Jens Ivar Brox

• Grotle, Margreth; Bråten, Lars Christian Haugli; Brox, Jens Ivar; Espeland, Ansgar; Zolic-Karlsson, Zinajda; Killingmo, Rikke Munk; Tingulstad, Alexander; Grøvle, Lars; Johanessen, Anne Froholdt; Kristoffersen, Per Martin; Wigemyr, Monica; van Tulder, Maurits W.; Storheim, Kjersti & Zwart, John-Anker (2020). Cost–utility analysis of antibiotic treatment in patients with chronic low back pain and Modic changes: results from a randomised, placebo-controlled trial in Norway (the AIM study). BMJ Open.  ISSN 2044-6055. . doi: 10.1136/bmjopen-2019-035461
• Hermansen, Erland; Austevoll, Ivar Magne; Hellum, Christian; Storheim, Kjersti; Myklebust, Tor Åge; Aaen, Jørn Ståle; Banitalebi, Hasan; Anvar, Masoud D; Rekeland, Frode; Brox, Jens Ivar; Franssen, Eric; Weber, Clemens; Solberg, Tore; Haug, Knut Jørgen; Grundnes, Oliver; Brisby, Helena & Indrekvam, Kari (2020). Comparable increases in dural sac area after three different posterior decompression techniques for lumbar spinal stenosis: radiological results from a randomized controlled trial in the NORDSTEN study. European spine journal.  ISSN 0940-6719. . doi: 10.1007/s00586-020-06499-0 Vis sammendrag

  Purpose: To investigate changes in dural sac area after three different posterior decompression techniques in patients undergoing surgery for lumbar spinal stenosis. Summary of background data: Decompression of the nerve roots is the main surgical treatment for lumbar spinal stenosis. The aim of this study was to radiologically investigate three commonly used posterior decompression techniques. Methods: The present study reports data from one of two multicenter randomized trials included in the NORDSTEN study. In the present trial, involving 437 patients undergoing surgery, we report radiological results after three different midline retaining posterior decompression techniques: unilateral laminotomy with crossover (UL) (n = 146), bilateral laminotomy (BL) (n = 142) and spinous process osteotomy (SPO) (n = 149). MRI was performed before and three months after surgery. The increase in dural sac area and Schizas grade at the most stenotic level was evaluated. Three different predefined surgical indicators of substantial decompression were used: (1) postoperative dural sac area of > 100 mm2, (2) increase in the dural sac area of at least 50% and (3) postoperative Schizas grade A or B. Results: No differences between the three surgical groups were found in the mean increase in dural sac area. Mean values were 66.0 (SD 41.5) mm2 in the UL-group, 71.9 (SD 37.1) mm2 in the BL-group and 68.1 (SD 41.0) mm2 in the SPO-group (p = 0.49). No differences in the three predefined surgical outcomes between the three groups were found. Conclusion: For patients with lumbar spinal stenosis, the three different surgical techniques provided the same increase in dural sac area.

• Hermansen, Erland; Austevoll, Ivar Magne; Hellum, Christian; Storheim, Kjersti; Myklebust, Tor Åge; Aaen, Jørn Ståle; Banitalebi, Hasan; Anvar, Masoud; Rekeland, Frode; Brox, Jens Ivar; Franssen, Eric; Weber, Clemens; Solberg, Tore; Haug, Knut Jørgen; Grundnes, Oliver; Brisby, Helena & Indrekvam, Kari (2020). Comparable Increases in Dural Sac Area After Three Different Posterior Decompression Techniques for Lumbar Spinal Stenosis: Radiological Results From a Randomized Controlled Trial in the NORDSTEN Study. European spine journal.  ISSN 0940-6719. . doi: 10.1007/s00586-020-06499-0 Fulltekst i vitenarkiv. Vis sammendrag

  Purpose: To investigate changes in dural sac area after three different posterior decompression techniques in patients undergoing surgery for lumbar spinal stenosis. Decompression of the nerve roots is the main surgical treatment for lumbar spinal stenosis. The aim of this study was to radiologically investigate three commonly used posterior decompression techniques. Methods: The present study reports data from one of two multicenter randomized trials included in the NORDSTEN study. In the present trial, involving 437 patients undergoing surgery, we report radiological results after three different midline retaining posterior decompression techniques: unilateral laminotomy with crossover (UL) (n = 146), bilateral laminotomy (BL) (n = 142) and spinous process osteotomy (SPO) (n = 149). MRI was performed before and three months after surgery. The increase in dural sac area and Schizas grade at the most stenotic level was evaluated. Three different predefined surgical indicators of substantial decompression were used: (1) postoperative dural sac area of > 100 mm2, (2) increase in the dural sac area of at least 50% and (3) postoperative Schizas grade A or B. Results: No differences between the three surgical groups were found in the mean increase in dural sac area. Mean values were 66.0 (SD 41.5) mm2 in the UL-group, 71.9 (SD 37.1) mm2 in the BL-group and 68.1 (SD 41.0) mm2 in the SPO-group (p = 0.49). No differences in the three predefined surgical outcomes between the three groups were found. Conclusion: For patients with lumbar spinal stenosis, the three different surgical techniques provided the same increase in dural sac area.

• Skjaker, Stein Arve; Enger, Martine; Engebretsen, Lars; Brox, Jens Ivar & Bøe, Berte Marie Grimsmo (2020). Young men in sports are at highest risk of acromioclavicular joint injuries: a prospective cohort study. Knee Surgery, Sports Traumatology, Arthroscopy.  ISSN 0942-2056. . doi: 10.1007/s00167-020-05958-x
• Taso, Mirad; Sommernes, Jon Håvard; Kolstad, Frode; Sundseth, Jarle Østberg; Bjorland, Siri; Pripp, Are Hugo; Zwart, John-Anker & Brox, Jens Ivar (2020). A randomised controlled trial comparing the effectiveness of surgical and nonsurgical treatment for cervical radiculopathy. BMC Musculoskeletal Disorders.  ISSN 1471-2474.  21(1), s 1- 9 . doi: 10.1186/s12891-020-3188-6
• Austevoll, Ivar Magne; Gjestad, Rolf; Grotle, Margreth; Solberg, Tore; Brox, Jens Ivar; Hermansen, Erland; Rekeland, Frode; Indrekvam, Kari; Storheim, Kjersti & Hellum, Christian (2019). Follow-up score, change score or percentage change score for determining clinical important outcome following surgery? An observational study from the Norwegian registry for Spine surgery evaluating patient reported outcome measures in lumbar spinal stenosis and lumbar degenerative spondylolisthesis. BMC Musculoskeletal Disorders.  ISSN 1471-2474.  20:31, s 1- 15 . doi: 10.1186/s12891-018-2386-y
• Austevoll, Ivar Magne; Hermansen, Erland; Fagerland, Morten; Rekeland, Frode; Solberg, Tore; Storheim, Kjersti; Brox, Jens Ivar; Lønne, Greger; Indrekvam, Kari; Aaen, Jørn Ståle; Grundnes, Oliver & Hellum, Christian (2019). Decompression alone versus decompression with instrumental fusion the NORDSTEN degenerative spondylolisthesis trial (NORDSTEN-DS); study protocol for a randomized controlled trial. BMC Musculoskeletal Disorders.  ISSN 1471-2474.  20:7, s 1- 10 . doi: 10.1186/s12891-018-2384-0 Fulltekst i vitenarkiv.
• Bråten, Lars Christian Haugli; Rolfsen, Mads Peder; Espeland, Ansgar; Wigemyr, Monica; Assmus, Jörg; Froholdt, Anne; Haugen, Anne Julsrud; Marchand, Gunn Hege; Kristoffersen, Per M; Lutro, Olav; Randen, Sigrun; Wilhelmsen, Maja; Winsvold, Bendik K S; Kadar, Thomas; Holmgard, Thor Einar; Vigeland, Maria Dehli; Vetti, Nils; Nygaard, Øystein Petter; Lie, Benedicte Alexandra; Hellum, Christian; Anke, Audny; Grotle, Margreth; Schistad, Ellina Iordanova; Skouen, Jan Sture; Grøvle, Lars; Brox, Jens Ivar; Zwart, John-Anker & Storheim, Kjersti (2019). Efficacy of antibiotic treatment in patients with chronic low back pain and Modic changes (the AIM study): double blind, randomised, placebo controlled, multicentre trial. BMJ. British Medical Journal.  ISSN 1756-1833.  367 . doi: 10.1136/bmj.l5654 Fulltekst i vitenarkiv. Vis sammendrag

