Aim: To preliminary validate a questionnaire that was developed in this study. The questionnaire was designed to investigate, if patient’s perception of appearance of their Boston corset influences their compliance, in a positive or negative way.   Background: Going through brace treatment brings a lot of feelings for adolescent idiopathic scoliosis patients. Not having a “perfect body” decreases body image and self-esteem. It is highly likely that by changing the patients’ perspective of their brace into liking the appearance of it; the probability of positive compliance will increase in patients.   Method: Mixed method approach was used to develop and validate a new questionnaire. The development and validation were done using literature, expert and patient groups. Qualitative data was evaluated, and quantitative data was analyzed using Pearson’s correlation coefficient and Cronbach alpha.   Result: Preliminary validated questionnaire was created. The group used for validation were all idiopathic scoliosis patients, four boys and four girls, between the age of 6 and 15 years old.   Conclusion and outlook: Further validation of the questionnaire is required before applying on future studies. Preliminary results indicate that patients who like the way they appear in their brace are also compliant. / Syfte: Att preliminär validera ett frågeformulär som utvecklades i denna studie. Frågeformuläret var utformat för att undersöka om patientens uppfattning om deras Boston korsett påverkar deras compliance på ett positivt eller negativt sätt.   Bakgrund: Att genomgå korsettbehandling innebär många känslor för ungdomar med idiopatisk skolios. Att inte ha en "perfekt kropp" minskar kroppsbilden och självkänslan. Det är högst sannolikt att genom att förändra patienternas perspektiv på deras korsett till att tycka om utseendet på den; så ökar sannolikheten för compliance med positiva känslor.   Metod: Mixed Metod användes för att utveckla och validera ett nytt frågeformulär. Utvecklingen och validering gjordes med hjälp av litteratur, expert- och patientgrupper. Kvalitativa data utvärderades och kvantitativa data analyserades med användning av Pearsons korrelationskoefficient och Cronbach alpha.   Resultat: Ett preliminärt validerat frågeformulär skapades. Gruppen som användes för validering var idiopatiska skoliospatienter, fyra pojkar och fyra tjejer, mellan 6 och 15 år gamla.   Slutsats: Ytterligare validering av frågeformuläret krävs före användning i framtida studier. Preliminära resultat indikerar att patienter som tycker om hur de ser ut i deras korsett också följer compliance med positiva känslor

The overall aim was to study outcome following surgery of the injured pelvis with focus on assessment from the patient’s perspective. All adult patients operatively treated for pelvic ring injuries or acetabular fractures at the Department of Orthopaedics, Uppsala University, starting 2003 were prospectively included and followed with quality of life (QoL) instruments for 2 years. The most common trauma mechanism was motor vehicle accident (MVA). Study I included 54 patients with pelvic ring injuries during the three-year period 2003-2005. The two instruments, SF-36 and LiSat-11, were used. In 45 responders lower than normative QoL and life satisfaction prevailed at two years after the injury. Study II included 12 patients with pelvic ring injuries or acetabular fractures sustained following a jump from height in an attempt to commit suicide. At four years all patients were still alive and SCID-interviews performed by a psychiatrist revealed low recurrence of self-destructive behaviour and high QoL in the younger patients. Study III included 136 patients with acetabular fractures where 52 had elementary and 84 associated fracture patterns. Fracture reduction was 0-1 mm in 106 patients and 2 mm or more in 30. QoL was significantly higher in patients with anatomically reduced fractures. Physical SF-36 domains improved with time, albeit QoL was lower than norm. Study IV had the aim to construct a condition-specific outcome instrument for patients with acetabular fractures. Closed and open questions were sent to 127 consecutive acetabular fracture patients at 6, 12 and 24 months following surgery. Responses were validated through factor analysis, scree tests, item reduction and principal component analysis which resulted in a multi-item verbal descriptive scale (VDS) with six condition-specific questions related to “Pain”, “Walking”, “Hip motion”, “Leg numbness”, “Sexual life”, “Operation scar” and a global question concerning impact on daily life activities for acetabular fracture assessment.

