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Andrea LC, Svendsen SW, Frost P, Smidt K, Gelineck J, Christiansen DH, Deutch SR, Hansen TB, Haahr JP, Dalbøge A. Radiographic findings in patients suspected of subacromial impingement syndrome: prevalence and reliability. Skeletal Radiol 2024:10.1007/s00256-024-04675-7. [PMID: 38652296 DOI: 10.1007/s00256-024-04675-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Aims were to (i) report prevalence and (ii) evaluate reliability of the radiographic findings in examinations of patients suspected of subacromial impingement syndrome (SIS), performed before a patient's first consultation at orthopaedic department. MATERIALS AND METHODS This cross-sectional study examined radiographs from 850 patients, age 18 to 63 years, referred to orthopaedic clinic on suspicion of SIS. Prevalence (%) of radiographic findings were registered. Inter- and intrarater reliability was analysed using expected and observed agreement (%), kappa coefficients, Bland-Altman plots, or intraclass coefficients. RESULTS A total of 850 patients with a mean age of 48.2 years (SD = 8.8) were included. Prevalence of the radiographic findings was as follows: calcification 24.4%, Bigliani type III (hooked) acromion 15.8%, lateral/medial acromial spurs 11.1%/6.6%, acromioclavicular osteoarthritis 12.0%, and Bankart/Hill-Sachs lesions 7.1%. Inter- and intrarater Kappa values for most radiographic findings ranged between 0.40 and 0.89; highest values for the presence of calcification (0.85 and 0.89) and acromion type (0.63 and 0.66). The inter- and intrarater intraclass coefficients ranged between 0.41 and 0.83; highest values for acromial tilt (0.79 and 0.83) and calcification area (0.69 and 0.81). CONCLUSION Calcification, Bigliani type III (hooked) acromion, and acromioclavicular osteoarthritis were prevalent findings among patients seen in orthopaedic departments on suspicion of SIS. Spurs and Bankart/Hill-Sachs lesions were less common. Optimal reliabilities were found for the presence of calcification, calcification area, and acromial tilt. Calcification qualities, acromion type, lateral spur, and acromioclavicular osteoarthritis showed suboptimal reliabilities. Newer architectural measures (acromion index and lateral acromial angle) performed well with respect to reliability.
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Affiliation(s)
- Linda Christie Andrea
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
- Department of Occupational Medicine- University Research Clinic - Danish Ramazzini Centre, Gødstrup Hospital, Herning, Denmark.
| | - Susanne Wulff Svendsen
- Department of Occupational Medicine- University Research Clinic - Danish Ramazzini Centre, Gødstrup Hospital, Herning, Denmark
| | - Poul Frost
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kate Smidt
- Department of Orthopedic Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - John Gelineck
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - David Høyrup Christiansen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Torben Bæk Hansen
- University Clinic of Hand, Hip and Knee Surgery, Holstebro Regional Hospital, Holstebro, Denmark
| | - Jens Peder Haahr
- Department of Occupational Medicine- University Research Clinic - Danish Ramazzini Centre, Gødstrup Hospital, Herning, Denmark
| | - Annett Dalbøge
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
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Agger N, Bøjstrup JN, Christiansen DH. Patient Preferences and Their Effects on Rehabilitation Outcomes: A Secondary Analysis of a Randomized Controlled Trial. J Orthop Sports Phys Ther 2024:1-23. [PMID: 38530232 DOI: 10.2519/jospt.2024.12314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
OBJECTIVE: To assess the effect of aligning patients' preferences with specific rehabilitation delivery modes on rehabilitation outcomes. DESIGN: A secondary analysis of a randomized controlled trial (RCT). METHODS: The study cohort comprised 208 patients referred for physiotherapy rehabilitation after non-surgical or surgical interventions for rotator cuff injury, shoulder impingement, or acromioclavicular osteoarthritis. Participants were randomly assigned to one of three rehabilitation modalities: 1) group-based exercise, 2) individual exercise, or 3) home exercise. In this study, participants were categorized into two groups: "matched preference" (MP) and "unmatched preference" (UP). The primary outcome measure was change in function, measured with the shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH). Secondary outcome measures were change in pain, assessed using the Numeric Rating Scale (NRS), mental well-being measured with the World Health Organization Well-Being Index (WHO-5), health-related quality of life assessed using the EuroQol-5Domain questionnaire (EQ-5D), fear avoidance assessed using the Örebro Musculoskeletal Pain Questionnaire (ÖMPQ), and overall treatment satisfaction. Outcomes were assessed at 3 and 6 months. RESULTS: The primary outcome measure, QuickDASH, showed no significant differences between groups at either 3 months (-3.0 [-8.2 to 2.3]) or 6 months (0.5 [-5.7 to 6.7]). Additionally, no significant differences were observed in the secondary outcome measures. CONCLUSION: Matching patients' preferences for specific rehabilitation delivery modes did not seem to effect rehabilitation outcomes.
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Affiliation(s)
- Nikolaj Agger
- Centre for Research in Health and Nursing, Research, Regional Hospital Central Jutland, Viborg, Denmark
| | - Jim Nørgaard Bøjstrup
- Centre for Research in Health and Nursing, Research, Regional Hospital Central Jutland, Viborg, Denmark
| | - David Høyrup Christiansen
- Centre for Research in Health and Nursing, Research, Regional Hospital Central Jutland, Viborg, Denmark
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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Vilsbøl S, Christiansen DH, Budtz CR, Andersen JH, Mose S. Change in number of pain sites - which factors are important? A 12-year prospective cohort study. BMC Musculoskelet Disord 2024; 25:219. [PMID: 38500099 PMCID: PMC10949606 DOI: 10.1186/s12891-024-07344-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 03/07/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Pain in multiple body sites is common and often persistent. The purpose of this prospective study was to examine the change in the number of pain sites (NPS) over time and to evaluate to which extent clinical, demographic, lifestyle and health-related factors predict a change in NPS. METHODS This was a population-based longitudinal cohort study of adults (n = 2,357). Data on pain, demographic, lifestyle, and health-related variables were collected by questionnaires in 2008 and 2020 and register data from 2006 to 2017. Data was analysed with linear regression. RESULTS We found a mean decrease in NPS over the 12-year follow-up period (-0.36 (95% CI; -0.44; -0.27) and 56% of this sample reported no change or only one pain site increase/decrease over 12 years. While participants reporting pain for less than 3 months at baseline had almost no change in NPS (-0.04 (95% CI; -0.18; 0.10)), participants with pain for longer than 3 months decreased by -0.51 (95% CI; -0.62; -0.41). Age at baseline (20-49 years), pain intensity, and obesity (BMI ≥ 30) were associated with an increase in NPS over the follow-up period. CONCLUSIONS NPS is relatively stable over time. We found a small mean decrease in NPS over 12 years varying between participants with pain for longer than 3 months and pain for less than 3 months respectively. The results also indicate that pain intensity, age, and obesity could be relevant factors to consider when predicting change in NPS.
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Affiliation(s)
- Susanne Vilsbøl
- School of Physiotherapy, VIA University College, Holstebro, Denmark
| | - David Høyrup Christiansen
- Centre for Research in Health and Nursing, Research, Regional Hospital Central Jutland, Viborg, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark & Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Cecilie Rud Budtz
- Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Johan Hviid Andersen
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark & Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Center, Goedstrup Hospital, Aarhus University, Herning, Denmark
| | - Søren Mose
- School of Physiotherapy, VIA University College, Holstebro, Denmark.
- Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, Denmark.
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Dalbøge A, Frost J, Grytnes R, Roy JS, Samani A, Høyrup Christiansen D. Effects of a passive shoulder exoskeleton on muscle activity among Danish slaughterhouse workers. Appl Ergon 2024; 114:104111. [PMID: 37611536 DOI: 10.1016/j.apergo.2023.104111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 07/02/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023]
Abstract
AIM To evaluate the effect of a shoulder exoskeleton on muscle activity and to compare the effect with a lifting glove among slaughterhouse workers in occupational settings. MATERIALS AND METHODS We conducted a crossover study of 26 workers measured during two work days with and without the use of a passive shoulder exoskeleton and a lifting glove at a Danish slaughterhouse. Electromyography sensors were placed bilateral on 5 shoulder muscles. The 10th, 50th, and 90th percentiles of muscle activity normalized by maximal voluntary contractions were measured and analyzed using mixed effect models. RESULTS For the 50th percentiles of the agonist muscles, the exoskeleton reduced muscle activity bilaterally for deltoid anterior with up to 29.47%, deltoid middle with 10.22%, and upper trapezius with 22.21%. The lifting glove only reduced muscle activity for right deltoid anterior (36.59%) and upper trapezius (7.11%), but generally increased left muscle activity with up to 15.58%. DISCUSSION The exoskeleton showed larger reductions in muscle activity compared to the lifting glove.
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Affiliation(s)
- Annett Dalbøge
- Department of Occupational Medicine, Danish Ramazzini Center, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark.
| | - Jeppe Frost
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital, 7400, Herning, Denmark
| | - Regine Grytnes
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital, 7400, Herning, Denmark
| | - Jean-Sebastian Roy
- Faculty of Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, QC, G1 V 0A6, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration, 525 Boulevard Wilfrid-Hamel, Quebec City, QC, G1 M 2S8, Canada
| | - Afshin Samani
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - David Høyrup Christiansen
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital, 7400, Herning, Denmark; Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark; Research, Regional Hospital Central Jutland, Viborg, Denmark
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Agger N, Desmeules F, Christiansen DH. Predicting outcomes across treatment settings in patients with shoulder pain referred to physiotherapy: a secondary analysis of two comparable prospective cohort studies. BMJ Open Sport Exerc Med 2023; 9:e001770. [PMID: 38156241 PMCID: PMC10753741 DOI: 10.1136/bmjsem-2023-001770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 12/30/2023] Open
Abstract
Objective Previous studies have examined factors that may contribute to predicting outcomes for patients with shoulder pain. However, there is still a lack of consensus on which factors predict the results and whether there are differences based on the treatment setting. Thus, this study aimed to analyse and compare how baseline variables are associated with future outcomes in patients with shoulder pain in primary and secondary care settings. Methods This study conducted a secondary analysis of two observational prospective cohort studies involving patients with shoulder pain in primary care (n=150) and secondary care (n=183). Multiple regression analyses were employed, with one interaction term at a time, to examine potential differences in association with baseline characteristics and future outcomes between the two settings. Results Changes in pain and function were statistically significant at 6 months for patients in primary care and secondary care. However, associations for most baseline variables and outcomes did not differ significantly across these two treatment settings. The only statistically significant interactions observed were for the associations between baseline level of pain, function and fear avoidance beliefs and change in pain scores at 6 months, with lower change scores observed among patients in the secondary care. Conclusion This study revealed that the association with outcomes did not differ across settings for most baseline characteristics. These findings suggest that it could be feasible to generalise the prognostic value of most baseline variables for patients with shoulder, irrespective of the treatment setting.
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Affiliation(s)
- Nikolaj Agger
- Centre for Research in Health and Nursing, Regional Hospital Central Jutland Viborg, Viborg, Denmark
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - François Desmeules
- School of Rehabilitation, Medicine Faculty, University of Montreal, Montreal, Quebec, Canada
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada
| | - David Høyrup Christiansen
- Centre for Research in Health and Nursing, Regional Hospital Central Jutland Viborg, Viborg, Denmark
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Mose S, Budtz CR, Rønn Smidt H, Kent P, Smith A, Hviid Andersen J, Christiansen DH. How do people with chronic pain explain their use, or non-use, of pain-related healthcare services? A qualitative study of patient experiences. Disabil Rehabil 2023; 45:4207-4217. [PMID: 36398748 DOI: 10.1080/09638288.2022.2147589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE This study aims to explore how people with chronic pain explain their use or non-use of pain-related healthcare services and their expectations of the healthcare provider, and explore how explanations and expectations vary between different levels of pain-related healthcare use. MATERIALS AND METHODS We conducted 20 individual semi-structured interviews with purposely sampled adults between 39 and 77 years of age with chronic pain. All interviews were audio-recorded, transcribed and analysed using a thematical template analysis approach. RESULTS Four key drivers for pain-related healthcare use were identified: (1) the healthcare system facilitates clinical pathways, (2) appraisal of pain-related healthcare initiatives influences future use, (3) autonomy, beliefs and values determine healthcare behaviour, and (4) recommendations from others impact healthcare behaviour. Comparing explanations across different pain-related healthcare user groups (high, medium and low) showed that perceived needs, beliefs and values, and appraisal of previous healthcare experiences differed between these groups. CONCLUSIONS Beliefs, pain characteristics, recommendations, and the search for a diagnostic label, often initiate pain-related healthcare use. Healthcare is modified by two interconnected systems: (1) perceived needs, beliefs and values and (2) previous healthcare experiences. Differences related to these systems could explain some of the variance in pain-related healthcare use.Implications for RehabilitationDifferent use of pain-related healthcare services for people with chronic pain could be related to differences in perceived needs, beliefs and values and appraisal of previous healthcare.It may be helpful to explore the perceived needs and beliefs of those seeking healthcare due to chronic pain.Previous healthcare experiences may impact and should be explored.
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Affiliation(s)
- Søren Mose
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital, Glostrup, Denmark
- School of Physiotherapy, VIA University College, Holstebro, Denmark
| | - Cecile Rud Budtz
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital, Glostrup, Denmark
| | - Helle Rønn Smidt
- School of Physiotherapy, VIA University College, Holstebro, Denmark
| | - Peter Kent
- School of Allied Health, Curtin University, Perth, WA, Australia
- Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Anne Smith
- School of Allied Health, Curtin University, Perth, WA, Australia
| | - Johan Hviid Andersen
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital, Glostrup, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - David Høyrup Christiansen
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
- Regional Hospital Central Jutland, Viborg, Denmark
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Kyndi M, Willert MV, Vestergaard JM, Andersen JH, Christiansen DH, Dalgaard VL. Long-term follow-up study of work status among patients with work-related mental disorders referred to departments of occupational medicine in Denmark. BMJ Open 2023; 13:e072217. [PMID: 37935518 PMCID: PMC10632875 DOI: 10.1136/bmjopen-2023-072217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 10/09/2023] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVES To describe the 5 year work status in patients referred for suspected work-related common mental disorders. To develop a prognostic model. DESIGN Register-based nationwide longitudinal follow-up study. SETTING All departments of occupational medicine in Denmark. PARTICIPANTS 17 822 patients aged 18-67 years, seen for the first time at a Department of Occupational Medicine in Denmark from 2000 to 2013 and diagnosed with stress, depression, post-traumatic stress disorder, anxiety or other mental disorders. INTERVENTIONS All patients were seen for diagnostic assessment and causal evaluation of the work-relatedness of their disorders. Some departments offered patients with stress disorders psychological treatment, which, however, was not organised according to patient selection or type of treatment. PRIMARY AND SECONDARY OUTCOME MEASURES Register data were collected for 5 year periods before and after the patients' first assessment at a department. Weekly percentages of patients are presented according to work status. The outcome in the prognostic model was a high Work Participation Score (ie, working>75% of potential work weeks/year) at 5 year follow-up. RESULTS For all subgroups of patients, a high proportion were working (>75%) 1-5 years before assessment, and all experienced a large reduction in work status at time of assessment. At 1 year follow-up, almost 60% of patients with stress were working, whereas in the other patient subgroups, less than 40% were working. In the following years, practically no increase was observed in the percentage of patients working in any of the subgroups. Based on these 5 year follow-up data, we developed a work participation model with only moderate discrimination and calibration. CONCLUSIONS In Denmark, not all return to previous work status 5 years after a referral due to a suspected work-related common mental disorder. We developed a prognostic model with only moderate discrimination and calibration for long-term work participation after suggested work-related common mental disorders.
