Nina Køpke Vøllestad

• Allen-Unhammer, Anna Jane; Vøllestad, Nina Køpke & Mengshoel, Anne Marit (2026). Between a rock and a hard place: balancing roles of clinician and co-researcher in a primary health care setting - A qualitative study. Chiropractic & Manual Therapies. 34. doi: 10.1186/s12998-026-00681-9. Full text in Research Archive Show summary

  Background The participation of clinicians in clinical research is necessary, but balancing research and clinical duties can be challenging. We explored chiropractors’ experiences of participating in a clinical trial on spinal manipulation of the neck in primary health care (PHC). Methods A qualitative design was adopted, underpinned by social interactionism. Five virtual focus group interviews were performed between August-November 2023, including 15 chiropractors, who were involved in a clinical trial in PHC. Thematic analysis was applied. Results The interviewees were motivated to participate in the clinical trial to contribute to professional development through investigating the use of spinal manipulation. However, patient recruitment and adherence to the treatment protocol were more difficult than anticipated, especially when patients realised that the treatment would be determined by randomisation and because the chiropractors had to deliver the sham/placebo interventions. The interviewed chiropractors continually negotiated conflicting obligations of clinicians, co-researchers, and breadwinners, shifting loyalties between these roles in response to situational demands. Conclusions The clinicians’ motivations to take part in the trial varied but were in general rooted in a wish to contribute to strengthening the chiropractic profession. The negotiation of multiple roles and shifting loyalties rendered them moral agents. Our findings illustrate the social and relational nature of participating as a co-researcher in a trial conducted in a chiropractic PHC context. Our study also highlights a need for better support systems for research in PHC. This calls for political and organisational will to establish systems that provide necessary support to researchers and clinical co-researchers.

• Holte, Jon Helgheim; Moger, Tron Anders; Edvardsen, Anne; Tjerbo, Trond; Vøllestad, Nina Køpke & Hellesø, Ragnhild [Show all 7 contributors for this article] (2026). Long-term patterns of health services utilization after hospitalization for COPD. A nationwide registry-based study from Norway. Respiratory Medicine. ISSN 0954-6111. 260. doi: 10.1016/j.rmed.2026.108958. Full text in Research Archive Show summary

  Chronic obstructive pulmonary disease (COPD) is commonly regarded as an ambulatory care-sensitive condition (ACSC), for which targeted outpatient and primary care can improve patients' outcomes and reduce their risk of hospitalization. Yet little is known about how COPD patients' use of such services evolves in real-life settings. Using national health registry data from Norway (2008–2020), linked to demographic and socioeconomic registers, we explore how COPD patients' combined use of primary and specialist services evolves in the first four years after an acute respiratory hospital episode, and assess whether these patterns align with clinical guidelines and vary by sociodemographic characteristics. A two-stage clustering approach was employed to identify individuals with similar care trajectories. The 13 057 patients were first grouped by the number of respiratory hospital episodes after the index episode (0, 1–2, or 3+), then K-medoid clustering was performed within each group to identify similar patterns of respiratory-related outpatient and primary health service utilization. Four distinct care trajectories emerged within each group, with similar combination patterns: (1) predominantly GP services (most common), (2) GP and outpatient services, (3) GP, out-of-hours primary care and infrequent outpatient services, and (4) frequent physiotherapist, GP and outpatient services (rarest). Notably, groups 2 and 4 had higher income and education than groups 1 and 3, and many patients do not follow care trajectories according to current guidelines for COPD treatment. Understanding the mechanisms that explain these variations in health services use, and their implications for care quality and equity, is essential for improving COPD management in universal healthcare systems.

• Amundsen, Olav; Moger, Tron Anders; Holte, Jon Helgheim; Haavaag, Silje Bjørnsen; Bragstad, Line Kildal & Hellesø, Ragnhild [Show all 8 contributors for this article] (2026). Use of primary care physiotherapy and its associations with clinical and socioeconomic outcomes in musculoskeletal disorders: a cohort study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 44(1). doi: 10.1080/02813432.2026.2660328. Full text in Research Archive Show summary

  Isolating the effects of outpatient care on hospitalisation in observational data is challenging. We estimate the effects of factors believed to influence hospital admissions in patients with COPD. The factors were related to outpatient care and social factors, motivated by recommendations in COPD guidelines and the literature. We applied linked national and municipal registry data on 25,369 COPD patients in Oslo and Trondheim 2008–2019. Yearly frequency and type of healthcare contacts (respiratory and non-respiratory, across providers), together with comorbidities, were used as proxies for patients’ health status. We constructed samples matched on the full set of proxy variables to estimate the effect of each factor on future COPD hospital admissions. Overall, 9.8% of follow up years had at least one COPD hospital admission. Findings indicated beneficial effects of several of the factors. Care interaction between general practitioner (GP) and other health providers, follow-up by GP within 30 days after COPD hospital discharge and counselling/psychotherapy by GP showed significant reductions of 2.9, 4.9 and 1.4% points in the rate of next-year COPD hospital admissions, respectively. The effects are noteworthy when extrapolated to the entire Norwegian COPD population. A reduction of 1% point could result in up to 1,500 fewer patients experiencing one or more COPD hospital admissions during a year. In the absence of detailed clinical information, creating samples that are multidimensionally matched on health service use and comorbidities as pragmatic proxies for health status could be a viable approach for estimating the effects of other factors.

• Moger, Tron Anders; Holte, Jon Helgheim; Amundsen, Olav; Haavaag, Silje Bjørnsen; Edvardsen, Anne & Bragstad, Line Kildal [Show all 9 contributors for this article] (2026). Matching on health status to estimate the effects of outpatient care and social factors in patients with COPD: a Norwegian registry‑based study. BMC Health Services Research. 26(1). doi: 10.1186/s12913-026-14285-9. Full text in Research Archive Show summary

  Isolating the effects of outpatient care on hospitalisation in observational data is challenging. We estimate the effects of factors believed to influence hospital admissions in patients with COPD. The factors were related to outpatient care and social factors, motivated by recommendations in COPD guidelines and the literature. We applied linked national and municipal registry data on 25,369 COPD patients in Oslo and Trondheim 2008–2019. Yearly frequency and type of healthcare contacts (respiratory and non-respiratory, across providers), together with comorbidities, were used as proxies for patients’ health status. We constructed samples matched on the full set of proxy variables to estimate the effect of each factor on future COPD hospital admissions. Overall, 9.8% of follow up years had at least one COPD hospital admission. Findings indicated beneficial effects of several of the factors. Care interaction between general practitioner (GP) and other health providers, follow-up by GP within 30 days after COPD hospital discharge and counselling/psychotherapy by GP showed significant reductions of 2.9, 4.9 and 1.4% points in the rate of next-year COPD hospital admissions, respectively. The effects are noteworthy when extrapolated to the entire Norwegian COPD population. A reduction of 1% point could result in up to 1,500 fewer patients experiencing one or more COPD hospital admissions during a year. In the absence of detailed clinical information, creating samples that are multidimensionally matched on health service use and comorbidities as pragmatic proxies for health status could be a viable approach for estimating the effects of other factors.

• Haavaag, Silje Bjørnsen; Obstfelder, Aud Uhlen; Hellesø, Ragnhild; Moger, Tron Anders; Amundsen, Olav & Tjerbo, Trond [Show all 9 contributors for this article] (2026). Patient Work in Long-Term Conditions. Qualitative Health Research. ISSN 1049-7323. doi: 10.1177/10497323261430632. Full text in Research Archive Show summary

  Long-term conditions are one of the major causes to morbidity and death worldwide. Management of such conditions in healthcare settings has been framed as a challenge for healthcare systems, and people living with long-term conditions often experience fragmented care. Integrated care approaches have been advocated as the solution, but few studies include the work done by patients and its significance for care processes. The present study aimed to explore the work of people with long-term conditions in the unfolding of their care trajectories. The study is based on semi-structured interviews of people living with chronic obstructive pulmonary disease and musculoskeletal disorders. The participants were all home-dwelling and living in Norway. Reflexive thematic analysis was used to guide the analysis. Theory about work as theorized by Strauss et al. was central to the analysis. The persons highlight that they feel that it is up to them to ask questions and initiate care, that they monitor their bodies to be equipped to act adequately when changes occur, and that they engage in deliberative interaction with healthcare personnel. The findings add depth to current knowledge and highlight that people living with long-term conditions participate in the unfolding of their care trajectories by doing comprehensive work. Framing what people with long-term conditions do when participating in their care trajectories as work brings forth aspects of healthcare use that may be less visible for healthcare personnel and enables addressing individual care trajectories as intertwined with patient work.

• Unsgaard-Tøndel, Monica; Vøllestad, Nina Køpke; Robinson, Hilde Stendal; Evensen, Kari Anne Indredavik; Granviken, Fredrik & Woodhouse, Astrid [Show all 7 contributors for this article] (2026). Can pain self-efficacy mediate the influence of pain intensity on outcomes for patients with musculoskeletal pain? A prospective mediation analysis with 12 months follow-up | Quality of Life Research. Quality of Life Research. ISSN 0962-9343. doi: 10.1007/s11136-025-04118-3. Full text in Research Archive Show summary

  In longstanding pain, a core treatment aim is to minimize the effect of pain on health-related quality of life and patient-specific function. The study aim was to assess whether the effect of pain intensity on outcome is mediated through pain self-efficacy. A secondary aim was to assess the mediating effect of pain self-efficacy for a subgroup of patients with low pain self-efficacy. Prospective data of 422 patients with musculoskeletal pain seeking physical therapy was applied in analyses. The exposure was baseline pain intensity and outcomes were health-related quality of life (EQ-5D), patient-specific function (PSFS) and global perceived effect (GPE) at 12 months. The mediator was measured by the 2-item pain self-efficacy questionnaire (PSEQ-2) at baseline and 3 months. The mediating effect of pain self-efficacy on the relation between pain intensity and health-related quality of life and patient-specific function was statistically, but not clinically, significant: − 0.01 (95% CI − 0.01 to − 0.00) and − 0.08 (95% CI (− 0.15 to − 0.01). For the mediating effect of pain self-efficacy on the relation between pain intensity and global perceived effect, odds ratio was 0.97 (95% CI 0.92 to 1.01). In a subgroup with low baseline pain self-efficacy, the mediating effect of pain self-efficacy was − 0.28 (− 0.55 to − 0.01) for patient-specific function. Pain self-efficacy did not have an important mediating effect on the relation between pain intensity and outcome. In a subgroup with reduced pain self-efficacy, the effect of baseline pain intensity on patient-specific function was mediated by pain self-efficacy. ClinicalTrials.gov Identifier: NCT03626389. Registered August 13, 2018 (retrospectively registered).

• Moger, Tron Anders; Holte, Jon Helgheim; Amundsen, Olav; Haavaag, Silje Bjørnsen; Døhl, Øystein & Bragstad, Line Kildal [Show all 9 contributors for this article] (2025). Predictors, Healthcare Utilization and Costs Related to Short-Term Stays in Patients with COPD: A Registry-Based Analysis in Norway. Clinical Epidemiology. Volume 17, p. 707–719. doi: 10.2147/clep.s521958. Full text in Research Archive Show summary

  Background: Chronic obstructive pulmonary disease (COPD) incurs significant healthcare costs, often accompanied by multimorbidity. Advanced patients may need short-term stays for rehabilitation, treatment, or respite to maintain home living. Aim: To identify predictors for a first short-term stay and study the healthcare utilization and costs compared with similar patients without a short-term stay. Patients and Methods: Data on COPD patients in the cities Oslo and Trondheim 2010–2019 and including information on specialist, primary and long-term care, diagnoses, sociodemographics and -economics were collected from national and municipal registries, resulting in a sample of 24,613 patients. Using discrete time survival models, we identified predictors for a short-term stay. We described the costs before and after admission, and the duration of living at home, compared to non-recipients matched on age, comorbidities and healthcare use. Results: Depression, anxiety, mental disorders, alcoholism, prior hospitalization and reception of home care were associated with higher odds of short-term stays. One to two GP visits for respiratory diseases, being in the top quartile for GP visits for non-respiratory diseases, visits to specialists, and physiotherapist visits for non-respiratory issues were significantly associated with lower odds of short-term institutional stay. Patients admitted to short-term stays incurred markedly higher costs both in the year before admission and during subsequent years compared to matched non-recipients, primarily due to increased use of inpatient and home care services. Conclusion: Prior receipt of home care, unlike standard outpatient services, was linked to a higher likelihood of short-term stays. This suggests that some outpatient services may delay the need for such stays, or that patients already in municipal services are more readily admitted. Additionally, patients with psychosocial issues may have greater care needs, indicating that resource allocation aligns with these needs. The findings suggest that by the time short-term stays are required, health deterioration has already become considerable.

• Moger, Tron Anders; Holte, Jon Helgheim; Amundsen, Olav; Haavaag, Silje Bjørnsen; Døhl, Øystein & Bragstad, Line Kildal [Show all 9 contributors for this article] (2024). The in- and outpatient health care use of patients with COPD before and after initiation of home care: a registry study from Norway. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 43(1). doi: 10.1080/02813432.2024.2404056. Full text in Research Archive Show summary

  Objective: Chronic obstructive pulmonary disease (COPD) is a common condition associated with age, multimorbidity and frequently involves the use of health care across levels. Understanding the factors associated with the initiation of long-term care is important when planning the future need for services. We describe healthcare use before and after the reception of any home care. We further studied the associations between healthcare use and first registered home care service and from first registered home care service to nursing home admission or death. Design and subjects: Patients residing in Oslo or Trondheim at the time of first contact with a COPD primary diagnosis, 2009–2018. Patient data were linked across national and municipal registries, covering healthcare and sociodemographics. The sample consisted of 16,738 individuals. Results: There was a marked increase in inpatient and outpatient hospital contacts in the years prior to and after the reception of any home care. Adjusted for comorbidities and sociodemographics, high numbers of GP consultations, and inpatient and outpatient hospital contacts for respiratory diagnoses were associated with a significantly higher likelihood of receiving home care the next year (hazard odds ratios > 1.3). Following the reception of home care, the type of home care service received (e.g. home nursing or short-term rehabilitation/treatment) was more important than outpatient services in predicting next-year nursing home admission or death. Conclusion: Including data on prior outpatient care when predicting future need for home care is beneficial. A high frequency (top 10%) of yearly GP, in- or outpatient hospital contacts can imply that the patient may be in need of home care in the near future.

• Amundsen, Olav; Moger, Tron Anders; Holte, Jon Helgheim; Haavaag, Silje Bjørnsen; Bragstad, Line Kildal & Hellesø, Ragnhild [Show all 8 contributors for this article] (2024). Patient characteristics and healthcare use for high-cost patients with musculoskeletal disorders in Norway: a cohort study. BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-12051-3. Full text in Research Archive Show summary

  Background: A high proportion of healthcare costs can be attributed to musculoskeletal disorders (MSDs). A small proportion of patients account for most of the costs, and there is increasing focus on addressing service overuse and high costs. We aimed to estimate healthcare use contributing to high costs over a five-year period at the individual level and to examine if healthcare use for high-cost patients is in accordance with guidelines and recommendations. These findings contribute to the understanding of healthcare use for high-cost patients and help in planning future MSD-care. Methods: This study combined Norwegian registries on healthcare use, diagnoses, demographic, and socioeconomic factors. Patients (≥ 18 years) were included by their first MSD-contact in 2013–2015. We analysed healthcare use during the subsequent five years. Descriptive statistics were used to compare high-cost (≥ 95th percentile) and non-high-cost patients. Total healthcare contacts and costs for high-cost patients were examined stratified by number of hospitalisations and surgical treatments. Healthcare use of General Practitioners (GPs), physiotherapy, chiropractor and Physical Medicine and Rehabilitation physicians prior to the first hospitalisation or surgical treatment for a non-traumatic MSD was registered. Results: High-cost patients were responsible for 61% of all costs. Ninety-four percent of their costs were related to hospital treatment. Ninety-nine percent of high-cost patients had at least one hospitalisation or surgical procedure. Out of the high-cost patients, 44% had one registered hospitalisation or surgical procedure, 52% had two to four and 4% had five or more. Approximately 30–50% of patients had seen any healthcare personnel delivering conservative treatment other than GPs the year prior to their first hospitalisation/surgical treatment for a non-traumatic MSD. Conclusion: Most healthcare costs were concentrated among a small proportion of patients. In contrast to guidelines and recommendations, less than half had been to a healthcare service focused on conservative management prior to their first hospitalisation or surgical treatment for a non-traumatic MSD. This could indicate that there is room for improvement in management of patients before hospitalisation and surgical treatment, and that ensuring sufficient capacity for conservative care and rehabilitation can be beneficial for reducing overall costs.

