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  • 1.
    Bergman, Stefan
    et al.
    Lund University, Lund, Sweden & University of Gothenburg, Gothenburg, Sweden & RandD centre Spenshult, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). RandD centre Spenshult, Halmstad, Sweden.
    Aili, Katarina
    RandD centre Spenshult, Halmstad, Sweden & Karolinska Institutet, Stockholm, Sweden.
    Olsson, Cecilia
    University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Lund University, Lund, Sweden & RandD centre Spenshult, Halmstad, Sweden.
    Chronic widespread pain, sleep problems and pressure pain thresholds in a population sample2018In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 7, no 2, p. 1645-1646Article in journal (Refereed)
  • 2.
    Brorsson, S.
    et al.
    Health and Welfare, Dala Sports Academy, Dalarna University, Falun, Sweden.
    Thorstensson, C.
    Department of Clinical Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
    Nilsdotter, A.
    Department of Research and Education, Halmstad County Hospital, Halmstad, Sweden.
    Bremander, Ann
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Two different sets of handexercises improved grip strength after after eight weeks in patients with arthritis2014In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, no Suppl. 2, p. 1210-1210Article in journal (Refereed)
    Abstract [en]

    Background Hand function measured as grip force and finger extension force is often impaired in patients with rheumatoid arthritis (RA) and hand osteoarthritis (HOA) affecting performance of daily activities why hand exercises are recommended. A number of hand exercises are often used in the clinic but there is little information about “the effects of a minimal set of hand exercises” and if the choice of exercises is important to improve strength and function in the hand.

    Objectives To study the effect on grip- and finger extension strength and patient reported hand function from two different sets of handexercises performed over 8 weeks using a randomized study design.

    Methods Female patients with arthritis (RA and HOA, n=121) were randomly assigned to two different sets of handexercises (HE) for 8 weeks. The four hand exercises applied in the program were exercises commonly used in traditional hand training programs. The exercises were split into two groups depending on if the muscle activation (measured with EMG) were greater in forearm flexor (HE I, n=62) or in extensor muscles (HE II, n=59) (REF). HE I: isolated finger opposition (digits II-V) and rolling the putty with a flat hand, HE II: squeezing the putty and finger extension with putty resistance. The two HE were performed daily and each set was repeated 15 times, training time per day was maximum 5 minutes 7 days/week.

    Grip strength was measured with Grippit and finger extension strength with EX-it both validated instruments (unit: N). Pain was measured with a Visual Analogue Scale (VAS), 0-10 (best to worst). Hand functions were evaluated with the patient reported questionnaire Quick Disability Arm Shoulder and Hand (QuickDASH), 0-100 (best to worst).

    Results Mean grip strength (p=0.01) and mean finger extension force (p=0.004) increased after the training period in the group using HE I. In HE II the mean finger extension force increased (p=0.044), table 1. Hand function was stable over the training period.

    Table 1.

    Descriptive data of finger extension (EXIT) force and grip strength in the right hand, hand function (QuickDASH) and VAS pain presented as mean ± SD (min–max)

    Conclusions Five daily minutes with two hand exercises resulted increased grip strength and finger extension force after eight weeks. We suggest that hand exercises should be combined and selected to improve both flexor and extensor muscle strength of the forearm.

  • 3.
    Brorsson, Sofia
    et al.
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS).
    Nilsdotter, Anna
    Department of Research and Education, Halmstad County Hospital, Halmstad, Sweden.
    Pedersen, Eja
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS).
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS).
    Thorstensson, Carina
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Relationship between finger flexion and extension force in healthy women and women with rheumatoid arthritis2012In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, no 7, p. 605-608Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Balance between flexor and extensor muscle activity is essential for optimal function. The purpose of this pilot study was to compare the relationship between maximum finger flexion force and maximum finger extension force in women with rheumatoid arthritis and healthy women.

    METHODS: Twenty healthy women (median age 61 years) and 20 women with rheumatoid arthritis (median age 59.5 years, median disease duration 16.5 years) were included in the study. Finger extension force was measured with an electronic device, EX-it, and finger flexion force using Grippit. The Grip Ability Test and the score from the patient-reported outcome Disability Arm Shoulder and Hand were used to evaluate activity limitations.

    RESULTS: Patients with rheumatoid arthritis showed significantly decreased hand function compared with healthy controls. A correlation was found between extension force and flexion force in the healthy group (r = 0.65, p = 0.002),but not in the rheumatoid arthritis group (r = 0.25, p = 0.289).