  Objective To assess the efficacy of three months of antibiotic treatment compared with placebo in patients with chronic low back pain, previous disc herniation, and vertebral endplate changes (Modic changes). Design Double blind, parallel group, placebo controlled, multicentre trial. Setting Hospital outpatient clinics at six hospitals in Norway. Participants 180 patients with chronic low back pain, previous disc herniation, and type 1 (n=118) or type 2 (n=62) Modic changes enrolled from June 2015 to September 2017. Interventions Patients were randomised to three months of oral treatment with either 750 mg amoxicillin or placebo three times daily. The allocation sequence was concealed by using a computer generated number on the prescription. Main outcome measures The primary outcome was the Roland-Morris Disability Questionnaire (RMDQ) score (range 0-24) at one year follow-up in the intention to treat population. The minimal clinically important between group difference in mean RMDQ score was predefined as 4. Results In the primary analysis of the total cohort at one year, the difference in the mean RMDQ score between the amoxicillin group and the placebo group was −1.6 (95% confidence interval −3.1 to 0.0, P=0.04). In the secondary analysis, the difference in the mean RMDQ score between the groups was −2.3 (−4.2 to−0.4, P=0.02) for patients with type 1 Modic changes and −0.1 (−2.7 to 2.6, P=0.95) for patients with type 2 Modic changes. Fifty patients (56%) in the amoxicillin group experienced at least one drug related adverse event compared with 31 (34%) in the placebo group. Conclusions In this study on patients with chronic low back pain and Modic changes at the level of a previous disc herniation, three months of treatment with amoxicillin did not provide a clinically important benefit compared with placebo. Secondary analyses and sensitivity analyses supported this finding. Therefore, our results do not support the use of antibiotic treatment for chronic low back pain and Modic changes.

• Enger, Martine Merete; Skjaker, Stein Arve; Nordsletten, Lars; Pripp, Are Hugo; Melhuus, Knut; Moosmeyer, Stefan & Brox, Jens Ivar (2019). Sports-related acute shoulder injuries in an urban population. BMJ Open sport & exercise medicine.  ISSN 2055-7647.  5(1), s 1- 9 . doi: 10.1136/bmjsem-2019-000551 Fulltekst i vitenarkiv.
• Hermansen, Erland; Myklebust, Tor Åge; Austevoll, Ivar Magne; Rekeland, Frode; Solberg, Tore; Storheim, Kjersti; Grundnes, Oliver; Aaen, Jørn Ståle; Brox, Jens Ivar; Hellum, Christian & Indrekvam, Kari (2019). Clinical outcome after surgery for lumbar spinal stenosis in patients with insignificant lower extremity pain. A prospective cohort study from the Norwegian registry for spine surgery. BMC Musculoskeletal Disorders.  ISSN 1471-2474.  20:36, s 1- 8 . doi: 10.1186/s12891-019-2407-5 Fulltekst i vitenarkiv.
• Hott, Alexandra Christine; Brox, Jens Ivar; Pripp, Are Hugo; Juel, Niels Gunnar & Liavaag, Sigurd (2019). Patellofemoral pain: One year results of a randomized trial comparing hip exercise, knee exercise, or free activity. Scandinavian Journal of Medicine & Science in Sports.  ISSN 0905-7188.  s 1- 13 . doi: 10.1111/sms.13613
• Hott, Alexandra Christine; Brox, Jens Ivar; Pripp, Are Hugo; Juel, Niels Gunnar & Liavaag, Sigurd (2019). Predictors of Pain, Function, and Change in Patellofemoral Pain. American Journal of Sports Medicine.  ISSN 0363-5465.  48(2), s 351- 358 . doi: 10.1177/0363546519889623
• Hott, Alexandra Christine; Brox, Jens Ivar; Pripp, Are Hugo; Juel, Niels Gunnar; Paulsen, Gøran & Liavaag, Sigurd (2019). Effectiveness of Isolated Hip Exercise, Knee Exercise, or Free Physical Activity for Patellofemoral Pain: A Randomized Controlled Trial. American Journal of Sports Medicine.  ISSN 0363-5465.  47(6), s 1312- 1322 . doi: 10.1177/0363546519830644
• Hott, Alexandra Christine; Liavaag, Sigurd; Juel, Niels Gunnar; Brox, Jens Ivar & Ekeberg, Ole Marius (2019). The reliability, validity, interpretability, and responsiveness of the Norwegian version of the Anterior Knee Pain Scale in patellofemoral pain. Disability and Rehabilitation.  ISSN 0963-8288. . doi: 10.1080/09638288.2019.1671499
• Molland, Ragnhild Susanne; Brox, Jens Ivar; Stuge, Britt; Holm, Inger; Riise, Rolf Bjarne & Kibsgård, Thomas (2019). Health related quality of life and physical activity after multiple-surgeries in patients with early onset scoliosis.. Spine Deformity.  ISSN 2212-134X.  7(6), s 1010- 1010 . doi: 10.1016
• Søberg, Helene L.; Engebretsen, Kaia Beck; Juel, Niels Gunnar; Røe, Yngve & Brox, Jens Ivar (2019). Associations between shoulder pain and functioning on the ICF Checklist and the Disabilities of the Arm, Shoulder and Hand scale – a cross-sectional study. Disability and Rehabilitation.  ISSN 0963-8288.  s 1- 8 . doi: 10.1080/09638288.2019.1584252
• Vandvik, Per Olav; Lähdeoja, Tuomas; Ardern, Clare; Buchbinder, Rachelle; Moro, Jaydeep; Brox, Jens Ivar; Burgers, Jaco; Hao, Quikui; Karjalainen, Teemu; van den Bekerom, Michel; Noorduyn, Julia; Lytvyn, Lyubov; Siemieniuk, Reed A.C.; Albin, Alexandra; Shunjie, Sean Chua; Fisch, Florian; Proulx, Laurie; Guyatt, Gordon; Agoritsas, Thomas & Poolman, Rudolf W. (2019). Subacromial decompression surgery for adults with shoulder pain: A clinical practice guideline. BMJ. British Medical Journal.  ISSN 1756-1833.  364:I294, s 1- 8 . doi: 10.1136/bmj.l294
• Aulie, Vibeke Smith; Halvorsen, Vera Baasland & Brox, Jens Ivar (2018). Motor abilities in 182 children treated for idiopathic clubfoot: a comparison between the traditional and the Ponseti method and controls. Journal of Children's Orthopaedics.  ISSN 1863-2521.  12(4), s 383- 389 . doi: 10.1302/1863-2548.12.170195
• Enger, Martine; Skjaker, Stein Arve; Melhuus, Knut; Nordsletten, Lars; Pripp, Are Hugo; Moosmeyer, Stefan & Brox, Jens Ivar (2018). Shoulder injuries from birth to old age A 1-year prospective study of 3031 shoulder injuries in an urban population. Injury.  ISSN 0020-1383.  49(7), s 1324- 1329 . doi: 10.1016/j.injury.2018.05.013
• Furunes, Håvard; Hellum, Christian; Espeland, Ansgar; Brox, Jens Ivar; Småstuen, Milada C; Berg, Linda & Storheim, Kjersti (2018). Adjacent disc degeneration after lumbar total disc replacement or non-operative Treatment: A randomized study with eight-year follow-up. Spine.  ISSN 0362-2436.  43(24), s 1695- 1703 . doi: 10.1097/BRS.0000000000002712 Fulltekst i vitenarkiv.
• Holtedahl, Robin; Brox, Jens Ivar; Aune, Arne Kristian; Nguyen, Daniel; Risberg, May Arna & Tjomsland, Ole (2018). Changes in the rate of publicly financed knee arthroscopies: An analysis of data from the Norwegian patient registry from 2012 to 2016. BMJ Open.  ISSN 2044-6055.  8(6), s 1- 6 . doi: 10.1136/bmjopen-2017-021199 Fulltekst i vitenarkiv. Vis sammendrag

  Objective: To examine rates of publicly financed knee arthroscopic surgery in Norway between 2012 and 2016. Design: Analysis of anonymised data from the National Patient Registry. Interventions: Beginning in 2012, South-Eastern Norway Regional Health Authority implemented administrative measures to bring down rates of knee arthroscopy. Similar measures were not introduced in the other three Regional Health Authorities. Main outcome measures: We analysed annual national rates of publicly financed knee arthroscopies in 2012 and 2016. We compared the rates in South-Eastern Norway Regional Health Authority with corresponding rates in the rest of the country. Variations by county, public hospital versus publicly reimbursed private hospital, gender and age were also assessed. Results: The overall annual rate of arthroscopic procedures declined by 33% from 2012 to 2016, from 310 to 207 per 100 000 inhabitants, respectively. Hospitals in South-Eastern Norway Regional Health Authority reported a 48% reduction, compared with mean 13% in the other three Regional Health Authorities. In public hospitals, rates decreased nationally by 42%, while rates in publicly reimbursed private hospitals increased by 12%. Rates in publicly reimbursed private hospitals decreased by 30% in South-Eastern Norway Regional Health Authority but increased by 63% in the other Regional Health Authorities. The proportion of patients ≥50 years (excluding meniscal repairs) in Norway was 54% in 2012 and fell to 46% in 2016. Average rates per county varied by a factor of 3:1. Conclusion: We report a marked overall reduction of knee arthroscopic procedures from 2012 to 2016 in publicly funded hospitals. The largest decrease was reported in South-Eastern Norway Regional Health Authority, and this coincides in time with implemented administrative measures. The results suggest that the trend of increasing rates of knee arthroscopies can be reversed through purposeful professional and administrative interventions.