• Robinson, Hilde Stendal; Vøllestad, Nina Køpke; Bennetter, Karin Elisabeth; Waage, Christin Wiegels; Jenum, Anne Karen & Richardsen, Kåre Rønn (2024). Pelvic girdle pain in pregnancy and early postpartum – prevalence and risk factors in a multi-ethnic cohort. BMC Musculoskeletal Disorders. 25(1). doi: 10.1186/s12891-023-07135-w. Full text in Research Archive Show summary

  Background Pelvic girdle pain (PGP) is common during and after pregnancy. It has been assumed that Scandinavian women report more PGP than women of other ethnicities. However, there are few population-based studies on ethnic diferences and few with ethnicity as risk factor for PGP. The purposes of the present study were: To examine the prevalence of self-reported PGP through pregnancy and early postpartum in a multi-ethnic cohort. To investigate how ethnicity and patient characteristics were associated with risk of PGP during pregnancy and early postpartum. To investigate if clinical and personal factors obtained in gestation week (GW) 15 were associated with PGP in GW28 and postpartum week (PPW) 14. Methods This study analyzed questionnaire data from 823 women from the Stork - Groruddalen mult-iethnic cohort study in Norway. Chi-square tests were used to investigate ethnic diferences in prevalence of self-reported PGP, and logistic regression analyses to identify factors associated with self-reported PGP. Results Women from South-Asia and Middle East reported 10-20% higher prevalence of self-reported PGP at all time points compared with Western women. Ethnicity was associated with PGP in GW15 and PPW14, adjusted for parity. Pain locations in pelvic area (PGP locations) in GW15, especially combined symphysis and posterior PGP, gave the highest risk (OR=7.4) for PGP in GW28 and in PPW14 (OR = 3.9). Being multiparous was a risk for PGP in PPW14 (OR=1.9). Conclusions Women of South Asian and Middle Eastern background had higher risk of self-reported PGP than Western women. Ethnicity was associated with PGP in GW15 and PPW14, after adjustments for parity. PGP locations in GW15 was the most prominent risk factor for PGP in GW28 and PPW14, whilst ethnicity was not signifcant in multivariable analyses.

• Moger, Tron Anders; Holte, Jon Helgheim; Amundsen, Olav; Haavaag, Silje Bjørnsen; Edvardsen, Anne & Bragstad, Line Kildal [Show all 9 contributors for this article] (2024). Associations between outpatient care and later hospital admissions for patients with chronic obstructive pulmonary disease - a registry study from Norway. BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-10975-4. Full text in Research Archive Show summary

  Background Although chronic obstructive pulmonary disease (COPD) admissions put a substantial burden on hospitals, most of the patients’ contacts with health services are in outpatient care. Traditionally, outpatient care has been difficult to capture in population-based samples. In this study we describe outpatient service use in COPD patients and assess associations between outpatient care (contact frequency and specific factors) and next-year COPD hospital admissions or 90-day readmissions. Methods Patients over 40 years of age residing in Oslo or Trondheim at the time of contact in the period 2009–2018 were identified from the Norwegian Patient Registry (in- and outpatient hospital contacts, rehabilitation) and the KUHR registry (contacts with GPs, contract specialists and physiotherapists). These were linked to the Regular General Practitioner registry (characteristics of the GP practice), long-term care data (home and institutional care, need for assistance), socioeconomic and–demographic data from Statistics Norway and the Cause of Death registry. Negative binomial models were applied to study associations between combinations of outpatient care, specific care factors and next-year COPD hospital admissions and 90-day readmissions. The sample consisted of 24,074 individuals. Results A large variation in the frequency and combination of outpatient service use for respiratory diagnoses (GP, emergency room, physiotherapy, contract specialist and outpatient hospital contacts) was apparent. GP and outpatient hospital contact frequency were strongly associated to an increased number of next-year hospital admissions (1.2–3.2 times higher by increasing GP frequency when no outpatient hospital contacts, 2.4-5 times higher in combination with outpatient hospital contacts). Adjusted for healthcare use, comorbidities and sociodemographics, outpatient care factors associated with lower numbers of next-year hospitalisations were fees indicating interaction between providers (7% reduction), spirometry with GP or specialist (7%), continuity of care with GP (15%), and GP follow-up (8%) or rehabilitation (18%) within 30 days vs. later following any current year hospitalisations. For 90-day readmissions results were less evident, and most variables were non-significant. Conclusion As increased use of outpatient care was strongly associated with future hospitalisations, this further stresses the need for good communication between providers when coordinating care for COPD patients. The results indicated possible benefits of care continuity within and interaction between providers.

• Torjusen, Marius Lamberg; Feiring, Eli; Barra, Mathias; Vøllestad, Nina Køpke & Solberg, Carl Tollef (2024). Priority Setting in Norwegian Municipal and Health Care Services: A Thematic Analysis of Public Consultation Documents. Tidsskrift for omsorgsforskning. ISSN 2387-5976. 10(2), p. 124–137. doi: 10.18261/tfo.10.2.9. Full text in Research Archive Show summary

  Despite Norway’s long history of open priority setting in healthcare, formal priority setting in municipal health and care services had been lacking prior to the publication of a Norwegian official report (English: Green paper, Norwegian: NOU) on the topic in 2018 (the Blankholm report). This article examines the reception of the report’s proposals from different stakeholders. Methods: We analysed 123 public consultation documents on the Blankholm report using a combined deductive and inductive thematic analysis. The consultation bodies represented the views of stakeholders, including patient and professional organisations, directorates, academic institutions, hospitals, and municipalities. Results: Our analysis resulted in two main themes: 1) Concerns about whether the proposed criteria are fit for purpose and 2) Concerns about infringing upon the principle of municipal autonomy and scepticism regarding whether the proposed priority setting process will enhance municipal services. Conclusion: Although there is acceptance for the necessity of priority setting, several issues remain. These issues relate to the proposals' lack of definition, the complexity of municipal health and care services, and a distrust between municipalities and the central government.

• Julsvoll, Elisabeth Heggem; Myhrvold, Birgitte Lawaetz; Waagan, Knut; Vøllestad, Nina Køpke & Robinson, Hilde Stendal (2024). Identifying phenotypes in persons with temporomandibular disorders using latent class analyses. Journal of Oral Rehabilitation. ISSN 0305-182X. doi: 10.1111/joor.13837. Full text in Research Archive Show summary

  Background The heterogeneity of persons with temporomandibular disorders (TMD) and the lack of effective treatments have called for a biopsychosocial model and the development of a more personalised treatment approach. Emphasis on phenotypes might be a beneficial approach. Objective Identifying phenotypes among persons with TMD using potential prognostic factors, including personal characteristics and responses to clinical tests. Additionally, examining the distribution of TMD diagnoses within the identified phenotypes. Methods A cross-sectional study including 208 persons (85% females) seeking physiotherapy for problems in the temporomandibular area. All participants were examined clinically and answered questionnaires electronically. The phenotypes were identified using latent class analysis based on seven potential prognostic factors selected within pain, function and psychological domains. Table analysis was used to explore the distribution of TMD diagnoses within the identified phenotypes. Results Most participants fit into one of three identified phenotypes. Phenotype 1 (32%) was characterised by functional disability, low psychosocial scores and low risk for developing chronicity and future work disability; Phenotype 2 (29%) by parafunctional habits, low psychosocial score and seeking treatment to reduce pain; and Phenotype 3 (39%) by high levels of mental distress, fear avoidance and a large risk of future work disability. Intra-articular disorders dominated Phenotype 1, myalgia and TMD-related headache Phenotype 2, while Phenotype 3 included all the different TMD diagnoses. Conclusion The knowledge about the three identified phenotypes might be useful for clinicians treating persons with TMD and for the development of preventive strategies and more personalised treatment.

• Vøllestad, Nina Køpke & Mengshoel, Anne Marit (2023). Post-exertional malaise in daily life and experimental exercise models in patients with myalgic encephalomyelitis/chronic fatigue syndrome. Frontiers in Physiology. 14, p. 1257557–1257557. doi: 10.3389/fphys.2023.1257557. Full text in Research Archive Show summary

  Post-exertional malaise (PEM) is commonly recognized as a hallmark of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and is often used as one of several criteria for diagnosing ME/CFS. In this perspective paper we want to reflect on how PEM is understood, assessed, and evaluated in scientific literature, and to identify topics to be addressed in future research. Studies show that patients use a wide variety of words and concepts to label their experience of PEM in everyday life, and they report physical or mental exertions as triggers of PEM. They also report that PEM may have an immediate or delayed onset and may last from a few days to several months. When standardized exercise tests are used to trigger PEM experimentally, the exacerbation of symptoms has a more immediate onset but still shows a wide variability in duration. There are indications of altered muscular metabolism and autonomic nervous responses if exercise is repeated on successive days in patients with ME/CFS. The decreased muscular capacity appears to be maintained over several days following such controlled exercise bouts. These responses may correspond to patients’ experiences of increased exertion. Based on this background we argue that there is a need to look more closely into the processes occurring in the restitution period following exercise, as PEM reaches the peak in this phase.

• Amundsen, Olav; Moger, Tron Anders; Holte, Jon Helgheim; Haavaag, Silje Bjørnsen; Bragstad, Line Kildal & Hellesø, Ragnhild [Show all 8 contributors for this article] (2023). Combination of health care service use and the relation to demographic and socioeconomic factors for patients with musculoskeletal disorders: a descriptive cohort study. BMC Health Services Research. 23(1). doi: 10.1186/s12913-023-09852-3. Full text in Research Archive Show summary

  Background Patients with musculoskeletal disorders (MSDs) access health care in different ways. Despite the high prevalence and significant costs, we know little about the different ways patients use health care. We aim to fill this gap by identifying which combinations of health care services patients use for new MSDs, and its relation to clinical characteristics, demographic and socioeconomic factors, long-term use and costs, and discuss what the implications of this variation are. Methods The study combines Norwegian registers on health care use, diagnoses, comorbidities, demographic and socioeconomic factors. Patients (≥ 18 years) are included by their first health consultation for MSD in 2013–2015. Latent class analysis (LCA) with count data of first year consultations for General Practitioners (GPs), hospital consultants, physiotherapists and chiropractors are used to identify combinations of health care use. Long-term high-cost patients are defined as total cost year 1–5 above 95th percentile (≥ 3 744€). Results We identified seven latent classes: 1: GP, low use; 2: GP, high use; 3: GP and hospital; 4: GP and physiotherapy, low use; 5: GP, hospital and physiotherapy, high use; 6: Chiropractor, low use; 7: GP and chiropractor, high use. Median first year health care contacts varied between classes from 1–30 and costs from 20€-838€. Eighty-seven percent belonged to class 1, 4 or 6, characterised by few consultations and treatment in primary care. Classes with high first year use were characterised by higher age, lower education and more comorbidities and were overrepresented among the long-term high-cost users. Conclusion There was a large variation in first year health care service use, and we identified seven latent classes based on frequency of consultations. A small proportion of patients accounted for a high proportion of total resource use. This can indicate the potential for more efficient resource use. However, the effect of demographic and socioeconomic variables for determining combinations of service use can be interpreted as the health care system transforming unobserved patient needs into variations in use. These findings contribute to the understanding of clinical pathways and can help in the planning of future care, reduction in disparities and improvement in health outcomes for patients with MSDs.

• Bennetter, Karin Elisabeth; Waage, Christin; Jenum, Anne Karen; Vøllestad, Nina Køpke; Robinson, Hilde Stendal & Richardsen, Kåre Rønn (2023). Cross-Cultural Contact and Norwegian Language Skills Among Ethnic Minority Women in Norway, and Relationship with Physical Activity in Pregnancy and Postpartum: The STORK-Groruddalen Cohort Study. Journal of Immigrant and Minority Health. ISSN 1557-1912. 26, p. 63–71. doi: 10.1007/s10903-023-01535-9. Full text in Research Archive
• Øyehaug, Gro Askland; Robinson, Hilde Stendal; Leren, Lena & Vøllestad, Nina Køpke (2023). Arbeidsevne hos muskelskjelettpasienter i primærhelsetjenesten. En kohortestudie. Fysioterapeuten. ISSN 0016-3384. 5, p. 46–53. Full text in Research Archive Show summary

  Hensikt: Å undersøke selvrapportert arbeidsevne hos muskelskjelettpasienter i fysioterapibehandling, hva som kjennetegner pasienter med redusert arbeidsevne, hvorvidt arbeidsevne endres i behandling og kjennetegn ved pasienter uten bedring i arbeidsevne. Design: Kohortestudie. Materiale: 1498 muskelskjelettpasienter i arbeidsfør alder som går til fysioterapi i primærhelsetjenesten. Metode: Spørreskjemaer ved baseline og etter tre måneder. Resultat: 63% rapporterte redusert arbeidsevne ved baseline. Faktorer assosiert med redusert arbeidsevne var redusert daglig aktivitetsnivå, fysisk arbeid, psykiske plager, utbredte plager og høy smerteintensitet. Deltakere med redusert arbeidsevne bedret gjennomsnittlig arbeidsevne med 1.7 på WAS (arbeidsevneskala 0-10), men 53% av dem oppnådde ingen bedring. Kjennetegn ved pasienter uten bedring i ar beidsevne var langvarige plager, utbredte plager og psykiske plager. Konklusjon: Det synes å være vanskelig å bedre arbeids evne hos pasienter med langvarige og sammensatte plager i fysioterapibehandling. Fysioterapeuter bør være spesielt oppmerksom på psykologiske faktorer som hemmende for bedring i arbeidsevne.

