Published in 2015

Multi-frequency bioimpedance in equine muscle assessment

Harrison, A. P., Elbrønd, V. S., Riis-Olesen, K. & Bartels, E. M. mar. 2015 I : Physiological Measurement. 36, 3, s. 453-64 12 s.

Publikation: Forskning - peer reviewTidsskriftartikel

Multi-frequency BIA (mfBIA) equipment has been shown to be a non-invasive and reliable method to assess a muscle as a whole or at fibre level. In the equine world this may be the future method of assessment of training condition or of muscle injury. The aim of this study was to test if mfBIA reliably can be used to assess the condition of a horse's muscles in connection with health assessment, injury and both training and re-training. mfBIA measurements was carried out on 10 'hobby' horses and 5 selected cases with known anamnesis. Impedance, resistance, reactance, phase angle, centre frequency, membrane capacitance and both extracellular and intracellular resistance were measured. Platinum electrodes in connection with a conductance paste were used to accommodate the typical BIA frequencies and to facilitate accurate measurements. Use of mfBIA data to look into the effects of myofascial release treatment was also demonstrated. Our findings indicate that mfBIA provides a non-invasive, easily measurable and very precise assessment of the state of muscles in horses. This study also shows the potential of mfBIA as a diagnostic tool as well as a tool to monitor effects of treatment e.g. myofascial release therapy and metabolic diseases, respectively.

Originalsprog Engelsk
Tidsskrift Physiological Measurement
Vol/bind 36
Tidsskriftsnummer 3
Sider (fra-til) 453-64
Antal sider 12
ISSN 0967-3334
DOI
Status Udgivet - mar. 2015

Multi-frequency bioimpedance in human muscle assessment

Bartels, E. M., Sørensen, E. R. & Harrison, A. P. apr. 2015 I : Physiological Reports. 3, 4, e12354

Publikation: Forskning - peer reviewTidsskriftartikel

Bioimpedance analysis (BIA) is a well-known and tested method for body mass and muscular health assessment. Multi-frequency BIA (mfBIA) equipment now makes it possible to assess a particular muscle as a whole, as well as looking at a muscle at the fiber level. The aim of this study was to test the hypothesis that mfBIA can be used to assess the anatomical, physiological, and metabolic state of skeletal muscles. mfBIA measurements focusing on impedance, resistance, reactance, phase angle, center frequency, membrane capacitance, and both extracellular and intracellular resistance were carried out. Eight healthy human control subjects and three selected cases were examined to demonstrate the extent to which this method may be used clinically, and in relation to training in sport. The electrode setup is shown to affect the mfBIA parameters recorded. Our recommendation is the use of noble metal electrodes in connection with a conductance paste to accommodate the typical BIA frequencies, and to facilitate accurate impedance and resistance measurements. The use of mfBIA parameters, often in conjunction with each other, can be used to reveal indications of contralateral muscle loss, extracellular fluid differences, contracted state, and cell transport/metabolic activity, which relate to muscle performance. Our findings indicate that mfBIA provides a noninvasive, easily measurable and very precise momentary assessment of skeletal muscles.

Originalsprog Engelsk
Artikelnummer e12354
Tidsskrift Physiological Reports
Vol/bind 3
Tidsskriftsnummer 4
DOI
Status Udgivet - apr. 2015

AIMS/HYPOTHESIS: The season of birth might influence prenatal circumstances, which may influence the risk of developing type 2 diabetes. The aim of this study was to determine whether the diagnosis of type 2 diabetes in Denmark changed with the season of birth.

METHODS: This study used data from the population-based Copenhagen School Health Records Register (CSHRR) that includes schoolchildren born between 1930 and 1989. Via a personal identification number, the CSHRR was linked to the National Patient Register containing hospital discharge diagnoses since 1977. The effect of seasonal variation in birth on the risk of type 2 diabetes was assessed using Cox regression, with month or season of birth as the predictor. The underlying time variable was age, and follow-up started in 1977 or at age 30 years.

RESULTS: The study population consisted of 223,099 people, of whom 12,486 developed adult type 2 diabetes. Using January as the reference month, the risk of type 2 diabetes by month of birth was not statistically different for any of the 11 comparative birth months. Grouping month of birth into seasons (spring was the reference) gave essentially similar results, showing no difference in the risk of type 2 diabetes for any season. Repeating the analysis by sex, birth cohort and birthweight categories revealed no associations.

CONCLUSIONS/INTERPRETATION: The risk of adult type 2 diabetes was not associated with month of birth in a large Danish population-based study. The results suggest that the causes of seasonality in birthweight are not causes of type 2 diabetes.