• Juel, Niels Gunnar; Brox, Jens Ivar; Hellund, Johan Castberg; Merckoll, Else; Holte, Kristine Bech & Berg, Tore Julsrud (2018). Radiological glenohumeral osteoarthritis in long-term type 1 diabetes. Prevalence and reliability of three classification systems. The Dialong shoulder study. Skeletal Radiology.  ISSN 0364-2348.  47(9), s 1245- 1251 . doi: 10.1007/s00256-018-2923-7
• Kvalvaag, Elisabeth Myrset; Røe, Cecilie; Engebretsen, Kaia Beck; Søberg, Helene L.; Juel, Niels Gunnar; Bautz-Holter, Erik; Sandvik, Leiv & Brox, Jens Ivar (2018). One year results of a randomized controlled trial on radial Extracorporeal Shock Wave Treatment, with predictors of pain, disability and return to work in patients with subacromial pain syndrome. European Journal of Physical and Rehabilitation Medicine.  ISSN 1973-9087.  54(3), s 341- 350 . doi: 10.23736/S1973-9087.17.04748-7
• Molland, Ragnhild Susanne; Diep, Lien My; Brox, Jens Ivar; Stuge, Britt; Holm, Inger & Kibsgård, Thomas (2018). Reliability and Construct Validity of the Adapted Norwegian Version of the Early-Onset Scoliosis 24-item Questionnaire. JAAOS: Global Research & Reviews.  ISSN 2474-7661. Fulltekst i vitenarkiv.
• Furunes, Håvard; Hellum, Christian; Brox, Jens Ivar; Rossvoll, Ivar; Espeland, Ansgar; Berg, Linda; Brøgger, Helga Maria; Småstuen, Milada C & Storheim, Kjersti (2017). Lumbar total disc replacement: predictors for long-term outcome. European spine journal.  ISSN 0940-6719.  27(3), s 709- 718 . doi: 10.1007/s00586-017-5375-1 Fulltekst i vitenarkiv.
• Furunes, Håvard; Storheim, Kjersti; Brox, Jens Ivar; Johnsen, Lars Gunnar; Skouen, Jan Sture; Franssen, Eric; Solberg, Tore; Sandvik, Leiv & Hellum, Christian (2017). Total disc replacement versus multidisciplinary rehabilitation in patients with chronic low back pain and degenerative discs: 8-year follow-up of a randomized controlled multicenter trial. The spine journal.  ISSN 1529-9430.  17(10), s 1480- 1488 . doi: 10.1016/j.spinee.2017.05.011 Fulltekst i vitenarkiv.
• Habiba, Samer; Nygaard, Øystein Petter; Brox, Jens Ivar; Hellum, Christian; Austevoll, Ivar Magne & Solberg, Tore (2017). Risk factors for surgical site infections among 1,772 patients operated on for lumbar disc herniation: a multicentre observational registry-based study. Acta Neurochirurgica.  ISSN 0001-6268.  159(6), s 1113- 1118 . doi: 10.1007/s00701-017-3184-2 Fulltekst i vitenarkiv.
• Hermansen, Erland; Austevoll, Ivar Magne; Romild, Ulla Kristina; Rekeland, Frode; Solberg, Tore; Storheim, Kjersti; Grundnes, Oliver; Aaen, Jørn; Brox, Jens Ivar; Hellum, Christian & Indrekvam, Kari (2017). Study-protocol for a randomized controlled trial comparing clinical and radiological results after three different posterior decompression techniques for lumbar spinal stenosis: the Spinal Stenosis Trial (SST) (part of the NORDSTEN Study). BMC Musculoskeletal Disorders.  ISSN 1471-2474.  18:121, s 1- 7 . doi: 10.1186/s12891-017-1491-7 Fulltekst i vitenarkiv.
• Holte, Kristine Bech; Juel, Niels Gunnar; Brox, Jens Ivar; Hanssen, Kristian Folkvord; Fosmark, Dag Sigurd; Sell, David R.; Monnier, Vincent M. & Berg, Tore Julsrud (2017). Hand, shoulder and back stiffness in long-term type 1 diabetes; cross-sectional association with skin collagen advanced glycation end-products. The Dialong study. Journal of diabetes and its complications.  ISSN 1056-8727.  31(9), s 1408- 1414 . doi: 10.1016/j.jdiacomp.2017.06.007
• Juel, Niels Gunnar; Brox, Jens Ivar; Brunborg, Cathrine; Holte, Kristine Bech & Berg, Tore Julsrud (2017). Very high prevalence of frozen shoulder in patients with type 1 diabetes of ≥45 years' duration: The Dialong Shoulder Study. Archives of Physical Medicine and Rehabilitation.  ISSN 0003-9993.  98(8), s 1551- 1559 . doi: 10.1016/j.apmr.2017.01.020
• Juel, Niels Gunnar; Brox, Jens Ivar; Hellund, Johan Castberg; Holte, Kristine Bech & Berg, Tore Julsrud (2017). The prevalence of radiological glenohumeral osteoarthritis in long-term type 1 diabetes: the Dialong shoulder study. Scandinavian Journal of Rheumatology.  ISSN 0300-9742.  47(4), s 325- 330 . doi: 10.1080/03009742.2017.1397189
• Kvalvaag, Elisabeth Myrset; Anvar, Masoud D; Karlberg, Anna Cecilia; Brox, Jens Ivar; Engebretsen, Kaia Beck; Søberg, Helene L.; Juel, Niels Gunnar; Bautz-Holter, Erik; Sandvik, Leiv & Røe, Cecilie (2017). Shoulder MRI features with clinical correlations in subacromial pain syndrome: A cross-sectional and prognostic study. BMC Musculoskeletal Disorders.  ISSN 1471-2474.  18(469), s 1- 10 . doi: 10.1186/s12891-017-1827-3
• Kvalvaag, Elisabeth Myrset; Brox, Jens Ivar; Engebretsen, Kaia Beck; Søberg, Helene L.; Juel, Niels Gunnar; Bautz-Holter, Erik; Sandvik, Leiv & Røe, Cecilie (2017). Effectiveness of radial extracorporeal shock wave therapy (rESWT) when combined with supervised exercises in patients with subacromial shoulder pain: a double-masked, randomized, sham-controlled trial. American Journal of Sports Medicine.  ISSN 0363-5465.  45(11), s 2547- 2554 . doi: 10.1177/0363546517707505
• Magnusson, Karin; Holte, Kristine Bech; Juel, Niels Gunnar; Brox, Jens Ivar; Hagen, Kåre Birger; Haugen, Ida Kristin & Berg, Tore Julsrud (2017). Long term type 1 diabetes is associated with hand pain, disability and stiffness but not with structural hand osteoarthritis features - The Dialong hand study. PLOS ONE.  ISSN 1932-6203.  12:e0177118(5), s 1- 13 . doi: 10.1371/journal.pone.0177118 Fulltekst i vitenarkiv.
• Moosmeyer, Stefan; Ekeberg, Ole Marius; Hallgren, Hanna Bjørnsson; Heier, Ingar; Kvalheim, Synnøve Kristin; Blomquist, Jesper; Pripp, Are Hugo; Juel, Niels Gunnar; Kjellevold, Stein Harald; Brox, Jens Ivar & KALK, study group (2017). KALK study: ultrasound guided needling and lavage (barbotage) with steroid injection versus sham barbotage with and without steroid injection - protocol for a randomized, double-blinded, controlled, multicenter study. BMC Musculoskeletal Disorders.  ISSN 1471-2474.  18:138, s 1- 9 . doi: 10.1186/s12891-017-1501-9 Fulltekst i vitenarkiv.
• Schrøder, Cecilie Piene; Skare, Øystein; Reikerås, Olav; Mowinckel, Petter & Brox, Jens Ivar (2017). Sham surgery versus labral repair or biceps tenodesis for type II SLAP lesions of the shoulder: a three-armed randomised clinical trial. British Journal of Sports Medicine.  ISSN 0306-3674.  51(24), s 1759- 1766 . doi: 10.1136/bjsports-2016-097098 Fulltekst i vitenarkiv.
• Storheim, Kjersti; Espeland, Ansgar; Grøvle, Lars; Skouen, Jan Sture; Assmus, Jörg; Anke, Audny; Froholdt, Anne; Pedersen, Linda Margareth; Haugen, AJ; Fors, Terese; Schistad, Ellina Iordanova; Lutro, Olav; Marchand, Gunn Hege; Kadar, Thomas; Vetti, Nils; Randen, Solfrid; Nygaard, Øystein Petter; Brox, Jens Ivar; Grotle, Margreth & Zwart, John-Anker (2017). Antibiotic treatment In patients with chronic low back pain and Modic changes (the AIM study): study protocol for a randomised controlled trial.. Trials.  ISSN 1745-6215.  15(18), s 596- 607 . doi: 10.1186/s13063-017-2306-8 Fulltekst i vitenarkiv.
• Austevoll, Ivar Magne; Gjestad, Rolf; Brox, Jens Ivar; Solberg, Tore; Storheim, Kjersti; Rekeland, Frode; Hermansen, Erland; Indrekvam, Kari & Hellum, Christian (2016). The effectiveness of decompression alone compared with additional fusion for lumbar spinal stenosis with degenerative spondylolisthesis: a pragmatic comparative non-inferiority observational study from the Norwegian Registry for Spine Surgery. European spine journal.  ISSN 0940-6719.  26(2), s 404- 413 . doi: 10.1007/s00586-016-4683-1 Vis sammendrag