• Bennetter, Karin Elisabeth; Richardsen, Kåre Rønn; Vøllestad, Nina Køpke; Jenum, Anne Karen; Robinson, Hilde Stendal & Mdala, Ibrahimu [Show all 7 contributors for this article] (2023). Associations between social support and physical activity in postpartum: a Norwegian multi-ethnic cohort study. BMC Public Health. 23(1). doi: 10.1186/s12889-023-15507-z. Full text in Research Archive Show summary

  Background Social support is associated with higher self-reported physical activity (PA) in postpartum women, but it is unknown if similar association occur when using objective PA data. The aim was to explore the associations between social support and objectively recorded moderate-to-vigorous physical activity (MVPA) postpartum, and if associations differed across ethnic groups. Methods We used data from 636 women who participated in the STORK Groruddalen cohort study (2008–2010). MVPA minutes/day in bouts of ≥ 10 minutes was recorded by SenseWear Armband™ Pro3 (SWA) over 7 days, 14 weeks postpartum. Social support for PA from family or friends was measured by a modified 12-item version of the Social Support for Exercise Scale. We used single items, family support mean score (6 items) and friends’ support mean score (6-items) in four separate count models, and adjusted for SWA week, age, ethnicity, education, parity, body mass index and time since birth. We tested interactions between social support and ethnicity. Analyses were performed on complete cases and imputed data. Results Based on imputed data, we observed that women who reported low and high support from family accumulated 16.2 (IQR: 6.1–39.1) and 18.6 (IQR: 5.0-46.5) MVPA minutes/day, respectively. Women who reported low and high support from friends accumulated 18.7 (IQR: 5.9–43.6) and 16.8 (IQR: 5.0-45.8) MVPA minutes/day. We observed a 12% increase in MVPA minutes/day for each additional increase in mean family support score (IRR = 1.12, 95% CI: 1.02 to 1.25). Women reporting high level of support from family on ‘discuss PA’, ‘co-participation’ and ‘take over chores’ accumulated 33%, 37% and 25% more MVPA minutes/day than women reporting low level of support respectively (‘discuss PA’: IRR = 1.33, 95% CI: 1.03 to 1.72, ‘co-participation’: IRR = 1.37, 95% CI: 1.13 to 1.66 and ‘take over chores’: IRR = 1.25, 95% CI: 1.02 to 1.54). Associations were not modified by ethnicity. No statistically significant association between support from friends and MVPA was observed. Similar results were found in complete case analyses, with a few exceptions. Conclusion Overall family support and specific forms of support from family were associated with MVPA across ethnic groups, while support from friends was not associated with MVPA postpartum. Keywords Physical activity, MVPA, Social support, Postpartum, Family, Friends, Ethnicity

• Myhrvold, Birgitte Lawaetz; Vøllestad, Nina Køpke; Irgens, Pernille Marie Stähr; Robinson, Hilde Stendal & Axén, Iben (2023). Clinical indicators for recommending continued care to patients with neck pain in chiropractic practice: a cohort study. Chiropractic & Manual Therapies. 31(1). doi: 10.1186/s12998-023-00507-y. Full text in Research Archive Show summary

  Background Chiropractors’ clinical indicators for recommending preventive continued care to patients with low back pain include previous pain episodes, a history of long pain duration and improvement after initial treatment. Our objectives were, in a cohort of patients with neck pain, to examine whether these clinical indicators were associated with being recommended continued care beyond 4 weeks, and if so whether this recommendation was dependent of chiropractor characteristics, as well as if the number of clinical indicators influenced this recommendation. Methods In this multi-center observational study, 172 patients seeking care for a new episode of neck pain in chiropractic practice in Norway were included between September 2015 and May 2016. The chiropractors treated their patients as per usual, and for this study, baseline data and 4-week follow-up data were used. Patient data included the clinical indicators (1) previous episodes of neck pain, (2) a history of long duration neck pain and (3) improvement four weeks after initial treatment. The recruiting chiropractors were asked at 4-week follow-up if each patient was recommended continued care, defined as care planned beyond the first 4 weeks. Univariate and multivariable logistic regression models investigated the association between clinical indicators and the continued care recommendation, as well as the influence of chiropractor characteristics on this recommendation. Cross tabulations investigated the relationship between the number of indicators present and recommendation of continued care. Results Long duration of neck pain was the strongest clinical indicator for being recommended continued care 4 weeks after the initial treatment. Chiropractor characteristics were not associated with this recommendation. In patients with all three clinical indicators present, 39% were recommended continued care. When two and one indicators were present, the percentages of those recommended continued care were 25% and 10%, respectively. Conclusion Chiropractors recommended continued care for patients experiencing neck pain based on their history of long pain duration, and this was not influenced by characteristics of the chiropractor. This differs from previous studies of indicators for maintenance care in patients with low back pain.

• Moger, Tron Anders; Amundsen, Olav; Tjerbo, Trond; Hellesø, Ragnhild; Holte, Jon Helgheim & Vøllestad, Nina Køpke (2023). Innovations in use of registry data (INOREG) - Design of a registry-based study analyzing care pathways and outcomes for chronic patients. Nordic Journal of Health Economics. ISSN 1892-9729. 6(1), p. 129–146. doi: 10.5617/njhe.10097. Full text in Research Archive Show summary

  In recent years there have been several political initiatives in Norway, requiring more research into how multimorbidity and health care pathways in the municipality affect outcomes such as work participation, hospital admissions, disability and quality of life for patients with chronic diseases. Most of the care is provided outside hospitals and has been difficult to capture in large, registry-based studies. Focusing on two important groups, patients with chronic obstructive pulmonary disease (COPD) and musculoskeletal disorders (MSD), the INOREG project aims to reduce these knowledge gaps. In the paper we present 1) the data that are used in the project, 2) the construction of samples, variables and possible methods for analysis and 3) an example on how the data and methods will be applied. The project database is constructed from a novel linkage of national health and welfare registries. The data cover social, primary and specialized care for all COPD and MSD patients in Norway, long-term care data from Oslo and Trondheim municipalities and functioning and quality of life for ca. 2,700 patients treated at physiotherapy clinics in the FYSIOPRIM project. This enables construction of care pathways and outcomes at the individual level from 2008 through 2019. The project will fill knowledge gaps regarding the patterns of care at different levels in the health care system, and the association to outcomes for chronic patient groups. If the project is successful, it will provide improved insight on how to further develop provision and coordination of services to the decision makers, and ideally reduce inequalities in health.

• Irgens, Pernille Marie Stähr; Myhrvold, Birgitte Lawaetz; Kongsted, Alice; Natvig, Bård; Vøllestad, Nina Køpke & Robinson, Hilde Stendal (2022). Exploring visual pain trajectories in neck pain patients, using clinical course, SMS-based patterns, and patient characteristics: a cohort study. Chiropractic & Manual Therapies. 30(1), p. 37–37. doi: 10.1186/s12998-022-00443-3. Full text in Research Archive Show summary

  Background The dynamic nature of neck pain has so far been identified through longitudinal studies with frequent measures, a method which is time-consuming and impractical. Pictures illustrating different courses of pain may be an alternative solution, usable in both clinical work and research, but it is unknown how well they capture the clinical course. The aim of this study was to explore and describe self-reported visual trajectories in terms of details of patients’ prospectively reported clinical course, their SMS-based pattern classification of neck pain, and patient’s characteristics. Methods Prospective cohort study including 888 neck pain patients from chiropractic practice, responding to weekly SMS-questions about pain intensity for 1 year from 2015 to 2017. Patients were classified into one of three clinical course patterns using definitions based on previously published descriptors. At 1-year follow-up, patients selected a visual trajectory that best represented their retrospective 1-year course of pain: single episode, episodic, mild ongoing, fluctuating and severe ongoing. Results The visual trajectories generally resembled the 1-year clinical course characteristics on group level, but there were large individual variations. Patients selecting Episodic and Mild ongoing visual trajectories were similar on most parameters. The visual trajectories generally resembled more the clinical course of the last quarter. Discussion The visual trajectories reflected the descriptors of the clinical course of pain captured by weekly SMS measures on a group level and formed groups of patients that differed on symptoms and characteristics. However, there were large variations in symptoms and characteristics within, as well as overlap between, each visual trajectory. In particular, patients with mild pain seemed predisposed to recall bias. Although the visual trajectories and SMS-based classifications appear related, visual trajectories likely capture more elements of the pain experience than just the course of pain. Therefore, they cannot be seen as a proxy for SMS-tracking of pain over 1 year.

• Myhrvold, Birgitte Lawaetz; Kongsted, Alice; Irgens, Pernille Marie Stähr; Robinson, Hilde Stendal & Vøllestad, Nina Køpke (2022). The association between different outcome measures and prognostic factors in patients with neck pain: a cohort study. BMC Musculoskeletal Disorders. 23(1). doi: 10.1186/s12891-022-05558-5. Full text in Research Archive Show summary

  Background Health domains like pain, disability, and health-related quality of life are commonly used outcomes for musculoskeletal disorders. Most prognostic studies include only one outcome, and it is unknown if prognostic factors and models may be generic across different outcomes. The objectives of this study were to examine the correlation among commonly used outcomes for neck pain (pain intensity, disability, and health-related quality of life) and to explore how the predictive performance of a prognostic model differs across commonly used outcomes. Methods We conducted an observational prospective cohort study with data from patients with neck pain aged 18–84 years consulting Norwegian chiropractors. We used three different outcomes: pain intensity (Numeric Pain Rating Scale), the Neck Disability Index (NDI), and health-related quality of Life (EQ-5D). We assessed associations between change in outcome scores at 12-weeks follow-up with Pearson’s correlation coefficient. We used multivariable linear regression models to explore differences in explained variance and relationship between predictors and outcomes. Results The study sample included 1313 patients and 941 (72%) completed follow-up at 12 weeks. The strongest correlation was between NDI and EQ-5D (r = 0.57) while the weakest correlation was between EQ-5D and pain intensity (r = 0.39). The correlation between NDI and pain intensity was moderate (r = 0.53) In the final regression models, the explained variance ranged from adjusted R2 of 0.26 to 0.60, highest with NDI and lowest with pain intensity as outcome. The predictive contributions of the included predictors were similar across outcomes. Among the investigated predictors, pain patterns and the baseline measure of the corresponding outcome measure contributed the most to explained variance across all outcomes. Conclusions The highest correlation was found between NDI and EQ-5D and the lowest with pain intensity. The same prognostic model showed highest predictive performance with NDI as outcome and poorest with pain intensity as outcome. These results suggest that we need more knowledge on the reasons for the differences in predictive performance variation across outcomes.

• Amundsen, Olav; Vøllestad, Nina Køpke; Meisingset, Ingebrigt & Robinson, Hilde Stendal (2021). Associations between treatment goals, patient characteristics, and outcome measures for patients with musculoskeletal disorders in physiotherapy practice. BMC Musculoskeletal Disorders. 22:182, p. 1–12. doi: 10.1186/s12891-021-04048-4. Full text in Research Archive Show summary

  Sammendrag Background Goal setting is linked to person-centred care and is a core component in physiotherapy, but the associations between goal classes, patient characteristics and outcome measures for musculoskeletal disorders has not been investigated. The study’s purpose was to examine 1) how goals used in clinical practice for patients with musculoskeletal disorders (MSD) are distributed in classes based on ICF, 2) if goal classes were associated with patient characteristics and 3) whether goal classes were associated with treatment outcome. Methods Data analysis from a longitudinal observational study (N = 2591). Goals were classified in symptom, function/structure, activity/participation and non-classifiable. Associations between patient characteristics and goal classes were examined using x2 and one-way ANOVA. Association between goal classes and outcomes were examined using multiple logistic and linear regression models. Outcomes are reported at 3 months or end of treatment if prior to 3 months. Results There was a high variability in goals used for patients with MSD. 17% had symptom goals, 32.3% function/structure, 43.4% activity/participation and 7.4% non-classifiable goals. We found significant associations between goal classes and age, gender, severity, region of pain/diagnosis and emotional distress (all p < .001). Activity/participation goals were associated with better outcomes on GPE (OR 1.80, 95% CI 1.23–2.66). Non-classifiable goal was associated with poorer outcomes on pain intensity (B .87, 95% CI .32–1.43). Conclusion There is an association between goal classes and patient characteristics. Including activity/participation in the main goal was associated with better outcomes for GPE and having a non-classifiable goal was associated with poorer outcomes for pain intensity. Trial registration The project is approved by the Regional committee for Medical and Health Research Ethics in Norway (REC no. 2013/2030). https://clinicaltrials.gov/ct2/show/NCT03626389.

• Engebretsen, Kaia Beck; Robinson, Hilde Stendal & Vøllestad, Nina Køpke (2021). Shoulder patients in primary and specialist health care. A cross-sectional study. Scandinavian Journal of Pain. ISSN 1877-8860. 21(2), p. 345–354. doi: 10.1515/sjpain-2020-0094. Full text in Research Archive Show summary

  Objectives Shoulder pain is a prevalent problem and has a considerable impact on the use of primary and specialist health care in Norway. It is important to improve short-term recovery and reduce long-term consequences regarding pain and disability, the high costs of treatment and the amount of sick-leave. Treatment for non-specific shoulder pain is mainly non-operative. The aims of this study were to investigate if there are differences in main characteristics, pain and disability (SPADI-score) and psycho-social factors between patients in primary and specialist health care. Methods This cross-sectional study included patients consulting physiotherapy in primary health care and patients at an outpatient clinic in specialist health care. Well-known and tested questionnaires for these populations were used and variables were divided into clinical, sociodemographic, psycho-social, and shoulder pain and disability. Descriptive statistics were applied. Two-sample t-test and linear regression were used for continuous data whereas chi-square tests and logistic regression were applied to test differences in categorical data between the two study populations. Results Two hundred and 36 patients were recruited from primary health care (FYSIOPRIM, Physiotherapy In Primary Care) and 167 from specialist health care. Patients in primary health care reported less regular use of pain medication (30.7 vs. 61.3%) and fewer patients had symptom duration >12 months (41.9 vs. 51.0%). Furthermore, they reported lower pain intensity, less shoulder pain and disability (SPADI-score), lower scores on psycho-social factors, but higher on expectations of recovery. Conclusions Patients with shoulder pain treated in primary health care and in specialist health care are different according to factors such as duration of symptoms, pain and disability, and some of the psycho-social variables. However, the differences are small and the variations within the two study samples is large. Patients treated in primary health care seemed to be less affected and to have higher expectations concerning their recovery. However, based on our results we may question why many patients are referred to specialist health care rather than continuing treatment in primary health care.

• Irgens, Pernille Marie; Myhrvold, Birgitte Lawaetz; Kongsted, Alice; Waagan, Knut; Engebretsen, Kaia Beck & Vøllestad, Nina Køpke [Show all 7 contributors for this article] (2021). The clinical course of neck pain: Are trajectory patterns stable over a 1-year period? European Journal of Pain. ISSN 1090-3801. p. 1–12. doi: 10.1002/ejp.1879. Full text in Research Archive Show summary

  Background Recent studies with data-driven approaches have established common pain trajectories. It is uncertain whether these trajectory patterns are consistent over time, and if a shorter measurement period will provide accurate trajectories. Methods We included 1,124 patients with non-specific neck pain in chiropractic practice. We classified patients into pre-defined trajectory patterns in each of four quarters of the follow-up year (persistent, episodic, and recovery) based on measures of pain intensity and frequency from weekly SMS. We explored the shifts between patterns and compared patients with stable and shifting patterns on baseline characteristics and clinical findings. Results 785 (70%) patients were in the same pattern in 1st and 4th quarters. Patients with episodic pattern in the 1st quarter shifted to other patterns more frequently than patients in the other patterns. A stable persistent pattern was associated with reduced function and higher scores on psychosocial factors. There was a decreased frequency of patients classified as persistent pattern (75% to 63%) and an increase of patients in recovery pattern (4% to 15%) throughout the four quarters. The frequency of patients classified as episodic remained relatively stable (21% to 24%). Conclusions We found an overall stability of the persistent pattern, and that episodic patterns have more potential for shifts. Shifts mostly occurred between patterns closest in pain variation. The deviation in pattern distribution compared with previous studies suggests that the duration of measurement periods has an impact on the results of the classification. Significance Having persistent pain and having very minor pain is relatively stable over one year, while episodic pain has more potential for shifts. The duration of measurement periods appears to have an impact on the results of the classification. The given criteria resulted in a reduced frequency of episodic pattern due to shorter measurement periods. Our findings contribute to improved understanding and predicting NP using a combination of patient characteristics and trajectory patterns.