Originalsprog Engelsk
Tidsskrift Diabetologia
Vol/bind 58
Tidsskriftsnummer 9
Sider (fra-til) 2045-50
Antal sider 6
ISSN 0012-186X
DOI
Status Udgivet - sep. 2015

BACKGROUND: The identification of detrimental dietary patterns early in life may contribute to reducing the high incidence of fracture among healthy children. However, information based on a systematic review of the effect of various dietary foods and nutrients on fracture risk is lacking.

OBJECTIVE: We conducted a systematic review and meta-analysis of observational studies that examined the association between dietary intake or serum nutritional concentrations and childhood fractures.

DESIGN: Studies published up until June 2015 were identified on the basis of a literature search in Medline, Web of Science, and Scopus databases and by hand searching references by first author based on predefined inclusion criteria. A meta-analysis was carried out for case-control studies that examined differences in mean calcium intake in the case compared with the control group. Random-effects analysis was performed on the basis of the effect estimates derived as the differences in mean calcium intakes between cases and controls.

RESULTS: From a total of 1960 articles, we identified 18 observational studies, which were primarily case-control in design. Randomized controlled trials were absent, potentially because of unethical aspects related to the enrollment of children randomly assigned to certain dietary exposures and later fracture rates. Overall, fracture risk seemed to be associated with milk avoidance, high energy intake, high cheese intake, high intake of sugar-sweetened beverages, and no breastfeeding. The pooled effect size of the 9 case-control studies that examined mean calcium intake, which had appropriate data for the meta-analysis, showed no association (P = 0.99) with fair heterogeneity (I(2) = 69.3%, P = 0.001) with the use of the random-effects model.

CONCLUSIONS: On the basis of a systematic review of studies that were judged to be of high or medium quality, there is an indication that some nutritional factors seem to be associated with an increased fracture risk among children. The results may be inflated by selection bias, bias in diet reporting, or residual confounding. More high-quality longitudinal observational or intervention studies are needed on the subject.

Originalsprog Engelsk
Tidsskrift The American journal of clinical nutrition
Vol/bind 102
Tidsskriftsnummer 5
Sider (fra-til) 1182-95
Antal sider 14
ISSN 0002-9165
DOI
Status Udgivet - nov. 2015

Occupational therapy evaluation: use of self-report and/or observation?

Nielsen, K. T. & Wæhrens, E. E. jan. 2015 I : Scandinavian Journal of Occupational Therapy. 22, 1, s. 13-23 11 s.

Publikation: Forskning - peer reviewTidsskriftartikel

BACKGROUND: The Occupational Therapy Intervention Process Model (OTIPM) serves to guide occupational therapists in their professional reasoning. The OTIPM prescribes evaluation of task performance based on both self-report and observation. Although this approach seems ideal, many clinicians raise the issue that time to perform evaluations is limited. It is, therefore, relevant to examine whether similar information concerning task performance can be obtained using self-report or observation.

OBJECTIVE: The aims were to investigate what information can be obtained regarding the quality of ADL task performance based on self-report and observation, respectively, and to examine the relationship between measures of self-reported and observed quality of ADL task performance.

METHODS: The quality of ADL task performance among 20 adults with depression was evaluated using the ADL Interview (ADL-I) and the Assessment of Motor and Process Skills (AMPS).

RESULTS AND CONCLUSIONS: Results indicated that participants both reported and demonstrated increased effort and/or fatigue, increased use of time, need for assistance, and safety problems. However, little relationship was found between measures of self-reported and observed quality of ADL task performance, supporting the use of both self-report and observation as part of the evaluation phase outlined in the OTIPM.

Originalsprog Engelsk
Tidsskrift Scandinavian Journal of Occupational Therapy
Vol/bind 22
Tidsskriftsnummer 1
Sider (fra-til) 13-23
Antal sider 11
ISSN 1103-8128
DOI
Status Udgivet - jan. 2015

PAIN MECHANISMS IN PATIENTS WITH INFLAMMATORY ARTHRITIS: A NATIONWIDE CROSS-SECTIONAL DANBIO REGISTRY SURVEY

Rifbjerg-Madsen, S., Christensen, A. W., Christensen, R., Hetland, M. L., Bliddal, H., Kristensen, L. E., Danneskiold-Samsøe, B. & Amris, K. 2015 I : Annals of the Rheumatic Diseases. 74, Suppl. 2, s. 313 1 s.