Abstract Introduction Wedged shoe insoles are used as a treatment for different problems in order to change the ground reaction force. They can secondary cause different loading patterns under the foot compared to normal. No previous study has, to the author’s knowledge, clinically evaluated the plantar foot pressure with different full-length wedges in normal persons. Purpose The purpose was to evaluate the plantar pressure with different degrees of full-length wedges in normal persons. Method Twenty persons with normal feet have participated in this single blind study. Wedges were produced clinically in four different shapes, 3° valgus, 0° flat, 3° varus och 6° varus. The test persons were told to walk with the wedges in their comfortable pace in a randomized order. The plantar pressure was measured in the medial and lateral heel as well as in the first and fifth metatarsal head. Results The results show significant increased mean pressure for varus wedges compared to flat as well as valgus wedges, in the area of the medial heel and first metatarsal joint. Also, valgus wedges show significant increased mean pressure compared to flat condition in area of the medial heel. There is no correlation between wedge height and mean pressure for any of the wedge conditions. Conclusion Treatment with wedges leads secondary to increased mean pressure for varus wedges compared to flat as well as valgus wedges, in medial heel and first metatarsal joint. Furthermore, valgus wedges show increased mean pressure compared to flat condition in medial heel. Patients sensitive to high plantar pressures in these areas should be treated with caution.  Further studies are recommended.

Background Stress and burnout in healthcare is a globally occurring problem that has been given attention in both media and research literature. Stress derives partly from a high workload and emotional exhaustion, but ethical and moral factors can also cause stress of conscience which in worst case can lead to burnout.   Objectives There is a lack of studies regarding prosthetists and orthotists experience of stress. By using the validated survey Stress of Conscience Questionnaire (SCQ) the aim is to find out the level of stress in prosthetists and orthotists in Sweden.   Method A web-based survey with the SCQ instrument was sent to prosthetists and orthotists in Sweden and the answers was compiled using SPSS.   Results 68 people answered the survey. The situations that caused the highest stress of conscience for prosthetists and orthotists was when there was a lack of time to provide the care the patient needed, when there were incompatible demands in ones work and when ones work was so demanding that they did not have the energy to devote to their family as they wanted to.   Conclusion The results are similar to results from studies made on other healthcare professions which implicates that stress of conscience is as likely for prosthetists and orthotists. A better understanding for causes of stress for prosthetists and orthotists could trough further studies contribute to a better healthcare-climate for both caregivers and patients. Keywords: conscience, stress, mental illness, prosthetists, orthotists / Bakgrund Stress och utbrändhet inom sjukvården är ett globalt förekommande problem som fått mycket uppmärksamhet inom både medier och forskningsvärlden. Stressen kommer delvis från en hög arbetsbörda och emotionella påfrestningar, men även etiska och moraliska faktorer kan ge upphov till samvetsstress som i värsta fall kan leda till utbrändhet.   Syfte Det finns en brist på studier om ortopedingenjörers upplevelse av stress. Genom att använda den validerade enkäten Stress of Conscience Questionnaire (SCQ) är syftet att ta reda på nivån av stress hos legitimerade ortopedingenjörer i Sverige.   Metod En webenkät med instrumentet SCQ skickades ut till ortopedingenjörer i Sverige och svaren sammanställdes med SPSS.   Resultat 68 personer svarade på enkäten. De situationer som orsakar högst samvetsstress för ortopedingenjörer var då man inte upplevde tillräcklig tid till att ge god vård, då man utsätts för oförenliga krav i sitt arbete och då ens arbete är så krävande att man inte orkar ägna sig åt sina närmaste.   Slutsatser Dessa resultat speglar resultat från studier gjorda på andra sjukvårdsyrken vilket skulle kunna betyda att samvetsstress är lika sannolikt inom ortopedingenjörsbranschen. En ökad förståelse för vad som orsakar stress för ortopedingenjörer kan genom vidare studier bidra till ett bättre vårdklimat för både kliniker och patienter. Nyckelord: samvete, stress, psykisk ohälsa, ortopedingenjörer