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Affiliation(s)
- Marianne Kyndi
- Department of Occupational Medicine, University Clinic, Gødstrup Regional Hospital, Herning, Denmark
- Department of Occupational and Environmental Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Vejs Willert
- Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Medom Vestergaard
- Department of Occupational Medicine, University Clinic, Gødstrup Regional Hospital, Herning, Denmark
- Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Johan Hviid Andersen
- Department of Occupational Medicine, University Clinic, Gødstrup Regional Hospital, Herning, Denmark
| | - David Høyrup Christiansen
- Centre for Research in Health and Nursing, Research, Regional Hospital Central Jutland, Viborg, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
- Elective surgery centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Vita Ligaya Dalgaard
- Department of Occupational Medicine, University Clinic, Gødstrup Regional Hospital, Herning, Denmark
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
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Rasmussen SP, Schougaard LMV, Hjøllund NH, Christiansen DH. Patient-reported outcome measures as determinants for the utilization of health care among outpatients with epilepsy: a prognostic cohort study. J Patient Rep Outcomes 2023; 7:103. [PMID: 37861867 PMCID: PMC10589170 DOI: 10.1186/s41687-023-00641-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Patient-reported outcome (PRO) measures can inform clinical decision making and planning of treatment in the health care system. The aim of this study was to examine whether patient-reported health domains influence the use of health care services in outpatients with epilepsy. METHODS This was a prognostic cohort study of 2,426 epilepsy outpatients referred to PRO-based follow-up at the Department of Neurology, Aarhus University Hospital, Denmark. Patients filled out a questionnaire covering health literacy areas, self-efficacy, well-being and general health. The main outcome was a record of contact to the epilepsy outpatient clinic, inpatient ward and/or emergency room within 1 year, retrieved from health register data. Associations were analysed by multivariable binomial logistic regression. RESULTS A total of 2,017 patients responded to the questionnaire and 1,961 were included in the final analyses. An outpatient contact was more likely among patients with very low health literacy ('social support'): odds ratio (OR) 1.5 (95% CI: 1.1-2.1), very low and low self-efficacy: OR 1.7 (95% CI: 1.2-2.3) and OR 1.4 (95% CI: 1.0-1.8), low and medium well-being: OR 2.2 (95% CI: 1.6-3.0) and OR 1.4 (95% CI: 1.1-1.9), and patients rating their general health as fair: OR 2.8 (95% CI: 1.7-4.6). Inpatient contact and emergency room contact were associated with the health domains of self-efficacy and general health. CONCLUSIONS PRO questionnaire data indicated that patients with low health literacy ("social support"), well-being, self-efficacy and self-rated general health had an increased use of health care services at 1 year.These results suggest that PRO measures may provide useful information in relation to the possibility of proactive efforts and prevention of disease-related issues and to help identify efficiency options regarding resource utilization.
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Affiliation(s)
- Stine Primdahl Rasmussen
- Department of Occupational Medicine, Danish Ramazzini Centre, Gødstrup Hospital, Hospitalsparken 15, Herning, 7400, Denmark
- AmbuFlex - Center for Patient-reported Outcomes, Central Denmark Region, Gødstrup Hospital, Møllegade 16, Herning, 7400, Denmark
| | - Liv Marit Valen Schougaard
- AmbuFlex - Center for Patient-reported Outcomes, Central Denmark Region, Gødstrup Hospital, Møllegade 16, Herning, 7400, Denmark
| | - Niels Henrik Hjøllund
- AmbuFlex - Center for Patient-reported Outcomes, Central Denmark Region, Gødstrup Hospital, Møllegade 16, Herning, 7400, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Blvd. 82, Aarhus, 8200, Denmark
| | - David Høyrup Christiansen
- Department of Occupational Medicine, Danish Ramazzini Centre, Gødstrup Hospital, Hospitalsparken 15, Herning, 7400, Denmark.
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Blvd. 82, Aarhus, 8200, Denmark.
- Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 1A, Silkeborg, 8600, Denmark.
- Centre for Research in Health and Nursing, Research, Regional Hospital Central Jutland, Heibergs Allé 2K, Viborg, 8800, Denmark.
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Jahn A, Andersen JH, Christiansen DH, Seidler A, Dalbøge A. Occupational mechanical exposures as risk factor for chronic low-back pain: a systematic review and meta-analysis. Scand J Work Environ Health 2023; 49:453-465. [PMID: 37581384 PMCID: PMC10838064 DOI: 10.5271/sjweh.4114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Indexed: 08/16/2023] Open
Abstract
OBJECTIVES The association between occupational mechanical exposures and low-back pain (LBP) has been studied in several systematic reviews. However, no systematic review addressing chronic LBP exists. The aim of this systematic review and meta-analysis was to examine the association between occupational mechanical exposures and chronic LBP. METHODS The study was registered in PROSPERO. We used an existing systematic review to identify articles published before January 2014. For studies published between January 2014 and September 2022, a systematic literature search was conducted in six databases. Two authors independently excluded articles, extracted data, and assessed risk of bias and level of evidence (GRADE). Meta-analyses were conducted using random-effects models comparing highest versus lowest exposure group with sensitivity analyses based on study quality (low/moderate versus high risk of bias), study design (cohort versus case-control), and outcome definition (non-specific LBP versus specific chronic LBP). RESULTS Twenty-six articles were included. Highest pooled odd ratios (OR) were found for combined mechanical exposures [OR 2.2, 95% confidence interval (CI) 1.4-3.6], lifting/carrying loads (OR 1.7, 95% CI 1.4-2.2), and non-neutral postures (OR 1.5, 95% CI 1.2-1.9). For the remaining mechanical exposures (ie, whole-body vibrations, standing/walking, and sitting), OR ranged between 1.0 and 1.4. In the sensitivity analyses, generally, higher pooled OR were found in low/moderate risk of bias studies, case-control studies, and studies of specific chronic LBP. CONCLUSIONS Moderate evidence of an association was found for lifting/carrying loads, non-neutral postures, and combined mechanical exposures. Low or very low evidence was found for whole-body vibrations, standing/walking, and sitting. Studies using standardized exposure definition, metric, and technical measurements are highly warranted.
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Affiliation(s)
- Alexander Jahn
- Danish Ramazzini Centre, Department of Occupational Medicine, Palle Juul-Jensens Boulevard 99, Aarhus University Hospital, Aarhus N, Denmark.
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Willert MV, Christiansen DH, Dalgaard L, Vestergaard JM, Andersen JH, Kyndi M. Developing prognostic models for health care utilization in patients with work-related mental health problems. BMC Health Serv Res 2023; 23:834. [PMID: 37550656 PMCID: PMC10405445 DOI: 10.1186/s12913-023-09802-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 07/10/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND The long-term prognosis for employees with work-related mental health problems is unclear. We aim to describe long-term trends in health care utilization (HCU) and develop multivariable prognostic models for long-term mental health care utilization. METHODS From the Danish Occupational Medicine Cohort we included mental health patients (N = 17,822) assessed from 2000 to 2013 at Departments of Occupational Medicine. Outcomes were general health (general practitioner, somatic hospital) and mental health (psychiatrist/psychologist, psychiatric hospital) HCU obtained from registries five years before/after assessment. The 10-year period was divided into phases relative to assessment: 5 - 3 years before, 2 years before/after, and 3-5 years after. We developed gender-stratified Lasso-penalized multivariable prognostic models for HCU 3-5 years after assessment assessing both calibration and discrimination. RESULTS Prevalent HCU for general practitioner, psychiatrist/psychologist and psychiatric hospital services was relatively stable 5 - 3 years prior to assessment, then rising during the 2 years before/after. At 3-5 years after assessment prevalent general practitioner HCU declined to previous levels, while prevalent HCU for psychologist/psychiatrist and psychiatric hospital services remained elevated compared to previous levels during years 5 - 3. Prognostic models for long-term psychologist/psychiatrist and psychiatric hospital HCU indicated acceptable calibration and modest discrimination. CONCLUSIONS Prevalent HCU rose two years before/after assessment and remained elevated for psychiatrist/psychologist and psychiatric hospital HCU 3-5 years after. Gender-stratified prognostic models were developed for long-term mental health HCU, but discrimination and calibration should be further improved before out-of-sample application for personal prognosis. TRIAL REGISTRATION The study was registered at clinicaltrials.gov (Identifier: NCT04459793) prior to analyses.
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Affiliation(s)
- Morten Vejs Willert
- Dept. of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Juul-Jensens Boulevard 35, Aarhus N, DK-8200, Denmark.
| | - David Høyrup Christiansen
- Research, Regional Hospital Central Jutland, Viborg, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
- Elective Surgery Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - Ligaya Dalgaard
- Dept of Occupational Medicine, University Research Clinic, Danish Ramazzini Center, Regional Hospital Gødstrup, Herning, Denmark
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Jesper Medom Vestergaard
- Dept. of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Juul-Jensens Boulevard 35, Aarhus N, DK-8200, Denmark
- Dept of Occupational Medicine, University Research Clinic, Danish Ramazzini Center, Regional Hospital Gødstrup, Herning, Denmark
| | - Johan Hviid Andersen
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
- Dept of Occupational Medicine, University Research Clinic, Danish Ramazzini Center, Regional Hospital Gødstrup, Herning, Denmark
| | - Marianne Kyndi
- Dept. of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Juul-Jensens Boulevard 35, Aarhus N, DK-8200, Denmark
- Dept of Occupational Medicine, University Research Clinic, Danish Ramazzini Center, Regional Hospital Gødstrup, Herning, Denmark
- Danish Ramazzini Centre, Dept. of Occupational and Environmental Medicine, Aalborg University Hospital, Aalborg, Denmark
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Dalgaard VL, Willert MV, Kyndi M, Vestergaard JM, Andersen JH, Christiansen DH. Cohort Profile: The Danish Occupational Medicine Cohort-a nationwide cohort of patients with work-related disease. Int J Epidemiol 2023; 52:e201-e210. [PMID: 36869758 PMCID: PMC10396417 DOI: 10.1093/ije/dyad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 02/10/2023] [Indexed: 03/05/2023] Open
Affiliation(s)
- Vita Ligaya Dalgaard
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre, Gødstrup Hospital, Herning, Denmark
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus C, Denmark
| | - Morten Vejs Willert
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus N, Denmark
| | - Marianne Kyndi
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre, Gødstrup Hospital, Herning, Denmark
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus N, Denmark
- Department of Occupational and Environmental Medicine, Danish Ramazzini Centre, Aalborg University Hospital, Aalborg, Denmark
| | - Jesper Medom Vestergaard
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre, Gødstrup Hospital, Herning, Denmark
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus N, Denmark
| | - Johan Hviid Andersen
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre, Gødstrup Hospital, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - David Høyrup Christiansen
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre, Gødstrup Hospital, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Centre for Research in Health and Nursing, Research, Regional Hospital Central Jutland, Viborg, Denmark
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Budtz CR, Rønnow MM, Stæhr TAB, Andersen NBDV, Christiansen DH. The usefulness of the STarT back screening tool and single-item general health measures when predicting future disability in patients with low back pain treated in Danish primary care physiotherapy. Musculoskelet Sci Pract 2023; 65:102767. [PMID: 37116370 DOI: 10.1016/j.msksp.2023.102767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/13/2023] [Accepted: 04/19/2023] [Indexed: 04/30/2023]
Abstract
INTRODUCTION The extent to which disease specific screening tools or other health measures add to the predictive value of common clinical factors (pain, disability and socio-demographics) has been sparsely investigated. The aim of this study was to investigate whether a disease specific screening tool and a single-item general health measure adds predictive value to basic information collected in primary physiotherapy care when predicting future disability in patients with low back pain. MATERIAL AND METHODS This longitudinal cohort study included 354 patients with low back pain from Danish primary care physiotherapy. Information was collected on socio-demographics, common clinical factors, The STarT Back Screening Tool (SBT) and general health perceptions measured as a single item from the SF-36 (GH-1). Disability at 6-month follow-up, measured by the Roland-Morris Disability Questionnaire, was predicted using multiple linear regression models. RESULTS Clinical factors and baseline disability level explained 28.3% of the variance in 6-month disability scores. With SBT and GH-1 added separately to the baseline model, the explained variance increased by 2.1% (p = 0.01) and 3.6% (p < 0.001), respectively. CONCLUSION The added value of the disease specific screening tools or the single-item general measure when predicting disability in patients with low back pain was generally small. Moreover, the predictive value of the single-item general measure seems comparable to and slightly better than the disease specific screening tool. Overall these findings may question the clinical utility of such measures.
