Karin Harms-ringdahl | Karolinska Institutet (original) (raw)

Papers by Karin Harms-ringdahl

Scandinavian journal of rehabilitation medicine. Supplement

Existing studies of shoulder joint loading, muscle strength and muscular activity do not, from th... more Existing studies of shoulder joint loading, muscle strength and muscular activity do not, from the point of view of clinical application, adequately cover these factors, knowledge of which is important for the design of optimal exercises for training shoulder impairments. In the present study, exercises using a weight-and-pulley device have been analysed in order to map the resistance moments of force in relation to the muscular strength capacity of shoulder internal rotators , and to map the activation of these muscles in response to the resistance from the device. The relationships established in the study provide a basis for optimising various types of shoulder training exercises. For example, an angle of 40 degrees between frontal plane and shoulder-pulley line has been found to give the best adaptation of resistance to strength. The study also demonstrates the possibility of using a pulley apparatus for shoulder inward rotator muscle training.

Journal of Rehabilitation Medicine, 2011

To investigate the feasibility and effects of a physical exercise programme on functioning and he... more To investigate the feasibility and effects of a physical exercise programme on functioning and health-related quality of life in adults with myotonic dystrophy type 1. A randomized controlled trial. Thirty-five adults with myotonic dystrophy type 1. After stratification for level of functioning, study participants were assigned by lot to either a training group or a control group. Training-group participants attended a 60-minute comprehensive group-training programme, Friskis&Svettis® Open Doors, twice a week for 14 weeks. The six-minute walk test was the primary outcome measure and the timed-stands test, the timed up-and-go test, the Epworth sleepiness scale and the Short Form-36 health survey were secondary outcome measures. Intention-to-treat analyses revealed no significant differences in any outcome measures, except for an increased between-group difference after intervention in the Short Form-36 mental health subscale and a decrease in the vitality subscale for the control group. The programme was well tolerated and many training-group participants perceived subjective changes for the better. No negative effects were reported. The Friskis&Svettis® Open Doors programme was feasible for adults with myotonic dystrophy type 1 who had been screened for cardiac involvement, had distal or mild-to-moderate proximal muscle impairment, and no severe cognitive impairments. No beneficial or detrimental effects were evident.

Aviation, space, and environmental medicine, 2003

Fighter pilots are frequently exposed to high acceleration (+Gz) forces during sorties. To counte... more Fighter pilots are frequently exposed to high acceleration (+Gz) forces during sorties. To counter these forces the pilots wear anti-G ensembles, use positive pressure breathing for G protection (PBG), and perform anti-G straining maneuvers (AGSMs). The purpose of this study was to analyze the muscle activity during sustained high G when no positive pressure breathing was used (control) compared with that during the use of PBG. Seven Swedish Air Force fighter pilots volunteered to be exposed to gradual and rapid onset runs to +9 Gz with and without PBG in a human centrifuge. Surface electromyography was recorded from the intercostals, rectus abdominis, vastus lateralis, biceps femoris, and gastrocnemius lateralis. Measured variables included mean muscle activity, relative time with high muscle activity levels, and individual activation preferences. G duration tolerance was significantly longer (p = 0.028) when PBG was used (57 s) compared with control (32 s) during rapid onset runs....

Scandinavian Journal of Caring Sciences, 1998

A questionnaire about assistive devices for lift and transfer was distributed to all individuals ... more A questionnaire about assistive devices for lift and transfer was distributed to all individuals evaluated at the Solberga Project outpatient service unit, a regional centre for long-term follow-up of severely brain injured persons in the Greater Stockholm area. The target group was 60 severely brain injured adults, of whom 57 (30 women and 27 men) answered a questionnaire created by one of the authors. The causes of injury in the study population were trauma (n = 27), cerebrovascular accident (n = 19), anoxia (n = 10) and other (n = 1). Thirty-two persons were quadriplegic after the injury and 21 were hemiplegic. More than half (33/57) reported problems with all five defined lift and transfer situations. Most (42/44) reported problems getting in and out of their wheelchairs. Technical aids were seldom used; 24 persons did not use any aids at all. The most commonly used aid was an adjustable bed. Most of the technical aids were used when the individual also had personal assistance. The persons who managed lift and transfer by themselves used few aids. It is reasonable to assume that severely brain injured individuals would be involved in more activities if they used technical aids more readily.