• Christensen, Lene; Vøllestad, Nina Køpke; Veierød, Marit Bragelien; Jakobsen, Vidar Eivind; Stuge, Britt & Bakke, Eva [Show all 8 contributors for this article] (2020). Trunk, pelvic and hip kinematics during the Stork test in pregnant women with pelvic girdle pain, asymptomatic pregnant and non-pregnant women. Clinical Biomechanics. ISSN 0268-0033. 80:105168, p. 1–8. doi: 10.1016/j.clinbiomech.2020.105168. Full text in Research Archive Show summary

  Background: Pelvic girdle pain is prevalent during pregnancy, and women affected report weight-bearing activities to be their main disability. The Stork test is a commonly used single-leg-stance test. As clinicians report specific movement patterns in those with pelvic girdle pain, we aimed to investigate the influence of both pregnancy and pelvic girdle pain on performance of the Stork test. Methods: In this cross-sectional study, 25 pregnant women with pelvic girdle pain, 23 asymptomatic pregnant and 24 asymptomatic non-pregnant women underwent three-dimensional kinematic analysis of the Stork test. Linear mixed models were used to investigate between-group differences in trunk, pelvic and hip kinematics during neutral stance, weight shift, leg lift and single leg stance. Findings: Few and small significant between-group differences were found. Pregnant women with pelvic girdle pain had significantly less hip adduction during single leg stance compared to asymptomatic pregnant women (estimated marginal means (95% confidence intervals) -1.1° (−2.4°, 0.3°) and 1.0° (−0.4°, 2.4°), respectively; P = 0.03). Asymptomatic pregnant women had significantly less hip internal rotation compared to non-pregnant women 4.1° (1.6°, 6.7°) and 7.9° (5.4°, 10.4°), respectively (P = 0.04) and greater peak hip flexion angle of the lifted leg in single leg stance 80.4° (77.0°, 83.9°) and 74.1° (70.8°, 77.5°), respectively (P = 0.01). Variation in key kinematic variables was large across participants in all three groups. Interpretation: Our findings indicate that trunk, pelvic and hip movements during the Stork test are not specific to pregnancy and/or pelvic girdle pain in the 2nd trimester. Instead, movement strategies appear unique to each individual.

• Meisingset, Ingebrigt; Vasseljen, Ottar; Vøllestad, Nina Køpke; Robinson, Hilde Stendal; Woodhouse, Astrid & Engebretsen, Kaia Beck [Show all 11 contributors for this article] (2020). Novel approach towards musculoskeletal phenotypes. European Journal of Pain. ISSN 1090-3801. 24, p. 921–932. doi: 10.1002/ejp.1541. Full text in Research Archive Show summary

  Background: The multidimensional array of clinical features and prognostic factors makes it difficult to optimize management within the heterogeneity of patients with common musculoskeletal pain. This study aimed to identify phenotypes across prognostic factors and musculoskeletal complaints. Concurrent and external validity were assessed against an established instrument and a new sample, respectively, and treatment outcome was described. Methods: We conducted a longitudinal observational study of 435 patients (aged 18–67 years) seeking treatment for nonspecific complaints in the neck, shoulder, low back or multisite/complex pain in primary health care physiotherapy in Norway. Latent class analysis was used to identify phenotypes based on 11 common prognostic factors within four biopsychosocial domains; pain, beliefs and thoughts, psychological and activity and lifestyle. Results: Five distinct phenotypes were identified. Phenotype 1 (n = 77, 17.7%) and 2 (n = 142, 32.6%) were characterized by the lowest scores across all biopsychosocial domains. Phenotype 2 showed somewhat higher levels of symptoms across the biopsychosocial domains. Phenotype 3 (n = 89, 20.5%) and 4 (n = 78, 17.9%) were more affected across all domains, but phenotype 3 and 4 had opposite patterns in the psychological and pain domains. Phenotype 5 (n = 49, 11.3%) were characterized by worse symptoms across all domains, indicating a complex phenotype. The identified phenotypes had good external and concurrent validity, also differentiating for the phenotypes in function and health-related quality of life outcome at 3-month follow-up. Conclusion: The phenotypes may inform the development of targeted interventions aimed at improving the treatment efficiency in patients with common musculoskeletal disorders. Significance: This observational prospective study identified five distinct and clinically meaningful phenotypes based on biopsychosocial prognostic factors across common musculoskeletal pain. These phenotypes were independent of primary pain location, showed good external validity, and clear variation in treatment outcome. The findings are particularly valuable as they describe the heterogeneity of patients with musculoskeletal pain and points to a need for more targeted interventions in common musculoskeletal disorders to improve treatment outcome.

• Irgens, Pernille Marie; Kongsted, Alice; Myhrvold, Birgitte Lawaetz; Waagan, Knut; Engebretsen, Kaia Beck & Natvig, Bård [Show all 8 contributors for this article] (2020). Neck pain patterns and subgrouping based on weekly SMS-derived trajectories. BMC Musculoskeletal Disorders. 21, p. 1–14. doi: 10.1186/s12891-020-03660-0. Full text in Research Archive Show summary

  Background Neck and low back pain represent dynamic conditions that change over time, often with an initial improvement after the onset of a new episode, followed by flare-ups or variations in intensity. Pain trajectories were previously defined based on longitudinal studies of temporal patterns and pain intensity of individuals with low back pain. In this study, we aimed to 1) investigate if the defined patterns and subgroups for low back pain were applicable to neck pain patients in chiropractic practice, 2) explore the robustness of the defined patterns, and 3) investigate if patients within the various patterns differ concerning characteristics and clinical findings. Methods Prospective cohort study including 1208 neck pain patients from chiropractic practice. Patients responded to weekly SMS-questions about pain intensity and frequency over 43 weeks. We categorized individual responses into four main patterns based on number of days with pain and variations in pain intensity, and subdivided each into four subgroups based on pain intensity, resulting in 16 trajectory subgroups. We compared baseline characteristics and clinical findings between patterns and between Persistent fluctuating and Episodic subgroups. Results All but two patients could be classified into one of the 16 subgroups, with 94% in the Persistent fluctuating or Episodic patterns. In the largest subgroup, “Mild Persistent fluctuating” (25%), mean (SD) pain intensity was 3.4 (0.6) and mean days with pain 130. Patients grouped as “Moderate Episodic” (24%) reported a mean pain intensity of 2.7 (0.6) and 39 days with pain. Eight of the 16 subgroups each contained less than 1% of the cohort. Patients in the Persistent fluctuating pattern scored higher than the other patterns in terms of reduced function and psychosocial factors. Conclusions The same subgroups seem to fit neck and low back pain patients, with pain that typically persists and varies in intensity or is episodic. Patients in a Persistent fluctuating pattern are more bothered by their pain than those in other patterns. The low back pain definitions can be used on patients with neck pain, but with the majority of patients classified into 8 subgroups, there seems to be a redundancy in the original model.

• Grongstad, Anita; Vøllestad, Nina Køpke; Oldervoll, Line Merethe; Spruit, Martijn Arthur & Edvardsen, Anne (2020). The acute impact of resistance training on fatigue in patients with pulmonary sarcoidosis. Chronic Respiratory Disease. ISSN 1479-9723. 17, p. 1–10. doi: 10.1177/1479973120967024. Full text in Research Archive
• Myhrvold, Birgitte Lawaetz; Irgens, Pernille Marie; Robinson, Hilde Stendal; Engebretsen, Kaia Beck; Natvig, Bård & Kongsted, Alice [Show all 7 contributors for this article] (2020). Visual trajectory pattern as prognostic factors for neck pain. European Journal of Pain. ISSN 1090-3801. 24(9), p. 1752–1764. doi: 10.1002/ejp.1622. Full text in Research Archive Show summary

  Background A novel approach capturing both temporal variation and pain intensity of neck pain is by visual trajectory patterns. Recently, both previous and expected visual trajectory patterns were identified as stronger predictors of outcome than traditional measures of pain history and psychological distress. Our aim was to examine patient characteristics within the various previous and expected patterns, relationship between the two patterns and predictive value of a variable combining the previous and expected patterns. Methods Patients with neck pain (n = 932) consulting chiropractors were included. Baseline measures included pain intensity, disability, psychological variables and symptom history and expectations. Participants reported global perceived effect after 12 weeks. Analyses included descriptive statistics and logistic regression. Results Pain intensity, disability, psychological and worse outcome expectations increased from a single pain episode to severe ongoing pain of previous and expected patterns. Having a severe pain history was associated with poor prognosis, particularly if combined with negative expectations. The variable combining previous and expected patterns had a discriminative ability similar to that of other predictors AUC = 0.64 (95% CI = 0.60–0–67) versus AUC = 0.66 (95% CI = 0.62–0.70). The model with highest discriminative ability was achieved when adding the combined patterns to other predictors AUC = 0.70 (95% CI = 0.66–0.73). Conclusion The study indicates that pain expectations are formed by pain history. The patients’ expectations were similar to or more optimistic compared with their pain history. The prognostic ability of the model including a simplified combination of previous and expected patterns, together with a few other predictors, suggests that the trajectory patterns might have potential for clinical use. Significance The dynamic nature of neck pain can be captured by visual illustrations of trajectory patterns. We report, that trajectory patterns of pain history and future expectations to some extent are related. The patterns also reflect a difference in severity assessed by higher degree of symptoms and distress. Moreover, the visual trajectory patterns predict outcome at 12‐weeks. Since the patterns are easily applicable, they might have potential as a clinical tool.

• Grongstad, Anita; Spruit, Martijn A.; Oldervoll, Line Merethe; Vøllestad, Nina Køpke & Edvardsen, Anne (2020). Pulmonary Rehabilitation in Patients with Pulmonary Sarcoidosis: Impact on Exercise Capacity and Fatigue. Respiration. ISSN 0025-7931. 99(4), p. 289–297. doi: 10.1159/000506295. Full text in Research Archive Show summary

  Background: There is limited evidence regarding the impact of multidisciplinary pulmonary rehabilitation (PR) on exercise capacity and fatigue in patients with pulmonary sarcoidosis. The aim of this study was to evaluate the impact on exercise capacity and fatigue following PR, and to examine whether baseline fatigue was related to change in peak oxygen uptake (ΔV̇O2peak). Methods: Forty-one patients with pulmonary sarcoidosis attending a 4-week inpatient PR program were recruited to this pre-post study. Both maximal exercise capacity, defined as V̇O2peak and measured with a cardiopulmonary exercise test, and fatigue, assessed with the Fatigue Assessment Scale (score 10–50 points), were measured before and after PR. Results: There was a statistically significant improvement in V̇O2peak (1.2 ± 2.3 mL/kg/min, p = 0.002), and fatigue decreased significantly (–1.7 ± 3.9 points, p = 0.009) following PR. Unadjusted linear regression analyses demonstrated that age (B = –0.076, p = 0.017) and baseline fatigue (B = 0.196, p = 0.001) were predictors for change in V̇O2peak, while in adjusted analyses (age, sex, baseline V̇O2peak, baseline fatigue, and diffusion capacity of the lung for carbon monoxide), only baseline fatigue predicted change in V̇O2peak following PR (B = 0.165, p = 0.026). Conclusion: A 4-week multidisciplinary PR program improves maximal exercise capacity and reduces fatigue in patients with pulmonary sarcoidosis. Baseline fatigue only partly predicted change in V̇O2peak following PR.

• Christensen, Lene; Vøllestad, Nina Køpke; Veierød, Marit Bragelien; Stuge, Britt; Cabri, Jan Maria Hendrick & Robinson, Hilde Stendal (2019). The Timed Up & Go test in pregnant women with pelvic girdle pain compared to asymptomatic pregnant and non-pregnant women. Musculoskeletal Science and Practice. ISSN 2468-8630. 43, p. 110–116. doi: 10.1016/j.msksp.2019.03.006. Full text in Research Archive Show summary

  Background: The Timed Up and Go (TUG) test, a standardized functional mobility test, has been proposed as aphysical performance-based measure in pregnant women with pelvic girdle pain (PGP).Objectives:This cross-sectional study aimed to investigate physical function by the use of TUG in pregnantwomen with PGP compared to asymptomatic pregnant and non-pregnant women, and to identify factors asso-ciated with increased TUG.Methods:In total, 25 pregnant women with PGP, 24 asymptomatic pregnant and 25 asymptomatic non-pregnantwomen participated. One-way analysis of variance was used to explore difference in TUG between the groupsand multiple linear regression analyses to explore associations between TUG and potential explanatory variables.Results:The time on TUG varied among pregnant women with PGP, and was significantly higher (mean (95% CI)6.9 (6.5, 7.3) seconds) than for asymptomatic pregnant (5.8 (5.5, 6.0), p < 0.001) and non-pregnant (5.5 (5.4,5.6), p < 0.001) women. In the total study sample, group, increased BMI and sick leave were significantlyassociated with increased TUG (p-values≤0.02). In pregnant women with PGP, pain intensity was the onlysignificant clinical factor associated with increased TUG (p= 0.002).Conclusion:Pregnant women with PGP used longer time and showed larger variation in TUG than asymptomaticpregnant and non-pregnant women, this underpins that TUG targets activities relevant to PGP. Our resultsprovide new knowledge about factors influencing TUG time. Importantly, multivariable analyses suggest thatpain intensity should be considered when interpreting TUG time in pregnant women with PGP.

• Thornes, Elisabeth; Robinson, Hilde Stendal; Moosmeyer, Stefan; Ekeland, Arne Erling & Vøllestad, Nina Køpke (2019). Low-impact exercise program for patients with symptomatic lumbar spinal stenosis awaiting surgery: a controlled pilot study. European Journal of Physiotherapy. ISSN 2167-9169. p. 1–9. doi: 10.1080/21679169.2018.1554000. Full text in Research Archive
• Øyehaug, Gro Askland; Smedsrud, Aina Paulsen; Vøllestad, Nina Køpke & Robinson, Hilde Stendal (2019). Prioritering og ventetid hos avtalefysioterapeuter – en tverrsnittstudie. Fysioterapeuten. ISSN 0016-3384. 7, p. 22–27. Full text in Research Archive Show summary

  Hensikt: Undersøke hva som karakteriserer personer som står på venteliste hos avtalefysioterapeuter, hvilken prioritet de får og hvor lenge de venter på behandling, sett opp mot prioriteringsnøkkel med maks anbefalt ventetid. Design: Tverrsnittstudie. Materiale: Personer som ble satt på ventelistene til 6 fellespraksiser i to østlandskommuner i løpet av 6 måneder. Metode: Ventelisteskjema med informasjon om demografi, prioritet og ventetid for hver person. Resultater: Totalt 837 personer sto på ventelistene. Av disse var 68% kvinner, 66% var i yrkesaktiv alder og 88% var fra egen kommune. Henvendelsene ble gitt prioritet fra 1-4 etter hastegrad, der 73% fikk prioritet 1 eller 2. Personer som fikk tilbud innenfor maks anbefalt ventetid etter prioriteringsnøkkelen: Prioritet 1: 48%, prioritet 2: 25%, prioritet 3: 14% og prioritet 4:18%. Tjueto prosent av alle på ventelistene ventet over 6 måneder uten å få tilbud. Ventetiden var signifikant lengre til psykomotorisk fysioterapi sammenlignet med annen fysioterapi. Konklusjon: Avtalefysioterapeutene vurderte et stort flertall av henvendelsene til å få høy prioritet. Totalt sett ble under halvparten tatt inn innen maks anbefalt ventetid. Resultatene tyder på at man bør se nærmere på gjeldende inntakspraksis, prioriteringsnøkkel, og tiltak for å redusere ventetiden.