Publikation: Forskning - peer reviewKonferenceabstrakt i tidsskrift

Originalsprog Engelsk
Tidsskrift Annals of the Rheumatic Diseases
Vol/bind 74
Tidsskriftsnummer Suppl. 2
Sider (fra-til) 313
Antal sider 1
ISSN 0003-4967
Status Udgivet - 2015

Objectives. In some rheumatoid arthritis (RA) patients, joint pain persists without signs of inflammation. This indicates that central pain sensitisation may play a role in the generation of chronic pain in a subgroup of RA. Our aim was to assess the degree of peripheral and central pain sensitisation in women with active RA compared to healthy controls (HC). Methods. 38 women with active RA (DAS28 > 2.6) and 38 female HC were included in, and completed, the study. Exclusion criteria were polyneuropathy, pregnancy, and no Danish language. Cuff Pressure Algometry measurements were carried out on the dominant lower leg. Pain threshold, pain tolerance, and pain sensitivity during tonic painful stimulation were recorded. Results. Women with active RA had significantly lower pain threshold (p < 0.01) and pain tolerance (p < 0.01) than HC. The mean temporal summation- (TS-) index in RA patients was 0.98 (SEM: 0.09) and 0.71 (SEM: 0.04) in HC (p < 0.01). Conclusion. Patients with active RA showed decreased pressure-pain threshold compared to HC. In addition, temporal summation of pressure-pain was increased, indicating central pain sensitization, at least in some patients. Defining this subgroup of patients may be of importance when considering treatment strategies.

Originalsprog Engelsk
Tidsskrift Arthritis
Vol/bind 2015
Sider (fra-til) 434109
ISSN 2090-1984
DOI
Status Udgivet - 2015

Patient-Reported Outcome (PRO) questionnaires for young to middle-aged adults with hip and groin disability: a systematic review of the clinimetric evidence

Thorborg, K., Tijssen, M., Habets, B., Bartels, E. M., Roos, E. M., Kemp, J., Crossley, K. M. & Hölmich, P. jun. 2015 I : British Journal of Sports Medicine. 49, 12, s. 812

Publikation: Forskning - peer reviewTidsskriftartikel

BACKGROUND/AIM: To recommend Patient-Reported Outcome (PRO) questionnaires to measure hip and groin disability in young-aged to middle-aged adults.

METHODS: A systematic review was performed in June 2014. The methodological quality of the studies included was determined using the COnsensus-based Standards for the selection of health Measurement INstruments list (COSMIN) together with standardised evaluations of measurement properties of each PRO.

RESULTS: Twenty studies were included. Nine different questionnaires for patients with hip disability, and one for hip and groin disability, were identified. Hip And Groin Outcome Score (HAGOS), Hip Outcome Score (HOS), International Hip Outcome Tool-12 (IHOT-12) and IHOT-33 were the most thoroughly investigated PROs and studies including these PROs reported key aspects of the COSMIN checklist. HAGOS and IHOT-12 were based on studies with the least ratings of poor study methodology (23% and 31%, respectively), whereas IHOT-33 and HOS had a somewhat larger distribution (46%). These PROs all contain adequate measurement qualities for content validity (except HOS), test-retest reliability, construct validity, responsiveness and interpretability. No information or poor quality rating on methodological aspects made it impossible to fully evaluate the remaining PROs at present.

CONCLUSIONS: HAGOS, HOS, IHOT-12 and IHOT-33 can be recommended for assessment of young-aged to middle-aged adults with pain related to the hip joint, undergoing non-surgical treatment or hip arthroscopy. At present, HAGOS is the only PRO also aimed for young-aged to middle-aged adults presenting with groin pain and is recommended for use in this population.

TRIAL REGISTRATION NUMBER: CRD42014009995.

Originalsprog Engelsk
Tidsskrift British Journal of Sports Medicine
Vol/bind 49
Tidsskriftsnummer 12
Sider (fra-til) 812
ISSN 0306-3674
DOI
Status Udgivet - jun. 2015

Performance of activities of daily living among hospitalized cancer patients

Lindahl-Jacobsen, L., Hansen, D. G., Wæhrens, E. E., la Cour, K. & Søndergaard, J. mar. 2015 I : Scandinavian Journal of Occupational Therapy. 22, 2, s. 137-46 10 s.

Publikation: Forskning - peer reviewTidsskriftartikel

BACKGROUND: Many cancer patients report unmet rehabilitation needs. Rehabilitation may include activities of daily living (ADL) tasks, but little is known about how cancer patients perform these tasks and how they prioritize their daily activities. Hence, this study aims to identify and characterize ADL task performance problems among a group of adult disabled hospitalized cancer patients using interview and questionnaire data.