European Journal of Applied Physiology and Occupational Physiology, 1992

The purpose of the study was to analyse the effect of arm-shoulder fatigue on manual performance.... more The purpose of the study was to analyse the effect of arm-shoulder fatigue on manual performance. Ten experienced carpenters performed three standardized tasks (nailing, sawing and screwing). Electromyographic activity was recorded from six arm-shoulder muscles and the performances were video-filmed. After 45 min of standardized arm-cranking (arm-shoulder-fatiguing exercise of approximately 70%-80% maximal oxygen consumption), the tasks were repeated. The number of work movements and the time taken for each task were recorded and the quality of the work performed was compared. After the fatiguing exercise, only nailing was perceived as being harder and more mistakes were made during nailing and sawing. Movement performance was not influenced during nailing but was slightly slower during sawing and faster during screwing. However, there were increased mean EMG amplitudes in the upper trapezius and biceps muscles during nailing, in the upper trapezius, anterior deltoid and infraspinatus muscles during sawing and in the anterior deltoid muscle during screwing. Of the muscles studied the upper trapezius and anterior deltoid muscles increased their activity most after the arm-shoulder-fatiguing exercise.

Clinical Biomechanics, 1995

Changes in kinematics as a function of lifting weight and frequency was investigated in sagittal ... more Changes in kinematics as a function of lifting weight and frequency was investigated in sagittal symmetric repetitive lifting. For every lift cycle (lowering and lifting) the motion range between the upright position (0 degrees ) and the maximum angular displacement of the thigh and lower-trunk body segments was recorded. Ten subjects performed five repetitive lifting bouts with different weight/frequency combinations, using both stoop and squat lifting techniques. In total, 6384 lifts were analysed. The lifting weight or frequency did not influence the motion ranges in stoop lifting. In squat lifting the weight lifted did not appear to have any influence on the motion ranges, while the thigh motion range was significantly smaller at lifting frequency of 20 lifts min(-1) than at a frequency of 10. A significant gradual decrease in the thigh motion range and corresponding increase in the lower-trunk motion range were seen for a majority of the subjects during squat lifting at frequency 20. These changes suggest that quadriceps muscle strength is the limiting factor in repetitive squat lifting. Also the variation in motion ranges was greater in squat lifting than in stoop lifting. RELEVANCE: Forestry work involves frequent lifting. However, compliance in using squat lifting technique, which is recommended for safe lifting, is sometimes poor. Fatigue may be one of the determinants for changes in kinematics and choice of technique in lifting tasks.

Knee joint loading and the level of knee muscle activation during rising exercises have been eval... more Knee joint loading and the level of knee muscle activation during rising exercises have been evaluated and methods have been developed for such studies. Floor-to-foot forces were recorded using a force-measuring platform. The loading moment of force representing the resistance for the knee joint was calculated. It was shown that the initial knee loading moment with much flexed knees was high at large knee angles. The loading moment showed a marked decrease with decreasing knee angles. For small knee angles there was no resistance to knee extension. Muscular activity level was studied using EMG. The levels of activity in the quadriceps muscles were high at large knee angles and low at small angles. The hamstrings and gastrocnemius showed only low activity. The magnitude of change in knee extension resistance due to adaptive adjustment of the exercise device was mapped. These rising exercises will increase strength mainly for large knee angles and only for quadriceps muscles.

Spine, 2005

A randomized assessor-blinded clinical trial was conducted. To compare 3 different physical thera... more A randomized assessor-blinded clinical trial was conducted. To compare 3 different physical therapy treatments with respect to pain and activity in women with pelvic girdle pain during pregnancy and 3, 6, and 12 months postpartum. In spite of the high prevalence of back pain during pregnancy, documented treatment programs are limited. Based on a clinical examination, 118 women with pelvic girdle pain diagnosed during pregnancy were randomized into 3 different treatment groups: Information Group, use of a nonelastic sacroiliac belt and oral/written information about pelvic girdle pain (n = 40); Home Exercise Group, same as in the Information Group, with the addition of a home exercise program (n = 41); and the In Clinic Exercise Group, same as in the Information Group, plus participation in a training program (n = 37). Pain intensity was rated on a visual analogue scale (0-100 mm) and marked on a pain drawing concerning localization. The activity ability was scored using the Disability Rating Index, covering 12 daily activity items. Outcome measures were obtained at inclusion, on average in gestation week 38, and 3, 6, and 12 months postpartum. There was no significant difference among the 3 groups during pregnancy or at the follow-ups postpartum regarding pain and activity. In all groups, pain decreased and the activity ability increased between gestation week 38 and at 12 months postpartum. Women with pelvic girdle pain seemed to improve with time in all 3 treatment groups. Neitherhome nor in clinic exercises had any additional value above giving a nonelastic sacroiliac belt and information.

