Þrálátir stoðkerfisverkir – áherslur doktorsritgerðar

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Þrálátir stoðkerfisverkir: algengi, áhrif og þverfræðileg úrræði á Íslandi

Background and aims: Worldwide chronic musculoskeletal (MSK) pain is a prevalent problem constituting a considerable societal burden. The aim was to investigate the prevalence of chronic MSK pain conditions in Iceland and the potential impact on physical and mental health, and further, to assess the potential influence of a 4-week traditional multidisciplinary pain management program (TMP) and a similar program adding neuroscience patient education and mindfulness based cognitive therapy (NEM) on health-related quality of life (HRQL) and pain intensity among women experiencing chronic MSK pain. Methods: Using a population-based randomly selected sample of 5,906 Icelanders, aged 18-79 years (response rate of 60.3%), the prevalence of chronic MSK pain conditions in Iceland, in December 2007, was assessed. The prevalence estimations were weighted by gender, age and residential area to properly represent the underlying population. Multivariate logistic regression models were used to assess associations between chronic MSK pain conditions and functional limitations as well as symptoms. To assess the effectiveness of the two programs we used data from an Icelandic rehabilitation center (Heilsustofnun NLFÍ) including 122 women who received TMP, 90 receiving NEM, and 57 waiting list controls. The HRQL (Icelandic Quality of Life Scale) and pain intensity (100 mm Visual Analogue Scale) had been measured before, as well as after the interventions and 6-months after the completion of the interventions. Analysis of variance and linear regression were used for comparisons. Results: The point prevalence of chronic MSK pain conditions was 19.9% with distinct gender differences (men=15.2%; women=24.7%) and varied considerably with sociodemographic factors. Compared with individuals without chronic MSK pain, those with the condition reported considerably higher odds ratios (OR) of poor physical (OR men=4.0 [95%CI=3.0-5.2]; OR women=6.8 [95%CI=5.4-8.5]) and mental health (OR men=1.7 [95%CI=1.3-2.3]; OR women=2.4 [95%CI=1.9-3.0]) as well as physically demanding daily activities (OR men=2.4 [95%CI=1.8-3.2] – 6.9 [95%CI=4.2-11.5]; OR women=3.2 [95%CI=2.3-4.6] – 7.9 [95%CI=6.3-10.0]), and lower quality of life (OR men=1.5 [95%CI=1.0-2.1]; OR women=1.6 [95%CI=1.2-2.1]). Statistically significant changes were observed immediately after multidisciplinary pain treatment in terms of increased HRQL (TMP=10.5; NEM=9.7 versus waiting list controls=1.3; p<0.001) and reduced pain intensity (TMP=22mm; NEM=17mm versus waiting list controls=0.6mm; p<0.001), with sustained improvements 7 months from baseline (increased HRQL [TMP=6.4; p<0.001 and NEM=6.9; p<0.001]; reduced pain intensity [TMP=11mm; p<0.001 and NEM=15mm; p<0.001]). Limited differences in treatment effectiveness were noted between the two interventions. The TMP participants did not sustain improvement in sleep domain (2.4; p=0.066) whereas the NEM did (3.4; p=0.013). Conclusions: The findings suggest that chronic MSK pain conditions are common in Iceland and are associated with poor health and diminished quality of life. Multidisciplinary