Capabilities, opportunities and motivations in implementing guideline-oriented biopsychosocial low back pain management: perceptions of occupational healthcare professionals after an educational intervention.

Background: We explored Finnish occupational healthcare professionals' (HCP) perceptions of biopsychosocial (BPS) low back pain (LBP) management after an educational intervention.

Methods: We conducted twelve group interviews of 51 physicians, physiotherapists and nurses from intervention units in a cluster randomized controlled trial (ISRCTN11875357). We used deductive and inductive content analysis to examine the data, and the Capability-Opportunity-Motivation-Behaviour (COM-B) model to identify the facilitators of and barriers to changes in three target behaviours: (A) forming a common BPS-based understanding with patients, (B) systematically using risk stratification tools, and (C) multidisciplinary collaboration in individualized care planning.

External validation of a prediction model for disability and pain after lumbar disc herniation surgery: a prospective international registry-based cohort study.

Background And Purpose:  We aimed to externally validate machine learning models developed in Norway by evaluating their predictive outcome of disability and pain 12 months after lumbar disc herniation surgery in a Swedish and Danish cohort.

Methods:  Data was extracted for patients undergoing microdiscectomy or open discectomy for lumbar disc herniation in the NORspine, SweSpine and DaneSpine national registries. Outcome of interest was changes in Oswestry disability index (ODI) (≥ 22 points), Numeric Rating Scale (NRS) for back pain (≥ 2 points), and NRS for leg pain (≥ 4 points).

Effectiveness of nighttime vs full-time bracing in the treatment of moderate-grade adolescent idiopathic scoliosis: a secondary analysis of the CONTRAIS trial.

Background And Purpose:  Data on effectiveness of nighttime bracing compared with full-time bracing in adolescent idiopathic scoliosis is scarce. We aimed to investigate risk of curve progression and surgery with nighttime bracing vs full-time bracing for patients with moderate-grade adolescent idiopathic scoliosis.

Methods:  Skeletally immature individuals with idiopathic scoliosis (25°-40°) treated with a nighttime brace as part of a parallel-group randomized controlled trial (RCT) were compared with non-participants treated with a full-time brace.

An action plan: The Swedish healthcare pathway for adults with chronic pain.

Objectives: Chronic pain is a major global public-health issue. In Sweden, 20% adults report moderate to severe chronic pain, with 7% continuously seeking healthcare. Shortcomings in treatment, accessibility, and knowledge in healthcare for chronic pain have previously been reported.

Development of a Person-Centred Coordinated Care Pathway in Swedish Healthcare for Low Back Pain.

Introduction: This project aimed to develop a Person-Centred Co-ordinated Care (P3C) pathway for low back pain (LBP).

Description: A national working group was formed consisting of representatives from all regional healthcare organisations in Sweden and included all relevant healthcare professions, academia, and patient organisations. A mixed method iterative design and consensus approach was applied in the development of the P3C pathway.

Trunk rotation, spinal deformity and appearance, health-related quality of life, and treatment adherence: Secondary outcomes in a randomized controlled trial on conservative treatment for adolescent idiopathic scoliosis.

Objective: To explore secondary outcomes at endpoint comparing treatments with adequate self-mediated physical activity combined with either night-time brace (NB), scoliosis-specific exercise (SSE), or adequate self-mediated physical activity alone (PA) in Adolescent Idiopathic Scoliosis (AIS).

Methods: A longitudinal, prospective, multicenter RCT was conducted including 135 girls/boys, Cobb angle 25-40°, 9-17 years, and ≥1-year remaining growth were randomly allocated into NB, SSE, or PA group. Endpoint was curve progression of ≤6° (success) at skeletal maturity or >6° (failure).

Impact of an intervention for osteoarthritis based on exercise and education on metabolic health: a register-based study using the SOAD cohort.

Objective: This study evaluated the effects of a 6-week osteoarthritis (OA) exercise and education intervention on metabolic health markers, including blood pressure (BP), glycated haemoglobin (HbA1c), high-density lipoprotein (HDL), cholesterol levels and weight in individuals with both OA and diabetes.

Methods: Data originated from the Swedish Osteoarthritis and Diabetes cohort, which is composed of the Swedish Osteoarthritis Register (SOAR) and National Diabetes Register. We included individuals diagnosed with OA and diabetes who underwent the intervention between January 2008 and December 2019, matched with controls with diabetes who did not based on birth year, sex, OA site (hip/knee) and OA diagnosis year.

Cost analysis comparing guideline-oriented biopsychosocial management to usual care for low-back pain: a cluster-randomized trial in occupational health primary care.

