Tony Bohman - Academia.edu (original) (raw)

Papers by Tony Bohman

Research paper thumbnail of Description and comparison of postoperative functioning of patients with hip fracture 2018 and 2008 at the Örebro University Hospital - a comparative cross-sectional study

BMC Geriatrics

Background Hip fractures are a global problem, and it will probably increase. Hip fractures impai... more Background Hip fractures are a global problem, and it will probably increase. Hip fractures impair health aspects which creates demands on postoperative care. This study describes and compares patients with hip fracture in 2008 and in 2018. An increased knowledge of this group could be a basis how to optimize aftercare and dimension rehabilitation. Methods Using a comparative cross-sectional study to describe and compare patients with hip fracture from 2018 and 2008 at Örebro University Hospital regarding age, sex, multimorbidity, fracture type, surgical materials, surgery within 24 hours, length of stay, postoperative walking ability, physical activity level and hand grip strength. Data was collected from 76 patients with hip fracture from 2018 and 78 patients from 2008. Outcome measures considering functioning were walking ability (Functional Ambulation Categories), physical activity level (Classification system of physical activity) and hand grip strength (Jamar hand dynamometer)...

Research paper thumbnail of Influence of work ability and smoking on the prognosis of long-duration activity-limiting neck/back pain: a cohort study of a Swedish working population

BMJ Open

ObjectivesLong-duration activity-limiting neck/back pain is common, but the knowledge of what wor... more ObjectivesLong-duration activity-limiting neck/back pain is common, but the knowledge of what work and lifestyle factors that influence the prognosis is sparse. The objective was therefore to evaluate if two factors, good self-perceived work ability and no daily smoking, are associated with a favourable prognosis of long-duration activity-limiting neck/back pain in a working population, and if these exposures have a synergistic prognostic effect.DesignA prospective cohort study based on three subsamples from the Stockholm Public Health Cohort.SettingsA working population in Stockholm County, Sweden.ParticipantsIndividuals, 18–61 years old, reporting long-duration activity-limiting neck/back pain the previous 6 months at baseline in 2010 (n=5177).MeasuresThe exposures were: self-perceived work ability (categorised into good, moderate and poor) and daily smoking (no/yes). The outcome in 2014 was ‘absence of long-duration activity-limiting neck/back pain’ the previous 6 months represen...

Research paper thumbnail of Do physical activity level and body mass index predict recovery from persistent neck pain in men and women of working age? A population-based cohort study

European Spine Journal, 2013

Purpose The study sought to examine the gender-specific effects of physical activity level and bo... more Purpose The study sought to examine the gender-specific effects of physical activity level and body mass index on recovery from persistent neck pain (PNP) among citizens of working age in Stockholm, Sweden. Methods A population-based cohort of 1,730 subjects (18-65) with PNP answered surveys in 2002 and 2007. Prognostic factors were self-reported body mass index (BMI) and physical activity level (PAL) at baseline. Analyses were performed with odds ratios (OR) with corresponding 95 % confidence intervals (95 % CI). Results Women reporting higher physical activity level had higher odds of recovering from PNP than women with sedentary leisure time (OR of 1.5, 95 % CI 1.0-2.4), but no associations were found in men. No associations were found between BMI and recovery from PNP in any analyses. Conclusion Physical activity seems to be associated with recovery from PNP in women and should therefore be encouraged. Future studies should continue investigating physical activity and lifestyle factors in relation to recovery from persistent neck pain, since these modifiable factors may be considered in interventions.

Research paper thumbnail of The long-term effects of naprapathic manual therapy on back and neck pain - Results from a pragmatic randomized controlled trial

BMC Musculoskeletal Disorders, 2010

Background: Back and neck pain are very common, disabling and recurrent disorders in the general ... more Background: Back and neck pain are very common, disabling and recurrent disorders in the general population and the knowledge of long-term effect of treatments are sparse. The aim of this study was to compare the longterm effects (up to one year) of naprapathic manual therapy and evidence-based advice on staying active regarding non-specific back and/or neck pain. Naprapathy, a health profession mainly practiced in Sweden, Finland, Norway and in the USA, is characterized by a combination of manual musculoskeletal manipulations, aiming to decrease pain and disability in the neuromusculoskeletal system. Methods: Subjects with non-specific pain/disability in the back and/or neck lasting for at least two weeks (n = 409), recruited at public companies in Sweden, were included in this pragmatic randomized controlled trial. The two interventions compared were naprapathic manual therapy such as spinal manipulation/mobilization, massage and stretching, (Index Group), and advice to stay active and on how to cope with pain, provided by a physician (Control Group). Pain intensity, disability and health status were measured by questionnaires. Results: 89% completed the 26-week follow-up and 85% the 52-week follow-up. A higher proportion in the Index Group had a clinically important decrease in pain (risk difference (RD) = 21%, 95% CI: 10-30) and disability (RD = 11%, 95% CI: 4-22) at 26-week, as well as at 52-week follow-ups (pain: RD = 17%, 95% CI: 7-27 and disability: RD = 17%, 95% CI: 5-28). The differences between the groups in pain and disability considered over one year were statistically significant favoring naprapathy (p ≤ 0.005). There were also significant differences in improvement in bodily pain and social function (subscales of SF-36 health status) favoring the Index Group. Conclusions: Combined manual therapy, like naprapathy, is effective in the short and in the long term, and might be considered for patients with non-specific back and/or neck pain.

Research paper thumbnail of The Ability of a Submaximal Cycle Ergometer Test to Detect Longitudinal Changes in VO2Max

Background The purpose of the present study was to examine the ability of a submaximal cycling te... more Background The purpose of the present study was to examine the ability of a submaximal cycling test to detect longitudinal changes in maximal oxygen uptake (VO2max) and examine the conformity between changes in measured and estimated VO2max over a time span of 5–8 years. Methods A total of 35 participants (21 men and 14 women), aged 29 to 63 years, performed the Ekblom-Bak (EB) submaximal cycle test for estimation of VO2max and a maximal treadmill running test for direct measurement of VO2max. The baseline tests were conducted between 2009 and 2012, and the follow-up tests were completed 5 to 8 years later. Pearson’s coefficient of correlation (r) and paired sample t-test were used to analyse the association between change in measured and estimated VO2max. Random and systematic errors between the measured and estimated VO2max were evaluated using Bland-Altman plots. Repeated measures ANOVA were used to test differences between changes over time. Results There was no significant chan...

