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Introduction
My research is in muskuloskeletal research in primary care. My main interest is the care provided for people with back pain. Here room for improvement.
Additional affiliations
April 2013 - November 2018
April 2010 - April 2013
Spine Center of Southern Denmark
Position
- Research Felllow
Position
- Senior Researcher
Education
September 2001 - October 2005
September 1993 - June 1999
Publications
Publications (184)
Background
Family physicians in Canada’s universal healthcare system often manage low back pain patients using interventions not recommended in clinical guidelines, such as pharmaceuticals, imaging and spinal injections, while guideline-based treatments like education and exercise remain unfunded. The Alberta Back Care pathway was developed to addr...
Objective
To investigate if a combination of an online and onsite implementation strategy was superior to an online-only strategy in enhancing the use of an injury prevention exercise programme (IPEP) and in reducing the risk of shoulder, knee and ankle injuries in youth community handball players (age 11–17) over a handball season.
Methods
In thi...
In chronic musculoskeletal conditions, the prognosis tends to be more informative than the diagnosis for the future course of the disease. Many studies have identified clusters of patients who seemingly share similar pain trajectories. In a dataset of low back pain (LBP) patients, pain trajectories have been identified, and distinct trajectory type...
Objective
To investigate symptom trajectories in chiropractic patients with lumbar spinal stenosis (LSS).
Methods
Patients diagnosed with LSS were recruited from chiropractic clinics and self-reported questionnaires were collected at baseline and 1-year follow-up. Patients received weekly text messages about low back pain (LBP) and leg symptoms fo...
Objectives
To describe the current content of low back pain (LBP) care in Danish general practice, the patients' self‐management activities, and the clinicians' experienced barriers to providing best practice care.
Methods
This cross‐sectional observational study included adults with LBP seeking care in Danish general practice from August 2022 to...
Background
Individual goal setting is a fundamental element in self-management supportive interventions, serving to guide actions and enhance motivation for engagement. Despite this, little is known about the goals people with back pain have and to what extent these differ across genders, age groups and geographical location. This study aimed to el...
Musculoskeletal (MSK) conditions are often managed in primary care settings. To facilitate research and health care quality, practice-based research networks (PBRNs) offer sustained collaborations between clinicians and researchers. A scoping review was conducted to describe characteristics of PBRNs used for MSK research and MSK research conducted...
Purpose
Practice-based research networks are collaborations between clinicians and researchers to advance primary care research. This study aims to assess the feasibility for longitudinal data collection within a newly established chiropractic PBRN in Switzerland.
Methods
A prospective observational cohort feasibility study was performed. PBRN par...
Introduction
Injury prevention exercise programs (IPEPs) are insufficiently implemented in practice. We hypothesized that a combination of an online and onsite implementation strategy would be superior to an online-only strategy in enhancing adherence to an injury prevention exercise program (IPEP), and in reducing shoulder, knee and ankle injury r...
Introduction
Behavioral factors (BFs) are associated with adherence to injury prevention exercise programs (IPEPs). We investigated the effect of adding an onsite implementation strategy to an online-only strategy of an IPEP on handball coachers’ BFs.
Materials and Methods
In a one-season randomized controlled trial, 20 youth handball clubs were a...
Objective
To explore how causal beliefs regarding non-specific low back pain (LBP) have been quantitatively investigated.
Methods
A scoping review based on the guidelines by the JBI (former Joanna Briggs Institute) was conducted. We searched Medline, Embase, Psychinfo, and CINAHL for relevant studies and included peer-reviewed original articles th...
Background
People with nonspecific low back pain (NSLBP) can also experience overlapping symptoms of lumbar spinal stenosis (LSS), but the impact on treatment outcomes is unknown. This study investigated differences in treatment outcomes for disability, back pain intensity, and leg pain intensity following an education and exercise therapy program...
This commentary closes the thematic series “A new paradigm for musculoskeletal pain care: moving beyond structural impairments”. The papers published in the series point to key aspects of shifting the paradigm of musculoskeletal care from clinician-led management often focused on addressing presumed structural anomalies to partnering with patients...
Control interventions (often called “sham,” “placebo,” or “attention controls”) are essential for studying the efficacy or mechanism of physical, psychological, and self-management interventions in clinical trials. This article presents core recommendations for designing, conducting, and reporting control interventions to establish a quality standa...