  Purpose To evaluate the effect of adding fusion to decompression in patients operated for lumbar spinal stenosis with a concomitant lumbar degenerative spondylolisthesis. Methods After propensity score matching, 260 patients operated with decompression and fusion and 260 patients operated with decompression alone were compared. Primary outcome measures were leg and back pain [Numeric Rating Scale (NRS), 0–10] and Oswestry Disability Index (ODI, 0–100) at 12 months. Results At 12-month follow-up, the fusion group rated their pain significantly lower than the decompression alone group [leg pain 3.0 and 3.6, respectively, mean difference −0.6, 95 % confidence interval (CI) −1.2 to −0.05, p = 0.03 and back pain 3.3 and 3.9, respectively, mean difference −0.6, 95 % CI −1.1 to −0.1, p = 0.02]. ODI was not significantly different between the groups (21.0 versus 23.3, mean difference −2.3, 95 % CI −5.8 to 1.1, p = 0.18). Seventy-four percent of the fusion group and 63 % of the decompression alone group achieved a clinically important improvement in back pain (difference in proportion of responders = 11 %, 95 % CI 2–20 %, p = 0.01), corresponding to a number needed to treat of 9 patients (95 % CI 5–50). There was no significant difference in responder rate for leg pain (74 and 67 %, respectively, difference 7 %, 95 % CI −1 to 16 %, p = 0.09) or for ODI (67 and 59 %, respectively, difference 8 %, 95 % CI 0–18 %, p = 0.06). The duration of surgery and hospital stay was longer for the fusion group (mean difference 68 min, 95 % CI 58–78, p < 0.01 and mean difference 4.2 days, 95 % CI 3.5–4.8, p < 0.01). Conclusion In the present non-inferiority study, we cannot conclude that decompression alone is as good as decompression with additional fusion. However, the small differences in the groups’ effect sizes suggest that a considerable number of patients can be treated with decompression alone. A challenge in future studies will be to find the best treatment option for each patient.

• Haugen, Anne Julsrud; Grøvle, Lars; Brox, Jens Ivar; Natvig, Bård & Grotle, Margreth (2016). Pain-related fear and functional recovery in sciatica: results from a 2-year observational study. Journal of Pain Research.  ISSN 1178-7090.  9, s 925- 931 . doi: 10.2147/JPR.S115003
• Hermansen, Erland; Romild, Ulla Kristina; Austevoll, Ivar Magne; Solberg, Tore; Storheim, Kjersti; Brox, Jens Ivar; Hellum, Christian & Indrekvam, Kari (2016). Does surgical technique influence clinical outcome after lumbar spinal stenosis decompression? A comparative effectiveness study from the Norwegian Registry for Spine Surgery. European spine journal.  ISSN 0940-6719.  26(2), s 420- 427 . doi: 10.1007/s00586-016-4643-9
• Olsen, Unni; Brox, Jens Ivar & Bjørk, Ida Torunn (2016). Preoperative bowel preparation versus no preparation before spinal surgery: a randomised clinical trial. International Journal of Orthopaedic and Trauma Nursing.  ISSN 1878-1241.  23, s 3- 13 . doi: 10.1016/j.ijotn.2016.02.001 Vis sammendrag

  Aims and objectives Investigate the effect of preoperative bowel preparations for patients undergoing spinal fusion surgery. Background Bowel preparation before major surgery is performed routinely to reduce the risk of postoperative complications related to gastrointestinal function. Methods A randomised clinical trial with forty-five elective spinal fusion patients and one control group and two treatment groups was performed. The patients received preoperative bowel preparation with enema, suppository or no bowel preparation. The outcome measure was defecation within 72 hours postoperatively, defecation on the fifth postoperative day, postoperative constipation, nausea, pain, well-being and ambulation. Results There were significant differences in favour of no bowel preparation compared with suppository group for primary outcome, days to first defecation. There was a tendency for the patients who received no bowel preparation to recover from constipation faster than patients in the bowel preparation groups. The majority of patients did not defecate until the fourth postoperative day. Conclusions This randomised study found no benefit from bowel preparation before major spine surgery on gastrointestinal function. The use of bowel preparation is not evidence based and should be considered omitted before major spine surgery until the effect is known. Keywords constipation; ileus; enema; bowel preparation; postoperative care; postoperative complication; spinal fusion

• Reme, Silje; Tveito, Torill Helene; Harris, Anette; Lie, Stein Atle; Grasdal, Astrid; Indahl, Aage; Brox, Jens Ivar; Tangen, Tone; Hagen, Eli Molde; Gismervik, Sigmund Østgård; Ødegård, Arit; Frøyland, Livar; Fors, Egil Andreas; Chalder, Trudie & Eriksen, Hege Randi (2016). Cognitive Interventions and Nutritional Supplements (The CINS Trial): A Randomized Controlled, Multicenter Trial Comparing a Brief Intervention with Additional Cognitive Behavioral Therapy, Seal Oil, and Soy Oil for Sick-Listed Low Back Pain Patients. Spine.  ISSN 0362-2436.  41(20), s 1557- 1564 . doi: 10.1097/BRS.0000000000001596 Fulltekst i vitenarkiv. Vis sammendrag

  STUDY DESIGN: A randomized controlled trial. OBJECTIVE: The aim of this study was to evaluate whether a tailored and manualized cognitive behavior therapy (CBT) or nutritional supplements of seal oil and soy oil had any additional benefits over a brief cognitive intervention (BI) on return to work (RTW). SUMMARY OF BACKGROUND DATA: Brief intervention programs are clinically beneficial and cost-effective for patients with low back pain (LBP). CBT is recommended for LBP, but evidence on RTW is lacking. Seal oil has previously been shown to have a possible effect on muscle pain, but no randomized controlled trials have so far been carried out in LBP patients. METHODS: Four hundred thirteen adults aged 18 to 60 years were included. Participants were sick-listed 2 to 10 months due to LBP. Main outcome was objectively ascertained work participation at 12-month follow-up. Participants were randomly assigned to BI (n = 100), BI and CBT (n = 103), BI and seal oil (n = 105), or BI and soy oil (n = 105). BI is a two-session cognitive, clinical examination program followed by two booster sessions, while the CBT program is a tailored, individual, seven-session manual-based treatment. RESULTS: At 12-month follow-up, 60% of the participants in the BI group, 50% in the BI and CBT group, 51% in the BI and seal oil group, and 53% in the BI and soy oil group showed reduced sick leave from baseline, and had either partly or fully RTW. The differences between the groups were not statistically significant (χ = 2.54, P = 0.47). There were no significant differences between the treatment groups at any of the other follow-up assessments either, except for a significantly lower sick leave rate in the BI group than the other groups during the first 3 months of follow-up (χ = 9.50, P = 0.02). CONCLUSION: CBT and seal oil had no additional benefits over a brief cognitive intervention on sick leave. The brief cognitive intervention alone was superior in facilitating a fast RTW.