SPINE, 1994

Local thigh and low back perceived exertion (RPE), sagittal peak load moments, and leg and trunk ... more Local thigh and low back perceived exertion (RPE), sagittal peak load moments, and leg and trunk muscular activity during repetitive submaximal lifting, with squat and stoop technique, were investigated. This study analyzed changes in kinetic variables caused by changes in body movements during the lifting bouts, and the contribution of the biomechanical and physiologic variables to the variability in the local RPE responses. Despite instructions that emphasize the "correct" lifting technique as the squat technique, the stoop technique is reported as more commonly used in practice. Few studies have investigated the effect of lifting technique on differentiated perceptual responses in repetitive lifting. Ten experienced forest workers performed submaximal repetitive lifting bouts until steady-state VO2 was reached, using five different weight and frequency combinations with both squat and stoop techniques. Borg's scale was used for RPE measurements. Muscular activity in lumbar, hip, knee extensors, and knee flexors was recorded with surface electrodes. Kinematic data was obtained from electronic liquid-level sensors, and vertical ground reaction forces from a two-dimensional force plate. Low back RPE was higher for stoop than for squat, whereas the opposite was true for thigh RPE. The total accountable variance (R2) for the biomechanical and physiologic variables to the RPE responses ranged from 0.25 (low back RPE in squat lifting) to 0.61-0.76 for the other assessments. During the time course in squat lifting at the highest frequency, the knee load moment decreased and the vertical ground reaction forces increased. The study indicates that "movement strategies" to reduce the demand on the knee-extensor muscles were used during the squat lifting bouts at the highest frequencies, which combined with the relatively high assessed thigh exertions, leads to the hypothesis that quadriceps muscle exertion is the "weak link" for the squat technique. The study also indicates a discrepancy between the measured and perceived low back stress in squat repetitive lifting.

Social Science & Medicine, 2006

This study explores the decision of 33 men and women to be sick-listed from work for neck pain or... more This study explores the decision of 33 men and women to be sick-listed from work for neck pain or low-back pain. Qualitative interviews with the subjects, who lived in a city or a sparsely populated area of Sweden, were tape-recorded, transcribed and analysed in the interpretive tradition by the three authors. New, intense and threatening pain quickly made persons report sick. For other pain, sickness absence, its timing and duration, were negotiated on the basis of the subjects' self-image, work-duty norms, organisational and extra-organisational work factors. Thirty-one people aimed to return to work, but spine-related pain was a hindrance. Five strategies to avoid, delay or shorten sickness absence were identified. Concepts of the illness flexibility model well described how the workers balanced the factors driving them from work and those forcing them or attracting them to remain. The conclusion is that reporting sick is neither undertaken lightly nor for short-term reasons only. Instead, personal history and anticipated future, spine-related pain, workplace and labour market factors are also important considerations.

Scandinavian Journal of Rheumatology, 1991

A model for functional assessment and a dynamic test of the shoulder joint were designed and test... more A model for functional assessment and a dynamic test of the shoulder joint were designed and tested for normal variation and clinical inter- and intra-rater reliability. The functional assessments, which covered four common shoulder functions, were compared with assessments of pain, recordings of active motion range and the results of a Health Assessment Questionnaire, in eight patients with rheumatoid arthritis according to the ARA criteria. Intra-rater reliability was satisfactory for all four functions and inter-rater reliability was satisfactory for the hand-raising and hand-to-opposite-shoulder functions but less so for hand-behind-back and hand-to-neck. A second test-retest study in 15 patients, with a slight modification of one of the functional tests, confirmed the results and improved the reliability of the modified test. The reliability of the dynamic test and of the active motion range measurement was less satisfactory or not satisfactory. No significant correlation was found between shoulder functional assessment and the Fries index, but there were positive significant correlations between active motion range and shoulder functions. It is concluded that the method presented for evaluating shoulder functions has satisfactory reliability and in the first test-retest study was more reliable than conventional motion range measurement of the shoulder joint.