• Myhrvold, Birgitte Lawaetz; Kongsted, Alice; Irgens, Pernille Marie; Robinson, Hilde Stendal; Thoresen, Magne & Vøllestad, Nina Køpke (2019). Broad External Validation and Update of a Prediction Model for Persistent Neck Pain After 12 Weeks. Spine. ISSN 0362-2436. 44(22), p. E1298–E1310. doi: 10.1097/BRS.0000000000003144. Full text in Research Archive Show summary

  Study Design. A prospective observational study. Objective. To externally validate the prediction model developed by Schellingerhout and colleagues predicting global perceived effect at 12 weeks in patients with neck pain and to update and internally validate the updated model. Summary of Background Data. Only one prediction model for neck pain has undergone some external validation with good promise. However, the model needs testing in other populations before implementation in clinical practice. Methods. Patients with neck pain (n = 773) consulting Norwegian chiropractors were followed for 12 weeks. Parameters from the original prediction model were applied to this sample for external validation. Subsequently, two random samples were drawn from the full study sample. One sample (n = 436) was used to update the model; by recalibration, removing noninformative covariates, and adding new possible predictors. The updated model was tested in the other sample (n = 303) using stepwise logistic regression analysis. Main outcomes for performance of models were discrimination and calibration plots. Results. Three hundred seventy patients (47%) in the full study sample reported persistent pain at 12 weeks. The performance of the original model was poor, area under the receiver operating characteristics curve was 0.55 with a Confidence Interval of 0.51–0.59. The updated model included Radiating pain to shoulder and/or elbow, education level, physical activity, consultation-type (first- time, follow-up or maintenance consultation), expected course of neck pain, previous course of neck pain, number of pain sites, and the interaction term Physical activity##Number of pain sites. The area under the receiver operating characteristics curve was 0.65 with a 95% Confidence Interval of 0.58–0.71 for the updated model. Conclusion. The predictive accuracy of the original model performed insufficiently in the sample of patients from Norwegian chiropractors and the model is therefore not recommended for that setting. Only one predictor from the original model was retained in the updated model, which demonstrated reasonable good performance predicting outcome at 12 weeks. Before considering clinical use, a new external validation is required. Level of Evidence: 3

• Christensen, Lene; Veierød, Marit Bragelien; Vøllestad, Nina Køpke; Jakobsen, Vidar Eivind; Stuge, Britt & Cabri, Jan Maria Hendrick [Show all 7 contributors for this article] (2019). Kinematic and spatiotemporal gait characteristics in pregnant women with pelvic girdle pain, asymptomatic pregnant and non-pregnant women. Clinical Biomechanics. ISSN 0268-0033. 68, p. 45–52. doi: 10.1016/j.clinbiomech.2019.05.030. Full text in Research Archive Show summary

  Background Walking difficulties are common among pregnant women with pelvic girdle pain. This cross-sectional study investigated the influence of pelvic girdle pain, pregnancy and speed on spatiotemporal and trunk, pelvic and hip kinematics during gait in the 2nd trimester of pregnancy. Methods Three-dimensional gait analysis at self-selected speed was performed in 25 pregnant women with pelvic girdle pain, 24 asymptomatic pregnant and 24 non-pregnant women. Linear mixed models were used to investigate between-group differences in gait variables. Adjustment for gait speed was included in the analysis. Correlations between speed and fear of movement, disability and pain were examined using Spearman correlation coefficient (rs). Findings Pregnant women with pelvic girdle pain walked 18% slower (estimated marginal means (95% confidence intervals) 1.18 (1.22, 1.24) meter/s) compared to asymptomatic pregnant women (1.44 (1.38, 1.50) meter/s) (P < 0.001). Moreover, with longer double limb support (5%, P = 0.04), shorter contralateral step length (3%, P = 0.03) and more restricted pelvic and hip kinematics (0.001 ≤ P ≤ 0.01) adjusted for speed. Only stance, double limb support and thoracic rotation (0.001 ≤ P ≤ 0.04) differed between asymptomatic pregnant and non-pregnant women. Speed was negatively correlated with fear of movement (rs = −0.63, P = 0.01) and disability (rs = −0.46, P = 0.03) in the pelvic girdle pain group. Interpretation Gait is primarily influenced by pelvic girdle pain and less by pregnancy. Pregnant women with pelvic girdle pain walked slower and with a more rigid gait pattern compared to asymptomatic pregnant women, presumably related to altered load transfer. Our results may assist clinical evaluation of pelvic girdle pain, as well as direct future research.

• Stafne, Signe Nilssen; Vøllestad, Nina Køpke; Mørkved, Siv; Salvesen, Kjell Å & Robinson, Hilde Stendal (2019). Impact of job adjustment, pain location and exercise on sick leave due to lumbopelvic pain in pregnancy: a longitudinal study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 37(2). doi: 10.1080/02813432.2019.1608058. Full text in Research Archive Show summary

  Objective: To identify factors associated with sick leave due to lumbopelvic pain (LPP) in pregnancy. Design: Prospective cohort study using participants from a randomized controlled trial (RCT) designed to study the effect of exercise during pregnancy on pregnancy related diseases. Setting: St. Olavs Hospital, Trondheim University Hospital and Stavanger University Hospital, April 2007 to December 2009. Subjects: Healthy pregnant women. Main outcome measures: Self-reported sick leave due to LPP in late pregnancy (gestation week 32–36). Results: In total, 532/716 (74%) women reported LPP at 32–36 weeks of pregnancy, and 197/716 (28%) reported sick leave due to LPP. Not receiving job adjustments when needed (Odds ratio, OR with 95% confidence interval, CI, was 3.0 (1.7–5.4)) and having any pain in the pelvic girdle versus no pain (OR 2.7 (1.3–5.6), OR 2.7 (1.4–5.2) and OR 2.2 (1.04–4.8)) for anterior, posterior and combined anterior and posterior pain in the pelvis respectively, were associated with sick leave due to LPP in late pregnancy. Also higher disability, sick listed due to LPP at inclusion and lower education, were significant explanatory variables. There was a trend of reduced risk for sick leave due to LPP when allocated to the exercise group in the original RCT (OR 0.7 (0.4–1.0)). Conclusion: Facilitating job adjustments when required might keep more pregnant women in employment. Furthermore, pain locations in pelvic area, disability, lower education and being sick listed due to LPP in mid pregnancy are important risk factors for sick leave in late pregnancy.

• Thornes, Elisabeth; Robinson, Hilde Stendal & Vøllestad, Nina Køpke (2018). Dynamic balance in patients with degenerative lumbar spinal stenosis; A cross-sectional study. BMC Musculoskeletal Disorders. 19(192). doi: 10.1186/s12891-018-2111-x. Full text in Research Archive Show summary

  Background Degenerative lumbar spinal stenosis (LSS) is a prevalent condition in adults over the age of 55 years. The condition is associated with activity limitations that are related to increased pain when engaging in weight-bearing activities, such as walking and standing, and release of pain while sitting down or bending forward. The limitation on ambulation is also associated with impaired balance although the types of balance problems are sparsely described in this patient group. The purpose of this study was to assess dynamic balance in persons with LSS by the Mini-BESTest and explore the associations with self-reported balance and functional disability. Methods Sixty two participants were included in this cross-sectional study. The main outcome measure was the Mini-BESTest, providing a total score and sub-scores for 4 balance control systems (Anticipatory Adjustment, Reactive Response, Sensory Orientation, Stability of Gait). The Swiss Spinal Stenosis Questionnaire provided sub-scores for self-reported balance problems and walking function (FUNC). Results The participants showed large inter-individual variation in all measures of balance. The Mini-BESTest score ranged from very good to poor and the mean value was 22.8 (SD 3.5). Nineteen participants (31%) reported having frequent balance problems. Logistic regression analyses showed that both the total Mini-BESTest score (OR (95% CI) 1.6 (1.2, 2.0)(P = .001) and 3 of the 4 balance control systems (Anticipatory Adjustment, Sensory Orientation, Stability in Gait) were significantly associated with self-reported balance problems (.001 ≤ P ≤ .01). The strongest association was seen between Sensory Orientation and balance problems, implying that it is 4.4 times more likely that persons would have no or occasional balance problems with each unit of increase in Sensory Orientation. The total score for the Mini-BESTest was significantly associated with FUNC (P = .042). Conclusions The dynamic balance of persons with LSS showed a large heterogeneity with a large fraction of the participants displaying no balance impairments. The test results were associated with the participants’ self-reported balance problems and walking function. The Mini-BESTest thus appears to provide additional information to self-reported disability, and by identifying different kind of balance control impairments, the Mini-BESTest could be useful for physiotherapists working with person-centered rehabilitation in persons with LSS.

• Robinson, Pernille Stendal; Balasundaram, Arun Prasad; Vøllestad, Nina Køpke & Robinson, Hilde Stendal (2018). The association between pregnancy, pelvic girdle pain and health-related quality of life – a comparison of two instruments. Journal of Patient-Reported Outcomes. 2. doi: 10.1186/s41687-018-0069-y. Full text in Research Archive Show summary

  Background The main purposes in this cross-sectional study were to study the impact of pregnancy and pelvic girdle pain (PGP) on health related quality of life (HRQoL), by comparing the scores on different domains of two HRQoL instruments in pregnant women with population norms as well as in women with severe and less severe PGP. Further, to explore the association between PGP and HRQoL and whether the two instruments differ in the way they assess the influence of PGP on HRQoL. Methods Pregnant women in gestation week 30 completed questionnaires containing the Short Form Health Survey (SF-36) and the Nottingham Health Profile (NHP). Additional variables, self-reported PGP, pain location in the pelvis and response on clinical tests were also collected. HRQoL scores were compared with expected age adjusted mean scores and comparisons between groups with different severity of PGP were made, using Mann-Whitney U, t-tests and Hodges-Lehman method. Results Two hundred eighty-three pregnant women, mean age 31.3 (SD 4.2) years, participated. We found statistical significant differences in all domains of both HRQoL instruments in late pregnancy compared to the expected age-adjusted means of the reference populations (p ≤ 0.003) except for Social isolation (p = 0.775). Women with PGP had lower HRQoL than women without, and the most affected women scored lowest. SF-36 detected a deficit in Social Function compared to norms whereas the NHP showed no evidence of Social Isolation. Conclusions Both instruments revealed changes in HRQoL in pregnant women compared with population norms. Pregnancy itself influences HRQoL and having PGP gave an additional impact. The consistency of the correlations between SF-36 and NHP domains across the sub-groups found in this study suggests convergent validity across levels of impairment. The results in social domains vary between SF-36 and NHP in pregnant women and might be due to the basic design (construction) of the tools.

• Wuytack, Francesca; Gutke, Annelie; Stuge, Britt; Mørkved, Siv; Olsson, Christina B & Robinson, Hilde Stendal [Show all 11 contributors for this article] (2018). Protocol for the development of a core outcome set for pelvic girdle pain, including methods for measuring the outcomes: the PGP-COS study. BMC Medical Research Methodology. 18:158. doi: 10.1186/s12874-018-0624-5. Full text in Research Archive Show summary

  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).

• Myrhaug, Hilde Tinderholt; Odgaard-Jensen, Jan; Østensjø, Sigrid; Vøllestad, Nina Køpke & Jahnsen, Reidun Birgitta (2018). Effects of a conductive education course in young children with cerebral palsy: A randomized controlled trial. Developmental Neurorehabilitation. ISSN 1751-8423. 21(8), p. 481–489. doi: 10.1080/17518423.2017.1360961. Full text in Research Archive Show summary

  Aim: To evaluate the effects of a conductive education (CE) course followed by conventional practice, on gross motor function, other functional skills, quality of life and parents’ experiences of family-centred services in young children with cerebral palsy (CP). Methods: Twenty-one children with CP, 3-6 years old, were randomised to one three-week CE course followed by conventional practice or conventional practice on a waiting list. Outcomes were measured four months after baseline. A web-based log collected data on the conventional practice. Results: No additional improvements in the children’s outcome were found. However, parents in the CE group reported that they received more information than parents in the waiting list group (p=0.01). Children in both groups performed high amount of conventional practice at home. Conclusions: A three-week CE course did not add any improvements in the children’s functioning, possibly explained by the large amount of conventional practice reported of both groups.

• Balasundaram, Arun Prasad; Robinson, Hilde Stendal & Vøllestad, Nina Køpke (2018). Do the key prognostic factors for non-specific neck pain have moderation effects? ? A study protocol. Medical Hypotheses. ISSN 0306-9877. 114, p. 65–68. doi: 10.1016/j.mehy.2018.03.004. Full text in Research Archive Show summary

  Neck pain is one of the common musculoskeletal conditions prevalent in the general population in Norway. Patients with neck pain, seek treatment from different health professionals such as general practitioners, physiotherapists, chiropractors and alternative medicine practitioners. The interventions for neck pain are typically provided in a primary care or specialised healthcare setting depending on the general practitioners’ referral patterns. Clinicians are interested to know the various prognostic factors that can explain the recovery from neck pain. In order to know this, studies have explored and reported on a range of prognostic factors that contribute to the outcomes in patients with neck pain. This information is currently available only for neck pain following whiplash injury that has a traumatic origin. There is limited information on the role of prognostic factors specifically for non-specific neck pain without a traumatic episode. Moreover, there is a lack of data on whether there are interactions (moderation effects) between the prognostic factors. Therefore, we propose a hypothesis to elucidate whether the same set of prognostic factors found in neck pain associated with whiplash injuries are also identified in patients with neck pain without trauma. Additionally, we hypothesize that the association between a prognostic factor and the outcome variable (s) would be dependent on the third variable, thereby confirming the moderation effects. Clinicians could make informed decisions in the clinical management of neck pain with the knowledge of prognostic factors that explain the outcomes. It could also be used for the development of new interventions or for modifying the existing ones. © 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/

• Evensen, Kari Anne Indredavik; Robinson, Hilde Stendal; Meisingset, Ingebrigt; Woodhouse, Astrid; Thielemann, Marit & Bjorbærkmo, Wenche Schrøder [Show all 10 contributors for this article] (2018). Characteristics, course and outcome of patients receiving physiotherapy in primary health care in Norway: design of a longitudinal observational project. BMC Health Services Research. 18(936). doi: 10.1186/s12913-018-3729-y. Full text in Research Archive Show summary

  Background Physiotherapists (PTs) in primary health care manage patients with large variation in medical diagnosis, age, functional status, disability and prognosis. Lack of knowledge and systematically collected data from patients treated by PTs in primary health care has prompted this longitudinal observational physiotherapy project. This paper aims to describe a method for developing a database of patients managed by PTs in primary health care, with the main purpose to study patients’ characteristics, treatment courses and prognostic factors for favourable outcome. Methods This is a longitudinal observational project, following patients through their physiotherapy treatment periods in primary health care in Norway and until one year after inclusion. The project involves both private practitioners and municipally employed PTs working in primary health care in nine municipalities in Norway. The patients are recruited to three different cohorts depending on age and whether they are referred to a private practitioner or a municipally employed PT. All data are recorded electronically, transferred and stored securely. For all patients we have included extensive questionnaires to obtain information about demographics, disability and function, pain-related variables, psychosocial factors, treatments and evaluation of treatment as well as response to clinical tests. The PTs have access to use their own patients’ data. We have also prepared for linkage to national patient registers and data collected in population-based studies to be able to gather further important data. Discussion This project will have important implications for physiotherapy services in primary health care. The database contains more than 3000 patients, and data collection is ongoing. Data collected so far suggest that the patients included are representative of the larger population of patients treated by private practitioners or municipally employed PTs in Norway. This large scale prospective physiotherapy project will provide knowledge about the patient groups, applied treatments and short- and long-term outcome of the patients.

