Ralph Nisell - Academia.edu (original) (raw)
Papers by Ralph Nisell
Journal of Rehabilitation Medicine
The purpose of the present study was to assess five manual tests for pain provocation of the neck... more The purpose of the present study was to assess five manual tests for pain provocation of the neck to determine their suitability for epidemiological investigations. To 75 randomly selected men, five manual pain-provoking tests were applied in a single-blind design. Prevalence of reported neck dysfunction, sensitivity, specificity, and positive and negative predicted value for each test were calculated. 22 of the 75 reported present neck pain, while the remainder reported freedom from neck pain for at least one year. Palpation over the facet joints in the cervical spine was found to be the most appropriate screening test to corroborate the replies in self-reported questionnaires on dysfunctions of the neck. The outcome of this test was quite consistent with the reported neck pain. The test of the formina intervertebralia and the upper limb tension test caused pain in almost all subjects with reported neck dysfunctions, though not causing referred pain in the arm as an indication of n...
Journal of Rehabilitation Medicine
The aim of the study was to develop a pain measurement instrument in Swedish intended for use in ... more The aim of the study was to develop a pain measurement instrument in Swedish intended for use in epidemiological surveys, and to report the pain assessments of individuals in a working population. The focus was on somato-sensory description in relation to work performance. The material comprised 22 randomly selected electricians attending health checkups, and reporting neck pain during the past week. The pain estimations were made in oral interviews using a specially developed questionnaire. Neck extension and hands above shoulder height caused increased neck pain in all the subjects. The quantitative assessments of present pain showed a limited intensity. To describe the pain quality a wide spectrum of words was used as pain descriptors, but five adjectives were preferred. The more the pain was spread on the pain drawing, the more differentiated was the assessment of its quality. The results concluded that the pain assessment instrument might be useful in epidemiological investigat...
Rheumatology, 2018
ObjectivesCurrent guidelines rank abatacept, rituximab, tocilizumab and TNF-inhibitors (TNFi) as ... more ObjectivesCurrent guidelines rank abatacept, rituximab, tocilizumab and TNF-inhibitors (TNFi) as having equal effectiveness for the treatment of RA, at least as second line therapies. These recommendations are mainly based on meta-analysis of randomized controlled trials, with few direct drug–drug comparisons. Our objective was to compare the real-world absolute and relative effectiveness among RA patients starting any of the available biologic DMARDs (bDMARDs).MethodsWe used the Swedish Rheumatology Register to identify patients with RA initiating TNFi, rituximab, abatacept or tocilizumab in 2010–2016 as first bDMARD (n = 9333), or after switch from TNFi as first bDMARD (n = 3941). National Swedish registers provided additional covariates and censoring events. Effectiveness was assessed 3 and 12 months after treatment start, as the proportion remaining on therapy and with EULAR Good Response, HAQ improvement >0.2, zero swollen/tender joints and CDAI remission. Adjusted differenc...
Archives of physical …, 2000
... The attempt was to have the 2 types of training equally aggressive and fatiguing. Statistics.... more ... The attempt was to have the 2 types of training equally aggressive and fatiguing. Statistics. ... 1. Weekly pain ratings: mean change (mm on VAS) for the different types of training: ○, endurance; ●, strength. The patient rated the worst pain experienced during the previous week. ...
Läkartidningen, Jan 6, 1992
Clinical Biomechanics, 1986
Clinical Biomechanics, 1988
Two healthy subjects were filmed on TV-video when performing 14 different steps and jumps from tw... more Two healthy subjects were filmed on TV-video when performing 14 different steps and jumps from two different heights (0.20 m and 0.43 m) onto two Kistler force platforms that recorded the reaction forces. The ankle and knee load moments and joint forces were calculated using a sag&al plane semi-dynamic biomechanical model. Steps with the ball of the foot from the lower height induced a vertical ground reaction force (Fz) close to 1 body weight (bw) and around 2 bw from the greater height. From the greater height the knee moments for the majority of the step-downs studied were about 100 Nm, which gave knee joint compressive forces of 4-7 bw. The ankle was exposed to loads of similar magnitude but not so much influenced by step height. The reasons why patients with knee pain prefer performing backward step-downs are discussed. Relevance This study presents a method that quantifies knee and ankle joint forces that arise during steps and jumps down. Such data are useful in rehabilitation work for assessing harmful effects of muscle and joint load at various ways of performing 'step-downs' and enable comparison of the joint load with other activities.