Scandinavian Journal of Rheumatology, 1991

Physiotherapy Research International, 1999

Physiotherapy Research International, 1999

Physiotherapy Research International, 2003

In the general population many daily activities have an impact on low back pain. The aim of the p... more In the general population many daily activities have an impact on low back pain. The aim of the present study was to describe pain intensity, localization, type of sensation and perceived activity limitation in women with different back pain patterns post-partum. In this cross-sectional survey 119 women with back pain persisting for two months after having given birth were interviewed and examined on average 7.2 months (range 6-10 months) post-partum. Based on pain provocation tests, four different back pain pattern groups were identified. Pain could be provoked in the area of the posterior pelvic/sacroiliac joints, in the lumbar spine, both in the posterior pelvic/sacroiliac joints and in the lumbar spine, and in none of the above areas. All women rated pain intensity on a visual analogue scale (VAS, 0-100 mm), and the pain localization and type of sensation were indicated on a pain drawing. They scored their activity limitations by use of the Disability Rating Index (DRI), which covers 12 daily activity items (VAS, 0-100 mm). There was no significant difference (p = 0.12) in pain intensity (range of medians 19.5-10 mm) between the four groups. However, on average, most areas in the lower back (median 5 mm (range 2-14 mm)), were marked in the group with pain in both the posterior pelvic/sacroiliac joints and in the lumbar spine. The women in the three groups where pain was provoked in the lower area of the back had significantly (p < 0.01) more difficulties with movement-related daily activities than the group where no pain could be provoked. The findings of this descriptive study suggest that back pain post-partum provoked by clinical tests considerably hampers movement-related activities. It seems important to pay special attention to the women where pain could be provoked in the lower back areas. The women should be identified early in the post-partum period to initiate adequate treatment.

Physiotherapy Research International, 2003

Pain, 1986

The purpose of the present study was to compare intensity levels assessed on Borg's Categ... more The purpose of the present study was to compare intensity levels assessed on Borg's Category Scale for Ratings of Perceived Pain (BRPP) (1982) (a verbal scale using adjectives and adverbs combined with the numbers 0-10), with assessments on the Visual Analogue Scale (VAS) (a 10 cm horizontal line). Eight healthy subjects volunteered in an experimental study, where pain was provoked by load on passive soft tissue elbow joint structures. Each subject participated 4 times on different occasions in the same experimental set-up, which was divided into six 2 min periods; 3 periods with load induced by applied external weights causing load moments of 3.4 Nm, 4.5 Nm and 6.8 Nm plus that induced by the weight of the lower arm and hand (average 2.9 Nm), followed by 3 periods without external weights. Each series consisted of 12 assessments given during the last 10 sec period of each minute on either the BRPP or the VAS. No significant difference was found between the first and second time a scale was used by the same subject, and none between the assessments on the VAS and the BRPP. Intensity levels of pain increased with load and time and decreased after reduction of the load moments. It is concluded that both scales can be used to reliably assess intensity levels of perceived pain elicited by loading joint structures. Intensity levels, as assessed on both scales, are associated with applied external load and time for exposure.

Journal of Rehabilitation Medicine, 2009

The purpose of this study was to describe and analyse self-rated perceived functioning, disabilit... more The purpose of this study was to describe and analyse self-rated perceived functioning, disability and environmental facilitators/barriers with regard to disease severity, using the International Classification of Functioning, Disability and Health (ICF) checklist, in adults with myotonic dystrophy type 1. Cross-sectional design. Forty-one women and 29 men with myotonic dystrophy type 1. A modified ICF checklist was used for self-rating of perceived problems in 29 body-function categories, difficulties in 52 activity and participation categories, and facilitators/barriers in 23 environmental-factor categories according to the verbal anchors of the ICF qualifiers. Disease severity classification was based on the muscular impairment rating scale. Of the persons with myotonic dystrophy type 1, 80% perceived problems of excessive daytime sleepiness, 76% of muscle power, and 66% of energy and drive functions, while over 59% perceived difficulties in physically demanding mobility activities. Disabilities in mobility, self-care and domestic life were more frequently reported by persons with severe disease. Support from the immediate family, medicines and social security services were perceived as facilitators for 50-60% of the participants. Disabilities and important environmental facilitators in adults with myotonic dystrophy type 1 were identified, and this clinically-relevant information can be used for developing health services for people with this condition.

