Gange- og hinkeferdigheter hos barn med alvorlig medfødte hjertefeil

Formål: Hensikten med studiet var å sammenlikne gange og hinking på en elektronisk gangmatte (GAITRite®) hos barn med alvorlig medfødte hjertefeil og friske barn. Teoretisk forankring: Studiet ble teoretisk forankret i litteratur som omhandlet barn med medfødte hjertefeil, og herunder kirurgiske teknikker, utvikling og funksjon. I tillegg ble det innhentet litteratur angående gange, hinking og motorikk, samt at litteratur som omhandlet måleinstrumentet (GAITRite®) også ble beskrevet. Metode: Studiet var et kasus-kontroll studie. Utvalget besto av to grupper i alderen syv til 13 år (2.-7.klasse) – 113 barn med alvorlig medfødt hjertefeil operert ved Rikshospitalet i første leveår, og 372 friske jevnaldrende barn. Måleinstrumentet som ble brukt var en elektronisk gangmatte (GAITRite®) og variablene som ble undersøkt var maksimal ganghastighet, steglengde, understøttelsesflate og cadence i gange, og hinkelengde, hinkebredde og hinkesyklus (svevefase og standfase) i hinking. Resultater: Det var ingen signifikant forskjell mellom gruppene når det gjaldt alder, høyde og vekt. Barn med CHD hadde signifikant langsommere ganghastighet enn de friske barna. CHD-gruppen viste også noe kortere steglengde og høyere cadence enn sine friske jevnaldrende, men forskjellene var ikke signifikante. Understøttelsesflaten var lik i de to gruppene. Barn med CHD hadde signifikant kortere hinkelengde enn de friske barna, men man fant ingen forskjell i hinkebredde. CHD-barna hadde signifikant kortere svevefase i forhold til de friske barna, mens standfasen ikke viste noen forskjell. Konklusjon: Man fant at flere variabler i både gange og hinking var signifikant forskjellig i de to gruppene. Spesielt i hinkelengde så man stor forskjell mellom gruppene, der CHD-gruppen i gjennomsnitt hinket 25 cm kortere i hvert hink enn den friske gruppen, og hvor kun syv CHD-barn hinket lenger enn gjennomsnittet for de friske barna. De forskjellene man så, kan, med forankring i litteraturen, tyde på en forsinkelse i motorisk utvikling hos barn med CHD. Nøkkelord: CHD (congenital heart disease / medfødte hjertefeil), gange, hinking, GAITRite, motoriske ferdighete

Risk factors for episodes of back pain in emerging adults. A systematic review

BACKGROUND AND OBJECTIVE: The transition from adolescence to adulthood is a sensitive period in life for health outcomes, including back pain. The objective was to synthesize evidence on risk factors for new episodes of back pain in emerging adults (18-29 years). METHODS: The protocol was registered in PROSPERO (CRD42016046635). We searched Medline; EMBASE; AMED and other databases up to September 2018 for prospective cohort studies that estimated the association between risk factor(s) and self-reported back pain. Risk factors could be measured before or during the age range 18-29 years, and back pain could be measured during or after this age range, with at least 12 months between assessments. Risk factors assessed in ≥3 studies were summarized. Risk of bias was assessed using a 6-item checklist. RESULTS: Forty-nine studies were included with more than 150 different risk factors studied. Nine studies had low risk of bias, 26 had moderate, and 14 had high risk of bias. Age, sex, height, body mass index (BMI), smoking, physical activity level, a history of back pain, job satisfaction and structural imaging findings were investigated in 3 or more studies. History of back pain was the only risk factor consistently associated with back pain after adjustment (9 studies). CONCLUSION: There is moderate quality evidence that a history of back pain is a risk factor for back pain. There are inconsistent associations for age, sex, height, BMI, smoking, and activity level. No associations were found between job satisfaction and structural imaging findings and back pain. This article is protected by copyright. All rights reserved

The persistence of anti-Spike antibodies following two SARS-CoV-2 vaccine doses in patients on immunosuppressive therapy compared to healthy controls—a prospective cohort study

The durability of vaccine-induced humoral immunity against SARS-CoV-2 in patients with immune mediated inflammatory diseases (IMIDs) on immunosuppressive therapy is not known. The aim of this study was to compare the persistence of anti-Spike antibodies following two-dose SARS-CoV-2 vaccination between IMID patients and healthy controls and to identify factors associated with antibody decline.publishedVersio

FysioPol; a new electronical database for development of quality and knowledge in physiotherapy