Research paper thumbnail of Work ability and psychological distress in a working population: results from the Stockholm Public Health Cohort

Scandinavian journal of public health, 2021

AIMS Psychological distress is a global public health concern with individual and societal implic... more AIMS Psychological distress is a global public health concern with individual and societal implications causing work-related disability and loss of productivity. It is less known how much work ability contributes to the development of psychological distress. This study aimed to assess the association between self-perceived physical and mental work ability in relation to job demands, and the incidence of psychological distress in a Swedish working population. METHODS Data were obtained from three subsamples of the Stockholm Public Health Cohort with baseline in 2010 and follow-up in 2014, based on a working population in Stockholm County aged 18-60 years, with no or mild psychological distress at baseline (n=29,882). Self-perceived physical and mental work ability in relation to job demands were assessed at baseline with a subscale from the Work Ability Index. Study participants scoring 4 or more on the General Health Questionnaire 12 at follow-up were classified as having developed ...

Research paper thumbnail of Vigorous regular leisure-time physical activity is associated with a clinically important improvement in back pain – a secondary analysis of randomized controlled trials

BMC Musculoskeletal Disorders

Background Neck and back pain are musculoskeletal conditions with serious individual and societal... more Background Neck and back pain are musculoskeletal conditions with serious individual and societal consequences. Current evidence about the prognostic value for neck and back pain is limited and conflicting. This prospective cohort study aimed to assess the association between leisure-time physical activity (LPA) and improvement of neck and/or back pain in a working population receiving manual therapy or general care in one of two randomized controlled trials (RCTs). Methods Analyses of data from two RCTs evaluating the effect of manual therapies for neck and/or back pain was conducted. Participants (n = 1 464) answered questionnaires about frequency and effort level of LPA at baseline. LPA on moderate or vigorous levels was compared to no or low/irregular moderate and vigorous levels. Pain intensity was assessed with numerical scales at baseline and 3-, 6-, and 12-month follow-up. The outcome was minimal clinically important improvement in pain intensity, defined as ≥2 points improv...

Research paper thumbnail of Non-Preferred Work and the Incidence of Spinal Pain and Psychological Distress—A Prospective Cohort Study

International Journal of Environmental Research and Public Health

Mental illness and psychological distress are global concerns. This study aimed to investigate th... more Mental illness and psychological distress are global concerns. This study aimed to investigate the association between having non-preferred work and the incidence of spinal pain, psychological distress, and spinal pain with concurrent psychological distress, and if associations are modified by sleep disturbance. A prospective study of 4285 participants 23–62 years old was conducted, from years 2007 to 2010. Participants reported their work situation as preferred/non-preferred regarding profession/workplace with a high/low possibility to change. Psychological distress was measured with the General Health Questionnaire 12 and spinal pain with questions about neck/back pain. Binominal regression analyses calculated relative risk (RR) with 95% confidence interval (CI). Non-preferred work with a low possibility to change was associated with a higher incidence of spinal pain (RR 1.8; 95% CI 1.2–2.6) and psychological distress (RR 1.8; 95% CI 1.4–2.4) compared to preferred work. The RR was...

Research paper thumbnail of Risk of transition from occasional neck/back pain to long-duration activity limiting neck/back pain: a cohort study on the influence of poor work ability and sleep disturbances in the working population in Stockholm County

BMJ Open

ObjectivesThe prevalence of neck/back pain (NBP) is high worldwide. Limited number of studies hav... more ObjectivesThe prevalence of neck/back pain (NBP) is high worldwide. Limited number of studies have investigated workers with occasional NBP regarding the risk of developing long-duration activity limiting NBP (LNBP). The objectives were to assess (1) the effect of poor work ability and sleep disturbances in persons with occasional NBP on the risk of LNBP, and (2) the interaction effect of these exposures.DesignCohort study based on three subsamples from the Stockholm Public Health Cohort.SettingsThe working population in Stockholm County.ParticipantsPersons aged 18–60 years, reporting occasional NBP the past 6 months at baseline year 2010 (n=16 460).MeasuresWork ability was assessed with items from the Work Ability Index, perceived mental and/or physical work ability. Sleep disturbances were self-reported current mild/severe disturbances. The outcome in year 2014 was reporting NBP the previous 6 months, occurring ≥couple of days per week and resulting in decreased work ability/restr...

Research paper thumbnail of Healthy lifestyle behaviour and risk of long-duration troublesome neck pain among men and women with occasional neck pain: results from the Stockholm public health cohort

BMJ Open

ObjectivesThe effect of a healthy lifestyle on the prognosis of neck pain is unknown. This study ... more ObjectivesThe effect of a healthy lifestyle on the prognosis of neck pain is unknown. This study aimed to investigate if a healthy lifestyle behaviour influences the risk of long-duration troublesome neck pain among men and women with occasional neck pain.DesignLongitudinal cohort study.SettingsGeneral population, and a subsample of the working population, in Stockholm County, Sweden.ParticipantsThis study involved 5342 men and 7298 women, age 18 to 84, from the Stockholm Public Health Cohort, reporting occasional neck pain at baseline in 2006.MeasuresBaseline information about leisure physical activity, smoking, alcohol consumption and consumption of fruits and vegetables were dichotomised into recommendations for healthy/not healthy behaviour. The exposure, a healthy lifestyle behaviour, was categorised into four levels according to the number of healthy behaviours (HB) met. Generalised linear models were applied to assess the exposure on the outcome long-duration troublesome neck...

Research paper thumbnail of Reliability and agreement of the IsoKai isokinetic lift test – A test used for admission to the Swedish Armed Forces

PLOS ONE

This study was performed to evaluate the reliability and agreement of the IsoKai isokinetic lift ... more This study was performed to evaluate the reliability and agreement of the IsoKai isokinetic lift test as it is currently administered in admission to the Swedish Armed Forces. The study included an intrarater (n = 534) and interrater reliability sample (n = 137), of Swedish male conscripts who performed the test on two test occasions about two hours apart. Two-to-four lifts were performed at each occasion, and the highest mean (IsoKai MF) and peak force (Iso-Kai PF) produced (N) were used for evaluation. All intraclass coefficients showed excellent reliability. The interrater analyses resulted in intraclass coefficients of 0.942 (95% CI; 0.920-0.959) and 0.858 (95% CI; 0.806-0.896) for the IsoKai MF and IsoKai PF , respectively, while the corresponding coefficients for the intrarater analyses were 0.935 (95% CI; 0.923-0.946) and 0.865 (95% CI; 0.842-0.886). Agreement, the capability of a test to detect changes, was assessed by the standard error of measurement (SEM/SEM%) and the smallest real difference (SRD/SRD%). These estimate indicated that it is possible to achieve measurements relevant to use in real practice with the IsoKai isokinetic lift test. Bland and Altman analyses revealed no systematic errors in either sample. Based on these findings, the IsoKai isokinetic lift test is suggested to be a highly reliable test for maximal dynamic muscular strength. The test could be of use in selection procedures in order to accurately evaluate maximal dynamic muscular strength, and for evaluating longitudinal changes in strength.

