Jane Carlsson

Person-Centered Care — Ready for Prime Time

Long-term diseases are today the leading cause of mortality worldwide and are estimated to be the leading cause of disability by 2020. Person-centered care (PCC) has been shown to advance concordance between care provider and patient on treatment plans, improve health outcomes and increase patient satisfaction. Yet, despite these and other documented benefits, there are a variety of significant challenges to putting PCC into clinical practice. Although care providers today broadly acknowledge PCC to be an important part of care, in our experience we must establish routines that initiate, integrate, and safeguard PCC in daily clinical practice to ensure that PCC is systematically and consistently practiced, i.e. not just when we feel we have time for it. In this paper, we propose a few simple routines to facilitate and safeguard the transition to PCC. We believe that if conscientiously and systematically applied, they will help to make PCC the focus and mainstay of care in long-term illness.

Walking training of patients with hemiparesis at an early stage after stroke: a comparison of walking training on a treadmill with body weight support and walking training on the ground:

Objective: To compare the effect of walking training on a treadmill with body weight support (BWS) and walking training on the ground at an early stage of rehabilitation in patients with hemiparesis after stroke. Design: Randomized controlled experimental study. Setting: Multicentre design; three departments of rehabilitation medicine. Subjects: Seventy-three consecutive first stroke patients admitted to a rehabilitation clinic were randomized into a treatment group and a control group. Interventions: The treatment group received walking training on a treadmill with BWS for 30 minutes, 5 days a week. The control group received walking training according to the Motor Relearning Programme (MRP) on the ground for 30 minutes 5 days a week, not including treadmill training. During the time in the rehabilitation department (about two months), all patients in the study also received professional stroke rehabilitation besides the walking training in the two groups. Main outcome measures: Functional Independence Measure (FIM), walking velocity for 10 m, Functional Ambulation Classification (FAC), Fugl-Meyer Stroke Assessment and Bergs Balance Scale. The assessments were performed at admission, at discharge and at 10-month follow-up. Results: There were no statistically significant differences between the groups at discharge or at the 10-month follow-up with regard to FIM, walking velocity, FAC, Fugl-Meyer Stroke Assessment, and Bergs Balance Scale. Patients in both groups improved in these variables from admission to the 10-month follow-up. Conclusions: Treadmill training with BWS at an early stage of rehabilitation after stroke is a comparable choice to walking training on the ground.

Exercise as migraine prophylaxis: A randomized study using relaxation and topiramate as controls

Aim: Scientific evidence regarding exercise in migraine prophylaxis is required. Therefore this study aimed to evaluate the effects of exercise in migraine prevention. Methods: In a randomized, controlled trial of adults with migraine, exercising for 40 minutes three times a week was compared to relaxation according to a recorded programme or daily topiramate use, which was slowly increased to the individual’s highest tolerable dose (maximum 200 mg/day). The treatment period lasted for 3 months, and migraine status, quality of life, level of physical activity, and oxygen uptake were evaluated. The primary efficacy variable was the mean reduction of the frequency of migraine attacks during the final month of treatment compared with the baseline. Results: Ninety-one patients were randomized and included in the intention-to-treat analysis. The primary efficacy variable showed a mean reduction of 0.93 (95% confidence interval (CI) 0.31–1.54) attacks in the exercise group, 0.83 (95% CI 0.22–1.45) attacks in the relaxation group, and 0.97 (95% CI 0.36–1.58) attacks in the topiramate group. No significant difference was observed between the groups (p = 0.95). Conclusion: Exercise may be an option for the prophylactic treatment of migraine in patients who do not benefit from or do not want to take daily medication.

Psychosocial functioning in schoolchildren with recurrent headaches.

The psychosocial functioning of 113 schoolchildren (8 to 15 years old) reporting headaches at least once a month was compared to a group of headache‐free control subjects matched for sex and age. Thirteen percent of the headache sufferers had migraine headaches, 28% had episodic tension‐type headaches, 30% had chronic tension‐type headaches, and 29% had migraine coexisting with tension‐type headaches.

Muscle Tenderness in Tension Headache Treated with Acupuncture or Physiotherapy

Sixty-two female patients with chronic tension headache were randomized into two treatment groups-acupuncture and physiotherapy. The intensity of headache, muscle tenderness and neck mobility was assessed before and after treatment. Thirty healthy women were used for comparison. Before treatment it was found that muscle tenderness was increased and neck rotation was reduced in the patient group compared with controls. There was a significant correlation between the intensity of headache and muscle tenderness. After treatment, the intensity of headache and muscle tenderness were reduced in both treatment groups. The headache was more improved in the physiotherapy group, and there was a marked reduction in the intake of analgesics. The tenderness was reduced in all muscles tested in the physiotherapy group but only in some of the muscles after acupuncture. The limitation of neck rotation was not influenced by either treatment.

