Bakgrund: År 2020 efterlyste Statens beredning för medicinsk och social utvärdering, (SBU), en uppdaterad litteraturöversikt gällande effekten av kontrakturprofylax. Kroniska neurologiska tillstånd som föranlett nedsättning av aktiv rörlighet utgör populationen där kontrakturprofylax är en del av den fysioterapeutiska interventionen och då oftast i form av passivt rörelseuttag.  Syftet: Denna systematiska översikt syftar till att undersöka effekten av kontrakturprofylax som förebyggande och behandlande åtgärd för vuxna individer med kroniska neurologiska tillstånd som föranlett nedsättning av aktiv rörlighet. Syftet utöver det var att sammanställa resultatets vetenskapliga kvalitet och tillförlitlighet. Metod: En systematisk översikt över RCT-studier producerade mellan 2013 och 2023, där interventionen syftar till att förebygga eller behandla kontrakturer. Artiklarnas kvalitet granskades med PEDro skalan och det sammanvägda resultatets tillförlitlighet granskades med den studentanpassade versionen av GRADE. Kvaliteten var genomgående hög medan det sammanvägda resultatet har en låg sammanvägd tillförlitlighet. Resultat: Sju artiklar med ett totalt deltagarantal på 367 granskades. Kvaliteten varierade bedömt utifrån PEDro mellan 7 och 10 poäng, samtliga studier inkluderades i den sammanvägda bedömningen av tillförlitlighet. Sammanvägt hade studierna låg tillförlitlighet, detta på grund av bristande samstämmighet och överförbarhet, precisionen ansågs acceptabel.  Slutsatser: Det går inte att dra slutsatser gällande enskild effekt av kontrakturprofylax i form av passiv rörelseträning. Samtidigt framkommer inte något underlag för att kontrakturprofylax skulle negativt påverka andra interventioner. Det behövs mer forskning inom området och mätning av ledrörlighet och definition av kontrakturprofylax bör även standardiseras för ett mer överförbart och samstämmigt resultat. Denna studie kan således inte konkludera om en fysioterapeut bör använda kontrakturprofylax, vare sig som förebyggande eller behandlande åtgärd. / Background: In 2020, the State's preparation for medical and social evaluation, (SBU), called for an updated literature review regarding the effect of contracture prophylaxis. Chronic neurological conditions that have caused a reduction in active mobility make up the population where contracture prophylaxis is part of the physiotherapeutic intervention and then usually in the form of passive range of motion. Aim: The aim of this systematic review was to investigate the effect of contracture prophylaxis as a preventive and treatment measure for adults with chronic neurological conditions that have caused impairment of active mobility. The purpose, in addition to that, was to compile the scientific quality and reliability of the results. Method: A systematic review of RCT-studies produced between 2013 and 2023, where the intervention aims to prevent or treat contractures. The quality of the articles was reviewed with the PEDro scale, and the reliability of the combined results was reviewed with the student-adapted version of GRADE. The quality was considered high, while the summarized result had a low reliability. Results: Seven articles with a total number of participants of 367 were reviewed. The quality varied as assessed based on PEDro between 7 and 10 points, all studies were included in the combined assessment of reliability. Summarized, the studies had low reliability, this due to a lack of consistency and transferability, the precision was considered acceptable. Conclusions: It is not possible to draw conclusions regarding the individual effect of contracture prophylaxis in the form of passive movement training. At the same time, there is no evidence that contracture prophylaxis would negatively affect other interventions. More research is needed in the field and measurement of joint mobility and definition of contracture prophylaxis should also be standardized for a more transferable and consistent result. This study cannot therefore conclude whether a physiotherapist should use contracture prophylaxis, either as preventive care or as treatment.

