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Biomedical subjects

C Ekdahl

Publications and source records attributed to C Ekdahl.

At least 37 records · Page 2Linked to original sources
PubMed1999

Recurrent infections and musculoskeletal disorders--signs of generally increased care demands? A descriptive study of medical records.

In this study we describe and analyse the health status, health-care consumption and the characteristics of persons visiting the primary care centre because of frequent symptoms of respiratory tract infections (RTI) (n = 83) and disorders related to the musculoskeletal system (DMS) (n = 166) as described in medical records for a three-year period. When all the medical diagnoses, health-care consumption, sick leave and other information had been gathered, the findings were that more women (73%) than men fulfilled the inclusion criteria. On average, the group with the highest frequency of symptoms paid 8.3 visits/three years to the physician compared with 1.0 for the controls (p < 0.05). The average total sick-leave attributable to RTI was 29.4 days/3 years and 8.1 days/3 years for the controls. Forty percent of patients in the frequent symptoms group had regular contact with children at work compared with only 18% of the controls. Subjects in the former group were usually manual workers with an increased physical and psychological workload compared with the controls. This group of subjects probably represents a category of vulnerable patients and their total situation should be further investigated.

Absenteeism↗
PubMed1999

Effects of compression bandaging with or without manual lymph drainage treatment in patients with postoperative arm lymphedema.

We examined the effects of low stretch compression bandaging (CB) alone or in combination with manual lymph drainage (MLD) in 38 female patients with arm lymphedema after treatment for breast cancer. After CB therapy for 2 weeks (Part I), the patients were allocated to either CB or CB + MLD for 1 week (Part II). Arm volume and subjective assessments of pain, heaviness and tension were measured. The mean lymphedema volume reduction for the total group during Part I was 188 ml (p < 0.001), a mean reduction of 26% (p < 0.001). During Part II the volume reduction in the CB + MLD group was 47 ml (p < 0.001) and in CB group 20 ml. These differences were not significant (p = 0.07). A percentage reduction of 11% (p < 0.001) in the CB + MLD group and 4% in the CB group was significantly different (p = 0.04). In both the CB and the CB + MLD group, a decrease of feeling of heaviness (p < 0.006 and p < 0.001, respectively) and tension (p < 0.001 for both) in the arm was found, but only the CB + MLD group showed decreased pain (p < 0.03). Low stretch compression bandaging is an effective treatment giving volume reduction of slight or moderate arm lymphedema in women treated for breast cancer. Manual lymph drainage adds a positive effect.

Adult↗
PubMed1999

Validity of the Body Awareness Scale-Health (BAS-H).

Quality of movement assessment using the Body Awareness Scale-Health (BAS-H) was validated against the following self-rating tests: Nottingham Health Profile (NHP); Arthritis Self-Efficacy Scale (ASES); Psychological General Well-Being (PGWB); Sense of Coherence (SoC); Sivic Psychosomatism test (SPS); Symptom Check List 90-R (SCL 90-R); and Visual Analogue Scale for pain intensity (VAS-pain). In total, 75 persons were included, divided into three groups: psychiatric outpatients (n = 25), chronic pain patients (n = 25) and healthy controls (n = 25). The highest significant correlations were obtained between the BAS-H total index and the sub-indices of grounding/stability to the centre line, centering/breathing and flow on the one hand, and the NHP, the ASES, and the PGWB on the other, with r ranging from 0.36 to 0.73. Multiple regression analysis revealed the NHP to explain 50% and ASES a further 5% of the variance in the BAS-H total index. Significant differences for both the BAS-H total index and the sub-indices were obtained between the two patient groups and the healthy controls. It is concluded that the construct validity of the BAS-H was found to be in accordance with theoretical expectations.

Adult↗
PubMed1999

Early planning of care and rehabilitation after amputation for vascular disease by means of Katz Index of Activities of Daily Living.

The aim of the study was to investigate whether the Swedish version of the Katz Index of ADL (Activities of Daily Living), on days 5-7 after amputation for vascular disease, had predictive value regarding length of hospital stay, discharge to the patient's own home or death within 1 month. Patients who had recently undergone primary unilateral trans-tibial amputation, living in their own homes before the amputation, were included. Fifty-two patients with a median age of 78 years (60-92) were assessed with the Katz Index of ADL. Results revealed that of the 10 (20%) patients discharged to their own homes within 1 month, only 2 belonged to grades A-C, that is, were independent in the majority of functions in personal ADL. Within 6 months 62% were discharged to their own homes. Eighty-four percent of the patients in grades D-G, i.e. most dependent on others, were still at the hospital or dead 1 month post-operatively. All the patients who belonged to grades A-F survived the first month post-operatively. The Katz Index of ADL had predictive value regarding early outcome in terms of length of hospital stay, discharge to the patient's own home or death within 1 month, and positive predictive value regarding survival the first month post-operatively.