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Affiliation(s)
- Cecilie Rud Budtz
- Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 1, 8600, Silkeborg, Denmark.
| | - Mathias Moselund Rønnow
- Department of Occupational Medicine, University Research Clinic, Goedstrup Hospital, Hospitalsparken 15, 7400, Herning, Denmark
| | - Thor Andre Brøndberg Stæhr
- Department of Occupational Medicine, University Research Clinic, Goedstrup Hospital, Hospitalsparken 15, 7400, Herning, Denmark
| | - Nils-Bo de Vos Andersen
- Central Denmark Region, Primary Health Care and Quality Improvement, Skottenborg 26, 8800, Viborg, Denmark
| | - David Høyrup Christiansen
- Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 1, 8600, Silkeborg, Denmark; Regional Hospital Central Jutland, Heibergs Allé 2K, 8000, Viborg, Denmark; Deartment of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
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13
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Remmen LN, Christiansen DH, Herttua K, Klakk H, Berg-Beckhoff G. The risk of an incident hospital contact with a musculoskeletal disorder in Danish occupational fishers: a register-based study. BMC Musculoskelet Disord 2023; 24:168. [PMID: 36879225 PMCID: PMC9987051 DOI: 10.1186/s12891-023-06274-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The prevalence of musculoskeletal disorders (MSDs) among occupational fishers is high, yet knowledge of the risk factors is scarce and inconsistent. The aim of this study was to investigate the risk from various work-related characteristics on incident hospital contact due to a musculoskeletal disorders and other pain disorders among Danish occupational fishers. METHODS This register-based study comprised data from the Danish Occupational Cohort with eXposure (DOC*X) for all persons registered as occupational fishers between 1994 and 2017. Time-to-event analysis with Cox regression model was used with age as the time scale. RESULTS Among the 15,739 fishers, 40% (n = 5,669 cases) had an incident hospital contact with an MSD during follow-up. Back disorders were the dominant complaint. Male fishers working less than 5 years or more than 15 years had higher risks of MSD (HR 2.40 (95% CI: 2.06, 2.80), HR: 2.04 (95% CI: 1.76, 2.35), respectively, than those working for over 20 years. Period effects confounded and reduced the risk from occupational seniority. CONCLUSION Fishers occupational seniority vary in risk of MSDs across working life. Results showed a nonlinear relationship between the highest risk for fishers working less than 5 years and the lowest risk working more than 20 years as occupational fisher. More years in the workforce, a captain education, and primarily working part time significantly reduced the risk of experiencing a first MSDs for men. Healthy worker effect was documented.
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Affiliation(s)
- Line Nørgaard Remmen
- Department of Public Health, Research Unit for Health Promotion, University of Southern Denmark, Esbjerg, Denmark. .,Research Unit of Applied Health Science (SUPRA), University College South Denmark (UCSYD), Esbjerg, Denmark.
| | - David Høyrup Christiansen
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre Goedstrup Hospital, Herning, Denmark.,Department of Clinical Medicine, Aarhus University, Health, Aarhus, Denmark.,Center for Health and Nursing Research, Regional Hospital Central Jutland, Research, Viborg, Denmark.,Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Kimmo Herttua
- Department of Public Health, Center for Maritime Health and Society, University of Southern Demark, Esbjerg, Denmark
| | - Heidi Klakk
- Research Unit of Applied Health Science (SUPRA), University College South Denmark (UCSYD), Esbjerg, Denmark.,Research Unit for Exercise Epidemiology (EXE), Department of Sports Science and Clinical Biomechanics (IOB), University of Southern Denmark, Odense M, Denmark.,Center for Clinical Research and Prevention, Section for Health Promotion and Prevention, The Capital Region, Frederiksberg, Denmark
| | - Gabriele Berg-Beckhoff
- Department of Public Health, Research Unit for Health Promotion, University of Southern Denmark, Esbjerg, Denmark.,Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark
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Jahn A, Andersen JH, Christiansen DH, Seidler A, Dalbøge A. Association between occupational exposures and chronic low back pain: Protocol for a systematic review and meta-analysis. PLoS One 2023; 18:e0285327. [PMID: 37146040 PMCID: PMC10162539 DOI: 10.1371/journal.pone.0285327] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 04/19/2023] [Indexed: 05/07/2023] Open
Abstract
INTRODUCTION The association between occupational mechanical exposures and chronic low back pain (LBP) has been widely studied, however, few systematic reviews have evaluated the evidence of an association. Furthermore, little is known of the impact of occupational psychosocial exposures on chronic LBP. The aim of this systematic review and meta-analysis is to study the association between occupational mechanical and psychosocial exposures and chronic LBP. METHODS The study will be conducted as a systematic review using another systematic review published in 2014 as basis and has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) with registration number CRD42021281996. A systematic literature search will be performed in 6 scientific databases to identified potential relevant studies published after 2014. Studies will systematically be excluded through a screening process performed independently by 2 reviewers. Exposures will include occupational mechanical and psychosocial exposures, and outcome will include chronic LBP (LBP ≥3 months, "degenerative" diseases, and lumbosacral radiculopathy). Study population will include persons in or above working age, and study designs will comprise cohort and case-control studies. The quality of each included study will be methodologically assessed by 2 independent reviewers and level of evidence of an association will be graded using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system. In meta-analyses, effect sizes will be addressed using random-effect models, sensitivity analyses will explore the robustness of the meta-analysis, and heterogeneity assessed. DISCUSSION This systematic review and meta-analysis will assess the evidence available of the association between occupational mechanical and psychosocial exposures and chronic LBP. The review can provide essential knowledge on the association, exposure-response relationships, thresholds, which may pave the way for political decisions on the occupational environment and the labour market insurance policy.
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Affiliation(s)
- Alexander Jahn
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Johan Hviid Andersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Occupational Medicine-University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital, Herning, Denmark
| | - David Høyrup Christiansen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Research, Regional Hospital Central Jutland, Viborg, Denmark
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Annett Dalbøge
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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15
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Remmen LN, Christiansen DH, Herttua K, Berg-Beckhoff G. Risk of first musculoskeletal disorder in Danish occupational fishermen – a register-based study. Eur J Public Health 2022. [PMCID: PMC9593497 DOI: 10.1093/eurpub/ckac130.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Occupational fishery increase risk of musculoskeletal disorders due to a combination of heavy workloads and strenuous settings. Scarce and inconsistent knowledge exists on work-related risk factors despite high prevalence is evident. The aim was to determine work-related risk factors for the first diagnosis of musculoskeletal disorders in Danish occupational fishermen. Methods This study was a register-based cohort study. We extracted data the from Nationwide Danish registers on work affiliation and health data for all persons registered as occupational fishermen between 1994 and 2017. Job titles were retrieved from the Danish Occupational Cohort with eXposure (DOC*X). Time-to-event analysis using cox regression with age as timescale was applied. Results Among 15.739 fishermen, forty percent (n = 6.218 cases) experienced first musculoskeletal disorder during 82.2 million person-years of follow-up. Adjusted gender-stratified analysis showed that male fishermen, who worked less than 5 years and more than 15 years had the highest significant risks of MSD (HR 2.40 (95%CI: 2.06, 2.80), HR: 2.40 (95%CI: 1.76, 2.35)) respectively, compared to working more than 20 years. In males, more years in workforce, a captain education and working part time significantly protected against first MSD, while shifting trades above three times increased risk. Women had estimates with greater uncertainties due to their small numbers in the industry. Conclusions A high incidence of musculoskeletal disorders was found in Danish occupational fishermen between 1994-2017. Findings suggest a bimodal relationship between occupational fishermen seniority level and their risk of musculoskeletal disorder, where highest risk was seen at five years in trade, afterwards from lower estimate slowly increasing with accumulating years until highest occupational seniority, compared to more than twenty years in trade. Continued development actions of preventive measures are suggested. Key messages
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Affiliation(s)
- LN Remmen
- Research Unit for Health Promotion, University of Southern Denmark , Esbjerg, Denmark
| | - DH Christiansen
- Department of Occupational Medicine, Regional Hospital West Jutland , Herning, Denmark
- Department of Clinical Medicine, Aarhus University , Aarhus N, Denmark
| | - K Herttua
- Center for Maritime Health and Society, University of Southern Demark , Esbejrg, Denmark
| | - G Berg-Beckhoff
- Research Unit for Health Promotion, University of Southern Denmark , Esbjerg, Denmark
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Christiansen DH, Nielsen KJ, Andersen DR, Andersen JH. Musculoskeletal health climate is associated with musculoskeletal pain and sickness absence among workers: a cross-sectional study. BMJ Open 2022; 12:e056485. [PMID: 35414557 PMCID: PMC9006822 DOI: 10.1136/bmjopen-2021-056485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study aimed to investigate whether a musculoskeletal health climate, expressing the shared perceptions among workers concerning musculoskeletal health, is associated with number of musculoskeletal pain sites and sickness absence. DESIGN Cross-sectional study. SETTING Six slaughterhouses from 2 companies in Denmark and 6 home-nursing units and 12 nursing homes from 1 municipality in Jutland, Denmark. PARTICIPANTS A total of 1092 slaughter house workers and 410 care workers completed an online questionnaire from February to October 2019. OUTCOME MEASURES The exposure variable was musculoskeletal health climate assessed by two domains; (1) perceived management priority of musculoskeletal health measured by a modified subscale from the Nordic Safety Climate Questionnaire and (2) work group pain acceptance which was a modified version of the activity engagement subscale of the chronic pain acceptance scale. Outcomes variables were number of musculoskeletal pain sites (0-6) and days with sickness absence. RESULTS The associations between the two subscales, number of musculoskeletal pain sites and sickness absence were calculated using mixed linear and generalised estimating equation regression models. Higher perceived management priority scores were associated with a lower number of musculoskeletal pain sites across both job groups: β=-.57 (95% CI -0.91 to -0.23) and sickness absence (>5 days) due to musculoskeletal pain prevalence ratio (PR) 0.79 (95% CI 0.57 to 1.08). In contrast higher work group pain acceptance scores were associated with higher number of musculoskeletal pain sites: β=0.38 (0.11 to 0.66), whereas associations with sickness absences seemed to be modified by job groups; PR 1.59 care workers and PR 0.86 slaughterhouse workers. CONCLUSION The observed relationship between musculoskeletal health climate, musculoskeletal pain sites and sickness absence indicate that cultural factors should receive increased attention in work place preventive interventions.
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Affiliation(s)
- David Høyrup Christiansen
- Department of Occupational Medicine - University Research Clinic, Regional Hospital West Jutland, Herning, Denmark
- Department of Clinical Medicine, Aarhus Universitet Health, Aarhus, Denmark
| | - Kent Jacob Nielsen
- Department of Occupational Medicine - University Research Clinic, Regional Hospital West Jutland, Herning, Denmark
| | - Dorte Raaby Andersen
- Department of Occupational Medicine - University Research Clinic, Regional Hospital West Jutland, Herning, Denmark
| | - Johan Hviid Andersen
- Department of Occupational Medicine - University Research Clinic, Regional Hospital West Jutland, Herning, Denmark
- Department of Clinical Medicine, Aarhus Universitet Health, Aarhus, Denmark
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Budtz CR, Rønn-Smidt H, Thomsen JNL, Hansen RP, Christiansen DH. Primary Care Physical Therapists' Experiences When Screening for Serious Pathologies Among Their Patients: A Qualitative Study. Phys Ther 2022; 102:6549490. [PMID: 35302642 PMCID: PMC9155951 DOI: 10.1093/ptj/pzac026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/12/2021] [Accepted: 01/07/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A vital part of the initial examination performed by a physical therapist is to establish whether the patient would benefit from physical therapist intervention. This process includes knowledge about contraindications for treatment and screening for serious pathologies. However, little is known about the physical therapists' views and thoughts about their own practice when screening for serious pathologies. The purpose of this study was to explore the experience gained by physical therapists when screening for serious pathologies among their patients. METHODS This was a qualitative study based on individual semi-structured interviews with 9 primary care physical therapists. The interviews were analyzed using reflexive thematic analysis, and generated themes were explained and reported with relevant quotes. RESULTS Three overall themes were generated: (1) the role of physical therapists in the diagnostic process; (2) responsibility from the individual to the group; and (3) the difficult task of cooperation. The physical therapists described how they relied more on their clinical suspicion than on asking red-flag questions when screening for serious pathologies. They also questioned their differential diagnostic abilities. Finally, they saw a potential to further enhance their confidence in the area by reflecting on the matter with colleagues and by receiving more feedback about their clinical reasoning regarding serious pathologies from general practitioners. CONCLUSION These findings suggest that physical therapists primarily rely on their clinical suspicion when screening for serious pathologies but at the same time are uncertain about their differential diagnostic abilities. IMPACT These findings can inform future interventions targeting the physical therapists' abilities to detect serious pathology.
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Affiliation(s)
| | | | | | | | - David Høyrup Christiansen
- Goedstrup Hospital, Department of Occupational Medicine - University Research Clinic, Herning, Denmark,Aarhus University, Department of Clinical Medicine, Aarhus, Denmark,Regional Hospital Central Jutland, Research, Heibergs Allé 2K, Viborg, Denmark
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18
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Jaensch C, Jepsen MH, Christiansen DH, Madsen AH, Madsen MR. Adenoma and serrated lesion detection with distal attachment in screening colonoscopy: a randomized controlled trial. Surg Endosc 2022; 36:1-9. [PMID: 35141776 DOI: 10.1007/s00464-022-09049-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Adenoma detection rate (ADR) is the single most important measure of quality in colonoscopy, but little is known about the detection rate of serrated lesions (SLDR). To improve ADR, Endocuff Vision (EV) can be used. Studies have shown differing results as to the effect on ADR; an effect on SLDR has not been shown. To investigate the effect of Endocuff Vision on ADR in a screening population, this randomized controlled open label trial with concealed allocation was performed. Randomization to trial group was carried out by the endoscopist using prepared numbered envelopes. METHODS Patients referred as part of the national bowel screening program at Regional Hospital Herning, Denmark were recruited and allocated to one of two groups: Endocuff Vision colonoscopy (EVC) and standard colonoscopy (SC). Outcomes were ADR, mean number, site, and size of lesions per procedure. SLDR as outcome was added after inclusion had begun. RESULTS A total of 1178 participants were included, with 1166 (EVC 583 and SC 583) available for analysis. There was no clinical relevant difference in ADR (59.2% [CI 55.1; 63.1] v 60.5% [CI 56.5; 64.4]) or SLDR (13.0% [CI 10.5; 16.0] v 10.3% [CI 8.0; 13.0]) between groups. More serrated lesions were found per procedure (MSP) (0.2 v 0.1, IRR 57% [CI 17; 109]. Removal rate of EV was similar in the two study groups. CONCLUSION We found no significant effects of the use of Endocuff Vision on ADR, when compared to standard colonoscopy, but more serrated lesions were detected in the Endocuff group. TRIAL REGISTRATION Clinical Trials NCT04651062.