Vid rehabilitering är det viktigt att veta om och när muskler vid det skadade området återfår sin styrka. Gällande axelskador finns det idag ingen etablerad metod för mätning av muskelstyrka. I de metoder som testats är vissa attribut inte önskvärda och därför vill man på Karolinska universitetssjukhuset, Huddinge ta fram en ny, förbättrad metod. I metoden ska man kunna mäta en patients muskelstyrka och se skillnaden mellan mätningar över en tidsperiod. Av intresse är den maximala muskelstyrkan samt muskelstyrkan vid 45° abduktion och flexion. Projektet går ut på att ta fram en prototyp som kan användas enligt metoden och se om prototypen är lämplig. En testgrupp bestående av både friska och axelskadade personer genomförde tester för prototypens noggrannhet hos vinkelmätning, prototypens användbarhet samt lämplig vinkel för maximal muskelkraft i axeln. Resultatet visade att prototypens noggrannhet var inom det godkända intervallet för metoden. Användbarheten var också godkänd då alla testpersoner kunde använda prototypen inom de begränsningar vi satte. Vi såg ingen övergripande trend där maximal muskelkraft i axeln erhölls vid 45° även om det stämde för vissa individer. För vidare arbete och ökad validitet krävs fler studier med större testgrupper. / During rehabilitation, it is important to know if and when the muscles in the injured area have regained their strength. Regarding shoulder injuries, there is currently no established method of measuring muscle strength. In the methods tested, certain attributes are undesirable. Therefore, Karolinska Universitetssjukhuset, Huddinge is looking into developing a new, improved method. In this method, one should be able to measure a patient's muscle strength and study the difference in measurements over time. The maximum muscle strength and the muscle strength at 45 ° of abduction and flexion is of interest. The project is to produce a prototype that can be used according to the new method and see if the prototype is appropriate. A test group consisting of both healthy and shoulder injured patients performed tests regarding the prototype accuracy of angular measurement, prototype usability and appropriate angle for maximum muscle strength in the shoulder. The result showed that the prototype accuracy was within the approved range of the method. Usability was also approved as all test subjects could use the prototype within the limits we set. We did not see an overall trend in which maximum muscle force in the shoulder were obtained at 45 °. For further work and increased validity, further studies with larger test groups is required / Nej

No description available.

No description available.

Congenital insensitivity to pain is a rare hereditary neuropathy. We present patients from a large family in Norrbotten, Sweden with a mutation in the nerve growth factor β gene (NGFß). Using a model of recessive inheritance, we identified an 8.3-Mb region on chromosome 1p11.2-p13.2 shared by the affected individuals in the family. Analysis of candidate genes in the disease-critical region revealed a mutation in the coding region of the NGFß gene specific for the disease haplotype. All three severely affected individuals were homozygous for the mutation. The disease haplotype was also observed in both unaffected and mildly affected family members, but in heterozygote form. We have identified 43 patients, 3 homozygous and 40 heterozygous. The homozygous patients have a severe congenital form with onset of symptoms at an early age, most often affecting the lower extremities with insidious progressive joint swellings or painless fractures. Fracture healing was normal, but the arthropathy was progressive, resulting in disabling Charcot joints with gross deformity and instability. These patients lacked deep pain perception in bones and joints and had no protective reflexes, leading to gross bone and joint complications. They also had abnormal temperature perception but normal ability to sweat. There was no mental retardation. Clinically, they fit best into the group HSAN type V. Sural nerve biopsies showed a moderate loss of thin myelinated fibers (Ad-fibers) and a severe reduction of unmyelinated fibers (C-fibers). 14 of the 40 heterozygous adult patients had mild or moderate problems with joint deformities, usually with only slight discomfort. Treatment was conservative with (if needed) different kinds of orthosis and in some cases joint replacement. Three patients had only neuropathy, and 16 patients had no symptoms. In congenital disorders like these, it is important to evaluate the age and also the slowly progressive nature, when considering treatment. There is an increased risk of growth disturbances in the very young. The orthopedic operations should therefore be planned from a long-term point of view, but patient education and orthosis are cornerstones in the treatment—to delay the development of neuropathic arthropathy. Arthrodesis, limb lengthening and spinal decompression with fusions are the only elective procedures that seem reasonable. This Norrbottnian disease is also interesting as a model system for the study of pain.

