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Background: Fibromyalgia is characterized by generalized pain, often leading to a significant decrease in physical function and quality of life. Physical exercise is considered crucial in rehabilitation and self-efficacy for exercise is important in changing and maintaining exercise behaviour. Aim: The present study aims to examine exercise self-efficacy (ESE) in women with fibromyalgia who performed resistance exercise or relaxation therapy. Method: Secondary analysis of a 15-week randomized controlled trial comparing progressive resistance exercise with relaxation therapy in 130 Swedish women with fibromyalgia. Correlation analysis between ESE at baseline and several variables was performed. Comparative analysis of those in the intervention group who reached 80% of 1RM loads and those who did not regarding ESE at baseline was performed. Between-group analysis of change in ESE from baseline to post-intervention was performed. Results: Weak correlations were found between ESE and symptom duration (rs=-0.185), physical activity level (rs=0.237), fear avoidance beliefs (rs=-0.237), mental component of health-related quality of life (rs=0.177), symptoms of depression (rs=-0.186) and symptoms of anxiety (rs=-0.195). ESE at baseline did not differ between those who reached 80% of 1RM loads and those who did not. Progressive resistance exercise significantly increased ESE compared to relaxation therapy, with an effect-size of 0.85. Conclusion: ESE weakly correlates with several aspects of health, physical activity, and fear-avoidance. Resistance exercise with progression according to self-efficacy principles improves ESE compared to relaxation therapy. ESE do not determine successful load progression. Low ESE is not an obstacle for resistance exercise in women living with fibromyalgia.

Objective: To identify the healthcare professional´s knowledge and training frequency of cardiopulmony resuscitation in a county hospital in central Sweden, and compliance of the Swedish Register of cardiopulmony resuscitation.

Method: Survey with quantitative approach consisting of 177 respondents, as well as a retrospective observational study.

Main results: Individuals answered correctly to all knowledge questions, but as a group, there were deficiencies in the knowledge of cardiopulmonary resuscitation. When comparing healthcare professional´s knowledge it was demonstrated that in four of the seven knowledge questions it was a significant difference in knowledge between the health professionals who have more regular training than those with fewer. Those who had more regular education had more right answers. A significant difference was also detected depending on when they had their latest CPR training, where those who have had their education more recently also had more right answers. Compliance of healthcare professional´s to register patients treated for cardiac arrest in hospital at the Swedish CPR registry, can be summarized by the deficiencies in reporting. Conclusion: It is important to create conditions for frequent training to health professionals to increase the knowledge and preparedness in CPR, which can also be seen as a quality assurance work. An improvement is necessary in order to improve compliance to registration.

Emergency department (ED) triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed:

1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED?

2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability)?

3. How valid is each triage scale in predicting hospitalization and hospital mortality?

A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (≥15 years) visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity). Methodological quality and clinical relevance of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted.

We found ED triage scales to be supported, at best, by limited and often insufficient evidence.

The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability) was limited for one triage scale and insufficient or lacking for all other scales. Two of the scales yielded limited scientific evidence, and one scale yielded insufficient evidence, on which to assess the risk of early death or hospitalization in patients assigned to the two lowest triage levels on a 5-level scale (validity).

Background: Many studies have been performed to identify important prognostic factors for outcomes after rehabilitation of patients with chronic pain, and there is a need to synthesize them through systematic review. In this process, it is important to assess the study quality and risk of bias. The "Quality In Prognosis Studies" (QUIPS) tool has been developed for this purpose and consists of several prompting items categorized into six domains, and each domain is judged on a three-grade scale (low, moderate or high risk of bias). The aim of the present study was to determine the interrater agreement of the risk of bias assessment in prognostic studies of patients with chronic pain using QUIPS and to elaborate on the use of this instrument.

