Wilhelmus Johannes Andreas Grooten

Sickness absence and concurrent low back and neck–shoulder pain: results from the MUSIC-Norrtälje study

In Sweden, musculoskeletal disorders, in particular low back disorders (LBD) and neck–shoulder disorders (NSD) constitute by far the most common disorders, causing sick leave and early retirement. Studies that compare sickness absence in individuals with LBD and individuals with NSD are lacking. Moreover, it is likely that having concurrent complaints from the low back region and the neck–shoulder region could influence sickness absence. The purpose of the present study was to explore potential differences in sickness absence and in long-term sickness absence during a 5-year period, 1995–2001, among individuals with (1) solely LBD, (2) solely NSD, and (3) concurrent LBD and NSD. The present study was based on 817 subjects from the MUSIC-Norrtalje study, whom were working at baseline and whom at both baseline and follow-up reported LBD and/or NSD. Three groups were identified based on pain and pain-related disability at both baseline and follow-up: (1) solely LBD, (2) solely NSD, and (3) concurrent LBD and NSD. Subjects who did not give consistent answers at both the baseline and follow-up occasions were assigned a fourth group: (4) migrating LBD/NSD. Two outcomes were analysed: (1) prevalence of sickness absence, and (2) long-term sickness absence among those with sickness absence days. Logistic regression analysis was used to calculate odds ratios (OR) for sickness absence in the different disorder groups, taking into account confounding factors such as gender, age and other non-musculoskeletal-related disorders. In the group concurrent LBD and NSD, 59% had been sickness absent between baseline and follow up, compared to 42% in the group solely LBD, 41% in the group solely NSD, and 46% in the group migrating LBD/NSD. No difference in sickness absence was found between the group solely LBD compared to the group solely NSD [OR 0.65 (0.36–1.17)]. The adjusted OR for sickness absence in the group concurrent LBD and NSD compared to subjects with solely LBD or solely NSD was [OR 1.69 (1.14–2.51)]. The adjusted OR for having long-term sickness absence was 2.48 (95% CI = 1.32–4.66) for the group concurrent LBD and NSD. In the present study, having concurrent LBD and NSD were associated with a higher risk for sickness absence and also long-term sickness absence. This suggests that, when research on sickness absence and return to work after a period of LBD or NSD is performed, it is important to take into consideration any concurrent pain from the other spinal region. The study also implies that spinal co-morbidity is an important factor to be considered by clinicians and occupational health providers in planning treatment, or in prevention of these disorders.

Motor control exercises reduces pain and disability in chronic and recurrent low back pain: a meta-analysis

Study Design. Meta-analysis of randomized, controlled trials. Objective. To determine the short-term, intermediate, and long-term effectiveness of MCE, with regard to pain and disability, in patients with chronic and recurrent low-back pain. Summary of Background Data. Previous meta-analyses have shown no difference between the effects of MCE and general exercise in the treatment of low back pain. Several high quality studies on this topic have been published lately, warranting a new meta-analysis. Methods. We searched electronic databases up to October 2011 for randomized controlled trials clearly distinguishing MCE from other treatments. We extracted pain and disability outcomes and converted them to a 0 to 100 scale. We used the RevMan5 (Nordic Cochrane Centre, Copenhagen, Denmark) software to perform pooled analyses to determine the weighted mean differences (WMDs) between MCE and 5 different control interventions. Results. Sixteen studies were included. The pooled results favored MCE compared with general exercise with regard to disability during all time periods (improvement in WMDs ranged from −4.65 to −4.86), and with regard to pain in the short and intermediate term (WMDs were −7.80 and −6.06, respectively). Compared with spinal manual therapy, MCE was superior with regard to disability during all time periods (the WMDs ranged between −5.27 and −6.12), but not with regard to pain. Furthermore, MCE was superior to minimal intervention during all time periods with regard to both pain (the WMDs ranged between −10.18 and −13.32) and disability (the WMDs ranged between −5.62 and −9.00). Conclusion. In patients with chronic and recurrent low back pain, MCE seem to be superior to several other treatments. More studies are, however, needed to investigate what subgroups of patients experiencing LBP respond best to MCE.

Seeking care for neck/shoulder pain: a prospective study of work-related risk factors in a healthy population.

This study estimated the 5-year cumulative incidence of neck/shoulder pain and identified work-related risk factors leading subjects to seek care for this problem. Four to six years after the case-referent MUSIC-Norrtälje Study, a postal questionnaire was sent to the referents of this study, and 81% responded. At baseline, 516 men and 697 women were assessed as to their work-related exposures. The 4- to 6-year cumulative incidence for seeking care for neck/shoulder pain was 29% for women and 18% for men. For men, moderately increased risks were found for manual handling, night work/shift work, hindrances at work, and solitary work. For men, the risk increased with an increasing number of risk indicators. No work-related risk factors were found for women, highlighting the difficulty of identifying risk factors in a general population.