interventions improved quality of life and pain intensity among women with chronic MSK pain conditions with lasting effects observed half a year after treatment completion.Inngangur og markmið: Þrálátir stoðkerfisverkir eru algengt vandamál um allan heim og hafa veruleg áhrif á samfélög. Markmið rannsóknanna var að meta algengi þrálátra stoðkerfisverkja á Íslandi og hugsanleg áhrif á líkamlega og andlega heilsu. Einnig að meta hugsanleg áhrif fjögurra vikna hefðbundinnar þverfræðilegrar verkjameðferðar (TMP) og svipaðs meðferðarúrræðis að viðbættri taugafræðilegri sjúklingafræðslu og gjörhygli (NEM) á heilsutengd lífsgæði (HRQL) og magn verkja, meðal kvenna sem upplifa þráláta stoðkerfisverki. Aðferðir: Notast var við lýðgrundað slembiúrtak 5.906 Íslendinga á aldrinum 18-79 ára (svarhlutfall = 60,3%) til að meta algengi þrálátra stoðkerfisverkja á Íslandi í desember 2007. Mat á algengi var viktað með tilliti til kyns, aldurs og búsetu til að endurspegla stöðuna í þjóðfélaginu. Fjölþátta leiðrétt lógistísk aðhvarfsgreining var notuð til að meta tengsl milli þrálátra verkja annars vegar og hömlunnar í daglegum athöfnum og ýmissa einkenna hins vegar. Í íhlutunarrannsókninni var notast við gögn frá íslenskri endurhæfingarstofnun, Heilsustofnun NLFÍ. Í rannsókninni tóku þátt 122 konur sem fengu TMP meðferðina, 90 konur í NEM meðferðinni og 57 konur á biðlista. HRQL (kvarðinn Heilsutengd lífsgæði) og magn verkja (100 mm sjónkvarði) voru mæld fyrir og eftir meðferð sem og sex mánuðum eftir að meðferð lauk. Til að greina árangur var notast við fervikagreiningu og línulega aðhvarfsgreiningu. Niðurstöður: Stundaralgengi þrálátra stoðkerfisverkja var 19,9% með áberandi kynjamun (karlar=15,2%; konur=24,7%) og er breytilegt eftir þjóðfélagslegum aðstæðum. Í samanburði við fólk án þrálátra verkja er fólk með þráláta stoðkerfisverki í aukinni áhættu (líkindahlutfall=OR) fyrir líkamlegum (OR karlar=4,0 [95%CI=3,0-5,2]; OR konur=6,8 [95%CI=5,4-8,5]) og andlegum heilsubresti (OR karlar=1,7 [95%CI=1,3-2,3]; OR konur=2,4 [95%CI=1,9-3,0]), að lýsa hömlunum við ýmsar líkamlega krefjandi athafnir daglegs lífs (OR karlar=2,4 [95%CI=1,8-3,2] – 6,9 [95%CI=4,2-11,5]; OR konur=3,2 [95%CI=2,3-4,6] – 7,9 [95%CI=6,3-10,0]) sem og lakari lífsgæðum (OR karlar=1,5 [95%CI=1,0-2,1]; OR konur=1,6 [95%CI=1,2-2,1]). Heilsutengd lífsgæði jukust í kjölfar þverfræðilegra verkjameðferða (TMP=10,5; NEM=9,7 miðað við biðlista=1,3; p<0,001) og verkir voru minni (TMP=22mm; NEM=17mm miðað við biðlista=0,6mm; p<0,001). Árangur stóðst sjö mánuðum eftir að meðferðin hófst (aukin HRQL [TMP=6,4; p<0,001 og NEM=6,9; p<0,001]; minni verkir [TMP=11mm; p<0,001 og NEM=15mm; p<0,001]). Lítill munur fannst á milli meðferðanna tveggja. Árangur þátttakenda í TMP stóðst ekki til lengri tíma með tilliti til svefns (2,4; p=0,066) öfugt við árangur þátttakenda í NEM meðferðinni (3,4; p=0,013). Ályktun: Niðurstöður benda til að þrálátir stoðkerfisverkir séu algengir á Íslandi og að fólk sem þá upplifir búi við lakara heilsufar og skert lífsgæði. Þverfræðileg endurhæfing eykur lífsgæði og minnkar verki meðal kvenna sem upplifa þráláta stoðkerfisverki og þeirra áhrifa gætir enn hálfu ári eftir að meðferð lýkur.Félag sjúkraþjálfara Fræðslunet Suðurlands Heilsustofnun NLFÍ Námsbraut í sjúkraþjálfun, Háskóla Ísland