Methods: We performed a systematic review and a meta-analysis of prognostic factors for long-term outcomes after multidisciplinary rehabilitation in patients with chronic pain. Two researchers rated the risk of bias in 43 published papers in two rounds (15 and 28 papers, respectively). The interrater agreement and Cohen's quadratic weighted kappa coefficient (κ) and 95% confidence interval (95%CI) were calculated in all domains and separately for the first and second rounds.

Results: The raters agreed in 61% of the domains (157 out of 258), with similar interrater agreement in the first (59%, 53/90) and second rounds (62%, 104/168). The overall weighted kappa coefficient (kappa for all domains and all papers) was weak: κ = 0.475 (95%CI = 0.358-0.601). A "minimal agreement" between the raters was found in the first round, κ = 0.323 (95%CI = 0.129-0.517), but increased to "weak agreement" in the second round, κ = 0.536 (95%CI = 0.390-0.682).

Conclusion: Despite a relatively low interrater agreement, QUIPS proved to be a useful tool in assessing the risk of bias when performing a meta-analysis of prognostic studies in pain rehabilitation, since it demands of raters to discuss and investigate important aspects of study quality. Some items were particularly hard to differentiate in-between, and a learning phase was required to increase the interrater agreement. This paper highlights several aspects of the tool that should be kept in mind when rating the risk of bias in prognostic studies, and provides some suggestions on common pitfalls to avoid during this process.

Trial registration: PROSPERO CRD42016025339; registered 05 February 2016.

Background: Most children and adolescents don't meet the generalrecommendations regarding physical activity. Active school transport (AST) canbe a way to increase the amount of physical activity. Parental attitudes towardsAST can influence decisions regarding children’s journey to school. Theory ofplanned behavior (TPB) is a model to explore attitudes. Few studies have surveyedparental attitudes in Sweden, especially during winter conditions.Aim: To survey parental attitudes to AST in Falu municipality and investigate therelationship between parental attitudes and social norms, geographical and sociodemographicvariables.Method:A cross-sectional web survey was conducted using the TPB-basedquestionnaire. The population consisted of parents of children in primary schoolwho attended a public school in Falun.The data was presented with descriptivestatistics. Differences between groups were analyzed with Mann-Whitney U Testand Kruskall Wallis test and relationships with Spearman's rank correlationcoefficient.Result: There were 465 parents who responded. The attitudes to AST werepredominantly neutral to positive. Women and higher educated were more positivecompared to men and lower educated. There was a weak correlation betweenattitudes and distance to school as well as social norms. Parents of children incentrally located schools were more positive compared to rural schools. Theattitude did not differ depending on the child's gender or age.Conclusion: Although the response rate was relatively low, the result is hopefullyhelpful in the work of increasing knowledge about parental attitudes to adaptfuture AST interventions.

Background: Physical activity is an important part of the treatment of people with chronic obstructive pulmonary disease (COPD), as it can increase the person's self-efficacy. Physical activity may also increase the physical capacity and perceived quality of life. The demand for accessibility, participation and independence in self-care has increased as a result and rapid development of digital solutions. Knowledge gaps are still built in how effectively an active e-health intervention affects people with COPD.Aim: Through this structured literature study, to investigate whether the use of active e-health interventions has an effect on physical capacity, self-efficacy and perceived quality of life in people with COPD.Method: Data collection was performed in the databases Pubmed, Cinahl, Web of science. A screening based on title and abstract was followed by a relevance and quality assessment of potentially relevant articles. Ethical aspects were considered in the review. Data were extracted and compiled and analyzed qualitatively.Results: A total of seven studies were included: six randomized controlled trials and one experimental crossover study. The quality assessment for systematic bias was low to medium. Physical capacity and quality of life improved significantly in all studies physical capacity and quality of life improved significantly in all studies with the mentioned outcome measures. However, only one of the studies showed significant improvement compared with the control group for physical capacity and two studies for quality of life. Self-efficacy improved significantly in two of four studies, one of which showed a significant improvement compared with the control group. Conclusion: This structured literature study indicates that active e-health interventions lead to improvements in physical capacity and perceived quality of life in people with COPD and it can be used as an alternative to conventional treatment. It is not possible to draw any conclusions about the effect of an active e-health intervention on self-efficacy.

