Short- and long-term effects of exercise on neck muscle function in cervical radiculopathy:A randomized clinical trial

OBJECTIVE: To compare short- and long-term changes in neck muscle endurance, electromyography measures of neck muscle activation and fatigue and ratings of fatigue and pain after neck-specific training or physical activity in people with cervical radiculopathy.DESIGN: Randomized clinical trial.SUBJECTS/PATIENTS: Seventy-five patients with cervical radiculopathy.METHODS: Patients underwent neck-specific training in combination with a cognitive behavioural approach or prescribed physical activity over a period of 14 weeks. Immediately after the intervention and 12 months later, surface electromyography was recorded from neck flexor and extensor muscles during neck endurance tests. Time to task failure, amplitude and median frequency of the electromyography signal, and subjective fatigue and pain ratings were analysed in 50 patients who completed at least one follow-up.RESULTS: A significant increase in neck flexor endurance time was observed for both groups at 14 weeks compared with baseline and this was maintained at the 12-month follow-up (p &lt; 0.005). No change was identified for the slope of the median frequency. For the neck-specific training group, splenius capitis was less active during neck flexion at both follow-ups (p &lt; 0.01), indicating reduced muscle co-activation.CONCLUSION: Both specific and general exercise increased neck flexor endurance, but neck-specific training only reduced co-activation of antagonist muscles during sustained neck flexion.</p

Kunskapsläget på kärnavfallsområdet 2018

Kärnavfallsrådet (rådet) ger årligen ut en kunskapslägesrapport. Åretsrapport är uppdelad i två delar: Del 1 handlar om beslut under osäkerhet. Regeringen ska framöver fatta beslut om ett slutförvar för använt kärnbränsle och det kommer att fattas under osäkerhet. Det i sig är inget ovanligt för regeringen utan görs hela tiden på olika områden, men det är däremot ett ovanligt komplicerat projekt. (Se kort översikt nedan). Rådet ger utifrån sin tvärvetenskapliga sammansättning några exempel på olika områden med osäkerheter och resonerar kring hur det går att hantera och förhålla sig till osäkerheter i beslutsfattande, såväl i allmänhet som när det gäller ett beslut om ett slutförvar för använt kärnbränsle i synnerhet. Del 2 innehåller en rapportering om rådets arbete och en kort beskrivning om vad som hänt på kärnavfallsområdet i Sverige under 2017. Mycket har hänt under året, exempelvis när det gäller tillståndsprocessen för använt kärnbränsle, tillståndsprocessen om utbyggnad för Slutförvaret för kortlivat avfall (SFR) och när det gäller finansieringsfrågor. Här finns även en kort beskrivning av vad som händer nu när regeringen den 23 januari 2018 har fått ärendet om ett slutförvar för använt kärnbränsle på sitt bord. Bakgrund till slutförvar, ansökningar och KBS-3-metoden När det gäller ett beslut om ett slutförvar för använt kärnbränsle är det av flera anledningar ett komplext projekt. Det är tekniskt komplicerat eftersom förvaret ska vara säkert i minst 100 000 år, s.k. långsiktigt säkert. Anläggningstiden för slutförvaret är ovanligt lång, det planeras vara klart först om ca 70–80 år. Vi vet inte vad som händer med tekniken, klimatet eller i samhället under de långa tidshorisonterna. Det finns inte heller något färdigbyggt förvar för använt kärnbränsle som vi kan dra lärdom av. En kärnkraftsreaktor drivs av kärnbränsle som efter ca 5 års användning blir s.k. använt kärnbränsle. Det högaktiva använda kärnbränslet betraktas inte som kärnavfall, enligt kärntekniklagen, innan det ligger placerat i ett slutförvar. Det är reaktorinnehavarnas ansvar att ta hand om sitt kärnavfall och använda kärnbränsle. För att ta sitt ansvar har reaktorinnehavarna tillsammans bildat bolaget Svensk Kärnbränslehantering AB (SKB) som planerar, driver och uppför mellanlager och slutförvar. SKB ansöker nu om att få uppföra och driva ett slutförvar för använt kärnbränsle enligt KBS-3-metoden. Ansökningarna gäller ett system som består av två anläggningar; en inkapslingsanläggning i Oskarshamns kommun och en slutförvarsanläggning i Forsmark, Östhammars kommun. KBS-3-metoden bygger på tre säkerhetsbarriärer: kopparkapslarna, bentonitleran och berget. Det använda kärnbränslet ska kapslas in i kopparkapslar som därefter placeras i ett tunnelsystem på ca 500 meters djup nere i berget. Kapslarna omges därefter med bentonitlera som ska svälla och skydda kapslarna. Planen är att deponera ca 6 000 kapslar med vardera ca 2 ton använt kärnbränsle, totalt ca 12 000 ton. I dag ligger det ca 7 000 ton under vatten i bassänger iOskarshamn (Clab). SKB lämnade in sina ansökningar om tillstånd att få uppföra, inneha och driva ett slutförvar för använt kärnbränsle i mars 2011. Det krävs tillstånd, och tillståndsprövningen sker i två separata processer. Mark- och miljödomstolen vid Nacka tingsrätt har berett ansökan enligt Miljöbalken (1998:808) och Strålsäkerhetsmyndigheten (SSM) har berett ansökningarna enligt Lagen (1984:3) om kärnteknisk verksamhet (kärntekniklagen). Den 23 januari 2018 lämnade mark- och miljödomstolen och SSM sina yttranden tillsammans med ansökningarna till regeringen. Det är regeringen som prövar ansökningarna och därefter fattar beslut om huruvida verksamheten kan tillåtas enligt miljöbalken (s.k. tillåtlighet) och om tillstånd enligt kärntekniklagen. En utmaning med att bedöma ansökningarna är att de bygger på referensutformningar som ska bli alltmer detaljerade, eftersom det tar lång tid att bygga och driva förvaret. Under driftstiden ska tunnlar grävas och byggas samtidigt som kapslarna med använt kärnbränsle ska placeras med bentonitlera runtom (deponeras). Yttrandena från mark- och miljödomstolen och SSM överlämnades till regeringen under absoluta slutskedet av arbetet med denna kunskapslägesrapport. Rådet har alltså inte haft dessa som bakgrund under skrivprocessen utan reflekterar endast kort kring dem