Er þörf á sérstakri heilbrigðismóttöku fyrir háskólanemendur?

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnTilgangur: Víða erlendis hafa háskólanemendur aðgang að heilbrigðisþjónustu sem er sérstaklega ætluð þeim. Tilgangur þessarar könnunar meðal nemenda við Háskóla Íslands var að skoða þörf þeirra fyrir sérstaka heilbrigðismóttöku. Aðferð: Rafræn könnun var lögð fyrir 9744 nemendur við háskólann vorið 2011 sem voru á póstlista. Spurningalistinn var saminn af vinnuhópi sem í voru fulltrúar frá öllum deildum Heilbrigðisvísindasviðs Háskóla Íslands. Stuðst var við lýsandi tölfræði við gagnagreiningu. Niðurstöður: Alls bárust svör frá 1487 þátttakendum, 1427 íslenskumælandi og 60 enskumælandi, og gefa svörin því mynd af viðhorfum 15,2% nemenda við skólann. Úrtakið endurspeglar einkum viðhorf kvenstúdenta og nema í grunnnámi. Tæplega 40% íslensku nemanna og um 70% þeirra erlendu höfðu ekki heimilislækni á höfuðborgarsvæðinu. Niðurstöður sýndu að meirihluti þeirra þurfti á heilbrigðisþjónustu að halda á árinu fyrir könnunina en rúmlega helmingur beið með að leita eftir heilbrigðisþjónustu og var meginástæða þess kostnaður. Um þriðjungur íslensku nemanna og fimmtungur þeirra erlendu sögðust eiga í fjárhagsvanda. Um 92% þeirra íslensku og allir erlendu nemarnir sögðust mundu leita á móttöku þar sem þjónustan væri veitt af nemendum skólans undir leiðsögn kennara. Báðir hóparnir vildu hafa aðgang að fjölbreyttri heilbrigðisþjónustu. Ályktanir: Niðurstöðurnar gefa til kynna að þeir háskólanemendur, sem þátt tóku í könnuninni, hafi mikla þörf fyrir sérstaka heilbrigðismóttöku. Kostnaður hefur hvað mest hindrað þá í að leita eftir heilbrigðisþjónustu. Jafnframt er stór hópur án heimilislæknis, einkum sá erlendi, og hefur því ekki greiðan aðgang að heilbrigðisþjónustu á heilsugæslustöðvum.Purpose: In many neighbouring countries university students have access to health services which are specially geared to their needs. The purpose of this survey among university students at the University of Iceland was to explore their need for a special health service. Method: The online survey was administered to 9744 students at the university in the spring of 2011 who were registered e-mail recipients, both Icelandic and English-speaking. The questionnaire was developed by a working group which consisted of representatives from all the faculties at the School of Health Sciences. Data were analysed by descriptive statistical methods. Results: There were 1487 participants who responded, 1427 Icelandic and 60 English-speaking representing 15,2% of the university student population. The sample represents especially the attitudes of undergraduate and female students. Almost 40% of the Icelandic students and nearly 70% of the English-speaking students did not have a family practitioner in the capital area. The results showed that the great majority of respondents had needed health services in the year before the study took place. More than half of them reported that they had postponed seeking health services citing cost as the main reason. About 92% of the Icelandic students and all of the foreign students reported that they would attend a health clinic which was provided by university students under supervision. Both groups would like to have access to various health care services. Conclusions: The results indicate that university students who answered the questionnaire had a great need for special health clinic. Costs of service had mainly prevented them from seeking health care services. Additionally, the proportion of students without a family practitioner is high, especially among the foreign students, which is a further hindrance regarding access to primary health care services.Heilbrigðisvísindasvið Landspítal

Posterior-anterior(PA) pressure Puffin for measuring and treating spinal stiffness: Mechanism and repeatability.

To access publisher's full text version of this article click on the hyperlink at the bottom of the pagePosterior-anterior (PA) pressure technique is widely used for assessing and treating spinal segments. PA pressure is manually applied and stiffness is subjectively assessed. The method has been deemed unreliable and is associated with occupational strain.To introduce a new ergonomically designed hand-held device measuring spinal stiffness, and to assess its repeatability.Quasi experimental study.A convenience sample of 30 university students, 20-30 years old was used. The participants were tested two consecutive days by two physical therapy students using the new device; the PA pressure Puffin. The spinal segments under study were L1, Th12, Th7 and Th6 which all were tested three times with 9 kg force by both testers, both days. Intra-class correlation coefficients (ICC3,k) were used to assess intra- and inter-tester repeatability and analysis of variance with alpha-level at 0.05 was used to assess differences in joint mobility at the four segments measured. Linear regression analyses were used to assess repeatability.Inter-tester and intra-tester coefficients (ICCs) ranged from 0.88 to 0.97 and from 0.83 to 0.97, respectively. There was no significant difference in displacement between Th6 and Th7 but all other joints were significantly different from each other. Displacement was always significantly greater the second day compared with day one (p < 0.05).This close to final prototype of the PA pressure Puffin measures segmental spinal stiffness and its ergonomically designed handle provides a promising tool for physical therapists applying PA pressure. Further research is needed for validation and reliability assessments.Icelandic Centre for Researc