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Background: In our previous randomized controlled trial (RCT), the progression/no progression of mild breast cancer-related arm lymphedema (BCRL) was examined among women randomized to a compression group (CG) with a compression sleeve (compression class (ccl) 1) or not (NCG) for 6 months. In the present prospective study, BCRL in the CG and NCG was followed for 12 months. Methods: At the end of the RCT, 33 women with mild BCRL were eligible in the CG and 37 in the NCG. The proportional differences in no progression/progression of BCRL were defined as a >2% increase from start of RCT or exceeding 10% in the lymphedema relative volume as measured by the water displacement method. In addition, changes in the lymphedema relative volume and tissue dielectric constant ratio, which measures local tissue water, were examined. At the end of the RCT (i.e., after 6 months), a one-month break of the compression treatment was made in the CG. If the lymphedema relative volume progressed by definition, the compression treatment was resumed and continued, with follow-up of all women at 9 and 12 months. Results: A larger proportion of women in the NCG showed progression (57%, 61%, 67%) compared to the CG (16%, 22%, 31%) at 6, 9, and 12 months (p < 0.001, 0.005, 0.012), respectively. Twelve (33%) women in the NCG did not progress at all. No changes of the lymphedema relative volume and local tissue water were found over time at any follow-ups, but were stable on a low level. Conclusions: To avoid the progression of mild BCRL into a chronic issue in the long-term, compression sleeve ccl 1 may be applied immediately after early diagnosis of mild BCRL.

Chronic pain amongst individuals with traumatic and nontraumatic spinal cord injury (SCI) has high prevalence rates, with severe impact on the activities of daily living, mood, sleep and quality of life. This study aimed to explore the experiences and challenges of chronic pain management amongst the traumatic spinal cord injury (TSCI) population in the Western Cape region of South Africa. A qualitative descriptive approach was chosen for the study, in which 13 individuals living with TSCI were purposively recruited and interviewed telephonically. An inductive thematic analytic approach was used. The results indicate ineffectiveness of standard pain management, with a lack of education regarding pain physiology and pain management strategies as well as unbalanced decision-making between clinician and patient. Thus, patients develop coping strategies to survive with pain. Current pain regimes are suboptimal at best, underpinned by the lack of clarity or a mutually agreed plan to mitigate and eradicate pain. There is a need for chronic pain management beyond pharmacological prescription. Future practices should focus on adopting a holistic, biopsychosocial approach, which includes alternative pain therapy management. In addition, advances in pain management cannot be achieved without adopting a therapeutic alliance between the clinician and patient.

Background In chronic LBP (CLBP), guideline-endorsed treatment is to stay active, return to normal activity, and to exercise. Several reviews on various exercise types used in CLBP have been published. We aimed to identify systematic reviews of common exercise types used in CLBP, to appraise their quality, and to summarize and compare their effect on pain and disability. Methods We searched the databases OVID MEDLINE, EMBASE, COCHRANE LIBRARY, and WEB OF SCIENCE (Core collection) for systematic reviews and meta-analyses on adults between 18 and 70 years of age suffering from chronic or recurrent LBP for a period of at least 12 weeks, which investigated the effects of exercises on pain and disability. All searches were conducted without language restriction. The search was performed up until 2022–01-26. The included reviews were grouped into nine exercise types: aerobic training, aquatic exercises, motor control exercises (MCE), resistance training, Pilates, sling exercises, traditional Chinese exercises (TCE), walking, and yoga. The study quality was assessed with AMSTAR-2. For each exercise type, a narrative analysis was performed, and the level of evidence for the effects of exercise was assessed through GRADE. Results Our database search resulted in 3,475 systematic reviews. Out of the 253 full texts that were screened, we included 45 systematic reviews and meta-analyses. The quality of the included reviews ranged from high to critically low. Due to large heterogeneity, no meta-analyses were performed. We found low-to-moderate evidence of mainly short-term and small beneficial effects on pain and disability for MCE, Pilates, resistance training, TCE, and yoga compared to no or minimal intervention. Conclusions Our findings show that the effect of various exercise types used in CLBP on pain and disability varies with no major difference between exercise types. Many of the included systematic reviews were of low-to-moderate quality and based on randomized controlled trials with high risk of bias. The conflicting results seen, undermine the certainty of the results leading to very-low-to-moderate quality of evidence for our results. Future systematic reviews should be of higher quality to minimize waste of resources. Trial registration PROSPERO: Reg no 190409 Registration date 01AUG 2020.

Background The assessment of generalized joint hypermobility is difficult due to differences in classification methods and in the performance of joint mobility assessment. The primary aim was to evaluate the validity of the self-reported five-part questionnaire, 5PQ, for identifying generalized joint hypermobility using the Beighton score as reference test. The secondary aim was to describe how joint angles measured in degrees included in the Beighton score varied in different cut-off levels in the self-reported 5PQ and the Beighton score. Methods A cross-sectional validity study with a total of 301 women in early pregnancy, mean age of 31 years, were included in the study. The participants answered the self-reported 5PQ before the joint angles were measured. To standardize the joint mobility measurement, a structural protocol was used. The sensitivity, specificity, receiver operating characteristic curve, area under curve, positive- and negative predictive value, positive likelihood ratio and Spearman’s rank correlation between the self-reported 5PQ ≥ 2 and the Beighton score ≥ 5 were used as main outcome measures in the validity analyses. Joint angles, measured in degrees, were calculated with means in relation to different cut-off levels. Results There was moderate correlation between the self-reported 5PQ and the Beighton score. The highest combined sensitivity, 84.1%, as well as specificity, 61.9%, was on 5PQ cut-off level ≥ 2, with a 38% false-positive rate, a moderate area under curve, a low positive predictive value and likelihood ratio, and a high negative predictive value. The odds of a self-reported 5PQ, cut-off level ≥ 2, among women with generalized joint hypermobility, Beighton ≥5, was low indicating a low post-test probability. The mean for all joint angles measured in degrees increased with increased cut-off levels, both in the Beighton score and in the self-reported 5PQ. However, there was a significant variation for each cut-off level. Conclusions There is uncertainty in identifying generalized joint hypermobility in young women using the self-reported 5PQ with a cut-off level of ≥2 when the Beighton score ≥ 5 is used as the reference test. The strength of the self-reported 5PQ is to rule-out women without generalized joint hypermobility.