BackgroundPatellar dislocation is a common traumatic knee injury and can lead to injury of the medial patellofemoral ligament (MPFL). MPFL can be surgically reconstructed, the surgery is getting more common. There is no consensus regarding postoperative regime and best practice related to physiotherapeutic rehabilitation.Aim:The aim was to map regime, restrictions, interventions and evaluation methods related to physiotherapeutic rehabilitation that are applied and constitute practice in Swedish orthopaedic clinics after MPFL-reconstruction.MethodSurvey-based study, quantitative method. Data collection via a self-designed web questionnaire. The questionnaire consisted of 50 questions and was divided into seven domains. The questionnaire was content validated twice. Physiotherapists working at clinics where MPFL-reconstruction was performed were included.ResultsTwenty physiotherapists were recruited and responses were received from 15 of them. Orthosis is used postoperatively in half of the clinics and full weight bearing is usually allowed. The surgeon’s planning is perceived to be the main reason for the current postoperative regime and half of the clinics have a documented rehab protocol. Common physiotherapeutic interventions directly postoperatively are gait training, muscle activation/strength training, patient education and mobility training. The time regarding when other interventions during rehabilitation begin varies. Rehabilitation is frequently evaluated. Functional tests are a common evaluation method.ConclusionThe study indicates that regime, interventions and evaluation methods differ between Swedish orthopaedic clinics. This contributes with new knowledge that there is a lack of consensus in Sweden regarding postoperative regime and rehabilitation after MPFLR. Results may be interpreted with caution due to few participating clinics.

The essay draws on the shifting methodology in an ongoing multi-sited digital ethnography research project about vaccination-related social media forums. The research, which focuses on vaccine caution and vaccine confidence, was initially directed by ‘following the conflict,’ one of the strategies of following thatGeorge Marcus discusses in his methodology for multi-sited ethnography. However, over the course of time, and after improvisations related to access, positionality, the changing nature of digital content and context of interactions, the initial focus on ‘the war on vaccines’ shifted into a challenging ofoversimplified ideas of oppositional stances, division, and ‘conflict’. What I refer to as ‘following agreements within the conflict’ helps to highlight how the forum members, regardless of their stance, can challenge debate divisions − such as scientific–unscientific, medical–anti-medical, research evidence–anecdotal evidence, and individual–public − while still adhering to medico-scientific discourses as zones of agreements. This enables a modest effort to put both vaccine caution and vaccine confidence on the map of improvisations of health activism and the social movements more generally. Inaddition, it highlights the limits to liminality. In an adult-centric debate that silences young people’s views on (child) vaccinations, I propose the strategy of ‘following silences’ as an additional form of agreement. Finally, I argue that afocus on agreements and silences in conflicts is in alignment with anthropological and post-structural research which commonly focuses onliminal zones and continuities and sheds light on complexities in a nuanced and ‘thick’ manner.

BACKGROUND AND OBJECTIVE: Health-related quality of life (hrQoL) is a core outcome in evaluating interdisciplinary pain rehabilitation (IPR). This systematic review aimed to identify prognostic factors for hrQoL at least six months after IPR in chronic pain patients.

METHODS: A systematic search was conducted in MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science and Cochrane CENTRAL until September 2020. Included were prognostic studies on the outcome hrQoL in adults aged 18 to 67 years with chronic pain (excluding malignancies, systemic-, inflammatory or degenerative joint diseases) who had undergone IPR. Studies were assessed with The Quality in Prognostic Studies-tool. Potential prognostic factors at baseline for the domains pain, psychological and physical functioning were qualitatively synthesized for hrQoL. Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the level of evidence.

