<p>SAMMANFATTNING</p><p><p>Ländryggsbesvär är generellt vanligt förekommande i befolkningen och samhällsekonomiskt kostsamt. Riskfaktorer för ländryggsbesvär beskrivs vara flerdimensionella, där nämns främst arbetsrelaterade och psykosociala faktorer. Poliser är en yrkesgrupp där arbetssjukdomar rapporteras vanligt förekommande oavsett kön. Trots det är polisers arbetssituation dåligt utforskad. Syftet med studien är att kartlägga upplevt hälsotillstånd och arbetssituation bland utryckningspoliser med fokus på ländryggsbesvär, som underlag för preventiva åtgärder. Metoden bestod av en tvärsnittsstudie i form av en omfattande enkätundersökning. Urvalet inom polisens utryckningsenhet i Västerås var totalt. Så många som 60 % angav arbetsrelaterade ländryggsbesvär, en större del med besvär var män och förekomst av tunga lyft var vanligare bland svarande med besvär. Personer med ländryggsbesvär tog i mindre utsträckning pauser, kände sig stressade på arbetet och besvärades oftare av kroppslig värk. Deltagarna själva kopplade sina ländryggsbesvär till dåligt utformad arbetsutrustning, dålig sittställning i yrkesfordonen och till fysiska ingripanden. Av litteraturen beskrivna riskfaktorer för ländryggsbesvär var vanligt förekommande inom enheten. Där nämns ogynnsamma arbetsställningar och arbetsmoment samt psykosociala faktorer i form av hög arbetsbelastning, lågt stöd från arbetsledning och låg möjlighet att påverka sin arbetssituation.</p><p>Slutsats: För att förbättra arbetsmiljön för utryckningspoliser bör åtgärder inriktas mot belastningsergonomiska- och psykosociala faktorer i arbetet samt utformning av utrustning och arbetsfordon utifrån ergonomi och säkerhet.</p></p> / <p>ABSTRACT</p><p>Low back pain is a common disorder which causes high economic costs for the society. Risk factors for back pain are described as multidimensional, including both work related and psychosocial factors. Police-officers belong to an occupational group were work related diseases are frequently reported, irrespective of gender. The work situation for these officers however is poorly covered by targeted research. The purpose of this study is to survey the health- and work situation among police-officers with the focus on low back pain. The hope is that the results can be used as a base for preventive interventions. A cross sectional design with an extensive survey was used for the study. The selection was total within the unit of patrolling police officers in Västerås. As many as 60 % reported low back pain, with an overrepresentation among men. Heavy lifting was more common among those with low back pain. Those reporting low back pain more rarely took breaks during the work day, they felt more stressed at work and were more often troubled with physical pain. The study participants linked their back problems to badly designed work equipment, badly adjusted vehicles and to physical interventions. Risk factors for low back pain, described by the literature, were common within the unit. Especially, work tasks involving unfavorable movements and body positions were singled out. Among psychosocial factors, low social support from management and low ability to influence the work situation were associated with low back pain.</p><p>Conclusion: To improve the work environment for patrolling police-officers, measures should be focused on load and strain ergonomics, psychosocial factors as well as to develop equipment and vehicles more on the basis of ergonomics and safety measures.</p>

