Patient education, exercise, and weight control is the first-line treatment for people with osteoarthritis (OA). In Sweden, a Supported Osteoarthritis Self-Management Program (SOASP), including patient education and exercise is provided by health professionals at more than 500 primary care units. The result of this intervention is still unclear. The overall aim of this thesis was to increase understanding of the results of the SOASP for people with knee and/or hip OA delivered in a real-world setting
Osteoarthritis of the carpometacarpal joint at the base of the thumb is common and causes difficulty in grasp, grip, and fine manipulation of the hand. The objectives of this thesis were to 1) evaluate the clinically important prevalence of CMC1 OA by age and sex using physician-assigned diagnoses; 2) study the impact of occupational load on the occurrence of CMC1 OA, and 3) evaluate surgical outcomes including register-based sick leave length as well as long-term follow-up in a tightly captured population. The findings confirmed long-held beliefs that there is a greater female prevalence of CMC1 OA and that heavy labor is associated with increased risk of CMC1 OA. Surgical treatment can relieve pain and improve function, with prosthetic implant arthroplasty associated with earlier return to work.
This thesis aimed to study the proteome and microstructure of the human meniscus, both in healthy subjects and OA patients, to increase our knowledge about the human meniscus and the processes that occur during degeneration and OA. Comparison of healthy and OA menisci revealed increased degeneration of the OA menisci, with more disorganised collagen networks and the presence of cysts and calcifications. The increased degeneration in OA menisci suggests a strong association between OA and meniscal degeneration.
This thesis consists of four parts answering several questions including: Which patients undergo meniscus removal tissue and do we operate on the "right" patients? How much sick leave on average do people with meniscus injuries take? It also examines whether the issuance of national recommendations not to operate on middle-aged patients with osteoarthritis has affected the frequency of surgery.
This thesis aimed to develop and evaluate clinically feasible measures of postural orientation in participants with or without lower extremity injury. Secondary aims were to evaluate sex differences in postural orientation and the association between postural orientation and other measures of physical function and self-reported outcomes, in men and women undergoing rehabilitation after ACL reconstruction. The results from this thesis indicate that visual assessment of the segment-specific POE (postural orientation error) KMFP (knee medial-to-foot position) is valid and reliable in healthy populations. The test battery for visual assessment of POEs showed no floor or ceiling effects, high internal consistency, and good inter-rater reliability in patients with an ACL injury. This indicates that visual assessment of POEs can be used in patients with an ACL injury, both in research and in clinical practice.
This thesis has deepened the knowledge on health care interventions in primary care for working-age patients with acute or subacute back and neck pain. The Swedish STarT Back Tool, a brief screening tool designed for tailored interventions based on risk stratification/triage, has been validated for individuals with acute or subacute back and neck pain in primary care. The long-term effects of a workplace dialogue as an add-on to structured physiotherapy on self-reported measures have been evaluated. The broad spectrum of interventions used by primary care physiotherapists for patients with back and neck pain in working-age are described.
The main objective of this thesis was to evaluate the importance of improved biomechanical restoration for the function and survival of THA, as well as finding ways of achieving this improvement. By using radiostereometry (RSA), low dose computer tomography (CT) for 3D measurements, 3D templating, prosthetic modularity, and 3D gait analysis, together with patient-reported outcomes, a strong correlation between initial postoperative femoral neck anteversion (FNA) and subsequent posterior rotation and loosening of cemented stems was found.
Joint disease biomarkers - discovery and application
This thesis aimed to find new biomarkers for various joint diseases including osteoarthritis. The thesis studied the degradation of cartilage tissue, including both the discovery of various potential biomarkers in an experimental model and follow-up studies with the development of new methods to measure these reliably. It was found that the formation of type I, II, and type V collagens, measured by PRO-C1, PRO-C2, and PRO-C5 biomarkers was age-dependent.
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