Research paper thumbnail of Concurrent validity of an isokinetic lift test used for admission to the Swedish Armed Forces

PLOS ONE

The aim of this study was to assess the concurrent validity of the IsoKai isokinetic lift test pe... more The aim of this study was to assess the concurrent validity of the IsoKai isokinetic lift test peak force (IsoKai Peak) in comparison to a submaximal 5-10RM deadlift test (5-10RM DL), and to develop an equation for converting the IsoKai Peak in Newton (N) to an estimated 1RM (1RM est) deadlift load in kilograms (kg). The participants included 28 males and 16 female employees in the Swedish Armed Forces (20-59 years). Each participant conducted the IsoKai lift test, followed by the 5-10RM DL test at one occasion. The Pearson 0 s correlation coefficient, with a 95% confidence interval was calculated to evaluate the validity between the IsoKai Peak and the 1RM est deadlift load derived from the 5-10RM DL test. Univariate and multivariable linear regressions were used to derive the equation for calculating the 1RM est deadlift load based on the IsoKai Peak. The IsoKai Peak showed good-to-excellent correlation with the 1RM est deadlift weight with a correlation coefficient of 0.84 (0.72-0.91) for the total sample, and 0.65 (0.37-0.83) and 0.81 (0.53-0.93) in males and females, respectively. The final equation, 1RM est deadlift weight (kg) =-51.63 + (0.08 x IsoKai Peak) + (2.28 x BMI), explained 72% (adjusted R 2 = 0.72) of the total variance in the 1RM est , and had a standard error of the estimate (SEE) of 16.57 kg. In conclusion, the IsoKai isokinetic lift test could be considered a highly valid measure of maximal dynamic muscular strength in comparison to the 5-10RM DL. The equation can be used to convert the IsoKai lift test (N) results to an 1RM est deadlift load (kg), but with consideration of the relative large SEE.

Research paper thumbnail of Healthy lifestyle behavior and risk of long duration troublesome neck pain or low back pain among men and women: results from the Stockholm Public Health Cohort

Clinical epidemiology, 2017

The role of healthy lifestyle behavior (HLB) in terms of physical activity, alcohol intake, smoki... more The role of healthy lifestyle behavior (HLB) in terms of physical activity, alcohol intake, smoking, and diet put together has not yet been explored for the risk of low back pain (LBP) and neck pain (NP). Our aim was to study if an HLB is protective against the onset of long duration troublesome LBP and NP in men and women. Two cohorts from the Stockholm Public Health Cohort, free from LBP (n=12,483) and NP (n=10,539), respectively, in 2006, were surveyed with questionnaires. Baseline information about physical activity, alcohol intake, diet, and smoking were dichotomized into being healthy/not healthy and combined in a categorical variable according to the number of healthy behaviors present. Binomial regression analyses were used to evaluate the role of HLB for the outcomes 4 years later. When men with three or four healthy lifestyles were compared to men with none or one, the risk ratio (RR) of LBP was 0.63 (95% confidence interval [CI]: 0.39-1.02). The corresponding RR for LBP i...

Research paper thumbnail of Sex and maturity status affected the validity of a submaximal cycle test in adolescents

Acta Paediatrica

This study assessed the validity and reliability of the Ekblom-Bak (EB) submaximal cycle test in ... more This study assessed the validity and reliability of the Ekblom-Bak (EB) submaximal cycle test in adolescents and identified any sex or maturity-related factors for prediction errors. Methods: We recruited 50 healthy subjects through a public announcement in Stockholm, Sweden, in 2016. The 27 boys and 23 girls were aged 10-15 years and in Tanner stages I-IV. They performed an EB test and incremental treadmill running test for direct measurement of maximal oxygen uptake (VO2max). Results: The estimation error of VO2max was 0.09 L/min. The correlation (r) was 0.86 and the standard error of the estimate (SEE) was 0.29 L/min. The largest overestimation was seen in pre-pubertal boys (0.49 L/min). The best precision of the EB test was achieved when boys in Tanner stages I and II were recalculated using the prediction equation developed for adult women. This yielded a mean difference of-0.05 L/min, r = 0.92 and SEE 0.23 L/min, in the entire sample. The prediction error was lowered in boys, but not girls, with increasing pubertal maturity. Conclusion: The EB test was reasonably valid in adolescents, seemed to be related to sex and maturity status and our findings support its use.

Research paper thumbnail of Back and neck pain : factors of importance for the prognosis

Back pain and neck pain are very common and among the most frequent causes of sickleave and disab... more Back pain and neck pain are very common and among the most frequent causes of sickleave and disability pension, thereby greatly affecting the individual and the community. This stresses the need for prognostic research regarding these conditions. Aim: The main aim of the present work was to study prognostic factors, including manual therapy, for back and neck pain. The specific aims were, to investigate the influence of regular leisure physical activity and the body mass index (BMI) on the recovery from persistent low back pain (Study I), to study the influence of healthy lifestyle behaviour on the prognosis of occasional low back pain (Study II), to explore the long-term effects (up to one year) of naprapathic manual therapy for patients with non-specific back and/or neck pain (Study III), and to develop a prediction model for the recovery from whiplash-associated disorders (WAD) in patients who consulted physiotherapy (Study IV). Methods: Studies I and II were based on the Stockholm Public Health Cohort, and comprised data from four questionnaire-based public-health surveys conducted between 2002 and 2010. Study I included 1836 individuals reporting persistent low back pain at baseline in 2002 and answering the follow-up in 2007, while Study II involved 8994 individuals with occasional low back pain at baseline in 2006 responding to the 2010 survey. Information on exposures and potential confounders was collected at baseline. The exposures were, regular leisure physical activity and BMI (Study I), and "healthy lifestyle behaviour", a combination of four lifestyle factors (smoking habits, alcohol consumption, leisure physical activity and consumption of fruit and vegetables) (Study II). Both Studies I and II assessed men and women separately. Study III was based on a Swedish randomized controlled trial of 409 patients with non-specific back and/or neck pain. It compared naprapathic manual therapy with evidence based support on staying active and on pain coping strategies. Questionnaires at 26 and 52 weeks provided the follow-up data. Study IV included 680 patients with WAD consulting physiotherapy, using data retrieved from the Saskatchewan Government Insurance study, Canada (1997-1999). A prediction model for recovery from WAD was developed and internally validated by assessing twenty-five possible prognostic factors, using survival analyses. Results and Conclusions: Regular leisure physical activity improved recovery from persistent low back pain among women. No such association was found among men, or between BMI and recovery regardless of sex (Study I). Healthy lifestyle behaviour decreased the risk of long duration troublesome low back pain among women with occasional low back pain. No clear association was found among men (Study II). Compared to evidence-based care, naprapathic manual therapy implied greater longterm improvement in pain and disability for patients with non-specific back and/or neck pain (Study III). The prediction model developed includes seven clinically important prognostic factors, and has acceptable predictive ability (Study IV). The conclusions in this thesis are, that lifestyle factors are of importance for the prognosis of low back pain among women, that combined manual therapy, such as naprapathy, has a long-term effect on non-specific back and/or neck pain, and that the present prediction model for recovery from WAD has acceptable predictive ability but has to be further validated to be used in clinical practice. LIST OF PUBLICATIONS This thesis is based on the following papers, referred to in the text by their Roman numerals (I-IV).