<p>Bakgrund: Varje individ rekommenderas att ägna sig åt någon form av fysisk aktivitet minst en halvtimme varje dag. Ett nytt arbetssätt är att skriva ut fysisk aktivitet på recept och en arbetsform för utskrivning kallas ordinerad fysisk aktivitet (OFA). Patientföljsamheten ökar genom personlig kommunikation mellan vårdgivare och patient, vårdpersonalens initiativ att kontakta patienten och patientens möjlighet till att aktivt deltaga i sin sjukdomsbehandling. Individens sjukdom eller skada, sociala intresse, personliga uppfattningar och omgivningens tillgänglighet för träning har betydelse för fysisk aktivitet enligt tidigare forskning.</p><p>Syfte: Studiens syfte var att studera vilka faktorer som möjliggjorde för personer som har fått OFA i Västmanland att följa sin ordination.</p><p>Metod: Studien var en kvalitativ intervjustudie med explorativ design. Kvalitativ innehållsanalys användes för bearbetning av intervjuerna.</p><p>Resultat och slutsats: Personalens betydelse för illtro till egen förmåga att träna framträder som ett centralt tema i informanternas berättelse enligt författarnas tolkning. Temat uttrycks i olika koder, underkategorier och kategorier. Fysiska faktorer som är betydelsefulla är kroppen och hälsan. Psykologiska faktorer är individens organisatoriska förmåga, tankar, känslor och erfarenheter samt personliga förhållningssätt. Närstående, personalen och deras insatser samt den fysiska miljön är betydelsefulla omgivningsfaktorer. Den sociala gemenskapen med familj och träningskamrater beskrivs också som betydelsefulla för att komma igång med OFA.</p> / <p>Background: Every individual are recommended to spend at least thirty minutes per day with some form of physical activity. Writing prescription of physical activity is a new approach and one form of prescription is called prescribed physical activity (OFA). Patient compliance increases through personal communication between health care professionals and patients, initiative from health care professionals and patients’ possibility to take active part in their own treatment. A person’s injury or illness, social interest, personal preferences and exercise possibilities in the environment has importance for physical activity according to previous research.</p><p>Purpose: The aim was to study what factors that made it possible for persons that have been prescribed physical activity (OFA) in Västmanland to follow their prescription.</p><p>Method: The study was a qualitative interview study with explorative design. Qualitative content analysis was used for analysing the interviews.</p><p>Results and Conclusion: Personnel’s importance for confidence in the ability to exercise appears as a central theme in the informants’ statement according to the authors’ interpretation. The theme is expressed in different codes, subcategories and categories. Important physical factors are body and health. Psychological factors are a person’s organizational ability, thoughts, feelings and experiences as well as personal adaptive attitude. Family, personnel and their contribution and the physical surroundings are important environmental factors. The social fellowship with family and exercise partners is also described as important in order to get started with OFA.</p>

<p><strong>Bakgrund:</strong> Hand-fot syndrom är en form av perifer sensorisk neuropati orsakad av cytostatikabehandling. Syndromet kan ge biverkningar såsom smärta, obehag, domningar, svullnad och nedsatt balans. Utvärderade behandlingsmetoder saknas.</p><p><strong>Syfte:</strong> Undersöka hur tolv veckors sjukgymnastisk behandling med långvågsdiametri, interferens och balansträning påverkar biverkningar i fot/underben orsakad av cytostatikabehandling hos sju patienter med hand-fot syndrom.</p><p><strong>Metod:</strong> Gruppstudie, kvasiexperimentell resultatstudie. Sju patienter deltog. Variabler som mättes var, smärta, obehag, domningar och balans. Tre mätningar utfördes, före, efter samt åtta veckor efter interventionen. Självrapporterad skattning och fysisk mätning användes.</p><p><strong>Resultat: </strong>Gruppens smärta, obehag och domningar minskade vid samtliga mätningar. För smärta visade mätning efter intervention samt åtta veckor efter signifikans (p=0,027), (p=0,042). Obehag visade signifikans efter interventionen (p=0,018). Domningar visade ingen signifikans. Balans visade signifikans i: Skärpt Romberg, höger, blundande, åtta veckor efter interventionen (p=0,043). Skärpt Romberg, vänster, blundande, efter interventionen (p=0,027), åtta veckor efter interventionen (p=0,028). Stående på ett ben, höger, blundande, efter interventionen (p=0,042), åtta veckor efter interventionen (p=0,027). Inga mätningar visade försämringar.</p><p><strong>Slutsats: </strong>Restultaten visade att behandling med långvårdsdiametri, interferens och balansträning minskade smärta, obehag, domningar och delvis förbättrade balans vid hand-fot syndrom. Dock går det inte att påvisa vilken behandlingskomponent som påverkat mest. Ytterligare studier behövs för att ge resultat större giltighet.</p> / <p><strong>Background</strong>: Hand-foot syndrome is a form of perifier sensory neuropathy caused by chemotherapy. The syndrome can cause side effects such as pain, discomfort, numbness, swelling and impaired balance. Evaluated treatment is lacking.</p><p><strong>Purpose:</strong> Examine how twelve week physiotherapy treatment short-wave diathermy, interference and balance training affects side effects of the foot/lower leg caused by chemotherapy in seven patients with hand-foot syndrome.</p><p><strong>Method:</strong> Study group, quasi-experimental outcome study. Seven patients participated. Variables measured were, pain, discomfort, numbness, and balance. Three measurements were carried out, before, after, and eight weeks after the intervention. Self-reported estimates and the physical measurement were used. <strong></strong></p><p><strong>Results:</strong> The group's pain, discomfort and numbness decreased in all measurements. For pain measurement after the intervention and eight weeks after showed significance (p = 0,027),(p = 0,042). Discomfort showed significance after the intervention (p = 0,018). Numbness showed no significance. Balance showed significance in: Sharpened Romberg, left, eyes closed, eight weeks after intervention (p = 0,043). Sharpened Romberg, left, eyes closed, after the intervention (p = 0,027), eight weeks after intervention (p = 0,028). Standing on one leg, the right, eyes closed, after the intervention (p = 0,042), eight weeks after intervention(p = 0,027). No measurements showed deterioration.</p><p><strong>Conclusion:</strong> The results showed that treatment with short-wave diathermy, interference and balance training reduced pain, discomfort, numbness and partial improvements in balance in hand-foot syndrome. However, it is not possible to demonstrate which treatment component that affected the most. Further studies are needed to produce results more valid.</p>