Activities of Daily Living↗
PubMed1998

Functional capacity and early radiographic osteoarthritis in middle-aged people with chronic knee pain.

BACKGROUND AND PURPOSE: In order to improve the physiotherapeutic treatment of patients with long-standing knee pain, it is important to identify osteoarthritis (OA) of the knee at an early stage. The aim of the present study was to test the value of single functional measurement variables with the focus on the lower extremities for the association to early radiographic signs of OA of the knee. The classification by Ahlbäck grade I (joint space narrowing) was used in a cohort of 204 individuals aged 35-54 years with long-standing knee pain. METHODS: The following five selected tests were employed: three tests of static and dynamic balance (Balance I-III); one test of muscle strength (one-leg-rising-test, OLR); and one test of walking ability (time for walking 300 m indoors). Odds ratios (ORs) were calculated with a 95% confidence interval. RESULTS AND CONCLUSIONS: Results revealed that the selected tests of functional capacity due to rather low sensitivity (0.15-0.81), specificity (0.21-0.86) and inconclusive odds ratios (0.78-1.62) are probably of limited value as assessment tools to find radiographic knee OA in a younger population with mild OA. However, it is also possible to conclude that in middle-aged individuals with chronic knee pain, the diagnosis of radiographic OA is not related to the functional capacity as measured in the present study.

Adult↗
PubMed1998

Knee injury and Osteoarthritis Outcome Score (KOOS)--validation of a Swedish version.

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.

Anterior Cruciate Ligament Injuries↗
PubMed1998

Isokinetic knee extensor strength and functional performance in healthy female soccer players.

The aims of this study were to determine the relationship between isokinetic knee extensor muscle strength at 60 degrees/s and 180 degrees/s and five functional performance tests (one-leg-hop, triple-jump, vertical-jump, one-leg-rising and square-hop), to determine the relationship between the five different functional performance tests and to present normative data and limb symmetry index concerning healthy female soccer players. In total 101 female soccer players (X = 20.3 years) were tested. A limb symmetry index, using weak/strong leg, varied from 83.9 to 96.3 in the tests. Between the functional performance tests there were in general correlations of r = 0.4-0.8 (P < 0.001). A correlation of r = 0.77 (P < 0.001) was obtained between one-leg-hop and triple-jump. No differences were found between the right and the left leg or the dominant and the non-dominant leg. Using linear regression models corrected for body weight, height and age, there were low correlations between the isokinetic strength measurements and the functional tests. It is not recommended using functional performance testing and isokinetic testing interchangeably.

Adult↗
PubMed1998

Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure.

There is broad consensus that good outcome measures are needed to distinguish interventions that are effective from those that are not. This task requires standardized, patient-centered measures that can be administered at a low cost. We developed a questionnaire to assess short- and long-term patient-relevant outcomes following knee injury, based on the WOMAC Osteoarthritis Index, a literature review, an expert panel, and a pilot study. The Knee injury and Osteoarthritis Outcome Score (KOOS) is self-administered and assesses five outcomes: pain, symptoms, activities of daily living, sport and recreation function, and knee-related quality of life. In this clinical study, the KOOS proved reliable, responsive to surgery and physical therapy, and valid for patients undergoing anterior cruciate ligament reconstruction. The KOOS meets basic criteria of outcome measures and can be used to evaluate the course of knee injury and treatment outcome.

Activities of Daily Living↗
PubMed1998

Effects of a multidisciplinary rehabilitation programme on health-related quality of life in patients with prolonged musculoskeletal disorders: a 6-month follow-up of a prospective controlled study.