Research paper thumbnail of Predictive models for short-term and long-term improvement in women under physiotherapy for chronic disabling neck pain: a longitudinal cohort study

BMJ Open

ObjectivesTo develop predictive models for short-term and long-term clinically important improvem... more ObjectivesTo develop predictive models for short-term and long-term clinically important improvement in women with non-specific chronic disabling neck pain during the clinical course of physiotherapy.DesignLongitudinal cohort study based on data from a randomised controlled trial evaluating short-term and long-term effects on sensorimotor function over 11 weeks of physiotherapy.Participants and settingsEighty-nine women aged 31–65 years with non-specific chronic disabling neck pain from Gävle, Sweden.MeasuresThe outcome, clinically important improvement, was measured with the Patient Global Impression of Change Scale (PGICS) and the Neck Disability Index (NDI), assessed by self-administered questionnaires at 3, 9 and 15 months from the start of the interventions (baseline). Twelve baseline prognostic factors were considered in the analyses. The predictive models were built using random-effects logistic regression. The predictive ability of the models was measured by the area under t...

Research paper thumbnail of Does a healthy lifestyle behaviour influence the prognosis of low back pain among men and women in a general population? A population-based cohort study

BMJ open, 2014

To study the influence of healthy lifestyle behaviour on the prognosis of occasional low back pai... more To study the influence of healthy lifestyle behaviour on the prognosis of occasional low back pain among men and women in a general population. Cohort study with a 4-year follow-up. General population in Stockholm County, Sweden. The study sample comprised 3938 men and 5056 women aged 18-84 from the Stockholm Public Health Cohort reporting occasional low back pain in the baseline questionnaire 2006. Lifestyle factors and potential confounders were assessed at baseline. The lifestyle factors smoking habits, alcohol consumption, leisure physical activity and consumption of fruit and vegetables were dichotomised using recommendations for a health-enhancing lifestyle and combined to form the exposure variable 'healthy lifestyle behaviour'. The exposure was categorised into five levels according to the number of healthy lifestyle factors met. The follow-up questionnaire in 2010 gave information about the outcome, long duration troublesome low back pain. Crude and adjusted binomia...

Research paper thumbnail of The influence of self-reported leisure time physical activity and the body mass index on recovery from persistent back pain among men and women: a population-based cohort study

BMC Public Health, 2013

Background: There is limited knowledge about leisure time physical activity and the body mass ind... more Background: There is limited knowledge about leisure time physical activity and the body mass index (BMI) as prognostic factors for recovery from persistent back pain. The aim of this study was to assess the influence of leisure time physical activity and BMI on recovery from persistent back pain among men and women in a general population.

Research paper thumbnail of Prognosis of patients with whiplash-associated disorders consulting physiotherapy: development of a predictive model for recovery

BMC Musculoskeletal Disorders, 2012

Background: Patients with whiplash-associated disorders (WAD) have a generally favourable prognos... more Background: Patients with whiplash-associated disorders (WAD) have a generally favourable prognosis, yet some develop longstanding pain and disability. Predicting who will recover from WAD shortly after a traffic collision is very challenging for health care providers such as physical therapists. Therefore, we aimed to develop a prediction model for the recovery of WAD in a cohort of patients who consulted physical therapists within six weeks after the injury. Methods: Our cohort included 680 adult patients with WAD who were injured in Saskatchewan, Canada, between 1997 and 1999. All patients had consulted a physical therapist as a result of the injury. Baseline prognostic factors were collected from an injury questionnaire administered by Saskatchewan Government Insurance. The outcome, global self-perceived recovery, was assessed by telephone interviews six weeks, three and six months later. Twenty-five possible baseline prognostic factors were considered in the analyses. A prediction model was built using Cox regression. The predictive ability of the model was estimated with concordance statistics (c-index). Internal validity was checked using bootstrapping. Results: Our final prediction model included: age, number of days to reporting the collision, neck pain intensity, low back pain intensity, pain other than neck and back pain, headache before collision and recovery expectations. The model had an acceptable level of predictive ability with a c-index of 0.68 (95% CI: 0.65, 0.71). Internal validation showed that our model was robust and had a good fit. Conclusions: We developed a model predicting recovery from WAD, in a cohort of patients who consulted physical therapists. Our model has adequate predictive ability. However, to be fully incorporated in clinical practice the model needs to be validated in other populations and tested in clinical settings.

Research paper thumbnail of The long-term effects of naprapathic manual therapy on back and neck pain - Results from a pragmatic randomized controlled trial

BMC Musculoskeletal Disorders, 2010

Background: Back and neck pain are very common, disabling and recurrent disorders in the general ... more Background: Back and neck pain are very common, disabling and recurrent disorders in the general population and the knowledge of long-term effect of treatments are sparse. The aim of this study was to compare the longterm effects (up to one year) of naprapathic manual therapy and evidence-based advice on staying active regarding non-specific back and/or neck pain. Naprapathy, a health profession mainly practiced in Sweden, Finland, Norway and in the USA, is characterized by a combination of manual musculoskeletal manipulations, aiming to decrease pain and disability in the neuromusculoskeletal system. Methods: Subjects with non-specific pain/disability in the back and/or neck lasting for at least two weeks (n = 409), recruited at public companies in Sweden, were included in this pragmatic randomized controlled trial. The two interventions compared were naprapathic manual therapy such as spinal manipulation/mobilization, massage and stretching, (Index Group), and advice to stay active and on how to cope with pain, provided by a physician (Control Group). Pain intensity, disability and health status were measured by questionnaires. Results: 89% completed the 26-week follow-up and 85% the 52-week follow-up. A higher proportion in the Index Group had a clinically important decrease in pain (risk difference (RD) = 21%, 95% CI: 10-30) and disability (RD = 11%, 95% CI: 4-22) at 26-week, as well as at 52-week follow-ups (pain: RD = 17%, 95% CI: 7-27 and disability: RD = 17%, 95% CI: 5-28). The differences between the groups in pain and disability considered over one year were statistically significant favoring naprapathy (p ≤ 0.005). There were also significant differences in improvement in bodily pain and social function (subscales of SF-36 health status) favoring the Index Group. Conclusions: Combined manual therapy, like naprapathy, is effective in the short and in the long term, and might be considered for patients with non-specific back and/or neck pain.