• Hanscom, David; Brox, Jens Ivar & Bunnage, Ray (2015). Defining the Role of Cognitive Behavioral Therapy in Treating Chrionic Low Back Pain: An Overview. Global Spine Journal (GSJ).  ISSN 2192-5682.  5, s 496- 505 . doi: 10.1055/s-0035-1567836
• Holtedahl, Robin; Brox, Jens Ivar & Tjomsland, Ole (2015). Placebo effects in trials evaluating 12 selected minimally invasive interventions: A systematic review and meta-analysis. BMJ Open.  ISSN 2044-6055.  5(1) . doi: 10.1136/bmjopen-2014-007331
• Hott, Alexandra; Liavaag, Sigurd; Juel, Niels Gunnar & Brox, Jens Ivar (2015). Study protocol: A randomised controlled trial comparing the long term effects of isolated hip strengthening, quadriceps-based training and free physical activity for patellofemoral pain syndrome (anterior knee pain). BMC Musculoskeletal Disorders.  ISSN 1471-2474.  16(40) . doi: 10.1186/s12891-015-0493-6
• Iversen, Trond; Solberg, Tore; Wilsgaard, Tom; Waterloo, Knut; Brox, Jens Ivar & Ingebrigtsen, Tor (2015). Outcome prediction in chronic unilateral lumbar radiculopathy: Prospective cohort study. BMC Musculoskeletal Disorders.  ISSN 1471-2474.  16(17) . doi: 10.1186/s12891-015-0474-9 Fulltekst i vitenarkiv.
• Kvalvaag, Elisabeth Myrset; Brox, Jens Ivar; Engebretsen, Kaia Beck; Søberg, Helene L.; Bautz-Holter, Erik & Røe, Cecilie (2015). Is radial Extracorporeal Shock Wave Therapy (rEWST) combined with supervised exercises (SE) more effective than sham rESWT and SE in patients with subacromial shoulder pain? Study protocol for a double-blind randomised, sham-controlled trial. BMC Musculoskeletal Disorders.  ISSN 1471-2474.  16:248 . doi: 10.1186/s12891-015-0712-1
• Omair, Ahmad; Mannion, Anne F.; Holden, Marit; Fairbank, Jeremy; Lie, Benedicte Alexandra; Hägg, Olle; Fritzell, Peter & Brox, Jens Ivar (2015). Catechol-O-methyltransferase (COMT) gene polymorphisms are associated with baseline disability but not long-term treatment outcome in patients with chronic low back pain. European spine journal.  ISSN 0940-6719.  24(11), s 2425- 2431 . doi: 10.1007/s00586-015-3866-5 Vis sammendrag

  Purpose: To examine the association between COMT and OPRM1 gene polymorphisms and pain and disability at baseline and long-term follow-up in patients treated for chronic low back pain (LBP). Methods: 371 of 767 unrelated European patients recruited from four randomised trials underwent genetic analyses at mean 11.4 years follow-up. 274 patients had fusion and 97 had non-operative treatment. Association analyses included disability, pain, five single nucleotide polymorphisms (SNPs) in the COMT gene, and one SNP in the OPRM1 gene. Analyses were adjusted for age, gender, smoking, analgesics and treatment. Results: Disability at baseline was significantly associated with COMT SNPs rs4818 (p = 0.02), rs6269 (p = 0.007), rs4633 (p = 0.04) rs2075507 (p = 0.009), two haplotypes (p < 0.002), age, gender and smoking (p ≤ 0.002). No significant associations with clinical variables were observed for OPRM1, or for COMT at long-term follow-up. Conclusions: Results suggest that genetic factors are partly responsible for the variation in disability levels in patients presenting with chronic LBP being considered for surgery; in contrast, genetics has no influence on the long-term outcome of treatment.

• Omair, Ahmad; Mannion, Anne F.; Holden, Marit; Leivseth, Gunnar; Fairbank, Jeremy; Hägg, Olle; Fritzell, Peter & Brox, Jens Ivar (2015). Age and pro-inflammatory gene polymorphisms influence adjacent segment disc degeneration more than fusion does in patients treated for chronic low back pain. European spine journal.  ISSN 0940-6719.  s 2- 13 . doi: 10.1007/s00586-015-4181-x Vis sammendrag

  Purpose: Does lumbar fusion lead to accelerated adjacent segment disc degeneration (ASDD) or is it explained by genetics and aging? The influence of genetics on ASDD remains to be explored. This study assesses whether the disc space height adjacent to a fused segment is associated with candidate gene single nucleotide polymorphisms (SNPs). Methods: Patients with low back pain from four RCTs (N = 208 fusion; 77 non-operative treatment) underwent standing plain radiography and genetic analyses at 13 ± 4 years follow-up. Disc space height was measured using a validated computer-assisted distortion-compensated roentgen analysis technique and reported in standard deviations from normal values. Genetic association analyses included 34 SNPs in 25 structural, inflammatory, matrix degrading, apoptotic, vitamin D receptor and OA-related genes relevant to disc degeneration. These were analysed for their association with disc space height (after adjusting for age, gender, smoking, duration of follow-up and treatment group) first, separately, and then together in a stepwise multivariable model. Results: Two SNPs from the IL18RAP gene (rs1420106 and rs917997) were each associated with a lower disc space height at the adjacent level (B = −0.34, p = 0.04 and B = −0.35, p = 0.04, respectively) and the MMP-9 gene SNP rs20544 was associated with a greater disc space height (B = 0.35, p = 0.04). Age (p < 0.001) and fusion (p < 0.008) were also significant variables in each analysis. The total explained variance in disc space height was for each SNP model 13–14 %, with 11–12 % of this being accounted for by the given SNP, 64–67 % by age and 19–22 % by fusion. In the multivariable regression analysis (with nine SNPs selected for entry, along with the covariates) the total explained variance in disc space height was 23 %, with the nine SNPs, age and fusion accounting for 45, 45 and 7 % of this, respectively. Conclusions: Age was the most significant determinant of adjacent segment disc space height followed by genetic factors, specifically inflammatory genes. Fusion explained a statistically significant but small proportion of the total variance. Much of the variance remained to be explained.

• Prestgaard, Tore Anders; Wormgoor, Marjon; Haugen, Simen; Harstad, Herlof; Mowinckel, Petter & Brox, Jens Ivar (2015). Ultrasound guided intra-articular and rotator interval corticosteroid injections in adhesive capsulitis of the shoulder: a double-blind, sham-controlled randomized study. Pain.  ISSN 0304-3959.  156(9), s 1683- 91 . doi: 10.1097/j.pain.0000000000000209
• Steen, Harald; Lange, Johan Emil & Brox, Jens Ivar (2015). Early weaning in idiopathic scoliosis. Scoliosis.  ISSN 1748-7161.  10(1) . doi: 10.1186/s13013-015-0059-2
• Adobor, Raphael Dziwornu; Joranger, Pål; Steen, Harald; Navrud, Ståle & Brox, Jens Ivar (2014). A health economic evaluation of screening and treatment in patients with adolescent idiopathic scoliosis. Scoliosis.  ISSN 1748-7161.  9(21) . doi: 10.1186/s13013-014-0021-8 Fulltekst i vitenarkiv.
• Brox, Jens Ivar (2014). Idiopathic scoliosis. European Medical Journal Cardiology.  ISSN 2054-3174.  1, s 10- 17
• Brox, Jens Ivar; Lange, Johan Emil & Steen, Harald (2014). Comorbidity influenced health-related quality of life of 390 patients with idiopathic scoliosis at long-term follow-up. European Journal of Physical and Rehabilitation Medicine.  ISSN 1973-9087.  50(1), s 73- 81
• Grøvle, Lars; Haugen, Anne Julsrud; Hasvik, Eivind; Natvig, Bård; Brox, Jens Ivar & Grotle, Margreth (2014). Patients' ratings of global perceived change during 2 years were strongly influenced by the current health status. Journal of Clinical Epidemiology.  ISSN 0895-4356.  67(5), s 508- 515 . doi: 10.1016/j.jclinepi.2013.12.001 Vis sammendrag

  Objectives: To investigate the longitudinal validity of patients' ratings of global perceived change (GPC) and to assess the implications of using the GPC as the anchor to determine the minimal important change (MIC). Study Design and Setting: Secondary analysis of data from a multicenter study including 380 patients with disc-related sciatica with follow-ups at 3, 6, 12, and 24 months. The GPC scale ranged from much worse to completely gone. Five patient-reported outcome measures were used. An MIC was defined as the mean change score in the actual outcome measure for patients reporting being better. The influence of patients' current state and baseline scores on the GPC was analyzed by multivariate linear regression. Differences in the magnitude of the MIC between the 3- and 24-month recall periods were analyzed by hierarchical linear models. Results: Across all recall periods and outcome measures, the GPC was strongly influenced by the patient's state at the time of asking. In four of five outcome measures, the magnitude of the MIC increased when recall increased from 3 to 24 months. Conclusion: Caution is needed when using the GPC to determine the MIC of patient-reported outcome measures in patients with chronic conditions.