Dimensions Underlying Measures of Disability, Personal Factors, and Health Status in Cervical Radiculopathy A Cross-Sectional Study

This cross-sectional study sought to identify dimensions underlying measures of impairment, disability, personal factors, and health status in patients with cervical radiculopathy. One hundred twenty-four patients with magnetic resonance imaging-verified cervical radiculopathy, attending a neurosurgery clinic in Sweden, participated. Data from clinical tests and questionnaires on disability, personal factors, and health status were used in a principal-component analysis (PCA) with oblique rotation. The PCA supported a 3-component model including 14 variables from clinical tests and questionnaires, accounting for 73% of the cumulative percentage. The first component, pain and disability, explained 56%. The second component, health, fear-avoidance beliefs, kinesiophobia, and self-efficacy, explained 9.2%. The third component including anxiety, depression, and catastrophizing explained 7.6%. The strongest-loading variables of each dimension were "present neck pain intensity," "fear avoidance," and "anxiety." The three underlying dimensions identified and labeled Pain and functioning, Health, beliefs, and kinesiophobia, and Mood state and catastrophizing captured aspects of importance for cervical radiculopathy. Since the variables "present neck pain intensity," "fear avoidance," and "anxiety" had the strongest loading in each of the three dimensions; it may be important to include them in a reduced multidimensional measurement set in cervical radiculopathy.Funding Agencies|Stockholm County Council ALF; Karolinska Institutet, Sweden</p

Dimensions Underlying Measures of Disability, Personal Factors, and Health Status in Cervical Radiculopathy A Cross-Sectional Study

This cross-sectional study sought to identify dimensions underlying measures of impairment, disability, personal factors, and health status in patients with cervical radiculopathy. One hundred twenty-four patients with magnetic resonance imaging-verified cervical radiculopathy, attending a neurosurgery clinic in Sweden, participated. Data from clinical tests and questionnaires on disability, personal factors, and health status were used in a principal-component analysis (PCA) with oblique rotation. The PCA supported a 3-component model including 14 variables from clinical tests and questionnaires, accounting for 73% of the cumulative percentage. The first component, pain and disability, explained 56%. The second component, health, fear-avoidance beliefs, kinesiophobia, and self-efficacy, explained 9.2%. The third component including anxiety, depression, and catastrophizing explained 7.6%. The strongest-loading variables of each dimension were "present neck pain intensity," "fear avoidance," and "anxiety." The three underlying dimensions identified and labeled Pain and functioning, Health, beliefs, and kinesiophobia, and Mood state and catastrophizing captured aspects of importance for cervical radiculopathy. Since the variables "present neck pain intensity," "fear avoidance," and "anxiety" had the strongest loading in each of the three dimensions; it may be important to include them in a reduced multidimensional measurement set in cervical radiculopathy.Funding Agencies|Stockholm County Council ALF; Karolinska Institutet, Sweden</p