Background: Most commonly, volume measurements are used to evaluate the effect of lymphedema treatment, but as the accumulation of lymph fluid can be local, this method may not always be the best. ...

OBJECTIVE To evaluate potential prognostic factors of self-reported lumbopelvic pain 6 months postpartum for pregnant women with and without lumbopelvic pain. METHODS Questionnaires were answered at gestational weeks 34-37 and again at 6 months postpartum. Psychosocial determinants and lumbopelvic pain symptoms were investigated using a visual analogue scale to assess pain intensity, and further using the Disability Rating Index, the Nottingham Health Profile, the Pain Catastrophizing Scale and the Fear-Avoidance Beliefs Questionnaire. Logistic regression analysis was used to analyse the data. RESULTS Of the 260 women who answered the questionnaires on both occasions, 186 did not suffer from lumbopelvic pain 6 months after pregnancy. The remaining 74 did. The results of the logistic regression analysis showed that fear-avoidance beliefs was a significant predictor of lumbopelvic pain 6 months postpartum, with an odds ratio of 1.060 (p ≤ .05). CONCLUSION Women with high fear-avoidance beliefs at 34-37 weeks of gestation had a higher risk of having lumbopelvic pain at 6 months postpartum. We theorize that early lumbopelvic pain intervention postpartum may be important in avoiding chronicity. Women at risk can be identified through clinically relevant questions which may help the clinician to choose appropriate rehabilitation strategies.

Background Pelvic girdle pain (PGP) is common during pregnancy but the causes remain poorly understood. Generalized joint hypermobility (GJH) is an inherited trait, with joint mobility beyond normal limits and is assumed to be related with PGP. The aim of this project was to study the association between self-reported GJH and the presence of PGP during pregnancy. Methods In this cohort study, 4884 Swedish-speaking women were consecutively recruited at their first visit for registration in the national antenatal screening programme in Sweden. We used the five-part questionnaire (5PQ) to assess GJH and pain drawings to identify PGP. Our primary outcome was the presence of PGP during the entire pregnancy and secondary outcomes were PGP in each trimesters. We tested the associations with logistic regression analysis, and adjusted for age and ethnicity. Results In all, 2455 (50.3%) women responded to both questionnaires. The prevalence of self-reported GJH was 28.7%. A higher proportion of women with GJH than women without GJH reported PGP during the entire pregnancy (47.9% vs. 41.0%), particularly in trimester 1 (31.6% vs. 22.0%). Thus, women with GJH also had higher odds of PGP during the entire pregnancy (adjusted odds ratio (aOR) 1.27: 95% CI 1.11–1.47) and in trimester 1 (aOR 1.54: 95% CI 1.20–1.96), but the associations were not statistically significant in trimester 2 (aOR 1.24: 95% CI 0.82–1.88) or trimester 3 (aOR 1.20: 95% CI 0.99–1.45). The odds of PGP in pregnancy increased with increasing numbers of positive answers to the 5PQ (p for linear trend p for linear trend p = 0.13 and p = 0.06, respectively). Conclusions Compared to women with normal joint mobility, women with GJH had higher odds of reporting PGP during pregnancy and the odds increased with number of positive responses to the 5PQ. The associations were present in trimester 1 but did not reach statistical significance in trimester 2 and 3.

Background and aim Health status is an independent predictor of mortality, morbidity and functioning in older people. The present study was designed to evaluate the link between socioeconomic status (SES), physical activity (PA), independence (I) and the health status (HS) of older people in Iran, using structural equation modelling. Methods Using computerized randomly selection, a representative sample of 851 75-year-olds living in Tehran (2007–2008), Iran, was included. Participants answered questions regarding indicators of HS, SES and also PA and I through interviews. Both measurement and conceptual models of our hypotheses were tested using Mplus 5. Maximum-likelihood estimation with robust standard errors (MLR estimator), chi-square tests, the goodness of fit index (and degrees of freedom), as well as the Comparative Fit Index (CFI), and the Root Mean Square Error of Approximation (RSMEA) were used to evaluate the model fit. Results The measurement model yielded a reasonable fit to the data, χ2 = 110.93, df = 38; CFI = 0.97; RMSEA = 0.047, with 90% C.I. = 0.037–0.058. The model fit for the conceptual model was acceptable; χ2 = 271.64, df = 39; CFI = 0.91; RMSEA = 0.084, with 90% C.I. = 0.074–0.093. SES itself was not a direct predictor of HS (β = 0.13, p = 0.059) but it was a predictor of HS either through affecting PA (β = 0.31, p

Background Good conceptual knowledge is an essential requirement for health professions students, in that they are required to apply concepts learned in the classroom to a variety of different contexts. However, the use of traditional methods of assessment limits the educator’s ability to correct students’ conceptual knowledge prior to altering the educational context. Concept mapping (CM) is an educational tool for evaluating conceptual knowledge, but little is known about its use in facilitating the development of richer knowledge frameworks. In addition, structured feedback has the potential to develop good conceptual knowledge. The purpose of this study was to use Kinchin’s criteria to assess the impact of structured feedback on the graphical complexity of CM’s by observing the development of richer knowledge frameworks. Methods Fifty-eight physiotherapy students created CM’s targeting the integration of two knowledge domains within a case-based teaching paradigm. Each student received one round of structured feedback that addressed correction, reinforcement, forensic diagnosis, benchmarking, and longitudinal development on their CM’s prior to the final submission. The concept maps were categorized according to Kinchin’s criteria as either Spoke, Chain or Net representations, and then evaluated against defined traits of meaningful learning. Results The inter-rater reliability of categorizing CM’s was good. Pre-feedback CM’s were predominantly Chain structures (57%), with Net structures appearing least often. There was a significant reduction of the basic Spoke- structured CMs (P = 0.002) and a significant increase of Net-structured maps (P

Objectives To update the incidence rate, aetiology and injury characteristics of acutely-injured adults with traumatic spinal cord injury in Stockholm, Sweden, using international standards of reporting. Study design Prospective, (regional) population-based observation. Subjects Forty-nine consecutively enrolled individuals. Methods A surveillance system of newly-injured adults with traumatic spinal cord injury was implemented for an 18-month period. The International Spinal Cord Injury Core Data Set was used to collect data on those who survived the first 7 days post-injury. Results After an 18-month period, 49 incident cases were registered, of whom 45 were included in this study. The crude incidence rate was 19.0 per million, consisting mainly of men (60%), and the mean age of the cohort was 55 years (median 58). Causes of injury were almost exclusively limited to falls and transport-related events, accounting for 58% and 40% of cases, respectively. The incidence has remained stable when compared with the previous study; however, significant differences exist for injury aetiology (p = 0.004) and impairment level (p = 0.01) in that more fall- and transport-related spinal cord injury occurred, and a larger proportion of persons was left with resultant tetraplegia, in the current study, compared with more sport-related injuries and those left with paraplegia in the previous study. Conclusion The incidence rate appeared to remain stable in Stockholm, Sweden. However, significant changes in injury aetiology and impairment-level post injury were found, compared with the previous study. There remains a need for developing fall-related prevention strategies in rehabilitation settings as well as in population-based programmes.