<p>During the past few years there has been an observed decrease in physical fitness within different patient groups. As a part of the rehabilitating physiotherapy treatment it is important to acknowledge the physical condition of the patient. Physical fitness testing might be difficult due to physical limitations within different patient groups. A broad range of exercise tests is therefore of importance in clinical practice. The aim of this overview was to describe exercise tests used in rehabilitation contexts, and to define areas of use and restrictions. The method was a systematic literature overview and data was gathered through medical and healthcare databases. Scientific articles were selected and put together to answer the questions in the overview. The result showed that exercise tests mainly described in the literature were tests performed on a bicycle ergometer, treadmill tests and walking tests. The tests were in several cases combined with rating scales. The tests were performed as submaximal or maximal tests to estimate VO₂max or VO₂Peak. Exercise testing was commonly used in rehabilitation of cardiac- and vascular diseases, pulmonary diseases and spinal cord injuries. Evaluation of an exercise program was the most common reason for using an exercise test. The question concerning restrictions of the tests could not be answered. The conclusion was that the most common exercise test was performed on a bicycle ergometer. Maximal VO₂Peak or VO₂max testing were mainly performed. The most common area for exercise testing was cardiac- and vascular rehabilitation. The most common purpose for performing an exercise test was evaluation of an exercise program. Further research is required in order to describe restrictions and implementations of the tests.</p>

<p><strong> </strong></p><p>Syftet var att undersöka om kinesiotejpning kunde påverka aktivitetsförmåga och smärta hos gravida kvinnor med pelvic girdle pain. Studien var en single subjekt experimentell AB-design. Fyra kvinnor inkluderades i pilotstudien för behandling av pelvic girdle pain. Smärtan skattades och mättes med visuell analog skala. Aktivitetsförmågan mättes med Roland &  Morris disability questionnaire.</p><p>Resultatet visade att gällande aktivitetsförmåga kunde det med 95 % säkerhet ses en förbättring hos tre av kvinnorna. Gällande smärtskattningen kunde endast hos en kvinna på kvällen och hos en annan kvinna på morgonen och kvällen ses en kliniskt signifikant minskad smärta. Resultaten i studien ger underlag för att en mer omfattande randomiserad och kontrollerad klinisk studie bör genomföras.</p>

Syftet var att undersöka om kinesiotejpning kunde påverka aktivitetsförmåga och smärta hos gravida kvinnor med pelvic girdle pain. Studien var en single subjekt experimentell AB-design. Fyra kvinnor inkluderades i pilotstudien för behandling av pelvic girdle pain. Smärtan skattades och mättes med visuell analog skala. Aktivitetsförmågan mättes med Roland &amp;  Morris disability questionnaire. Resultatet visade att gällande aktivitetsförmåga kunde det med 95 % säkerhet ses en förbättring hos tre av kvinnorna. Gällande smärtskattningen kunde endast hos en kvinna på kvällen och hos en annan kvinna på morgonen och kvällen ses en kliniskt signifikant minskad smärta. Resultaten i studien ger underlag för att en mer omfattande randomiserad och kontrollerad klinisk studie bör genomföras.