• Johnsen, Lars Gunnar; Hellum, Christian; Storheim, Kjersti; Nygaard, Øystein Petter; Brox, Jens Ivar; Rossvoll, Ivar; Rø, Magne; Andresen, Hege; Lydersen, Stian; Grundnes, Oliver; Pedersen, Marit; Leivseth, Gunnar; Olafsson, Gylfi; Borgstrôm, Fredrik & Fritzell, P (2014). Cost-effectiveness of total disc replacement versus multidisciplinary rehabilitation in patients with chronic low back pain: A norwegian multicenter RCT. Spine.  ISSN 0362-2436.  39(1), s 23- 32 . doi: 10.1097/BRS.0000000000000065 Vis sammendrag

  Study Design. Randomized clinical trial with 2-year follow-up. Objective. To evaluate the cost-effectiveness of total disc replacement (TDR) versus multidisciplinary rehabilitation (MDR) in patients with chronic low back pain (CLBP). Summary of Background Data. The existing studies on CLBP report cost-effectiveness of fusion surgery versus disc replacement and fusion versus rehabilitation. This study evaluated the cost-effectiveness of TDR versus MDR. Methods. Between April 2004 and May 2007, 173 patients with CLBP (>1 yr) were randomized to TDR (n = 86) or MDR (n = 87). Treatment effects (Euro Qol 5D [EQ-5D] and Short Form 6D [SF-6D]) and relevant direct and indirect costs at 6 weeks and at 3, 6, 12, and 24 months after treatment were assessed. Gain in quality-adjusted life years (QALYs) after 2 years was estimated. Cost-effectiveness was expressed as an incremental cost-effectiveness ratio. Results. The mean QALYs gained (standard deviation) using EQ-5D was 1.29 (0.53) in the TDR group and 0.95 (0.52) in the MDR group, a significant difference of 0.34 (95% confidence interval 0.18–0.50). The mean total cost per patient in the TDR group was €87,622 (58,351) compared with €74,116 (58,237) in the MDR group, which was not significantly different (95% confidence interval: −4041 to 31,755). The incremental cost-effectiveness ratio for the TDR procedure varied from €39,748 using EQ-5D (TDR cost-effective) to €128,328 using SF-6D (TDR not cost-effective). The dropout rate was 20% (15% TDR group, 24% MDR group). Five patients moved from the MDR to the TDR group, whereas 9 patients randomized to TDR declined surgery. Using per-protocol analysis instead of intention-to-treat analysis indicated that TDR was not cost-effective, irrespective of the use of EQ-5D or SF-6D. Conclusion. In this study, TDR was cost-effective compared with MDR after 2 years when using EQ-5D for assessing QALYs gained and a willingness to pay of €74,600 (kr500,000/QALY). TDR was not cost-effective when SF-6D was used; therefore, our results should be interpreted with caution. Longer follow-up is needed to accurately assess the cost-effectiveness of TDR.

• Mannion, Anne F.; Leivseth, Gunnar; Brox, Jens Ivar; Fritzell, Peter; Hägg, Ole & Fairbank, Jeremy C.T. (2014). ISSLS prize winner: Long-term follow-up suggests spinal fusion is associated with increased adjacent segment disc degeneration but without influence on clinical outcome: Results of a combined follow-up from 4 randomized controlled trials. Spine.  ISSN 0362-2436.  39(17), s 1373- 1383 . doi: 10.1097/BRS.0000000000000437
• Skare, Øystein; Mowinckel, Petter; Schrøder, Cecilie Piene; Liavaag, Sigurd; Reikerås, Olav & Brox, Jens Ivar (2014). Responsiveness of outcome measures in patients with superior labral anterior and posterior lesions. Shoulder & Elbow.  ISSN 1758-5732.  6(262), s 262- 272 . doi: 10.11.1177/1758573214534650
• Berg, Linda; Hellum, Christian; Gjertsen, Øivind; Neckelmann, Gesche F; Johnsen, Lars Gunnar; Storheim, Kjersti; Brox, Jens Ivar; Eide, Geir Egil & Espeland, Ansgar (2013). Do more MRI findings imply worse disability or more intense low back pain? A cross-sectional study of candidates for lumbar disc prosthesis. Skeletal Radiology.  ISSN 0364-2348.  42(11), s 1593- 1602 . doi: 10.1007/s00256-013-1700-x
• Grøvle, Lars; Haugen, Anne Julsrud; Keller, Anne; Natvig, Bård; Brox, Jens Ivar & Grotle, Margreth (2013). Prognostic factors for return to work in patients with severe sciatica. The spine journal.  ISSN 1529-9430.  13(12), s 1849- 1857 . doi: 10.1016/j.spinee.2013.07.433
• Grøvle, Lars; Haugen, Anne Julsrud; Natvig, Bård; Brox, Jens Ivar & Grotle, Margreth (2013). The prognosis of self-reported paresthesia and weakness in disc-related sciatica. European spine journal.  ISSN 0940-6719.  22(11), s 2488- 2495 . doi: 10.1007/s00586-013-2871-9
• Iversen, Trond; Solberg, Tore; Romner, Bertil; Wilsgaard, Tom; Nygaard, Øystein Petter; Waterloo, Knut; Brox, Jens Ivar & Ingebrigtsen, Tor (2013). Accuracy of physical examination for chronic lumbar radiculopathy. BMC Musculoskeletal Disorders.  ISSN 1471-2474.  14(206) . doi: 10.1186/1471-2474-14-206 Fulltekst i vitenarkiv.
• Johnsen, Lars Gunnar; Hellum, Christian; Nygaard, Øystein Petter; Storheim, Kjersti; Brox, Jens Ivar; Rossvoll, Ivar; Leivseth, Gunnar & Grotle, Margreth (2013). Comparison of the SF6D, the EQ5D, and the oswestry disability index in patients with chronic low back pain and degenerative disc disease. BMC Musculoskeletal Disorders.  ISSN 1471-2474.  14:148 . doi: 10.1186/1471-2474-14-148 Fulltekst i vitenarkiv.
• Mannion, Anne F.; Brox, Jens Ivar & Fairbank, Jeremy C.T. (2013). Comparison of spinal fusion and nonoperative treatment in patients with chronic low back pain: long-term follow-up of three randomized controlled trials. The spine journal.  ISSN 1529-9430.  13(11), s 1438- 1448 . doi: 10.1016/j.spinee.2013.06.101
• Omair, Ahmad; Holden, Marit; Lie, Benedicte Alexandra; Reikerås, Olav & Brox, Jens Ivar (2013). Treatment outcome of chronic low back pain and radiographic lumbar disc degeneration are associated with inflammatory and matrix degrading gene variants: a prospective genetic association study. BMC Musculoskeletal Disorders.  ISSN 1471-2474.  14(105) . doi: 10.1186/1471-2474-14-105 Vis sammendrag

  Background: Inflammatory and matrix degrading gene variants have been reported to be associated with disc degeneration. Some of these variants also modulate peripheral pain. This study examines the association of these genetic variants with radiographic lumbar disc degeneration and changes in pain and disability at long-term after surgical and cognitive behavioural management. Methods: 93 unrelated patients with chronic low back pain (CLBP) for duration of >1 year and lumbar disc degeneration were treated with lumbar fusion or cognitive intervention and exercises. Standardised questionnaires included the Oswestry Disability Index (ODI) and Visual Analog Score (VAS) for CLBP, were filled in by patients both at baseline and at 9 years follow-up. Degenerative changes at baseline Magnetic Resonance Imaging and Computed Tomography scans, were graded as moderate and severe (N=79). Yield and quality of blood and saliva DNA was assessed by nano drop spectrophotometry. Eight SNPs in 5 inflammatory and matrix degrading genes were successfully genotyped. Single marker and haplotype association with severity of degeneration, number of discs involved, changes in ODI and VAS CLBP, was done using Haploview, linear regression and R-package Haplostats. Results: Association analysis of individual SNPs revealed association of IL18RAP polymorphism rs1420100 with severe degeneration (p = 0.05) and more than one degenerated disc (p = 0.02). From the same gene two SNPs, rs917997 and rs1420106, were found to be in strong linkage disequilibrium (LD) and were associated with post treatment improvement in disability (p = 0.02). Haplotype association analysis of 5 SNPs spanning across IL18RAP, IL18R1 and IL1A genes revealed significant associations with improvement in disability (p=0.02) and reduction in pain (p=0.04). An association was found between MMP3 polymorphism rs72520913 and improvement in pain (p = 0.03) and with severe degeneration (p = 0.006). Conclusions: The findings of the current study suggest a role of variation at inflammatory and matrix degrading genes with severity of lumbar disc degeneration, pain and disability.

