Hilde Stendal Robinson

• Tyrdal, Mari Kristine; Perrier, Flavie; Røe, Cecilie; Natvig, Bård; Wahl, Astrid Klopstad & Veierød, Marit Bragelien [Vis alle 7 forfattere av denne artikkelen] (2026). Treatment trajectories among patients with musculoskeletal disorders in Norway–a register-based cohort study over 2 years. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 44(1), s. 1–15. doi: 10.1080/02813432.2026.2633751. Fulltekst i vitenarkiv Vis sammendrag

  Objective Explore treatment trajectories over a two-year follow-up among patients with musculoskeletal disorders (MSDs) in Norway and investigate the associations with education and country of origin. Design Register-based cohort study. Settings Data were obtained from three national registers, the Norwegian Control and Payment of Health Reimbursements Database (KUHR), the Norwegian Patient Registry (NPR) and Statistics Norway (SSB). Subjects Patients diagnosed with MSDs in 2015 in primary healthcare according to the International Classification of Primary Care, second edition (ICPC-2). Main outcome measures Treatment trajectory classes of healthcare use over a 2-years follow-up were generated using group-based multi-trajectory modelling, for all patients registered with MSDs and three common diagnoses: spine pain, osteoarthritis and fibromyalgia. Results From the analysis, four treatment trajectory classes of healthcare use were identified for MSD patients overall; low (75%), stable (10%), descending (9%) and high use (5%). The pattern was almost similar for the three diagnostic groups. High use was primarily caused by consistent high use of physiotherapy. For MSD patients overall, low education increased the probability of being in the low and stable use classes, while high education increased the probability of being in the descending use class. Patients with Norway as country of origin, were less likely to be in the class with low use and more likely to be in the class with descending use. Conclusion Using nationwide register data and group-based multi-trajectory modelling show that about 75% of all patients with MSD, consulting primary healthcare in Norway, were classified as low users of healthcare services and 5% were classified as high users. Overall, both education and country of origin were associated with the treatment trajectory classes. However, high use was not associated with neither education nor country of origin.

• Unsgaard-Tøndel, Monica; Vøllestad, Nina Køpke; Robinson, Hilde Stendal; Evensen, Kari Anne Indredavik; Granviken, Fredrik & Woodhouse, Astrid [Vis alle 7 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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).

• Handeland, Hege; Evensen, Kari Anne Indredavik & Robinson, Hilde Stendal (2025). Focus on physiotherapy and manual therapy for infants in Norway, a cross-sectional study on referral practice, and planned interventions. BMC Pediatrics. 25, s. 1–7. doi: 10.1186/s12887-025-05627-3. Fulltekst i vitenarkiv Vis sammendrag

  Background The Norwegian health care system has a mandatory program for close and systematically follow-up on all children, starting in early infancy through the Child Health Care Centers in the municipalities. Additionally, some infants are referred to physiotherapists and manual therapists for several reasons. Little is known about who is referring them and the cause for the referral. In Norway, physiotherapists working with infants can be employed in the communities or work in outpatient clinics, both are within the primary health care system. The main purpose of the present study was to explore the referral practice of infants to physiotherapy and compare those treated by physiotherapists and manual therapists in primary health care in Norway. Furthermore, to describe the planned interventions. Methods Cross-sectional study including 444 infants (age under 12 months) referred to physiotherapists or manual therapists working in primary health care in Norway. Results Median age (range) of the infants was 14 (1, 52) weeks and 344 were born at due date. Most infants examined by a physiotherapist were referred from other health personnel and more of the referrals to manual therapists were from parents due to their concern. Age at examination was between week 1–12 for 42% of the participants. Infants referred for motor development problems were equally distributed between the physiotherapists and manual therapists. All premature infants were referred to the physiotherapists. Concerning the interventions, both physiotherapists and manual therapists planned to use advice, handling, and stimulation. More of the physiotherapists reported to focus on advice related to motor development and the use of prone play. Conclusion The infants in Norway are referred to physiotherapists and/or manual therapists for numerous reasons, and the distribution of diagnoses between the therapists seem reasonable. Infants are mostly referred by other health personnel but also because of parents’ own concern. Based on recommendations, some infants with asymmetries should be examined earlier.

• Fossmo, Hanne Ludt; Ellefsen-Martinsen, Mari; Ørstavik, Kristin; Arora, Tarun; Frich, Jan C & Robinson, Hilde Stendal (2025). Psychometric properties of MFM32 in Myotonic Dystrophy type 1. Archives of Physical Medicine and Rehabilitation. ISSN 0003-9993. doi: 10.1016/j.apmr.2025.10.013. Fulltekst i vitenarkiv Vis sammendrag

  Objective To examine the psychometric properties of the Motor Function Measure 32 (MFM32) in adults with myotonic dystrophy type 1 (DM1). MFM32 is an instrument for evaluating function in neuromuscular diseases that have not been adequately assessed in DM1. Design Cross-sectional study using video recording of the performance for evaluation of intra- and inter-rater reliability. Setting Data collection was performed at 5 different sites (3 neurologic departments, 1 rehabilitation center, 1 center for rare disorders) and in several of the participants’ home. Participants Convenience sample of 86 adults (N=86) with DM1. Interventions Not applicable. Main Outcome Measures The MFM32. The objective was to assess internal consistency, intra and inter-rater reliability, measurement error, convergent validity, and floor and ceiling effects of MFM32 in adults with DM1. We analyzed the total percentage score and the 3 domain scores: D1 (standing and transfers), D2 (axial, proximal motor function), and D3 (distal motor function). Results Internal consistency measured by Cronbach’s alpha for the total percentage score was 0.94. For the 3 domains it was 0.95 (D1), 0.70 (D2), and 0.66 (D3). The intra-rater reliability coefficients were excellent (ICC2.1=0.96-0.99), and the inter-rater reliability coefficients were good to excellent (ICC2.1=0.86-0.99). SEM of the total percentage score was 1.59 for the intra-rater reliability and 1.66 for the inter-rater reliability. Minimal detectable change was 4.42 for the intra-rater reliability and 4.6 for the inter-rater reliability. Convergent validity was medium to high. There was a tendency for a ceiling effect on the total percentage score, as well as on some of the domain percentage scores. Conclusions The MFM32 has a high internal consistency, intra- and inter- rater reliability, and convergent validity in adults with DM1. Calculated SEM and minimal detectable change were low. There is a ceiling effect of MFM32, especially in the distal function domain and among the participants with high motor function.

• Handeland, Hege; Evensen, Kari Anne Indredavik & Robinson, Hilde Stendal (2025). Focus on physiotherapy and manual therapy for infants in Norway, a cross-sectional study on referral practice, and planned interventions. BMC Pediatrics. 25(1), s. 1–7. doi: 10.1186/s12887-025-05627-3. Fulltekst i vitenarkiv Vis sammendrag

  Background The Norwegian health care system has a mandatory program for close and systematically follow-up on all children, starting in early infancy through the Child Health Care Centers in the municipalities. Additionally, some infants are referred to physiotherapists and manual therapists for several reasons. Little is known about who is referring them and the cause for the referral. In Norway, physiotherapists working with infants can be employed in the communities or work in outpatient clinics, both are within the primary health care system. The main purpose of the present study was to explore the referral practice of infants to physiotherapy and compare those treated by physiotherapists and manual therapists in primary health care in Norway. Furthermore, to describe the planned interventions. Methods Cross-sectional study including 444 infants (age under 12 months) referred to physiotherapists or manual therapists working in primary health care in Norway. Results Median age (range) of the infants was 14 (1, 52) weeks and 344 were born at due date. Most infants examined by a physiotherapist were referred from other health personnel and more of the referrals to manual therapists were from parents due to their concern. Age at examination was between week 1–12 for 42% of the participants. Infants referred for motor development problems were equally distributed between the physiotherapists and manual therapists. All premature infants were referred to the physiotherapists. Concerning the interventions, both physiotherapists and manual therapists planned to use advice, handling, and stimulation. More of the physiotherapists reported to focus on advice related to motor development and the use of prone play. Conclusion The infants in Norway are referred to physiotherapists and/or manual therapists for numerous reasons, and the distribution of diagnoses between the therapists seem reasonable. Infants are mostly referred by other health personnel but also because of parents’ own concern. Based on recommendations, some infants with asymmetries should be examined earlier.