Scandinavian journal of rehabilitation medicine. Supplement

Existing studies of shoulder joint loading, muscle strength and muscular activity do not, from th... more Existing studies of shoulder joint loading, muscle strength and muscular activity do not, from the point of view of clinical application, adequately cover these factors, knowledge of which is important for the design of optimal exercises for training shoulder impairments. In the present study, exercises using a weight-and-pulley device have been analysed in order to map the resistance moments of force in relation to the muscular strength capacity of shoulder internal rotators , and to map the activation of these muscles in response to the resistance from the device. The relationships established in the study provide a basis for optimising various types of shoulder training exercises. For example, an angle of 40 degrees between frontal plane and shoulder-pulley line has been found to give the best adaptation of resistance to strength. The study also demonstrates the possibility of using a pulley apparatus for shoulder inward rotator muscle training.

Journal of Rehabilitation Medicine, 2011

To investigate the feasibility and effects of a physical exercise programme on functioning and he... more To investigate the feasibility and effects of a physical exercise programme on functioning and health-related quality of life in adults with myotonic dystrophy type 1. A randomized controlled trial. Thirty-five adults with myotonic dystrophy type 1. After stratification for level of functioning, study participants were assigned by lot to either a training group or a control group. Training-group participants attended a 60-minute comprehensive group-training programme, Friskis&Svettis® Open Doors, twice a week for 14 weeks. The six-minute walk test was the primary outcome measure and the timed-stands test, the timed up-and-go test, the Epworth sleepiness scale and the Short Form-36 health survey were secondary outcome measures. Intention-to-treat analyses revealed no significant differences in any outcome measures, except for an increased between-group difference after intervention in the Short Form-36 mental health subscale and a decrease in the vitality subscale for the control group. The programme was well tolerated and many training-group participants perceived subjective changes for the better. No negative effects were reported. The Friskis&Svettis® Open Doors programme was feasible for adults with myotonic dystrophy type 1 who had been screened for cardiac involvement, had distal or mild-to-moderate proximal muscle impairment, and no severe cognitive impairments. No beneficial or detrimental effects were evident.

Aviation, space, and environmental medicine, 2003

Fighter pilots are frequently exposed to high acceleration (+Gz) forces during sorties. To counte... more Fighter pilots are frequently exposed to high acceleration (+Gz) forces during sorties. To counter these forces the pilots wear anti-G ensembles, use positive pressure breathing for G protection (PBG), and perform anti-G straining maneuvers (AGSMs). The purpose of this study was to analyze the muscle activity during sustained high G when no positive pressure breathing was used (control) compared with that during the use of PBG. Seven Swedish Air Force fighter pilots volunteered to be exposed to gradual and rapid onset runs to +9 Gz with and without PBG in a human centrifuge. Surface electromyography was recorded from the intercostals, rectus abdominis, vastus lateralis, biceps femoris, and gastrocnemius lateralis. Measured variables included mean muscle activity, relative time with high muscle activity levels, and individual activation preferences. G duration tolerance was significantly longer (p = 0.028) when PBG was used (57 s) compared with control (32 s) during rapid onset runs....

Scandinavian Journal of Caring Sciences, 1998

A questionnaire about assistive devices for lift and transfer was distributed to all individuals ... more A questionnaire about assistive devices for lift and transfer was distributed to all individuals evaluated at the Solberga Project outpatient service unit, a regional centre for long-term follow-up of severely brain injured persons in the Greater Stockholm area. The target group was 60 severely brain injured adults, of whom 57 (30 women and 27 men) answered a questionnaire created by one of the authors. The causes of injury in the study population were trauma (n = 27), cerebrovascular accident (n = 19), anoxia (n = 10) and other (n = 1). Thirty-two persons were quadriplegic after the injury and 21 were hemiplegic. More than half (33/57) reported problems with all five defined lift and transfer situations. Most (42/44) reported problems getting in and out of their wheelchairs. Technical aids were seldom used; 24 persons did not use any aids at all. The most commonly used aid was an adjustable bed. Most of the technical aids were used when the individual also had personal assistance. The persons who managed lift and transfer by themselves used few aids. It is reasonable to assume that severely brain injured individuals would be involved in more activities if they used technical aids more readily.