<p>Tendon healing is a slow process and the tendon may not regain its initial mechanical properties after rupture. Mechanical stimuli have shown to have positive effect on tendon healing. This study is the first to investigate the effect of vibration stimuli on healing tendons. Vibration was also compared to treadmill running, which has previously been used for mechanical stimuli.63 female Sprauge-Dawley rats were used. A 3 mm segment was removed from the Achilles tendon and the tendon was left to heal. The animals were subjected to 15 min of daily exercise, vibration or treadmill running or acted as controls without exercise. The study was divided into three experiments. Experiment 1; the animals had full time cage activity and was randomized into running, vibration and control group. Experiment 2; the animals were unloaded and randomized into vibration, running and control group. There was also a control group with full time cage activity in experiment 2. Experiment 3; the animals were unloaded and randomized into vibration and placebo group. 14 days after surgery the animals were killed and mechanical testing of the Achilles tendons was performed. The results showed no significant difference between the groups in experiment 1. Experiment 2 showed that controls with full time cage activity had higher peak load, stiffness and cross sectional area than unloaded running, vibration and control groups. In experiment 3, there was no significant difference between vibration and placebo group. In conclusion, this study shows that vibration, as applied here, does not affect tendon healing.</p>

Chronic exertional compartment syndrome (CECS) of the lower leg, defined as a condition with exercise-induced pain due to increased intramuscular pressure (IMP), has previously mainly been described in running athletes, and etiologic factors are poorly described. CECS has not been reported to occur together with other diseases and information about consequences on muscles morphology after treatment with fasciotomy is largely unknown. We investigated etiologic and pathophysiologic aspects to CECS in a consecutive series of 63 patients with exercise-related leg pain and in 17 diabetic patients with symptoms of intermittent claudication but no circulatory insufficiency. Clinical examination, radiography, scintigraphy and IMP measurements at rest and after reproduction of symptoms were done. Patients with CECS were recommended treatment with fasciotomy. Biopsies were taken from the tibialis anterior muscle at time of fasciotomy and at follow-up 1 year later. For comparison muscle samples were taken from normal controls. Enzyme- and immunohistochemical and morphometric methods were used for analysis of muscle fiber morphology/pathology, fiber phenotype composition, mitochondrial oxidative capacity and capillary supply. Thirty-six of the 63 patients fulfilled the criteria for diagnosis of CECS in the anterior tibial compartment. The CECS patients could be divided into different etiologic groups: 18 healthy, 10 with history of trauma against the lower leg, 4 diabetic patients and 4 others. Only 5 of 36 CECS patients were athletes. The results after fasciotomy were good or excellent in 41 of 57 treated legs.  Sixteen of the 17 diabetic patients were diagnosed with CECS, 11 with diabetes type 1 and 5 with type 2. The diabetic patients differed from the other groups with longer symptom-duration, shorter pain-free walking distance, firm and tender lower leg muscles and higher IMP. The postoperative outcome was good or excellent in 15 of 18 treated legs. The muscle biopsies taken at fasciotomy showed frequent histopathological changes including small and large sized fibers, fiber atrophy, internal myonuclei, split fibers, fibrosis, disorganization of mitochondria in contrast to healthy CECS subjects having low muscle capillarization as the main finding. Muscular abnormalities were generally more complex, severe and widespread in diabetic patients. After 1 year, the majority of CECS patients could return to unrestricted physical activity and the histopathological muscle changes were clearly reduced. The muscle fiber size was larger and the muscles contained signs of regeneration and repair. Remaining muscle abnormalities were present mainly in diabetic patients. CECS is a new differential-diagnosis in diabetic patients with symptoms of claudication without signs of vascular disease. A low ability for physical activity, reflected by the signs of both myopathy and neuropathy, indicates that high IMP and circulatory impairment has deleterious effects for the involved muscles. Increased physical activity and normalization of muscle morphology 1 year after treatment shows the benefit of fasciotomy. The more severe clinical and morphological findings in diabetic compared to healthy subjects with CECS indicate differences in the pathogenesis. The unrestricted physical ability after treatment is very important for diabetic patients, since physical activity is an essential part of the therapy of the disease.