podsiadlo and
Acupuncture in medicine : journal of the British Medical Acupuncture Society, 2014
Pattern differentiation and diagnosis are fundamental principles of Traditional Chinese Medicine ... more Pattern differentiation and diagnosis are fundamental principles of Traditional Chinese Medicine (TCM). Studies have shown low inter-rater reliability in TCM pattern diagnoses. This variability may originate from both the identification and the interpretation of symptoms and signs. To examine the inter-rater reliability in TCM pattern diagnoses made in the style of Maciocia for 25 case histories by eight acupuncturists and to explore the impact of demographic factors on the diagnostic conclusion. Further, the association between the diagnosis and the presence of symptoms was examined for a single TCM diagnosis. Eight acupuncturists independently diagnosed 25 women (15 fertile, 10 infertile) based on written case histories. Descriptive statistics, logistic regression and inter-rater reliability (κ) were used. Poor inter-rater reliability on TCM patterns (κ<0.20) and large variation in the number of TCM pattern diagnoses were found. Sex, duration of practice and education had a hig...
Assessment of everyday functioning in children may depend to a considerable extent on the framewo... more Assessment of everyday functioning in children may depend to a considerable extent on the framework used to conceptualise functioning and disability. The Pediatric Evaluation of Disability Inventory (PEDI) has incorporated the mediating role of the environment on disability, using different measurement scales. The construction of the Functional Skills scales, which measure capability, and the Caregiver Assistance scales, which measure performance, was based on the Nagi disablement scheme. The International Classification of Functioning, Disability and Health (ICF) represents a new framework of functioning and disability that could be used to compare the measurement constructs and the content of different outcome measurements. To examine the conceptual basis and the content of the PEDI using the ICF. Phrases that describe the conceptual basis of the PEDI scales and of the ICF classifications were systematically collected and compared. Two researchers classified the item content of the Functional Skills scales independently before consensus was reached. The analyses indicate that the conceptual basis of the PEDI scales to a large extent match the ICF concepts of activity, participation and environmental factors. Both the PEDI and the ICF use the constructs of capacity and performance, but differ in how to operationalise these constructs. The classification of the Functional Skills scales shows that the PEDI primarily is a measure of activities and participation. The frequently use of environmental codes to classify the context of the requested functions demonstrates that the PEDI has incorporated the environment into the assessment. Our analyses indicate that the ICF could serve as a conceptual framework to clarify the measurement construct of the PEDI scales, and as taxonomy to describe and clarify the item content of the Functional Skills scales. Both as framework and taxonomy the ICF showed limitations in covering functioning in early childhood.
Purpose. The study describes use of assistive devices and other environmental modifications, and ... more Purpose. The study describes use of assistive devices and other environmental modifications, and their impact on everyday activities and care in young children with cerebral palsy (CP). Method. Ninety-five children (55 boys, 40 girls; mean age 58 months, SD 18 months) and their parents were studied using a cross-sectional design. The Pediatric Evaluation of Disability Inventory (PEDI) was applied to assess daily activities using the three measurement scales: functional skills, caregiver assistance, and modifications of the environment. Use of modifications was described related to the five severity levels of the Gross Motor Function Classifications System (GMFCS). Impact was rated on the Caregiver Assistance scale of the PEDI and on a five-point Likert scale. Results. Out of the 1075 provided environmental modifications, 980 were in regular use to support mobility, self-care and social function among 84 children. The number increased with GMFCS levels; children at levels IV and V used 80% of the modifications, with large variations between the children at same level. Adaptations of housing and transportation facilitated effective use of assistive devices. Half of the parents rated the modifications to have moderate to very large effect on the child's mobility, 25% on self-care skills, and 20% on social function. Furthermore, 65% reported that the modifications lightened the caregiving for mobility, 75% for self-care and 25% for social function. Functional independence and care demands often benefited from different types of modifications. Conclusion. The variations in use and benefits of environmental modifications indicate need of comprehensive assistive technology assessments, including child factors, family factors, technology factors and service system factors.