METHODS: Cross-sectional study on prevalence of ADL task performance problems experienced by disabled hospitalized cancer patients using the Activities of Daily Living Questionnaire (ADL-Q) (n = 118) and the Canadian Occupational Performance Measure (COPM) (n = 55).

RESULTS: All 118 patients reported problems with ADL task performance. Based on the ADL-Q patients reported more problems within instrumental (I-)ADL than personal (P-)ADL. In both I-ADL and P-ADL the results differed between women and men. There was significant overlap between problems identified using the COPM and the ADL-Q instruments. RESULTS from the COPM showed that 65% of problems were related to self-care, 25% to leisure, and 19% to productivity. Using both instruments identified more ADL problems than when using only one of the instruments.

CONCLUSION: Adult hospitalized disabled cancer patients experience a high degree and variation in difficulties performing ADL, illustrating the need for a comprehensively planned assessment of problems and needs.

Originalsprog Engelsk
Tidsskrift Scandinavian Journal of Occupational Therapy
Vol/bind 22
Tidsskriftsnummer 2
Sider (fra-til) 137-46
Antal sider 10
ISSN 1103-8128
DOI
Status Udgivet - mar. 2015

Polymorphisms in the Toll-Like Receptor and the IL-23/IL-17 Pathways Were Associated with Susceptibility to Inflammatory Bowel Disease in a Danish Cohort

Bank, S., Andersen, P. S., Burisch, J., Pedersen, N., Roug, S., Galsgaard, J., Ydegaard Turino, S., Broder Brodersen, J., Rashid, S., Kaiser Rasmussen, B., Avlund, S., Bastholm Olesen, T., Hoffmann, H. J., Andersen Nexø, B., Sode, J., Vogel, U. & Andersen, V. 25 dec. 2015 I : P L o S One. 10, 12, s. e0145302

Publikation: Forskning - peer reviewTidsskriftartikel

BACKGROUND: The inflammatory bowel diseases (IBD), Crohn's disease (CD) and ulcerative colitis (UC), result from the combined effects of susceptibility genes and environmental factors. Previous studies have shown that polymorphisms in the Toll-like receptor (TLR), the apoptosis, the IL-23/IL-17 and the interferon gamma (IFNG) pathways are associated with risk of both CD and UC.

METHODS: Using a candidate gene approach, 21 functional single nucleotide polymorphisms (SNPs) in 15 genes were assessed in a clinical homogeneous group of severely diseased ethnic Danish patients consisting of 624 patients with CD, 411 patients with UC and 795 controls. The results were analysed using logistic regression.

RESULTS: The polymorphisms TLR5 (rs5744174) and IL12B (rs6887695) were associated with risk of CD, and TLR1 (rs4833095) and IL18 (rs187238) were associated with risk of both CD and UC (p<0.05). After Bonferroni correction for multiple testing, the homozygous variant genotype of TLR1 743 T>C (rs4833095) was associated with increased risk CD (OR: 3.15, 95% CI: 1.59-6.26, p = 0.02) and CD and UC combined (OR: 2.96, 95% CI: 1.64-5.32, p = 0.005).

CONCLUSION: Our results suggest that genetically determined high activity of TLR1 and TLR5 was associated with increased risk of both CD and UC and CD, respectively. This supports that the host microbial composition or environmental factors in the gut are involved in risk of IBD. Furthermore, genetically determined high activity of the IL-23/IL-17 pathway was associated with increased risk of CD and UC. Overall, our results support that genetically determined high inflammatory response was associated with increased risk of both CD and UC.

Originalsprog Engelsk
Tidsskrift P L o S One
Vol/bind 10
Tidsskriftsnummer 12
Sider (fra-til) e0145302
ISSN 1932-6203
DOI
Status Udgivet - 25 dec. 2015

Power and color Doppler settings for inflammatory flow - impact on scoring of disease activity in patients with rheumatoid arthritis

Torp-Pedersen, S. T., Christensen, R., Szkudlarek, M., Ellegaard, K., D'Agostino, M. A., Iagnocco, A., Naredo, E., Balint, P., Wakefield, R. J., Torp-Pedersen, A. & Terslev, L. 2015 I : Arthritis & Rheumatology. 67, 2, s. 386-95