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Affiliation(s)
- Claudia Jaensch
- Surgical Research Department, Regional Hospital West Jutland, Gl. Landevej 61, 7400, Herning, Denmark.
| | | | - David Høyrup Christiansen
- Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Herning, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
| | - Anders Husted Madsen
- Surgical Research Department, Regional Hospital West Jutland, Gl. Landevej 61, 7400, Herning, Denmark
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Schlünsen ADM, Christiansen DH, Fredberg U, Vedsted P. Effectiveness of a 24-hour access outpatient clinic for patients with chronic conditions in hospital outpatient follow-up: a registry-based controlled cohort study of healthcare utilisation and mortality. Integ Health J 2022. [DOI: 10.1136/ihj-2020-000069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
ObjectiveTo evaluate the effectiveness of a 24-hour telephone access outpatient clinic (24-hour access clinic) in terms of healthcare utilisation and mortality in patients with five chronic conditions (chronic obstructive pulmonary disease, atrial fibrillation/flutter, congestive heart failure, inflammatory bowel disease and chronic liver disease).Methods and analysisThis was a registry-based controlled cohort study. The 24-hour access clinic was established at Silkeborg Regional Hospital in Central Denmark Region. The five other regional hospitals served as comparison hospitals. The 24-hour access clinic allowed patients with five chronic conditions with ongoing hospital outpatient follow-up to call the hospital outpatient clinic in case of an exacerbation. Outcomes were use of hospital admissions, length of stay (LOS), outpatient visits, contacts to general practice and all-cause mortality during 18 months of follow-up.ResultsThe study included 992 the 24-hour access patients and 3878 usual care patients. For the five conditions combined, the 24 hours access patients had fewer all-cause admissions (incidence rate ratio (IRR) 0.81, 95% Cl 0.71 to 0.92), general practice out-of-hours contacts (IRR 0.81, 95% C 0.71 to .92) and shorter LOS (IRR 0.71, 95% CI 0.57 to 0.88). The rate of all-cause outpatient visits tended to be higher (IRR 1.07, 95% CI 0.99 to 1.15). General practice daytime contacts were similar between the groups, and there was no significant difference in mortality.ConclusionsThe results suggest that a 24-hour telephone access clinic may lead to enhanced integration of care measured as unplanned acute care substituted with planned outpatient care.
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Budtz CR, Rønn-Smidt H, Thomsen JNL, Hansen RP, Christiansen DH. Primary care physiotherapists ability to make correct management decisions - is there room for improvement? A mixed method study. BMC Fam Pract 2021; 22:196. [PMID: 34615482 PMCID: PMC8496017 DOI: 10.1186/s12875-021-01546-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/22/2021] [Indexed: 11/19/2022]
Abstract
Background With increasing interest in direct access to physiotherapy, it is important to consider the physiotherapists (PTs) ability to make correct management decisions, because identification of differential diagnostic pathologies and timely referral for specialist care is vital for patient safety. The aims of the study were to investigate PTs ability to make correct management decisions in patients presenting with musculoskeletal conditions and to identify explanatory factors associated with this ability. Furthermore, we wanted to explore the PTs views on the identified factors. Methods The study was a mixed methods study with an explanatory sequential design consisting of a questionnaire survey and semi-structured interviews. The questionnaire comprised 12 clinical vignettes describing patient scenarios for musculoskeletal conditions, non-critical medical conditions and critical medical conditions. Based on this, the PTs indicated whether the patient should be managed by the PT or were in need of medical referral. Associations between correct decisions and explanatory variables was analyzed by mixed- effects logistic regression. Interviews were performed with nine PTs to explore their reactions to the results. A directed content analysis was performed. Results A total of 195 PTs participated in the questionnaire survey and 9 PTs were interviewed. Overall, PTs were more likely to make correct management decisions in the musculoskeletal conditions category, whereas wrong decisions were more often chosen for underlying medical conditions categories. Positive associations between correct management decision in the critical medical category were found for experience: odds ratio (OR) 2.73 (1.33;5.57) and passed quality audit OR 2.90 (1.50;5.58). In the interviews, PTs expressed concerns about the differential diagnostic abilities. They all noted, that experience is immensely important in the clinical reasoning process because the ability to recognise diagnostic patterns evolves over time. Furthermore, the quality audit seems to address and systematize the clinical reasoning process and workflow within the clinics. Conclusion The lack of ability to make correct management decision in critical medical categories and the uncertainties expressed by PT’s should raise concern, as direct access to physiotherapy is already well-established and the results indicate that patient safety could be at risk. The findings that experience and passed quality audit was associated with correct management decisions highlights the need for ongoing awareness and education into differential diagnostics. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01546-1.
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Affiliation(s)
- Cecilie Rud Budtz
- Department of Occupational Medicine, University Research Clinic, Gl. Landevej 61, 7400, Herning, Denmark.
| | | | | | | | - David Høyrup Christiansen
- Department of Occupational Medicine, University Research Clinic, Gl. Landevej 61, 7400, Herning, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
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Mose S, Kent P, Smith A, Andersen JH, Christiansen DH. Trajectories of Musculoskeletal Healthcare Utilization of People with Chronic Musculoskeletal Pain - A Population-Based Cohort Study. Clin Epidemiol 2021; 13:825-843. [PMID: 34557040 PMCID: PMC8455515 DOI: 10.2147/clep.s323903] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/20/2021] [Indexed: 12/29/2022] Open
Abstract
Background and Aim Chronic musculoskeletal pain is common and associated with more general healthcare-seeking. However, musculoskeletal-related healthcare utilization is under-explored. This study aimed to explore, describe and profile trajectories of long-term musculoskeletal healthcare for people reporting chronic musculoskeletal pain. Methods This exploratory prognostic cohort study combined survey and national health register data from a representative group of adult Danes reporting chronic musculoskeletal pain (N = 2929). Trajectories of long-term musculoskeletal healthcare use were generated using latent class growth analysis. Types of healthcare-seeking, individual, sociodemographic, health, belief and work-related factors were used to describe and profile identified trajectories. Results We identified five distinct trajectories of long-term musculoskeletal healthcare utilization (low stable, low ascending, low descending, medium stable and high stable). The low stable trajectory group (no or almost no annual contacts) represented 39% of the sample, whereas the high stable trajectory group (consistent high number of annual contacts) represented 8%. Most healthcare-seeking was in primary healthcare settings (GP/physiotherapy/chiropractor). Opioid consumption was primarily in the high stable trajectory group, and surgery was rare. There were statistically significant differences across the five trajectory groups in individual, sociodemographic, health, belief and work-related profiles. Conclusion Long-term use of musculoskeletal healthcare services varied in this chronic musculoskeletal pain population. Almost 40% coped without seeking care, whereas 8% had consistent high use of healthcare services. Chronic musculoskeletal pain was mostly managed in primary care settings, which aligns with musculoskeletal guidelines, as did the use of pain medication and surgery. People with different musculoskeletal healthcare trajectories had different individual, sociodemographic, health, belief and work-related profiles. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/o24sO5gidU4
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Affiliation(s)
- Søren Mose
- Department of Occupational Medicine, Danish Ramazzini Centre - University Research Clinic, Herning, Denmark.,School of Physiotherapy, VIA University College, Holstebro, Denmark
| | - Peter Kent
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia.,Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Anne Smith
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Johan Hviid Andersen
- Department of Occupational Medicine, Danish Ramazzini Centre - University Research Clinic, Herning, Denmark
| | - David Høyrup Christiansen
- Department of Occupational Medicine, Danish Ramazzini Centre - University Research Clinic, Herning, Denmark
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Mose S, Kent P, Smith A, Andersen JH, Christiansen DH. Number of musculoskeletal pain sites leads to increased long-term healthcare contacts and healthcare related costs - a Danish population-based cohort study. BMC Health Serv Res 2021; 21:980. [PMID: 34535148 PMCID: PMC8447684 DOI: 10.1186/s12913-021-06994-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with musculoskeletal pain seek more healthcare than the general population, however little is known about the long-term effect on healthcare use. The aim of this study was to examine the consequences of number of musculoskeletal pain sites on long-term care-seeking and healthcare-related costs and explore how health anxiety influences this relationship. METHODS We conducted a Danish population-based longitudinal cohort study of 4883 participants combining self-reported survey data from 2008 with ten-year follow-up data from national health registers. Using a causal inference framework, we examined associations between number of pain sites (range 0-7)/level of health anxiety (high/low level) and face-to-face healthcare contacts/healthcare-related costs. Data were analyzed using negative binomial regression with generalized estimating equations. Regression models were adjusted for sex, age, duration of pain, level of education, comorbidity, personality traits, risk of depression, marital status, physical job exposure, and previous healthcare utilization. RESULTS For each additional pain site general healthcare contacts (Incidence Rate Ratio (IRR): 1.04 (95% CI: 1.03-1.05)), healthcare-related costs (IRR: 1.06 (95% CI: 1.03-1.08) and musculoskeletal healthcare contacts (IRR: 1.11 (95% CI:1.09-1.14) increased. Those with high levels of health anxiety at baseline had a slightly higher number of general healthcare contacts (IRR 1.06 (1.01-1.11), independent of number of pain sites. However, level of anxiety did not influence the effect of number of pain sites on any healthcare use or cost outcomes. CONCLUSIONS We found evidence for a causal association between increasing number of pain sites and greater healthcare use and cost, and high levels of health anxiety did not increase the strength of this association. This suggests that number of pain sites could be a potential target for biopsychosocial interventions in order to reduce the need for future care-seeking.
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Affiliation(s)
- S Mose
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre, Herning, Denmark. .,VIA University College, School of Physiotherapy, Holstebro, Denmark.
| | - P Kent
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia.,Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - A Smith
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - J H Andersen
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre, Herning, Denmark
| | - D H Christiansen
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre, Herning, Denmark
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Rønnow MM, Stæhr TAB, Christiansen DH. Predicting change in symptoms and function in patients with persistent shoulder pain: a prognostic model development study. BMC Musculoskelet Disord 2021; 22:732. [PMID: 34452608 PMCID: PMC8401246 DOI: 10.1186/s12891-021-04612-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/15/2021] [Indexed: 12/23/2022] Open
Abstract
Background Persistent shoulder pain causes considerable disruption of the individual’s life and imposes high costs on healthcare and society. Well-informed treatment and referral pathways are crucial as unsuccessful interventions and longer duration of symptoms minimizes the likelihood of success in future interventions. Although physiotherapy is generally recommended as first line treatment, no prognostic model or clinical prediction rules exists to help guide the treatment of patients with persistent shoulder pain undergoing physiotherapy. Thus, the objective of this study was to develop a prognostic model to inform clinical decision making and predict change in symptoms and function in patients with persistent shoulder pain. Methods This was a prospective cohort study of 243 patients with persistent shoulder pain referred to outpatient physiotherapy rehabilitation centres. Data was collected at baseline and six-month follow-up. The outcome was change in shoulder symptoms and function as measured by the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) from baseline to 6 months follow up. Potential predictors were included in a multivariable linear regression model which was pruned using modified stepwise backwards elimination. Results The final model consisted of seven predictors; baseline QuickDASH score, employment status, educational level, movement impairment classification, self-rated ability to cope with the pain, health-related quality of life and pain catastrophizing. Together these variables explained 33% of the variance in QuickDASH-change scores with a model root mean squared error of 17 points. Conclusion The final prediction model explained 33% of the variance in QuickDASH change-scores at 6 months. The root mean squared error (model SD) was relatively large meaning that the prediction of individual change scores was quite imprecise. Thus, the clinical utility of the prediction model is limited in its current form. Further work needs be done in order to improve the performance and precision of the model before external validity can be examined along with the potential impact of the model in clinical practice. Two of the included predictors were novel and could be examined in future studies; movement impairment classification based on diagnosis and health-related quality of life. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04612-y.
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Affiliation(s)
- Mathias Moselund Rønnow
- Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Gl. Landevej 61, 7400, Herning, Denmark.
| | - Thor André Brøndberg Stæhr
- Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Gl. Landevej 61, 7400, Herning, Denmark
| | - David Høyrup Christiansen
- Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Gl. Landevej 61, 7400, Herning, Denmark
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Lafrance S, Ouellet P, Alaoui R, Roy JS, Lewis J, Christiansen DH, Dubois B, Langevin P, Desmeules F. Motor Control Exercises Compared to Strengthening Exercises for Upper- and Lower-Extremity Musculoskeletal Disorders: A Systematic Review With Meta-Analyses of Randomized Controlled Trials. Phys Ther 2021; 101:6145046. [PMID: 33609357 DOI: 10.1093/ptj/pzab072] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/27/2020] [Accepted: 12/31/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this review was to compare the efficacy of motor control exercises (MCEs) to strengthening exercises for adults with upper- or lower-extremity musculoskeletal disorders (MSKDs). METHODS Electronic searches were conducted up to April 2020 in Medline, Embase, Cochrane CENTRAL, and CINAHL. Randomized controlled trials were identified on the efficacy of MCEs compared to strengthening exercises for adults with upper- or lower-extremity MSKDs. Data were extracted with a standardized form that documented the study characteristics and results. For pain and disability outcomes, pooled mean differences (MDs) and standardized mean differences (SMDs) were calculated using random-effects inverse variance models. RESULTS Twenty-one randomized controlled trials (n = 1244 participants) were included. Based on moderate-quality evidence, MCEs lead to greater pain (MD = -0.41 out of 10 points; 95% CI = -0.72 to -0.10; n = 626) and disability reductions (SMD = -0.28; 95% CI = -0.43 to -0.13; n = 713) when compared to strengthening exercises in the short term; these differences are not clinically important. When excluding trials on osteoarthritis (OA) participants and evaluating only the trials involving participants with rotator cuff-related shoulder pain, shoulder instability, hip-related groin pain, or patellofemoral pain syndrome, there is moderate quality evidence that MCEs lead to greater pain (MD = -0.74 out of 10 points; 95% CI = -1.22 to -0.26; n = 293) and disability reductions (SMD = -0.40; 95% CI = -0.61 to -0.19; n = 354) than strengthening exercises in the short term; these differences might be clinically important. CONCLUSIONS MCEs lead to statistically greater pain and disability reductions when compared to strengthening exercises among adults with MSKDs in the short term, but these effects might be clinically important only in conditions that do not involve OA. Inclusion of new trials might modify these conclusions. IMPACT These results suggest that MCEs could be prioritized over strengthening exercises for adults with the included non-OA MSKDs; however, results are unclear for OA disorders.
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Affiliation(s)
- Simon Lafrance
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada
| | - Philippe Ouellet
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada
| | - Reda Alaoui
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Quebec, Canada
| | - Jeremy Lewis
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, United Kingdom.,Therapy Department, Central London Community Healthcare National Health Service Trust, London, United Kingdom.,Department of Physical Therapy and Rehabilitation Science, Qatar University, Doha, Qatar
| | - David Høyrup Christiansen
- Department of Occupational Medicine, Regional Hospital West Jutland University Research Clinic, Herning, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | | | - Pierre Langevin
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Quebec, Canada
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada
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25
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Langella F, Christensen SWM, Palsson TS, Høgh M, Gagni N, Bellosta-López P, Christiansen DH, Delle Chiaie M, Domenéch-García V, Johnston V, Szeto GPY, Villafañe JH, Herrero P, Berjano P. Development of the Prevent for Work questionnaire (P4Wq) for assessment of musculoskeletal risk in the workplace: part 1-literature review and domains selection. BMJ Open 2021; 11:e043800. [PMID: 33846150 PMCID: PMC8048000 DOI: 10.1136/bmjopen-2020-043800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE This study aims to define appropriate domains and items for the development of a self-administered questionnaire to assess the risk of developing work-related musculoskeletal disorder (WMSD) and the risk of its progression to chronicity. DESIGN Literature review and survey study. SETTING AND PARTICIPANTS A literature review and a two-round interview with 15 experts in musculoskeletal pain were performed to identify the available domains for WMSD assessment. INTERVENTIONS AND OUTCOME To ensure quality, only validated questionnaires were included for the Delphi process. A three-round Delphi method, with three round steps, was used to select the most pertinent and relevant domains and items. RESULTS Nine questionnaires were identified through the expert discussion and literature review, comprising 38 candidate domains and 504 items. In the first round of the Delphi group, 17 domains reached more than 70% agreement and were selected. In the second round, 10 domains were rejected, while 11 were selected to complete the pool of domains. In the third and final round, 89 items belonging to 28 domains were defined as significant to develop a WMSDs risk assessment questionnaire. CONCLUSIONS No specific risk assessment questionnaires for WMSDs were identified from the literature. WMSD risk of presence and chronicity can be defined by an assessment tool based on the biopsychosocial model and the fear-avoidance components of chronic pain. The present study provides the formulation and operationalisation of the constructs in domains and items needed for developing and validating the questionnaire.