Archives of Physical Medicine and Rehabilitation, 2000
Objectives: To study whether isometric shoulder endurance was more advantageous than isometric sh... more Objectives: To study whether isometric shoulder endurance was more advantageous than isometric shoulder strength training in reducing pain and perceived exertion and to increase shoulder function through improved muscle endurance and strength. Design: Randomized trial. Setting: Three occupational health care centers. Participants: Women industrial workers with nonspecific neck-shoulder pain. The International Classification of Diseases, 10th Revision (ICD-10) diagnosis was ''cervicobrachial syndrome'' (M53.1). Thirty-eight patients completed the isometric shoulder endurance training and 31 patients completed the isometric shoulder strength training. Intervention: Twelve weeks of training. Main Outcome Measures: Self-reported pain and rating of perceived exertion (RPE), arm motion performance test, shoulder muscle strength, shoulder muscle endurance, and shoulder functional tests, as well as follow-up after supervised training had ended. Results: The isometric shoulder strength training resulted in an almost one-scale step decrease in RPE at work and a 5% to 15% improvement of arm motion performance compared with the endurance training. The isometric shoulder strength training more effectively improved left side shoulder abduction strength (p Ͻ .026), but no major differences were found for the other strength measurements. The isometric shoulder endurance training was not more successful than the strength training in the endurance test (p .51 to .81). Conclusions: Physical training programs for neck-shoulder pain may include isometric shoulder muscular strength exercise in addition to isometric shoulder endurance training, rather than endurance training only.
The ankle joint moment, joint compressive force, and Achilles tendon force obtained during ergome... more The ankle joint moment, joint compressive force, and Achilles tendon force obtained during ergometer cycling were calculated by using a quartz force-measuring transducer mounted on the pedal. Six healthy subjects rode in 11 different ways at different workloads, pedalling rates, saddle heights, and pedal foot positions. The mean maximum dorsiflexing load moment about the ankle joint during standardized ergometer cycling was calculated to 30.9 nm. The mean ankle joint compressive force and mean Achilles tendon force measured 1008 N (1.4 times body weight) and 762 N (1.1 times body weight), respectively. The ankle joint moment was significantly changed by a change of workload or pedal foot position.
We estimated the patellofemoral joint forces generated during pedaling on a bicycle ergometer. Ou... more We estimated the patellofemoral joint forces generated during pedaling on a bicycle ergometer. Our calculations were based on measurements from a force transducer mounted on the pedal, 16-mm cine-film sequences, and biomechanical models of the cycling motion and of the patellofemoral joint. Six healthy male subjects cycled at different work loads, pedaling rates, saddle heights, and pedal foot positions. The maximum patellofemoral compressive force was 905 N (1.3 times body weight [BW]) when cycling with an anterior foot position at 120 W, 60 rpm, and middle saddle height. The mean peak compressive force between the quadriceps tendon and the intercondylar groove was 295 N (0.4 BW), and the patellar-tendon and quadriceps-tendon strain forces were 661 N (0.9 BW) and 938 N (1.3 BW), respectively. The patellofemoral joint forces were increased with increased work load or decreased saddle height. Different pedaling rates or foot positions did not significantly change these forces.