• Thornes, Elisabeth; Robinson, Hilde Stendal & Vøllestad, Nina Køpke (2018). Degenerative lumbar spinal stenosis and physical functioning: an exploration of associations between self-reported measures and physical performance tests. Disability and Rehabilitation. ISSN 0963-8288. 40(2), p. 232–237. doi: 10.1080/09638288.2016.1250123. Full text in Research Archive
• Mahmood, Aqsa; Moen, Aurora Lie; Stafne, Signe Nilssen; Robinson, Hilde Stendal; Vøllestad, Nina Køpke & Salvesen, Kjell Å [Show all 8 contributors for this article] (2018). The MMP9 rs17576 A>G polymorphism is associated with increased lumbopelvic pain-intensity in pregnant women. Scandinavian Journal of Pain. ISSN 1877-8860. 18(1), p. 93–98. doi: 10.1515/sjpain-2017-0168. Full text in Research Archive Show summary

  Background and aims: Matrix metalloproteinase 9 (MMP9) is an enzyme that may affect degradation of several extracellular matrix (ECM) components in the pelvic ligaments during pregnancy. Previous studies indicate that genetic variations in the gene encoding MMP9 may affect the enzymatic activity. One such genetic variant is a single nucleotide polymorphism (SNP), rs17576 A>G. In this study we investigated whether the MMP9 SNP rs17576 A>G may be associated with increased lumbopelvic pain in 838 pregnant woman. The study was registered with ClinicalTrials.gov (NCT 00476567) on May 21, 2007. Methods: Lumbopelvic pain-intensity was measured by visual analog scale (VAS) at two time points during pregnancy, T1 (18–22 weeks), T2 (32–36 weeks) and 3 months after delivery. Blood samples were collected at each point and SNP genotyping was carried out using predesigned TaqMan SNP genotyping assays. Results: The results showed a significant association between the number of G alleles and pain-intensity in the evening at T2. The pain among G/G carriers was higher than among A/G carriers, which in turn was higher than among the A/A carriers. The most pronounced association between the G allele and pain-intensity was observed in primiparae. Conclusions: We conclude that the MMP9 rs17576 A>G polymorphism is associated with increased lumbopelvic pain-intensity during pregnancy. The present data support the hypothesis that lumbopelvic pain during pregnancy may be related to a relaxin – MMP9 – tissue remodeling mechanism.

• Steen, Unni; Wekre, Lena Lande & Vøllestad, Nina Køpke (2017). Physical functioning and activities of daily living in adults with amyoplasia, the most common form of arthrogryposis. A cross-sectional study. Disability and Rehabilitation. ISSN 0963-8288. 40(23), p. 2767–2779. doi: 10.1080/09638288.2017.1357211. Full text in Research Archive Show summary

  Background: Amyoplasia, the most common form of arthrogryposis is characterized by typical deformities of the joints and replacement of skeletal muscles by fibrous tissue and fat. There is sparse literature on adaptation to adult life with amyoplasia. Purpose: To describe physical function and activity strategies in adults with amyoplasia, as this knowledge is important for relevant function-enhancing measures. Materials and methods: Twenty-two adults (20–91 years) with amyoplasia participated. Demographic factors and clinical history were registered. Body proportions were measured. Joint mobility and muscle strength in the upper limbs were examined. The Functional Independent Measure was used to assess performance of activities of daily living. Compensatory strategies were described. Results: The majority had undergone comprehensive conservative and surgical treatment. Mean height was below typical. Range of motion was below lower limit of normal in most joints, passive range of motion was mainly larger than active. Muscle strength was reduced for most movements. Seven were independent in all activities. Need of assistance was highest regarding bathing and dressing. A variety of compensatory strategies were used. Conclusions: Adults with amyoplasia are heterogeneous regarding function. Independence in everyday life requires a combination of muscle strength to move against gravity, ability to passive joint motion, and use of compensatory strategies.

• Julsvoll, Elisabeth Heggem; Vøllestad, Nina Køpke; Opseth, Gro & Robinson, Hilde Stendal (2017). Inter-tester reliability of selected clinical tests for long-lasting temporomandibular disorders. Journal of Manual & Manipulative Therapy. ISSN 1066-9817. 25(4), p. 182–189. doi: 10.1080/10669817.2017.1322346. Full text in Research Archive Show summary

  Objective: Clinical tests used to examine patients with temporomandibular disorders vary in methodological quality, and some are not tested for reliability. The purpose of this cross-sectional study was to evaluate inter-tester reliability of clinical tests and a cluster of tests used to examine patients with long-lasting temporomandibular disorders. Methods: Forty patients with pain in the temporomandibular area treated by health-professionals were included. They were between 18–70 years, had 65 symptomatic (33 right/32 left) and 15 asymptomatic joints. Two manual therapists examined all participants with selected tests. Percentage agreement and the kappa coefficient (k) with 95% confidence interval (CI) were used to evaluate the tests with categorical outcomes. For tests with continuous outcomes, the relative inter-tester reliability was assessed by the intraclass-correlation-coefficient (ICC3,1, 95% CI) and the absolute reliability was calculated by the smallest detectable change (SDC). Results: The best reliability among single tests was found for the dental stick test, the joint-sound test (k = 0.80–1.0) and range of mouth-opening (ICC3,1 (95% CI) = 0.97 (0.95–0.98) and SDC = 4 mm). The reliability of cluster of tests was excellent with both four and five positive tests out of seven. Conclusion: The reliability was good to excellent for the clinical tests and the cluster of tests when performed by experienced therapists. The tests are feasible for use in the clinical setting. They require no advanced equipment and are easy to perform. This is an Accepted Manuscript of an article published by Taylor & Francis Group in Journal of Manual & Manipulative Therapy on 14 May 2017, available online: http://www.tandfonline.com/10.1080/10669817.2017.1322346

• Larsen, Øivind; Tellnes, Gunnar; Bruusgaard, Dag & Vøllestad, Nina Køpke (2017). Per Sundby. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137(3), p. 226–226. Full text in Research Archive Show summary

  Minneord over professor i sosialmedisin ved Universitetet i Oslo Per Sundby (1928-2016).

• Julsvoll, Elisabeth Heggem; Vøllestad, Nina Køpke & Robinson, Hilde Stendal (2017). Kan smerte og funksjon bidra til å diagnostisere temporomandibulær dysfunksjon? :. Fysioterapeuten. ISSN 0016-3384. 84(3), p. 20–25. Full text in Research Archive Show summary

  Temporomandibulær dysfunksjon (TMD) er en samlebetegnelse for tilstander som kan gi symptomer fra kjeveledd og tyggemuskulatur (1, 2). De vanligste symptomene er smerter, endret bevegelsesmønster, funksjonsforstyrrelser (for eksempel problemer med å gape, tygge, gjespe, snakke og smile), leddlyder samt låsning og luksasjon av leddet (3). I tillegg opplever mange å ha øresus, nakkesmerter og hodepine. Bruk av kjeven innebærer aktiviteter der begge leddene brukes samtidig, som når vi spiser, drikker, gjesper, synger, kaster opp og ikke minst når vi må gape høyt hos tannlegen. I vår relasjonelle omgang med andre mennesker, for eksempel når vi snakker eller kysser noen, bruker vi også kjeven. Alle nevnte aktiviteter kan bli påvirket ved TMD. Videre vil smerte eller redusert bevegelsesutslag i et av kjeveleddene påvirke funksjonen i det andre leddet. Kjeveleddet er spesielt rent anatomisk, bygget opp med en leddskive (diskus) som deler leddet i to leddhuler (øvre og nedre del). Ved bevegelser av kjeven skjer det bevegelse i begge disse, dvs. mellom leddskiven og kondylen og mellom leddskiven og tinningbenet. I bakkant går leddskiven over i et retrodiskalt vev. Dette vevet er rikt innervert og har god blodgjennomstrømning samtidig som det er tøyelig nok til å tillate at leddskiven beveger seg både ved åpning og lukking av munnen (4-6). Helsedirektoratets nasjonale faglige retningslinje og ”Diagnostic Criteria for TMD” (DC/TMD) viser til at flere av diagnosene som hører inn under TMD innebærer en forskyvning av leddskiven (2, 7). Den mest vanlige er at leddskiven forskyves fremover slik at denne ligger foran kjevebenshodet (kondylen) ved lukket munn. Dette kalles en fremre forskyvning eller anterior diskus displassering (ADD) og medfører forandringer i intraartikulære strukturer. Leddskiven kan enten gli tilbake (normaliseres) på kondylen når det gapes (anterior disc displacement with reduction - ADDwR) eller forbli liggende i forskjøvet posisjon dvs. uten normalisering (anterior disc displacement without reduction - ADDWOR).

• Jolsvoll, Elisabeth Heggem; Vøllestad, Nina Køpke & Robinson, Hilde Stendal (2016). Validation of clinical tests for patients with long-lasting painful temporomandibular disorders with anterior disc displacement without reduction. Manual Therapy. ISSN 1356-689X. 21, p. 109–119. doi: 10.1016/j.math.2015.06.005. Full text in Research Archive
• Haukaas, Fredrik Salvesen; Vøllestad, Nina Køpke; Robinson, Hilde Stendal & Aas, Eline (2015). Helseøkonomisk evaluering i fysioterapi. Fysioterapeuten. ISSN 0016-3384. 82(10), p. 22–27. Full text in Research Archive
• Engebretsen, Eivind; Vøllestad, Nina Køpke; Wahl, Astrid Klopstad; Robinson, Hilde Stendal & Heggen, Kristin (2015). Unpacking the Process of Interpretation in Evidence-Based Decision-Making. Journal of Evaluation In Clinical Practice. ISSN 1356-1294. 21, p. 529–531. doi: 10.1111/jep.12362. Full text in Research Archive
• Sveaas, Silje Halvorsen; Berg, Inger Jorid; Provan, Sella Aarrestad; Semb, Anne Grete; Olsen, Inge Christoffer & Ueland, Thor [Show all 11 contributors for this article] (2015). Circulating levels of inflammatory cytokines and cytokine receptors in patients with ankylosing spondylitis: A cross-sectional comparative study. Scandinavian Journal of Rheumatology. ISSN 0300-9742. 44(2), p. 118–124. doi: 10.3109/03009742.2014.956142. Full text in Research Archive
• Tellnes, Gunnar; Irgens, Lorentz M.; Kristensen, Petter; Larsen, Øivind; Vøllestad, Nina Køpke & Lie, Rolv T. [Show all 9 contributors for this article] (2015). MINNEORD: Tor Bjerkedal. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 135(17). doi: 10.4045/tidsskr.15.0755. Full text in Research Archive Show summary

  Professor i forebyggende medisin, dr.med. Tor Bjerkedal døde 11. 6. 2015, 88 år gammel. Etableringen av Medisinsk fødselsregister kom til å bli hans livsverk, og dette arbeidet var han engasjert i inn til det siste. Tor Bjerkedal deltok i motstandsarbeid under den annen verdenskrig, og han satt på Grini deler av krigsårene. Etter krigen fikk han plass på legestudiet i København, der han også traff den danske tannlegestudenten Gudrun Kjerulff som ble hans kone. Sammen fikk de tre barn, seks barnebarn og tre oldebarn. I 1952 fullførte Bjerkedal legeutdanningen ved Universitetet i Oslo. Han arbeidet deretter et års tid som distriktslege i Vik i Sogn før han i 1954 ble vitenskapelig assistent ved Hygienisk Institutt i Oslo. Bjerkedal hadde flere forskningsopphold i USA og tok mastergrad i folkehelse ved Harvard i 1958. Sin doktorgrad om tuberkulose forsvarte han ved Universitetet i Oslo i 1965, og året etter ble han styrer for Institutt for hygiene og sosialmedisin ved Universitetet i Bergen. Gjennom sin tilknytning til Statistisk sentralbyrå ble Bjerkedal engasjert i arbeidet med den medisinske fødselsmeldingen. Han overbeviste raskt alle involverte parter om at dette datagrunnlaget i forskning og helsetjeneste burde knyttes til et aktivt medisinsk forskningsmiljø. I 1970 etablerte Bjerkedal Medisinsk fødselsregister, verdens første i sitt slag. Han var en drivende kraft i nordisk og internasjonalt samarbeid innenfor dette fagfeltet. Videre gjennomførte han forsøk med nye rutiner for systematisk og standardisert registering av helseopplysninger om småbarn, med mål om å effektivisere helsestasjonsarbeidet. Han etablerte også et system, SYSVAK, for registrering av alle vaksinasjoner utført på småbarn og skolebarn. Bjerkedal tok tidlig i bruk informasjonsteknologi, noe han ble en pådriver for å innføre i helsevesenet. Her møtte han en rekke tilbakeslag og frustrasjoner. Selv i sine senere år kunne han registrere at hans visjoner ennå langt fra var realiserte. I 1976 ble Bjerkedal styrer for Institutt for forebyggende medisin, Universitetet i Oslo. Han var arbeidsom og utholdende, og ble en nestor i forebyggende medisin og epidemiologi. Samtidig var han en visjonær og hjelpsom kollega. Noen kunne kanskje oppleve hans krav til kvalitet og nøyaktighet som en utfordring. Men kanskje ikke alle så de samme mulighetene som Bjerkedal selv så, eller riktig forsto hans kraftfulle personlighet og de mange visjonene som var en naturlig del av hans liv. Kanskje hadde tiden på Grini og oppholdene i USA også satt sitt preg på hans visjonære, kvalitetsbevisste, kritiske og handlekraftige måte å arbeide på? Han var veileder for en rekke stipendiater og forskere, noe som bidro til å gi ham en bred akademisk kompetanse innen samfunnsmedisin. Hans store lidenskap var registerepidemiologi for å finne årsaker til sykdom. Dette ga mulighet for helsefremmende og forebyggende tiltak. Han forsket også på arbeidsmedisin, infeksjonsmedisin, kreftsykdommer, trygdemedisin og initierte global helseforskning i Palestina. I sin lange pensjonisttid publiserte Bjerkedal over 50 artikler. Da han var 76 år, etablerte han en fødselskohort basert på de ti første årgangene i Medisinsk fødselsregister og koblet denne til et flertall nasjonale registre. Dette har resultert i et stort antall originalartikler, også i Science. Samarbeidet med Haakon Natvig på Hygienisk institutt i 1960-årene omfattet en oppfølging av det såkalte «oljeforsøket». Bjerkedal fulgte opp denne kohorten helt til de yngste gjenlevende var over 90 år gamle. Siste publikasjon med ham som førsteforfatter sto i Tidsskriftet i 2012. En visjonær og hjelpsom kollega har gått bort. Varm takk til vår venn Bjerkedal for hans innsats til folkehelsens beste. Våre tanker går til Gudrun og øvrige familie. På vegne av kolleger tilknyttet Universitetet i Oslo og Universitet i Bergen

• Sveaas, Silje Halvorsen; Berg, Inger Jorid; Provan, Sella Aarrestad; Semb, Anne Grete; Hagen, Kåre Birger & Vøllestad, Nina Køpke [Show all 13 contributors for this article] (2014). Efficacy of High Intensity Exercise on Disease Activity and Cardiovascular Risk in Active Axial Spondyloarthritis: A Randomized Controlled Pilot Study. PLOS ONE. 9(9). doi: 10.1371/journal.pone.0108688. Full text in Research Archive
• Gutke, Annelie; Olsson, Christina B; Vøllestad, Nina Køpke; Öberg, Birgitta; Nilsson-Wikmar, Lena & Robinson, Hilde Stendal (2014). Association between lumbopelvic pain, disability and sick leave during pregnancy; a comparison of three Scandinavian cohorts. Journal of Rehabilitation Medicine. ISSN 1650-1977. 46(5), p. 468–474. doi: 10.2340/16501977-1801. Full text in Research Archive
• Birkeflet, Oddveig; Laake, Petter & Vøllestad, Nina Køpke (2014). Poor multi-rater reliability in TCM pattern diagnoses and variation in the use of symptoms to obtain a diagnosis. Acupuncture in Medicine. ISSN 0964-5284. 32(4), p. 325–332. doi: 10.1136/acupmed-2013-010473. Full text in Research Archive
• Robinson, Hilde Stendal; Vøllestad, Nina Køpke & Veierød, Marit Bragelien (2014). Clinical course of pelvic girdle pain postpartum - Impact of clinical findings in late pregnancy. Manual Therapy. ISSN 1356-689X. 19(3), p. 190–196. doi: 10.1016/j.math.2014.01.004. Full text in Research Archive
• Vikne, Harald; Bakke, Eva; Liestøl, Knut; Engen, Stian Rugsveen & Vøllestad, Nina Køpke (2013). Muscle activity and head kinematics in unconstrained movements in subjects with chronic neck pain; cervical motor dysfunction or low exertion motor output? BMC Musculoskeletal Disorders. 14(1), p. 314–314. doi: 10.1186/1471-2474-14-314. Full text in Research Archive Show summary