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Affiliation(s)
| | - Steffan Wittrup McPhee Christensen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
| | | | - Morten Høgh
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Nicolo Gagni
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Pablo Bellosta-López
- Department of Physiotherapy, Faculty of Health Sciences, Universidad San Jorge, 50830 Villanueva de Gállego, Zaragoza, Spain
| | - David Høyrup Christiansen
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre, Regional Hospital Gødstrup, Herning, Denmark
| | | | - Victor Domenéch-García
- Department of Physiotherapy, Faculty of Health Sciences, Universidad San Jorge, 50830 Villanueva de Gállego, Zaragoza, Spain
| | - Venerina Johnston
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Grace P Y Szeto
- School of Medical & Health Sciences, Tung Wah College, Hong Kong SAR, China
| | | | - Pablo Herrero
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Aragón, Spain
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Christiansen DH, Hjort J. Group-based exercise, individually supervised exercise and home-based exercise have similar clinical effects and cost-effectiveness in people with subacromial pain: a randomised trial. J Physiother 2021; 67:124-131. [PMID: 33744191 DOI: 10.1016/j.jphys.2021.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/15/2021] [Accepted: 02/26/2021] [Indexed: 12/11/2022] Open
Abstract
QUESTION What are the relative effects of group-based exercise, individual exercise and home-based exercise on clinical outcomes and costs in patients with subacromial pain? DESIGN Multicentre, three-arm, randomised controlled trial with concealed allocation and intention-to-treat analysis. PARTICIPANTS A total of 208 patients referred to municipal rehabilitation for management of subacromial pain in six municipalities in the Central Denmark Region. INTERVENTIONS Patients were randomly allocated to group-based exercise rehabilitation (GE), individual exercise rehabilitation (IE) or home exercise rehabilitation (HE) for a period of 8 weeks. OUTCOME MEASURES The primary outcome measure was the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (Quick-DASH). The secondary outcome measures included the EQ-5D-5L index, pain intensity, fear avoidance, psychological wellbeing, and the participant's perception of improvement and satisfaction. Healthcare and productivity costs were extracted from national health and social registers. RESULTS There was no important between-group difference in Quick-DASH scores at 6 months: adjusted mean differences GE minus IE -2 (95% CI -9 to 5), GE minus HE -2 (95% CI -9 to 5) and HE minus IE 1 (95% CI -6 to 7). The estimates of the between-group differences were able to exclude any clinically important differences in the three regimens' effects on health benefits according to the EQ-5D-5L index and other secondary outcomes. The total average costs were highest for the IE group and lowest for the HE, but not statistically different across groups. CONCLUSION In people with subacromial pain, group-based exercise, individually supervised exercise and home-based supervised exercise regimens have similar benefits. The home exercise intervention was associated with lowest costs. TRIAL REGISTRATION ClinicalTrials.gov: NCT03055117.
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Affiliation(s)
- David Høyrup Christiansen
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre Regional Hospital Gødstrup, Herning, Denmark; Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark.
| | - Jakob Hjort
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
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Budtz CR, Hansen RP, Thomsen JNL, Christiansen DH. The prevalence of serious pathology in musculoskeletal physiotherapy patients - a nationwide register-based cohort study. Physiotherapy 2021; 112:96-102. [PMID: 34034209 DOI: 10.1016/j.physio.2021.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Musculoskeletal conditions are the single largest contributor to years lived with disability worldwide. Most musculoskeletal conditions can be managed in primary care, but for a small proportion of these patients the symptoms are caused by serious pathology. Although the general practitioner usually performs initial screening for serious pathology, evaluation and treatment by physiotherapists are often part of the treatment pathway. It is however unclear, how many patients in primary care physiotherapy have symptoms caused by serious pathology. OBJECTIVE To estimate the prevalence of neoplasm, cauda equina syndrome, spinal fracture, infection and inflammatory pathology among patients referred for musculoskeletal physiotherapy. METHODS The study was a nationwide register-based cohort study. The authors identified all referrals for primary care musculoskeletal physiotherapy in the Danish National Health Insurance Service Register from 2014 to 2017. Records of hospital contacts were extracted from the Danish National Patient Register within 180 days from first physiotherapy contact, identifying all diagnoses of serious pathology. Prevalence estimates of the serious pathology categories were reported. RESULTS A total of 1568704 courses of treatment were included in the analysis. The overall prevalence of serious pathology was 2.30%. The prevalence of neoplasm was 2.11%, cauda equina syndrome 0.01%, fractures 0.13%, infections 0.01% and inflammatory pathology 0.06%. Higher prevalence's were observed among patients with a previous history of serious pathology, aged above 50 and with comorbidites. CONCLUSIONS Although serious pathology among patients referred by the General Practitioner to musculoskeletal physiotherapy is rare, the present study found an overall prevalence of serious pathology which exceeded the guideline endorsed prevalence estimates.
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Affiliation(s)
- Cecilie Rud Budtz
- Regional Hospital West Jutland, Department of Occupational Medicine - University Research Clinic, Gl. Landevej 61, 7400 Herning, Denmark.
| | | | | | - David Høyrup Christiansen
- Regional Hospital West Jutland, Department of Occupational Medicine - University Research Clinic, Gl. Landevej 61, 7400 Herning, Denmark; Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus, Denmark
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Ouellet P, Lafrance S, Pizzi A, Roy JS, Lewis J, Christiansen DH, Dubois B, Langevin P, Desmeules F. Region-specific Exercises vs General Exercises in the Management of Spinal and Peripheral Musculoskeletal Disorders: A Systematic Review With Meta-analyses of Randomized Controlled Trials. Arch Phys Med Rehabil 2021; 102:2201-2218. [PMID: 33684362 DOI: 10.1016/j.apmr.2021.01.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare the efficacy of region-specific exercises to general exercises approaches for adults with spinal or peripheral musculoskeletal disorders (MSKDs). DATA SOURCES Electronic searches were conducted up to April 2020 in Medline, Embase, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health. STUDY SELECTION Randomized control trials (RCTs) on the efficacy of region-specific exercises compared to general exercises approaches for adults with various MSKDs. DATA EXTRACTION Mean differences and standardized mean differences were calculated using random-effects inverse variance modeling. Eighteen RCTs (n=1719) were included. Cohorts were composed of participants with chronic neck (n=313) or low back disorders (n=1096) and knee osteoarthritis (OA) (n=310). DATA SYNTHESIS Based on low-quality evidence in the short-term and very low-quality in the mid- and long-term, there were no statistically significant differences between region-specific and general exercises in terms of pain and disability reductions for adults with spinal disorders or knee OA. Secondary analyses for pain reduction in the short-term for neck or low back disorders did not report any statistically significant differences according to very low- to low-quality of evidence. CONCLUSIONS The difference in treatment effect remains uncertain between region-specific and general exercises approaches. Based on very low- to low-quality evidence, there appear to have no differences between both types of exercise approaches for pain reduction or disability for adults with spinal disorders. Future trials may change the current conclusions. More evidence is needed for region-specific exercises compared to general exercises for other peripheral MSKDs including knee OA.
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Affiliation(s)
- Philippe Ouellet
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Simon Lafrance
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada
| | - Andrea Pizzi
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada
| | - Jean-Sebastien Roy
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Quebec, Canada
| | - Jeremy Lewis
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, United Kingdom; Therapy Department, Central London Community Healthcare National Health Service Trust, London, United Kingdom; Department of Physical Therapy & Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - David Høyrup Christiansen
- Department of Occupational Medicine, Regional Hospital West Jutland University Research Clinic, Herning, Denmark; Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | | | - Pierre Langevin
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Quebec, Canada
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada.
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Næss-Schmidt E, Andersen NBDV, Christiansen DH, Nielsen JF, Stubbs PW. Cohort profile: Design and implementation of the Danish Physiotherapy Research Database for patients receiving primary care with chronic disease. BMJ Open 2020; 10:e040207. [PMID: 33148759 PMCID: PMC7640532 DOI: 10.1136/bmjopen-2020-040207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/02/2020] [Accepted: 10/10/2020] [Indexed: 01/30/2023] Open
Abstract
PURPOSE Free of charge physiotherapy (FCP) is free physiotherapy provided by the Danish government for patients with a range of chronic diseases. To date, the population has not been described in depth making evaluation and decision making difficult. The purpose of this study was to (1) describe the development and the content of a novel clinical physiotherapy database for FCP (PhysDB-FCP) and (2) present the cohort profile based on the data collected. PARTICIPANTS Ninety-nine clinics (17 460 FCP patients) were invited to participate in the development process from 2018 to 2019. Eleven clinics consented (2780 FCP patients) and 534 patients performed the physiotherapy assessment using the PhysDB-FCP tool, with 393/534 completing the patient survey. FINDINGS TO DATE The content of the PhysDB-FCP was developed through an iterative process involving consensus between clinical and research workgroups. Prior to using the tool all consenting sites received training to use/administer the tool. All data were collected/stored using the PhysDB-FCP. Items finally chosen for the PhysDB-FCP included demographic information, questions about health status and daily functioning, functional tests, treatment plan and validated questionnaires. The initial patient cohort composed of 63.4% women with main diagnoses of multiple sclerosis (22.7%) and Parkinson's disease (17.0%). The ability to perform personal/instrumental activities of daily living and functional ability varied widely. Other non-physiotherapy related issues were identified in numerous patients (ie, 34.9% of patients were at risk of depression) and multidisciplinary interventional approaches could be considered. FUTURE PLANS The current study has provided a comprehensive description of patients receiving FCP, using data collected from the novel PhysDB-FCP. Collected information can be used to facilitate microlevel to macrolevel programme evaluation and decisions. Although the PhysDB-FCP is promising, the tool requires optimisation before it is implemented regionally and/or nationally.
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Affiliation(s)
- Erhard Næss-Schmidt
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | | | - David Høyrup Christiansen
- Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland - University Research Clinic, Aarhus University, Herning, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - Peter William Stubbs
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, Sydney, New South Wales, Australia
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Schlünsen ADM, Christiansen DH, Fredberg U, Vedsted P. Patient characteristics and healthcare utilisation among Danish patients with chronic conditions: a nationwide cohort study in general practice and hospitals. BMC Health Serv Res 2020; 20:976. [PMID: 33106173 PMCID: PMC7586660 DOI: 10.1186/s12913-020-05820-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 10/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background The complexity of caring for patients with chronic conditions necessitates new models of integrated care to accommodate an increasing demand. To inform the development of integrated care models, it is essential to map patients’ use of healthcare resources. In this nationwide registry-based cohort study, we describe and compare patient characteristics and healthcare utilisation between Danish patients with chronic conditions in general practice follow-up and in hospital outpatient follow-up. Methods On 1 January 2016, we identified 250,402 patients registered in 2006–2015 with a hospital diagnosis of atrial fibrillation/flutter, congestive heart failure, chronic liver disease, inflammatory bowel disease or chronic obstructive pulmonary disease. By linkage to national social and health registries, patient characteristics and 12-month healthcare utilisation were extracted. Incidence rates of health care utilisation were compared between patients with chronic conditions in general practice follow-up and patients in hospital outpatient follow-up using negative binomial regression. Results Across all five conditions, the largest proportions of patients were in general practice follow-up (range = 59–87%). Patients in hospital outpatient follow-up had higher rates of exacerbation-related admissions (adjusted incidence rate ratio (IRR) range = 1.3 to 2.8) and total length of stay (IRR range = 1.2 to 2.2). For these five conditions, all-cause admissions and lengths of stay, general practice daytime and out-of-hours contacts, and municipal home nursing contacts were similar between follow-up groups or higher among patients in general practice follow-up. The exception was patients with chronic obstructive pulmonary disease, where patients in hospital outpatient follow-up had higher utilisation of healthcare resources. Conclusions Patients in general practice follow-up accounted for the largest proportion of total healthcare utilisation, but patients in hospital outpatient follow-up were characterised by high exacerbation rates. Enhanced integration of chronic care may be of most benefit if patients in general practice follow-up are targeted, but it is also likely to have an impact on exacerbation rates among patients in hospital outpatient follow-up.
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Affiliation(s)
- Anders Damgaard Møller Schlünsen
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Department of Clinical Medicine, Silkeborg Regional Hospital, Aarhus University, Silkeborg, Denmark.
| | - David Høyrup Christiansen
- Department of Occupational Medicine, Regional Hospital West Jutland, University Research Clinic, Herning, Denmark.,Department of Clinical Medicine, HEALTH, Aarhus University, Aarhus, Denmark
| | - Ulrich Fredberg
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Department of Clinical Medicine, Silkeborg Regional Hospital, Aarhus University, Silkeborg, Denmark
| | - Peter Vedsted
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Department of Clinical Medicine, Silkeborg Regional Hospital, Aarhus University, Silkeborg, Denmark.,Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus, Denmark
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Nørgaard Remmen L, Fromsejer Heiberg R, Høyrup Christiansen D, Herttua K, Berg-Beckhoff G. Work-related musculoskeletal disorders among occupational fishermen: a systematic literature review. Occup Environ Med 2020; 78:oemed-2020-106675. [PMID: 33023968 DOI: 10.1136/oemed-2020-106675] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/27/2020] [Accepted: 09/07/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Commercial fishing constitutes an increased risk of musculoskeletal disorders (MSD), as it consists of heavy workloads and uncontrollable strenuous settings. The aims of this systematic review were to describe the prevalence of MSD among occupational fishermen and to identify risk factors for onset work-related MSD. METHODS All studies investigating MSD in occupational fishermen were systematically identified and reviewed. Searched databases were PubMed/MEDLINE, EMBASE and CINAHL. Two independent researchers performed the quality assessments of the studies. RESULTS From 292 articles identified, 16 articles consisting of 13 studies were suitable for inclusion. Prevalence of overall MSD ranged from 15% to 93%. The only consistent work-related risk factor was 'working part time', while other risk factors, such as vessel and job type showed conflicting results. CONCLUSION MSDs in occupational fishermen are common across countries. Variations observed in MSD prevalence might be due to differences in methodology, populations and definitions of MSD. Evidence on work-related risk factors for MSD is sparse and most studies were of poor methodological quality. Only working part time was identified as a consistent risk factor for MSD possibly caused by a healthy worker effect. There is a need for investigating causality in longitudinal studies, including both active and retired fishermen to better understand the complexity of MSD. PROSPERO REGISTRATION NUMBER CRD42020147318.