Control interventions (often called “sham,” “placebo,” or “attention controls”) are essential for studying the efficacy or mechanism of physical, psychological, and self-management interventions in clinical trials. This article presents core recommendations for designing, conducting, and reporting control interventions to establish a quality standa...
Objectives:
To unpack the complexity and impact of self-management interventions targeting musculoskeletal health conditions, we need to learn more about treatment delivery in clinical settings. Fidelity evaluation can illuminate how complex treatments are delivered and help understand the elements that lead to the effect. The objective of this st...
The Swiss chiropractic practice-based research network (PBRN) is a nationwide project developed in collaboration with patients, clinicians, and academic stakeholders to advance musculoskeletal epidemiologic research. The aim of this study was to describe the clinician population recruited and representativeness of this PBRN to inform future collabo...
Background
Previous studies have found that lumbar spinal stenosis (LSS) often co-occurs with knee or hip OA and can impact treatment response. However, it is unclear what participant characteristics may be helpful in identifying individuals with these co-occurring conditions. The aim of this cross-sectional study was to explore characteristics ass...
Different trajectories of low back pain (LBP) have been identified prospectively using repeated measures. For these trajectories to inform clinical practice, they must be available in the clinical consultation. Therefore, identified LBP trajectories have been translated into visual pain trajectories (VPTs) that allow people with LBP, at the time of...
Background:
Low back pain (LBP) is one of the world's most prevalent health issues. Patients with LBP experience various intensities and durations of symptoms, which can lead to distinctive course patterns commonly described as symptom trajectories.
Purpose:
This study aimed to investigate the association between different amounts of physical ac...
Background
Benefits from low back pain (LBP) treatments seem to be related to patients changing their pain cognitions and developing an increased sense of control. Still, little is known about how these changes occur. The objective of this study was to gain insights into possible shifts in the understanding of LBP and the sense of being able to man...
Background
It is unclear if the use of imaging for low back pain (LBP) is impacted by patient beliefs. This study aimed to: (1) describe beliefs about the importance of imaging and whether patients wanted imaging when presenting for chiropractic care for LBP; (2) describe associations between baseline patient characteristics and imaging beliefs and...
Background
Practice-based guidelines recommend patient education and exercise as first-line care for low back pain (LBP); however, these recommendations are not routinely delivered in practice. GLA:D® Back, developed in Denmark to assist clinicians to implement guideline recommendations, offers a structured education and supervised exercise program...
Objective
To understand the physical, activity, pain and psychological pathways contributing to low back pain (LBP) -related disability, and if these differ between subgroups.
Methods
Data came from the baseline observations (n = 3849) of the “GLA:D Back” intervention program for long-lasting non-specific LBP. 15 variables comprising demographic,...
Objective
People with knee or hip osteoarthritis (OA) can experience comorbid lumbar spinal stenosis (LSS), but the impact on treatment outcomes is unknown. The aim of this study was to investigate associations between comorbid LSS symptoms and changes in pain, function, and quality of life following a patient education and exercise therapy program...
The Swiss chiropractic practice-based research network (PBRN) is a nationwide project developed in collaboration with patients, clinicians, and academic stakeholders to advance epidemiological research relating to chiropractic care and musculoskeletal pain. The aim of this study was to describe the clinician population recruited and representativen...
Background
The dynamic nature of neck pain has so far been identified through longitudinal studies with frequent measures, a method which is time-consuming and impractical. Pictures illustrating different courses of pain may be an alternative solution, usable in both clinical work and research, but it is unknown how well they capture the clinical c...
Background
Back pain is a main driver of disability and the most prevalent reason why people in Demark visit a general practitioner (GP). However, little is known about back pain management in primary care. For new strategies to be sustainable and to accommodate the recommendations for evidence-based practice, patients’ perspectives are paramount t...
Background
Health domains like pain, disability, and health-related quality of life are commonly used outcomes for musculoskeletal disorders. Most prognostic studies include only one outcome, and it is unknown if prognostic factors and models may be generic across different outcomes. The objectives of this study were to examine the correlation amon...
Introduction
Musculoskeletal (MSK) pain conditions, a leading cause of global disability, are usually first managed in primary care settings such as medical, physiotherapy, and chiropractic community-based practices. While chiropractors often treat MSK conditions, there is limited real-world evidence on the topic of health service outcomes among pa...