    CONCLUSION: Impaired hand function appears to influence the relationship between maximum finger flexion and extension force. This study showed a difference in the relationship between maximum finger flexion and extension force in healthy controls and those with rheumatoid arthritis. © 2012 Foundation of Rehabilitation Information.

  • 4.
    Emilson, Christina
    et al.
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Demmelmaier, Ingrid
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Bergman, Stefan
    Research and Development Center Spenshult, Halmstad, Sweden & Department of Public Health, and Community medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lindberg, Per
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Denison, Eva
    School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Åsenlöf, Pernilla
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    A 10-year follow-up of tailored behavioural treatment and exercise-based physiotherapy for persistent musculoskeletal pain2017In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 31, no 2, p. 186-196Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study the long-term outcomes of two interventions targeting patients with sub-acute and persistent pain in a primary care physiotherapy setting.

    DESIGN: A 10-year follow-up of a two-armed randomised controlled trial, initially including 97 participants.

    INTERVENTIONS: Tailored behavioural medicine treatment, applied in a physiotherapy context (experimental condition), and exercise-based physiotherapy (control condition).

    MAIN MEASURES: Pain-related disability was the primary outcome. The maximum pain intensity, pain control, fear of movement, sickness-related absence (register data) and perceived benefit and confidence in coping with future pain problems were the secondary outcomes.

    RESULTS: Forty-three (44%) participants responded to the follow-up survey, 20 in the tailored behavioural medicine treatment group and 23 in the exercise-based physiotherapy group. The groups did not differ in terms of the change in the scores for the primary outcome (p=0.17) of pain-related disability between the experimental group (median: 2.5, Q1-Q3: -2.5-14.25), and the control group (median: 0, Q1-Q3: -5-6). Further, there were also no significant differences found for the secondary outcomes except for sickness-related absence, where the exercise-based physiotherapy group had more days of sickness-related absence three months before treatment (p= 0.02), and at the 10-year follow-up (p=0.03).

    DISCUSSION: The beneficial effects favouring tailored behavioural medicine treatment that observed post-treatment and at the two-year follow-up were not maintained 10 years after treatment. 

    © The Author(s) 2016

  • 5.
    Johnson, Urban
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Parker, James
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Ivarsson, Andreas
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Andersen, Mark
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Svetoft, Ingrid
    Halmstad University, School of Business, Engineering and Science, Centre for Innovation, Entrepreneurship and Learning Research (CIEL).
    Connection in the Fresh Air: A Study on the Benefits of Participation in an Electronic Tracking Outdoor Gym Exercise Programme2019In: Montenegrin Journal of Sports Science and Medicine, ISSN 1800-8755, E-ISSN 1800-8763, Vol. 8, no 1, p. 61-67Article in journal (Refereed)
    Abstract [en]

    This study aimed to explore whether a six-week intervention, based on participation in outdoor exercise, including activity-tracking devices and combined with individual consulting sessions, can both increase physical activity and yield positive changes in physiological and psychological health measures. A total of six participants, with a mean age of 41.2 (range 33-50 years), completed the ten-week study and the six-week intervention. The full study consisted of a four-week control/baseline and a six-week intervention period in which each participant acted as their own controls. Continuous measures of physical activity data were collected using a wrist-worn activity sensor during the ten-week study, along with pre- and post-measures of cardiovascular fitness, upper-body strength, BMI, general health, and motivation to exercise. The intervention consisted of a resistance-training programme for an outdoor gym and three motivational interviewing sessions. Eff ect sizes (percentage) for changes pre- to post-training were calculated. The results, because of the small sample size, are presented as individual cases, but the group, as a whole, showed average increases from baseline (pre-) to post-measures in strength (maximum row; 15.33%), time to exhaustion (3.58%), number of steps per day (4%), and autonomous motivation (12%) and average decreases in body weight (-1.08%), fat percentage (-7.58%), strength (chest; -2.5%), and stress symptoms (-2.17%). Th e six-week intervention programme showed promising results regarding physical activity changes. This study contributes to the limited evidence of the impact of resistance training programmes using outdoor gyms, electronic tracker, and motivational interviewing on physical activity outcomes. © 2019 by the authors.