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Affiliation(s)
- Line Nørgaard Remmen
- Department of Public Health, Research Unit for Health Promotion, University of Southern Denmark, Esbjerg, Denmark
- University College South Denmark, Esbjerg, Denmark
| | - Regina Fromsejer Heiberg
- Department of Public Health, Center for Maritime Health and Society, University of Southern Denmark, Esbjerg, Denmark
| | - David Høyrup Christiansen
- Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Herning, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Kimmo Herttua
- Department of Public Health, Center for Maritime Health and Society, University of Southern Denmark, Esbjerg, Denmark
| | - Gabriele Berg-Beckhoff
- Department of Public Health, Research Unit for Health Promotion, University of Southern Denmark, Esbjerg, Syddanmark, Denmark
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Christiansen DH, McCray G, Winding TN, Andersen JH, Nielsen KJ, Karstens S, Hill JC. Measurement properties of the musculoskeletal health questionnaire (MSK-HQ): a between country comparison. Health Qual Life Outcomes 2020; 18:200. [PMID: 32576190 PMCID: PMC7313180 DOI: 10.1186/s12955-020-01455-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 06/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Musculoskeletal Health Questionnaire (MSK-HQ) has been developed to measure musculoskeletal health status across musculoskeletal conditions and settings. However, the MSK-HQ needs to be further evaluated across settings and different languages. OBJECTIVE The objective of the study was to evaluate and compare measurement properties of the MSK-HQ across Danish (DK) and English (UK) cohorts of patients from primary care physiotherapy services with musculoskeletal pain. METHODS MSK-HQ was translated into Danish according to international guidelines. Measurement invariance was assessed by differential item functioning (DIF) analyses. Test-retest reliability, measurement error, responsiveness and minimal clinically important change (MCIC) were evaluated and compared between DK (n = 153) and UK (n = 166) cohorts. RESULTS The Danish version demonstrated acceptable face and construct validity. Out of the 14 MSK-HQ items, three items showed DIF for language (pain/stiffness at night, understanding condition and confidence in managing symptoms) and three items showed DIF for pain location (walking, washing/dressing and physical activity levels). Intraclass Correlation Coefficients for test-retest were 0.86 (95% CI 0.81 to 0.91) for DK cohort and 0.77 (95% CI 0.49 to 0.90) for the UK cohort. The systematic measurement error was 1.6 and 3.9 points for the DK and UK cohorts respectively, with random measurement error being 8.6 and 9.9 points. Receiver operating characteristic (ROC) curves of the change scores against patients' own judgment at 12 weeks exceeded 0.70 in both cohorts. Absolute and relative MCIC estimates were 8-10 points and 26% for the DK cohort and 6-8 points and 29% for the UK cohort. CONCLUSIONS The measurement properties of MSK-HQ were acceptable across countries, but seem more suited for group than individual level evaluation. Researchers and clinicians should be aware that some discrepancy exits and should take the observed measurement error into account when evaluating change in scores over time.
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Affiliation(s)
- David Høyrup Christiansen
- Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland - University Research Clinic, Herning, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Gareth McCray
- School of Primary, Community and Social Care, Keele University, Staffordshire, UK
| | - Trine Nøhr Winding
- Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland - University Research Clinic, Herning, Denmark
| | - Johan Hviid Andersen
- Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland - University Research Clinic, Herning, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Kent Jacob Nielsen
- Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland - University Research Clinic, Herning, Denmark
| | - Sven Karstens
- Department of Computer Science; Therapeutic Sciences, Trier University of applied Sciences, Trier, Germany
| | - Jonathan C. Hill
- School of Primary, Community and Social Care, Keele University, Staffordshire, UK
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Budtz CR, Mose S, Christiansen DH. Socio-demographic, clinical and psychological predictors of healthcare utilization among patients with musculoskeletal disorders: a prospective cohort study. BMC Health Serv Res 2020; 20:239. [PMID: 32293420 PMCID: PMC7092455 DOI: 10.1186/s12913-020-05100-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 03/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Musculoskeletal disorders are common in the general population and a leading cause for care seeking. Despite the large number of patients with musculoskeletal disorders seeking care, little is known of the clinical course, pathways and predictors of healthcare utilization among these patients. The purposes of the study were to 1) describe the clinical course and related healthcare utilization in primary care physiotherapy and secondary healthcare among patients with neck, shoulder and low-back pain treated in physiotherapy practice, and 2) identify independent clinical, socio-demographic, psychological and general health predictors of healthcare utilization. METHODS The study was a prospective cohort study of patients seeking physiotherapy treatment for neck, shoulder, or low-back pain in physiotherapy practices across Denmark. A total of 759 physiotherapy patients completed questionnaires containing information on clinical course and potential predictors of healthcare utilization. Healthcare utilization was obtained from the Danish National Health Service Register and National Patient Register. Associations between potential predictors and low/high primary care physiotherapy utilization and hospital contacts in relation to specific neck, shoulder or low-back disorders were analysed using binomial regression analyses and adjusted for age, sex, duration of pain and comorbidity. RESULTS During 6 months follow-up, patients experienced clinically relevant improvements in pain, fear avoidance and psychological wellbeing. Patients with higher baseline pain and disability and who were on sickness leave were more likely to have high primary care physiotherapy utilization. Hospital contacts were predicted by higher levels of pain, disability and low psychological wellbeing. CONCLUSIONS Clinical factors and sickness leave seems to be the main predictors of primary care physiotherapy utilization, whereas for secondary care contacts, psychological factors may also be of importance. The study contributes to the on-going research into clinical pathways and may identify future target areas to reduce healthcare utilization in patients with musculoskeletal disorders.
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Affiliation(s)
- Cecilie Rud Budtz
- Regional Hospital West Jutland, Department of Occupational Medicine, University Research Clinic, Gl. Landevej 61, 7400, Herning, Denmark.
| | - Søren Mose
- Regional Hospital West Jutland, Department of Occupational Medicine, University Research Clinic, Gl. Landevej 61, 7400, Herning, Denmark.,VIA University College, School of Physiotherapy, Gl. Struervej 1, 7500, Holstebro, Denmark
| | - David Høyrup Christiansen
- Regional Hospital West Jutland, Department of Occupational Medicine, University Research Clinic, Gl. Landevej 61, 7400, Herning, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
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Næss-Schmidt ET, Christiansen DH, Østgård RD, Andersen NBDV, Nielsen JF, Odgaard L. Incidence of Free of Charge Physiotherapy in a Danish National Cohort of Stroke, Parkinson's Disease, Multiple Sclerosis and Rheumatoid Arthritis Patients. Clin Epidemiol 2020; 12:23-29. [PMID: 32021468 PMCID: PMC6969682 DOI: 10.2147/clep.s223000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/12/2019] [Indexed: 11/29/2022] Open
Abstract
Background Denmark is a welfare state with a publically funded healthcare system that includes the right to free of charge physiotherapy (FCP) for patients with chronic or progressive disease who fulfill strict criteria. The aim of this study was to investigate the incidence of referral to FCP in patients with a hospital diagnosis of stroke, multiple sclerosis (MS), Parkinson’s disease (PD) and rheumatoid arthritis (RA) between 2007 and 2016. Methods The study was register-based and included data from The Danish National Patient Registry and The National Health Service Registry. The study population included the four largest disease groups receiving FCP in Denmark. The incidence of receiving FCP was reported as the cumulated incidence proportion (CIP). Results The study showed that FCP was mainly initiated within the first 2 years after diagnosis. The 2-year CIP was 8% for stroke patients, 53% for PD patients, 49% for MS patients, and 16% for RA patients. The proportion of patients referred to FCP generally increased over the period of the study due to more patients being referred from medical specialists in primary care. Conclusion This study found substantial differences in the incidence of referral to FCP in a Danish population of stroke, PD, MS and RA patients.
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Affiliation(s)
| | - David Høyrup Christiansen
- Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland - University Research Clinic, Herning, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | | | | | | | - Lene Odgaard
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
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Budtz CR, Andersen JH, de Vos Andersen NB, Christiansen DH. Responsiveness and minimal important change for the quick-DASH in patients with shoulder disorders. Health Qual Life Outcomes 2018; 16:226. [PMID: 30526622 PMCID: PMC6288952 DOI: 10.1186/s12955-018-1052-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Responsiveness and minimal important change (MIC) are central measurement properties when interpreting scores from health questionnaires. The aim of the study was to evaluate the responsiveness and MIC of the Danish version of the shortened version the Disabilities of the Arm, Shoulder and Hand questionnaire (Quick-DASH) in patients with shoulder disorders referred to primary care physiotherapy treatment. METHODS The study included 261 patients who completed questionnaires at baseline and 3 and 6 months follow up. Absolute and relative change scores was analysed using receiver-operating-characteristics (ROC) curve analysis with the Patient Global Impression of Change (PGIC) as external anchor. RESULTS At both 3 and 6 months follow up, the Area under the Curve (ROC AUC) exceeded 0.70 and MIC was 9.1 and 13.6 at 3 and 6 months respectively. CONCLUSION The Danish version of the Quick-DASH demonstrated adequate ability to measure changes in disability over 3 and 6 months in patients with shoulder disorders undergoing primary care physiotherapy treatment.
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Affiliation(s)
- Cecilie Rud Budtz
- Department of Occupational Medicine, Regional Hospital West Jutland, University Research Clinic, Gl. Landevej 61, 7400, Herning, Denmark.
| | - Johan Hviid Andersen
- Department of Occupational Medicine, Regional Hospital West Jutland, University Research Clinic, Gl. Landevej 61, 7400, Herning, Denmark
| | - Nils-Bo de Vos Andersen
- Central Denmark Region, Primary Health Care and Quality Improvement, Skottenborg 26, 8800, Viborg, Denmark
| | - David Høyrup Christiansen
- Department of Occupational Medicine, Regional Hospital West Jutland, University Research Clinic, Gl. Landevej 61, 7400, Herning, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
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Schougaard LMV, de Thurah A, Bech P, Hjollund NH, Christiansen DH. Test-retest reliability and measurement error of the Danish WHO-5 Well-being Index in outpatients with epilepsy. Health Qual Life Outcomes 2018; 16:175. [PMID: 30189867 PMCID: PMC6127948 DOI: 10.1186/s12955-018-1001-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/28/2018] [Indexed: 11/24/2022] Open
Abstract
Background The generic questionnaire WHO-5 Well-being Index (WHO-5), which measures the construct of mental well-being has been widely used in several populations across countries. The questionnaire has demonstrated sufficient psychometric properties; however, the test- retest reliability of the WHO-5 scale has yet to be determined. The aim of this study was to evaluate the test-retest reliability and measurement error of the Danish WHO-5 Well-being Index for outpatients with epilepsy. A further aim was to evaluate whether the method of administration (web, paper, or a mixture of the two modalities) influenced the results. Methods Epilepsy outpatients aged ≥15 years from three outpatient clinics in Central Denmark Region were included from August 2016 to April 2017. The participants were randomly divided into four test-retest groups: web-web, paper-paper, web-paper, and paper-web. Test-retest reliability was assessed by intraclass correlation coefficients (ICC) and measurement error by calculating minimal detectable change (MDC) on the basis of the standard error of the measurement. Results A total of 554 patients completed the questionnaire at two time points. The median duration between test-retest was 22 days. The pooled test-retest reliability estimate was ICC 0.81 (95% CI 0.78; 0.84). The estimated MDC was 23.60 points (95% CI 22.27; 25.10). These estimates showed little variation across administration methods. Conclusions WHO-5 showed acceptable test-retest reliability in a Danish epilepsy outpatient population across different method of administration; however, the relatively large measurement error should be taken into account when evaluating changes in WHO-5 scores over time. Further research should be done to explore these findings.
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Affiliation(s)
- Liv Marit Valen Schougaard
- AmbuFlex/WestChronic, Occupational Medicine, Regional Hospital West Jutland, University Research Clinic, Aarhus University, Herning, Denmark.
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Per Bech
- Psychiatric Research Unit, Psychiatric Centre North Zealand, University of Copenhagen, Hillerød, Denmark
| | - Niels Henrik Hjollund
- AmbuFlex/WestChronic, Occupational Medicine, Regional Hospital West Jutland, University Research Clinic, Aarhus University, Herning, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - David Høyrup Christiansen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Occupational Medicine, Regional Hospital West Jutland, University Research Clinic, Herning, Denmark
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Schougaard LMV, de Thurah A, Christiansen DH, Sidenius P, Hjollund NH. Patient-reported outcome (PRO) measure-based algorithm for clinical decision support in epilepsy outpatient follow-up: a test-retest reliability study. BMJ Open 2018; 8:e021337. [PMID: 30049693 PMCID: PMC6067405 DOI: 10.1136/bmjopen-2017-021337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/26/2018] [Accepted: 06/06/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Patient-reported outcome (PRO) measures have been used in epilepsy outpatient clinics in Denmark since 2011. The patients' self-reported PRO data are used by clinicians as a decision aid to support whether a patient needs contact with the outpatient clinic or not based on a PRO algorithm. Validity and reliability are fundamental to any PRO measurement used at the individual level in clinical practice. The aim of this study was to evaluate the test-retest reliability of the PRO algorithm used in epilepsy outpatient clinics and to analyse whether the method of administration (web and paper) would influence the result. DESIGN AND SETTING Test-retest reliability study conducted in three epilepsy outpatient clinics in Central Denmark Region, Denmark. PARTICIPANTS A total of 554 epilepsy outpatients aged 15 years or more were included from August 2016 to April 2017. The participants completed questionnaires at two time points and were randomly divided into four test-retest groups: web-web, paper-paper, web-paper and paper-web. In total, 166 patients completed web-web, 112 paper-paper, 239 web-paper and 37 paper-web. RESULTS Weighted kappa with squared weight was 0.67 (95% CI 0.60 to 0.74) for the pooled PRO algorithm, and perfect agreement was observed in 82% (95% CI 78% to 85%) of the cases. There was a tendency towards higher test-retest reliability and agreement estimates within same method of administration (web-web or paper-paper) compared with a mixture of methods (web-paper and paper-web). CONCLUSIONS The PRO algorithm used for clinical decision support in epilepsy outpatient clinics showed moderate to substantial test-retest reliability. Different methods of administration produced similar results, but an influence of change in administration method cannot be ruled out.