Everyday functioning is described in 95 children with cerebral palsy (CP; 55 males and 40 females... more Everyday functioning is described in 95 children with cerebral palsy (CP; 55 males and 40 females; mean age 58 months, SD 18 months, range 25 to 87 months) using the three scales of the Pediatric Evaluation of Disability Inventory (PEDI): Functional Skills, Caregiver Assistance, and Modifications of the Environment. Types of CP in the children were hemiplegia, (n=19), spastic/ataxic diplegia, (n=44), spastic quadriplegia, (n=16), dyskinetic, (n=9), and mixed (n=7). Symptoms were grouped by severity according to the Gross Motor Function Classification System (GMFCS): 23% were classified at level I, 21% at level II, 10% at level III, 23% at level IV, and 23% level V. A large variability in functioning in mobility, self-care, and social function was seen because of the heterogeneity of children with CP. Limitations in achievement of activities, need for assistance, and use of assistive devices increased progressively with GMFCS level. Furthermore, these children differed to a great extent from the normative sample of the PEDI. Stepwise regression analysis showed that the GMFCS was a good predictor of everyday functioning with age and learning problems as significantly contributing factors, particularly in self-care and social function. In conclusion, the three scales of the PEDI represent different but strongly related aspects of everyday functioning in young children with CP.
Archives of Pediatrics & Adolescent Medicine, 2007
Participants: One hundred twenty children aged 7 to 12 years with complex CHD and 387 healthy sch... more Participants: One hundred twenty children aged 7 to 12 years with complex CHD and 387 healthy schoolchildren in the same age range (control group). Interventions: All children with CHD were surgically treated with multiple corrections within the first year of life. Main Outcome Measures: Movement Assessment Battery for Children, grip strength, quadriceps muscle strength, and balance. Results: Compared with the control group, children with CHD had a risk of having any degree of impaired motor competence of 5.8 (95% confidence interval, 3.8-8.8). The risk for having severe motor problems was 11.0 (95% confidence interval, 5.4-22.5). There were highly significant differences between the groups for manual dexterity, ball skills, grip strength, quadriceps muscle strength, and static and dynamic balance (P Ͻ.001). Conclusions: Children with CHD have a risk of severe motor problems 11-fold that of schoolchildren without any known heart failure. This suggests that primary health care providers should screen the motor competence in children with CHD at an early age to initiate therapeutic actions for children who show incipient motor problems. Optimal rehabilitative, social, and environmental support may improve the children's motor competence and prevent future health problems.
Background Acupuncture is rooted in traditional Chinese medicine (TCM) and emphasises individuali... more Background Acupuncture is rooted in traditional Chinese medicine (TCM) and emphasises individualised treatment according to TCM patterns. Eight TCM patterns are regarded as typical for female infertility. There are no empirical data comparing these patterns in fertile and infertile women. Objective To identify and compare the TCM patterns and recommended acupuncture points in infertile and fertile women. The hypothesis that infertile and fertile women should differ in occurrence of TCM patterns described as typical for infertility was examined. Methods A cross-sectional study examined the distribution of TCM patterns and acupuncture points among 24 infertile and 24 fertile women. TCM patterns and points proposed by two acupuncturists were analysed. The odds ratio was used as the effect measure. Results Three patterns were found in more than 92% of the women. Five patterns occurred more frequently among infertile (p≤0.03), and four among fertile (p≤0.02) women. Only three of the eigh...