Publikation: Forskning - peer reviewTidsskriftartikel

Objectives: To determine how settings for power and color Doppler sensitivity varies on different high and intermediate range ultrasound (US) machines and to evaluate the impact of these changes on Doppler scoring of inflammatory joints Methods: Six different types of ultrasound machine were used. On each machine, the factory setting (FS) for superficial musculoskeletal scanning was used unchanged for both color and power Doppler modalities. The settings were then adjusted for increased Doppler sensitivity - study settings (SS). Eleven RA patients with wrist involvement were scanned on the 6 machines each with 4 settings generating 264 Doppler images for scoring and color quantification. Doppler sensitivity was measured with a quantitative assessment of Doppler activity - color fraction (CF) - higher CF indicated higher sensitivity. Results: Power Doppler was more sensitive on half of the machines whereas color Doppler was more sensitive on the other half with both FS and SS. There was an average increase in Doppler sensitivity despite modality of 78% when SS were applied. Over the 6 machines, 2 Doppler modalities, and 2 settings, 7 patients varied between grades 0 and 3 with the other 4 patients between grades 0 and 2. Conclusion: The effect of using different machines, Doppler modalities, and settings has a considerable influence on the quantification of inflammation in RA patients and this must be taken into account in multi-centre studies. © 2014 American College of Rheumatology.

Originalsprog Engelsk
Tidsskrift Arthritis & Rheumatology
Udgivelsesdato 2015
Vol/bind 67
Tidsskriftsnummer 2
Sider 386-95
ISSN 1537-2960
DOI
Status Udgivet

Power and color Doppler ultrasound settings for inflammatory flow: impact on scoring of disease activity in patients with rheumatoid arthritis

Torp-Pedersen, S., Christensen, R., Szkudlarek, M., Ellegaard, K., D'Agostino, M. A., Iagnocco, A., Naredo, E., Balint, P., Wakefield, R. J., Torp-Pedersen, A. & Terslev, L. feb. 2015 I : Arthritis & rheumatology (Hoboken, N.J.). 67, 2, s. 386-95 10 s.

Publikation: Forskning - peer reviewTidsskriftartikel

OBJECTIVE: To determine how settings for power and color Doppler ultrasound sensitivity vary on different high- and intermediate-range ultrasound machines and to evaluate the impact of these changes on Doppler scoring of inflamed joints.

METHODS: Six different types of ultrasound machines were used. On each machine, the factory setting for superficial musculoskeletal scanning was used unchanged for both color and power Doppler modalities. The settings were then adjusted for increased Doppler sensitivity, and these settings were designated study settings. Eleven patients with rheumatoid arthritis (RA) with wrist involvement were scanned on the 6 machines, each with 4 settings, generating 264 Doppler images for scoring and color quantification. Doppler sensitivity was measured with a quantitative assessment of Doppler activity: color fraction. Higher color fraction indicated higher sensitivity.

RESULTS: Power Doppler was more sensitive on half of the machines, whereas color Doppler was more sensitive on the other half, using both factory settings and study settings. There was an average increase in Doppler sensitivity, despite modality, of 78% when study settings were applied. Over the 6 machines, 2 Doppler modalities, and 2 settings, the grades for each of 7 of the patients varied between 0 and 3, while the grades for each of the other 4 patients varied between 0 and 2.

CONCLUSION: The effect of using different machines, Doppler modalities, and settings has a considerable influence on the quantification of inflammation by ultrasound in RA patients, and this must be taken into account in multicenter studies.

Originalsprog Engelsk
Tidsskrift Arthritis & rheumatology (Hoboken, N.J.)
Vol/bind 67
Tidsskriftsnummer 2
Sider (fra-til) 386-95
Antal sider 10
DOI
Status Udgivet - feb. 2015

BACKGROUND: Reports vary considerably concerning characteristics of patients who will respond to mobilizing exercises or manipulation. The objective of this prospective cohort study was to identify characteristics of patients with a changeable lumbar condition, i.e. presenting with centralization or peripheralization, that were likely to benefit the most from either the McKenzie method or spinal manipulation.

METHODS: 350 patients with chronic low back pain were randomized to either the McKenzie method or manipulation. The possible effect modifiers were age, severity of leg pain, pain-distribution, nerve root involvement, duration of symptoms, and centralization of symptoms. The primary outcome was the number of patients reporting success at two months follow-up. The values of the dichotomized predictors were tested according to the prespecified analysis plan.

RESULTS: No predictors were found to produce a statistically significant interaction effect. The McKenzie method was superior to manipulation across all subgroups, thus the probability of success was consistently in favor of this treatment independent of predictor observed. When the two strongest predictors, nerve root involvement and peripheralization, were combined, the chance of success was relative risk 10.5 (95% CI 0.71-155.43) for the McKenzie method and 1.23 (95% CI 1.03-1.46) for manipulation (P = 0.11 for interaction effect).