• Fossmo, Hanne Ludt; Ørstavik, Kristin; Gurandsrud, Aagot; Frich, Jan C & Robinson, Hilde Stendal (2025). Rehabilitation technology in assessment and treatment of arm and hand function in Myotonic Dystrophy type 1: a single subject experimental design study. Journal of Neuromuscular Diseases. ISSN 2214-3599. 13(1), s. 1–12. doi: 10.1177/22143602241301675. Fulltekst i vitenarkiv Vis sammendrag

  Background: Myotonic Dystrophy type 1 (DM1) is a slowly progressive hereditary neuromuscular disorder affecting several organ systems including the musculoskeletal system. Objective: To examine the effects of rehabilitation technology on arm and hand function in the assessment and treatment of adults with DM1 with moderate to severe muscle impairment. Methods: A single subject experimental design study (SSED) with 6 participants. The assessments were done weekly through remote study assessments using the video-conference system Whereby®. Participants performed the nine-hole peg test (NHPT), active range of motion (AROM) of the shoulder and patient reported outcome measures (PROMS). Three participants also measured grip and pinch strength and performed the Nut and Bolt task. The intervention was a three-week in-patient rehabilitation stay with the use of rehabilitation technology for exercising arm and hand function. Exercises were performed in AMADEO and the ArmeoSenso. The participants exercised the upper extremities for 30 min 5 times a week. Results: Improvement on the NHPT test on the dominant hand were found for five of the six participants. Three of six improved on the non-dominant hand and in AROM. Two of the three participants that measured pinch and grip strength improved, and all three improved on the Nut and Bolt task. Self- reported function, myotonia and fatigue remained stable. All participants were able to participate in video assessments. Conclusions: Impairment in arm- and hand function affects independence in people with DM1.Our findings suggest that exercising arm- and hand using rehabilitation technology may have a positive effect on function measured by dexterity, strength, and movement in DM1. There is a need to study the effect of exercise on arm- and hand function in DM1 in larger studies. The use of video-consultations can be a supplement in assessment of people with neuromuscular conditions in research and clinical practise.

• Tyrdal, Mari Kristine; Perrier, Flavie; Røe, Cecilie; Natvig, Bård; Wahl, Astrid Klopstad & Veierød, Marit Bragelien [Vis alle 7 forfattere av denne artikkelen] (2024). Musculoskeletal disorders in Norway: trends in health care utilization and patient pathways: a nationwide register study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 42(4), s. 582–592. doi: 10.1080/02813432.2024.2368848. Fulltekst i vitenarkiv Vis sammendrag

  Objective Describe trends in health care utilization, demographic characteristics and patient pathways among patients with musculoskeletal disorders (MSD) in Norway. Design Register-based cohort study. Settings Data were obtained from two Norwegian National registries; the Norwegian Control and Payment of Health Reimbursements Database (KUHR) and the Norwegian Patient Registry (NPR). Subjects Patients with MSD according to ICPC-2 and ICD-10 during 2014–2017. Main outcome measures Patient pathways from the first contact and the following two years, described in a Sankey Diagram for all MSD patients and three common diagnoses: spine pain, osteoarthritis (OA) and fibromyalgia (FM). Result About 26% of the Norwegian population consulted PHC annually while 7% were treated in SHC. Mean age was 47 and 53 years in PHC and SHC, respectively. The proportion of women increased by age. Spine pain was the most common diagnosis; 33% and 22% in PHC and SHC, respectively. Over 90% visited a GP first, 50% of them were treated by PT and/or in SHC during follow-up. Patients visiting the PT first were less likely to be treated in SHC. OA patients were most likely to be treated by more than one health care professional (>70%). Conclusion One third of the Norwegian population consulted health care services due to MSD annually between 2014–2017. GP was the most consulted health care professional. Among MSD patients with long-term use of health care services, 50% were treated by a PT and/or in SHC in addition to a GP.

• 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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• 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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• 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, s. 63–71. doi: 10.1007/s10903-023-01535-9. Fulltekst i vitenarkiv
• Øyehaug, Gro Askland; Robinson, Hilde Stendal; Leren, Lena & Vøllestad, Nina Køpke (2023). Arbeidsevne hos muskelskjelettpasienter i primærhelsetjenesten. En kohortestudie. Fysioterapeuten. ISSN 0016-3384. 5, s. 46–53. Fulltekst i vitenarkiv Vis sammendrag

  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 [Vis alle 7 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Gregersen, Martin; Robinson, Hilde Stendal & Molund, Marius (2023). Concomitant Unstable and Stable Gravity Stress Tests on Weight-Bearing Stable Weber B Ankle Fractures Treated Nonoperatively: A 2-Year Outcome Study. Journal of Bone and Joint Surgery. American volume. ISSN 0021-9355. 105(18), s. 1435–1441. doi: 10.2106/JBJS.23.00195. Fulltekst i vitenarkiv Vis sammendrag

  Background: Replacing gravity stress tests with weight-bearing radiographs to evaluate the stability of Weber B (also called Lauge-Hansen supination-external rotation [SER]) ankle fractures results in a lower surgery rate, thus avoiding associated risks and complications. Still, nonoperative treatment of weight-bearing stable fractures is controversial because of the scarcity of strong evidence. We investigated the influence of a concomitant unstable gravity stress test compared with a stable gravity stress test on outcomes after nonoperative treatment of weight-bearing stable fractures. Methods: We performed a prospective, noninferiority study on 149 patients with Weber B ankle fractures and stable weight-bearing radiographs. Gravity stress radiographs classified fractures as stable (SER2 [n = 88]) or partially unstable (SER4a [n = 61]). All were treated with a functional orthosis and weight-bearing was allowed; patients were followed for 2 years. The primary outcome was the Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ), with a range from 0 to 100, in which lower scores indicate fewer symptoms. A noninferiority margin was prospectively defined as 7.5 points. The secondary outcomes included the Olerud-Molander Ankle Score, assessment of ankle congruence, and treatment-related adverse events. Results: The primary outcome data were available for 144 (96.6%) of 149 participants at 2 years. The between-group difference in the MOXFQ score was 1.0 point (95% confidence interval, −1.4 to 3.4 points; p = 0.397) in favor of the SER2 group, consistent with noninferiority. We found no appreciable between-group differences for any other outcome. Conclusions: In Weber B/SER ankle fractures that are stable on weight-bearing radiographs, are treated with removable orthoses, and are allowed to bear weight, a concomitant unstable gravity stress test (SER4a) was not associated with worse patient-reported or radiographic outcomes compared with a stable gravity stress test (SER2) at the 2-year follow-up. Thus, the identification of stress instability seems redundant, which questions the applicability of stress instability for surgical decision-making. Level of Evidence: Diagnostic Level II . See Instructions for Authors for a complete description of levels of evidence.

• Fossmo, Hanne Ludt; Ørstavik, Kristin; Frich, Jan C & Robinson, Hilde Stendal (2023). Translation, reliability, and validity of the Norwegian version of the ABILHAND-NMD and the ACTIVLIM for Myotonic Dystrophy type 1. Disability and Rehabilitation. ISSN 0963-8288. 46(12), s. 2699–2707. doi: 10.1080/09638288.2023.2231848. Fulltekst i vitenarkiv Vis sammendrag

  Purpose To translate ABILHAND-NMD and ACTIVLIM into Norwegian and assess their psychometric properties in adults with Myotonic Dystrophy type 1(DM1). Methods ABILHAND-NMD and ACTIVLIM were translated into Norwegian through a standardized translation process. Psychometric properties of the translated questionnaires were tested. Intraclass correlation coefficient (ICC3.1) was used to assess test-retest reliability and Cronbach’s α for internal consistency. The validity of the questionnaires was also assessed. Results A total of 39 adults with DM1 were included. We found excellent test-retest reliability on ABILHAND-NMD (ICC 0.91) and ACTIVLIM (ICC 0.93). We found a good internal consistency of ABILHAND-NMD with Cronbach’s α (95%CI) of 0.80 (0.69–0.88) and ACTIVLIM with Cronbach’s α (95%CI) of 0.88 (0.82–0.93) An expert group of healthcare professionals and a pilot group reported good face and content validity. We found a high correlation between ABILHAND-NMD and ACTIVLIM (r = 0.75), p < 0.001 implying good convergent validity. ABILHAND-NMD and ACTIVLIM showed no floor effect, but a potential for ceiling effect. Conclusion The Norwegian versions of ABILHAND-NMD and ACTIVLIM are reliable and valid patient reported outcome measures for Myotonic Dystrophy type 1. The questionnaires are easy to administer as they take a short time to answer, and the participants reported no problems understanding the questions. Implications for rehabilitation Myotonic Dystrophy type 1 cause myopathy and altered muscle function. Impaired arm- and hand function increases patients’ need for assistance and reduces independence. The use of patient reported outcome measures (PROMs) to uncover impairments and activity limitations is important in clinical practice and research. The Norwegian versions of ABILHAND-NMD and ACTIVLIM are reliable and valid measures of manual ability and activity limitations for adults with Myotonic Dystrophy type 1.