RESULTS: Fourteen studies on 6668 participants (mean age 37.4-52.8y), with musculoskeletal pain/fibromyalgia and a pain duration ranging between 13.1 to 177.4 months were considered eligible. With a very low certainty of evidence, pain intensity, emotional distress and physical functioning at baseline were inconsistent for prediction of hrQoL and pain duration was not predictive. With low certainty of evidence, fewer pain sites, lower levels of negative cognitive behavioral factors, and higher levels of positive cognitive behavioral factors predicted a better outcome.

CONCLUSIONS: The overall certainty of evidence was low to very low, making it difficult to reach definitive conclusions at present. Future studies with a predefined core set of predictors investigating hrQoL in patients with chronic pain after IPR are needed.

BackgroundPatellar tendinopathy (PT) is common within an active population, especially elite athletes, but less is known about the presence among sedentary people. Previous research has focused on the physical impairments with modest effect on outcomes like pain and function through different training protocols. Nonetheless, PT tends to be persistent and many fail to recover. Current international consensus highlights the lack of knowledge of tendinopathy through a biopsychosocial perspective. No studies have explored people with PT and their experiences with living and rehabilitating the condition.PurposeTo explore the experiences of living with and rehabilitating PT among people who exercise or do sports recreationally.MethodA descriptive interview study with semi-structured online interviews was performed. A total of 10 participants participated. A thematic analysis was performed with a semantic and inductive procedure.ResultsFive main-themes were identified from the data: (1) Threatened identity, (2) Not being able to live your life to the fullest, (3) A adverse relationship with pain, (4) To feel in charge over ones situation brought back control (5) To be seen as a whole and not just a knee was crucial to rehab.ConclusionPT has a larger impact beyond the physical impairments. Negative cognitions and emotions coupled with maladaptive behaviours in relation to the pain emerged to a considerable degree. These results could have an important clinical message, that the management of PT would benefit from being person-centred where the biopsychosocial impact of pain is acknowledged. Caution should be taken in regards to this study's transferability to a wider population due to methodological aspects.

BACKGROUND: Research shows that variety of factors are related to risks of not returning to work among people with acquired brain injury (ABI). In Sweden, 40% of those with ABI in working age return to work within two years after the injury, which in line with international findings. However, since countries may differ in work rehabilitation, social security systems, culture and laws, different factors may influence the possibilities of returning to work across countries.

AIMS: The aim of this study was to investigate person, injury, activity and rehabilitation related risk markers for not return to work among persons with ABI in Sweden.

METHODS: Retrospective data of an ABI cohort of 2008 people from the WebRehab Sweden quality register were used.

RESULTS: Analyses showed that the risk ratio for not returning to work was larger for people that, among the Personal factors, were woman, born outside of Sweden, had low education level, and not having children in the household; among the injury related factors, had long (> 2 months) hospital stay, aphasia, low motor function, low cognitive function, high pain/discomfort, and high anxiety/depression; among the activity related factors, had low function in self-care, inability to perform usual activities, and had their driver´s license suspended; and finally among the rehabilitation related factors, were satisfied with treatment and having influence over their rehabilitation plan.

DISCUSSION / CONCLUSION: Several factors in different areas were risk markers for not returning to work among people with ABI. This suggest that work rehabilitation and interventions, in addition to direct injury related issues, need to address personal related, activity related and rehabilitation related factors in order to increase the patient´s possibility to return to work. Influences of general and country specific factors on returning to work among people with ABI will be discussed.