The knee joint is a diarthrodial joint that rotates in the flexion-extension axis to provide individuals mobility. A limitation in the passive range of motion (ROM) is detrimental for function and this limitation is termed a joint contracture. A commonly shared characteristic between conditions that lead to contracture formation is prolonged periods of immobilization. However, the etiology of immobility-induced joint contractures is not well described and requires quantitative data on anatomical structures limiting knee mobility to design new interventions aimed at restoring function. In turn, our research group has developed an experimental animal model to study the temporal pathophysiology of knee immobilization and reversibility through unassisted remobilization. With durations of immobilization ranging from 1 to 32 weeks and remobilization up to 48 weeks, our experimental design provides a comprehensive temporal overview on the various stages of contracture formation: initiation, progression, and severity. A combination of muscles and articular structures are involved in the pathophysiology of knee flexion contractures, but the posterior joint capsule is of particular interest. Through histomorphological analysis, we provided quantitative data on the contribution of the reduced posterior capsule length in the limitation of knee extension and increased joint stiffness. Moreover, elucidation of synoviocyte profiles within the synovium of the capsule provided insights to potential mechanisms of capsule shortening. Our novel measurable outcome of mechanical joint stiffness revealed distinct temporal differences with ROM measurements after joint immobilization and remobilization, suggesting that alterations in the biomechanical properties of articular tissue structures are also contributing to the limitation in function. Malleability of the dynamic reciprocal relationship between trabecular bone loss and accumulation of marrow adipose tissue (predominately through adipocyte hyperplasia) after knee immobilization underscores the sensitivity of the bone marrow microenvironment in response to mechanical stimuli and lack thereof. Remobilization of the knee joint is limited in its capacity to reverse detriments induced by extended periods of joint immobilization. Findings from this work point to the temporal changes detected in different musculoskeletal tissues during knee immobilization and emphasizes the contribution of the joint capsule in limiting joint mobility.

UCS is described as a muscle imbalance pattern located within the cervical and thoracic spine region. These imbalances have been shown to produce elevation and forward movement of the shoulders, winging of the scapula, and a forward extension of the head. These changes, in turn, lead to overstress of the cervical cranial junction and shoulders, which can cause neck and/or jaw pain, headaches, and shoulder problems. The purpose of this study was to determine if quantifiable differences existed in active range of motion, muscle strength and muscle endurance capacity between a group of patients with Upper Crossed Syndrome (UCS) and an asymptomatic group. A case-control experiment was completed. The case group consisted of 17 subjects with UCS, recruited through physical therapy and chiropractic clinics. The control group consisted of 17 healthy subjects, which were matched for age, gender and BMI on a group level. Isometric strength and endurance tests were completed. Neck range of motion was assessed about three axes. Significant differences in strength generating ability (neck flexion/extension, shoulder internal/external rotation, shoulder abduction/adduction) and range of motion (neck bending, neck rotation) were evident between the two groups. Endurance measures though, were comparable between groups. The results show that it is possible to use objective measures to distinguish between people with UCS and healthy controls, and thus demonstrate the possibility to move from a subjective to a quantitative objective diagnostic approach. / Master of Science

Bakgrund: Subakromiell smärta är ett vanligt förekommande muskuloskeletalt besvär. Behandlingen består ofta av antingen styrketräning, kortisoninjektion eller en kombination av behandlingsformerna.  Syfte: Att undersöka effekten av kombinerad behandling (styrketräning och kortisoninjektion) jämfört med enbart styrketräning som behandling för subakromiell smärta samt att utföra en kvalitetsgranskning och en bedömning av den sammanvägda tillförlitligheten. Metod: En systematisk litteraturöversikt utifrån formulerat PICO. Systematiska sökningar utfördes i databaserna AMED, CINAHL, PEDro, PubMed och Web of Science. Genomförande av kvalitetsgranskning enligt granskningsmallen PEDro och bedömning av den sammanvägda tillförlitligheten enligt ”Bedömning av den sammanvägda tillförlitligheten i systematiska översikter”. Resultat: Motstridiga resultat visades gällande effekten av kombinerad behandling. Totalt 8 studier inkluderades till kvalitetsgranskningen där resultatet varierade från medel till hög kvalitet. Av dessa bedömdes den sammanvägda tillförlitligheten i 6 studier. För funktion var den måttligt hög till att ingen effekt kan ses av interventionen. För smärta och rörelseomfång var tillförlitligheten låg respektive mycket låg till att effekt ses av interventionen. Konklusion: Det har inte varit möjligt att fastslå vilken effekt en kombinerad behandling jämfört med styrketräning har på smärta, funktion och rörelseomfång på kort sikt då resultaten har varit motstridiga. Inga långsiktiga effekter har observerats. Tillförlitligheten för funktion var måttligt hög till att ingen effekt ses av interventionen. För smärta bedömdes den som låg och för rörelseomfång som mycket låg till att effekt ses av interventionen. Framtida forskning bör fokusera på att utföra studier med mer likvärdiga interventioner för att kunna utvärdera effekten av kombinerad behandling jämfört med styrketräning för personer med subakromiell smärta. / Background: Subacromial pain syndrome is a common musculoskeletal condition. The treatment consists of either physiotherapy, corticosteroid injection or a combination of the two. Objective: To research the effects of a combined treatment compared to exclusively resistance training in individuals with subacromial pain syndrome and to assess the quality of the evidence as well as the overall reliability.  Method: A systematic review. Systematic searches were conducted using the databases AMED, CINAHL, PEDro, PubMed and Web of Science. The quality of the evidence was assessed using the PEDro scale. The overall reliability was assessed using “Bedömningen av den sammanvägda tillförlitligheten i systematiska översikter”.  Results: Contradictory results were found regarding the effect of combined treatment. A total of 8 studies were included in the quality assessment, with results varying from moderate to high quality. Of these, the overall reliability was assessed in 6 studies. The reliability for the outcome measure of function was assessed as moderately high that no effect of the intervention could be observed. Effects from the intervention on pain and range of motion were found to have low and very low reliability, respectively.  Conclusion: It has not been possible to determine the effect of combined treatment compared to resistance training on pain, function and range of motion in the short term, as the results have been conflicting. No long term effects have been observed. Overall reliability for the outcome measure of function was assessed as moderately high that no effect could be seen from the intervention. Effects on pain and range of motion from the intervention were found to have low and very low reliability, respectively. Future research should focus on conducting studies with more comparable interventions to evaluate the effect of combined treatment compared to resistance training for individuals with subacromial pain.