• Handeland, Hege & Robinson, Hilde Stendal (2022). Fysioterapi til de minste barna – en spørreundersøkelse blant fysioterapeuter i Bergen kommune. Fysioterapeuten. ISSN 0016-3384. Fulltekst i vitenarkiv Vis sammendrag

  Vitenskapelig artikkel

• 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), s. 37–37. doi: 10.1186/s12998-022-00443-3. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Tyrdal, Mari Kristine; Veierød, Marit Bragelien; Røe, Cecilie; Natvig, Bård; Wahl, Astrid Klopstad & Robinson, Hilde Stendal (2022). Neck and back pain: Differences between patients treated in primary and specialist health care. Journal of Rehabilitation Medicine. ISSN 1650-1977. 54, s. jrm00300–jrm00300. doi: 10.2340/jrm.v54.363. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To describe and compare patients with neck and back pain treated by physiotherapists in primary healthcare (PHC) and in departments for physical medicine and rehabilitation in specialist healthcare (SHC) in Norway. Design: Cross-sectional study using data from the FYSIOPRIM database in PHC and the Norwegian Neck and Back Registry in SHC. Neck and back pain patients in the period 2014–18 aged ≥ 18 years were included. Demographics, lifestyle and clinical factors were investigated. Results: A total of 8,125 patients were included: 584 in PHC and 7,541 in SHC. Mean age was 47.1 and 45.5 years, respectively, with more females in PHC (72% vs 56%). Low levels of education and physical activity, high workload and receiving social benefits were associated with treatment in SHC. Treatment in SHC was most common from 3 to 12 months’ pain duration. Higher pain intensity and lower health-related quality of life were found in patients treated in SHC, no differences were found for psychological distress. Conclusion: This is the first study comparing register data in patients with neck and back pain treated in PHC and SHC. Differences were found in pain and health-related quality of life, but levels of psychological distress were similar between patients treated in PHC and those treated in SHC. LAY ABSTRACT Patients with neck or back pain have high levels of healthcare utilization, both in primary and specialist healthcare. The aim of this study was to investigate patients referred and treated by physiotherapists in primary healthcare and by specialists in specialist healthcare in Norway, to evaluate differences in the demographics, lifestyle and clinical factors of patients treated in each healthcare setting. Included patients had been diagnosed with neck or back pain from 2014 to 2018, and were aged ≥18 years. Patients in specialist care had more pain and lower health-related quality of life, but similar levels of psychological distress to those treated in primary healthcare. Furthermore, patients treated in specialist healthcare had lower socioeconomic status (education, workload, social benefits) compared with those treated in primary healthcare.

• Handeland, Hege & Robinson, Hilde Stendal (2022). Fysioterapi til de minste barna – en spørreundersøkelse blant fysioterapeuter i Bergen kommune. Fysioterapeuten. ISSN 0016-3384. 89(2), s. 44–49. Fulltekst i vitenarkiv Vis sammendrag

  Hensikt: Kartlegge fysioterapipraksis i Bergen kommune for spedbarn fra 0-12 måneder. Hvilke spedbarn henvises, når, hvorfor og av hvem - og hvilken oppfølging og behandling ble planlagt? Vi ville også undersøke andelen med spedbarnsasymmetri, og om det var sammenhenger mellom asymmetrier og andre faktorer. Design: Tverrsnittstudie. Materiale: Alle foreldre med barn mellom 0-12 måneder som ble henvist til den kommunale fysioterapitjenesten i Bergen i løpet av fire måneder i 2018 ble forspurt om deltagelse Metode: Fysioterapeutene (24) fylte ut spørreskjema med følgende temaer vedrørende barnet: Anamnese, fødsel, reguleringsvansker, klinisk undersøkelse av barnet og eventuell videre henvisning og tiltak. Deskriptiv statistikk, korrelasjon og logistisk regresjon ble benyttet. Resultater: Studien inkluderte 175 barn, gjennomsnittsalder var 18 uker ved undersøkelse. Totalt 162 barn var henvist fra helsestasjonen. Vanligste henvisningsårsak var spedbarnsasymmetri (61%). 76 av 175 spedbarn (45%) hadde ingen asymmetri. Vi fant en sammenheng mellom hodeasymmetri og favorittside og kjønn i multivariable analyser. Vanligste tiltak fra fysioterapeutene var råd og veiledning til foreldre samt tiltak for å oppnå normale bevegelsesutslag og bevegelsesutvikling. Konklusjon: De fleste henvisningene av spedbarn var på grunn av spedbarnsasymmetri. Registrerte tiltak var i hovedsak veiledning til foreldre, i tillegg til fysioterapi med den hensikt om å oppnå normale bevegelsesutslag og en symmetrisk bevegelsesutvikling. Nøkkelord: fysioterapipraksis, spedbarnsasymmetri, bevegelsesutvikling.

• 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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Bjorbækmo, Wenche Schrøder; Mengshoel, Anne Marit & Robinson, Hilde Stendal (2022). Bridging troubled water - exploring improvement and patients' experiences using patient-reported outcome measures in physiotherapy: A mixed-method study. Health Science Reports. 5(2). doi: 10.1002/hsr2.530. Fulltekst i vitenarkiv Vis sammendrag

  Background and Aims Increased use of patient-reported outcomes in health care has been emphasized. Our aim was to use the Patient-Specific Functional Scale (PSFS) to examine improvement in neck pain patients' activity limitations during physiotherapy treatment, with the purpose to explore the patients' experiences of using PSFS. The study illuminates whether and how PSFS can be useful in clinical physiotherapy. Methods Six patients participated. A mixed-method study design was applied, triangulating ontological perspectives of realism and phenomenology, quantitative and qualitative methods. Single Subject Experimental Design with PSFS as outcome measure examined changes over time and phenomenological interviews examined its meaningfulness for patients. Patients defined their personal activity limitations due to neck pain and scored difficulties several times, during the physiotherapy treatment period, using PSFS. We used visual analyses of the quantitative data and thematic analyses of the qualitative data. Integration and combination of the results from the two designs are presented in the discussion. Results In the quantitative analyses, PSFS showed improvement in most activity limitations during treatment. The qualitative analyses revealed that using PSFS required the patient to engage in different bodily awareness processes and handle the dilemma of a possible double function of scoring chosen activities. The mixed findings revealed improved functionality and that the context and the interaction between patient and therapist have a significant influence on the assessment process. Conclusions To be able to improve the utilization of PSFS, communication between patients and physiotherapists is of vital importance. When using PSFS, physiotherapists should direct their attention to the importance of interaction as always present and vital in assessments.

• Sødal, Hild Flatmark; Storvig, Gøril; Tverdal, Cathrine Buaas; Robinson, Hilde Stendal; Helseth, Eirik & Taubøll, Erik (2022). Early post-traumatic seizures in hospitalized patients with traumatic brain injury. Acta Neurologica Scandinavica. ISSN 0001-6314. 146(5), s. 485–491. doi: 10.1111/ane.13670. Fulltekst i vitenarkiv Vis sammendrag

  Objectives Early post-traumatic seizures (EPTS) are a well-known complication of traumatic brain injury (TBI). EPTS increase the risk of secondary brain injury and may cause significant challenges during the period of critical care. Routine use of prophylactic anti-seizure medication is controversial due to conflicting reports on efficacy and risk of adverse effects. The purpose of this study was to expand the understanding of EPTS by examining incidence and risk factors in hospitalized patients with TBI. Material & Methods Adult patients with TBI and evidence of intracranial injury admitted to Oslo University Hospital between 2015 and 2019 were identified from the Oslo TBI Registry - Neurosurgery. Demographic and clinical data including occurrence of seizures were retrieved from the registry. The patients did not receive routine seizure prophylaxis. Univariate and multivariable logistic regression analyses were used to investigate risk factors associated with EPTS. Results 103 of 1827 patients (5.6%) had new-onset seizures within the first week after TBI. The following factors were in multivariable analyses associated with EPTS; alcohol abuse (odds ratio [OR] 3.6, 95% CI 2.3–5.7, p < .001), moderate and severe brain injury (OR 2.2, 95% CI 1.3–3.8, p = .004 and OR 2.1, 95% CI 1.2–3.6, p = .012), brain contusion (OR 1.6, 95% CI 1.0–2.4, p = .046) and subdural hematoma (OR 1.6, 95% CI 1.0–2.6, p = .052). Conclusion In our material, EPTS occurred in 5.6% of hospital-admitted TBI-patients. Alcohol abuse was the most significant risk factor, followed by moderate and severe brain injury. The results of this study contribute to the discussion about preventive treatment of EPTS in certain risk groups.