Background: Early diagnosis of mild lymphedema and treatment are important to prevent its progress. The tissue dielectric constant (TDC), measuring local tissue water in the skin and upper subcutis, has neither been related to the water displacement method (WDM) nor been used to diagnose mild arm lymphedema in patients at risk. Our aims were to evaluate TDC and WDM in combination with palpation, examine the association between TDC and WDM measurements, and compare lymphedema-related factors. Methods and Results: Seventy-two women treated for breast cancer were diagnosed with mild arm lymphedema using skin palpation in combination with TDC from fixed measurement sites (threshold ratio for upper arm ≥1.45 and forearm ≥1.3) and/or WDM (lymphedema relative volume [LRV]: ≥5% to ≤8%). Results revealed that 32 (45%) women were diagnosed by TDC only, 19 (26%) by WDM only, and 21 (29%) by both TDC and WDM. TDC ratios exceeding the threshold were most frequently identified on the medial site of the arm, proximal and distal to the antecubital fossa. TDC and WDM were negatively associated; LRV (r = -0.545, p

Objectives (i) To determine the prevalence of secondary complications after traumatic spinal cord injury during acute care and rehabilitation; (ii) to investigate whether associations exist between level and completeness of injury and the development of common complications; and (iii) to assess whether associations exist between secondary complications and return-to-work 1 year after injury. Design and participants A prospective, population-based study, including all newly-injured persons with traumatic spinal cord injury for an 18-month period. Methods The International Spinal Cord Injury Core Data Set was used to capture injury characteristics, as well as associated injuries and neurological severity. All secondary medical complications (e.g. pressure injuries, pulmonary embolism, pneumonia, urinary tract infection) were screened for during acute care and rehabilitation. Inferential statistics were carried out. Results Out of the 45 persons undergoing acute care, the 3 most common complications were urinary tract infections (47%), pneumonia (22%) and neuropathic pain (18%). Of the 31 persons who received rehabilitation, the most common complications were urinary tract infections (42%), neuropathic pain (42%), and spasticity (35%). A significant association was found between injury level and development of neuropathic pain during rehabilitation. Conclusion Although a specialized system for spinal cord injury management is available in Sweden, secondary complications are still common. These findings could be used to inform the development of strategies for prevention of secondary complications.

To evaluate the extent to which the rehabilitation outcome levels (ROL) and the spinal cord independence measure (SCIM) III could be mapped to the International Classification of Functioning, Disability and Health (ICF) and the brief core set for spinal cord injury (SCI) in the post-acute context.Two professionals used the published protocol to map the concepts derived from both measures to the ICF categories. Further, the endorsed categories at the second level of the ICF were used to determine the coverage of the Brief ICF Core Set for SCI.Three items of the ROL could not be conceptualised within the ICF, while the rest were mapped to 42 second-level categories, mainly to the activity and participation domain. All the items of the SCIM III were mapped, yielding 52 ICF categories, mostly at the third level (32). For the mapping to the Core Set for SCI, the ROL covered five and the SCIM III all nine categories of 'activities and participation' included as the candidate categories of the brief version.In terms of content, the ROL appears to be a more global measure of functioning, compared with the SCIM III that covers specific 'activity' aspects as proposed in the Brief Core Set for SCI. It is thus recommended that standardised measures, such as the SCIM III, be used due to its conceptual underpinnings and coverage of important aspects. Implications for Rehabilitation Rehabilitation professionals should select appropriately validated outcome measures specific to the health condition in order to evaluate the effectiveness of rehabilitation. Rehabilitation professional working with outcome measures should be aware of the limitations of measures, in terms of content, and supplement the evaluation with appropriate standardised measures or the use of the Core Sets. To enhance evidence-based practise in routine clinical practise, standardised outcome measures should be used.

Background Pelvic Girdle Pain (PGP) is an important cause of disability and economic cost worldwide. There is a need for effective preventative and management strategies. Emerging studies measure a variety of outcomes rendering synthesis and translation to clinical practice difficult. A Core Outcome Set (COS) can address this problem by ensuring that data are relevant, useful and usable for making well-informed healthcare choices. The aim of this study is to develop a consensus-based PGP-COS, including agreement on methods (e.g. instruments) for measuring the construct outcomes in the COS for use in research and clinical practice. Furthermore, as there is uncertainty as to whether incorporating stakeholder interviews in addition to conducting a systematic review to determine an initial list of outcomes for the Delphi survey, or, whether using different rating scales in a Delphi survey impacts on the final COS, we propose to embed two methodological studies within the PGP-COS development process to address these questions. Methods The PGP-COS study will include five phases: (1) A systematic review of the literature and semi-structured interviews with 15 patients (three countries) to form the initial list of outcomes for the Delphi survey; (2) A 3-round Delphi including patients, clinicians, researchers and service providers; (3) A systematic review of methods for measuring the outcomes in the preliminary PGP-COS identified in the Delphi survey; (4) A face-to-face consensus meeting to agree on the final PGP-COS and methods for measuring the COS; (5) Global dissemination. To address the methodological questions, we will assess the number and type of outcomes, in the final PGP-COS, that were exclusively derived from the interviews. Secondly, we will randomise Delphi survey participants to either a 5-point or 9-point importance rating scale, and examine potential differences in ‘important’ ratings between the groups. Discussion There is currently no COS for measuring/monitoring PGP in trials and clinical practice. A PGP-COS will ensure that relevant outcomes are measured using appropriate measurement instruments for patients with PGP globally. Core outcome set registration This PGP-COS was registered with COMET (Core Outcome Measures for Effectiveness Trials) in January 2017 (http://www.comet-initiative.org/studies/details/958). © The Author(s). 2018. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