European Journal of Applied Physiology and Occupational Physiology, 1992

The purpose of the study was to analyse the effect of arm-shoulder fatigue on manual performance.... more The purpose of the study was to analyse the effect of arm-shoulder fatigue on manual performance. Ten experienced carpenters performed three standardized tasks (nailing, sawing and screwing). Electromyographic activity was recorded from six arm-shoulder muscles and the performances were video-filmed. After 45 min of standardized arm-cranking (arm-shoulder-fatiguing exercise of approximately 70%-80% maximal oxygen consumption), the tasks were repeated. The number of work movements and the time taken for each task were recorded and the quality of the work performed was compared. After the fatiguing exercise, only nailing was perceived as being harder and more mistakes were made during nailing and sawing. Movement performance was not influenced during nailing but was slightly slower during sawing and faster during screwing. However, there were increased mean EMG amplitudes in the upper trapezius and biceps muscles during nailing, in the upper trapezius, anterior deltoid and infraspinatus muscles during sawing and in the anterior deltoid muscle during screwing. Of the muscles studied the upper trapezius and anterior deltoid muscles increased their activity most after the arm-shoulder-fatiguing exercise.

Clinical Biomechanics, 1995

Changes in kinematics as a function of lifting weight and frequency was investigated in sagittal ... more Changes in kinematics as a function of lifting weight and frequency was investigated in sagittal symmetric repetitive lifting. For every lift cycle (lowering and lifting) the motion range between the upright position (0 degrees ) and the maximum angular displacement of the thigh and lower-trunk body segments was recorded. Ten subjects performed five repetitive lifting bouts with different weight/frequency combinations, using both stoop and squat lifting techniques. In total, 6384 lifts were analysed. The lifting weight or frequency did not influence the motion ranges in stoop lifting. In squat lifting the weight lifted did not appear to have any influence on the motion ranges, while the thigh motion range was significantly smaller at lifting frequency of 20 lifts min(-1) than at a frequency of 10. A significant gradual decrease in the thigh motion range and corresponding increase in the lower-trunk motion range were seen for a majority of the subjects during squat lifting at frequency 20. These changes suggest that quadriceps muscle strength is the limiting factor in repetitive squat lifting. Also the variation in motion ranges was greater in squat lifting than in stoop lifting. RELEVANCE: Forestry work involves frequent lifting. However, compliance in using squat lifting technique, which is recommended for safe lifting, is sometimes poor. Fatigue may be one of the determinants for changes in kinematics and choice of technique in lifting tasks.

Knee joint loading and the level of knee muscle activation during rising exercises have been eval... more Knee joint loading and the level of knee muscle activation during rising exercises have been evaluated and methods have been developed for such studies. Floor-to-foot forces were recorded using a force-measuring platform. The loading moment of force representing the resistance for the knee joint was calculated. It was shown that the initial knee loading moment with much flexed knees was high at large knee angles. The loading moment showed a marked decrease with decreasing knee angles. For small knee angles there was no resistance to knee extension. Muscular activity level was studied using EMG. The levels of activity in the quadriceps muscles were high at large knee angles and low at small angles. The hamstrings and gastrocnemius showed only low activity. The magnitude of change in knee extension resistance due to adaptive adjustment of the exercise device was mapped. These rising exercises will increase strength mainly for large knee angles and only for quadriceps muscles.

Spine, 2005

A randomized assessor-blinded clinical trial was conducted. To compare 3 different physical thera... more A randomized assessor-blinded clinical trial was conducted. To compare 3 different physical therapy treatments with respect to pain and activity in women with pelvic girdle pain during pregnancy and 3, 6, and 12 months postpartum. In spite of the high prevalence of back pain during pregnancy, documented treatment programs are limited. Based on a clinical examination, 118 women with pelvic girdle pain diagnosed during pregnancy were randomized into 3 different treatment groups: Information Group, use of a nonelastic sacroiliac belt and oral/written information about pelvic girdle pain (n = 40); Home Exercise Group, same as in the Information Group, with the addition of a home exercise program (n = 41); and the In Clinic Exercise Group, same as in the Information Group, plus participation in a training program (n = 37). Pain intensity was rated on a visual analogue scale (0-100 mm) and marked on a pain drawing concerning localization. The activity ability was scored using the Disability Rating Index, covering 12 daily activity items. Outcome measures were obtained at inclusion, on average in gestation week 38, and 3, 6, and 12 months postpartum. There was no significant difference among the 3 groups during pregnancy or at the follow-ups postpartum regarding pain and activity. In all groups, pain decreased and the activity ability increased between gestation week 38 and at 12 months postpartum. Women with pelvic girdle pain seemed to improve with time in all 3 treatment groups. Neitherhome nor in clinic exercises had any additional value above giving a nonelastic sacroiliac belt and information.