• Unsgaard-Tøndel, Monica; Vasseljen, Ottar; Nilsen, Tom Ivar Lund; Myhre, Gard; Robinson, Hilde Stendal & Meisingset, Ingebrigt (2021). Prognostic ability of STarT Back Screening Tool combined with work-related factors in patients with low back pain in primary care: a prospective study. BMJ Open. 11(6). doi: 10.1136/bmjopen-2020-046446. Fulltekst i vitenarkiv Vis sammendrag

  Objective: Primary care screening tools for patients with low back pain may improve outcome by identifying modifiable obstacles for recovery. The STarT Back Screening Tool (SBST) consists of nine biological and psychological items, with less focus on work-related factors. We aimed at testing the prognostic ability of SBST and the effect of adding items for future and present work ability. Methods: Prospective observational study in patients (n=158) attending primary care physical therapy for low back pain. The prognostic ability of SBST and the added prognostic value of two work items; expectation for future work ability and current work ability, were calculated for disability, pain and quality of life outcome at 3 months follow-up. The medium and high-risk group in the SBST were collapsed in the analyses due to few patients in the high-risk group. The prognostic ability was assessed using the explained variance (R2) of the outcomes from univariable and multivariable linear regression and beta values with 95% CIs were used to assess the prognostic value of individual items. Results: The SBST classified 107 (67.7%) patients as low risk and 51 (32.3%) patients as medium/high risk. SBST provided prognostic ability for disability (R2=0.35), pain (R2=0.25) and quality of life (R2=0.28). Expectation for return to work predicted outcome in univariable analyses but provided limited additional prognostic ability when added to the SBST. Present work ability provided additional prognostic ability for disability (β=-2.5; 95% CI=-3.6 to -1.4), pain (β=-0.2; 95% CI=-0.5 to -0.002) and quality of life (β=0.02; 95% CI=0.001 to 0.04) in the multivariable analyses. The explained variance (R2) when work ability was added to the SBST was 0.60, 0.49 and 0.47 for disability, pain and quality of life, respectively. Conclusions: Adding one work ability item to the SBST gives additional prognostic information across core outcomes. Clinical trial number: NCT03626389.

• Julsvoll, Elisabeth Heggem & Robinson, Hilde Stendal (2021). The Dental stick test – useful to reveal intra-articular conditions in persons with temporomandibular conditions? Musculoskeletal Science and Practice. ISSN 2468-8630. 56. doi: 10.1016/j.msksp.2021.102435. Fulltekst i vitenarkiv
• Rimehaug, Stein Arne; Kaat, Aaron J.; Nordvik, Jan Egil; Klokkerud, Mari & Robinson, Hilde Stendal (2021). Psychometric properties of the PROMIS-57 questionnaire, Norwegian version. Quality of Life Research. ISSN 0962-9343. s. 1–12. doi: 10.1007/s11136-021-02906-1. Fulltekst i vitenarkiv
• Remus, Alexandria; Smith, Valerie; Gutke, Annelie; Mena, Juan Jose Saldaña; Mørkved, Siv & Wikmar, Lena Nilsson [Vis alle 11 forfattere av denne artikkelen] (2021). A core outcome set for research and clinical practice in women with pelvic girdle pain: PGP-COS. PLOS ONE. 16(2), s. 1–13. doi: 10.1371/journal.pone.0247466. Fulltekst i vitenarkiv Vis sammendrag

  Background Inconsistent reporting of outcomes in clinical trials of women with Pelvic Girdle Pain (PGP) hinders comparison of findings and the reliability of evidence synthesis. A core outcome set (COS) can address this issue as it defines a minimum set of outcomes that should be reported in all clinical trials on the condition. The aim of this study was to develop a consensus-based COS for evaluating the effectiveness of interventions in PGP during pregnancy and postpartum for use in research and clinical practice. Methods A systematic review of previous studies on PGP and semi-structured interviews with women were undertaken to identify all outcomes that were reported in prior studies and that are relevant to those experiencing the condition. Key stakeholders (clinicians, researchers, service providers/policy makers and individuals with PGP) then rated the importance of these outcomes for including in a preliminary PGP-COS using a 3-round Delphi study. The final COS was agreed at a face-to-face consensus meeting. Results Consensus was achieved on five outcomes for inclusion in the final PGP-COS. All outcomes are grouped under the “life impact” domain and include: pain frequency, pain intensity/severity, function/disability/activity limitation, health-related quality of life and fear avoidance. Conclusion This study identified a COS for evaluating the effectiveness of interventions in pregnancy-related and postpartum-related PGP in research and clinical settings. It is advocated that all trials, other non-randomised studies and clinicians in this area use this COS by reporting these outcomes as a minimum. This will ensure the reporting of meaningful outcomes and will enable the findings of future studies to be compared and combined. Future work will determine how to measure the outcomes of the PGP-COS.

• 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, s. 1–12. doi: 10.1186/s12891-021-04048-4. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Robinson, Hilde Stendal; Lindgren, Anne & Bjelland, Elisabeth Krefting (2021). Generalized joint hypermobility and risk of pelvic girdle pain in pregnancy: does body mass index matter? Physiotherapy Theory and Practice. ISSN 0959-3985. 38(12), s. 2222–2229. doi: 10.1080/09593985.2021.1913774. Fulltekst i vitenarkiv
• 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), s. 345–354. doi: 10.1515/sjpain-2020-0094. Fulltekst i vitenarkiv Vis sammendrag

  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 [Vis alle 7 forfattere av denne artikkelen] (2021). The clinical course of neck pain: Are trajectory patterns stable over a 1-year period? European Journal of Pain. ISSN 1090-3801. s. 1–12. doi: 10.1002/ejp.1879. Fulltekst i vitenarkiv Vis sammendrag

  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 [Vis alle 8 forfattere av denne artikkelen] (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, s. 1–8. doi: 10.1016/j.clinbiomech.2020.105168. Fulltekst i vitenarkiv Vis sammendrag

  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 [Vis alle 11 forfattere av denne artikkelen] (2020). Novel approach towards musculoskeletal phenotypes. European Journal of Pain. ISSN 1090-3801. 24, s. 921–932. doi: 10.1002/ejp.1541. Fulltekst i vitenarkiv Vis sammendrag

  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 [Vis alle 8 forfattere av denne artikkelen] (2020). Neck pain patterns and subgrouping based on weekly SMS-derived trajectories. BMC Musculoskeletal Disorders. 21, s. 1–14. doi: 10.1186/s12891-020-03660-0. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Tangen, Gro Gujord; Hurum, Jon-Håvard; Karlsen, Ragnhild; Haugan, Kjersti; Frogh, Einar & Skarbekk, Anne Kari [Vis alle 7 forfattere av denne artikkelen] (2020). Fysisk funksjon hos eldre som går til fysioterapeut i Kongsberg kommune - en tverrsnittundersøkelse. Fysioterapeuten. ISSN 0016-3384. 8, s. 70–75. Fulltekst i vitenarkiv
• Myhrvold, Birgitte Lawaetz; Irgens, Pernille Marie; Robinson, Hilde Stendal; Engebretsen, Kaia Beck; Natvig, Bård & Kongsted, Alice [Vis alle 7 forfattere av denne artikkelen] (2020). Visual trajectory pattern as prognostic factors for neck pain. European Journal of Pain. ISSN 1090-3801. 24(9), s. 1752–1764. doi: 10.1002/ejp.1622. Fulltekst i vitenarkiv Vis sammendrag

  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.

• 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, s. 110–116. doi: 10.1016/j.msksp.2019.03.006. Fulltekst i vitenarkiv Vis sammendrag

  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. s. 1–9. doi: 10.1080/21679169.2018.1554000. Fulltekst i vitenarkiv
• Vegstein, Kristine; Robinson, Hilde Stendal & Jensen, Roar (2019). Neurodynamic tests for patellofemoral pain syndrome: A pilot study. Chiropractic & Manual Therapies. 27(26). doi: 10.1186/s12998-019-0242-2. Fulltekst i vitenarkiv Vis sammendrag

  Background Patellofemoral pain syndrome (PFPS) is a common musculoskeletal disorder. There is little consensus on the etiology, but one explanatory model suggests that PFPS can be caused by referred pain. Neurodynamic tests are used to explore the mechanosensitivity of peripheral nerves, and previous studies have shown a relationship between increased mechanosensitivity and anterior knee pain by using the femoral slump test (FST). Previously the prone knee bend test (PKB) does not appear to have been included. The main purpose of this pilot study was to examine whether there was an identifiable difference in mechanosensitivity between left and right sides that could be identified using both the PKB and FST tests for the femoral nerve in patients with unilateral PFPS. Methods This cross-sectional pilot study tested 12 patients with unilateral PFPS for altered mechanosensitivity using both PKB and FST. The pain-free knee was used as a control. The selected test procedures were similar to those clinicians use in everyday practice. Results 8 and 4 of the 12 patients were found to have increased levels of mechanosensitivity in the PFPS leg using the PKB and FST, respectively. Both tests provoked stronger pain in the leg with PFPS compared with the asymptomatic leg (p < 0.05 Wilcoxon Signed Rank Test). The symptoms were more often located in the anterior knee, with structural differentiation by neck flexion appearing to increase the symptoms more when testing the leg with PFPS. Conclusions Although the reliability of the tests is unknown and the study sample size was small, the PKB and FST test procedures used in clinical practice appear capable of revealing altered mechanosensitivity in unilateral PFPS patients. The PKB test appears to detect mechanosensitivity in more patients than the FST. We recommend including both tests in future larger blinded controlled studies which should also assess reliability of the tests. Trial registration ISRCTN 12473526. Registered 20 May 2015, retrospectively registered.