Research question: Is the new FysioPol database useful to explore some core questions in physiotherapy: What characterize patients seeking physiotherapy treatment? Which activity problems do patients report? Which treatment alternatives are used? Will patients improve due to the treatment they receive? Design: Prospective cohort study. Material and methods: Patients at the two clinics are asked to participate in the FysioPol database. A standardized questionnaire is used at baseline and after treatment (9 weeks). Result: A total of 979 patients were asked: 688 (70 %) patients responded to the baseline questionnaire, whereas 516 (75 %) responded after treatment. Most patients were female (66 %) and about 50% were employed. Most patients reported a musculoskeletal disorder (49 %), whereas 24 % of the patients reported several disorders. Other patient groups were heart/lung disease and neurological diseases. Walking/climbing stairs was the most frequently reported activity problem. The main treatment provided were information and individually tailored exercises. After treatment the patients had a statistically significant improvement in work ability, pain intensity, quality of life, emotional distress and activity problems. Conclusion: The FysioPol database is the first quality register of physiotherapy in Norway, and the data from the FysioPol database may be used to assess core physiotherapy issues

The Patient-Specific Functional Scale - A useful tool for physiotherapists working in primary care

Purpose: To examine content validity, reliability and responsiveness of the Patient-Specific Functional Scale (PSFS), for patients with musculoskeletal disorders receiving physiotherapy in primary care. Design: A methodological study with a cross-sectional design for the investigation of content validity and reliability and a prospective cohort design for the investigation of responsiveness. Materials: For the study of content validity and reliability 81 patients were included. For the study of responsiveness 180 patients were included. Methods: Content validity was examined by categorizing the reported activities according to ICF. In the study of reliability Intraclass Correlation Coefficient (ICC), Smallest Error of Measurement (SEM) and Smallest Detectable Change (SDC) were calculated. Responsiveness was examined through a criterion approach. Area under the curve (AUC), sensitivity, specificity and Minimal Important Change (MIC) were calculated with Receiver Operating Characteristics (ROC). Results :Patients mainly reports problems at ICF-activity level. Reliability was acceptable for first reported activity (ICC>0.7), but poorer for activity 2 and 3 (ICC<0.7). Based on SDC and MIC, 2 points change in PSFS score can be considered clinically and statistically relevant. Conclusion: PSFS is a reliable and responsive tool when used to map and evaluate activity problems in patients with musculoskeletal disorders seeking physiotherapy in primary care

Reliability, validity and responsiveness of pelvic floor muscle surface electromyography and manometry

Introduction and hypothesis: Vaginal surface electromyography (sEMG) is commonly used to assess pelvic floor muscle (PFM) function and dysfunction but there is a lack of studies regarding the assessment properties. The aim of the study was to test the hypotheses that sEMG has good test-retest intratester reliability, good criterion validity and is responsive to changes compared to manometry. Methods: PFM resting tone, maximum voluntary contraction (MVC) and endurance were measured in 66 women with pelvic floor dysfunction. One assessment by manometry was followed by two testing sessions with sEMG at baseline. After 4 to 42 weeks of supervised PFM strength training, 29 participants were retested with both devices. Results: Median age of the participants was 41 years (range 24-83) and parity 2 (range 0-10). Very good test-retest intratester reliability was found for all three sEMG measurements. The correlation between sEMG and manometry was moderate for vaginal resting tone (r = 0.42, n = 66, p < 0.001) and strong for MVC (r = 0.66, n = 66, p < 0.001) and endurance (r = 0.67, n = 66, p < 0.001). Following the strength training period, participants demonstrated increased MVC and endurance measured with manometry, but not with sEMG. A significant reduction in resting tone was found only with sEMG. Conclusion: sEMG is reliable and correlates well with manometry. However, sEMG is not as responsive as manometry for changes in PFM MVC and endurance. For measurement of PFM resting tone, sEMG seems more responsive than manometry, but this requires further investigation

Reliability, validity and responsiveness of pelvic floor muscle surface electromyography and manometry

Introduction and hypothesis: Vaginal surface electromyography (sEMG) is commonly used to assess pelvic floor muscle (PFM) function and dysfunction but there is a lack of studies regarding the assessment properties. The aim of the study was to test the hypotheses that sEMG has good test-retest intratester reliability, good criterion validity and is responsive to changes compared to manometry. Methods: PFM resting tone, maximum voluntary contraction (MVC) and endurance were measured in 66 women with pelvic floor dysfunction. One assessment by manometry was followed by two testing sessions with sEMG at baseline. After 4 to 42 weeks of supervised PFM strength training, 29 participants were retested with both devices. Results: Median age of the participants was 41 years (range 24-83) and parity 2 (range 0-10). Very good test-retest intratester reliability was found for all three sEMG measurements. The correlation between sEMG and manometry was moderate for vaginal resting tone (r = 0.42, n = 66, p < 0.001) and strong for MVC (r = 0.66, n = 66, p < 0.001) and endurance (r = 0.67, n = 66, p < 0.001). Following the strength training period, participants demonstrated increased MVC and endurance measured with manometry, but not with sEMG. A significant reduction in resting tone was found only with sEMG. Conclusion: sEMG is reliable and correlates well with manometry. However, sEMG is not as responsive as manometry for changes in PFM MVC and endurance. For measurement of PFM resting tone, sEMG seems more responsive than manometry, but this requires further investigation