PURPOSE: The aim of this prospective, controlled, follow-up study (6 months) was to examine the effects of a multidisciplinary rehabilitation programme on perceived health-related quality of life (HRQL) in patients with prolonged musculoskeletal disorders (PMSD). The programme focused on body awareness therapy and cognitive and relaxation treatment. METHOD: The rehabilitation group comprised 122 patients, and there were 114 patients in the matched control group (CG). Both groups of patients had access to primary health care. Baseline data were compared with 6-month follow-up data within and between the groups. The following measurements were employed: HRQL (Nottingham Health Profile), body awareness, postural control, pain (VAS), pain-related medicine consumption, isometric arm muscle endurance, aerobic capacity, psychosomatic symptoms, physical and psychosocial working environment and sick leave. RESULTS: Variables that improved significantly as compared with the CG were: HRQL, anxiety, pain related to movements, psychosomatic symptoms and need for pain-related medicines. CONCLUSIONS: The multidisciplinary rehabilitation programme used here improved HRQL in patients with PMSD to a greater extent than the standard treatment provided within primary heath care (p = 0.01) at least in the short term.

Adult↗
PubMed1998

A randomized study comparing manual lymph drainage with sequential pneumatic compression for treatment of postoperative arm lymphedema.

We compared manual lymph drainage (MLD) with sequential pneumatic compression (SPC) for treatment of unilateral arm lymphedema in 28 women previously treated for breast cancer. After 2 weeks of therapy with a standard compression sleeve (Part I) with maintenance of a steady arm volume, each patient was randomly assigned to either one of two treatment regimens (Part II). MLD was performed according to the Vodder technique for 45 min/day and SPC was performed with a pressure of 40-60 mmHg for 2 hours/day. Both treatments were carried out for 2 weeks. Arm volume was measured by water displacement. Arm mobility, strength, and subjective assessments were also determined. Lymphedema was reduced by 49 ml (7% reduction) (p = 0.01) in the total group during Part I. During Part II, the MLD group decreased by 75 ml (15% reduction) (p < 0.001) and the SPC group by 28 ml (7% reduction) (p = 0.03). The total group reported a decrease of tension (p = 0.004) and heaviness (p = 0.01) during Part I. During Part II, only the MLD group reported a further decrease of tension (p = 0.01) and heaviness (p = 0.008). MLD and SPC each significantly decreased arm volume but no significant difference was detected between the two treatment methods.

Aged↗
PubMed1998

Outcome after trans-tibial amputation for vascular disease. A follow-up after eight years.

All 112 patients (55 females and 57 males) with a primary unilateral trans-tibial amputation for vascular disease performed in one year at all five hospitals in Malmöhus county, Sweden were examined at 6 months according to the prosthetic function and prospectively followed-up 8 years after the amputation for survival, and prosthetic fitting. The prosthetic function was re-examined among the survivors 8 years postoperatively. At 6 months 50% were fitted with a prosthesis and later (up to 8 years) a further 13%, in total 32 females and 39 males. The mortality at 6 months was 33%, at 2 years 47% and at 8 years 92%. Age at amputation (p = 0.015), to be amputated on the left leg (p = 0.0004), to be able to walk alone outdoors before the amputation (p = 0.007) and not using a wheelchair (p = 0.02) were all found to be statistically significant predictors for receiving a prosthesis. Predictors for good function with the prosthesis 6 months postoperatively was male sex (23 of 57 vs 8 of 55 females) (p = 0.006) and greater ability to walk alone outdoors before the amputation (p = 0.01). There was no significant age difference in this comparison. The finding that it is more favourable to be amputated on the left leg merits further study.

Adult↗
PubMed1997

Assessment of functional limitation and disability in patients with fibromyalgia.

Fibromyalgia syndrome (FMS) is characterized by diffuse widespread musculoskeletal pain. The aims of this literature study were to review measures and instruments used to assess functional limitations and disability in patients with FMS. A 10-year search was done on Medline, CATS, and CINAHL. Of the 73 articles found, only standardized instruments and tests permitting quantification were included. Reviews, trials of medication therapy, epidemiological studies, and measures of the psychological and impairment level were excluded. The articles were divided into cross-sectional and longitudinal studies. No studies evaluating the reliability, validity or sensitivity of the functional tests applied to the FMS were found. Of the disability instruments reviewed, only the Arthritis Impact Measurement Scales and Fibromyalgia Impact Questionnaire were evaluated for reliability and validity for the FMS population. The Arthritis Self-Efficacy Scales and Quality of Life Scale proved their sensitivity, detecting change in a controlled longitudinal study.

Cross-Sectional Studies↗
PubMed1997

Extended telemedical consultation using Arden Syntax based decision support, hypertext and WWW technique.

