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Background Various interventions have been developed with the intention to increase the amount of physical activity among children, including those promoting active school travel (AST). However, no gold standard currently exists for measuring different travel modes in AST. This study evaluates the criterion validity of a web-based data collection tool designed for children to self-report their school travel.

Purpose To assess the criterion validity of a web-based data collection tool for daily self-registration of commuting mode, time, and distance among middle school children in Sweden.

Methods Thirty children (10–12 years old) from six schools in Falun, Sweden, were recruited using snowball sampling. The children self-reported their school travel data for one day, including travel mode, commuting time, and distance. Their reports were compared to a criterion standard based on direct observations. Spearman correlation and the Wilcoxon signed-rank test were used to analyze the accuracy of the self-reported data.

Result The web-based data collection tool demonstrated 100% agreement between self-reported and observed travel modes, with high correlations for commuting time and distance (rs=0.953–0.989, p < 0.001). The Wilcoxon signed rank test showed no significant differences between self-reported data and criterion standard (p = 0.243–0.903).

Conclusion The strong agreement between self-reported and observed travel data indicates high criterion validity, suggesting that the web-based data collection tool is a reliable method for middle school children to self-report their daily school travel.

Background: Chronic pain affects 20-30% of adults and is a leading cause of disability and societal cost. Interdisciplinary, team-based treatment (IDT) is the most comprehensive approach, yet outcomes vary widely, and long-term benefits are, on average, modest. We aimed to develop clinically interpretable patient clusters from routine pre-treatment intake data and to validate them externally using independent national registry indicators, as a foundation for data-driven clinical decision support.

Methods: We analyzed a nationwide cohort of 90,505 patients entering specialist IDT in Sweden. A theory-informed unsupervised approach was used to cluster biopsychosocial intake features from the Swedish Quality Registry for Pain Rehabilitation using k-means clustering. Internal validation assessed stability and separation, while external validation tested concordance between questionnaire-derived cluster structures and pre-intake sick-leave trajectories and medication prescriptions derived from national registers using the Mantel statistic and logistic regression.

Results: Eight distinct clusters were identified, characterized by differing constellations of pain severity, psychological distress, functional status, and pain duration. Registry indicators tracked with cluster burden: higher-severity clusters showed greater sick leave and more medication prescriptions. Concordance between questionnaire-based and registry-based distance matrices was moderate to strong (Mantel r = 0.65; p = 0.0016) and cluster membership was significantly associated with the registry-based features. Three pre-intake sick-leave trajectories (high/stable, medium/stable, and low/increasing) were observed and differed across clusters.

Conclusions: Population-scale unsupervised clustering of routine patient-reported data, externally validated with independent national registries and supported by longitudinal sickness-absence patterns, yields clinically interpretable subgroups with strengthened construct validity. This provides a scalable foundation for patient stratification and the development of future clinical decision-support tools to better target and monitor IDT in real-world care.

Using registry and questionnaire data from 47,235 chronic pain patients, we evaluated whether supervised learning outperforms clustering in predicting nine one-year outcomes. Supervised models showed small but consistent improvements (best RMSE 5.49 vs. 5.92; R2 0.34 vs. 0.19), with overall comparable performance.

BACKGROUND: A wide range of school interventions have been launched to increase childrens' physical activity. Evaluation of the effectiveness of interventions requires suitable study designs and feasible quantitative evaluations relating to the school setting. The purpose of this study was to assess the evaluation design and methods for data collection, in order to make decisions about approaching forthcoming studies of the effectiveness of active school travel (AST) interventions.

METHODS: Children from four Swedish schools in fifth grade (11-12 years old) participated in this non-randomized pilot study, two schools received an AST intervention and two schools were controls. The school-based AST intervention Sustainable Innovation for Children Transporting Actively (SICTA) was conducted by teachers in the classroom setting during four weeks. To assess feasibility of the evaluation design and methods for data collection a combination of quantitative and qualitative methods were applied, using participation- and response rates, a feasibility questionnaire and focus group interviews.

RESULTS: Out of 25 potential schools, four schools accepted participation with explicit allocation requests preventing randomization. Out of 181 children, 107 children (59%) accepted participation. A total of 82% of the participating children reported active travel before the AST intervention, and 80% found reporting of daily school travels in the web-based survey to be easy. The children were in general positive about participating in the study and the methods for data collection were considered easy for the participating children to conduct and to blend well with usual school activities. There was an imbalance in reporting rates between intervention and control schools as well as a decrease in reporting rates during the study period.

CONCLUSIONS: Our results highlight the complexity and challenges in conducting controlled research among school children. Although children were positive about participation and found reporting to be easy, our results invoke the need to use alternative research designs and recruitment strategies that also attract children using non-active modes of travel when evaluating AST interventions in school contexts.

TRIAL REGISTRATION: The study is registered 2023/11/02 with Researchweb, the Swedish Register for Research with registration number 281,543. The registration can be reached via this link: https://www.researchweb.org/is/sverige/project/281543 .