• Robinson, Hilde Stendal & Tangen, Gro Gujord (2019). Fysisk aktive eldre og treningsvaner? Fysioterapeuten. ISSN 0016-3384. 86(4), s. 24–28. Fulltekst i vitenarkiv Vis sammendrag

  Hensikt: Undersøke hva som kjennetegner eldre personer som har trent regelmessig over tid og om helsemyndighetenes anbefalinger om fysisk aktivitet følges. Er det forskjell på de som trener hos fysioterapeut og de som har abonnement på treningssenter? Design: Tverrsnittstudie. Materiale: 105 personer over 70 år som har trent regelmessig i minst ett år. Median (range) alder var 74 (70-90) år. Metode: Spørreskjemaer og fysiske tester (styrke, utholdenhet, balanse, mobilitet). Resultat: Median (range) antall år med trening var 20 (1-70) år. 64% hadde muskelskjelettplager og 46% var kvinner. Oppgitt varighet, intensitet og hyppighet av trening samsvarer stort sett med myndighetenes anbefalinger. De fleste trente utholdenhet og styrke, kun halvparten oppga å trene balanse. En større andel av gruppen som trente hos fysioterapeut oppga medisinske grunner som motivasjon for trening. Det var ingen forskjell mellom gruppene på de fysiske testene. Konklusjon: Resultatene viser at oppgitt varighet, intensitet og frekvensen av treningen i stor grad samsvarer med anbefalingene fra Helsedirektoratet. Det var ingen forskjeller på eldre som trente hos fysioterapeut og de som trente på treningssenter, bortsett fra motivasjon for trening. Balanse og bevegelighet er dårligst ivaretatt og bør antagelig oppmuntres i større grad også hos aktive eldre.

• 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, s. 22–27. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Tangen, Gro Gujord & Robinson, Hilde Stendal (2019). Measuring physical performance in highly active older adults: associations with age and gender? Aging Clinical and Experimental Research. ISSN 1594-0667. doi: 10.1007/s40520-019-01190-x. Fulltekst i vitenarkiv Vis sammendrag

  Background Higher age is associated with reduced physical capability in the general population. The role of age and gender for physical performance in older adults who exercises regularly is, however, not clear, and there is also a lack of recommendations for outcomes to address physical performance for this population. Aims To explore the associations between physical performance, age and gender, and to examine the suitability and feasibility of clinical field tests for physical performance in active older adults. Methods In this cross-sectional study we included 105 persons, 70–90 years of age, who had exercised regularly for ≥ 12 months. The field tests were Short Physical Performance Battery (SPPB), Timed Up and Go and gait speed for mobility; One-leg standing (OLS) test and Mini-BESTest for balance; Stair test for endurance, 30 s sit-to-stand, and grip strength for muscle strength. Results We found associations between age and physical performance, and the associations were slightly stronger for women. Men performed better on tests of muscle strength, balance and endurance, while no gender differences were found in mobility. Grip strength was not associated with mobility tests for men. All tests were feasible, while SPPB and OLS had ceiling and floor effects that limit their suitability in this population. Conclusions Both age and gender were associated with physical performance. We recommend using the gait speed, Mini-BESTest, 30 s sit-to-stand, grip strength and stair tests to assess physical performance in physically active older adults.

• 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), s. E1298–E1310. doi: 10.1097/BRS.0000000000003144. Fulltekst i vitenarkiv Vis sammendrag

  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 [Vis alle 7 forfattere av denne artikkelen] (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, s. 45–52. doi: 10.1016/j.clinbiomech.2019.05.030. Fulltekst i vitenarkiv Vis sammendrag

  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. Fulltekst i vitenarkiv Vis sammendrag

  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. Fulltekst i vitenarkiv Vis sammendrag

  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. Fulltekst i vitenarkiv Vis sammendrag

  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 [Vis alle 11 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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).

• Bjorbærkmo, Wenche Schrøder; Robinson, Hilde Stendal & Engebretsen, Eivind (2018). Which knowledge? An examination of the knowledge at play in physiotherapy with children. Physiotherapy Theory and Practice. ISSN 0959-3985. 34(10), s. 773–782. doi: 10.1080/09593985.2018.1423654. Fulltekst i vitenarkiv
• 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, s. 65–68. doi: 10.1016/j.mehy.2018.03.004. Fulltekst i vitenarkiv Vis sammendrag

  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 [Vis alle 10 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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), s. 232–237. doi: 10.1080/09638288.2016.1250123. Fulltekst i vitenarkiv
• Mahmood, Aqsa; Moen, Aurora Lie; Stafne, Signe Nilssen; Robinson, Hilde Stendal; Vøllestad, Nina Køpke & Salvesen, Kjell Å [Vis alle 8 forfattere av denne artikkelen] (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), s. 93–98. doi: 10.1515/sjpain-2017-0168. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Robinson, Hilde Stendal & Dagfinrud, Hanne (2017). Reliability and screening ability of the StarT Back screening tool in patients with low back pain in physiotherapy practice, a cohort study. BMC Musculoskeletal Disorders. 18(1). doi: 10.1186/s12891-017-1553-x. Fulltekst i vitenarkiv Vis sammendrag

  Background Low back pain (LBP) is the most common reported musculoskeletal disorder, with large prevalence numbers and high costs. Focus on early identification of patients at risk of developing chronic LBP has increased. The Keele Start Back Tool (SBT) is a questionnaire aiming at screening prognostic indicators in LBP patients, categorizing patients into risk-groups and guide treatment. The aim of this study was to explore the Norwegian version of the SBT with regard to reliability of the SBT-scoring and the screening ability in LBP patients in primary care physiotherapy. Methods LBP patients answered a package of questionnaires twice, with 1-3 days in between, containing SBT, Hannover functional ability questionnaire, pain intensity questions and demographics. The relative and absolute reliability of SBT was calculated using intraclass correlation coefficient (ICC) and the smallest detectable change respectively. Independent sample t-tests were used for group comparisons. Results Fifty-two patients with LBP. Mean age (SD) was 45 (12) years and 62% were female. The ICC (95% CI) for SBT total score and psychosocial subscore was 0.89 (0.82, 0.94) and 0.82 (0.70, 0.90) respectively. None of the participants were allocated to the high risk group. The medium risk group reported significantly more pain last week and more activity limitations than the low risk group at both test and retest (0.001 ≤ p ≤ 0.003), whereas no significant difference between the groups was found on pain now (0.05 ≤ p ≤ 0.16). Conclusions The Norwegian version of the SBT was reliable and the screening ability was good as the subgrouping of patients into risk-groups reflected the severity of their back problems. The SBT may be an applicable and useful tool in physiotherapy practice.

• Balasundaram, Arun Prasad & Robinson, Hilde Stendal (2017). Effectiveness of physical therapy interventions for pregnancy-related pelvic girdle pain (PEDro synthesis). British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2017-098287. Fulltekst i vitenarkiv
• Bjorbærkmo, Wenche Schrøder; Robinson, Hilde Stendal & Engebretsen, Eivind (2017). A phenomenological and critical examination of knowledge expressed and exchanged in physiotherapy with children. European Journal of Physiotherapy. ISSN 2167-9169. 19, s. 36–38. doi: 10.1080/21679169.2017.1381326. Fulltekst i vitenarkiv
• Robinson, Hilde Stendal; Coward, Camilla; Bjorbærkmo, Wenche Schrøder & Langeland, Eva (2017). Long term sick leave, subjective health complaints and sense of coherence, a cross-sectional study. Cogent Medicine. 4. doi: 10.1080/2331205X.2017.1308082. Fulltekst i vitenarkiv Vis sammendrag

  Background: Long-term work absence is increasing in Western countries. More people suffer from subjective health complaints, such as musculoskeletal pain and depression-like symptoms. Social rights and benefits are based on medical diagnoses; hence large resources are used to identify the biological causes. An alternative approach towards medicalization and diagnosis, like Salutogenesis, with the key factor “Sense of coherence” (SOC) should be approved. Purpose: To explore the level of SOC, anxiety and depression, as well as the associations between SOC and general resistance resources (GRRs) and deficits, in people with subjective health complaints on long term sick leave. Material and methods: Cross-sectional study, including data from 892 participants from the Friskgården (Norwegian health promotion center) database. The questionnaire included the SOC-13, the Hospital Anxiety and Depression Scale and questions about demographics and sick leave. Multivariable linear regression models were used. Results: Participants’ mean (SD) age was 49 (10) years, 70% were women. Mean SOC was 59.4 (13.3). The mean anxiety and depression for all participants were 8.7 (4.4) and 6.2 (3.8) respectively. No difference was found in SOC in participants on sick leave less than, compared with more than one year (p = 0.07). Conclusions: People on long-term sick leave have lower SOC and higher level of anxiety and depression than previously shown in general populations. Large parts of the SOC variation are explained by GRRs and deficits, indicating potentials for improvement by for instance participation in Salutogenic/resource oriented therapy.