In Sweden approximately 25000 distal radius fractures occur annually, which is 37 % of all fractures related to osteoporosis. In this thesis, risk factors for osteoporosis, bone mineral density (BMD) and health-related quality of life (the SF-36) were compared in patients who suffered a distal radius fracture after low energy trauma with a control group matched on the basis of age, gender, and municipality of residence. The aim was also to analyse, among these patients, whether a risk factor questionnaire, tests on dynamic and static balance and a one-leg rise test could identify those, who have osteopenia or osteoporosis, and run a risk of new falls. Moreover, in a three-year follow-up, mortality, the need for in- and outpatient care, and health-related quality of life after radius fracture were investigated and compared between the patients and matched controls. Finally, the effect of a preventive intervention program including patient education and self-training was evaluated. Falls were reported in a risk factor questionnaire and in a fall diary. The patients aged 45-64 years showed lower, although not statistically significant, BMD, compared with the controls of the same age, but there was no difference concerning their history of falls. In contrast, the patients aged 64 years or older had a history of falling more often than the corresponding controls, but no difference in BMD was found. For all other risk factors, except falls, no differences were found between the patients and the controls. The results of the one-leg rise test were associated with those of dynamic and static balance, but none of the functional tests were associated with the number of falls. Decreased height and cigarette smoking were the only risk factors, which predicted osteopenia and osteoporosis. Five patients, although none of the controls, died during the study time. The patients needed statistically significantly more episodes as inpatients than the controls. The patients also had lower SF-36, Role Physical scores, than the controls at three months. This difference disappeared by the time of the follow-up. Both the patients, who participated in a four-week intervention program, “the osteoporosis school” followed by a one-year home-based exercise program, and the controls showed statistically significantly improved dynamic and static balance, ability to walk backwards and to stand on one leg with eyes open and closed at the end of the study. However, no significant differences were found between the patients and the controls in any of the tests, in BMD or in the number of the falls. The thesis shows that, except for the falls in patients aged over 64 years, there were no significant differences between patients and controls with respect to BMD and other risk factors related to osteoporosis. Consequently, in patients aged 45-64 years and older, the underlying cause of a distal radius fracture is more related to falls than to osteoporosis. Furthermore, the thesis shows that the functional tests and the risk factor questionnaire seem to be of limited value for identifying 8 people with a radius fracture, who are at risk of falling or have osteopenia or osteoporosis. If, in spite of this, functional tests on musculoskeletal function are considered for testing of functional ability in patients with a recent radius fracture, the one leg-rise test may be sufficient. There seems to be an increased mortality and morbidity necessitating inpatient care among patients with a recent radius fracture. The osteoporosis school had no significant effect on BMD, balance, muscle strength or falls in this thesis. Therefore, the lack of proven efficacy of the osteoporosis school for the secondary prevention of distal radius fractures highlights the need for more and long-term randomised controlled follow-up studies in this specific population.

Background: A sedentary lifestyle diminishes quality of life (QOL) and contributes to increasing prevalence of obesity, diabetes and cardiovascular diseases (CVD), and thus increases the economic burden on health care and society. Expensive and tightly controlled lifestyle interventions reduce cardiovascular risk and onset of diabetes. Transferring these findings to the primary care setting is of clinical importance. The primary aim of this thesis was to apply a lifestyle intervention program in the primary care setting among individuals with moderate-to-high risk for CVD, and evaluate the effects on physical activity, cardiovascular risk factor levels and QOL. A secondary aim was to investigate the cost-effectiveness. Methods: A randomized controlled trial with one intervention group (n=75) and one control group (n=76) with follow-up at 3, 12, 24 and 36 months was used. Patients with the diagnosis obesity, hypertension, dyslipidemia, type 2 diabetes or any combination thereof (mean age 54 yr, 57% female) were recruited from a primary health centre in northern Sweden. The three-month intervention period consisted of group-based supervised exercise sessions and diet counselling, followed by regular, but sparse, group meetings with a behavioural approach during three years. Clinical measurements included anthropometrics, aerobic fitness, blood pressure and metabolic traits. Questionnaires on self-reported physical activity, stages of change for physical activity, and QOL were used. In a cost-utility analysis the costs, gained quality-adjusted life years (QALY), and savings in health care were considered. Probability of cost-effectiveness was described using Net Monetary Benefit Method. Results: Overall, the lifestyle intervention generated beneficial improvements in anthropometrics, blood pressure, aerobic fitness and activity level, and QOL, compared to the control group which only received one information meeting.  At 36 months, intention-to-treat analyses showed that lifestyle modification reduced waist circumference (–2.2 cm), waist-hip ratio (–0.02), systolic blood pressure (–5.1 mmHg), and diastolic blood pressure (–1.6 mmHg) and significantly improved aerobic fitness (5%).  BMI, lipid or glucose values did not differ between groups. Progression to active stages of change for physical activity and increases in time spent exercising and total physical activity were reported. Both physical and mental dimensions of QOL were improved during the study period, but after 3 years differences persisted mainly in physical dimensions. Cost per gained QALY was low, 1668-4813 USD (savings not counted). Visits to family physicians significantly decreased and there was a net saving of 47 USD per participant. Probabilities of cost-effectiveness were 89-100% when 50 000 USD was used as threshold of willingness to pay for a gained QALY. Conclusions: A group-based lifestyle intervention program in a primary health care setting favourably influences cardiovascular risk-factor profiles, increases physical activity level, and improves several dimensions of QOL in high-risk individuals, at least up to 3 years. The intervention method was highly cost-effective in relation to standard care. The results emphasize the advantage of an intervention that combines supervised exercise with regular follow-ups for reaching long term effects.  The study high-lights the feasibility of lifestyle interventions in the primary care setting and the importance of health care professionals supporting change in lifestyle.