CONCLUSIONS: We did not find any baseline variables which were statistically significant effect modifiers in predicting different response to either McKenzie treatment or spinal manipulation when compared to each other. However, we did identify nerve root involvement and peripheralization to produce differences in response to McKenzie treatment compared to manipulation that appear to be clinically important. These findings need testing in larger studies.

TRIAL REGISTRATION: Clinicaltrials.gov: NCT00939107.

Originalsprog Engelsk
Tidsskrift B M C Musculoskeletal Disorders
Vol/bind 16
Sider (fra-til) 74
ISSN 1471-2474
DOI
Status Udgivet - 2015

Prenatal exposure to persistent organochlorine pollutants is associated with high insulin levels in 5-year-old girls

Tang-Péronard, J. L., Heitmann, B. L., Jensen, T. K., Vinggaard, A. M., Madsbad, S., Steuerwald, U., Grandjean, P., Weihe, P., Nielsen, F. & Andersen, H. R. 29 jul. 2015 I : Environmental Research. 142, s. 407-413 7 s.

Publikation: Forskning - peer reviewTidsskriftartikel

BACKGROUND: Several persistent organochlorine pollutants (POPs) possess endocrine disrupting abilities, thereby potentially leading to an increased risk of obesity and metabolic diseases, especially if the exposure occurs during prenatal life. We have previously found associations between prenatal POP exposures and increased BMI, waist circumference and change in BMI from 5 to 7 years of age, though only among girls with overweight mothers.

OBJECTIVES: In the same birth cohort, we investigated whether prenatal POP exposure was associated with serum concentrations of insulin and leptin among 5-year-old children, thus possibly mediating the association with overweight and obesity at 7 years of age.

METHODS: The analyses were based on a prospective Faroese Birth Cohort (n=656), recruited between 1997 and 2000. Major POPs, polychlorinated biphenyls (PCBs), p,p'-dichlorodiphenyldichloroethylene (DDE) and hexachlorobenzene (HCB), were measured in maternal pregnancy serum and breast milk. Children were followed-up at the age of 5 years where a non-fasting blood sample was drawn; 520 children (273 boys and 247 girls) had adequate serum amounts available for biomarker analyses by Luminex® technology. Insulin and leptin concentrations were transformed from continuous to binary variables, using the 75th percentile as a cut-off point. Multiple logistic regression was used to investigate associations between prenatal POP exposures and non-fasting serum concentrations of insulin and leptin at age 5 while taking into account confounders.

RESULTS: Girls with highest prenatal POP exposure were more likely to have high non-fasting insulin levels (PCBs 4th quartile: OR=3.71; 95% CI: 1.36, 10.01. DDE 4th quartile: OR=2.75; 95% CI: 1.09, 6.90. HCB 4th quartile: OR=1.98; 95% CI: 1.06, 3.69) compared to girls in the lowest quartile. No significant associations were observed with leptin, or among boys. A mediating effect of insulin or leptin on later obesity was not observed.

CONCLUSION: These findings suggest, that for girls, prenatal exposure to POPs may play a role for later development of metabolic diseases by affecting the level of insulin.

Originalsprog Engelsk
Tidsskrift Environmental Research
Vol/bind 142
Sider (fra-til) 407-413
Antal sider 7
ISSN 0013-9351
DOI
Status Udgivet - 29 jul. 2015

Progressive high-load strength training compared with general low-load exercises in patients with rotator cuff tendinopathy: study protocol for a randomised controlled trial

Ingwersen, K. G., Christensen, R., Sørensen, L., Jørgensen, H. R., Jensen, S. L., Rasmussen, S., Søgaard, K. & Juul-Kristensen, B. 2015 I : Trials. 16, 1, s. 27

Publikation: Forskning - peer reviewTidsskriftartikel

BACKGROUND: Shoulder pain is the third most common musculoskeletal disorder, often affecting people's daily living and work capacity. The most common shoulder disorder is the subacromial impingement syndrome (SIS) which, among other pathophysiological changes, is often characterised by rotator cuff tendinopathy. Exercise is often considered the primary treatment option for rotator cuff tendinopathy, but there is no consensus on which exercise strategy is the most effective. As eccentric and high-load strength training have been shown to have a positive effect on patella and Achilles tendinopathy, the aim of this trial is to compare the efficacy of progressive high-load exercises with traditional low-load exercises in patients with rotator cuff tendinopathy.