• 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), s. 182–189. doi: 10.1080/10669817.2017.1322346. Fulltekst i vitenarkiv Vis sammendrag

  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

• 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), s. 20–25. Fulltekst i vitenarkiv Vis sammendrag

  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, s. 109–119. doi: 10.1016/j.math.2015.06.005. Fulltekst i vitenarkiv
• Haukaas, Fredrik Salvesen; Vøllestad, Nina Køpke; Robinson, Hilde Stendal & Aas, Eline (2015). Helseøkonomisk evaluering i fysioterapi. Fysioterapeuten. ISSN 0016-3384. 82(10), s. 22–27. Fulltekst i vitenarkiv
• 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, s. 529–531. doi: 10.1111/jep.12362. Fulltekst i vitenarkiv
• Engh, Lisette; Strand, Liv Inger; Robinson, Hilde Stendal; Tveter, Anne Therese; Moseng, Tuva & Dagfinrud, Hanne (2015). Back Performance Scale (BPS): Funksjonsvurdering av pasienter med ryggplager i primærhelsetjenesten. Fysioterapeuten. ISSN 0016-3384. 82(9), s. 22–27. Fulltekst i vitenarkiv Vis sammendrag

  Spørsmål: Er Back Performance Scale (BPS) egnet til å vurdere funksjon hos pasienter som behandles for ryggproblemer hos fysioterapeuter i primærhelsetjenesten? Design: Tverrsnittsstudie. Materiale og metode: To fysioterapeuter samlet data på flere fysioterapiklinikker i Hedmark og Oslo fra til sammen 52 pasienter med ryggplager. Pasientene utførte BPS-testene og rapporterte sin funksjon på spørreskjemaet Hannover på to tidspunkt med en til tre dagers mellomrom (test-retest). Resultat: Ryggpasienter som ble behandlet av fysioterapeuter i primærhelsetjenesten hadde moderat grad av funksjonsproblemer i daglige aktiviteter, både ut fra skårene på testbatteriet BPS og på spørreskjemaet Hannover. En stor andel av pasientene hadde ingen eller lite problemer med å utføre de enkelte fysiske testene i BPS, men sumskåren ga et bredere bilde av funksjonsevnen. BPS har en betydelig takeffekt for denne gruppen. De fysiske testene korrelerte høyt med pasientenes egenrapporterte funksjon, og ser derved ut til å fange opp relevante funksjoner. Test-retest stabiliteten for BPS var svært god og målefeilen akseptabel. Konklusjon: BPS er et valid testbatteri som er egnet til å kartlegge funksjonsevne relatert til dagliglivsaktiviteter hos pasienter som behandles for sine ryggplager i primærhelsetjenesten. Testbatteriet har god test-retest stabilitet og målefeilen er akseptabel, men på grunn av takeffekt, er det ikke egnet som effektmål hos alle pasienter i primærhelsetjenesten.

• Wahl, Astrid Klopstad; Langeland, Eva; Larsen, Marie Hamilton; Robinson, Hilde Stendal; Osborne, Richard H & Polesie, Anne Lene Krogstad (2015). Positive Changes in Self-management and Disease Severity Following Climate Therapy in People with Psoriasis. Acta Dermato-Venereologica. ISSN 0001-5555. 95(3), s. 317–321. doi: 10.2340/00015555-1939. Fulltekst i vitenarkiv Vis sammendrag

  The aim of this study was to investigate the impact of climate therapy on self-management in people with psoriasis. This was a prospective study of 254 adults with chronic psoriasis who participated in a 3-week climate therapy (CT) programme. The 8-scale Health Education Impact Questionnaire (heiQ) was completed at baseline, after 3 weeks of CT, and 3 months later. Change was assessed using paired sample t-tests mean (95% confidence interval) change scores (range 1–4). All heiQ scales showed statistically significant improvement after 3 weeks of CT. The greatest improvement was in Health-directed activity, followed by Emotional distress, and Skill and technique acquisition. At the 3-month follow-up, only the Emotional distress scale remained improved. In addition, disease severity (self-administered PASI; SAPASI) improved significantly from before CT to 3 weeks and 3 months after CT. This study suggests that CT provides a range of benefits that are important to people with psoriasis, particularly in the short term. A challenge is how to achieve long-term benefits.

• 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), s. 468–474. doi: 10.2340/16501977-1801. Fulltekst i vitenarkiv
• 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), s. 190–196. doi: 10.1016/j.math.2014.01.004. Fulltekst i vitenarkiv
• Bathen, Trine; Velvin, Gry; Rand-Hendriksen, Svend & Robinson, Hilde Stendal (2014). Fatigue in adults with Marfan syndrome, occurrence and associations to pain and other factors. American Journal of Medical Genetics. Part A. ISSN 1552-4825. 164A(8), s. 1931–1939. doi: 10.1002/ajmg.a.36574. Fulltekst i vitenarkiv Vis sammendrag

  This study aims to investigate how fatigue affects adults with verified Marfan syndrome (MFS) in their daily lives, by examining fatigue levels and prevalence of severe fatigue compared to the general Norwegian population and individuals with other comparable chronic conditions. We investigated associations between socio-demographic characteristics, Marfan-related health problems, pain and fatigue. A cross-sectional study was conducted, using a postal questionnaire including the Fatigue Severity Scale (FSS) and questions on socio-demographic characteristics, Marfan-related health problems and pain. One hundred seventeen persons with MFS were invited to participate, 73 answered (62%). Participants reported significantly higher FSS scores and prevalence of severe fatigue compared to the general Norwegian population and patients with rheumatoid arthritis (RA), but lower than for other chronic conditions. Participants with chronic pain reported higher fatigue scores than those without chronic pain. Participants on disability benefits reported higher fatigue scores than participants who were working or enrolled in higher education. Marfan-related health problems like aortic dissection and use of blood pressure medication were not significantly associated with fatigue. In multivariable regression analyses chronic pain and employment status were significantly associated with fatigue. The final multivariable model explained 24% of the variance in fatigue scores. Our results show that fatigue is common in MFS patients and that it interferes with their daily lives. Chronic pain and employment status show significant associations to fatigue. This implies that fatigue is important to address when meeting MFS patients in clinical practice. There is need for more research on fatigue in Marfan syndrome. © 2014 Wiley Periodicals, Inc.

• Wahl, Astrid Klopstad; Robinson, Hilde Stendal; Langeland, Eva; Larsen, Marie Hamilton; Polesie, Anne Lene Krogstad & Moum, Torbjørn Åge (2014). Clinical characteristics associated with illness perception in psoriasis. Acta Dermato-Venereologica. ISSN 0001-5555. 94(3), s. 271–275. doi: 10.2340/00015555-1673. Fulltekst i vitenarkiv Vis sammendrag

  Knowledge of illness perception may aid the identification of groups of patients with a higher risk of coping poorly with the demands of their illness. This study aims to investigate associations between illness perception, clinical characteristics, patient knowledge, quality of life and subjective health in persons with psoriasis. The present study was based on cross-sectional data from patients awaiting climate therapy in Gran Canaria. We included 254 eligible patients (74%) who completed a questionnaire including the revised Illness Perception Questionnaire, the Psoriasis Knowledge Questionnaire, and the Dermatological Life Quality Index. Disease severity was measured using the Psoriasis Area and Severity Index. Several statistically significant associations between clinical characteristics, knowledge and various illness perception dimensions were found. Illness perception was also significantly related to disease-specific quality of life and subjective health. These findings contradict previous findings, which suggested that objective disease factors are not relevant to illness perception in psoriasis. © 2014 The Authors