Research paper thumbnail of Description and comparison of postoperative functioning of patients with hip fracture 2018 and 2008 at the Örebro University Hospital - a comparative cross-sectional study

BMC Geriatrics

Background Hip fractures are a global problem, and it will probably increase. Hip fractures impai... more Background Hip fractures are a global problem, and it will probably increase. Hip fractures impair health aspects which creates demands on postoperative care. This study describes and compares patients with hip fracture in 2008 and in 2018. An increased knowledge of this group could be a basis how to optimize aftercare and dimension rehabilitation. Methods Using a comparative cross-sectional study to describe and compare patients with hip fracture from 2018 and 2008 at Örebro University Hospital regarding age, sex, multimorbidity, fracture type, surgical materials, surgery within 24 hours, length of stay, postoperative walking ability, physical activity level and hand grip strength. Data was collected from 76 patients with hip fracture from 2018 and 78 patients from 2008. Outcome measures considering functioning were walking ability (Functional Ambulation Categories), physical activity level (Classification system of physical activity) and hand grip strength (Jamar hand dynamometer)...

Research paper thumbnail of Influence of work ability and smoking on the prognosis of long-duration activity-limiting neck/back pain: a cohort study of a Swedish working population

BMJ Open

ObjectivesLong-duration activity-limiting neck/back pain is common, but the knowledge of what wor... more ObjectivesLong-duration activity-limiting neck/back pain is common, but the knowledge of what work and lifestyle factors that influence the prognosis is sparse. The objective was therefore to evaluate if two factors, good self-perceived work ability and no daily smoking, are associated with a favourable prognosis of long-duration activity-limiting neck/back pain in a working population, and if these exposures have a synergistic prognostic effect.DesignA prospective cohort study based on three subsamples from the Stockholm Public Health Cohort.SettingsA working population in Stockholm County, Sweden.ParticipantsIndividuals, 18–61 years old, reporting long-duration activity-limiting neck/back pain the previous 6 months at baseline in 2010 (n=5177).MeasuresThe exposures were: self-perceived work ability (categorised into good, moderate and poor) and daily smoking (no/yes). The outcome in 2014 was ‘absence of long-duration activity-limiting neck/back pain’ the previous 6 months represen...

Research paper thumbnail of Do physical activity level and body mass index predict recovery from persistent neck pain in men and women of working age? A population-based cohort study

European Spine Journal, 2013

Purpose The study sought to examine the gender-specific effects of physical activity level and bo... more Purpose The study sought to examine the gender-specific effects of physical activity level and body mass index on recovery from persistent neck pain (PNP) among citizens of working age in Stockholm, Sweden. Methods A population-based cohort of 1,730 subjects (18-65) with PNP answered surveys in 2002 and 2007. Prognostic factors were self-reported body mass index (BMI) and physical activity level (PAL) at baseline. Analyses were performed with odds ratios (OR) with corresponding 95 % confidence intervals (95 % CI). Results Women reporting higher physical activity level had higher odds of recovering from PNP than women with sedentary leisure time (OR of 1.5, 95 % CI 1.0-2.4), but no associations were found in men. No associations were found between BMI and recovery from PNP in any analyses. Conclusion Physical activity seems to be associated with recovery from PNP in women and should therefore be encouraged. Future studies should continue investigating physical activity and lifestyle factors in relation to recovery from persistent neck pain, since these modifiable factors may be considered in interventions.

Research paper thumbnail of The long-term effects of naprapathic manual therapy on back and neck pain - Results from a pragmatic randomized controlled trial

BMC Musculoskeletal Disorders, 2010

Background: Back and neck pain are very common, disabling and recurrent disorders in the general ... more Background: Back and neck pain are very common, disabling and recurrent disorders in the general population and the knowledge of long-term effect of treatments are sparse. The aim of this study was to compare the longterm effects (up to one year) of naprapathic manual therapy and evidence-based advice on staying active regarding non-specific back and/or neck pain. Naprapathy, a health profession mainly practiced in Sweden, Finland, Norway and in the USA, is characterized by a combination of manual musculoskeletal manipulations, aiming to decrease pain and disability in the neuromusculoskeletal system. Methods: Subjects with non-specific pain/disability in the back and/or neck lasting for at least two weeks (n = 409), recruited at public companies in Sweden, were included in this pragmatic randomized controlled trial. The two interventions compared were naprapathic manual therapy such as spinal manipulation/mobilization, massage and stretching, (Index Group), and advice to stay active and on how to cope with pain, provided by a physician (Control Group). Pain intensity, disability and health status were measured by questionnaires. Results: 89% completed the 26-week follow-up and 85% the 52-week follow-up. A higher proportion in the Index Group had a clinically important decrease in pain (risk difference (RD) = 21%, 95% CI: 10-30) and disability (RD = 11%, 95% CI: 4-22) at 26-week, as well as at 52-week follow-ups (pain: RD = 17%, 95% CI: 7-27 and disability: RD = 17%, 95% CI: 5-28). The differences between the groups in pain and disability considered over one year were statistically significant favoring naprapathy (p ≤ 0.005). There were also significant differences in improvement in bodily pain and social function (subscales of SF-36 health status) favoring the Index Group. Conclusions: Combined manual therapy, like naprapathy, is effective in the short and in the long term, and might be considered for patients with non-specific back and/or neck pain.

Research paper thumbnail of The Ability of a Submaximal Cycle Ergometer Test to Detect Longitudinal Changes in VO2Max

Background The purpose of the present study was to examine the ability of a submaximal cycling te... more Background The purpose of the present study was to examine the ability of a submaximal cycling test to detect longitudinal changes in maximal oxygen uptake (VO2max) and examine the conformity between changes in measured and estimated VO2max over a time span of 5–8 years. Methods A total of 35 participants (21 men and 14 women), aged 29 to 63 years, performed the Ekblom-Bak (EB) submaximal cycle test for estimation of VO2max and a maximal treadmill running test for direct measurement of VO2max. The baseline tests were conducted between 2009 and 2012, and the follow-up tests were completed 5 to 8 years later. Pearson’s coefficient of correlation (r) and paired sample t-test were used to analyse the association between change in measured and estimated VO2max. Random and systematic errors between the measured and estimated VO2max were evaluated using Bland-Altman plots. Repeated measures ANOVA were used to test differences between changes over time. Results There was no significant chan...