When suffering a spinal cord injury (SCI), the patient and family face numerous challenges regardless of socio-economic level. The stigmatisation of persons with disabilities has been reported, however, reports from Southern Africa are largely lacking.To explore the experiences of living with a traumatic SCI in Botswana concerning perceived attitudes, obstacles and challenges.A qualitative approach with semi-structured interviews was conducted. Thirteen community-dwelling persons who have lived with an SCI for at least two years participated.A theoretical model was formed that illustrate the associations between the core category, Self, and the categories Relationships and Society. The model illustrates that personal resources, including a strong identity and a positive attitude, are crucial to the experience of inclusion in the community. A supportive family, a source of income, and faith were strong facilitators, while inaccessibility and devaluing attitudes were barriers. Having a disability led to increased risk of poverty and social exclusion.This study emphasised the importance of personal resources, family support, and improved accessibility to facilitate inclusion in the society. Informants requested legislation to advocate for the rights of persons with disabilities to be respected, with the aim of moving towards an equal accessible society. Implications for Rehabilitation Reclaiming or restructuring one's identity after a SCI is crucial for the person's ability to move on and develop beneficial coping strategies. Support from family and friends, staff and peer support are crucial parts in that process. Spirituality, values, needs and coping strategies vary profoundly among persons sustaining disabling injuries. In striving to optimise care, rehabilitation staff needs to be attentive to the personal resources and preferences to be able to individualise care, encounter, and facilitate transition back to the community. Family members play a crucial part in rehabilitation. It is essential for the patients' well-being and care that they get explicit descriptions of the patient's abilities. Living in a well-adapted home will facilitate well-being, independence, and return to work. Rehabilitation staff needs to focus their efforts on making this successful prior to discharge from hospital.

Study design:Descriptive study with a cross-sectional design.OBJECTIVES:To describe the epidemiology of traumatic spinal cord injuries (TSCIs) in Botswana, with a specific focus on road traffic crashes (RTC).Setting:Main public referral hospital, Gaborone, Botswana.METHOD:Two samples were included. Sample one described the epidemiology and included patients admitted during a 2-year period with acute TSCI. Sample two included only patients with TSCI due to RTC.RESULTS:Annual incidence was 13 per million population. Epidemiology of TSCI: 49 patients were included, 71% male, age ranging from 4 to 81 years, 80% ⩽45 years. Tetraplegia was more common than paraplegia (59/41%), and 39% had C1-C4 level of injury. The main cause of TSCI was RTC (68%), followed by assault (16%) and falls (10%). Mortality was 20%, where all, but one, had tetraplegia (18%). Median time from injury to spinal surgery was 12 days, with longer time for women, 16 days compared with 8 for men. Burst tire was the primary cause of RTC resulting in a TSCI, followed by hitting animals on the road. The majority had been passengers and 72% were involved in single crashes.CONCLUSION:The most common cause for TSCI was RTC, followed by assault. In-hospital mortality was high and the waiting period from the time of accident to spinal surgery was long, especially for women. The aetiology and high mortality of TSCI in Botswana indicate that improvements in roadway safety and medical care may decrease the TSCI incidence and mortality.Spinal Cord advance online publication, 25 November 2014; doi:10.1038/sc.2014.203. Language: en

Lymphoedema after breast cancer surgery is a chronic condition. Lymphoedema treatment consists of information/advice, compression, physical exercise, skin care, and manual lymph drainage. Little is known about how patients experience, adapt, and respond to lymphoedema treatment. Thus, the purpose of the study was to investigate and describe women's perceptions of lymphoedema treatment after breast cancer surgery. Sixteen women with breast-cancer-related lymphoedema, recruited from four hospitals and two rehabilitation clinics, participated in the study. Semi-structured interviews were conducted and analysed using a phenomenographic method. Five qualitatively different categories of description could be identified: uncertainty, disappointment, guilt and shame, safety, and autonomy. The categories could be described based on a two-dimensional structure: the patients role (internal vs. external locus of control) and an understanding of lymphoedema as a chronic disease or a burden. The study has provided a deeper understanding of different ways in which patients perceive and respond to lymphoedema treatment. The present findings enable the lymphoedema therapist to individualise treatment and counselling based on each patient's approach to the patient role, ability to take responsibility for treatment, and acceptance of lymphoedema as a chronic disease.

Objective: To explore the association between disability and sick leave due to lumbopelvic pain in pregnant women in 3 cohorts in Sweden and Norway and to explore possible factors of importance to sick leave. A further aim was to compare the prevalence of sick leave due to lumbopelvic pain. Design/subjects: Pregnant women (n=898) from two cohorts in Sweden and one in Norway answered to questionnaires in gestational weeks 10-24; two of the cohorts additionally in weeks 28-38. Methods: Logistic regression models were performed with sick leave due to lumbopelvic pain as dependent factor. Disability, pain, age, parity, cohort, civilian status, and occupational classification were independents factors. Results: In gestational weeks 10-24 the regression model included 895 cases; 38 on sick leave due to lumbopelvic pain. Disability, pain and cohort affiliation were associated with sick leave. In weeks 28-38, disability, pain and occupation classification were the significant factors. The prevalence of lumbopelvic pain was higher in Norway than in Sweden (65%, vs 58% and 44%; pless than0.001). Conclusion: Disability, pain intensity and occupation were associated to sick leave due to lumbopelvic pain. Yet, there were significant variations between associated factors among the cohorts, suggesting that other factors than workability and the social security system are also of importance.

Background and purpose: The pattern of population aging is highly complex and contextually based. Cross-national comparisons are helpful to explore related factors. Two cross-sectional studies designed to compare physical activity level, physical functioning and certain health related factors in 75-year-old women and men in Sweden and Iran. Materials and methods: Cohorts of 637 Swedish and 851 Iranian 75-year-olds were investigated with the same methods regarding physical activity level, physical functioning and health related factors. Results: There were differences in physical activity level (p < 0.001), self-reported physical functioning (p < 0.001) objective physical functioning (p < 0.001), health status (p < 0.001) and most socio-demographic aspects between the two countries. Here the Swedish cohort had the advantage. There was no difference between the countries regarding prevalence of vertigo or falls. The only variables where the Iranian cohort had advantage over the Swedes were grip strength and smoking habits. There were larger gender differences in walking habits, self-selected walking speed, timed chair stand, and one-leg stance in Iran, and in grip strength in Sweden, all to the disadvantage of women. Conclusions: Iranian 75-years-olds had a lower physical activity level, a worse lower extremity physical function but a better grip strength, a worse physical health status, but smoked less than their Swedish counterparts. Despite this, there were no differences regarding vertigo or falls. In most aspects, the magnitude of gender differences was about the same and in disadvantage of women, although there were larger differences in Iran in some lower extremity functions. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

To evaluate potential determinants of self-reported lumbopelvic pain 6 months postpartum for pregnant women with and without lumbopelvic pain.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.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.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.