Background: The demand for e-health has increased with growing digitalization in society, not least with the COVID-19 pandemic. Digital work tools (DAV) in healthcare can increase the availability of healthcare and efficient use of resources. Few studies in Sweden have examined how healthcare professionals experience the appropriateness and usefulness of DAV.Aim: The aim of the study was to investigate the experiences of licensed healthcare professionals of what facilitates and complicates their daily work with DAV in hospital care, outpatient care as well as primary care in the Dalarna and Gävleborg Region.Method: The method was a qualitative interview study. Five focus group discussions have been conducted with a semi-structured question guide. Data have been coded and analyzed with qualitative content analysis with an inductive approach.Results: The analysis resulted in three main categories and twelve subcategories that include the healthcare staff's experiences of facilitating and aggravating factors, respectively, when using DAV and how they wanted DAV to be designed in the future.Conclusion: The results showed that DAV are not user-friendly according to the needs of the healthcare staff. The work was made more difficult due to a lack of support from the management during implementation and use. In the future DAV and digital systems that interact with each other were desired. However, it emerged that e-health was a good alternative during the COVID-19 pandemic to continue to provide care.

Background: “Targeted health dialogues” is a preventive method that aims to reduce the risk of cardiovascular disease and type 2 diabetes. It includes a health-survey containing physical activity (PA)-questions. Health region Skåne introduced the method 2020 and decided to add additional questions about PA and sedentary behavior (SB). With the wish to replace current validated PA-questions with new validated questions and describe SB. Aim: Analyze concurrent validity between the answers of the original PA-questions (kcal/week) in the method and new answers (activity-minutes/last 7-days) and describe SB (hours/day). Method: Quantitative cross-sectional study with non-random, appropriate selection. Participants were 40-year-old health dialogue-participants that consented to research. Data on kcal/week, activity-minutes/last 7-days, sedentary hours/day and basic characteristics were retrieved from digital health-survey. Agreement between PA-questions was analyzed by Cohen´s weighted kappa and intraclass correlation-coefficient (ICC). SB was presented with descriptive statistics and analyzed by Chi2-test, Fisher's-exact-test and independent t-test. Result: Weak agreement between the PA-questions was found (Kw=0,378; ICC=0,273). Participants born in Sweden were more sedentary than those born outside Sweden (p<0.001) and participants with high education were more sedentary compared with lower education (p=0.014). Significant associations were found between SB and BMI (p=0.028; dichotomized analysis). Sedentary participants (>9 hours/d) also had higher mean BMI compared to those who were less sedentary (29,0(SD5,7) and 26,7(SD5,2) respectively; p=0,008). Conclusion: Current PA-questions cannot be replaced in favor of new questions in their current form. Further validation studies are warranted, preferably using objective PA-measures. SB was significantly associated with country of birth, education level and BMI.

Introduction: Results from previous acupuncture studies for labour pain are contradictory and lack important information on methodology. The sample sizes are in general small, information about the intervention such as needle placement, number of acupuncture points, type of stimulation, and duration of treatment, is often sparse or lacking However, studies indicate that acupuncture has a positive effect on women’s experiences of labour pain.

Aim: The aim of the present study was to evaluate the efficacy of two different acupuncture stimulations, manual or electrical stimulation, compared with standard care in the relief of labour pain. Our hypothesis is that acupuncture with manual or electrical stimulation is more effective than standard care in the relief of labor pain, and that acupuncture with electrical stimulation is the most effective.

Outcome measures: Primary outcome: Labour pain measured with visual analogue scale (VAS). Secondary outcomes are use of epidural analgesia, experience of relaxation, labour outcomes and infant outcomes. Biochemical markers of proinflammatory cytokines, memory of labour pain and overall childbirth experience.

Methods: The study was designed as a randomized controlled trial based on Western medical theories. Nulliparous women with normal pregnancies admitted to the delivery ward after a spontaneous onset of labour were randomly allocated into one of three groups: manual acupuncture, electroacupuncture or standard care. Sample size calculation gave 101 women in each group, including a total of 303 women. VAS was used for assessing pain every 30 minutes for five hours and thereafter every hour until birth. Questionnaires were distributed before treatment, directly after the birth, and at one day and two months postpartum. Blood samples were collected before and after the first treatment.

At the conference, information on the design of the study will be presented and the considerations of whether to use placebo controls or not will be discussed.

ClinicalTrials.gov: NCT01197950