Research paper thumbnail of Work ability and psychological distress in a working population: results from the Stockholm Public Health Cohort

Scandinavian journal of public health, 2021

AIMS Psychological distress is a global public health concern with individual and societal implic... more AIMS Psychological distress is a global public health concern with individual and societal implications causing work-related disability and loss of productivity. It is less known how much work ability contributes to the development of psychological distress. This study aimed to assess the association between self-perceived physical and mental work ability in relation to job demands, and the incidence of psychological distress in a Swedish working population. METHODS Data were obtained from three subsamples of the Stockholm Public Health Cohort with baseline in 2010 and follow-up in 2014, based on a working population in Stockholm County aged 18-60 years, with no or mild psychological distress at baseline (n=29,882). Self-perceived physical and mental work ability in relation to job demands were assessed at baseline with a subscale from the Work Ability Index. Study participants scoring 4 or more on the General Health Questionnaire 12 at follow-up were classified as having developed ...

Research paper thumbnail of Vigorous regular leisure-time physical activity is associated with a clinically important improvement in back pain – a secondary analysis of randomized controlled trials

BMC Musculoskeletal Disorders

Background Neck and back pain are musculoskeletal conditions with serious individual and societal... more Background Neck and back pain are musculoskeletal conditions with serious individual and societal consequences. Current evidence about the prognostic value for neck and back pain is limited and conflicting. This prospective cohort study aimed to assess the association between leisure-time physical activity (LPA) and improvement of neck and/or back pain in a working population receiving manual therapy or general care in one of two randomized controlled trials (RCTs). Methods Analyses of data from two RCTs evaluating the effect of manual therapies for neck and/or back pain was conducted. Participants (n = 1 464) answered questionnaires about frequency and effort level of LPA at baseline. LPA on moderate or vigorous levels was compared to no or low/irregular moderate and vigorous levels. Pain intensity was assessed with numerical scales at baseline and 3-, 6-, and 12-month follow-up. The outcome was minimal clinically important improvement in pain intensity, defined as ≥2 points improv...

Research paper thumbnail of Non-Preferred Work and the Incidence of Spinal Pain and Psychological Distress—A Prospective Cohort Study

International Journal of Environmental Research and Public Health

Mental illness and psychological distress are global concerns. This study aimed to investigate th... more Mental illness and psychological distress are global concerns. This study aimed to investigate the association between having non-preferred work and the incidence of spinal pain, psychological distress, and spinal pain with concurrent psychological distress, and if associations are modified by sleep disturbance. A prospective study of 4285 participants 23–62 years old was conducted, from years 2007 to 2010. Participants reported their work situation as preferred/non-preferred regarding profession/workplace with a high/low possibility to change. Psychological distress was measured with the General Health Questionnaire 12 and spinal pain with questions about neck/back pain. Binominal regression analyses calculated relative risk (RR) with 95% confidence interval (CI). Non-preferred work with a low possibility to change was associated with a higher incidence of spinal pain (RR 1.8; 95% CI 1.2–2.6) and psychological distress (RR 1.8; 95% CI 1.4–2.4) compared to preferred work. The RR was...

Research paper thumbnail of Risk of transition from occasional neck/back pain to long-duration activity limiting neck/back pain: a cohort study on the influence of poor work ability and sleep disturbances in the working population in Stockholm County

BMJ Open

ObjectivesThe prevalence of neck/back pain (NBP) is high worldwide. Limited number of studies hav... more ObjectivesThe prevalence of neck/back pain (NBP) is high worldwide. Limited number of studies have investigated workers with occasional NBP regarding the risk of developing long-duration activity limiting NBP (LNBP). The objectives were to assess (1) the effect of poor work ability and sleep disturbances in persons with occasional NBP on the risk of LNBP, and (2) the interaction effect of these exposures.DesignCohort study based on three subsamples from the Stockholm Public Health Cohort.SettingsThe working population in Stockholm County.ParticipantsPersons aged 18–60 years, reporting occasional NBP the past 6 months at baseline year 2010 (n=16 460).MeasuresWork ability was assessed with items from the Work Ability Index, perceived mental and/or physical work ability. Sleep disturbances were self-reported current mild/severe disturbances. The outcome in year 2014 was reporting NBP the previous 6 months, occurring ≥couple of days per week and resulting in decreased work ability/restr...

Research paper thumbnail of Healthy lifestyle behaviour and risk of long-duration troublesome neck pain among men and women with occasional neck pain: results from the Stockholm public health cohort

BMJ Open

ObjectivesThe effect of a healthy lifestyle on the prognosis of neck pain is unknown. This study ... more ObjectivesThe effect of a healthy lifestyle on the prognosis of neck pain is unknown. This study aimed to investigate if a healthy lifestyle behaviour influences the risk of long-duration troublesome neck pain among men and women with occasional neck pain.DesignLongitudinal cohort study.SettingsGeneral population, and a subsample of the working population, in Stockholm County, Sweden.ParticipantsThis study involved 5342 men and 7298 women, age 18 to 84, from the Stockholm Public Health Cohort, reporting occasional neck pain at baseline in 2006.MeasuresBaseline information about leisure physical activity, smoking, alcohol consumption and consumption of fruits and vegetables were dichotomised into recommendations for healthy/not healthy behaviour. The exposure, a healthy lifestyle behaviour, was categorised into four levels according to the number of healthy behaviours (HB) met. Generalised linear models were applied to assess the exposure on the outcome long-duration troublesome neck...

Research paper thumbnail of Reliability and agreement of the IsoKai isokinetic lift test – A test used for admission to the Swedish Armed Forces

PLOS ONE

This study was performed to evaluate the reliability and agreement of the IsoKai isokinetic lift ... more This study was performed to evaluate the reliability and agreement of the IsoKai isokinetic lift test as it is currently administered in admission to the Swedish Armed Forces. The study included an intrarater (n = 534) and interrater reliability sample (n = 137), of Swedish male conscripts who performed the test on two test occasions about two hours apart. Two-to-four lifts were performed at each occasion, and the highest mean (IsoKai MF) and peak force (Iso-Kai PF) produced (N) were used for evaluation. All intraclass coefficients showed excellent reliability. The interrater analyses resulted in intraclass coefficients of 0.942 (95% CI; 0.920-0.959) and 0.858 (95% CI; 0.806-0.896) for the IsoKai MF and IsoKai PF , respectively, while the corresponding coefficients for the intrarater analyses were 0.935 (95% CI; 0.923-0.946) and 0.865 (95% CI; 0.842-0.886). Agreement, the capability of a test to detect changes, was assessed by the standard error of measurement (SEM/SEM%) and the smallest real difference (SRD/SRD%). These estimate indicated that it is possible to achieve measurements relevant to use in real practice with the IsoKai isokinetic lift test. Bland and Altman analyses revealed no systematic errors in either sample. Based on these findings, the IsoKai isokinetic lift test is suggested to be a highly reliable test for maximal dynamic muscular strength. The test could be of use in selection procedures in order to accurately evaluate maximal dynamic muscular strength, and for evaluating longitudinal changes in strength.