Objective:
To investigate associations between beliefs about low back pain (LBP) at baseline and pain intensity and disability at 2-week, 13-week and 52-week follow-up.
Design:
Observational cohort study.
Setting:
Primary care private chiropractic clinics in Denmark.
Participants:
A total of 2734 adults consulting a chiropractor for a new ep...
Background
Disease monitoring is an important element of self-management of several chronic diseases. Pain monitoring has become very easily available, but the role in musculoskeletal pain conditions is not clear. Awareness of pain might be helpful for people to understand pain, but focusing on pain may on the contrary negatively affect pain experi...
Background
Evidence suggests that diagnostic imaging for low back pain does not improve care in the absence of suspicion of serious pathology. However, the effect of imaging use on clinical outcomes has not been investigated in patients presenting to chiropractors. The aim of this study was to determine if diagnostic imaging affects clinical outcom...
Background
Recent studies with data-driven approaches have established common pain trajectories. It is uncertain whether these trajectory patterns are consistent over time, and if a shorter measurement period will provide accurate trajectories.
Methods
We included 1,124 patients with non-specific neck pain in chiropractic practice. We classified p...
Background
Although many people with chronic low back pain (LBP) improve following conservative treatment, one in five will experience worsening symptoms after discharge from treatment and seek health care again. The current LBP clinical care pathway in many health services lacks a well-integrated, systematic approach to support patients to remain...
Objective
The aims of this study were to evaluate: the proportion of people reporting symptoms associated with lumbar spinal stenosis (LSS) in primary care programs for knee or hip osteoarthritis (OA) or persistent low back pain (LBP) and; the prevalence of self-reported clinical LSS in these three cohorts, according to two sets of adapted criteria...
Background
Low back pain is often long-lasting, and implementation of low-cost interventions to improve care and minimise its burden is needed. GLA:D® Back is an evidence-based programme consisting of patient education and supervised exercises for people with low back pain, which was implemented nationwide in primary care clinics in Denmark. To ass...
Introduction and aims:
Guidelines for low back pain (LBP) management recommend patient education and exercises. GLA:D Back, a structured group-based patient-education exercise program for LBP, facilitates evidence-based care implementation. This study aimed to inform on the implementation processes, assessing clinician-related factors. Objectives...
Background
A paradigm shift away from clinician-led management of people with chronic disorders to people playing a key role in their own care has been advocated. At the same time, good health is recognised as the ability to adapt to changing life circumstances and to self-manage. Under this paradigm, successful management of persistent back pain i...
Background
Currently, there are no outcome measures assessing the ability of people with non-specific low back pain to self-manage their illness. Inspired by the ‘Patient Enablement Instrument’, we developed the Patient Enablement Instrument for Back Pain (PEI-BP). The aim of this study was to describe the development of the Patient Enablement Inst...
Background and Aims
Best‐practice low back pain (LBP) primary care programmes have been developed based on evidence‐based clinical guidelines and implemented in Sweden and Denmark. The theoretical domains framework (TDF) was utilized in the design of the implementation strategy. Based on the TDF domains, the Determinants of Implementation Behavior...
We developed an algorithm to classify non-specific low back pain patients by their long-term pain fluctuations, known as pain trajectories. This algorithm will be used to perform a large scale multidimensional subgroup analysis to identify moderators and or mediators of low back pain trajectories.
Background
Translation of research into practice is a methodological challenge. The GLA:D® Back program was initiated to implement evidence-based care for people with low back pain inspired by GLA:D® (Good Life with osteoArthritis in Denmark) that has succeeded in implementing evidence-based care for knee and hip osteoarthritis. This study evaluate...
Background
Evidenced-based clinical guidelines for the treatment of low back pain (LBP) consistently suggest educating patients about their back pain, its natural course, and providing advice to keep active and continue working. Despite this evidence, clinicians routinely do not follow these recommendations resulting in ineffective and fragmented c...
Background
Currently, there are no outcome measures assessing the ability of people with non-specific low back pain to self-manage their illness. Inspired by the ‘Patient Enablement Instrument’, we developed the Patient Enablement Instrument for Back Pain (PEI-BP). The aim of this study was to describe the development of the Patient Enablement Inst...