Acta Orthopaedica, 1985
The load moment of force about the knee joint during machine milking and when lifting a 12.8 kg b... more The load moment of force about the knee joint during machine milking and when lifting a 12.8 kg box was quantified using a computerized static sagittal plane body model. Surface electromyography of quadriceps and hamstrings muscles was normalized and expressed as a percentage of an isometric maximum voluntary test contraction. Working with straight knees and the trunk flexed forwards induced extending knee load moments of maximum 55 Nm. Lifting the box with flexed knees gave flexing moments of 50 Nm at the beginning of the lift, irrespective of whether the burden was between or in front of the feet. During machine milking, a level difference between operator and cow of 0.70 m-1.0 m significantly lowered the knee extending moments. To quantify the force magnitudes acting in the tibio-femoral and patello-femoral joints, a local biomechanical model of the knee was developed using a combination of cadaver knee dissections and lateral knee radiographs of healthy subjects. The moment arm of the knee extensor was significantly shorter for women than for men, which resulted in higher knee joint forces in women if the same moment was produced. A diagram for quantifying patellar forces was worked out. The force magnitudes given by the knee joint biomechanical model correlated well with experimentally forces measured by others. During the parallel squat in powerlifting, the maximum flexing knee load moment was estimated to 335-550 Nm when carrying a 382.5 kg burden and the in vivo force of a complete quadriceps tendon-muscle rupture to between 10,900 and 18,300 N. During isokinetic knee extension, the tibio-femoral compressive force reached peak magnitudes of 9 times body weight and the anteroposterior shear force was close to 1 body weight at knee angles straighter than 60 degrees, indicating that high forces stress the anterior cruciate ligament. A proximal resistance pad position decreased the shear force considerably, and this position is recommended in early rehabilitation after anterior cruciate ligament repairs or reconstructions. The methods presented quantify muscle activity, sagittal ynee joint moments and forces, enabling assessments to be made of different work postures, training exercises and joint derangements. This thesis is based on the following papers which will be referred to in the text by their Roman numerals I-VI. I.
Scandinavian Journal of Rehabilitation Medicine
The aim of the study was to calculate the magnitudes of moments of force acting about the bilater... more The aim of the study was to calculate the magnitudes of moments of force acting about the bilateral hip and knee joint axes during ergometer cycling. Six healthy subjects pedalled a weight-braked bicycle ergometer at different workloads, pedalling rates, saddle heights and pedal foot position. During cycling at 120 Watts, 60 revolutions per minute with mid-saddle height and anterior pedal foot position, the mean peak flexing and extending hip load moments were 34.3 and 8.9 Nm, respectively. Mean peak flexing knee load moments was 28.8 Nm and extending moment was 11.9 Nm. Hip load moments were significantly increased by increasing the ergometer workload or pedalling rate. For knee load moments, workload was the most important factor. The flexing knee load moment did not change with changes in pedalling rate. Different saddle heights or pedal food positions had a slight but not always statistically significant influence on the hip and knee joint loads. The maximum hip and knee joint load moments induced during cycling were small compared with those obtained during other exercises or normal activities such as level walking, stair climbing, and lifting.
Journal of Rehabilitation Medicine
The purpose of the present study was to assess five manual tests for pain provocation of the neck... more The purpose of the present study was to assess five manual tests for pain provocation of the neck to determine their suitability for epidemiological investigations. To 75 randomly selected men, five manual pain-provoking tests were applied in a single-blind design. Prevalence of reported neck dysfunction, sensitivity, specificity, and positive and negative predicted value for each test were calculated. 22 of the 75 reported present neck pain, while the remainder reported freedom from neck pain for at least one year. Palpation over the facet joints in the cervical spine was found to be the most appropriate screening test to corroborate the replies in self-reported questionnaires on dysfunctions of the neck. The outcome of this test was quite consistent with the reported neck pain. The test of the formina intervertebralia and the upper limb tension test caused pain in almost all subjects with reported neck dysfunctions, though not causing referred pain in the arm as an indication of n...
Journal of Rehabilitation Medicine
The aim of the study was to develop a pain measurement instrument in Swedish intended for use in ... more The aim of the study was to develop a pain measurement instrument in Swedish intended for use in epidemiological surveys, and to report the pain assessments of individuals in a working population. The focus was on somato-sensory description in relation to work performance. The material comprised 22 randomly selected electricians attending health checkups, and reporting neck pain during the past week. The pain estimations were made in oral interviews using a specially developed questionnaire. Neck extension and hands above shoulder height caused increased neck pain in all the subjects. The quantitative assessments of present pain showed a limited intensity. To describe the pain quality a wide spectrum of words was used as pain descriptors, but five adjectives were preferred. The more the pain was spread on the pain drawing, the more differentiated was the assessment of its quality. The results concluded that the pain assessment instrument might be useful in epidemiological investigat...