Research paper thumbnail of Concurrent validity of an isokinetic lift test used for admission to the Swedish Armed Forces

PLOS ONE

The aim of this study was to assess the concurrent validity of the IsoKai isokinetic lift test pe... more The aim of this study was to assess the concurrent validity of the IsoKai isokinetic lift test peak force (IsoKai Peak) in comparison to a submaximal 5-10RM deadlift test (5-10RM DL), and to develop an equation for converting the IsoKai Peak in Newton (N) to an estimated 1RM (1RM est) deadlift load in kilograms (kg). The participants included 28 males and 16 female employees in the Swedish Armed Forces (20-59 years). Each participant conducted the IsoKai lift test, followed by the 5-10RM DL test at one occasion. The Pearson 0 s correlation coefficient, with a 95% confidence interval was calculated to evaluate the validity between the IsoKai Peak and the 1RM est deadlift load derived from the 5-10RM DL test. Univariate and multivariable linear regressions were used to derive the equation for calculating the 1RM est deadlift load based on the IsoKai Peak. The IsoKai Peak showed good-to-excellent correlation with the 1RM est deadlift weight with a correlation coefficient of 0.84 (0.72-0.91) for the total sample, and 0.65 (0.37-0.83) and 0.81 (0.53-0.93) in males and females, respectively. The final equation, 1RM est deadlift weight (kg) =-51.63 + (0.08 x IsoKai Peak) + (2.28 x BMI), explained 72% (adjusted R 2 = 0.72) of the total variance in the 1RM est , and had a standard error of the estimate (SEE) of 16.57 kg. In conclusion, the IsoKai isokinetic lift test could be considered a highly valid measure of maximal dynamic muscular strength in comparison to the 5-10RM DL. The equation can be used to convert the IsoKai lift test (N) results to an 1RM est deadlift load (kg), but with consideration of the relative large SEE.

Research paper thumbnail of Healthy lifestyle behavior and risk of long duration troublesome neck pain or low back pain among men and women: results from the Stockholm Public Health Cohort

Clinical epidemiology, 2017

The role of healthy lifestyle behavior (HLB) in terms of physical activity, alcohol intake, smoki... more The role of healthy lifestyle behavior (HLB) in terms of physical activity, alcohol intake, smoking, and diet put together has not yet been explored for the risk of low back pain (LBP) and neck pain (NP). Our aim was to study if an HLB is protective against the onset of long duration troublesome LBP and NP in men and women. Two cohorts from the Stockholm Public Health Cohort, free from LBP (n=12,483) and NP (n=10,539), respectively, in 2006, were surveyed with questionnaires. Baseline information about physical activity, alcohol intake, diet, and smoking were dichotomized into being healthy/not healthy and combined in a categorical variable according to the number of healthy behaviors present. Binomial regression analyses were used to evaluate the role of HLB for the outcomes 4 years later. When men with three or four healthy lifestyles were compared to men with none or one, the risk ratio (RR) of LBP was 0.63 (95% confidence interval [CI]: 0.39-1.02). The corresponding RR for LBP i...

Research paper thumbnail of Sex and maturity status affected the validity of a submaximal cycle test in adolescents

Acta Paediatrica

This study assessed the validity and reliability of the Ekblom-Bak (EB) submaximal cycle test in ... more This study assessed the validity and reliability of the Ekblom-Bak (EB) submaximal cycle test in adolescents and identified any sex or maturity-related factors for prediction errors. Methods: We recruited 50 healthy subjects through a public announcement in Stockholm, Sweden, in 2016. The 27 boys and 23 girls were aged 10-15 years and in Tanner stages I-IV. They performed an EB test and incremental treadmill running test for direct measurement of maximal oxygen uptake (VO2max). Results: The estimation error of VO2max was 0.09 L/min. The correlation (r) was 0.86 and the standard error of the estimate (SEE) was 0.29 L/min. The largest overestimation was seen in pre-pubertal boys (0.49 L/min). The best precision of the EB test was achieved when boys in Tanner stages I and II were recalculated using the prediction equation developed for adult women. This yielded a mean difference of-0.05 L/min, r = 0.92 and SEE 0.23 L/min, in the entire sample. The prediction error was lowered in boys, but not girls, with increasing pubertal maturity. Conclusion: The EB test was reasonably valid in adolescents, seemed to be related to sex and maturity status and our findings support its use.

Research paper thumbnail of Back and neck pain : factors of importance for the prognosis

Back pain and neck pain are very common and among the most frequent causes of sickleave and disab... more Back pain and neck pain are very common and among the most frequent causes of sickleave and disability pension, thereby greatly affecting the individual and the community. This stresses the need for prognostic research regarding these conditions. Aim: The main aim of the present work was to study prognostic factors, including manual therapy, for back and neck pain. The specific aims were, to investigate the influence of regular leisure physical activity and the body mass index (BMI) on the recovery from persistent low back pain (Study I), to study the influence of healthy lifestyle behaviour on the prognosis of occasional low back pain (Study II), to explore the long-term effects (up to one year) of naprapathic manual therapy for patients with non-specific back and/or neck pain (Study III), and to develop a prediction model for the recovery from whiplash-associated disorders (WAD) in patients who consulted physiotherapy (Study IV). Methods: Studies I and II were based on the Stockholm Public Health Cohort, and comprised data from four questionnaire-based public-health surveys conducted between 2002 and 2010. Study I included 1836 individuals reporting persistent low back pain at baseline in 2002 and answering the follow-up in 2007, while Study II involved 8994 individuals with occasional low back pain at baseline in 2006 responding to the 2010 survey. Information on exposures and potential confounders was collected at baseline. The exposures were, regular leisure physical activity and BMI (Study I), and "healthy lifestyle behaviour", a combination of four lifestyle factors (smoking habits, alcohol consumption, leisure physical activity and consumption of fruit and vegetables) (Study II). Both Studies I and II assessed men and women separately. Study III was based on a Swedish randomized controlled trial of 409 patients with non-specific back and/or neck pain. It compared naprapathic manual therapy with evidence based support on staying active and on pain coping strategies. Questionnaires at 26 and 52 weeks provided the follow-up data. Study IV included 680 patients with WAD consulting physiotherapy, using data retrieved from the Saskatchewan Government Insurance study, Canada (1997-1999). A prediction model for recovery from WAD was developed and internally validated by assessing twenty-five possible prognostic factors, using survival analyses. Results and Conclusions: Regular leisure physical activity improved recovery from persistent low back pain among women. No such association was found among men, or between BMI and recovery regardless of sex (Study I). Healthy lifestyle behaviour decreased the risk of long duration troublesome low back pain among women with occasional low back pain. No clear association was found among men (Study II). Compared to evidence-based care, naprapathic manual therapy implied greater longterm improvement in pain and disability for patients with non-specific back and/or neck pain (Study III). The prediction model developed includes seven clinically important prognostic factors, and has acceptable predictive ability (Study IV). The conclusions in this thesis are, that lifestyle factors are of importance for the prognosis of low back pain among women, that combined manual therapy, such as naprapathy, has a long-term effect on non-specific back and/or neck pain, and that the present prediction model for recovery from WAD has acceptable predictive ability but has to be further validated to be used in clinical practice. LIST OF PUBLICATIONS This thesis is based on the following papers, referred to in the text by their Roman numerals (I-IV).