Objectives: This study aimed to investigate the effect of a brief training intervention for occupational health services (OHS) professionals on multiprofessional resource utilization and the costs of biopsychosocial management of patients with low-back pain (LBP) compared to usual care among all participants and those in work disability-based risk groups.

Methods: OHS utilization and back-related sick leave data were collected from electronic patient records over one-year follow-up comparing 232 patients in the intervention arm and 80 control-arm patients, stratified for risk of work disability based on the Örebro Musculoskeletal Pain Screening Questionnaire. We estimated costs using linear mixed models by multiplying unit costs (in euros) by each type of OHS resource use (visits to physicians, physiotherapists, nurses, use of imaging) and the number of sick leaves.

The PainSMART project: Protocol for a research program on effectiveness, mechanisms of effect and patient-practitioner experiences of the PainSMART-strategy as an adjunct to usual primary care physiotherapy management for musculoskeletal pain.

Background: Musculoskeletal pain (MSKP) disorders entail a significant burden for individuals and healthcare systems. The PainSMART-strategy has been developed aiming to reduce divergences between patients and healthcare practitioners in their understanding of MSKP by providing a shared basis for communication and to facilitate patients' self-management of MSKP. The objective of the PainSMART-project is to evaluate the effects of the PainSMART-strategy as an adjunct to usual physiotherapy management compared to usual physiotherapy management alone.

Prognostic model development for risk of curve progression in adolescent idiopathic scoliosis: a prospective cohort study of 127 patients.

Background And Purpose:  The study's purpose was to develop and internally validate a prognostic survival model exploring baseline variables for adolescent idiopathic scoliosis curve progression.

Methods:  A longitudinal prognostic cohort analysis was performed on trial data (n = 135) including girls and boys, Cobb angle 25-40°, aged 9-17 years, remaining growth > 1 year, and previously untreated. Prognostic outcome was defined as curve progression of Cobb angle of > 6° prior to skeletal maturity.

The coexistence of diabetes, hypertension and obesity is associated with worse pain outcomes following exercise for osteoarthritis: A cohort study on 80,893 patients.

Objectives: To investigate how the co-occurrence of diabetes, hypertension and overweight/obesity is associated with pain following an exercise intervention for knee and hip osteoarthritis (OA).

Methods: Register-based cohort study. We included people from the Swedish Osteoarthritis Register who underwent education and exercise for knee or hip OA.

Nighttime Bracing or Exercise in Moderate-Grade Adolescent Idiopathic Scoliosis: A Randomized Clinical Trial.

Importance: Moderate-grade adolescent idiopathic scoliosis (AIS) may be treated with full-time bracing. For patients who reject full-time bracing, the effects of alternative, conservative interventions are unknown.

Objective: To determine whether self-mediated physical activity combined with either nighttime bracing (NB) or scoliosis-specific exercise (SSE) is superior to a control of physical activity alone (PA) in preventing Cobb angle progression in moderate-grade AIS.

Physiotherapists' experiences of implementation of the BetterBack model of care for low back pain in primary care - a focus group interview study.

Introduction: The BetterBack model of care (MoC), a best practice physiotherapy MoC for low back pain (LBP), was implemented in Swedish primary care to improve management of patients with LBP and provide patients with support tools to better self-manage episodes of LBP.

Purpose: The objective was to describe how physiotherapists in primary care experienced the implementation of the BetterBack MoC for LBP.

Methods: Focus group interviews were conducted with physiotherapists in 2018-2019, 14-18 months after the introduction of the BetterBack MoC.

Correction: Dufvenberg et al. Six-Month Results on Treatment Adherence, Physical Activity, Spinal Appearance, Spinal Deformity, and Quality of Life in an Ongoing Randomised Trial on Conservative Treatment for Adolescent Idiopathic Scoliosis (CONTRAIS). 2021, , 4967.

In the original publication [...

Measuring the determinants of implementation behavior in multiprofessional rehabilitation.

Background: The Determinants of Implementation Behavior Questionnaire (DIBQ) measures facilitators or barriers of healthcare professionals' implementation behaviors based on the current implementation research on practice and policy. The DIBQ covers 18 domains of the Theoretical Domains Framework and consists of 93 items. A previously tailored version (DIBQ-t) covering 10 domains and 28 items focuses on implementing best-practice low back pain care.

Are illness perceptions and patient self-care enablement mediators of treatment effect in best practice physiotherapy low back pain care? Secondary mediation analyses in the BetterBack trial.

Introduction: A best practice physiotherapy model of care (BetterBack MoC) for low back pain (LBP) aimed to improve patients' illness perceptions and self-care enablement, according to the Common-Sense Model of Self-Regulation (CSM).