The objective was to explore and describe nursing staff's body awareness and communication in patient transfers and evaluate any changes made after an educational intervention to promote staff competence in guiding patients to move independently. In total, 63 nursing staff from two hospitals wrote weekly notes before and after the intervention. The topics were: A) reflect on a transfer during the last week that you consider was good and one that was poor; B) reflect on how your body felt during a good and a poor transfer. The notes were analysed with content analysis. The results showed five different communication modes connected with nursing staff's physical and verbal communication. These communication modes changed after 1 year to a more verbal communication, focusing on the patient's mobility. The use of instructions indicated a new or different understanding of patient transfer, which may contribute to a development of nursing staff's competence. STATEMENT OF RELEVANCE: The present findings indicate that patient transfer consists of communication. Therefore, verbal and bodily communication can have an integral part of training in patient transfer; furthermore, the educational design of such programmes is important to reach the goal of developing new understanding and enhancing nursing staff's competence in patient transfer.

Study design The study was a randomized controlled trial. Treatment was for 8 weeks, with follow-up posttreatment and at 6-, 12-, and 36- months. Objective The purpose was to evaluate the effect of a graded exercise intervention emphasizing stabilizing exercises in patients with nonspecific, recurrent low back pain (LBP). Summary of background data Exercise therapy is recommended and widely used as treatment for LBP. Although stabilizing exercises are reportedly effective in the management of certain subgroups of LBP, such intervention protocols have not yet been evaluated in relation to a more general exercise regimen in patients with recurrent LBP, all at work. Methods Seventy-one patients recruited consecutively (36 men, 35 women) with recurrent nonspecific LBP seeking care at an outpatient physiotherapy clinic were randomized into 2 treatment groups; graded exercise intervention or daily walks. The primary outcome was perceived disability and pain at 12-month follow-up. Secondary outcomes included physical health, fear-avoidance, and self-efficacy beliefs. Results Of the participants, 83% provided data at the 12-month follow-up and 79% at 36 months. At 12 months, between-group comparison showed a reduction in perceived disability in favor of the exercise group, whereas such an effect for pain emerged only immediately postintervention. Ratings of physical health and self-efficacy beliefs also improved in the exercise group over the long term, though no changes were observed for fear-avoidance beliefs. Conclusion A graded exercise intervention, emphasizing stabilizing exercises, for patients with recurrent LBP still at work seems more effective in improving disability and health parameters than daily walks do. However, no such positive results emerged for improvement regarding pain over a longer term, or for fear-avoidance beliefs.

To examine and compare levels of catastrophizing, fear-avoidance beliefs, physical ability, and health-related quality of life in women with and without lumbopelvic pain (LP and NLP) in early pregnancy.A cross-sectional study of early pregnancy.Five midwife clinics, one in the center, two in the outskirts of Stockholm, and two in a medium-sized town.Three hundred and twenty-four women in the 19th-21st week of pregnancy.Questionnaires.The Pain Catastrophizing Scale of exaggerated negative thoughts about pain experiences, the Fear-Avoidance Beliefs Questionnaire of beliefs about how physical activity and work affect back pain, the Disability Rating Index of physical ability, and the Nottingham Health Profile to assess health-related quality of life.Two groups were defined: LP (n=141) and NLP (n=183). The Mann-Whitney U-test was used for comparisons. Pregnant women with LP had significantly (p0.05) higher levels of exaggerated negative thoughts and fear-avoidance beliefs. They also had lower physical ability and health-related quality of life compared to women in the NLP group.It is important to consider exaggerated negative thoughts about pain experiences and fear-avoidance beliefs when treating women with LP during pregnancy and to be aware of the great impact lumbopelvic pain has on women's lives during early pregnancy.

Objective: The aim of this study was to explore and analyse the experience of living with long-term neck/shoulder pain and its effect on daily life. Design: A thematic interview study with emergent design. Subjects: Twelve patients in primary care (6 women and 6 men) with long-term neck/shoulder pain. Methods: Thematic interviews analysed using grounded theory. Results: A conceptual model emerged. The core category “striving to master variable pain” comprises how the informants are constantly aiming at not letting it become too much of a hindrance. The 3 sub-categories “space for health”, “strategies for pain control” and “disruptions in daily life” interact with each other. Giving oneself adequate time and prioritizing one’s health-promoting behaviour in relation to pain were important when adopting strategies for pain control. Men and women differed when describing consequences for domestic life and prioritizing their own health in relation to pain. Conclusion: Living with long-term variable neck/shoulder pain involves a struggle not to let the pain become too much of a physical obstacle to daily life. Individuals learn to respond to the pain in different ways. Allowing oneself adequate time and prioritizing health in relation to pain appear to be important for controlling pain.

Background and Purpose. Many women suffer from back pain and experience activity limitation post-partum. To our knowledge the physiological factors and physiotherapy related to back pain post-partum have received limited evaluation and the effectiveness of specific physiotherapeutic approaches to exercise should be tested. In addition, there has been limited research on kinesiophobia in women with back pain post-partum. The purpose of the current study was to test the influence of specific trunk muscle training on pain, activity limitation and kinesiophobia in 10 subjects with back pain post-partum. Method. The treatment consisted of specific deep muscle training of the transversus abdominus and multifidus muscles. Pain was rated based on the visual analogue scale (VAS) and pain drawings. Activity limitation was recorded using the Disability Rating Index. Kinesiophobia was evaluated using the Swedish version of the Tampa Scale for Kinesiophobia. An A–B–A single-subject research design was used and a number of measurements were obtained during each phase. The analysis consisted of a visual inspection and a two standard deviation band test (2-SD). Results. The visual analysis showed a trend towards reduced pain and activity limitation for all 10 subjects. The 2-SD test showed mixed results among all subjects. In addition, all subjects reported kinesiophobia before and after treatment. Conclusions. Individual specific deep muscle training of the transversus abdominus and multifidus muscles reduced pain and activity limitation in women with back pain post-partum. Further research is needed to determine more precisely how kinesiophobia affects women with back pain post-partum. Copyright © 2007 John Wiley & Sons, Ltd.