Development and external validation of a prediction model for patient-relevant outcomes in patients with chronic widespread pain and fibromyalgia

Background The objective of this study was to develop prediction models and explore the external validity of the models in a large sample of patients with chronic widespread pain (CWP) and fibromyalgia (FM). Methods Patients with CWP and FM referred to rehabilitation services in Norway (n = 986) self-reported data on potential predictors prior to entering rehabilitation, and self-reported outcomes at one-year follow-up. Logistic regression models of improvement, worsening and work status, and a linear regression model of health-related quality of life (HRQoL), were developed using lasso regression. Externally validated estimates of model performance were obtained from the validation set. Results The number of participants in the development and the validation sets was 771 and 215 respectively; only participants with outcome data (n = 519–532 and 185, respectively) were included in the analyses. On average, HRQoL and work status changed little over one year. The prediction models included 10–11 predictors. Discrimination (AUC statistic) for prediction of outcome at follow-up was 0.71 for improvement, 0.67 for worsening, and 0.87 for working. The median absolute error of predictions of HRQoL was 0.36 (0.22–0.51). Reasonably good predictions of working at follow-up and HRQoL could be obtained using only the baseline scores as predictors. Conclusions Moderately complex prediction models (10–11 predictors) generated poor to excellent predictions of patient-relevant outcomes. Simple prediction models of working and HRQoL at follow-up may be nearly as accurate and more practical. Significance Prediction modelling of outcome in rehabilitation has been sparsely explored. Such models may guide clinical decision-making. This study developed and externally validated prediction models for outcomes of people with chronic widespread pain and fibromyalgia in a rehabilitation setting. Multivariable prediction models generated poor to excellent predictions of patient-relevant outcomes, but the complexity of these models may reduce their clinical utility. Simple univariable prediction models were nearly as accurate and may have more potential for use in clinical practice

Development and external validation of a prediction model for patient-relevant outcomes in patients with chronic widespread pain and fibromyalgia

Background The objective of this study was to develop prediction models and explore the external validity of the models in a large sample of patients with chronic widespread pain (CWP) and fibromyalgia (FM). Methods Patients with CWP and FM referred to rehabilitation services in Norway (n = 986) self-reported data on potential predictors prior to entering rehabilitation, and self-reported outcomes at one-year follow-up. Logistic regression models of improvement, worsening and work status, and a linear regression model of health-related quality of life (HRQoL), were developed using lasso regression. Externally validated estimates of model performance were obtained from the validation set. Results The number of participants in the development and the validation sets was 771 and 215 respectively; only participants with outcome data (n = 519–532 and 185, respectively) were included in the analyses. On average, HRQoL and work status changed little over one year. The prediction models included 10–11 predictors. Discrimination (AUC statistic) for prediction of outcome at follow-up was 0.71 for improvement, 0.67 for worsening, and 0.87 for working. The median absolute error of predictions of HRQoL was 0.36 (0.22–0.51). Reasonably good predictions of working at follow-up and HRQoL could be obtained using only the baseline scores as predictors. Conclusions Moderately complex prediction models (10–11 predictors) generated poor to excellent predictions of patient-relevant outcomes. Simple prediction models of working and HRQoL at follow-up may be nearly as accurate and more practical. Significance Prediction modelling of outcome in rehabilitation has been sparsely explored. Such models may guide clinical decision-making. This study developed and externally validated prediction models for outcomes of people with chronic widespread pain and fibromyalgia in a rehabilitation setting. Multivariable prediction models generated poor to excellent predictions of patient-relevant outcomes, but the complexity of these models may reduce their clinical utility. Simple univariable prediction models were nearly as accurate and may have more potential for use in clinical practice

Bruk av videokonsultasjon ved en revmatologisk poliklinikk

På grunn av covid-19-pandemien ble implementering av videokonsultasjon som alternativ til fysisk oppmøte ved polikliniske konsultasjoner fremskyndet for personer med revmatisk sykdom ved Diakonhjemmet Sykehus. Videokonsultasjon ble innført i mars 2020, og vi presenterer her erfaringer blant behandlere og pasienter