Objective: To confirm if illness perceptions and patient self-care enablement, in line with the CSM, are mediators of treatment effects on disability and pain of the BetterBack MoC for patients with LBP compared to routine primary care. A secondary aim was to explore if illness perceptions and patient self-care enablement are mediators of guideline adherent care.

PREventing Mild Idiopathic SCOliosis PROgression (PREMISCOPRO): A protocol for a randomized controlled trial comparing scoliosis-specific exercises with observation in mild idiopathic scoliosis.

Background: Idiopathic scoliosis is the most common spinal deformity in children. Treatment strategies aim to halt progression of the curve. Mild scoliosis is in many cases observed or, in some cases, treated with scoliosis-specific exercises.

The effect of neck-specific exercise and prescribed physical activity on headache and dizziness in individuals with cervical radiculopathy: Further analyses of a randomized study with a 1-year follow-up.

Objective: To evaluate the effect of neck-specific exercise (NSE) compared to prescribed physical activity (PPA) on headache and dizziness in individuals with cervical radiculopathy (CR). Also, to investigate associations between headache or dizziness and pain, neck muscle endurance (NME), neck mobility, physical activity, and fear avoidance beliefs.

Methods: Individuals randomized to either NSE or PPA were selected to a headache subgroup (n = 59) and/or a dizziness subgroup (n = 73).

Learning from the past to plan for the future: A scoping review of musculoskeletal clinical research in Sweden 2010-2020.

Background: The aims of this study are to 1) determine the scope of musculoskeletal (MSK)-related clinical research in Sweden; 2) collate the amount of first-tier funding received; 3) discuss strategies and infrastructure supporting future MSK clinical trials in Sweden.

Methods: A systematic scoping review protocol was applied in PubMed, Scopus, and SweCRIS databases. The articles were examined, and data were extracted in multiple stages by three blinded authors.

Digitally Delivered Exercise and Education Treatment Program for Low Back Pain: Longitudinal Observational Cohort Study.

Background: Exercise and education is recommended as first-line treatment by evidence-based, international guidelines for low back pain (LBP). Despite consensus regarding the treatment, there is a gap between guidelines and what is offered to patients. Digital LBP treatments are an emerging way of delivering first-line treatment.

The association between patients' illness perceptions and longitudinal clinical outcome in patients with low back pain.

Introduction: Illness perception is suggested to influence outcome in patients with low back pain (LBP). It is unknown if specific illness perceptions are of more importance for longitudinal outcomes, including development of self-management strategies.

Objectives: This study explores whether patients' initial illness perceptions were associated with disability, pain, health-related quality of life, and self-care enablement outcomes in patients with LBP after 3 and 12 months.

Improved adherence to clinical guidelines for low back pain after implementation of the BetterBack model of care: A stepped cluster randomized controlled trial within a hybrid type 2 trial.

Background: The BetterBack model of care (MoC) for low back pain (LBP) was recently developed in Swedish physiotherapy (PT) primary care.

Objective: To evaluate if PTs' adherence to LBP clinical practice guidelines (CPGs) improves after implementation of the BetterBack MoC (intervention).

Methods: This was a stepped, single-blinded cluster randomized controlled trial.

Six-Month Results on Treatment Adherence, Physical Activity, Spinal Appearance, Spinal Deformity, and Quality of Life in an Ongoing Randomised Trial on Conservative Treatment for Adolescent Idiopathic Scoliosis (CONTRAIS).

Adolescents with idiopathic scoliosis (AIS) often receive conservative treatments aiming to prevent progression of the spinal deformity during puberty. This study aimed to explore patient adherence and secondary outcomes during the first 6 months in an ongoing randomised controlled trial of three treatment interventions. Interventions consisted of physical activity combined with either hypercorrective Boston brace night shift (NB), scoliosis-specific exercise (SSE), or physical activity alone (PA).

Analgesic prescriptions received by patients before commencing the BOA model of care for osteoarthritis: a Swedish national registry study with matched reference and clinical guideline benchmarking.

Background and purpose - Swedish clinical guidelines for osteoarthritis (OA) prioritize patient education, exercise, and-if necessary-weight reduction before considering adjunct pharmacological intervention. Contrariwise, we investigated the proportion and type of dispensed analgesic prescriptions in Sweden received by patients during 3 years before commencing non-pharmacological primary care interventions for OA (2008-2016) compared with the general population. Furthermore, we analyzed the proportion of analgesic prescriptions dispensed before (2008-2012) compared with after (2012-2016) guideline publication in terms of concordance with clinical guideline recommendations.