Leitthema ARBEIT(S).WISSEN.SCHAF(F)T ; Grundlage für Management & Kompetenzentwicklung Mit zunehmendem Alter kommt es zu einer Verringerung der Beweglichkeit. Mit Hilfe digitaler Menschmodelle können daraus resultierende Auswirkungen auf die Arbeitsgestaltung analysiert und bei der Planung von Arbeitssystemen berücksichtigt werden. Als Voraussetzung dafür müssen in Menschmodellen valide Daten integriert werden. Hierzu werden im Beitrag Datenquellen zur Beweglichkeit in Bezug zur altersbedingten Veränderung vorgestellt und deren Nutzung zur Ableitung von Referenzdaten für eine Integration in digitale Menschmodelle diskutiert. Als Quellen können Fachbücher, Primärstudien, Reviews und Meta-Analysen verwendet werden. Diese sind anhand von Kriterien zur Qualität und der Aufstellung von Referenzwerten zu bewerten. Im Ergebnis wird festgestellt, dass es wesentliche Unterschiede in der Studien- und Berichtsqualität gibt. Insbesondere fehlende Angaben zur Erhebung und der Studienpopulation erschweren die Studienbewertung und Einordnung hinsichtlich Referenzwerte. Referenzdaten unterscheiden sich auch hinsichtlich der Bereitstellung von alters- und geschlechtsspezifischen Angaben. Um eine adäquate Integration in digitale Menschmodelle vornehmen zu können, muss eine kritische Auseinandersetzung mit der Qualität der Erhebung und Repräsentativität der Daten erfolgen.

No description available.

Non-specific low back pain (LBP) is a major health problem affecting a substantial portion of the population. The current treatments offered for non-specific LBP are oftentimes unsuccessful because the acting mechanism(s) of most treatment options are unknown. Obtaining a better understanding about the acting mechanism behind existing treatment options is, therefore, essential for the improvement of non-specific LBP treatment and management. The objective of this study was to gain a more comprehensive understanding about the acting mechanism of high velocity low amplitude spinal manipulative therapy, specifically the impact that high velocity low amplitude spinal manipulative therapy may have on the active and passive spinal musculoskeletal stabilizing subsystems along with the resultant spinal stability for healthy participants. A pre-post intervention study design completed by six healthy participants was used to quantify changes in the above noted aspects of spinal stability using a series of tests performed both before and after six sessions of high velocity low amplitude spinal manipulative therapy. The tests included seated balancing tests, lower back range of motion tests, and stress relaxation test. The six sessions of high velocity low amplitude spinal manipulative therapy did not significantly affect any of the test measurements among our healthy participant group.