  Background: Chronic neck pain after whiplash associated disorders (WAD) may lead to reduced displacement and peak velocity of neck movements. Dynamic neck movements in people with chronic WAD are also reported to display altered movement patterns such as increased irregularity, which is suggested to signify impaired motor control. As movement irregularity is strongly related to the velocity and displacement of movement, we wanted to examine whether the increased irregularity in chronic WAD could be accounted for by these factors. Methods: Head movements were completed in four directions in the sagittal plane at three speeds; slow (S), preferred (P) and maximum (M) in 15 men and women with chronic WAD and 15 healthy, sex and age-matched control participants. Head kinematics and measures of movement smoothness and symmetry were calculated from position data. Surface electromyography (EMG) was recorded bilaterally from the sternocleidomastoid and splenius muscles and the root mean square (rms) EMG amplitude for the accelerative and decelerative phases of movement were analyzed. Results: The groups differed significantly with regard to movement velocity, acceleration, displacement, smoothness and rmsEMG amplitude in agonist and antagonist muscles for a series of comparisons across the test conditions (range 17 – 121%, all p-values < 0.05). The group differences in peak movement velocity and acceleration persisted after controlling for movement displacement. Controlling for differences between the groups in displacement and velocity abolished the difference in measures of movement smoothness and rmsEMG amplitude. Conclusions: Simple, unconstrained head movements in participants with chronic WAD are accomplished with reduced velocity and displacement, but with normal muscle activation levels and movement patterns for a given velocity and displacement. We suggest that while reductions in movement velocity and displacement are robust changes and may be of clinical importance in chronic WAD, movement smoothness of unconstrained head movements is not.

• Lillehagen, Ida; Vøllestad, Nina Køpke; Heggen, Kristin & Engebretsen, Eivind (2013). Protocol for a qualitative study of knowledge translation in a participatory research project. BMJ Open. 3(8). doi: 10.1136/bmjopen-2013-003328. Full text in Research Archive Show summary

  Introduction: In this article, we present a methodological design for qualitative investigation of knowledge translation (KT) between participants in a participatory research project. In spite of a vast expansion of conceptual models and frameworks for conducting KT between research and practice, few models emphasise how KTs come about. Better understanding of the actions and activities involved in a KT process is important for promoting diffusion of knowledge and improving patient care. The purpose of this article is to describe a methodological design for investigating how KTs come about in participatory research. Methods and analysis: The article presents an ethnographic study which investigates meetings between participants in a participatory research project. The participants are researchers and primary healthcare clinicians. Data are collected through observation, interviews and document studies. The material is analysed using the analytical concepts of knowledge objects, knowledge forms and knowledge positions. These concepts represent an analytical framework enabling us to observe knowledge and how it is translated between participants. The main expected outcome of our study is to develop a typology of KT practices relevant to participatory research. Ethics and dissemination: The project has been evaluated and approved by the Norwegian Social Science Data Services. Informed consent was obtained for all participants. The findings from this study will be disseminated through peer-reviewed publications and national and international conference presentations.

• Halvorsen, Silje; Vøllestad, Nina Køpke; Provan, Sella Aarrestad; Semb, Anne Grete; Heijde, Désirée van der & Hagen, Kåre Birger [Show all 7 contributors for this article] (2013). Cardiorespiratory Fitness and Cardiovascular Risk in Patients With Ankylosing Spondylitis: A Cross-Sectional Comparative Study. Arthritis Care and Research. ISSN 0893-7524. 65(6), p. 969–976. doi: 10.1002/acr.21926. Full text in Research Archive
• Eilertsen, Heidi; Vøllestad, Nina Køpke & Hagve, Tor-Arne (2013). The Usefulness of Blast Flags on the Sysmex XE-5000 Is Questionable. American Journal of Clinical Pathology. ISSN 0002-9173. 139(5), p. 633–640. doi: 10.1309/AJCPDUZVRN5VY9WZ. Full text in Research Archive
• Vikne, Harald; Bakke, Eva; Liestøl, Knut; Sandbæk, Gunnar & Vøllestad, Nina Køpke (2013). The smoothness of unconstrained head movements is velocity-dependent. Human Movement Science. ISSN 0167-9457. 32(4), p. 540–554. doi: 10.1016/j.humov.2012.12.013. Full text in Research Archive
• Halvorsen, Silje; Vøllestad, Nina Køpke; Provan, Sella Aarrestad; Semb, Anne Grete; Heijde, Désirée van der & Hagen, Kåre Birger [Show all 7 contributors for this article] (2012). High cardiorespiratory fitness is related to lower cardiovascular risk in patients with ankylosing spondylitis. Arthritis Care and Research. ISSN 0893-7524. doi: 10.1002/acr.21925. Full text in Research Archive
• Vikne, Harald; Gundersen, Kristian; Liestøl, Knut; Mæhlen, Jan & Vøllestad, Nina Køpke (2012). Intermuscular relationship of human muscle fiber type proportions: Slow leg muscles predict slow neck muscles. Muscle and Nerve. ISSN 0148-639X. 45(4), p. 527–535. doi: 10.1002/mus.22315. Full text in Research Archive

View all works in NVA

• Moger, Tron Anders; Vøllestad, Nina Køpke; Tjerbo, Trond; Amundsen, Olav; Holte, Jon Helgheim & Haavaag, Silje Bjørnsen [Show all 8 contributors for this article] (2025). Bruk av registerdata i analyse av tjenesteforløp for muskelskjelett- og KOLS-pasienter – et sammendrag av INOREG prosjektet. Full text in Research Archive Show summary

  Bakgrunn: Muskel-/skjelettlidelser (MSK) og kronisk obstruktiv lungesykdom (KOLS) representerer to betydelige typer av kroniske sykdommer. I et tverrfaglig forskningsprosjekt ved Institutt for Helse og Samfunn, UiO, som ble introdusert på Helsetjenestekonferansen 2022, har vi analysert tjenesteforløpene for disse pasientgruppene ved hjelp av koblede registerdata. Formål: Beskrive pasientforløpene for de to pasientgruppene, finne faktorer i forløpene assosiert med utfall som sykehusinnleggelser, hjemmetjenester, høy fremtidig tjenestebruk og uførhet. Metode: Kvantitative og kvalitative analyser av pasientforløp. Kvantitative analyser baseres på data fra nasjonale registre, fra registre i pleie- og omsorgstjenestene i Oslo og Trondheim, samt internt fysioterapiregister. Resultater: Flere viktige avvik fra anbefalt oppfølging for pasientgruppene ble oppdaget i analysene. Noen eksempler er at mer enn 50 % av MSK-pasienter fikk kirurgi, uten å ha forsøkt konservativ behandling først, og at mer enn 10 % av KOLS-pasienter ikke mottar oppfølging for luftveisdiagnoser i året før en sykehusinnleggelse med KOLS. Samtidig hadde mange av pasientene med gjentatte KOLS-innleggelser begrenset oppfølging i primærhelsetjenesten i årene etter indeksinnleggelsen. For KOLS-pasienter observerer man videre en sterk økning i fastlegekontakter i året før man mottar hjemmetjenester, som har betydning for å predikere fremtidig tjenestebruk. På den positive siden fant vi at MSK-pasienter med dårlig prognose hadde fire ganger høyere sjanse for å rapportere et godt klinisk utfall dersom de hadde høy bruk av fysioterapi, som videre var assosiert med lavere sjanse for fremtidig uførhet. For pasienter med god/middels prognose var det ingen sammenheng mellom klinisk utfall og høy frekvens av fysioterapi. For KOLS-pasienter fant vi at bruk av samhandlingstakster, kontinuitet i fastlegeoppfølging, og psykososial støtte for særlig sårbare grupper var assosiert med lavere sannsynlighet for fremtidige akutte sykehusinnleggelser for KOLS. Konklusjon: Prosjektet illustrerer mulighetene ved bruk av administrative helseregisterdata. Samtidig finnes det flere begrensninger dersom man ikke har data på tvers av tjenestene, mer detaljerte kliniske data, samt pasientrapporterte utfallsmål

• Moger, Tron Anders; Hellesø, Ragnhild; Tjerbo, Trond; Holte, Jon Helgheim; Haavaag, Silje Bjørnsen & Bragstad, Line Kildal [Show all 8 contributors for this article] (2025). INOREG workshop, perspective paper. Full text in Research Archive
• Moger, Tron Anders; Haavaag, Silje Bjørnsen; Vøllestad, Nina Køpke; Tjerbo, Trond; Holte, Jon Helgheim & Hellesø, Ragnhild [Show all 8 contributors for this article] (2025). INOREG workshop 2025. Full text in Research Archive
• Skonnord, Trygve; Vøllestad, Nina Køpke; Heggen, Kristin Margrete & Brekke, Mette (2024). GPs of the future as agents of sustainability. Full text in Research Archive
• Moger, Tron Anders; Vøllestad, Nina Køpke; Tjerbo, Trond; Hellesø, Ragnhild; Bragstad, Line Kildal & Holte, Jon Helgheim [Show all 8 contributors for this article] (2024). INOREG workshop 2024. Full text in Research Archive
• Amundsen, Olav; Moger, Tron Anders & Vøllestad, Nina Køpke (2024). Arbeid med registerdata - Erfaringer fra INOREG-prosjektet. Full text in Research Archive
• Amundsen, Olav; Moger, Tron Anders; Vøllestad, Nina Køpke; Tjerbo, Trond; Hellesø, Ragnhild & Bragstad, Line Kildal [Show all 8 contributors for this article] (2023). INOREG workshop 2023. Full text in Research Archive
• Waage, Christin; Toftemo, Ingun; Brænd, Anja Maria; Sletner, Line; Sommer, Christine & Birkeland, Kåre Inge [Show all 10 contributors for this article] (2023). Cohort profile update: the Norwegian STORK Groruddalen (STORK G) pregnancy and birth cohort—the role of ethnicity and causal pathways for obesity, type 2 diabetes, cardiovascular disease and other health issues. BMJ Open. 13(10), p. 1–11. doi: 10.1136/bmjopen-2023-076251. Full text in Research Archive Show summary

  Purpose The STORK Groruddalen cohort was set up in 2008 to explore ethnic differences in: (1) maternal health, primarily gestational diabetes (GDM) and related health issues during pregnancy and post partum, and effects of exposures on risk for type 2 diabetes, cardiovascular disease and other health issues, and (2) offspring’s growth and body composition, overweight/obesity and effects of early life exposures. Participants 823 women (74% of invited) were followed from gestational week (GW) 15. Data were collected from 618 fathers. In total, 59% of women and 53% of fathers had origin from non-Western countries. Maternal mean age was 29.9 years (SD 4.9), and body mass index (BMI) 25.3 kg/m 2 (4.9). Data were obtained from 772 women (94%) at GW 28, and 662 women (80%) 14 weeks post partum. Eleven years post partum, 385 women (53% of eligible/47% of original cohort) attended, age was 42.0 years (4.8) and BMI 27.1 kg/m 2 (5.1). We have data for 783 children at birth, and for 586 at last time point, mean age 8.6 (0.5) years, weight 30.7 (6.8) kg and length 133.9 (6.3) cm. Findings to date We collected questionnaire data from parents, clinical measurements and blood samples from mothers, and data on children’s growth (mid-pregnancy to 8 years). Our biobank includes maternal blood and urine samples, biopsy material from placentas and umbilical venous cord blood. We found several clinically important differences in maternal health, with higher risk in ethnic minority groups for GDM, insulin resistance, vitamin D and iron deficiency, depressive symptoms and physical inactivity. Contrasting patterns of fetal growth and risk of overweight/thinness at preschool age were observed across ethnic groups. Maternal GDM, obesity and high gestational weight gain were associated with children’s BMI trajectories. Future plans We will examine the impact of maternal and fetal health and development during pregnancy on long- term outcomes for mothers and offspring.

• Chaibi, Aleksander; Allen-Unhammer, Anna Jane; Vøllestad, Nina Køpke & Russell, Michael Bjørn (2023). Chiropractic spinal manipulative therapy for acute neck pain: A 4-arm clinical placebo randomized controlled trial. A prospective study protocol. PLOS ONE. 18(12). doi: 10.1371/journal.pone.0295115. Full text in Research Archive Show summary

  Introduction Neck pain poses enormous individual and societal costs worldwide. Spinal manipulative therapy and Non-Steroidal Anti-Inflammatory Drug treatment are frequently used despite a lack of compelling efficacy data. This protocol describes a multicentre 4-arm, clinical placebo randomized controlled trial (RCT), investigating the efficacy of chiropractic spinal manipulative therapy (CSMT) versus sham CSMT, ibuprofen, and placebo medicine for acute neck pain. This superiority study will employ parallel groups, featuring a 1:1:1:1 allocation ratio. Material and methods We will randomize 320 participants equally into four groups: CSMT, sham CSMT, ibuprofen, or placebo medicine. CSMT groups are single-blinded, while the medicine groups are double-blinded. Data will be collected at baseline (Day 0), during treatment and post-treatment. The primary endpoint will assess the difference in mean pain intensity from Day 0 to Day 14 on a numeric rating scale 0–10; the CSMT group is compared to sham CSMT, ibuprofen, and placebo medicine groups, respectively. Secondary endpoints will assess mean pain intensity and mean duration at different time points, and adverse events, blinding success, and treatment satisfaction, including comparison between ibuprofen and placebo medicine. Power calculation is based on a mean neck pain rating of 5 at Day 0, with standard deviation of 1 in all groups. Mean pain reduction at Day 14 is expected to be 60% in the CSMT group, 40% in sham CSMT and ibuprofen groups, and 20% in the placebo medicine group. A linear mixed model will compare the mean values for groups with corresponding 95% confidence intervals. P values below 0.017 will be considered statistically significant. All analyses will be conducted blinded from group allocation. Discussion This RCT aims towards the highest research standards possible for manual-therapy RCTs owing to its two placebo arms. If CSMT and/or ibuprofen proves to be effective, it will provide evidence-based support for CSMT and/or ibuprofen for acute neck pain.