Rheumatology, 2018
ObjectivesCurrent guidelines rank abatacept, rituximab, tocilizumab and TNF-inhibitors (TNFi) as ... more ObjectivesCurrent guidelines rank abatacept, rituximab, tocilizumab and TNF-inhibitors (TNFi) as having equal effectiveness for the treatment of RA, at least as second line therapies. These recommendations are mainly based on meta-analysis of randomized controlled trials, with few direct drug–drug comparisons. Our objective was to compare the real-world absolute and relative effectiveness among RA patients starting any of the available biologic DMARDs (bDMARDs).MethodsWe used the Swedish Rheumatology Register to identify patients with RA initiating TNFi, rituximab, abatacept or tocilizumab in 2010–2016 as first bDMARD (n = 9333), or after switch from TNFi as first bDMARD (n = 3941). National Swedish registers provided additional covariates and censoring events. Effectiveness was assessed 3 and 12 months after treatment start, as the proportion remaining on therapy and with EULAR Good Response, HAQ improvement >0.2, zero swollen/tender joints and CDAI remission. Adjusted differenc...
Archives of physical …, 2000
... The attempt was to have the 2 types of training equally aggressive and fatiguing. Statistics.... more ... The attempt was to have the 2 types of training equally aggressive and fatiguing. Statistics. ... 1. Weekly pain ratings: mean change (mm on VAS) for the different types of training: ○, endurance; ●, strength. The patient rated the worst pain experienced during the previous week. ...
Läkartidningen, Jan 6, 1992
Clinical Biomechanics, 1986
Clinical Biomechanics, 1988
Two healthy subjects were filmed on TV-video when performing 14 different steps and jumps from tw... more Two healthy subjects were filmed on TV-video when performing 14 different steps and jumps from two different heights (0.20 m and 0.43 m) onto two Kistler force platforms that recorded the reaction forces. The ankle and knee load moments and joint forces were calculated using a sag&al plane semi-dynamic biomechanical model. Steps with the ball of the foot from the lower height induced a vertical ground reaction force (Fz) close to 1 body weight (bw) and around 2 bw from the greater height. From the greater height the knee moments for the majority of the step-downs studied were about 100 Nm, which gave knee joint compressive forces of 4-7 bw. The ankle was exposed to loads of similar magnitude but not so much influenced by step height. The reasons why patients with knee pain prefer performing backward step-downs are discussed. Relevance This study presents a method that quantifies knee and ankle joint forces that arise during steps and jumps down. Such data are useful in rehabilitation work for assessing harmful effects of muscle and joint load at various ways of performing 'step-downs' and enable comparison of the joint load with other activities.
Archives of Physical Medicine and Rehabilitation, 2000
Objectives: To study whether isometric shoulder endurance was more advantageous than isometric sh... more Objectives: To study whether isometric shoulder endurance was more advantageous than isometric shoulder strength training in reducing pain and perceived exertion and to increase shoulder function through improved muscle endurance and strength. Design: Randomized trial. Setting: Three occupational health care centers. Participants: Women industrial workers with nonspecific neck-shoulder pain. The International Classification of Diseases, 10th Revision (ICD-10) diagnosis was ''cervicobrachial syndrome'' (M53.1). Thirty-eight patients completed the isometric shoulder endurance training and 31 patients completed the isometric shoulder strength training. Intervention: Twelve weeks of training. Main Outcome Measures: Self-reported pain and rating of perceived exertion (RPE), arm motion performance test, shoulder muscle strength, shoulder muscle endurance, and shoulder functional tests, as well as follow-up after supervised training had ended. Results: The isometric shoulder strength training resulted in an almost one-scale step decrease in RPE at work and a 5% to 15% improvement of arm motion performance compared with the endurance training. The isometric shoulder strength training more effectively improved left side shoulder abduction strength (p Ͻ .026), but no major differences were found for the other strength measurements. The isometric shoulder endurance training was not more successful than the strength training in the endurance test (p .51 to .81). Conclusions: Physical training programs for neck-shoulder pain may include isometric shoulder muscular strength exercise in addition to isometric shoulder endurance training, rather than endurance training only.
The ankle joint moment, joint compressive force, and Achilles tendon force obtained during ergome... more The ankle joint moment, joint compressive force, and Achilles tendon force obtained during ergometer cycling were calculated by using a quartz force-measuring transducer mounted on the pedal. Six healthy subjects rode in 11 different ways at different workloads, pedalling rates, saddle heights, and pedal foot positions. The mean maximum dorsiflexing load moment about the ankle joint during standardized ergometer cycling was calculated to 30.9 nm. The mean ankle joint compressive force and mean Achilles tendon force measured 1008 N (1.4 times body weight) and 762 N (1.1 times body weight), respectively. The ankle joint moment was significantly changed by a change of workload or pedal foot position.