The overall aim of this thesis was to evaluate effects of a multi-component pain and stress self-management group intervention (PASS) and to explore plausible predictors associated with short-term and long-term treatment effects among patients with persistent tension-type neck pain in primary health care (PHC). Study I was a pilot study in order to explore feasibility of the study design and methods. It included 37 participants randomly assigned to the intervention (n=18) or treatment-as-usual (n=19). Study II-III was a pragmatic randomized controlled trial that compared effects of the PASS and individually administered physiotherapy (IAPT) on patients with persistent tension-type neck pain in PHC. Study II evaluated short-term effects over a 20-week follow-up. Study III evaluated long-term effects on maintenance over a follow-up period of 2 years. Studies included 156 participants randomly assigned to PASS (n=77) or IAPT (n=79). Study IV explored predictive factors for favorable outcome in disability regarding participants assigned to PASS. The results showed that PASS had better effects than IAPT regarding coping with pain, in terms of patients’ ability to control pain, self-efficacy regarding activities interfered with by pain, disability and catastrophizing, over the 20-week follow-up, and treatment effects were largely maintained over a 2-year follow-up. Post-treatment scores in disability, self-efficacy and pain intensity were associated with long-term outcome in pain-related disability 2 years post-treatment following PASS. Pre-treatment characteristics explained only a minor proportion of variance in disability, and were assumed weakly associated with treatment success and long-term outcome. Key components for enhancement of long-term efficacy in pain self-management coping efforts were adequately targeted by PASS. It is suggested important to strengthen self-efficacy beliefs in regard to pain coping, to reduce disability and enhance pain self-management in the treatment of persistent neck pain, and to induce long-term maintenance of treatment gains on disability following a pain self-management intervention.

Fysisk aktivitet kan förebygga och minska åldersrelaterade fysiologiska och psykologiska förändringar. Effekterna av funktionell träning för äldre är dåligt studerat. I Sörmland pågår ett fallpreventionsprojekt som syftar till att halvera antalet höftfrakturer till år 2012. Studiens syfte var att undersöka om äldres balans, benstyrka och self-efficacy, en persons grad av självtillit att utföra en specifik aktivitet framgångsrikt, påverkades av att göra fem uppresningar från sittande till stående två gånger om dagen under fyra veckor. En intervention genomfördes med 23 deltagare på ett servicehus/äldreboende. Test genomfördes innan och efter interventionen. Mätinstrumenten var Timed Up and Go (TUG) för balans, Falls Efficacy Scale Swedish version (FES(s)) för self-efficacy och 30- seconds chair stand för benstyrka. Komparativ statistik med parametriskt test användes för att analysera skillnader inom gruppen. Resultatet av interventionen visade en signifikant ökad balans och benstyrka, men oförändrad self-efficacy. Författarna rekommenderar att servicehuset/äldreboendet bibehåller rutinen med fem uppresningar två gånger om dagen, men ytterligare studier med större deltagarantal, längre interventionstid, en kontrollgrupp och uppföljning behövs för att styrka och generalisera resultatet till fler verksamheter. / Physical activity can prevent and reduce age-related physiological and psychological changes. The effects of functional training on older people are poorly studied. A prevention programme in the county of Sörmland is underway, which aims to halve the number of hip fractures by 2012. The aim of this study was to examine whether the balance, leg strength and self-efficacy, a person's degree of self-confidence to perform a specific task successfully, of elderly persons was affected by performing five sitting-to-standing exercises twice a day during a four weeks period. An intervention was received by 23 participants in a service/residential home. Testing was conducted before and after the intervention. The measuring tools used were Timed Up and Go (TUG) for balance, Falls Efficacy Scale Swedish version (FES(s)) for self-efficacy and 30- seconds chair stand for leg strength. Comparative statistics with parametric test were used to analyze differences within the group. The results showed significant increased balance and leg strength, however self-efficacy was unchanged. The authors recommend that the service/residential home maintain the routine of five sitting-to-standing exercises twice a day, although further studies with a more participants, longer intervention time, a control group and follow up are needed to verify and generalize the results to other areas.