Sagittal head excursions are frequently used as diagnostic and treatment tools by physiotherapists. Retractions are performed to promote good head-on-body orientation. This study examined the regional contribution of spinal movements to head pro- and retraction in addition to the effect of a more or less restrained sitting position in healthy women. Fourteen healthy women performed seven sagittal head excursions in a more or less restrained sitting position, during which time their kinematic response was measured with an optoelectronic system. Total anterior/posterior head excursion was smaller ( P = 0.005 ) in the more restrained sitting position. In both sitting positions, approximately 60% of the total anterior/posterior head excursion originated from the cervical spine, almost 30% from the cervicothoracic spine C7-T4, and approximately 10% from thoracic regions down to T12. Middle thoracic vertical displacement was smaller ( p = 0.005 ) in the more restrained sitting position. A high correlation was found between total head excursion and the cervicothoracic unit displacements in both sitting positions ( r = 0.79 , r = 0.85 , respectively). In each sitting position, the craniovertebral angle, and the tragus-C7-horizontal line decreased in protraction. Movements in the thoracic region contributed to the total head excursion. Therefore, clinicians should recognize the thoracic contribution to sagittal head excursion when using pro- and retraction as a diagnostic and treatment tool.

Objective: To explore and describe how patients with recurrent low back pain perceive and respond to the recurrence of pain. Design: A semi-structured interview study. Subjects: Seventeen patients (10 women and 7 men) with recurrent low back pain. Methods: Semi-structured interviews were analysed using the phenomenographic method. Results: Patients’ perceptions of relapse of low back pain could be divided into 4 different categories: (i) an unsolved mystery, a source of uncertainty and self-accusation; (ii) an obvious part of life that has to be ignored; (iii) a reminder to keep within limits, both physically and psychologically; and (iv) an indication to change behaviour to prevent further relapse. The categories could be grouped hierarchically such that they reflect to what extent the patients showed readiness and self-efficacy in adopting self-management strategies to prevent further relapses. Conclusion: The results suggest that patients with relapse in low back pain could respond in different ways to the recurrence of pain and show different degree of readiness to change behavioural and movement patterns in order to prevent further relapses. The different responses might be important aspects to which physicians and allied health professionals should pay attention in the rehabilitation process.

The study aimed to elucidate the meaning of acceptance in relation to the lived body and sense of self when entering a pain rehabilitation programme.Six women and three men with long-term pain were interviewed. The interviews were analysed according to interpretative phenomenological analysis.The analysis revealed three different meaning structures, first: acceptance as a process of personal empowerment, "the only way forward". Here, the individuals expressed that the body felt integrated: a trusting cooperation between self and body gave rise to hope. Second: acceptance as an equivocal project, a possible but challenging way forward. The hopeful insight was there, acknowledging that acceptance was the way to move forward, but there was also uncertainty and doubt about one's ability with a body ambiguous and confusing, difficult but important to understand. Third, in acceptance as a threat and a personal failure, "no way forward" the integration of the aching body in sense of self was impossible and pain was incomprehensible, unacceptable and unfair. Pain was the cause of feeling stuck in the body, affecting the sense of self and the person's entire life.The meaning of acceptance was related to acceptance of the persistency of pain, to how the individual related to the lived body and the need for changes in core aspects of self, and to the issue of whether to include others in the struggle of learning to move on with a meaningful life.Healthcare professionals should be aware that individuals with long-term pain conceptualize and hold different meanings of acceptance when starting rehabilitation; this should be considered and addressed in rehabilitation programmes. The meaning given to acceptance is related to the experience of the lived body and the sense of self, as well as to getting legitimization/acceptance by others; therefore these aspects need to be considered during rehabilitation. The process of achieving acceptance seems to embrace different processes which can be understood as, and facilitated by, an embodied learning process. The bodily existential challenges presented in the present study, for example to develop an integrated and cooperative relationship with the painful body, can inspire health professionals to develop interventions and communication strategies focusing on the lived body. A wide range of competencies in rehabilitation clinics seems to be needed.

BackgroundThe development of rehabilitation services promoting participation in people living with a traumatic spinal cord injury (TSCI) is of major concern for physical therapists. What the client sees as effective participation, barriers, and facilitators might be different due to their particular context. This study was conducted to gain insight into the experiences of attaining an important outcome in a developing context.ObjectiveThe aim of this study was to explore the experiences of reclaiming participation in community-dwelling people with TSCI in South Africa.DesignThis was an explorative, qualitative study with inductive content analysis.MethodsIndividual semistructured interviews were conducted with 17 adults living with a TSCI in order to explore their experience of participation. The verbatim transcripts were analyzed, and the end result was an overall theme that included 4 emerging categories.ResultsThe theme “participation possibility” denotes the eventual involvement in life situations. Within this theme, there were 4 categories that emerged as a representation of essential aspects along the continuum of reclaiming participation: (1) dealing with the new self, (2) a journey dominated by obstacles, (3) the catalyst of participation, and (4) becoming an agent. Dealing with and recognizing these intervening conditions seem critical for clients to reconstruct the meaning that is necessary for a broader conception of participation.LimitationsThe transferability of these findings to dissimilar contexts may be limited.ConclusionClient perspectives on reclaiming participation after injury affirm the notion of eventual participation, with each person finding strategies to succeed. In order to help clients reclaim participation, health professionals should develop contextually sensitive programs that include peer mentoring and reduce the influence of hindering factors.

Objective The objective of this study was to determine whether applied force and time interval of force exposure varied within and between physiotherapists (PTs) when they used sacroiliac (SI) distraction testing to provoke pain among subjects with sacroiliitis. Methods Two force plates recording 3 orthogonal forces and time intervals were used during repetitive testing. Eleven subjects with sacroiliitis were examined with the use of distraction testing by each of 3 PTs. Subjects lay on an examination board equipped with one force plate for each SI joint. They indicated provoked pain by pressing a button that gave a mark in the data collection. Results Applied force and time interval of force exposure varied within and between PTs. Significant differences between PTs were found in the impulse (force × time) for the vertical and lateral force components ( P ≤ .05). A significant decrease was found in the amplitude of force during the time interval of force exposure ( P ≤ .05) for 2 of the 3 PTs. The median level of pain was lowest when examined by the PT who applied the least magnitude of force. Conclusions Recording force and time events indicates that variation in examination technique within and between PTs may influence the outcome of the distraction test. Such recording, simultaneously monitored by the investigator, would therefore seem to offer standardized testing and improve clinical evaluation of SI pain over time.