METHODS/DESIGN: The current study is a randomised, participant- and assessor-blinded, controlled multicentre trial. A total of 260 patients with rotator cuff tendinopathy will be recruited from three outpatient shoulder departments in Denmark, and randomised to either 12 weeks of progressive high-load strength training or to general low-load exercises. Patients will receive six individually guided exercise sessions with a physiotherapist and perform home-based exercises three times a week. The primary outcome measure will be change from baseline to 12 weeks in the patient-reported outcome Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.

DISCUSSION: Previous studies of exercise treatment for SIS have not differentiated between subgroups of SIS and have often had methodological flaws, making it difficult to specifically design target treatment for patients diagnosed with SIS. Therefore, it was considered important to focus on a subgroup such as tendinopathy, with a specific tailored intervention strategy based on evidence from other regions of the body, and to clearly describe the intervention in a methodologically strong study.

TRIAL REGISTRATION: The trial was registered with Clinicaltrials.gov ( NCT01984203 ) on 31 October 2013.

Originalsprog Engelsk
Tidsskrift Trials
Vol/bind 16
Tidsskriftsnummer 1
Sider (fra-til) 27
ISSN 1745-6215
DOI
Status Udgivet - 2015

Ranibizumab vs. aflibercept for wet age-related macular degeneration: network meta-analysis to understand the value of reduced frequency dosing

Szabo, S. M., Hedegaard, M., Chan, K., Thorlund, K., Christensen, R., Vorum, H. & Jansen, J. P. nov. 2015 I : Current Medical Research and Opinion. 31, 11, s. 2031-42 12 s.

Publikation: Forskning - peer reviewTidsskriftartikel

OBJECTIVE: Although a reduced aflibercept (2.0 mg) injection frequency relative to the approved dosing posology is included in national treatment guidelines for wet age-related macular degeneration (AMD), there is limited evidence of its comparative efficacy. The objective was to compare the efficacy and safety of reduced frequency dosing for aflibercept, relative to other approved and marketed vascular endothelial growth factor inhibitors for wet AMD, over 12 months.

RESEARCH DESIGN AND METHODS: Based on a systematic literature review performed according to a pre-specified protocol, a Bayesian network meta-analysis (NMA) was conducted to indirectly compare posologies of aflibercept and ranibizumab (0.5 mg). The efficacy outcome, mean change from baseline in best-corrected visual acuity (BCVA) on the ETDRS chart, was evaluated at 3 and 12 months; and safety data at 12 months. Standard NMA models were used to analyze change at 3 months, and fractional polynomial regression over 12 months. Safety data were analyzed using binomial models with a logistic link function.

RESULTS: Five trials formed a complete evidence network. At 3 months, all posologies of aflibercept and ranibizumab resulted in similar changes in BCVA. Over 12 months, approved posologies of aflibercept and ranibizumab resulted in similar changes from baseline, between 6.7 (95% credible interval [CrI], 5.5, 7.8) and 9.1 (8.1, 10.1) ETDRS letters; however, reduced frequency aflibercept was associated with a smaller change (1.8 letters, [-25.9, 29.2]). There was a trend towards a greater change in BCVA, with increasing frequency of dosing. All posologies performed similarly with respect to safety, and CrIs were wide.

CONCLUSIONS: Approved posologies of ranibizumab and aflibercept are similarly effective treatments for wet AMD. Reduced frequency aflibercept was associated with the poorest visual outcomes, and sample sizes were small. Findings from these analyses provide novel evidence of the comparative efficacy and safety of aflibercept and ranibizumab for wet AMD.

Originalsprog Engelsk
Tidsskrift Current Medical Research and Opinion
Vol/bind 31
Tidsskriftsnummer 11
Sider (fra-til) 2031-42
Antal sider 12
ISSN 0300-7995
DOI
Status Udgivet - nov. 2015

Reablement in a community setting

Winkel, A., Langberg, H. & Wæhrens, E. E. 2015 I : Disability and rehabilitation. 37, 15, s. 1347-52 6 s.

Publikation: Forskning - peer reviewTidsskriftartikel

PURPOSE: When older adults experience a decrease in functional independence including decreased ability to perform activities of daily living (ADL) tasks, rehabilitation services are required. The aim of this pilot study was to evaluate if a home-based reablement program influenced the ADL ability of older adults.

METHODS: Ninety-one older adults (80 ± 9 years) were allocated to a 12-weeks home-based reablement program consisting of ADL task performance training by a home carer supervised by an occupational therapist. ADL ability was measured at baseline, at 12 weeks and at follow-up (range: 310-592 d) using the ADL-Interview (ADL-I).