There is an obvious need for geographic distribution of expert knowledge among several health care units without increasing the cost of on-site expertise in locations where health care is provided. This paper describes the design of a knowledge-based decision-support system for extended consultation in clinical medicine. The system is based on Arden Syntax for Medical Logic Modules and hypertext using World Wide Web technology. It provides advice and explanations regarding the given advice. The explanations are presented in a hypertext format allowing the user to browse related information and to verify the relevance of the given advice. The system is intended to be used in a closed local network. With special precautions regarding issues of safety and patient security, the system can be used over wider areas such as in rural medicine. A prototype has been developed in the field of clinical microbiology and infectious diseases regarding infective endocarditis.

Artificial Intelligence↗
PubMed1997

A qualitative study of clinicians ways of using a decision-support system.

We have studied how clinicians approached a decision-support system to manage patient cases. The design of the system under study was based on an integration of hypertext and rule-based systems. World-Wide Web technology was used for the implementation of the system. By using grounded theory and stimulated recall, we found that getting patient-specific support and continuing medical education were the two major usages of the system and that the three parameters relevance, validity, and work were important in describing how the system was experienced by the users.

Attitude to Computers↗
PubMed1996

Dynamic and static physical training in patients with rheumatoid arthritis: application of a self-appraisal and coping model.

A self-appraisal and coping model was examined using a longitudinal data set involving 56 classical or definite rheumatic arthritis patients randomly assigned to either dynamic (n = 28) or static (n = 28) physiotherapeutic training. The model considers both adaptational consequences and antecedents of training (muscular endurance, pain, self-appraisal, and coping through avoidance or painful problem-solving). Measures were obtained prior to and after a 6-week training period (partly supervised and partly self-training) at a health-care centre, and after an additional 3 months of self-training only. Path analysis supported the mediating role of self-appraisal and of avoidance in influencing muscular endurance in dynamic training patients. Regression analyses likewise supported these conclusions, suggesting some patients in dynamic training to be caught in a vicious circle of avoidance and low self-appraisal. Theoretical issues are discussed, and suggestions made for developing more effective interventions in rheumatic patients.

Adaptation, Psychological↗
PubMed1995

Evaluation of a Swedish version of the arthritis self-efficacy scale in people with fibromyalgia.

The major purpose of this study was to determine the utility and construct validity of the Swedish version of the Arthritis Self-Efficacy Scale (ASES-S). Ninetynine women with fibromyalgia (FS) were included in a randomized, controlled trial of fibromyalgia efficacy-based self-management education and physical training. Several self-report instruments were used to evaluate the outcome of the intervention. Evidence of construct validity of the ASES-S was revealed in the factor analysis which produced a three factor solution similar to previous results. Significant correlations between ASES-S and pre and post health status measures were consistent with theoretically derived hypotheses, further testifying to construct validity. Multiple regression analyses confirmed that pretest ASES-S was the strongest predictor of posttest ASES-S. The results indicated that the intervention had produced a significant change in ASES-S and that this positive change in self-efficacy was associated with changes in health status. In conclusion, this study has shown the ASES-S to be a valid measure of treatment effects also for patients with FS.

Adult↗
PubMed1994

Gait in male trans-tibial amputees: a comparative study with healthy subjects in relation to walking speed.

Walking speed, stance duration and ground reaction forces were studied with the use of a stable force platform (Kistler) in 24 male transtibial amputees and 12 healthy subjects matched for sex and age. The aim of the study was to compare the gait performance of two groups with unilateral trans-tibial amputations for either vascular disease or trauma and also to compare the results of the two groups with the results of a group of healthy subjects. Multiple linear regression analysis was used to compare the stance duration and the ground reaction forces in relation to walking speed. The vascular and traumatic amputees had significantly reduced walking speeds compared with the healthy subjects, 0.85 +/- 0.2 m/s and 0.99 +/- 0.2 m/s. respectively, as compared to 1.42 +/- 0.2 m/s. By comparing the vascular and traumatic amputees with the healthy subjects in relation to walking speed, it was shown that the gait performance of the vascular amputee differed from that of the traumatic amputee, a difference that was not caused by the reduced walking speed. The active forces during push off on both the healthy (p = 0.02) and the prosthetic leg (p = 0.003) in the trauma group were not found in the vascular group. This disparity could be an effect of the systemic disease. It may be argued that the results of this study contribute to the understanding of the reduced walking ability of the vascular amputee and should be borne in mind when planning rehabilitation.

Aged↗