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Affiliation(s)
- Liv Marit Valen Schougaard
- AmbuFlex/West Chronic, Occupational Medicine, Regional Hospital West Jutland, University Research Clinic, Aarhus University, Herning, Denmark
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - David Høyrup Christiansen
- Department of Occupational Medicine, Regional Hospital West Jutland, University Research Clinic, Herning, Denmark
| | - Per Sidenius
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Henrik Hjollund
- AmbuFlex/West Chronic, Occupational Medicine, Regional Hospital West Jutland, University Research Clinic, Aarhus University, Herning, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Morso L, Schiøttz-Christensen B, Søndergaard J, Andersen NBDV, Pedersen F, Olsen KR, Jensen MS, Hill J, Christiansen DH. The effectiveness of a stratified care model for non-specific low back pain in Danish primary care compared to current practice: study protocol of a randomised controlled trial. Trials 2018; 19:315. [PMID: 29884217 PMCID: PMC5994129 DOI: 10.1186/s13063-018-2685-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 05/11/2018] [Indexed: 11/16/2022] Open
Abstract
Background Prior studies indicate that stratified care for low back pain results in better clinical outcome and reduced costs in healthcare compared to current practice. Stratified care may be associated with clinical benefits for patients with low back pain at a lower cost, but evidence is sparse. Hence this study aims to evaluate the clinical effects and cost-effectiveness of stratified care in patients with non-specific low back pain compared to current practice. Methods/design The study is a two-armed randomised controlled trial in primary care in the Regions of Southern and Central Denmark (2.5 million citizens). Patients with non-specific low back will be recruited by paticpating GPs. Patients are randomised to either (1) stratified care or (2) current practice at participating physiotherapy clinics. In the stratified care arm, the intervention is based on the patient’s STarT Back Tool classification and trained accordingly, whereas physiotherapists in the current pratice arm are blinded to the STarT score. Primary outcomes in the trial will be group differences in time off work, improvement in LBP disability measured by the Roland Morris Disability Questionnaire (RMDQ) and patient-reported global change. Secondary measures will be pain intensity, patient satisfaction, data on patient healthcare resource utilisation and quality-adjusted life year based on the EQ-5D-5L. Discussion Stratified care that effectively targets treatment to relevant sub-groups of patients has potentially great impact on the treatment pathways of low back pain. Thus, if effective, this could result in better patient outcomes and at the same time reduce the costs for treatment of low back pain. Trial registration ClinicalTrials.gov, NCT02612467. Registered on 16 November 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-2685-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lars Morso
- Centre for Quality, Region of Southern Denmark, P.V. Tuxensvej 5, 5500, Middelfart, Denmark. .,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Berit Schiøttz-Christensen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Spine Centre of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | | | - Flemming Pedersen
- Physiothery Primary Care Consultant, Region of Southern Denmark, Vejle, Denmark
| | - Kim Rose Olsen
- Department of Business and Economics, COHERE, University of Southern Denmark, Odense, Denmark
| | - Morten Sall Jensen
- Centre for Quality, Region of Southern Denmark, P.V. Tuxensvej 5, 5500, Middelfart, Denmark
| | - Jonathan Hill
- Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - David Høyrup Christiansen
- Department for Health Provision, Region of Central Denmark, Viborg, Denmark.,Department of Occupational Medicine, Regional Hospital West Jutland, University Research Clinic, Herning, Denmark
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Moll LT, Jensen OK, Schiøttz-Christensen B, Stapelfeldt CM, Christiansen DH, Nielsen CV, Labriola M. Return to Work in Employees on Sick Leave due to Neck or Shoulder Pain: A Randomized Clinical Trial Comparing Multidisciplinary and Brief Intervention with One-Year Register-Based Follow-Up. J Occup Rehabil 2018; 28:346-356. [PMID: 28836120 PMCID: PMC5978826 DOI: 10.1007/s10926-017-9727-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Purpose The aim of this study was to evaluate the effect of a multidisciplinary intervention (MDI) compared to a brief intervention (BI) with respect to return to work (RTW), pain and disability in workers on sick leave because of neck or shoulder pain. Methods 168 study participants with sickness absence for 4-16 weeks due to neck or shoulder pain were enrolled in a hospital-based clinical study and randomized to either MDI or BI. The primary outcome was RTW obtained by a national registry on public transfer payments. Secondary outcomes were self-reported pain and disability levels. One-year follow-up RTW rates were estimated by Cox proportional hazard regression adjusted for gender, age, sick leave prior to inclusion, part-time sick leave and clinical diagnosis. Secondary outcomes were analysed using logistic and linear regression analysis for pain and disability, respectively. Results In the MDI group, 50 participants (59%) experienced four or more continuous weeks of RTW while 48 (58%) returned to work in the BI group during the 1 year of follow-up. Results showed a statistically non significant tendency towards a lower rate of RTW in the MDI group than in the BI group (adjusted HR = 0.84, 95% CI 0.54, 1.31). There were no statistically significant differences in secondary outcomes between the MDI and BI groups. Conclusion The brief and the multidisciplinary interventions performed equally with respect to both primary and secondary outcomes. The added focus on RTW in the multidisciplinary group did not improve RTW rates in this group.
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Affiliation(s)
- Line Thorndal Moll
- DEFACTUM, Central Denmark Region, P.P. Oerums Gade 11, bygn. 1B, 8000, Aarhus C, Denmark.
- Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, P.P. Oerums Gade 9-11, bygn. 1B, 8000, Aarhus C, Denmark.
- Spine Centre, Diagnostic Centre, Silkeborg Regional Hospital, Falkevej 1-3, 8600, Silkeborg, Denmark.
| | - Ole Kudsk Jensen
- Spine Centre, Diagnostic Centre, Silkeborg Regional Hospital, Falkevej 1-3, 8600, Silkeborg, Denmark
| | - Berit Schiøttz-Christensen
- Spine Centre of Southern Denmark, Hospital Lillebaelt Middelfart and Institute of Regional Health Research, University of Southern Denmark, Oestre Hougvej 55, 5500, Middelfart, Denmark
| | - Christina Malmose Stapelfeldt
- DEFACTUM, Central Denmark Region, P.P. Oerums Gade 11, bygn. 1B, 8000, Aarhus C, Denmark
- Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, P.P. Oerums Gade 9-11, bygn. 1B, 8000, Aarhus C, Denmark
| | - David Høyrup Christiansen
- Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Gl. Landevej 61, 7400, Herning, Denmark
| | - Claus Vinther Nielsen
- DEFACTUM, Central Denmark Region, P.P. Oerums Gade 11, bygn. 1B, 8000, Aarhus C, Denmark
- Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, P.P. Oerums Gade 9-11, bygn. 1B, 8000, Aarhus C, Denmark
| | - Merete Labriola
- DEFACTUM, Central Denmark Region, P.P. Oerums Gade 11, bygn. 1B, 8000, Aarhus C, Denmark
- Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, P.P. Oerums Gade 9-11, bygn. 1B, 8000, Aarhus C, Denmark
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Christiansen DH, Michener LA, Roy JS. Influence of dominant- as compared with nondominant-side symptoms on Disabilities of the Arm, Shoulder and Hand and Western Ontario Rotator Cuff scores in patients with rotator cuff tendinopathy. J Shoulder Elbow Surg 2018; 27:1112-1116. [PMID: 29452899 DOI: 10.1016/j.jse.2017.12.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/22/2017] [Accepted: 12/26/2017] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS AND BACKGROUND The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Western Ontario Rotator Cuff (WORC) index are 2 widely used patient-reported questionnaires in individuals with rotator cuff (RC) tendinopathy. In contrast to the WORC index, for which the items are specific to the affected shoulder, the items of the DASH questionnaire assess the ability to perform activities regardless of the arm used. The objective of this study is to determine whether scores on the DASH questionnaire and WORC index are affected if the symptoms are on the dominant or nondominant side in individuals with RC tendinopathy. Given the number of items that can be influenced by dominance, the hypothesis is that DASH scores will be impacted by the side of the symptoms. METHODS Individuals with RC tendinopathy (N = 149) completed questions on symptomatology and hand dominance, the DASH questionnaire, and the WORC index. Differences in total scores (independent t test) and single items (Wilcoxon rank sum test) were compared between groups of participants with dominant-side symptoms and those without dominant-side symptoms. RESULTS No significant differences were observed for WORC or DASH total scores when comparing participants with and without symptoms on their dominant side. Single-item comparison revealed more items being affected by symptom side on the DASH questionnaire (6 of 30 items) than on the WORC index (2 of 21 items). CONCLUSIONS The side of the symptoms does not influence the DASH and WORC total scores, as there are no systematic differences between individuals with and without symptoms in their dominant shoulder. However, the presence of dominant symptoms does influence item scores more on the DASH questionnaire than on the WORC index.
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Affiliation(s)
- David Høyrup Christiansen
- Department of Occupational Medicine, Regional Hospital West Jutland, University Research Clinic, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute, Quebec City, QC, Canada.
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Christiansen DH, Møller AD, Vestergaard JM, Mose S, Maribo T. The scapular dyskinesis test: Reliability, agreement, and predictive value in patients with subacromial impingement syndrome. J Hand Ther 2018; 30:208-213. [PMID: 28571725 DOI: 10.1016/j.jht.2017.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 04/21/2017] [Accepted: 04/21/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Prospective cohort. INTRODUCTION Assessment of scapular dysfunction is considered important in the clinical evaluation and treatment of patients with symptoms of subacromial impingement. However, sparse research has been conducted into the reliability and predictive value of clinical tests with which to identify scapular dyskinesis. PURPOSE OF THE STUDY To evaluate intrarater and interrater reliability and predictive value of the Scapular Dyskinesis Test (SDT) in patients with subacromial impingement syndrome. METHODS Forty-five patients with subacromial impingement syndrome were included. The presence of scapular dyskinesis was classified by 2 raters using the SDT. Intrarater and interrater reliabilities were examined and compared. Patients with and without scapular dyskinesis were compared in terms of Oxford Shoulder Score and EQ-5D-5L scores at baseline and 3 months, as well rating of overall improvement in shoulder condition. RESULTS SDT could not be performed in 5 patients, leaving 40 patients for further analysis. Kappa with squared weights was 0.64 for rater A and 0.86 for rater B; the intrarater agreement was 88% for A and 96% for B. For interrater comparison, the Kappa value was 0.59 and agreement 86%. No statically significant differences in Oxford Shoulder Score and EQ-5D-5L baseline and change scores or overall improvement in shoulder condition at 3 months were observed between patients with or without scapular dyskinesis. CONCLUSIONS Intrarater and interrater reliability and agreement of the SDT were determined. The findings that functional impairment and outcomes did not differ between patients with or without the presences of scapular dyskinesis may question the clinical value of the SDT in patients with subacromial impingement syndrome. LEVEL OF EVIDENCE 1b.
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Affiliation(s)
- David Høyrup Christiansen
- Department of Occupational Medicine, Regional Hospital West Jutland, University Research Clinic, Herning, Denmark.
| | - Anders Damgaard Møller
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Regional Hospital Central Jutland, Silkeborg, Denmark
| | - Jesper Medom Vestergaard
- Department of Occupational Medicine, Regional Hospital West Jutland, University Research Clinic, Herning, Denmark
| | - Søren Mose
- VIA Faculty of Health Sciences, Physiotherapist College, Holstebro, Denmark
| | - Thomas Maribo
- Department of Public Health, Section of Clinical Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark; DEFACTUM, Central Denmark Region, Aarhus, Denmark
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Moll LT, Stapelfeldt CM, Schiøttz-Christensen B, Jensen OK, Christiansen DH, Nielsen CV, Labriola M. Return to work after neck or shoulder pain: a randomized clinical trial. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- LT Moll
- Department of Occupational Medicine, University Research Clinic, Regionl Hospital West Jutland, Herning, DK
| | | | | | - OK Jensen
- Spine Centre, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, DK
| | - DH Christiansen
- Department of Occupational Medicine, University Research Clinic, Regionl Hospital West Jutland, Herning, DK
| | - CV Nielsen
- DEFACTUM, Central Denmark Region, Aarhus, DK
| | - M Labriola
- DEFACTUM, Central Denmark Region, Aarhus, DK
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Lauridsen LS, Willert MV, Eskildsen A, Christiansen DH. Cross-cultural adaptation and validation of the Danish 10-item Connor-Davidson Resilience Scale among hospital staff. Scand J Public Health 2017; 45:654-657. [PMID: 28707513 DOI: 10.1177/1403494817721056] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: The 10-item Connor-Davidson Resilience Scale (CD-RISC 10) is a brief instrument measuring resilience in adults. The scale has shown sound psychometric properties in different populations and cultures. Our objectives were to cross-culturally adapt the CD-RISC 10 into Danish and to establish the psychometric properties of the Danish version in terms of internal consistency, construct validity and longitudinal validity. Methods: The CD-RISC 10 was translated using established guidelines. Employees ( N=272) at hospitals in the Central Denmark Region completed questionnaires at baseline and three months follow-up. Questionnaires included the translated Danish version of the CD-RISC 10 and the 10-item Perceived Stress Scale (PSS-10). Internal consistency was assessed by Cronbach’s alpha and construct and longitudinal validity by correlating CD-RISC 10 and PSS-10 baseline scores and change scores from baseline to follow-up. Results: The Danish CD-RISC 10 provides acceptable internal consistency (Cronbach’s alpha = 0.87). Analysis of construct validity revealed a negative correlation with the PSS-10 at baseline ( r=−.63 [95%CI: −.70; −.55], p<.0001). Analysis of longitudinal validity similarly demonstrated a negative correlation on change scores from baseline to follow-up ( r=−.51 [95%CI: −.62; −.39], p<.0001). Conclusions: The scale has acceptable psychometric properties as an instrument for measuring resilience in a Danish-speaking population.