To provide normative age- and gender-associated values on muscular strength, power and endurance ... more To provide normative age- and gender-associated values on muscular strength, power and endurance and to establish a reference database on healthy school children aged 7 to 12 years. In addition, associations between some simple functional tests and the more sophisticated isokinetic strength measures were investigated. Three hundred seventy-six children, 191 girls and 185 boys, performed different muscle-strength tests like knee flexion/extension, handgrip, back extension and vertical jump. There was a significant and linear increase in strength with no gender differences from 7 up to 11 years of age. There was a large variability within each age group, indicating that a normative sample of muscle-strength measurements includes a wide range of values for each age group. The relationship between hand- grip strength and observed quadriceps strength was high (r = 0.84) and the correlation between vertical jump and relative quadriceps strength was moderate (r = 0.50). All the different strength measures showed almost the same pattern, indicating increased absolute strength values with increasing age and no significant gender differences except for flexion at the age of 11 and 12 years . The association between grip strength, vertical jump and quadriceps strength measured isokinetically was moderate to strong. The back muscle endurance test (The Biering-Sørensen test) showed a great roof effect and should not be included in a test battery for school children.
We determined the repeatability and correlations between force, endurance and muscle activity dur... more We determined the repeatability and correlations between force, endurance and muscle activity during isometric contractions over three years. Twenty-six subjects, with and without complaints of the shoulder and neck, performed standardized maximal and submaximal shoulder-abduction contractions and wrist extension-contractions at yearly intervals from 1997 to 1999. Peak forces developed during maximal contraction and the endurance times of submaximal contractions during shoulder abduction and wrist extension were measured. Electromyography (EMG) of muscle activity was recorded bilaterally from the upper trapezius, middle deltoid, and forearm extensor muscles. Root mean square EMG amplitudes were calculated. We found statistically significant associations between peak forces developed during wrist extension and shoulder abduction, and between endurance times of submaximal wrist extension and shoulder abduction. No statistically significant changes in peak force and EMG peak were found over the measurement years. The responses were not statistically significantly influenced by gender, or neck and shoulder pain. However, we observed considerable intra-individual variation in the inter-year measurements particularly for the responses to submaximal contraction. Such large variations represent a challenge when attempting to use the responses to interpret the effects of therapies.
in 2013. Julsvoll received the Norwegian Musculosceletal Research Award 2014 for her research on ... more in 2013. Julsvoll received the Norwegian Musculosceletal Research Award 2014 for her research on temporomandibular disorders and have presented her research results both at international and national congresses. Julsvoll works at Hans & Olaf Physical therapy clinic, Oslo. She collaborates with other physical therapists and with dentists, oral surgeons and maxillo-facial radiologists. She is also responsible for specialization courses for physiotherapists, manual therapists and chiropractors in Norway and has given support to the Norwegian guidelines for patients with TMD, published by the Norwegian Directorate for Health.
Background: Fatigue is a common symptom in patients with sarcoidosis. Despite lacking evidence on... more Background: Fatigue is a common symptom in patients with sarcoidosis. Despite lacking evidence on whether high-intensity interval training (HIIT) will aggravate fatigue, moderate-intensity exercise is often recommended. This study aimed to investigate whether a single session of HIIT would affect fatigue differently from a single session of moderate-intensity continuous training (MICT). Methods: Forty-one patients with pulmonary sarcoidosis were recruited to a cross-over study. All patients completed one treadmill session of HIIT (85% of peak heart rate (HRpeak)) and one of MICT (70% of HRpeak). Fatigue was assessed with the Visual Analogue Scale 0–100 mm, before (T0), after (T1), and 24 hours after (T2) each exercise session. Paired sample t-test was used to compare changes in fatigue from T0 to T1 and from T0 to T2 between HIIT and MICT. Results: No statistically significant difference in fatigue levels was found between HIIT and MICT, either at T1 (3.6 (13.5) and 1.4 (13.5)) or a...