Inter-rater and test-retest reliability of movement control tests for the neck, shoulder, thoracic, lumbar, and hip regions in military personnel

Strategies are needed to mitigate the high rates and related risks of musculoskeletal complaints and injuries (MSCI) in the military aviator community. Previous work on Swedish Armed Forces (SwAF) soldiers have shown that proper screening methods have been successful in reducing early discharge from military training. Research has pointed at the importance of optimal spinal movement control in military aviators. The aim of this work was to investigate the inter-rater and test-retest reliability of a battery of clinical tests for evaluating movement control in the neck, shoulders, thoracic, lumbar, and hip regions in a population of SwAF military personnel. Inter-rater and test-retest reliability of 15 movement control tests were assessed by crude and prevalence-adjusted kappa coefficient. The study included 37 (inter-rater) and 45 (test-retest) SwAF personnel and was performed with two physiotherapists simultaneously observing and rating the movements on the first occasion and repeated with one physiotherapist on the second occasion. For inter-rater reliability, the kappa coefficient ranged from .19 to .95. Seven tests showed substantial to almost perfect agreement (kappa &gt; .60). With the adjusted kappa, three more tests reached the level of substantial agreement. The corresponding values for test-retest reliability ranged from .26 to .65. Substantial agreement was attained for two tests, three with adjusted kappa. The following tests can reliably be used when screening for biomechanically less advantageous movement patters in military aviators: Shoulder flexion, and rotation, Neck flexion in sitting and supine, Neck extension and rotation in sitting, Pelvic tilt, Forward lean and Single and Double knee extension tests. Grading criteria for tests in supine and quadruped positions need to be further elaborated

Effects of functional electrical stimulation training for six months on body composition and spasticity in motor complete tetraplegic spinal cord-injured individuals

The effect of functional electrical stimulation (FES) training on body composition, assessed by computed tomography, and the effect of spasticity, assessed by both objective and subjective measures, are evaluated. Fifteen motor-complete spinal-cord-injured men participated in the study. Eight of the 15 subjects undertook FES cycling 3 times weekly for 6 months. Whole body computed tomography scans evaluated changes in body composition. Simultaneous Modified Ashworth Scale and electromyography (EMG) measurements, resistive torque (Kin-Com) and EMG measurements, and self-ratings with Visual Analogue Scale during four consecutive days were used to evaluate changes in spasticity. Lower extremity muscle volume increased by an average of 1300 cm3 (p < 0.001) in the training group compared to the control group, who experienced no change. Otherwise no changes in body composition were seen. Significant correlations (Spearman) were found between individual EMG activity recordings and movement-provoked Modified Ashworth Scale ratings in 26% of the test situations, irrespective of group and time. The objective and subjective evaluation of movement-provoked passive (viscoelastic) and active (spasticity-related) resistance remained unchanged

How does exercise dose affect patients with long-term osteoarthritis of the knee? A study protocol of a randomised controlled trial in Sweden and Norway : the SWENOR Study

INTRODUCTION: Osteoarthritis (OA) of the knee is characterised by knee pain, disability and degenerative changes, and places a burden on societies all over the world. Exercise therapy is an often-used modality, but there is little evidence of what type of exercise dose is the most effective, indicating a need for controlled studies of the effect of different dosages. Thus, the aim of the study described in this protocol is to evaluate the effects of high-dose versus low-dose medical exercise therapy (MET) in patients with knee OA. METHODS AND ANALYSIS: This is a multicentre prospective randomised two-arm trial with blinded assessment and data analysis. We are planning to include 200 patients aged 45-85 years with symptomatic (pain and decreased functioning) and X-ray verified diagnosis of knee OA. Those eligible for participation will be randomly allocated to either high-dose (n=100) or low-dose (n=100) MET. All patients receive three supervised treatments each week for 12 weeks, giving a total of 36 MET sessions. The high-dose group exercises for 70-90 min compared with 20-30 min for the low-dose group. The high-dose group exercises for a longer time, and receives a greater number of exercises with more repetitions and sets. Background and outcome variables are recorded at inclusion, and outcome measures are collected after every sixth treatment, at the end of treatment, and at 6-month and 12-month follow-ups. Primary outcome is self-rated knee functioning and pain using the Knee Injury and Osteoarthritis Outcome Score (KOOS). The primary end point is at the end of treatment after 3 months, and secondary end points are at 6 months and 12 months after the end of treatment. ETHICS AND DISSEMINATION: This project has been approved by the Regional Research Ethics Committees in Stockholm, Sweden, and in Norway. Our results will be submitted to peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER: NCT02024126; Pre-results