We estimated the patellofemoral joint forces generated during pedaling on a bicycle ergometer. Ou... more We estimated the patellofemoral joint forces generated during pedaling on a bicycle ergometer. Our calculations were based on measurements from a force transducer mounted on the pedal, 16-mm cine-film sequences, and biomechanical models of the cycling motion and of the patellofemoral joint. Six healthy male subjects cycled at different work loads, pedaling rates, saddle heights, and pedal foot positions. The maximum patellofemoral compressive force was 905 N (1.3 times body weight [BW]) when cycling with an anterior foot position at 120 W, 60 rpm, and middle saddle height. The mean peak compressive force between the quadriceps tendon and the intercondylar groove was 295 N (0.4 BW), and the patellar-tendon and quadriceps-tendon strain forces were 661 N (0.9 BW) and 938 N (1.3 BW), respectively. The patellofemoral joint forces were increased with increased work load or decreased saddle height. Different pedaling rates or foot positions did not significantly change these forces.
Acta Orthopaedica, 1985
The load moment of force about the knee joint during machine milking and when lifting a 12.8 kg b... more The load moment of force about the knee joint during machine milking and when lifting a 12.8 kg box was quantified using a computerized static sagittal plane body model. Surface electromyography of quadriceps and hamstrings muscles was normalized and expressed as a percentage of an isometric maximum voluntary test contraction. Working with straight knees and the trunk flexed forwards induced extending knee load moments of maximum 55 Nm. Lifting the box with flexed knees gave flexing moments of 50 Nm at the beginning of the lift, irrespective of whether the burden was between or in front of the feet. During machine milking, a level difference between operator and cow of 0.70 m-1.0 m significantly lowered the knee extending moments. To quantify the force magnitudes acting in the tibio-femoral and patello-femoral joints, a local biomechanical model of the knee was developed using a combination of cadaver knee dissections and lateral knee radiographs of healthy subjects. The moment arm of the knee extensor was significantly shorter for women than for men, which resulted in higher knee joint forces in women if the same moment was produced. A diagram for quantifying patellar forces was worked out. The force magnitudes given by the knee joint biomechanical model correlated well with experimentally forces measured by others. During the parallel squat in powerlifting, the maximum flexing knee load moment was estimated to 335-550 Nm when carrying a 382.5 kg burden and the in vivo force of a complete quadriceps tendon-muscle rupture to between 10,900 and 18,300 N. During isokinetic knee extension, the tibio-femoral compressive force reached peak magnitudes of 9 times body weight and the anteroposterior shear force was close to 1 body weight at knee angles straighter than 60 degrees, indicating that high forces stress the anterior cruciate ligament. A proximal resistance pad position decreased the shear force considerably, and this position is recommended in early rehabilitation after anterior cruciate ligament repairs or reconstructions. The methods presented quantify muscle activity, sagittal ynee joint moments and forces, enabling assessments to be made of different work postures, training exercises and joint derangements. This thesis is based on the following papers which will be referred to in the text by their Roman numerals I-VI. I.
Scandinavian Journal of Rehabilitation Medicine
The aim of the study was to calculate the magnitudes of moments of force acting about the bilater... more The aim of the study was to calculate the magnitudes of moments of force acting about the bilateral hip and knee joint axes during ergometer cycling. Six healthy subjects pedalled a weight-braked bicycle ergometer at different workloads, pedalling rates, saddle heights and pedal foot position. During cycling at 120 Watts, 60 revolutions per minute with mid-saddle height and anterior pedal foot position, the mean peak flexing and extending hip load moments were 34.3 and 8.9 Nm, respectively. Mean peak flexing knee load moments was 28.8 Nm and extending moment was 11.9 Nm. Hip load moments were significantly increased by increasing the ergometer workload or pedalling rate. For knee load moments, workload was the most important factor. The flexing knee load moment did not change with changes in pedalling rate. Different saddle heights or pedal food positions had a slight but not always statistically significant influence on the hip and knee joint loads. The maximum hip and knee joint load moments induced during cycling were small compared with those obtained during other exercises or normal activities such as level walking, stair climbing, and lifting.