Effects of eccentric training on hand strength in subjects with lateral epicondylalgia: a randomized‐controlled trial

The main aim of this study was to evaluate the short‐term effects of daily eccentric exercises on functional pain‐free hand strength in subjects with long‐term lateral epicondylalgia. Forty‐two subjects with lateral epicondylalgia were randomly assigned either to a 6‐week home exercise regimen receiving eccentric training for their wrist extensors and a forearm band or to a control group receiving a forearm band only. The main outcomes were pain‐free hand‐grip and wrist‐extensor strength at mid‐ and end‐intervention follow‐ups, 3 and 6 weeks after inclusion, respectively. Secondary outcomes were a change in the proportion of cases with epicondylalgia and ratings of perceived pain (VAS) at follow‐up. Thirty‐seven (88%) subjects completed both the mid‐ and the end‐intervention follow‐up. Exercise members had significantly higher pain‐free hand‐grip (P=0.025) and wrist‐extensor strength (P<0.001) at the end of follow‐up, although there was no such effect at mid‐intervention. Regression analysis showed a reduction in the proportion of cases in the exercise group at the end of follow‐up (P=0.035). However, no between‐groups effect emerged for perceived pain. These data suggest that the daily home eccentric exercise regimen is effective in increasing functional pain‐free grip strength and reducing cases suffering from lateral epicondylalgia. However, no effect emerged for global perceived pain during the last week.

Effects of Weight-Shift Training on Balance Control and Weight Distribution in Chronic Stroke: A Pilot Study

Abstract Purpose: The objective was to evaluate the effect of weight-shift training on functional balance, weight distribution, and postural control measures during standing and forward reach tasks in subjects with chronic stroke. Methods: Nine male subjects (mean age, 66 years; range, 60–75 years) who experienced a stroke 3 to 13 years previously participated in a 4-week training program consisting of static and dynamic balance exercises with visual feedback and gait training with wall support. Balance control was assessed before and after the intervention with clinical measures (Berg Balance Scale) and with a pressure platform for registering the center of pressure (CoP) during quiet stance (weight distribution, CoP sway area, and velocity), and during a forward reach task at shoulder and knee levels. Intervention effects were evaluated with the Wilcoxon matched-pairs test. Results: After training, the group improved their Berg Balance Scale median score from 42 (range, 14–54) to 46 (20–55) (P = .01), CoP sway area [10.6 (5.0–31.4) to 3.0 (1.8–10.8) cm2; P = .01], and mean velocity [3.5 (2.4–8.0) to 1.7 (0.9–3.7) mm/s; P = .01] during quiet standing but not weight distribution (P = .59). During the forward reach tasks, most of the postural control measures such as movement time, CoP displacement, and CoP velocity were significantly (P < .05) improved after the training period for both the affected and nonaffected sides as compared to before the training period. Conclusion: A weight-shift training program improved balance control but not weight distribution in a group of chronic stroke subjects. Larger, randomized, and controlled studies are necessary.

Is active sitting as active as we think

The aim of this study was to compare the biomechanical characteristics of sitting on a stool without a backrest (so as to encourage active sitting), sitting on a conventional office chair and standing in healthy participants. Thirteen healthy participants performed a keyboard-writing task during four (stable and unstable) sitting conditions and standing. Body segment positions and posture, postural sway and muscle activity of neck and trunk muscles were assessed with a motion capture system, a force plate and surface electromyography. The results showed that body segment positions, postural sway and trunk muscle activity were relatively similar for the stools without backrests compared with standing. All sitting conditions showed lower vertical upper body alignment, less anterior pelvic tilt and larger hip angles, compared with standing (p = 0.000). Unexpectedly, the muscle activity levels and total postural sway, sway velocity and sway in M/L and A/P directions were lower (p = 0.000) for the conditions that encouraged active sitting and standing, compared with the conventional office chair conditions. Practitioner Summary: Thirteen healthy participants performed a keyboard-writing task during different sitting conditions and standing and were analysed regarding posture, postural sway and trunk muscle activity. Surprisingly, less postural sway and less muscle activity were observed during the conditions that encourage active sitting, compared with sitting on a conventional office chair.

Catastrophizing During and After Pregnancy: Associations With Lumbopelvic Pain and Postpartum Physical Ability

Background There is a lack of knowledge about the possible role of catastrophizing in lumbopelvic pain during and after pregnancy and in postpartum physical ability. Objective The aims of this study were to explore how catastrophizing fluctuates over time during and after pregnancy and to investigate the associations between catastrophizing and lumbopelvic pain and between catastrophizing and postpartum physical ability. Design A prospective questionnaire was used. Methods The Pain Catastrophizing Scale was used to assess exaggerated negative thoughts about pain experiences in weeks 19 to 21 and weeks 34 to 37 of pregnancy and at 6 months postpartum. The Disability Rating Index was used to assess physical ability at 6 months postpartum. The occurrence of lumbopelvic pain was reported by participants. Parametric and nonparametric tests were used for the analyses. Results A total of 242 of 324 women were categorized according to reported levels of catastrophizing. A majority of women (57.9%) reported not catastrophizing at all test occasions, whereas 10.3% reported catastrophizing at all occasions. For the remaining 31.8%, the levels of catastrophizing varied over time. Women who catastrophized at 1 or more of the occasions reported higher proportions of postpartum lumbopelvic pain and had more restricted postpartum physical ability than women who did not catastrophize. Limitations The fact that some women did not complete the questionnaire at all test occasions might have reduced the generalizability of the results. Conclusions The common idea that levels of catastrophizing are “stable” within personality should be reconsidered, because for 1 of 3 women, the levels of catastrophizing changed over time. A majority of women reported not catastrophizing. However, catastrophizing in relation to pregnancy seems to be associated with lumbopelvic pain and postpartum physical ability. The results indicated that the role of catastrophizing in this context should be studied further.