Background
Neck and low back pain represent dynamic conditions that change over time, often with an initial improvement after the onset of a new episode, followed by flare-ups or variations in intensity. Pain trajectories were previously defined based on longitudinal studies of temporal patterns and pain intensity of individuals with low back pain....
Background
Back pain is among the most frequent reasons for care seeking globally. Observational clinical cohorts are useful for understanding why people seek care, the content of that care, and factors related to prognosis. This paper describes the Danish Chiropractic low back pain Cohort (ChiCo) and summarizes the primary characteristics of the p...
The overall quality of care for musculoskeletal pain conditions is suboptimal, partly due to a considerable evidence-practice gap. In osteoarthritis and low back pain, structured models of care exist to help overcome that challenge. In osteoarthritis, focus is on stepped care models, where treatment decisions are guided by response to treatment, an...
Objective:
To evaluate the long-term predictive value of The Danish Whiplash Group Risk Assessment Score (DWGRAS) with 7 risk-strata.
Design:
E-questionnaire based follow-up study (n=927) combining two cohorts of whiplash injured subjects, one observational (n=187) one interventional RCT (n=740).
Methods:
927 previously healthy persons exposed...
Background
A novel approach capturing both temporal variation and pain intensity of neck pain is by visual trajectory patterns. Recently, both previous and expected visual trajectory patterns were identified as stronger predictors of outcome than traditional measures of pain history and psychological distress. Our aim was to examine patient charact...
Background:
Prognostic research has many important purposes, including (i) describing the natural history and clinical course of health conditions, (ii) investigating variables associated with health outcomes of interest, (iii) estimating an individual's probability of developing different outcomes, (iv) investigating the clinical application of p...
Introduktion Mellem 10 og 20 % af de patienter, der ses i almen praksis med et laende-problem, har tegn på nerverodspåvirkning som følge af diskusprolaps, og det kan vaere en udfordrende diagnose at stille i en travl hverdag. Laenderygsmerter er en af de hyppigste henvendelsesårsager hos prakti-serende laeger, og alligevel udgør diagnosefejl i grup...
Abstract Background Implementing clinical guidelines is challenging. To facilitate uptake, we developed a model of care (BetterBack Model of Care) and an implementation strategy to support management of low back pain in primary care. The aim of this study was to evaluate physiotherapists´ confidence, attitudes and beliefs in managing patients with...
Background
A recent study showed that chiropractic patients had fewer days with bothersome (activity-limiting) low back pain (LBP) when receiving care at regular pre-planned intervals regardless of symptoms (‘maintenance care’, MC) compared to receiving treatment only with a new episode of LBP. Benefit varied across psychological subgroups. The aim...
Objectives:
To investigate: 1) the impact of low back pain (LBP) over 1-year in people recently recovered from an episode of LBP; 2) if the impact differs in people who do and do not experience a recurrence; 3) the impact of LBP based on three definitions of a recurrence of LBP.
Design:
Cohort.
Methods:
In 250 individuals recently recovered fr...
Clinician guidelines recommend health management to tailor the form of care to the expected course of diseases. Hence, in order to decide upon a suitable treatment plan, health professionals benefit from decision support, i.e., predictions about how a disease is to evolve. In clinical practice, such a prediction model requires interpretability. Int...
Objective:
Baseline characteristics of patients low back pain differ substantially between care settings, but it is largely unknown whether predictors are of equal importance across settings. The aim of this study was to investigate whether 8 known predictors relate differently to outcomes in chiropractic practice and in general practice and to wh...
Background: Best-practice low back pain (LBP) primary care programs have been developed based on evidence-based clinical guidelines and are implemented in Sweden and Denmark. The Theoretical Domains Framework and its linkage to The Behavioural Change Wheel has been utilised in the design of the implementation object and its implementation strategy....
Background
Due to the recurrent nature of low back pain (LBP), the traditional concepts of cure and recovery are challenged, and investigating the course rather than status at fixed time-points may help us understand prognosis as well as treatment effect. However, methods of frequent measuring still need development and validation. Therefore, this...
Background:
The Back Belief Questionnaire (BBQ) measures beliefs about negative consequences of back pain. The aim of this study was to describe the back beliefs of a large clinical population with low back pain (LBP), to investigate the associations between back beliefs and patient characteristics when care-seeking, and between on-going pain and...