• Vøllestad, Nina Køpke; Brekke, Mette; Skonnord, Trygve & Heggen, Kristin (2023). Fremtidens fastleger som bærekraftsagenter. 143(15), p. 1–5. doi: 10.4045/tidsskr.23.0520. Full text in Research Archive
• Vøllestad, Nina Køpke; Irgens, Pernille Marie Stähr; Myhrvold, Birgitte Lawaetz; Amundsen, Olav; Tyrdal, Mari & Robinson, Hilde Stendal (2023). Rating of current pain intensity is lower than rating of the last two wees of pain. Full text in Research Archive
• Bennetter, Karin Elisabeth; Waage, Christin; Richardsen, Kåre Rønn; Jenum, Anne Karen; Vøllestad, Nina Køpke & Robinson, Hilde Stendal [Show all 7 contributors for this article] (2022). Associations between social support and physical activity among postpartum women: a cohort study. Full text in Research Archive
• Amundsen, Olav; Vøllestad, Nina Køpke; Moger, Tron Anders; Tjerbo, Trond & Holte, Jon Helgheim (2022). Is future disability benefit associated with specific combinations of health care use for musculoskeletal disorders? Full text in Research Archive Show summary

  Background Musculoskeletal disorders (MSD) are one of the highest contributors to disability benefit in Norway and other OECD-countries. This is an increasing problem in most OECD countries and is a major challenge for welfare states. To be able to prevent people from falling out of the work force it is important to identify combinations of care associated with poorer outcomes and increased risk of future disability pension. Objective Examine how combinations of health care use relate to future disability benefit, controlling for demographic, socioeconomic and clinical factors. Methods The study combines Norwegian data registers with information on health care use, diagnosis, comorbidities, demographic, education, socioeconomic factors and disability benefits. Patients are included at the time of their first health care visit for MSD in 2013-2015 and are followed until end of 2020. Patients between 18-62 years and registered in the work force at index are included. The outcome is being registered with disability benefit minimum 12 months after index. Multivariable regression analysis is used with combinations of health care use for the first 12 months as the main explanatory variables. Combinations of health care use are identified by variables for having used GP, physiotherapy and specialist health care for MSD and creating combinations of these dichotomous variables. Other variables were included as covariates. Results/conclusion Using specialist health care for MSD in combination with GP (OR 1.91, 95%CI 1.36-2.68) or in combination with both GP and physiotherapy services (OR 2.38, 95%CI 1.53-3.71) was associated with increased risk of future disability pension compared to seeing GP alone. Seeing physiotherapist only or in combination with GP was not associated with increased risk of future disability pension. Reasons for these associations remain to be explored.

• Amundsen, Olav; Holte, Jon Helgheim; Vøllestad, Nina Køpke & Moger, Tron Anders (2022). INOREG-prosjektet - drøfting av resultater. Full text in Research Archive
• Moger, Tron Anders; Vøllestad, Nina Køpke; Hellesø, Ragnhild; Tjerbo, Trond; Holte, Jon Helgheim & Amundsen, Olav (2022). INOREG workshop 2022. Full text in Research Archive
• Waage, Christin; Richardsen, Kåre Rønn; Jenum, Anne Karen; Vøllestad, Nina Køpke & Robinson, Hilde Stendal (2022). Associations between social support and physical activity among postpartum women: a cohort study. European Journal of Public Health. ISSN 1101-1262. doi: 10.1093/eurpub/ckac131.440. Full text in Research Archive
• Robinson, Hilde Stendal; Waage, Christin Wiegels; Vøllestad, Nina Køpke; Jenum, Anne Karen; Mdala, Ibrahimu & Richardsen, Kåre Rønn (2022). Associations between social support and physical activity among postpartum women: a cohort study. Full text in Research Archive
• Mdala, Ibrahimu; Richardsen, Kåre Rønn; Vøllestad, Nina Køpke; Jenum, Anne Karen; Robinson, Hilde Stendal & Waage, Christin Wiegels (2022). Moderate-to-vigorous physical activity level 11 years postpartum in a multi-ethnic sample. Full text in Research Archive
• Amundsen, Olav & Vøllestad, Nina Køpke (2022). Registerforskning – et nyttig fugleperspektiv for klinikere? Full text in Research Archive
• Amundsen, Olav & Vøllestad, Nina Køpke (2022). Hvordan er første års helsetjenestebruk for pasienter med muskel-skjelettplager assosiert med bruk av spesialisthelsetjenesten 3 år senere? Full text in Research Archive Show summary

  Bakgrunn: Muskel-skjelettplager (MUSP) inkluderer noen av de mest prevalente lidelsene både internasjonalt og i Norge. I Norge er kostanden for helsetjenester relatert til MUSP beregnet til 14.3 mrd NOK, og den økonomiske byrden relatert til redusert arbeidsdeltakelse og sosiale ytelser er estimert til å være 69-73 mrd NOK. For å kunne håndtere den økende byrden av MUSP trengs forskning på hvordan vi kan bedre individuelle helserelaterte utfallsmål og gjøre de samfunnsmessige kostnadene bærekraftige. Dette inkluderer et behov for å identifisere og fremme behandlingsforløp som er effektive, og redusere bruken av ineffektive behandlingsforløp. Metode: Studien henter data fra offentlige konsultasjoner hos fysioterapeut og spesialisthelsetjenesten fra dataregistrene KUHR og NPR-somatikk. Studiepopulasjonen er pasienter registrert med MUSP for første gang hos fastlege/fysioterapeut i 2015. Ressursbruk hos fysioterapeut og spesialisthelsetjeneste kodes i kategoriene høy/lav/ingen. Kategoriene "høy" og "lav" kodes basert på 50-percentilen. Kategoriene brukes som hovedvariabel i logistisk regresjonsanalyse hvor utfallsmålet er høy/lav eller ingen spesialisthelsetjenestebruk 3 år senere. Det er kontrollert for alder, kjønn, utdanning, arbeidslivstilknytning og komorbiditeter. Analysene er foreløpige og under utvikling. Resultater: Høy og lav bruk av spesialisthelsetjeneste første år var assosiert med høy bruk av spesialisthelsetjeneste 3 år senere, sammenlignet med ingen bruk. (Høy: OR 1.98, 95%CI 1.60-2.46. Lav: OR 1.25 95%CI 1.01-1.57). For kombinasjoner mellom helsetjenestebruk første år har gruppene med høy spesialisthelsetjenestebruk økt risiko for høy bruk etter 3 år, men gruppen med samtidig høy bruk av fysioterapi har lavest risiko av disse (Høy spesialisthelsetjeneste ingen fysioterapi: OR 2.00, 95%CI 1.54-2.61. Høy spesialisthelsetjeneste lav fysioterapi: OR 3.00 95%CI 1.90-4.75. Høy spesialisthelsetjeneste høy fysioterapi: OR 1.47, 95%CI 1.04-2.07). Diskusjon/konklusjon Høy bruk av spesialisthelsetjeneste første år var assosiert med høy bruk 3 år senere. Samtidig høy bruk av fysioterapi kan redusere risikoen for høy bruk av spesialisthelsetjeneste i denne gruppen, noe som kan ha betydning for reduksjon i samfunnskostnad.

• Amundsen, Olav & Vøllestad, Nina Køpke (2022). Smerter hos voksne og bruk av helsetjenester. Full text in Research Archive
• Amundsen, Olav & Vøllestad, Nina Køpke (2022). Is future disability benefit associated with specific combinations of health care use for musculoskeletal disorders? Full text in Research Archive Show summary

  Bakgrunn og formål Musculoskeletal disorders (MSD) are one of the highest contributors to disability benefit in Norway and other OECD-countries. This is an increasing problem in most OECD countries and is a major challenge for welfare states. To be able to prevent people from falling out of the work force it is important to identify combinations of care associated with poorer outcomes and increased risk of future disability pension. The study’s objective is to examine how combinations of health care use relate to future disability benefit, controlling for demographic, socioeconomic and clinical factors. Metode The study combines Norwegian data registers with information on health care use, diagnosis, comorbidities, demographic, education, socioeconomic factors and disability benefits. Patients are included at the time of their first health care visit for MSD in 2013-2015 and are followed until end of 2020. Patients between 18-62 years and registered in the work force at index are included. The outcome is being registered with disability benefit minimum 12 months after index. Multivariable regression analysis is used with combinations of health care use for the first 12 months as the main explanatory variables. Combinations of health care use are identified by variables for having used GP, physiotherapy and specialist health care for MSD and creating combinations of these dichotomous variables. Other variables were included as covariates. Resultater Using specialist health care for MSD in combination with GP (OR 1.91, 95%CI 1.36-2.68) or in combination with both GP and physiotherapy services (OR 2.38, 95%CI 1.53-3.71) was associated with increased risk of future disability pension compared to seeing GP alone. Konklusjon Using specialist health care for MSD was associated with increased risk of future disability pension, while seeing physiotherapist only or in combination with GP was not associated with increased risk of future disability pension. Reasons for these associations remain to be explored.

• Moger, Tron Anders; Tjerbo, Trond; Hellesø, Ragnhild & Vøllestad, Nina Køpke (2021). INOREG opening seminar. Full text in Research Archive
• Grongstad, Anita; Vøllestad, Nina Køpke; Oldervoll, Line Merethe; Spruit, Martijn & Edvardsen, Anne (2019). The effects of high- versus moderate-intensity exercise on fatigue in sarcoidosis. Journal of Clinical Medicine. 8(4). doi: 10.3390/jcm8040460. Full text in Research Archive
• Meisingset, Ingebrigt; Robinson, Hilde Stendal; Evensen, Kari Anne Indredavik; Woodhouse, Astrid; Vasseljen, Ottar & Granviken, Fredrik [Show all 15 contributors for this article] (2018). Hvem får oppfølging av avtalefysioterapeuter i primærhelsetjenesten. Full text in Research Archive
• Christensen, Lene; Vøllestad, Nina Køpke; Veierød, Marit B; Stuge, Britt Karin; Cabri, Jan Maria Hendrick & Robinson, Hilde Stendal (2018). Timed Up and Go test (TUG) hos gravide kvinner med bekkenleddsmerter. Full text in Research Archive
• Meisingset, Ingebrigt; Robinson, Hilde Stendal; Evensen, Kari Anne Indredavik; Woodhouse, Astrid; Thielemann, Marit & Bones, Anita [Show all 15 contributors for this article] (2017). Pasienter hos privatpraktiserende fysioterapeuter i primærhelsetjenesten;hvem er de? Fysioterapeuten. ISSN 0016-3384. Full text in Research Archive
• Grongstad, Anita; Spruit, Martijn A.; Vøllestad, Nina Køpke; Oldervoll, Line Merethe & Edvardsen, Anne (2017). Does endurance exercise intensity affect fatigue in sarcoidosis patients? Full text in Research Archive
• Grongstad, Anita; Spruit, Martijn A.; Oldervoll, Line Merethe; Vøllestad, Nina Køpke & Edvardsen, Anne (2017). Muscle strength trainig; does number of repetitions affect fatigue in sarcoidosis? Full text in Research Archive
• Woodhouse, Astrid; Robinson, Hilde Stendal; Evensen, Kari Anne Indredavik; Meisingset, Ingebrigt; Thielemann, Marit & Bjorbærkmo, Wenche Schrøder [Show all 9 contributors for this article] (2017). Fysioterapeuter i primærhelsetjenesten - Hva gjør vi egentlig. p. 24–26. Full text in Research Archive
• Engebretsen, Eivind; Vøllestad, Nina Køpke; Wahl, Astrid Klopstad; Robinson, Hilde Stendal & Heggen, Kristin (2015). Opening the black box of clinical decision making: Interpretation is a central feature in evidence-based medicine. LSE Impact Blog. Full text in Research Archive
• Vasseljen, Ottar & Vøllestad, Nina Køpke (2015). Forskning og praksis - sammen om fagutvikling. Full text in Research Archive
• Vøllestad, Nina Køpke (2013). FYSIOPRIM - for å styrke primærhelsetjenesten gjennom forskning. Fysioterapeuten. ISSN 0016-3384. 2, p. 27–27. Full text in Research Archive Show summary

  FYSIOPRIM er lagt opp for å favne hele dette spekteret gjennom arbeid innenfor tre hovedområder som beskrives nedenfor. Metoder og verktøy Ett hovedmål er å utvikle og etablere metoder for standardisert registrering av data som er relevante for klinisk praksis. Dette gjør vi gjennom å utvikle og teste ut kjernesett av metoder som gir relevante opplysninger om pasientene, hvilken behandling de får og hvordan de responderer på behandlingen. I ett delprosjekt har vi et særlig fokus på måleinstrumenter for fysisk form, der metodiske egenskaper for aktuelle spørreskjemaer og fysiske tester undersøkes. Muligheten for klinisk nytte og anvendelse er førende for utviklingen og etableringen av metodene, samtidig som en systematisk registering av kliniske data også vil kunne gi bedre grunnlag for forskning i primærhelsetjenesten. Kliniske studier og forløpsstudier I FYSIOPRIM gjennomføres flere kliniske studier som har til hensikt å skape kunnskap om kliniske forløp, samhandlingsprosesser og behandlingseffekter (inkludert kost:nytte). Tre studier er lagt opp som randomiserte kontrollerte kliniske (RCT) studier, hvorav to undersøker effekten av intervensjon for personer som har artrose i knær og/eller hender. Videre skal det undersøkes om behandlingen av artrosepasienter følger anbefalinger i gjeldende internasjonale retningslinjer. I en annen RCT undersøkes bevegelsesmønster og motorisk kontroll hos pasienter med nakkesmerter, om ordinær fysioterapibehandling påvirker motorisk avvik og om avviksmønster kan knyttes til symptomendringer. For å få mer innsikt i samhandlingsprosessene mellom pasient og terapeut og i de individuelle forløpene, har vi også en studie av nakkepasienter der kvalitativ og kvantitativ tilnærming kombineres. Til sammen vil disse kliniske studiene kunne gi et fundament for videreutvikling av klinisk praksis og muligheter for mer tilpasset behandling. Det er lagt opp til to forløpsstudier, der den ene tar utgangspunkt i en befolkningsstudie (HUNT3) og følger en gruppe personer med nyoppståtte rygg- og nakkeplager gjennom ett års tett oppfølging. Den andre forløpsstudien vil ta utgangspunkt i pasienter som søker behandling hos privatpraktiserende fysioterapeuter og vi vil følge dem gjennom og etter en behandlingsperiode. Her benyttes registreringsmetodene vi har utviklet (se ovenfor). Antallet pasienter i denne gruppen vil bli så stort at vi kan studere forskjellige pasientgrupper (f. eks. nakke- eller ryggplager), og derved sammenligne med andre studier i FYSIOPRIM (og utenfor). Gjennom forløpsstudiene vil vi også identifisere prediktorer for langvarige plager. Modeller for samarbeid Et helt sentralt mål for FYSIOPRIM er å prøve ut ulike samarbeidsmodeller mellom fysioterapeuter i primærhelsetjenesten og forskere. Slik vil vi skape grunnlag for bedre samarbeid og derved sikre varig økt forskningsinnsats i primærhelsetjenesten, og bedre tjenester i fremtiden. Dette gjøres på flere måter. For det første har vi gjennom hele prosjektperioden et formalisert samarbeid med fysioterapeuter fra primærhelsetjenesten. Disse deltar regelmessig i diskusjoner i alle faser av prosjektet og har derved en gjennomgående påvirkning på forskningen. Samarbeidet har også ført til at forskerne har deltatt i samtaler med administrasjonen i kommunene om hvordan vi best kan samarbeide om forskning og bruk av forskningsresultater. Vi har nylig utlyst hospitantstillinger for å prøve ut samarbeidsformer mellom klinikere og forskere enda bredere. Det er vår ambisjon at det nære samarbeidet mellom forskere og klinikere vil synliggjøre gevinster i form av positive effekter for klinisk praksis, og at det bidrar til at viktige spørsmål fra primærhelsetjenesten blir tatt opp av forskerne.

• Eilertsen, Heidi; Hagve, Tor-Arne & Vøllestad, Nina Køpke (2013). Interinstrumental variability of the blast flag on Sysmex XE-5000. Full text in Research Archive
• Eilertsen, Heidi; Vøllestad, Nina Køpke & Hagve, Tor-Arne (2013). The reliability of the blast flagging on the Sysmex XE-5000 is questionable. Full text in Research Archive

View all works in NVA