RESULTS: Overall, ADL ability improved significantly over time (p = 0.041). Post-hoc t-tests indicated that the improvements occurred between baseline and end of intervention (p = 0.042) and were maintained at follow-up 10 months after intervention (p = 0.674). There were no effects related to age (p = 0.787) or to whether the older adult had received help previously (p = 0.120).

CONCLUSION: A 12-weeks home-based reablement program was found to improve ADL ability among older adults regardless of whether they previously received help. This implies that receiving home care services should not be considered a barrier to participation in a reablement program. [Box: see text].

Originalsprog Engelsk
Tidsskrift Disability and rehabilitation
Vol/bind 37
Tidsskriftsnummer 15
Sider (fra-til) 1347-52
Antal sider 6
ISSN 1464-5165
DOI
Status Udgivet - 2015

Reply

Torp-Pedersen, S., Christensen, R., Ellegaard, K., Torp-Pedersen, A., Szkudlarek, M., D'Agostino, M. A., Iagnocco, A., Naredo, E., Balint, P., Wakefield, R. J., Terslev, L. & Jensen, J. A. jun 2015 I : Arthritis & rheumatology (Hoboken, N.J.). 67, 6, s. 1681-3 3 s.

Publikation: Forskning - peer reviewTidsskriftartikel

Originalsprog Engelsk
Tidsskrift Arthritis & rheumatology (Hoboken, N.J.)
Udgivelsesdato jun 2015
Vol/bind 67
Tidsskriftsnummer 6
Sider 1681-3
Antal sider 3
DOI
Status Udgivet

Reply: To PMID 25370843.

Torp-Pedersen, S., Christensen, R., Ellegaard, K., Torp-Pedersen, A., Szkudlarek, M., D'Agostino, M. A., Iagnocco, A., Naredo, E., Balint, P., Wakefield, R. J., Terslev, L. & Jensen, J. A. jun. 2015 I : Arthritis & rheumatology (Hoboken, N.J.). 67, 6, s. 1681-3 3 s.

Publikation: Forskning - peer reviewLetter

Originalsprog Engelsk
Tidsskrift Arthritis & rheumatology (Hoboken, N.J.)
Vol/bind 67
Tidsskriftsnummer 6
Sider (fra-til) 1681-3
Antal sider 3
DOI
Status Udgivet - jun. 2015

BACKGROUND: Low back pain is prevalent and is a frequent cause of disability and sick leave among working adults. Individuals with low back pain often consult general practice or other health care providers which often results in a unilateral intervention focussed on their symptoms. Employment is associated with physical and mental well-being, so, patients may benefit from an early additional occupational medicine intervention. For individuals with physically demanding jobs it can be especially challenging to retain their jobs. The aim of the 'GoBack trial' is to develop and evaluate the efficacy and feasibility of an occupational medicine intervention for individuals with low back pain in physically demanding jobs.

METHODS/DESIGN: We will conduct a randomised controlled trial enrolling 300 participants with difficulty in maintaining physically demanding jobs due to low back pain for a current period of 2 to 4 weeks. Participants will be randomised and stratified according to their age and gender before being allocated in a 1:1 ratio to either control or additional occupational medicine intervention. Both groups will receive conventional treatment for their low back pain during the study. All participants will be thoroughly assessed for causes of low back pain and potential prognostic factors by questionnaires, clinical specialist assessments and magnetic resonance imaging (MRI) scans of the lumbar spine. Primary outcome is the accumulated duration of self-assessed sick leave (in days) due to low back pain during 6 months from baseline. Secondary outcomes include general self-rated back pain, disability and screening for potential prognostic factors: fear avoidance behaviour, disability, health status and degenerative MRI findings. For tertiary purposes selected outcomes will also be assessed after 1 and 2 years from baseline.

DISCUSSION: Many guidelines exist for the management of low back pain, but they provide limited guidance on occupational aspects. The findings from this randomised trial will provide high-quality evidence for the efficacy and feasibility of an occupational medicine intervention model for individuals with low back pain in physically demanding jobs.

TRIAL REGISTRATION: This trial was registered with ClinicalTrials.gov (identifier: NCT02015572 ) on 29 November 2013.

Originalsprog Engelsk
Tidsskrift Trials
Vol/bind 16
Tidsskriftsnummer 1
Sider (fra-til) 166
ISSN 1745-6215
DOI
Status Udgivet - 2015

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