• Skare, Øystein; Liavaag, Sigurd; Reikerås, Olav; Mowinckel, Petter & Brox, Jens Ivar (2013). Evaluation of Oxford instability shoulder score, Western Ontario instability index and Euroqol in patients with SLAP (superior labral anterior posterior)lesions or recurret anterior dislocations of the shoulder. BMC Research Notes.  ISSN 1756-0500.  6 . doi: 10.1186/1756-0500-6-273
• Brox, Jens Ivar; Lange, Johan Emil; Gundersen, Ragnhild B. & Steen, Harald (2012). Good brace compliance reduced curve progression and surgical rates in patients with idiopathic scoliosis. European spine journal.  ISSN 0940-6719.  21(10), s 1957- 1963 . doi: 10.1007/s00586-012-2386-9
• Froholdt, Anne; Reikerås, Olav; Holm, Inger; Keller, Anne & Brox, Jens Ivar (2012). No difference in 9-year outcome in CLBP patients randomized to lumbar fusion versus cognitive intervention and exercises. European spine journal.  ISSN 0940-6719.  21(12), s 2531- 2538 . doi: 10.1007/s00586-012-2382-0
• Grøvle, Lars; Haugen, Anne Julsrud; Keller, Anne; Natvig, Bård; Brox, Jens Ivar & Grotle, Margreth (2012). Poor agreement found between self-report and a public registry on duration of sickness absence. Journal of Clinical Epidemiology.  ISSN 0895-4356.  65(2), s 212- 218 . doi: 10.1016/j.jclinepi.2011.05.009
• Haugen, Anne Julsrud; Brox, Jens Ivar; Grøvle, Lars; Keller, Anne; Natvig, Bård; Soldal, Dag & Grotle, Margreth (2012). Prognostic factors for non-success in patients with sciatica and disc herniation. BMC Musculoskeletal Disorders.  ISSN 1471-2474.  13 . doi: 10.1186/1471-2474-13-183
• Hellum, Christian; Johnsen, Lars Gunnar; Gjertsen, Øivind; Berg, Linda; Neckelmann, Gesche F; Grundnes, Oliver; Rossvoll, Ivar; Skouen, Jan Sture; Brox, Jens Ivar & Storheim, Kjersti (2012). Predictors of outcome after surgery with disc prosthesis and rehabilitation in patients with chronic low back pain and degenerative disc: 2-year follow-up. European spine journal.  ISSN 0940-6719.  21(4), s 681- 690 . doi: 10.1007/s00586-011-2145-3
• Omair, Ahmad; Lie, Benedicte Alexandra; Reikerås, Olav; Holden, Marit & Brox, Jens Ivar (2012). Genetic contribution of catechol-O-methyltransferase variants in treatment outcome of low back pain: a prospective genetic association study. BMC Musculoskeletal Disorders.  ISSN 1471-2474.  13 . doi: 10.1186/1471-2474-13-76 Vis sammendrag

  Background Treatment outcome of low back pain (LBP) is associated with inter-individual variations in pain relief and functional disability. Genetic variants of catechol-O-methyltransferase (COMT) gene have previously been shown to be associated with pain sensitivity and pain medication. This study examines the association between COMT polymorphisms and 7–11 year change in Oswestry Disability Index (ODI) and Visual Analog Score (VAS) for LBP as clinical outcome variables in patients treated with surgical instrumented lumbar fusion or cognitive intervention and exercise. Methods 93 unrelated patients with chronic LBP for duration of >1 year and lumbar disc degeneration (LDD) were treated with lumbar fusion (N = 60) or cognitive therapy and exercises (N = 33). Standardised questionnaires assessing the ODI, VAS LBP, psychological factors and use of analgesics, were answered by patients both at baseline and at 7–11 years follow-up. Four SNPs in the COMT gene were successfully genotyped. Single marker as well as haplotype association with change in ODI and VAS LBP, were analyzed using Haploview, linear regression and R-package Haplostats. P-values were not formally corrected for multiple testing as this was an explorative study. Results Association analysis of individual SNPs adjusted for covariates revealed association of rs4633 and rs4680 with post treatment improvement in VAS LBP (p = 0.02, mean difference (β) = 13.5 and p = 0.02, β = 14.2 respectively). SNPs, rs4633 and rs4680 were found to be genotypically similar and in strong linkage disequilibrium (LD). A significant association was found with covariates, analgesics (p = 0.001, β = 18.6); anxiety and depression (p = 0.008, β = 15.4) and age (p = 0.03, mean difference per year (β) = 0.7) at follow-up. There was a tendency for better improvement among heterozygous patients compared to the homozygous. No association was observed for the analysis of the common haplotypes, these SNPs were situated on. Conclusions Results suggest an influence of genetic variants of COMT gene in describing the variation in pain after treatment for low back pain. Replication in large samples with testing for other pain related genes is warranted.

• Schrøder, Cecilie Piene; Skare, Øystein; Gjengedal, Erling; Uppheim, Gisle; Reikerås, Olav & Brox, Jens Ivar (2012). Long-Term Results After SLAP Repair: A 5-Year Follow-up Study of 107 Patients With Comparison of Patients Aged Over and Under 40 Years. Arthroscopy: The Journal of Arthroscopy And Related.  ISSN 0749-8063.  28(11), s 1601- 1607 . doi: 10.1016/j.arthro.2012.02.025
• Storheim, Kjersti; Brox, Jens Ivar; Løchting, Ida; Werner, Erik L & Grotle, Margreth (2012). Cross-cultural adaptation and validation of the Norwegian version of the Core Outcome Measures Index for low back pain. European spine journal.  ISSN 0940-6719.  21(12), s 2539- 2549 . doi: 10.1007/s00586-012-2393-x
• Virta, Lena; Joranger, Pål; Brox, Jens Ivar & Eriksson, Rikard (2012). Costs of shoulder pain and resource use in primary health care: a cost-of-illness study in Sweden. BMC Musculoskeletal Disorders.  ISSN 1471-2474.  13 . doi: 10.1186/1471-2474-13-17 Fulltekst i vitenarkiv. Vis sammendrag

  Background: Painful shoulders pose a substantial socioeconomic burden. A prospective cost-of-illness study was performed to assess the costs associated with healthcare use and loss of productivity in patients with shoulder pain in primary health care in Sweden. Methods: The study was performed in western Sweden, in a region with 24 000 inhabitants. Data were collected during six months from electronic patient records at three primary healthcare centres in two municipalities. All patients between 20 and 64 years of age who presented with shoulder pain to a general practitioner or a physiotherapist were included. Diagnostic codes were used for selection, and the cases were manually controlled. The cost for sick leave was calculated according to the human capital approach. Sensitivity analysis was used to explore uncertainty in various factors used in the model. Results: 204 (103 women) patients, mean age 48 (SD 11) years, were registered. Half of the cases were closed within six weeks, whereas 32 patients (16%) remained in the system for more than six months. A fifth of the patients were responsible for 91% of the total costs, and for 44% of the healthcare costs. The mean healthcare cost per patient was €326 (SD 389) during six months. Physiotherapy treatments accounted for 60%. The costs for sick leave contributed to 84% of the total costs. The mean annual total cost was €4139 per patient. Estimated costs for secondary care increased the total costs by one third. Conclusions: The model applied in this study provides valuable information that can be used in cost evaluations. Costs for secondary care and particularly for sick leave have a major influence on total costs and interventions that can reduce long periods of sick leave are warranted.

• Adobor, Raphael Dziwornu; Rimeslåtten, S; Steen, Harald & Brox, Jens Ivar (2011). School screening and point prevalence of adolescent idiopathic scoliosis in 4000 Norwegian children aged 12 years. Scoliosis.  ISSN 1748-7161.  6(23) . doi: 10.1186/1748-7161-6-23
• Engebretsen, Kaia Beck; Grotle, Margreth; Bautz-Holter, Erik; Ekeberg, Ole Marius; Juel, Niels Gunnar & Brox, Jens Ivar (2011). Supervised Exercises Compared With Radial Extracorporeal Shock-Wave Therapy for Subacromial Shoulder Pain: 1-Year Results of a Single-Blind Randomized Controlled Trial. Physical Therapy.  ISSN 0031-9023.  91(1), s 37- 47 . doi: 10.2522/ptj.20090338 Vis sammendrag

  BACKGROUND: Evidence from a recent randomized controlled trial indicated that supervised exercises (SE) were more effective than radial extracorporeal shock-wave therapy (rESWT) for the treatment of subacromial shoulder pain in the short to medium term. Little knowledge exists about the long-term results of rESWT for subacromial pain. OBJECTIVE: The aim of this study was to evaluate the results of rESWT and SE provided to patients with subacromial shoulder pain after 1 year. DESIGN: This was a single-blind randomized controlled trial. SETTING: The study was conducted in the outpatient clinic of the Physical Medicine and Rehabilitation Department at Oslo University Hospital, Ullevaal, Norway. PATIENTS: One hundred four patients with subacromial shoulder pain lasting at least 3 months participated. Patients were randomly assigned to either an rESWT group (n=52) or an SE group (n=52). INTERVENTION: The rESWT intervention consisted of one session weekly for 4 to 6 weeks. The SE intervention consisted of two 45-minute sessions per week for up to 12 weeks. MEASUREMENTS: The primary outcome measure was the Shoulder Pain and Disability Index. Secondary outcome measures were questions regarding pain and function and work status. RESULTS: After 1 year, an intention-to-treat analysis showed no significant differences between the 2 groups for the primary outcome measure (-7.6 points, 95% confidence interval=-16.6 to 0.5) and pain, function, and medication use. Twenty-nine participants (60%) in the SE group versus 24 participants (52%) in the rESWT group were categorized as clinically improved. Thirty-eight participants in the SE group were at work compared with 30 participants in the rESWT group (odds ratio=1.1, 95% confidence interval=1.0 to 1.2). Fewer patients in the SE group had received additional treatments between 18 weeks and 1 year. LIMITATIONS: The lack of a placebo control group, the lack of a cost-benefit analysis, and the small sample size were limitations of the study. CONCLUSION: No significant difference was found between the SE and rESWT groups at the 1-year follow-up. More participants in the SE group had returned to work.