Commissaris DA, Nilsson-Wikmar LB, van Dieen JH, Hirschfeld H. Joint coordination during whole-body lifting in women with low back pain after pregnancy. Arch Phys Med Rehabil 2002;83:1279-89. Objective: To quantify differences in the kinematics of lifting between women with low back and/or pelvic pain after pregnancy and women without. Design: Comparison study. Setting: Research laboratory. Participants: Volunteer sample of 7 women with pain (positive pain drawing, no physical examination) and 9 female controls (not matched). Interventions: Not applicable. Main Outcome Measures: Duration of downward and upward phases, relative instant of box lift-off, joint angles, spatial angles of trunk and pelvis, pelvic angle relative to trunk, and phase angle relationships between joints. Results: The duration of the upward phase ± standard deviation was longer in the pain group (1731±290ms vs 1489±187ms, P =.031). At box lift-off, this group had less hip joint flexion (101.9°±20.8° vs 78.7°±12.4°, P =.015) but more backward pelvis tilt relative to the trunk, that is, more lumbar spine flexion (126.3°±16.8° vs 109.0°±12.3°, P =.031). The pain group showed an immediate transition from lumbar spine flexion to extension, whereas the controls maintained peak flexion for about 600ms. The peak phase lag between knee and hip joint extension in the upward phase was larger for the pain group (−29.7°±8.3° vs −17.2°±5.5°, P =.003). Conclusion: Women with low back and/or pelvic pain after pregnancy showed different kinematics of lifting. Further research is needed to determine the exact relationship between the altered kinematics and the underlying disorder. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

The purpose was to compare progression/regression of arm lymphoedema, health-related quality of life and medical background data among women who discontinued their treatment (non-continued treatment group, NCTG) with these factors among women who continued treatment (continued treatment group, CTG).Seventy-two women were included in the NCTG and 58 women in the CTG. Women in the NCTG were invited to an examination and measurement of affected arm volume at the clinic in 2008. Medical background data and arm volume values, measured using the water displacement method, were collected from patient records and the Breast Cancer Quality Register of the Uppsala Örebro Region. The functional assessment of cancer therapy for breast cancer (FACT-B) was used to assess health-related quality of life in both groups.There were no differences with regard to progression/regression of arm lymphoedema or health-related quality of life. The CTG had experienced more advanced disease and received more extensive surgical and oncological treatment. The CTG had significantly larger arm volume due to lymphoedema at diagnosis (mean 422 ml) compared to the NCTG (mean 283 ml; p0.001), and at the last visit at the clinic (CTG mean 414 ml versus NCTG mean 239 ml; p0.001).The results indicate that there might be a spontaneous regression of lymphoedemas in the NCTG but there is a need for more research to make it possible to draw firm conclusions regarding this.

Studies have demonstrated improvements in arm motor function after constraint-induced (CI) therapy. Few studies of CI therapy for lower extremity conditions have been done. Our purpose was to evaluate the effect of modified CI therapy for the lower extremity in terms of motor control in elderly persons with chronic stroke.A single-subject experimental AB design was used, with 3 months of follow-up. The A phase consisted of a baseline period of 2 weeks with 6 measurements, and the B phase was a 4-week intervention with 8 measurements. Two men and 1 woman were included. The intervention consisted of intensive rehabilitation of the affected leg for 2 hours each weekday. A whole-leg orthosis was used to immobilize the nonaffected leg. The following tests were conducted: a step test for dynamic balance, Fugl-Meyer assessment for lower-extremity motor function, the Timed Up and Go test for mobility, and the 6-minute and 10-meter walk tests for walking ability. Statistical significance was analyzed by using Shewhart charts with a 2-standard deviation band method.A positive change was observed in 14 of 18 variables. Significant improvements existed in 7 of the 14 positively changed variables. Positive changes remained in 13 of 14 variables at the 3-month follow-up evaluation.Modified CI therapy may result in positive changes in balance and motor function in elderly persons with chronic stroke.

The influence of ovarian stimulation in in-vitro fertilization (IVF) on the prevalence of back pain with onset during pregnancy was studied in 31 women who became pregnant after IVF treatment and compared with that of 200 spontaneously pregnant women. A two times higher prevalence rate of sacral pain in late pregnancy was reported among IVF pregnant women (P < 0.0001), as well as a significantly higher prevalence rate of positive results of pelvic pain provocation tests performed in late pregnancy (0.0001 < or = P < or = 0.015), as compared with that of the spontaneously pregnant women. Among the IVF pregnant women, there was a significant positive correlation between relaxin concentrations in early pregnancy and the outcome of pelvic pain provocation tests (0.44 < or = r < or = 0.51, P < 0.05). In addition, the serum relaxin concentration was the factor that best explained differences in sacral pain prevalence. When the influence of serum relaxin concentration on back pain prevalence was taken into account, women carrying multiple pregnancies had no more pain than women carrying singletons, and IVF pregnant women had no more pain than spontaneously pregnant women. These results support the hypothesis that relaxin is involved in the generation of pelvic pain in pregnant women.

An active life style can postpone the aging process, prevent many aspects of functional decline and improve health and quality of life. The aim of this study was to compare elderly people who walked at least 30 min a day with others who walked less, from a gender perspective, regarding perceived health and fitness, physiological capacity and functional performance. A representative sample of 75-year-olds born 1932-33 and living in Tehran, in 2007-2008 was included by randomly selecting 1100 subjects from the latest Iranian census records (1996) by the Statistical Centre of Iran using computerized methods. Participants answered questions regarding health status and physical activity and performed functional tests. Better results for Walkers were observed in most subjective and objective outcome measures. Walkers were less likely to feel generally tired, more likely to have better physical fitness and to have the maximum score on the Falls Efficacy Scale, less likely to feel unstable during walking outdoors and less likely to be dependent or unsafe in ADL. Walkers of both genders performed better in the following tests: chair stand, one leg stance, maximal walking speed and six min walking. The difference between Walkers and Non-Walkers was greater in men. In general, older women and men who walked at least 30 min daily/almost daily showed better results in most health-related outcomes, ADL and functional performance than people who walked less. This study showed gender differences in the level of physical activity and functioning that must be taken into account when planning intervention programs. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

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.