Tests of functional limitations in fibromyalgia syndrome: a reliability study.

OBJECTIVE To evaluate the reliability and discriminative ability of a test battery consisting of 7 tests designed for the assessment of functional limitations in patients with fibromyalgia syndrome (FMS). METHODS The intrarater reliability of the test battery was evaluated for 15 women with FMS. Interrater reliability was calculated on 4 tests separately. Fifteen healthy women constituted a reference group. RESULTS The intrarater coefficient of variation was < 8% for the shoulder range of motion tests, chair test, and 6-minute walk test, and < 21% for the shoulder endurance test, with correlation coefficients above 0.80 for all tests. Kappa was 0.70-0.80 for the hand-to-scapula tests. The interrater coefficient of variation was < 5% for shoulder range of motion. The performances of the FMS patients were significantly decreased in comparison with healthy subjects in all the tests except for the hand-to-scapula movement. CONCLUSIONS All but 1 of the selected 7 tests were considered to possess acceptable intrarater reliability for use in FMS in clinical physical therapy practice.

Chronic Tension-Type Headache Treated with Acupuncture, Physical Training and Relaxation Training. Between-Group Differences

The aim of this study was to compare acupuncture, relaxation training and physical training in the treatment of chronic tension-type headache (CTTH). The study comprised 90 consecutive patients with CTTH who were randomly allocated to acupuncture, relaxation training or physical training. Headache intensity, headache-free days and headache-free periods were registered using a visual analogue scale and a headache diary. The measurements were made 4 weeks before, immediately after, and 3 and 6 months after the treatment period. Immediately after the last treatment, the number of headache-free periods and of headache-free days was higher in the relaxation group compared with the acupuncture group. There were no other significant differences between the groups at any time point. The clinical implications of our findings are that relaxation training induced the most pronounced effects directly after the treatment period, compared with acupuncture and physical training.

The effectiveness of a supervised physical training model tailored to the individual needs of patients with whiplash-associated disorders - a randomized controlled trial

Objective: To evaluate the effects of a physical training programme which is supervised and tailored to meet the needs of patients with subacute whiplash-associated disorders. Design: A randomized controlled trial with follow-up at three and nine months after randomization. Setting: An interdisciplinary rehabilitation centre. Subjects: Forty-seven patients with subacute disorders following a whiplash trauma. Interventions: Patients were randomized to a supervised training group or a self-administered home training group. Main measures: Primary outcome measures were the Self-Efficacy Scale, the Tampa Scale for Kinesiophobia and the Pain Disability Index. Secondary outcome measures were neck pain intensity, sensory and affective dimensions of pain, pain location and duration, muscle tenderness, grip strength, cervical mobility, sick leave and analgesic consumption. Results: Forty patients (85%) completed the intervention period, and the drop-outs were followed up by intention-to-treat. The results showed that supervised training was significantly more favourable than home training, with a more rapid improvement in self-efficacy (P=0.03), fear of movement/(re)injury (P=0.03) and pain disability (P=0.03) at three months. Further, supervised training significantly reduced the frequency of analgesic consumption (P=0.03). The improvements were partly maintained at nine months, even though there was no amelioration in pain and physical disorders. Despite the favourable outcome, supervised intervention did not reduce sick leave. Conclusions: The findings indicate a treatment approach that is feasible in the rehabilitation of patients with subacute whiplash-associated disorders in the short term, but additional research is needed to extend these findings and elucidate treatment strategies that also are cost effective.

Relaxation Treatment of Adolescent Headache Sufferers: Results From a School-Based Replication Series

Background.—In recent reviews of psychological and drug treatment, relaxation training approaches have been found to be efficacious for children and adolescents suffering from recurrent tension‐type headache (TTH), while biofeedback procedures provide effective help for migraine headache sufferers, primarily treated in tertiary clinics.

A study to evaluate the feasibility of an aerobic exercise program in patients with migraine.

Objectives.— The aim of this study was to develop and evaluate an exercise program to improve maximum oxygen uptake (VO2 max) in untrained patients with migraine without making their migraines worse.