Se alle arbeider i Cristin

• Brox, Jens Ivar (2014). I Idrettskader - diagnostikk og behandling (redaktør Roald Bahr): Kapittel 5 - Nakke og rygg (Jens Ivar Brox, Mike Wilkinson, Robert G. Watkins III, Robert G. Watkins IV, Roger Sørensen, Bjørn Fossan). Fagbokforlaget.  ISBN 978-82-450-1224-8.
• Juel, Niels Gunnar & Brox, Jens Ivar (2014). Norsk fysikalsk medisin Kapittel 11 Skulder: Jens Ivar Brox og Niels Gunnar Juel Kapittel 13 Rygg: Jens Ivar Brox Kapittel 18 Muskelsmerter Jens Ivar Brox og Niels Gunnar Juel. Fagbokforlaget.  ISBN 978-82-450-1664-2.

Se alle arbeider i Cristin

• Brox, Jens Ivar (2019). The Fear Avoidance Beliefs Questionnaire-the FABQ-for the benefit of another 70 million potential pain patients. Scandinavian Journal of Pain.  ISSN 1877-8860.  19(1), s 1- 2 . doi: 10.1515/sjpain-2018-2005
• Juel, Niels Gunnar; Pedersen, Stein Jarle; Engebretsen, Kaia Beck; Brurberg, Kjetil Gundro; Ekeberg, Ole Marius; Reme, Silje Endresen; Brox, Jens Ivar & Natvig, Bård (2019). Atraumatiske skuldersmerter i prim?rhelsetjenesten. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  139(7) . doi: 10.4045/tidsskr.19.0116
• Brox, Jens Ivar (2018). Lifting with straight legs and bent spine is not bad for your back. Scandinavian Journal of Pain.  ISSN 1877-8860.  s 1- 2 . doi: 10.1515/sjpain-2018-0302
• Ekeberg, Ole Marius; Pedersen, Stein Jarle; Juel, Niels Gunnar; Brox, Jens Ivar; Biringer, Eva Aaker & Natvig, Bård (2018). Shoulder pain in primary care. Cost-effectiveness..
• Juel, Niels Gunnar; Brox, Jens Ivar; Ekeberg, Ole Marius; Brurberg, Kjetil Gundro; Engebretsen, Kaia Beck; Reme, Silje Endresen; Natvig, Bård & Pedersen, Stein Jarle (2018). Norwegian guidelines for shoulder pain in primary care..
• Olsen, Unni Solveig Johansen; Lerdal, Anners; Aamodt, Arild; Brox, Jens Ivar; Furnes, Ove; Denison, Eva Marie-Louise; Skare, Øystein & Lindberg, Maren Falch (2018). Preoperative and intraoperative predictors of persistent postoperative pain and impaired physical function in total knee arthroplasty - a systematic review of prognostic studies.
• Pedersen, Stein Jarle; Juel, Niels Gunnar; Brox, Jens Ivar; Engebretsen, Kaia Beck; Ekeberg, Ole Marius; Reme, Silje Endresen & Natvig, Bård (2018). Shoulder pain in primary care. Presentation of a simple net-based educational program for the general practitioner..
• Brox, Jens Ivar (2017). Specific symptoms and signs of unstable back segments and curative surgery?. Scandinavian Journal of Pain.  ISSN 1877-8860.  16, s 211- 222 . doi: doi: 10.1136/bjsports-2017-098251
• Brox, Jens Ivar; Schrøder, Cecilie Piene; Skare, Øystein; Mowinckel, Petter & Reikerås, Olav (2017). Author response - Sham surgery versus labral repair or biceps tenodesis for type II SLAP lesions of the shoulder: A three-armed randomised clinical trial. British Journal of Sports Medicine.  ISSN 0306-3674.  51(24), s 1778- 1779 . doi: 10.1136/bjsports-2017-098251
• Molland, Ragnhild Susanne; Diep, Lien My; Brox, Jens Ivar; Stuge, Britt; Holm, Inger & Kibsgård, Thomas (2017). Discriminative characteristics of the Early Onset Scoliosis-24-item Questionnaire (EOSQ-24) and its usefulness in follow-up examinations.
• Adobor, Raphael Dziwornu; Joranger, Pål; Steen, Harald; Navrud, Ståle & Brox, Jens Ivar (2016). Re: To screen or not to screen for adolescent idiopathic scoliosis? A review of the literature. Public Health.  ISSN 0033-3506.  133, s 124- 125 . doi: 10.1016/j.puhe.2015.12.010
• Mannion, Anne F.; Brox, Jens Ivar & Fairbank, Jeremy C. (2016). Consensus at last! Long-term results of all randomized controlled trials show that fusion is no better than non-operative care in improving pain and disability in chronic low back pain.. The spine journal.  ISSN 1529-9430.  16(5), s 588- 590 . doi: 10.1016/j.spinee.2015.12.001
• Mannion, Anne F.; Brox, Jens Ivar & Fairbank, Jeremy C.T. (2015). Reply to letter to the editor from Berg S, Tullberg T. Letter to the editor regarding Mannion, Brox, Fairbank. Comparison of spinal fusion and nonoperative treatment in patients with chronic low back pain: Long-term follow-up of three randomized controlled trials. Spine J 2014;14:1087. The spine journal.  ISSN 1529-9430.  15(2), s 380- 381 . doi: 10.1016/j.spinee.2014.08.459 Vis sammendrag

  We thank Berg and Tulberg [1] for their interest in our article [2] and would like to respond to their criticisms of our work. They find it questionable whether intention to treat (ITT) analyses—the recommended method for analyzing randomized controlled trial data—should have been applied to our data and instead plead for removal from the analysis of the patients who crossed over. They will be aware that with ITT, patients are analyzed in the group to which they were randomly allocated (regardless of what happens afterwards), otherwise the benefit of randomization will be lost. ITT is used to assess the clinical effectiveness because it mirrors actual practice: not everyone adheres to the treatment and the treatment received may be changed according to how patients respond to it [3]. In our study, the per-protocol and as-treated analyses came to essentially the same conclusions as the ITT, increasing confidence in the results.

• Steen, Harald; Lange, Johan Emil & Brox, Jens Ivar (2015). Early weaning in idiopathic scoliosis.
• Adobor, Raphael Dziwornu; Joranger, Pål; Steen, Harald; Navrud, Ståle & Brox, Jens Ivar (2014). A Health Economic Evaluation of Screening and Treatment in Patients with Adolsescent Idiopathic Scoliosis.
• Brox, Jens Ivar (2014). Current evidence on catastrophizing and fear avoidance beliefs in low back pain patients. The spine journal.  ISSN 1529-9430.  14(11), s 2679- 2681 . doi: 10.1016/j.spinee.2014.08.454
• Brox, Jens Ivar (2013). Trening, kognitiv intervensjon eller operasjon?. Fysioterapeuten.  ISSN 0016-3384.  80(9), s 48- 50
• Austevoll, Ivar Magne; Indrekvam, Kari; Müller, Oliver; Brox, Jens Ivar; Hellum, Christian; Hermansen, Erland; Storheim, Kjersti; Habiba, Samer; Husby, P & Solberg, Tore (2012). Degenerativ pondylolisthese: Er det nødvendig å gjøre fiksasjon i tillegg til dekompresjon? Presentasjon av planlagt norsk multisenterstudie.
• Brox, Jens Ivar (2011). Re: Ward K, Ogilvie JW, Singleton, et al. Validation of DNA-based prognostic testing to predict spinal curve progression in adolescent idiopathic scoliosis. Spine 2010;35:E1455-64 RESPONSE. Spine.  ISSN 0362-2436.  36(15), s 1258- 1259 . doi: 10.1097/BRS.0b013e318221f107
• Engebretsen, Kaia Beck & Brox, Jens Ivar (2011). On "Supervised exercises compared with radial extracorporeal shock-wave therapy ..." Engebretsen K, Grotle M, Bautz-Holter E, et al. Phys Ther. 2011;91:37-47 Response. Physical Therapy.  ISSN 0031-9023.  91(5), s 826- 827 . doi: 10.2522/ptj.2011.91.5.826.2
• Engebretsen, Kaia Beck & Brox, Jens Ivar (2011). Patients with subacromial shoulder pain : treatment and predictors of outcome. Series of dissertations submitted to the Faculty of Medicine, University of Oslo. 1157.

Se alle arbeider i Cristin