Objectives Shoulder pain is a prevalent problem and has a considerable impact on the use of prima... more Objectives Shoulder pain is a prevalent problem and has a considerable impact on the use of primary and specialist health care in Norway. It is important to improve short-term recovery and reduce long-term consequences regarding pain and disability, the high costs of treatment and the amount of sick-leave. Treatment for non-specific shoulder pain is mainly non-operative. The aims of this study were to investigate if there are differences in main characteristics, pain and disability (SPADI-score) and psycho-social factors between patients in primary and specialist health care. Methods This cross-sectional study included patients consulting physiotherapy in primary health care and patients at an outpatient clinic in specialist health care. Well-known and tested questionnaires for these populations were used and variables were divided into clinical, sociodemographic, psycho-social, and shoulder pain and disability. Descriptive statistics were applied. Two-sample t-test and linear regre...
Background: Fatigue is a common symptom in patients with sarcoidosis. Despite lacking evidence on... more Background: Fatigue is a common symptom in patients with sarcoidosis. Despite lacking evidence on whether high-intensity interval training (HIIT) will aggravate fatigue, moderate-intensity exercise is often recommended. This study aimed to investigate whether a single session of HIIT would affect fatigue differently from a single session of moderate-intensity continuous training (MICT). Methods: Forty-one patients with pulmonary sarcoidosis were recruited to a cross-over study. All patients completed one treadmill session of HIIT (85% of peak heart rate (HRpeak)) and one of MICT (70% of HRpeak). Fatigue was assessed with the Visual Analogue Scale 0-100 mm, before (T0), after (T1), and 24 hours after (T2) each exercise session. Paired sample t-test was used to compare changes in fatigue from T0 to T1 and from T0 to T2 between HIIT and MICT. Results: No statistically significant difference in fatigue levels was found between HIIT and MICT, either at T1 (3.6 (13.5) and 1.4 (13.5)) or at T2 (8.2 (17.0) and 2.1 (17.1)). Conclusions: A single session of HIIT did not affect fatigue differently than a single session of MICT. These preliminary findings support the need for further research on the long-term effect of HIIT on fatigue in patients with sarcoidosis.
Background and aims: Matrix metalloproteinase 9 (MMP9) is an enzyme that may affect degradation o... more Background and aims: Matrix metalloproteinase 9 (MMP9) is an enzyme that may affect degradation of several extracellular matrix (ECM) components in the pelvic ligaments during pregnancy. Previous studies indicate that genetic variations in the gene encoding MMP9 may affect the enzymatic activity. One such genetic variant is a single nucleotide polymorphism (SNP), rs17576 A>G. In this study we investigated whether the MMP9 SNP rs17576 A>G may be associated with increased lumbopelvic pain in 838 pregnant woman. The study was registered with ClinicalTrials.gov (NCT 00476567) on May 21, 2007. Methods: Lumbopelvic pain-intensity was measured by visual analog scale (VAS) at two time points during pregnancy, T1 (18–22 weeks), T2 (32–36 weeks) and 3 months after delivery. Blood samples were collected at each point and SNP genotyping was carried out using predesigned TaqMan SNP genotyping assays. Results: The results showed a significant association between the number of G alleles and ...
OBJECTIVE: To investigate the associations between cardiorespiratory fitness (CRF) and level of c... more OBJECTIVE: To investigate the associations between cardiorespiratory fitness (CRF) and level of cardiovascular (CV) risk factors in patients with ankylosing spondylitis (AS) and controls. METHODS: In a cross sectional comparative study CRF was measured with a maximal treadmill test for estimation of peak oxygen uptake. Metabolic syndrome (MS), body composition, traditional CV risk factors and inflammatory markers were assessed. Multivariable linear regression models were used to study the associations between CRF and CV risk factors. All models were adjusted for age, gender and smoking, and adjusted for inflammation when C-reactive protein (CRP) or sedimentation rate (SR) were not already included as dependent variables. RESULTS: 126 patients (mean age 47.9 (SD 10.8)) and 111 controls (mean age 52.1 (SD 11.1)) were included. For patients and controls there were significant inverse associations between CRF and body mass index, waist circumference, triglycerides, CRP and SR (p=<0.0...
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