Many women who have experienced breast cancer (BC) report continued impairments in upper extremity (UE) function beyond the time required for normal healing after surgical treatment. Most research supporting this has not made comparisons between survivors of breast cancer (BCS) to a sample of healthy women. This lack of comparison to a healthy cohort prevents an understanding of whether continued deficits in UE function are due to normal aging or the BC treatment. The purpose of this research was to compare quality of life (QOL) and UE function among long term breast cancer survivors and similar aged women without cancer. Both self-report and objective measurements of UE function were used to create an understanding of UE functional abilities in both populations. Data on self-reported QOL and UE function, ROM, strength, and muscular endurance were collected on 79 healthy women ages 30-69, stratified by decade. Comparisons between decades and between dominant and non-dominant limbs were made. Findings supported no effect of aging on measures, and that dominance does affect some objective measures of motion, strength, and muscular endurance. A group of 42 survivors of breast cancer (BCS) were compared to the data from healthy controls on the same measures. BCS reported lower levels of QOL and UE function, and demonstrated less motion and strength than the healthy cohort, particularly when cancer occurred on the non-dominant limb. The values of the measures, however, are not clinically relevant, and reveal that BCS 6 years after treatment recover UE function to levels similar to healthy controls. In view of a lack of clinically feasible measures of UE muscular endurance, a new test to assess this was designed and implemented: the modified Upper Body Strength and Endurance test (mUBSE). It was believed this new test would be less variable than the Functional Impairment Test – Hand and Neck, Shoulder, Arm – FIT-HaNSA. Seventeen BCS and 17 matched controls were compared on the mUBSE and FIT-HaNSA. Findings were similar for both tests. Furthermore, BCS who are 6 years post BC treatment appear to recover muscular endurance levels to normal ranges.

The wrist is one of the most complex joints in the human body. As such, the wrist joint is difficult to model due to the number of bones involved and its intricate soft tissue interactions. Many studies have attempted modeling the wrist previously; however, the majority of these studies simplify the joint into two-dimensions or idealized mechanical joints to reduce the complexity of the simulation. While these approaches still yield valuable information, the omission of a third-dimension or geometry defined movements limits the models’ usefulness in predicting joint function under non-idealized conditions. Therefore, the goal of this study was to develop a computational model of the wrist joint complex using commercially available software, whereby joint motion and behavior is dictated by highly accurate three-dimensional articular contact, ligamentous constraints, muscle loads, and external perturbations only. As such, a computational model of the human wrist was created using computed tomography (CT) images of a cadaver right upper extremity. Commercially available medical imaging software and three-dimensional computer aided design (CAD) software were used to reconstruct the osteoarticular surfaces and accurately add soft tissue constraints, as well as calculate kinematic motion simulations. The model was able to reproduce physiologic motion including flexion/extension and radial/ulnar deviation. Validation of the model was achieved by comparing predicted results from the model to the results of a published cadaveric experiment that analyzed wrist function under effects of various surgical procedures. The model was used to replicate the exact testing conditions prescribed for the experiment, and the model was able to accurately reproduce the trends and, in many instances, the magnitudes of the range of motion measurements in the study. Furthermore, the model can now be used to predict the magnitudes for the joint contact forces within the wrist as well as the tension developed in ligaments in hopes locating potential areas of concern after these surgical procedures have been conducted, including further development of arthritis in the wrist and ligament breakdown.

Title: Spontaneous activity of lower limbs in a vertical position in the aquatic environment Objectives: The aim of this study was to determinate whether spontaneous activity of lower limb in the aquatic environment enable to determinate preferred swimming stroke of an individual. Also, whether identified asymmetry of the lower limbs during treading water depend on passive range of hip joints. Methods: Spontaneous activity of lower limbs in a vertical position with a hands and head out of water was recorded on video. Passive intra/extrarotion, flexion, extension, abduction in hip joints were measured using mechanical two-arm goniometer. Qualitative analysis of spontaneous activity of lower limbs recorded on video was conducted using Kinovea 0.8.15. Results: According to the results of our work, it can not be said that the preferred swimming stroke can be determined on the basis of the spontaneous activity of the lower limbs in a vertical position in the aquatic environment. We can assume that the individual chose the pattern of treading water according to an energetically economical way while minimizing resistive forces and not in pursuance of preferred swimming stroke. Bilateral asymmetry (left-right) during the water treading movement was detected in the whole group. The most significant...