• Robinson, Hilde Stendal & Mengshoel, Anne Marit (2014). Assessments of lumbar flexion range of motion: Intertester reliability and concurrent validity of 2 commonly used clinical tests. Spine. ISSN 0362-2436. 39(4), s. 270–275. doi: 10.1097/BRS.0000000000000131. Fulltekst i vitenarkiv
• Langeland, Eva; Robinson, Hilde Stendal; Moum, Torbjørn Åge; Larsen, Marie Hamilton & Wahl, Astrid Klopstad (2013). Mental health among people with psoriasis undergoing patient education in climate therapy. Scandinavian Journal of Psychology. ISSN 0036-5564. 54(6), s. 508–514. doi: 10.1111/sjop.12073. Fulltekst i vitenarkiv
• Langeland, Eva; Robinson, Hilde Stendal; Moum, Torbjørn Åge; Larsen, Marie Hamilton; Polesie, Anne Lene Krogstad & Wahl, Astrid Klopstad (2013). Promoting sense of coherence: Salutogenesis among people with psoriasis undergoing patient education in climate therapy. BMC Psychology. 1(11). doi: 10.1186/2050-7283-1-11. Fulltekst i vitenarkiv Vis sammendrag

  Background There is a need for further investigation of sense of coherence (SOC), the central concept of salutogenesis, and its relationship with long-term illnesses such as psoriasis. The aim of this study is to investigate the development of SOC during patient education in the context of climate therapy and to explore factors that may predict changes in SOC among people with psoriasis. Methods A prospective design included a baseline assessment and two follow-ups after a 3-week patient education and climate therapy programme (follow-up 1) and again 3 months later (follow-up 2). A total of 254 adults (aged 20–80) with psoriasis participated. SOC was measured by the SOC Questionnaire, illness perception was measured by the Revised Illness Perception Questionnaire, and positive and active engagement in life was measured by the positive and active engagement subscale of the Health Education Impact Questionnaire. Paired-sample t tests were used to evaluate changes in SOC from the baseline to follow-up. Multiple linear regression was used to analyse the ability of socio-demographic and clinical variables, illness perception and positive and active engagement in life to predict the changes in SOC. Results The SOC score changed significantly by 2.65 points, (95% CI = 0.621, 3.685) from the baseline to follow-up 1. SOC score was still improved by 1.15 points (95% CI = 0.073, 0.223) at follow-up 2. Baseline and change in positive and active engagement in life were linked to change in SOC with standardized beta 0.170 (95% CI = 0.024, 0.319) and 0.259 (95% CI = 0.092, 0.428), respectively. In addition illness coherence perception at baseline and change in emotional representations were significantly associated with the change in SOC with standardized beta 0.212 (95% CI = 0.073, 0.361) and –0.270 (95% CI = –0.481, –0,077), respectively. Conclusions SOC improved significantly from before to after patient education in the context of climate therapy. The results indicate that improving positive and active engagement in life, coping with emotional distress and a coherent understanding of the illness might provide important opportunities to improve SOC among people with psoriasis.

• Wahl, Astrid Klopstad; Moum, Torbjørn Åge; Robinson, Hilde Stendal; Langeland, Eva; Larsen, Marie Hamilton & Polesie, Anne Lene Krogstad (2013). Psoriasis patients' knowledge about the disease and treatments. Dermatology Research and Practice. ISSN 1687-6105. doi: 10.1155/2013/921737. Fulltekst i vitenarkiv Vis sammendrag

  Patients’ knowledge about psoriasis and its treatment has been randomly studied previously. The aim of the study is to investigate patients’ knowledge about psoriasis in relation to undergoing patient education in the context of climate therapy (CT).Thepsoriasis knowledge questionnaire (PKQ) was used in a follow-up pre–post study design ofNorwegian patients with psoriasis at the age of 20 years and older undergoing CT at Gran Canaria (Spain). Patients completed the PKQ and provided selected demographic, clinical and health information before (T1), immediately after (T2), and 3 months after (T3) CT. Disease severity was assessed using the psoriasis area and severity index (PASI). 254 psoriasis patients were included (74%).The PKQ score improved significantly fromT1 to T2 and T3 (𝑃 < 0.001 for both comparisons). Although patient’s knowledge improved, further research should use gold standard designs (experiments) to study the effects of educational interventions in different contexts.

• Vøllestad, Nina Køpke; Torjesen, Peter A & Robinson, Hilde Stendal (2012). Association between the serum levels of relaxin and responses to the active straight leg raise test in pregnancy. Manual Therapy. ISSN 1356-689X. 17(3), s. 225–230. doi: 10.1016/j.math.2012.01.003. Fulltekst i vitenarkiv
• Robinson, Hilde Stendal; Mengshoel, Anne Marit; Bjelland, Elisabeth Krefting & Vøllestad, Nina Køpke (2010). Pelvic girdle pain, clinical tests and disability in late pregnancy. Manual Therapy. ISSN 1356-689X. 15(3), s. 280–285. doi: 10.1016/j.math.2010.01.006. Fulltekst i vitenarkiv
• Robinson, Hilde Stendal; Veierød, Marit Bragelien; Mengshoel, Anne Marit & Vøllestad, Nina Køpke (2010). Pelvic girdle pain - associations between risk factors in early pregnancy and disability or pain intensity in late pregnancy: a prospective cohort study. BMC Musculoskeletal Disorders. 11. doi: 10.1186/1471-2474-11-91. Fulltekst i vitenarkiv Vis sammendrag

  Background Recent studies have shown high prevalence rates for pelvic girdle pain (PGP) in pregnancy. Some risk factors for developing PGP have been suggested, but the evidence is weak. Furthermore there is almost no data on how findings from clinical examinations are related to subsequent PGP. The main purpose for this study was to study the associations between socio-demographical, psychological and clinical factors measured at inclusion in early pregnancy and disability or pain intensity in gestation week 30. Methods This is a prospective cohort study following women from early to late pregnancy. Eligible women were recruited at their first attendance at the maternity care unit. 268 pregnant women answered questionnaires and underwent clinical examinations in early pregnancy and in gestation week 30. We used scores on disability and pain intensity in gestation week 30 as outcome measures to capture the affliction level of PGP. Multiple linear regression analysis was used to study the associations between potential risk factors measured in early pregnancy and disability or pain intensity in gestation week 30. Results Self-reported pain locations in the pelvis, positive posterior pelvic pain provocation (P4) test and a sum of pain provocation tests in early pregnancy were significantly associated with disability and pain intensity in gestation week 30 in a multivariable statistic model. In addition, distress was significantly associated with disability. The functional active straight leg raise (ASLR) test, fear avoidance beliefs and the number of pain sites were not significantly associated with either disability or pain intensity. Conclusions The results suggest that a clinical examination, including a few tests, performed in early pregnancy may identify women at risk of a more severe PGP late in pregnancy. The identification of clinical risk factors may provide a foundation for development of targeted prevention strategies.

• Robinson, Hilde Stendal; Mengshoel, Anne Marit; Veierød, Marit Bragelien & Vøllestad, Nina Køpke (2010). Pelvic girdle pain: Potential risk factors in pregnancy in relation to disability and pain intensity three months postpartum. Manual Therapy. ISSN 1356-689X. 15(6), s. 522–528. doi: 10.1016/j.math.2010.05.007. Fulltekst i vitenarkiv
• Robinson, Roar; Robinson, Hilde Stendal; Bjorke, Gustav; Bjørke, Gustav; Kvale, Alice & Kvåle, Alice (2009). Reliability and validity of a palpation technique for identifying the spinous processes of C7 and L5. Manual Therapy. ISSN 1356-689X. 14(4), s. 409–414. doi: 10.1016/j.math.2008.06.002. Fulltekst i vitenarkiv Vis sammendrag

  Published before print 2008. Adresser OK./tøf ------------------------------------------------------------------------------------- Abstract The objective was to examine inter-tester reliability and validity of two therapists identifying the spinous processes (SP) of C7 and L5, using one predefined surface palpation procedure for each level. One identification method made it possible to examine the reliability and the validity of the procedure itself. Two manual therapists examined 49 patients (29 women). Aged between 26 and 79 years, 18 were cervical and 31 lumbar patients. An invisible marking pen and ultraviolet light were used, and the findings were compared. X-rays were taken as an objective measure of the correct spinal level. Percentage agreement and kappa statistics were used to evaluate reliability and validity. The best inter-therapist agreement was found for the skin marks. Percentage agreement within 10 mm and 20 mm was 67% and 85%, respectively. The inter-tester reliability for identifying a radiological nominated SP by palpation was found to be poor for C7 and moderate for L5, with kappa of 0.18 and 0.48, respectively. The results indicated acceptable inter-therapist surface palpation agreement, but the chosen procedures did not identify the correct SP. This indicates that the procedures are not precise enough. Future reliability studies should test other non-invasive palpation procedures, both individually and in combination, and compare these with radiological investigation.