SPINE, 1994

Local thigh and low back perceived exertion (RPE), sagittal peak load moments, and leg and trunk ... more Local thigh and low back perceived exertion (RPE), sagittal peak load moments, and leg and trunk muscular activity during repetitive submaximal lifting, with squat and stoop technique, were investigated. This study analyzed changes in kinetic variables caused by changes in body movements during the lifting bouts, and the contribution of the biomechanical and physiologic variables to the variability in the local RPE responses. Despite instructions that emphasize the "correct" lifting technique as the squat technique, the stoop technique is reported as more commonly used in practice. Few studies have investigated the effect of lifting technique on differentiated perceptual responses in repetitive lifting. Ten experienced forest workers performed submaximal repetitive lifting bouts until steady-state VO2 was reached, using five different weight and frequency combinations with both squat and stoop techniques. Borg's scale was used for RPE measurements. Muscular activity in lumbar, hip, knee extensors, and knee flexors was recorded with surface electrodes. Kinematic data was obtained from electronic liquid-level sensors, and vertical ground reaction forces from a two-dimensional force plate. Low back RPE was higher for stoop than for squat, whereas the opposite was true for thigh RPE. The total accountable variance (R2) for the biomechanical and physiologic variables to the RPE responses ranged from 0.25 (low back RPE in squat lifting) to 0.61-0.76 for the other assessments. During the time course in squat lifting at the highest frequency, the knee load moment decreased and the vertical ground reaction forces increased. The study indicates that "movement strategies" to reduce the demand on the knee-extensor muscles were used during the squat lifting bouts at the highest frequencies, which combined with the relatively high assessed thigh exertions, leads to the hypothesis that quadriceps muscle exertion is the "weak link" for the squat technique. The study also indicates a discrepancy between the measured and perceived low back stress in squat repetitive lifting.

Social Science & Medicine, 2006

This study explores the decision of 33 men and women to be sick-listed from work for neck pain or... more This study explores the decision of 33 men and women to be sick-listed from work for neck pain or low-back pain. Qualitative interviews with the subjects, who lived in a city or a sparsely populated area of Sweden, were tape-recorded, transcribed and analysed in the interpretive tradition by the three authors. New, intense and threatening pain quickly made persons report sick. For other pain, sickness absence, its timing and duration, were negotiated on the basis of the subjects' self-image, work-duty norms, organisational and extra-organisational work factors. Thirty-one people aimed to return to work, but spine-related pain was a hindrance. Five strategies to avoid, delay or shorten sickness absence were identified. Concepts of the illness flexibility model well described how the workers balanced the factors driving them from work and those forcing them or attracting them to remain. The conclusion is that reporting sick is neither undertaken lightly nor for short-term reasons only. Instead, personal history and anticipated future, spine-related pain, workplace and labour market factors are also important considerations.

Scandinavian Journal of Rheumatology, 1991

A model for functional assessment and a dynamic test of the shoulder joint were designed and test... more A model for functional assessment and a dynamic test of the shoulder joint were designed and tested for normal variation and clinical inter- and intra-rater reliability. The functional assessments, which covered four common shoulder functions, were compared with assessments of pain, recordings of active motion range and the results of a Health Assessment Questionnaire, in eight patients with rheumatoid arthritis according to the ARA criteria. Intra-rater reliability was satisfactory for all four functions and inter-rater reliability was satisfactory for the hand-raising and hand-to-opposite-shoulder functions but less so for hand-behind-back and hand-to-neck. A second test-retest study in 15 patients, with a slight modification of one of the functional tests, confirmed the results and improved the reliability of the modified test. The reliability of the dynamic test and of the active motion range measurement was less satisfactory or not satisfactory. No significant correlation was found between shoulder functional assessment and the Fries index, but there were positive significant correlations between active motion range and shoulder functions. It is concluded that the method presented for evaluating shoulder functions has satisfactory reliability and in the first test-retest study was more reliable than conventional motion range measurement of the shoulder joint.