Research paper thumbnail of Predictive models for short-term and long-term improvement in women under physiotherapy for chronic disabling neck pain: a longitudinal cohort study

BMJ Open

ObjectivesTo develop predictive models for short-term and long-term clinically important improvem... more ObjectivesTo develop predictive models for short-term and long-term clinically important improvement in women with non-specific chronic disabling neck pain during the clinical course of physiotherapy.DesignLongitudinal cohort study based on data from a randomised controlled trial evaluating short-term and long-term effects on sensorimotor function over 11 weeks of physiotherapy.Participants and settingsEighty-nine women aged 31–65 years with non-specific chronic disabling neck pain from Gävle, Sweden.MeasuresThe outcome, clinically important improvement, was measured with the Patient Global Impression of Change Scale (PGICS) and the Neck Disability Index (NDI), assessed by self-administered questionnaires at 3, 9 and 15 months from the start of the interventions (baseline). Twelve baseline prognostic factors were considered in the analyses. The predictive models were built using random-effects logistic regression. The predictive ability of the models was measured by the area under t...

Research paper thumbnail of Does a healthy lifestyle behaviour influence the prognosis of low back pain among men and women in a general population? A population-based cohort study

BMJ open, 2014

To study the influence of healthy lifestyle behaviour on the prognosis of occasional low back pai... more To study the influence of healthy lifestyle behaviour on the prognosis of occasional low back pain among men and women in a general population. Cohort study with a 4-year follow-up. General population in Stockholm County, Sweden. The study sample comprised 3938 men and 5056 women aged 18-84 from the Stockholm Public Health Cohort reporting occasional low back pain in the baseline questionnaire 2006. Lifestyle factors and potential confounders were assessed at baseline. The lifestyle factors smoking habits, alcohol consumption, leisure physical activity and consumption of fruit and vegetables were dichotomised using recommendations for a health-enhancing lifestyle and combined to form the exposure variable 'healthy lifestyle behaviour'. The exposure was categorised into five levels according to the number of healthy lifestyle factors met. The follow-up questionnaire in 2010 gave information about the outcome, long duration troublesome low back pain. Crude and adjusted binomia...

Research paper thumbnail of The influence of self-reported leisure time physical activity and the body mass index on recovery from persistent back pain among men and women: a population-based cohort study

BMC Public Health, 2013

Background: There is limited knowledge about leisure time physical activity and the body mass ind... more Background: There is limited knowledge about leisure time physical activity and the body mass index (BMI) as prognostic factors for recovery from persistent back pain. The aim of this study was to assess the influence of leisure time physical activity and BMI on recovery from persistent back pain among men and women in a general population.

Research paper thumbnail of Prognosis of patients with whiplash-associated disorders consulting physiotherapy: development of a predictive model for recovery

BMC Musculoskeletal Disorders, 2012

Background: Patients with whiplash-associated disorders (WAD) have a generally favourable prognos... more Background: Patients with whiplash-associated disorders (WAD) have a generally favourable prognosis, yet some develop longstanding pain and disability. Predicting who will recover from WAD shortly after a traffic collision is very challenging for health care providers such as physical therapists. Therefore, we aimed to develop a prediction model for the recovery of WAD in a cohort of patients who consulted physical therapists within six weeks after the injury. Methods: Our cohort included 680 adult patients with WAD who were injured in Saskatchewan, Canada, between 1997 and 1999. All patients had consulted a physical therapist as a result of the injury. Baseline prognostic factors were collected from an injury questionnaire administered by Saskatchewan Government Insurance. The outcome, global self-perceived recovery, was assessed by telephone interviews six weeks, three and six months later. Twenty-five possible baseline prognostic factors were considered in the analyses. A prediction model was built using Cox regression. The predictive ability of the model was estimated with concordance statistics (c-index). Internal validity was checked using bootstrapping. Results: Our final prediction model included: age, number of days to reporting the collision, neck pain intensity, low back pain intensity, pain other than neck and back pain, headache before collision and recovery expectations. The model had an acceptable level of predictive ability with a c-index of 0.68 (95% CI: 0.65, 0.71). Internal validation showed that our model was robust and had a good fit. Conclusions: We developed a model predicting recovery from WAD, in a cohort of patients who consulted physical therapists. Our model has adequate predictive ability. However, to be fully incorporated in clinical practice the model needs to be validated in other populations and tested in clinical settings.

Research paper thumbnail of The long-term effects of naprapathic manual therapy on back and neck pain - Results from a pragmatic randomized controlled trial

BMC Musculoskeletal Disorders, 2010

Background: Back and neck pain are very common, disabling and recurrent disorders in the general ... more Background: Back and neck pain are very common, disabling and recurrent disorders in the general population and the knowledge of long-term effect of treatments are sparse. The aim of this study was to compare the longterm effects (up to one year) of naprapathic manual therapy and evidence-based advice on staying active regarding non-specific back and/or neck pain. Naprapathy, a health profession mainly practiced in Sweden, Finland, Norway and in the USA, is characterized by a combination of manual musculoskeletal manipulations, aiming to decrease pain and disability in the neuromusculoskeletal system. Methods: Subjects with non-specific pain/disability in the back and/or neck lasting for at least two weeks (n = 409), recruited at public companies in Sweden, were included in this pragmatic randomized controlled trial. The two interventions compared were naprapathic manual therapy such as spinal manipulation/mobilization, massage and stretching, (Index Group), and advice to stay active and on how to cope with pain, provided by a physician (Control Group). Pain intensity, disability and health status were measured by questionnaires. Results: 89% completed the 26-week follow-up and 85% the 52-week follow-up. A higher proportion in the Index Group had a clinically important decrease in pain (risk difference (RD) = 21%, 95% CI: 10-30) and disability (RD = 11%, 95% CI: 4-22) at 26-week, as well as at 52-week follow-ups (pain: RD = 17%, 95% CI: 7-27 and disability: RD = 17%, 95% CI: 5-28). The differences between the groups in pain and disability considered over one year were statistically significant favoring naprapathy (p ≤ 0.005). There were also significant differences in improvement in bodily pain and social function (subscales of SF-36 health status) favoring the Index Group. Conclusions: Combined manual therapy, like naprapathy, is effective in the short and in the long term, and might be considered for patients with non-specific back and/or neck pain.