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Affiliation(s)
| | - Morten Vejs Willert
- Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Region Midt, Denmark
| | - Anita Eskildsen
- Department of Occupational Medicine, The Regional Hospital West Jutland, Herning, Denmark
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Shire AR, Stæhr TAB, Overby JB, Bastholm Dahl M, Sandell Jacobsen J, Høyrup Christiansen D. Specific or general exercise strategy for subacromial impingement syndrome-does it matter? A systematic literature review and meta analysis. BMC Musculoskelet Disord 2017; 18:158. [PMID: 28416022 PMCID: PMC5393017 DOI: 10.1186/s12891-017-1518-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 04/04/2017] [Indexed: 02/01/2023] Open
Abstract
Background Exercise is frequently suggested as a treatment option for patients presenting with symptoms of subacromial impingement syndrome. Some would argue implementing a specific exercise strategy with special focus on correction of kinematic deficits would be superior to general exercise strategy. There is however a lack of evidence comparing such exercise strategies to determine which is the most effective in the treatment of subacromial impingement syndrome. The aim of this review is to evaluate whether implementing specific exercise strategies involving resistive exercises are more effective than a general exercise strategy for the treatment of patients with subacromial impingement syndrome. Methods Randomized controlled trials were identified through an electronic search on PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science and PEDro. In addition, article reference lists and Clinicaltrials.gov were searched. Studies were considered eligible if they included interventions with resistive specific exercises as compared to general resistance exercise. Four reviewers assessed risk of bias and methodological quality guided by Cochrane recommendations. Results were synthesised qualitatively or quantitatively, where appropriate. Results Six randomized controlled trials were included with 231 participants who experienced symptoms of subacromial impingement syndrome. Four studies evaluated the effectiveness of specific scapular exercise strategy and two studies evaluated the effectiveness of specific proprioceptive strategy. Five studies were of moderate quality and one study was of low quality. No consistent statistical significant differences in outcomes between treatment groups were reported in the studies. Standardized mean difference (SMD) for pain was SMD −0.19 (95% CI −0.61, 0.22) and SMD 0.30 (95% CI −0.16, 0.76) for function. Conclusions There is insufficient evidence to support or refute the effectiveness of specific resistive exercise strategies in the rehabilitation of subacromial impingement syndrome. More high quality research is needed to accurately assess this. This review provides suggestions on how to improve the methodological design of future studies in this area. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1518-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alison R Shire
- Department of Physiotherapy, VIA University College, Hedeager 2, Aarhus N, Denmark.
| | - Thor A B Stæhr
- Department of Physiotherapy, VIA University College, Hedeager 2, Aarhus N, Denmark
| | - Jesper B Overby
- Department of Physiotherapy, VIA University College, Hedeager 2, Aarhus N, Denmark
| | | | | | - David Høyrup Christiansen
- Danish Ramazzini Centre, Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Herning, Denmark
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de Vos Andersen NB, Kent P, Hjort J, Christiansen DH. Clinical course and prognosis of musculoskeletal pain in patients referred for physiotherapy: does pain site matter? BMC Musculoskelet Disord 2017; 18:130. [PMID: 28356140 PMCID: PMC5371202 DOI: 10.1186/s12891-017-1487-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 03/14/2017] [Indexed: 11/10/2022] Open
Abstract
Background Danish patients with musculoskeletal disorders are commonly referred for primary care physiotherapy treatment but little is known about their general health status, pain diagnoses, clinical course and prognosis. The objectives of this study were to 1) describe the clinical course of patients with musculoskeletal disorders referred to physiotherapy, 2) identify predictors associated with a satisfactory outcome, and 3) determine the influence of the primary pain site diagnosis relative to those predictors. Methods This was a prospective cohort study of patients (n = 2,706) newly referred because of musculoskeletal pain to 30 physiotherapy practices from January 2012 to May 2012. Data were collected via a web-based questionnaire 1–2 days prior to the first physiotherapy consultation and at 6 weeks, 3 and 6 months, from clinical records (including primary musculoskeletal symptom diagnosis based on the ICPC-2 classification system), and from national registry data. The main outcome was the Patient Acceptable Symptom State. Potential predictors were analysed using backwards step-wise selection during longitudinal Generalised Estimating Equation regression modelling. To assess the influence of pain site on these associations, primary pain site diagnosis was added to the model. Results Of the patients included, 66% were female and the mean age was 48 (SD 15). The percentage of patients reporting their symptoms as acceptable was 32% at 6 weeks, 43% at 3 months and 52% at 6 months. A higher probability of satisfactory outcome was associated with place of residence, being retired, no compensation claim, less frequent pain, shorter duration of pain, lower levels of disability and fear avoidance, better mental health and being a non-smoker. Primary pain site diagnosis had little influence on these associations, and was not predictive of a satisfactory outcome. Conclusion Only half of the patients rated their symptoms as acceptable at 6 months. Although satisfactory outcome was difficult to predict at an individual patient level, there were a number of prognostic factors that were associated with this outcome. These factors should be considered when developing generic prediction tools to assess the probability of satisfactory outcome in musculoskeletal physiotherapy patients, because the site of pain did not affect that prognostic association. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1487-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Peter Kent
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, WA, Australia.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jakob Hjort
- Department of Clinical Medicine, HEALTH, Aarhus University, Aarhus, Denmark
| | - David Høyrup Christiansen
- Department of Occupational Medicine, Regional Hospital West Jutland-University Research Clinic, Herning, Denmark.
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Mose S, Christiansen DH, Jensen JC, Andersen JH. Widespread pain - do pain intensity and care-seeking influence sickness absence? - A population-based cohort study. BMC Musculoskelet Disord 2016; 17:197. [PMID: 27142067 PMCID: PMC4855327 DOI: 10.1186/s12891-016-1056-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 04/28/2016] [Indexed: 11/29/2022] Open
Abstract
Background Both musculoskeletal pain-intensity in relation to a specific location (e.g. lower back or shoulder) and pain in multiple body regions have been shown to be associated with impaired function and sickness absence, but the impact of pain intensity on the association between widespread pain and sickness absence has not been studied. Additionally it is unknown whether care-seeking in general practice due to musculoskeletal disorders has a positive or negative impact on future absenteeism. The purpose of this study was to examine the influence of pain intensity on the association between number of musculoskeletal pain sites and sickness absence, and to analyze the impact on absenteeism from care-seeking in general practice due to musculoskeletal disorders. Methods 3745 Danish adults registered with eight General Practitioners (GPs) in one primary medical center reported location and intensity of experienced musculoskeletal pain in seven different body regions in February 2008. Outcome was duration of sickness absence based on register data divided into long-term (>52 weeks during follow-up) and sickness absence of shorter duration (12–52 weeks during follow-up) over a period of 4 years. Data on pain-intensity were analyzed at three different cut-off levels for each body region: i) > 1 (any pain), ii) > 2 (bothersome pain), iii) > 3 (very bothersome pain). Analyses were stratified and compared between participants without GP contact and participants with GP contact due to musculoskeletal disorders. Results Musculoskeletal pain in more than two body regions was strongly associated with long-term sickness absence in an exposure-response pattern. Different cut-off levels of pain intensity and adjustment for age, sex, educational level and work environmental factors did not alter the results. Similar findings were observed for sickness absence of shorter duration, although the association was weaker. Care-seeking in general practice due to musculoskeletal disorders did not overall alter the odds of later sickness absence. Conclusion Pain intensity and care-seeking due to musculoskeletal disorders did not seem to influence the association between the number of pain sites and later sickness absence. The number of musculoskeletal pain sites seems to be a strong risk factor for later sickness absence.
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Affiliation(s)
- Søren Mose
- Danish Ramazzini Center, Department of Occupational Medicine, Regional Hospital Herning, Gl. Landevej 61, DK-7400, Herning, Denmark. .,VIA Faculty of Health Sciences, Physiotherapist College, Gl. Struervej 1, DK-7500, Holstebro, Denmark.
| | - David Høyrup Christiansen
- Danish Ramazzini Center, Department of Occupational Medicine, Regional Hospital Herning, Gl. Landevej 61, DK-7400, Herning, Denmark
| | - Jens Christian Jensen
- Danish Ramazzini Center, Department of Occupational Medicine, Regional Hospital Herning, Gl. Landevej 61, DK-7400, Herning, Denmark
| | - Johan Hviid Andersen
- Danish Ramazzini Center, Department of Occupational Medicine, Regional Hospital Herning, Gl. Landevej 61, DK-7400, Herning, Denmark
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Christiansen DH, Frost P, Frich LH, Falla D, Svendsen SW. The Use of Physiotherapy among Patients with Subacromial Impingement Syndrome: Impact of Sex, Socio-Demographic and Clinical Factors. PLoS One 2016; 11:e0151077. [PMID: 26954692 PMCID: PMC4783058 DOI: 10.1371/journal.pone.0151077] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 02/23/2016] [Indexed: 11/18/2022] Open
Abstract
Background Physiotherapy with exercises is generally recommended in the treatment of patients with subacromial impingement syndrome (SIS). Objective We aimed to investigate the use of physiotherapy in patients with SIS in Danish hospital settings as part of initial non-surgical treatment and after SIS-related surgery and to evaluate to which extent sex, socio-demographic and clinical factors predict the use of physiotherapy. Methods Using national health registers, we identified 57,311 patients who had a first hospital contact with a diagnosis of ICD-10, groups M75.1–75.9, 1 July 2007 to 30 June 2011. Records of physiotherapy were extracted within 52 weeks after first contact (or until surgery), and for surgically treated patients within 26 weeks after surgery. Predictors of the use of physiotherapy after first contact and after surgery were analysed as time-to-event. Results Within 52 weeks after first contact, 43% of the patients had physiotherapy and 30% underwent surgery. Within 26 weeks after surgery, 80% had a record of physiotherapy. After first contact and after surgery, exercise was part of physiotherapy in 65% and 84% of the patients, respectively. A public hospital contact, physiotherapy before hospital contact, administrative region, female sex, a diagnosis of other or unspecified disorders (M75.8-M75.9), and surgical procedure predicted higher use of physiotherapy. Low education level predicted slightly lower use of physiotherapy after first contact, but not after surgery. Conclusion In patients with SIS in Danish hospital settings, physiotherapy was more often used after surgery than as part of initial non-surgical treatment. The use of physiotherapy was less common among men than women, whereas unequal use of physiotherapy in relation to education level was not noticeable. The use of physiotherapy with exercises in initial non-surgical treatment was relatively limited.
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Affiliation(s)
- David Høyrup Christiansen
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland—University Research Clinic, Herning, Denmark
- * E-mail:
| | - Poul Frost
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus Hospital, Aarhus University Hospital, Aarhus, Denmark
| | | | - Deborah Falla
- Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany
- Institute for Neurorehabilitation Systems, Bernstein Focus Neurotechnology (BFNT) Göttingen Bernstein Center for Computational Neuroscience (BCCN), University Medical Center Göttingen Georg-August University, Göttingen, Germany
| | - Susanne Wulff Svendsen
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland—University Research Clinic, Herning, Denmark
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Christiansen DH, Falla D, Frost P, Frich LH, Svendsen SW. Physiotherapy after subacromial decompression surgery: development of a standardised exercise intervention. Physiotherapy 2015; 101:327-39. [DOI: 10.1016/j.physio.2015.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 01/13/2015] [Indexed: 10/24/2022]
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McBeath A, Aamelfot M, Christiansen DH, Matejusova I, Markussen T, Kaldhusdal M, Dale OB, Weli SC, Falk K. Immersion challenge with low and highly virulent infectious salmon anaemia virus reveals different pathogenesis in Atlantic salmon, Salmo salar L. J Fish Dis 2015; 38:3-15. [PMID: 24820820 DOI: 10.1111/jfd.12253] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/21/2014] [Accepted: 03/24/2014] [Indexed: 06/03/2023]
Abstract
The salmonid orthomyxovirus infectious salmon anaemia virus (ISAV) causes disease of varying severity in farmed Atlantic salmon, Salmo salar L. Field observations suggest that host factors, the environment and differences between ISAV strains attribute to the large variation in disease progression. Variation in host mortality and dissemination of ISAV isolates with high and low virulence (based on a previously published injection challenge) were investigated using immersion challenge. Virus dissemination was determined using real-time PCR and immunohistochemistry in several organs, including blood. Surprisingly, the low virulent virus (LVI) replicated and produced nucleoprotein at earlier time points post-infection compared to the virus of high virulence (HVI). This was particularly noticeable in the gills as indicated by different viral load profiles. However, the HVI reached a higher maximum viral load in all tested organs and full blood. This was associated with a higher mortality of 100% as compared to 20% in the LVI group by day 23 post-infection. Immersion challenge represented a more natural infection method and suggested that specific entry routes into the fish may be of key importance between ISAV strains. The results suggest that a difference in virulence is important for variations in virus dissemination and pathogenesis (disease development).
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Affiliation(s)
- A McBeath
- Marine Scotland Science, Marine Laboratory, Aberdeen, UK
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Rolving N, Christiansen DH, Andersen LL, Skotte J, Ylinen J, Jensen OK, Nielsen CV, Jensen C. Effect of strength training in addition to general exercise in the rehabilitation of patients with non-specific neck pain. A randomized clinical trial. Eur J Phys Rehabil Med 2014; 50:617-626. [PMID: 24955503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND The optimal type of exercise protocol in the physical rehabilitation of non-specific neck pain has not yet been established. Furthermore, the role of fear-avoidance belief in the maintenance of pain and disability has been highlighted. Research indicates that exercise may be a means to reduce fear-avoidance belief, but evidence is scarce. AIM To compare the effect of two different exercise programs on pain, strength and fear-avoidance belief. DESIGN Randomized clinical trial. SETTING A specialized outpatient hospital clinic in Denmark. POPULATION Twenty-three men and 60 women on sick leave due to non-specific neck pain. METHODS Participants were randomized to either general physical activity (GPA group) or GPA and additional strength training of the neck and shoulder (SST group). The primary outcome was pain intensity. Secondary outcomes were muscle strength of the neck and shoulder and fear-avoidance belief. RESULTS Pain was significantly reduced within groups with a median of -1 (IQR: -3 to 0, P<0.001) in the SST group and -1 (IQR: -4 to 1, P=0.046) in the GPA group. The difference between groups was not significant. Changes in strength did not differ between groups. Both groups experienced significant increases in neck flexion strength of 14.7 N (IQR: -1 to 28.4, P=0. 001) in the SST group and 6.9 N (IQR: -4.9 to18.6, P=0.014) in the GPA group. Furthermore, the SST group achieved an increase of 18.6 N (IQR: -2.6 to 69.7, P=0.005) in neck extension. Fear-avoidance beliefs improved with 6 (IQR: 3 to 12, P<0.001) in the SST group, while the GPA group improved with 3 (IQR: 0 to 8, P=0.004). This between-group difference was significant (P=0.046). CONCLUSION AND REHABILITATION IMPACT This study indicates that in rehabilitation of subjects severely disabled by non-specific neck pain, there is no additional improvement on pain or muscle strength when neck exercises are given as a home-based program with a minimum of supervision. However, strength training of the painful muscles seems to be effective in decreasing fear-avoidance beliefs.
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Affiliation(s)
- N Rolving
- Department of Physiotherapy and Occupational Therapy Aarhus University Hospital, Aarhus, Denmark -
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