The aim of this cohort study was to identify early predictive factors for a poor outcome of disability and pain 12- and 36-months after an intervention in patients with recurrent low-back pain, currently at work.Seventy-one patients with recurrent low-back pain, all at work, seeking care in a primary health care setting were included. Predictive indicators including demographic data and health-related variables were derived from questionnaires pre- and post intervention over eight weeks. The dependent outcome variables were perceived disability and present pain at 12- and 36-months.Multivariate regression analyses show that early data on poor self-efficacy for physical activity, greater disability, and higher level of pain-ratings emerged as independent predictors of a poor outcome of disability at 12 and 36 months. Higher ratings of pain and poor self-efficacy appeared again as independent predictors of a poor outcome of pain at the 12-month follow-up. Pain frequency ratings predicted a poor outcome of pain at 36 months.Our results suggest that ratings of poor self-efficacy for physical activity, greater disability, and pain-ratings, are the most consistent independent predictors of long-term poor outcome of disability and pain. This indicates the importance of screening for such factors to optimize the management of low-back pain. However, larger studies in similar patient populations are needed to confirm these results.

Interprofessional education in health care today is a prioritized area. Among many studies on interprofessional learning, few focus on student expectations prior to interprofessional education for health professionals at an advanced level. The purpose of the study was to explore and describe expectations of post-professional graduate students enrolled in an interprofessional master's degree program for health professionals.Prior to entering their programs of study, a questionnaire with three questions was given to 42 participants from six professions: biomedical analysis, dietetics, nursing, occupational therapy, physiotherapy, and social work. Their responses were analyzed using inductive qualitative content analysis.Four categories of expectations emerged regarding the interprofessional program and future learning experiences: (1) increased professional competence for clinical practice and research; (2) enhanced interprofessional collaboration; (3) personal development; and (4) increased quality of patient care. Most individual answers covered more than one category.Expectations when entering an interprofessional master's degree program for health professionals include sociocultural learning, which enables students to contribute to increased quality of care. That the students expected not only increased skills for interprofessional collaboration and personal development but also for professional competence is of special interest and needs attention in research and practice.

To translate the Swedish version of the Falls Efficacy Scale (FES), the FES(S), into Persian, and to determine reliability and validity of the scale to be used for Persian speaking elderly people.The 'forward-backward' procedure was applied to translate the FES(S) into Persian. A methodological study was then carried out to determine the psychometric properties of the Persian version of the scale. Eighty-one community-dwelling elderly persons (≥65 years) were included.Both reliability and validity of the Persian FES(S) were found to be acceptable (Cronbach's α= 0.75, interclass correlation coefficients = 0.99, p0.001 and standard errors of measurements = 1.82). Low to moderate negative correlations of the total score of the scale with the age of the participants and number of falls in the past year were shown. There were also low to moderate correlations between the Persian FES(S) score and the Mini-Mental State Examination score, duration of walks and physical fitness. The participants who took a daily walk, felt healthy, reported no general tiredness and who had had no fall during the past year rated their self-efficacy higher than did their peers.The present study verified that the Persian FES(S) is a culturally relevant, valid and reliable tool for measuring self-perceived confidence in Iranian older adults.

The objective was to evaluate changes after a two half-day patient transfer course regarding nursing staff's movement and body awareness, attitudes, reported behaviour, strain, disorder and sick leave. The course aimed at increasing staff's self-awareness of movements and body, and their communication competence, with the intention to promote the patient's independent mobility. Ninety-nine staff in an intervention group and 77 staff in two control groups answered a questionnaire before and after the intervention. After one year there was a significant increase in the number of instructions given and nursing staff's movement awareness in the intervention group compared to the control group. Reported physical disorders decreased significantly in the intervention group compared with both control groups. Increased movement awareness and frequent use of instructions during transfers may encourage patients to move independently and thereby reduce the strain in nursing staff.

Objective: The aims of this study were to compare the aerobic fitness level of working patients who have recurrent low back pain with those of healthy age- and gender-matched controls, and to investigate the relationship of aerobic fitness level with pain intensity, general health, perceived disability, fear-avoidance beliefs and self-efficacy. Subjects and methods: A total of 57 patients with recurrent low back pain, with a mean of 10 years’ pain duration and 57 healthy controls performed a sub-maximal Astrand cycle test. Predicted maximum oxygen consumption was calculated and compared. Correlations between the low back pain patients’ predicted aerobic fitness level and the assessed variables were calculated. Results: The women with low back pain had lower predicted aerobic fitness levels than the healthy women ( p < 0.05). For the men there was no such difference. Multiple regression analysis showed that age, gender, body mass index and selfefficacy were associated with the predicted aerobic fitness level. Conclusion: This study suggests no overall difference in predicted aerobic fitness level for a sample of subjects with re current low back pain compared with healthy controls. This is perhaps because all the patients were still at work despite the pain. The results indicate, however, that the factors associated with aerobic fitness differ between men and women.

Many women suffer from back pain and experience activity limitation post-partum. To our knowledge the physiological factors and physiotherapy related to back pain post-partum have received limited evaluation and the effectiveness of specific physiotherapeutic approaches to exercise should be tested. In addition, there has been limited research on kinesiophobia in women with back pain post-partum. The purpose of the current study was to test the influence of specific trunk muscle training on pain, activity limitation and kinesiophobia in 10 subjects with back pain post-partum.The treatment consisted of specific deep muscle training of the transversus abdominus and multifidus muscles. Pain was rated based on the visual analogue scale (VAS) and pain drawings. Activity limitation was recorded using the Disability Rating Index. Kinesiophobia was evaluated using the Swedish version of the Tampa Scale for Kinesiophobia. An A-B-A single-subject research design was used and a number of measurements were obtained during each phase. The analysis consisted of a visual inspection and a two standard deviation band test (2-SD).The visual analysis showed a trend towards reduced pain and activity limitation for all 10 subjects. The 2-SD test showed mixed results among all subjects. In addition, all subjects reported kinesiophobia before and after treatment.Individual specific deep muscle training of the transversus abdominus and multifidus muscles reduced pain and activity limitation in women with back pain post-partum. Further research is needed to determine more precisely how kinesiophobia affects women with back pain post-partum.