  • 6.
    Kling, Michaela
    Halmstad University, School of Business and Engineering (SET), Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine.
    EFFEKTER AV STABILITETSTRÄNING I FOTLEDEN EFTER SKADA: EN LITTERATURSTUDIE2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 7.
    Qvarfordt, Maria
    et al.
    Halmstad University, School of Health and Welfare.
    Andersson, Maria LE
    Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Center, Halmstad, Sweden.
    Factors influencing physical activity inpatients with early rheumatoid arthritis: A mixed-methods study2019In: SAGE Open Medicine, E-ISSN 2050-3121, Vol. 7, article id 31523427Article in journal (Refereed)
    Abstract [en]

    Objective: The goal of this study was to provide a greater understanding of physical activity in patients with early rheumatoidarthritis. The aim was twofold: first to explore if physical activity was associated with factors in the clinical picture ofrheumatoid arthritis in this patient group, and second, to explore factors influencing physical activity in patients with earlyrheumatoid arthritis.

    Methods: A total of 66 patients with early rheumatoid arthritis were included in the study. A sequential explanatorymixed-methods design was used, where quantitative data from a questionnaire were analysed with Mann–Whitney, post hocKruskal–Wallis and χ2 test in order to detect differences between groups, and find possible associations between physicalactivity and independent variables, such as disease activity, health-related quality of life and physical function. Qualitative datawere collected in a follow-up questionnaire with open-ended questions that focused on factors influencing physical activity.

    Results: Associations between physical activity, disease activity and health-related quality of life were seen in patients withearly rheumatoid arthritis together with strong negative correlations between physical activity and physical function. Patientson sick leave showed the strongest associations between disease-related variables and lower levels of physical activity.The findings from the qualitative analysis showed that physical limitations, awareness as a motivational factor and externalenvironment factors influenced physical activity in patients with early rheumatoid arthritis.

    Conclusion: The results showed a complex underlying motive where physical, psychological and environmental factorsinfluenced the physical activity in patients with early rheumatoid arthritis. In order to provide more effective healthinterventions, it is important to consider the complex nature of practicing physical activity, where a person-centred approachshould be considered. Factors such as physical limitations, economic aspects and time for practicing physical activity shouldbe included in the person-centred approach.

  • 8.
    Thorstensson, Carina
    Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden & Lund University, Lund, Sweden.
    Exercise and Functional Performance in Middle-aged Patients with Knee Osteoarthritis2005Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall purpose of this thesis was to explore the impact of exercise and functional performance on development and treatment of knee osteoarthritis in the middle aged.

    In this thesis, I have studied a population based cohort of middle-aged subjects (35-54 years, 42 % women) with chronic knee pain at baseline, to evaluate the longitudinal effect of muscle weakness on knee osteoarthritis development, the relationship between muscle function and joint load and the effects of exercise on joint load. I have also studied the effect of exercise on pain and function in another middle-aged cohort (36-65 years, 51 % women) with moderate to severe knee osteoarthritis, and explored their conceptions of exercise as treatment. In the first study, 148 subjects with chronic knee pain underwent radiographic examination and tests of functional performance at baseline. 94 of them had no radiographic signs of knee osteoarthritis. Five years later they had new radiographs taken and 41/94 (44 %) had developed incident knee osteoarthritis. I found that reduced functional performance, assessed by maximum number of one-leg rises from a stool, predicted knee osteoarthritis development. The result was controlled for the previously known risk factors of age, BMI and pain.

    In the second study, I used 3-dimensional motion analysis to explore the possibility of altering joint load by exercise. The medial compartment joint load (peak adduction moment) during maximum number of one-leg rises was assessed in 13 subjects with early radiographic signs of knee osteoarthritis from the cohort in study one, before and after 8 weeks of exercise. Two subjects were lost to follow up for reasons not related to the knee. The peak adduction moment could be reduced by exercise, and a high maximum number of one-leg rises was associated with lower levels of peak adduction moment.

    The third study included 61 subjects with moderate to severe radiographic knee osteoarthritis. They were randomized to 6 weeks of intensive exercise or to a control group. The effects of exercise were assessed using questionnaires. No effects were seen on pain or self estimated function, however, the quality of life improved. The individual response to exercise ranged from clinically significant improvement to clinically significant worsening.

    As an attempt to understand this large inter individual response to exercise, I designed the fourth study, where I interviewed 16 of the 30 patients in the exercise group about their conceptions of exercise as treatment. The interviews were analysed using qualitative methodology, and it was revealed that all patients were aware of the general health benefits of exercise, but had doubts about exercise as treatment of osteoarthritis even if they had perceived pain relief and improvement in physical function from the exercise intervention. The pain experienced during exercise caused the patients to believe that exercise was harmful to their knees, and some of them would prefer not to exercise at all. They thought that exercise should be introduced early during the course of the disease, and all of them expressed the need of continuous encouragement and support to adhere to exercise.