Se alle arbeider i NVA

• Robinson, Hilde Stendal & Stafne, Signe (2025). Gravide og jobbnærvær: Arbeidsgivere har også en jobb å gjøre. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• Bennetter, Karin Elisabeth; Waage, Christin; Richardsen, Kåre Rønn; Jenum, Anne Karen; Vøllestad, Nina Køpke & Robinson, Hilde Stendal [Vis alle 7 forfattere av denne artikkelen] (2022). Associations between social support and physical activity among postpartum women: a cohort study. Fulltekst i vitenarkiv
• Bennetter, Karin Elisabeth; Waage, Christin; Richardsen, Kåre Rønn; Jenum, Anne Karen & Robinson, Hilde Stendal (2022). Moderate-to-vigorous physical activity level 11 years postpartum in a multiethnic sample. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• Storvig, Gøril; Sødal, Hild Flatmark; Robinson, Hilde Stendal; Tverdal, Cathrine Buaas; Helseth, Eirik & Taubøll, Erik (2022). Tidlig post-traumatiske epileptiske anfall hos pasienter med traumatisk hjerneskade. Fulltekst i vitenarkiv
• Tangen, Gro Gujord & Robinson, Hilde Stendal (2020). Correction to: Measuring physical performance in highly active older adults: associations with age and gender? (Aging Clinical and Experimental Research, (2020), 32, 2, (229-237), 10.1007/s40520-019-01190-x). Aging Clinical and Experimental Research. ISSN 1594-0667. 32(2), s. 361–362. doi: 10.1007/s40520-019-01290-8. Fulltekst i vitenarkiv
• Tangen, Gro Gujord & Robinson, Hilde Stendal (2018). Physical performance in elderly who exercise regularly - associations with age and gender. Fulltekst i vitenarkiv
• Meisingset, Ingebrigt; Robinson, Hilde Stendal; Evensen, Kari Anne Indredavik; Woodhouse, Astrid; Vasseljen, Ottar & Granviken, Fredrik [Vis alle 15 forfattere av denne artikkelen] (2018). Hvem får oppfølging av avtalefysioterapeuter i primærhelsetjenesten. Fulltekst i vitenarkiv
• Tangen, Gro Gujord & Robinson, Hilde Stendal (2018). HVILKE FYSISKE TESTER ER EGNET FOR EVALUERING AV FYSISK FUNKSJON HOS ELDRE SOM TRENER REGELMESSIG? Fulltekst i vitenarkiv
• Tangen, Gro Gujord & Robinson, Hilde Stendal (2018). Bruk av standardiserte tester. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• Meisingset, Ingebrigt; Robinson, Hilde Stendal; Evensen, Kari Anne Indredavik; Woodhouse, Astrid; Thielemann, Marit & Bones, Anita [Vis alle 15 forfattere av denne artikkelen] (2017). Pasienter hos privatpraktiserende fysioterapeuter i primærhelsetjenesten;hvem er de? Fysioterapeuten. ISSN 0016-3384. Fulltekst i vitenarkiv
• Woodhouse, Astrid; Robinson, Hilde Stendal; Evensen, Kari Anne Indredavik; Meisingset, Ingebrigt; Thielemann, Marit & Bjorbærkmo, Wenche Schrøder [Vis alle 9 forfattere av denne artikkelen] (2017). Fysioterapeuter i primærhelsetjenesten - Hva gjør vi egentlig. s. 24–26. Fulltekst i vitenarkiv
• Tangen, Gro Gujord & Robinson, Hilde Stendal (2017). Fysisk funksjon og sammenheng med alder og kjønn hos eldre som trener regelmessig. Fulltekst i vitenarkiv
• Robinson, Hilde Stendal & Tangen, Gro Gujord (2017). Eldre som trener regelmessig – hvem, hva, hvor, hvorfor? Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• Langeland, Eva; Robinson, Hilde Stendal; Moum, Torbjørn Åge; Larsen, Marie Hamilton & Wahl, Astrid Klopstad (2013). Positive mental health among people with psoriasis. Fulltekst i vitenarkiv
• Langeland, Eva; Robinson, Hilde Stendal; Moum, Torbjørn Åge; Larsen, Marie Hamilton & Wahl, Astrid Klopstad (2013). Positive mental health among people with psoriasis. Quality of Life Research. ISSN 0962-9343. 22, s. 10–11. doi: 10.1007/s11136-013-0543-1. Fulltekst i vitenarkiv
• Langeland, Eva; Robinson, Hilde Stendal; Larsen, Marie Hamilton; Polesie, Anne Lene Krogstad; Moum, Torbjørn Åge & Wahl, Astrid Klopstad (2012). Sense of coherence among people with psoriasis. Quality of Life Research. ISSN 0962-9343. 21, s. 81–82. Fulltekst i vitenarkiv Vis sammendrag

  Aims: The aims for the present study is to investigate Sense of Coherence (SOC); the central concept in salutogenesis and its relation to people with psoriasis by exploring the effect on SOC as a result of climate therapy and investigate factors that predict change in SOC among people with psoriasis. Method: The present study has a prospective design, including a baseline assessment and one follow up in relation to a 3 week climate therapy program. A total of 254 adults with psoriasis participated. SOC was measured by the Sense of Coherence questionnaire (SOC-13), illness perception by using the Revised Illness Perception Questionnaire (IPQ-R) and positive and active engagement in life was measured by the positive and active engagement subscale from the Health Education Impact Questionnaire (HeiQ) (all Norwegian versions). To evaluate possible change in SOC score from baseline to follow-up paired samples T-test was performed. With regard to investigate the predictive value of illness perception versus positive and active engagement in life on SOC, multiple linear regression analysis was used. Results: SOC improved significantly before to after climate therapy. Results show a significant statistical change (p < 0.001) in SOC from baseline to follow-up with a difference of 2.6, (95% C.I: 1.6-3.6). Furthermore, the attitude of positive and active engagement in life (standardized beta coefficient .22, P =. 0.002) and illness perception –coherence dimension (standardized beta coefficient .15, P =. 0.04) predict change in SOC. Conclusion: This is the first study that investigates the effect on SOC as a result of climate therapy. SOC significantly improved before to after climate therapy. Further the results indicate that improving positive and active engagement in life and a coherent understanding of the illness might provide important opportunities to improve SOC among people with psoriasis. We need more studies that investigate SOC among people with psoriasis undergoing climate therapy and what factors that predict positive change in SOC.

• Langeland, Eva; Robinson, Hilde Stendal; Larsen, Marie Hamilton; Polesie, Anne Lene Krogstad; Moum, Torbjørn Åge & Wahl, Astrid Klopstad (2012). Sense of coherence among people with psoriasis. Fulltekst i vitenarkiv
• Bathen, Trine; Robinson, Hilde Stendal & Rand-Hendriksen, Svend (2013). Marfans syndrom og fatigue : En tverrsnittsstudie i en gruppe voksne personer med verifisert Marfans syndrom. Universitetet i Oslo. Fulltekst i vitenarkiv Vis sammendrag

  Hensikt: Hensikten med denne studien er å få en forståelse av fenomenet opplevd fatigue (tretthet) og hvordan det arter seg for voksne med verifisert Marfans syndrom (MFS). Jeg vil undersøke grad av fatigue og forekomst av alvorlig fatigue hos voksne med MFS, og sammenligne dette med rapportert forekomst i den generelle befolkningen og for noen aktuelle kroniske tilstander. Assosiasjoner mellom fatigue og sosiodemografiske karakteristika og selvrapporterte helseproblemer hos voksne med MFS vil bli undersøkt i multivariable analyser. Metode: Tverrsnittsstudie med postutsendt spørreskjema. Fatigue Severity Scale (FSS), sosio-demografiske forhold og selvrapporterte helseproblemer ble undersøkt hos 72 voksne personer med MFS. Resultater: Deltakerne rapporterte signifikant høyere FSS gjennomsnittsskår og høyere forekomst av alvorlig fatigue (gjennomsnittsskår ≥ 5), sammenlignet med rapportert nivå for den generelle befolkningen og noen kroniske tilstander. Kronisk smerte og arbeidstilknytning hadde signifikant assosiasjon til fatigue i multivariable analyser. Personer med smerte hadde høyere fatigueskår enn personer uten kronisk smerte. Personer som mottok trygdeytelser hadde høyere fatigue enn personer som var i arbeid/ under utdanning. Den endelige multivariable modellen forklarte 24 % av variasjonen i fatigueskår. Dette indikerer at det også er andre assosierte faktorer til opplevd fatigue hos voksne med MFS. Konklusjon: Personer med MFS har høyere grad av fatigue og høyere forekomst av alvorlig fatigue, sammenlignet med den generelle befolkningen og noen kroniske tilstander som rheumatoid artritt. I multivariable analyser var kronisk smerte og arbeidstilknytning de faktorene som var signifikant assosiert med fatigue. Det er behov for videre forskning om fatigue ved MFS.

Se alle arbeider i NVA