Determinants for lumbopelvic pain 6 months postpartum

Purpose: To evaluate potential determinants of self-reported lumbopelvic pain 6 months postpartum for pregnant women with and without lumbopelvic pain. Methods: Questionnaires were answered in weeks 19–21 of pregnancy and at 6 months postpartum. The Pain Catastrophizing Scale was used to assess exaggerated negative thoughts about pain experiences, the Fear-Avoidance Beliefs Questionnaire to assess beliefs about how physical activity affects back pain, the Visual Analogue Scale to assess pain intensity, the Disability Rating Index to assess physical ability, and the Nottingham Health Profile to assess health-related quality of life. A Cox proportional hazards model was used to analyse the data. Results: Of the 273 women who answered at both occasions, 112 had lumbopelvic pain in pregnancy and 161 did not. For pregnant women with lumbopelvic pain a higher level of catastrophizing and a more restricted physical ability both doubled the risk for postpartum lumbopelvic pain. Conclusions: We conclude that catastrophizing and physical ability, in weeks 19–21 of pregnancy determine postpartum lumbopelvic pain, and hence that, women at risk might be identified by the use of a biopsychosocial approach in pregnancy. It seems important to take these results into consideration both when forming preventive strategies and in rehabilitation. Implications for Rehabilitation A high level of catastrophizing and a low physical ability in women with lumbopelvic pain during pregnancy increased the risk of reporting postpartum lumbopelvic pain. A biopsychosocial approach during pregnancy seems important for to identify women at risk for future pain. Interventions targeting catastrophizing might have a positive effect but that needs to be studied for this specific population.

Reliability of isokinetic supine bench press in healthy women using the Ariel Computerized Exercise System

The aim of this study was to assess reliability of the Ariel Computerized Exercise System (ACES) ‘multifunction exerciser’. Twenty‐three healthy women completed three sets, three repetitions each, of maximal isokinetic supine bench press at two different velocities, slow (10/s) and moderate (25/s). The following performance parameters were studied: peak and average force, peak and average power, and total work. The experiment was repeated for two days. Intraclass correlation coefficients (ICC[2,1]) varied between 0.947 and 0.755 at 10 °/s and between 0.861 and 0.654 at 25 °/s. The standard error of the measurement (SEM), the smallest detectable difference (SDD), and the coefficient of variation (CV) indicated that it is possible to achieve reliable and clinically relevant measurements with the ACES.

Criterion validation of two submaximal aerobic fitness tests, the self-monitoring Fox-walk test and the Åstrand cycle test in people with rheumatoid arthritis

BackgroundAerobic capacity tests are important to evaluate exercise programs and to encourage individuals to have a physically active lifestyle. Submaximal tests, if proven valid and reliable could be used for estimation of maximal oxygen uptake (VO2max). The purpose of the study was to examine the criterion-validity of the submaximal self-monitoring Fox-walk test and the submaximal Åstrand cycle test against a maximal cycle test in people with rheumatoid arthritis (RA). A secondary aim was to study the influence of different formulas for age predicted maximal heart rate when estimating VO2max by the Åstrand test.MethodsTwenty seven subjects (81% female), mean (SD) age 62 (8.1) years, diagnosed with RA since 17.9 (11.7) years, participated in the study. They performed the Fox-walk test (775 meters), the Åstrand test and the maximal cycle test (measured VO2max test). Pearson’s correlation coefficients were calculated to determine the direction and strength of the association between the tests, and paired t-tests were used to test potential differences between the tests. Bland and Altman methods were used to assess whether there was any systematic disagreement between the submaximal tests and the maximal test.ResultsThe correlation between the estimated and measured VO2max values were strong and ranged between r = 0.52 and r = 0.82 including the use of different formulas for age predicted maximal heart rate, when estimating VO2max by the Åstrand test. VO2max was overestimated by 30% by the Fox-walk test and underestimated by 10% by the Åstrand test corrected for age. When the different formulas for age predicted maximal heart rate were used, the results showed that two formulas better predicted maximal heart rate and consequently a more precise estimation of VO2max.ConclusionsDespite the fact that the Fox-walk test overestimated VO2max substantially, the test is a promising method for self-monitoring VO2max and further development of the test is encouraged. The Åstrand test should be considered as highly valid and feasible and the two newly developed formulas for predicting maximal heart rate according to age are preferable to use when estimating VO2max by the Åstrand test.