    From this thesis I conclude that reduced muscle function is a risk factor of knee osteoarthritis development among middle aged subjects with knee pain. Reduced muscle function is associated with increased joint load, which seem to be modifiable by exercise. Initial pain when starting exercise, or occasional pain from exercise, should be treated by combining exercise with pain relief such as analgesics or acupuncture. Pain contributes to the difficulty patients have determining the degree of benefit or damage related to exercise, and thus causes feelings of anxiety and helplessness (paper IV). Pain also seems to interfere with the possibility of achieving increased functional performance (paper II, III, IV).

  • 9.
    Thorstensson, Carina A.
    et al.
    Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden & Dept. of Rheumatology, Lund University, Lund, Sweden.
    Roos, Ewa M.
    Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden & Dept. of Orthopedics, Lund University, Lund, Sweden.
    Petersson, Ingemar F.
    Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden & Dept. of Orthopedics, Lund University, Lund, Sweden.
    Ekdahl, Charlotte
    Dept. of Physical Therapy, Lund University, Lund, Sweden.
    Six-week high-intensity exercise program for middle-aged patients with knee osteoarthritis: a randomized controlled trial [ISRCTN20244858]2005In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 6, article id 27Article in journal (Refereed)
    Abstract [en]

    Background: Studies on exercise in knee osteoarthritis (OA) have focused on elderly subjects. Subjects in this study were middle-aged with symptomatic and definite radiographic knee osteoarthritis. The aim was to test the effects of a short-term, high-intensity exercise program on self-reported pain, function and quality of life. Methods: Patients aged 36-65, with OA grade III (Kellgren & Lawrence) were recruited. They had been referred for radiographic examination due to knee pain and had no history of major knee injury. They were randomized to a twice weekly supervised one hour exercise intervention for six weeks, or to a non-intervention control group. Exercise was performed at ≥ 60% of maximum heart rate (HR max). The primary outcome measure was the Knee injury and Osteoarthritis Outcome Score (KOOS). Follow-up occurred at 6 weeks and 6 months. Results: Sixty-one subjects (mean age 56 (SD 6), 51 % women, mean BMI 29.5 (SD 4.8)) were randomly assigned to intervention (n = 30) or control group (n = 31). No significant differences in the KOOS subscales assessing pain, other symptoms, or function in daily life or in sport and recreation were seen at any time point between exercisers and controls. In the exercise group, an improvement was seen at 6 weeks in the KOOS subscale quality of life compared to the control group (mean change 4.0 vs. -0.7, p = 0.05). The difference between groups was still persistent at 6 months (p = 0.02). Conclusion: A six-week high-intensive exercise program had no effect on pain or function in middle-aged patients with moderate to severe radiographic knee OA. Some effect was seen on quality of life in the exercise group compared to the control group. © 2005 Thorstensson et al; licensee BioMed Central Ltd.

  • 10.
    Wikander, Robert
    et al.
    Halmstad University, School of Business and Engineering (SET), Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine.
    Augustsson, Johan
    Halmstad University, School of Business and Engineering (SET), Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine.
    Kan ett nyutvecklat handledsstöd förbättra möjligheterna för funktionell träning av övre extremiteten för reumatiker?: En SEMG-studie2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    In a general rehabilitation phase weight training is an important part because of muscle weakness may contribute lower functional ability and could lead to decreasing movement patterns. Limited range of motion (ROM) in the upper extremity is a contributing factor to individuals unable to perform everyday activities. Several studies have documented that patients with rheumatoid arthritis (RA) have impaired hand function due to reduced grip strength and limitations in ROM. Functional training is designed to strengthen the weak muscles that cause imbalance or pain while your body becomes more mobile. Using everyday movements and implement them with training will make the training more functional. The purpose of this study was to develop and evaluate a new wrist support that increases the possibilities to functional training of upper extremities for rheumatoid arthritis patients.

    The study involved 27 women, 8 were diagnosed with RA and 19 healthy subjects. The average age was 38 year (20-73year). Muscle activity in m. trapezius and m. rhomboideus was measured using surface electromyography (sEMG) in three exercises to compare the differences between both RA and healthy, and with and without a developed product.

    The results showed that it was possible to perform functional training of upper extremities without using the hand grip strength. There were no significant differences in muscle activity in m. trapezius and m. rhomboideii with or without the product. The results also showed that rheumatic muscles are not different from healthy muscles. The participants' subjective opinions were very positive there 24 of 27 participants found it easier to carry out the exercise

    with the product and 9 of 27 felt it was easier to focus on exercise.

    The study resulted in a new wrist support that allows functional training of m.trapezius and m.rhomboideus for patients with rheumatoid arthritis.

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