Background

Patients with chronic pain often struggle to engage in physical activity despite its health benefits. The eVISualisation of physical activity and pain intervention (eVIS) was developed to support adherence to physical activity plans in Interdisciplinary Pain Rehabilitation Programs (IPRPs) by visualising activity, pain levels, pain interference, and pharmacological use. This pilot study assesses the feasibility and acceptability of trial design and trial conduct of a registry-based randomised clinical trial (R-RCT).

Method

This randomised clinical pilot study included the first 10% (n = 39, mean age 43.5, 74.4% females) of the R-RCT sample (n≈400). Participants with non-cancer chronic pain from six IPRP units were randomly assigned to either the intervention group (IPRP + eVIS, n = 19) or the control group (IPRP, n = 20). Feasibility and acceptability were evaluated using pre-defined criteria on recruitment- and data collection procedures (e.g., inclusion rates, representativeness, adverse events), physiotherapists’ ratings of trial design and conduct (e.g., acceptability, feasibility), and outcome data characteristics and completeness (e.g., adherence, data accessibility).

Results

Recruitment was largely feasible, though attrition differences and the need for refined eligibility screening were noted. Physiotherapists cited time and implementation challenges. Both groups had satisfactory data completeness, but the control group showed lower adherence to daily reporting in the final third of the study. The intervention group had greater improvements in physical health, with 19.5% more participants achieving the minimum clinically important difference (≥3) on the physical component summary scale (PCS). No adverse events occurred.

Conclusion

With minor adjustments, the R-RCT design is mostly feasible, though some challenges to feasibility were identified and addressed.

BACKGROUND: When establishing Physical Employment Standards, validity is dependent on the correct identification and characterisation of critical job tasks.

OBJECTIVE: To develop and validate a standardised protocol for the identification, characterisation, and documentation of critical physical job tasks in military occupational specialities in the Swedish Armed Forces (SwAF), and propose a definition of critical physical job tasks for use in the SwAF.

METHODS: A protocol was drafted with three content domains, including a preliminary definition. Protocol content validity was iteratively assessed in two consecutive stages where ten subject experts rated relevance and simplicity. A consensus panel revised the protocol after each stage. Content validity index (CVI) was calculated as item-CVI (I-CVI) per each feature and as scale average (S-CVI/Ave) per content domain. Acceptable content validity thresholds were 0.78 and 0.90, respectively.

RESULTS: The validated protocol consisted of 35 items with an I-CVI≥0.90 and≥0.80 for relevance and simplicity, respectively. The S-CVI/Ave was 0.97 for relevance and 0.98 for simplicity. The protocol was language reviewed, reorganised for easy use, and approved by the consensus panel. The final protocol includes: background and aim of the protocol, the accepted generic and critical physical job task definitions, protocol instructions, subject expert-qualifications, job task source and characteristics.

CONCLUSION: A standardised protocol for identification and characterisation of critical job tasks in SwAF military occupational specialties was developed. The protocol content was rated relevant and simple by experts and will be of importance in future work establishing physical requirements in the SwAF.

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.

BACKGROUND: To date, no consensus exists as to whether one exercise type is more effective than another in chronic neck pain. This systematic review and meta-analysis of systematic reviews aimed to summarize the literature on the effect of various exercise types used in chronic neck pain and to assess the certainty of the evidence.

METHODS: We searched the databases Ovid MEDLINE, Embase, Cochrane Library, SportDiscus, and Web of Science (Core Collection) for systematic reviews and meta-analyses on adults between 18 and 70 years with chronic neck pain lasting ≥ 12 weeks which investigated the effects of exercises on pain and disability. The included reviews were grouped into motor control exercise (MCE), Pilates exercises, resistance training, traditional Chinese exercise (TCE), and yoga. Study quality was assessed with AMSTAR-2 and the level of certainty for the effects of the exercise through GRADE. A narrative analysis of the results was performed and in addition, meta-analyses when feasible.

RESULTS: Our database search resulted in 1,794 systematic reviews. We included 25 systematic reviews and meta-analyses including 17,321 participants (overlap not accounted for). The quality of the included reviews ranged from critically low to low (n = 13) to moderate to high (n = 12). We found low to high certainty of evidence that MCE, Pilates exercises, resistance training, TCE, and yoga have short-term positive effects on pain and that all exercise types except resistance training, show positive effects on disability compared to non-exercise controls. We found low to moderate certainty of evidence for conflicting results on pain and disability when the exercise types were compared to other exercise interventions in the short-term as well as in intermediate/long-term apart for yoga, as no long-term results were available.

CONCLUSION: Overall, our findings show low to high certainty of evidence for positive effects on pain and disability of the various exercise types used in chronic neck pain compared to non-exercise interventions, at least in the short-term. Based on our results, no optimal exercise intervention for patients with chronic neck pain can be recommended, since no large differences between the exercise types were shown here. Because the quality of the included systematic reviews varied greatly, future systematic reviews need to increase their methodological quality.

TRIAL REGISTRATION: Prospero CRD42022336014.