Scandinavian Journal of Rheumatology, 1991

Physiotherapy Research International, 1999

Physiotherapy Research International, 1999

Physiotherapy Research International, 2003

In the general population many daily activities have an impact on low back pain. The aim of the p... more In the general population many daily activities have an impact on low back pain. The aim of the present study was to describe pain intensity, localization, type of sensation and perceived activity limitation in women with different back pain patterns post-partum. In this cross-sectional survey 119 women with back pain persisting for two months after having given birth were interviewed and examined on average 7.2 months (range 6-10 months) post-partum. Based on pain provocation tests, four different back pain pattern groups were identified. Pain could be provoked in the area of the posterior pelvic/sacroiliac joints, in the lumbar spine, both in the posterior pelvic/sacroiliac joints and in the lumbar spine, and in none of the above areas. All women rated pain intensity on a visual analogue scale (VAS, 0-100 mm), and the pain localization and type of sensation were indicated on a pain drawing. They scored their activity limitations by use of the Disability Rating Index (DRI), which covers 12 daily activity items (VAS, 0-100 mm). There was no significant difference (p = 0.12) in pain intensity (range of medians 19.5-10 mm) between the four groups. However, on average, most areas in the lower back (median 5 mm (range 2-14 mm)), were marked in the group with pain in both the posterior pelvic/sacroiliac joints and in the lumbar spine. The women in the three groups where pain was provoked in the lower area of the back had significantly (p < 0.01) more difficulties with movement-related daily activities than the group where no pain could be provoked. The findings of this descriptive study suggest that back pain post-partum provoked by clinical tests considerably hampers movement-related activities. It seems important to pay special attention to the women where pain could be provoked in the lower back areas. The women should be identified early in the post-partum period to initiate adequate treatment.

Physiotherapy Research International, 2003

Pain, 1986

The purpose of the present study was to compare intensity levels assessed on Borg's Categ... more The purpose of the present study was to compare intensity levels assessed on Borg's Category Scale for Ratings of Perceived Pain (BRPP) (1982) (a verbal scale using adjectives and adverbs combined with the numbers 0-10), with assessments on the Visual Analogue Scale (VAS) (a 10 cm horizontal line). Eight healthy subjects volunteered in an experimental study, where pain was provoked by load on passive soft tissue elbow joint structures. Each subject participated 4 times on different occasions in the same experimental set-up, which was divided into six 2 min periods; 3 periods with load induced by applied external weights causing load moments of 3.4 Nm, 4.5 Nm and 6.8 Nm plus that induced by the weight of the lower arm and hand (average 2.9 Nm), followed by 3 periods without external weights. Each series consisted of 12 assessments given during the last 10 sec period of each minute on either the BRPP or the VAS. No significant difference was found between the first and second time a scale was used by the same subject, and none between the assessments on the VAS and the BRPP. Intensity levels of pain increased with load and time and decreased after reduction of the load moments. It is concluded that both scales can be used to reliably assess intensity levels of perceived pain elicited by loading joint structures. Intensity levels, as assessed on both scales, are associated with applied external load and time for exposure.

Journal of Rehabilitation Medicine, 2009

The purpose of this study was to describe and analyse self-rated perceived functioning, disabilit... more The purpose of this study was to describe and analyse self-rated perceived functioning, disability and environmental facilitators/barriers with regard to disease severity, using the International Classification of Functioning, Disability and Health (ICF) checklist, in adults with myotonic dystrophy type 1. Cross-sectional design. Forty-one women and 29 men with myotonic dystrophy type 1. A modified ICF checklist was used for self-rating of perceived problems in 29 body-function categories, difficulties in 52 activity and participation categories, and facilitators/barriers in 23 environmental-factor categories according to the verbal anchors of the ICF qualifiers. Disease severity classification was based on the muscular impairment rating scale. Of the persons with myotonic dystrophy type 1, 80% perceived problems of excessive daytime sleepiness, 76% of muscle power, and 66% of energy and drive functions, while over 59% perceived difficulties in physically demanding mobility activities. Disabilities in mobility, self-care and domestic life were more frequently reported by persons with severe disease. Support from the immediate family, medicines and social security services were perceived as facilitators for 50-60% of the participants. Disabilities and important environmental facilitators in adults with myotonic dystrophy type 1 were identified, and this clinically-relevant information can be used for developing health services for people with this condition.