Iben Axén

• PhD
• Professor (Associate) at Karolinska Institutet & ELIB

Background The study aimed to explore which sociodemographic, health-related, and work-related factors were associated with the number of sickness absence days during 18 months among employees on sickness absence due to common mental disorders. Methods A longitudinal study with participants from a cluster-randomized controlled trial was conducted....

Objective: To assess (i) the impact of self-reported fatigue on functioning in daily life, and (ii) the association with sociodemographics, physical capacity, and work ability among people with post-COVID-19. Design: A cross-sectional study. Subjects: Adults reporting post-COVID-19 symptoms for at least 2 months. Methods: Participants were recruite...

Background This study examined manual therapy business owners’ perception of official recommendations during the COVID-19 pandemic and the impact on their clinics’ economic performance, including clinic activity hours and business turnover. Materials and methods In a longitudinal study design, data were collected in November 2021 (baseline), and a...

Purpose The aim was to evaluate the effectiveness of a problem-solving intervention with workplace involvement (PSI-WPI) added to care as usual (CAU) in reducing sickness absence days among employees with common mental disorders compared to CAU alone in Swedish primary health care on a monthly basis over 18-months follow-up. Methods We conducted a...

Background: Dizziness is a common symptom in post-COVID condition (PCC) which may have a large impact on several life domains. However, knowledge on dizziness-severity and disability in PCC is sparse. Objective: The aim was to describe the severity of dizziness-related disability in individuals with PCC, and how it is manifested in daily life....

The world’s elderly population is growing at a rapid pace. This has led to an increase in demand on the health and welfare systems due to age-related disorders, with musculoskeletal complaints driving the need for rehabilitation services. However, there are concerns about health services’ ability to meet this demand. While chiropractic care is gain...

Objectives The aim of this study is to investigate the criterion validity, specifically the concurrent validity of the measure of days with bothersome pain, by investigating its association with measures of pain intensity, disability, and quality of life. Methods We used two separate cohorts to study the concurrent validity of “days with bothersom...

Purpose This study aims to explore ethical challenges potentially arising from a problem-solving intervention with workplace involvement (PSI-WPI) in primary health care (with first-line manager involvement) for employees on sickness absence due to common mental disorders. Methods A qualitative design guided by the theoretical framework for system...

Background Back pain is the number one condition contributing to years lived with disability worldwide, and one of the most common reasons for seeking primary care. Research on this condition in the ageing population is sparse. Further, the heterogeneity of patients with back pain complicates the management in clinical care. It is possible that sub...

Objective: The purpose of this study was to develop and externally validate multivariable prediction models for future pain intensity outcomes to inform targeted interventions for patients with neck or low back pain in primary care settings. Methods: Model development data was obtained from a group of 679 adults with neck or low back pain who co...

Background The COVID-19 pandemic had an unprecedented impact on healthcare, and the health of healthcare workers has been subject of much research. However, studies of health-related factors in manual therapists during the COVID-19 pandemic are scarce. Research in this field can provide valuable insights for future crises policy and guidelines, inc...

Background Chiropractors’ clinical indicators for recommending preventive continued care to patients with low back pain include previous pain episodes, a history of long pain duration and improvement after initial treatment. Our objectives were, in a cohort of patients with neck pain, to examine whether these clinical indicators were associated wit...

Background Chiropractors use a treatment strategy called maintenance care with the intent of secondary and tertiary prevention. The Nordic Maintenance Care Program provides evidence of when and for whom maintenance care should be offered. Dissemination has occurred through articles, workshops, social media, conference in Europe and internationally....

Background Work-directed interventions that include problem-solving can reduce the number of sickness absence days. The effect of combining a problem-solving intervention with involvement of the employer is currently being tested in primary care in Sweden for employees on sickness absence due to common mental disorders (PROSA trial). The current st...

Background Evidence-based practice (EBP) is essential in improving the quality of healthcare and of importance for all health care personnel. No study in Norway has investigated attitudes, skills and use related to EBP among chiropractors. The aim of this study was to describe Norwegian chiropractors’ attitudes, skills, and use of EBP, as well as t...

Objectives Conditioned pain modulation is a commonly used quantitative sensory test, measuring endogenous pain control. The temporal stability of the test is questioned, and there is a lack of agreement on the effect of different pain conditions on the conditioned pain modulation response. Thus, an investigation of the temporal stability of a condi...

A significant number of individuals experience post-COVID-19 symptoms, but knowledge of perceived consequences and life satisfaction is lacking. Here, we investigate perceived consequences regarding everyday life, health, physical activity and work post-COVID-19 and factors associated with low life satisfaction. A total of 766 people (mean age 48;...

Background Common mental disorders count for a large percentage of sick leave cases in Europe and in Sweden. Problem-solving with workplace involvement have shown promising results in reducing the number of sick leave days for employees on sick leave for these conditions. Engaging the workplace by for example including the first-line manager in the...

Background Persistent or recurrent neck pain is associated with perturbations in the autonomic nervous system balance, and nociceptive stimulation has been seen to influence this balance. However, very few prospective studies have addressed the extent to which changes in pain associate with changes in autonomic cardiac regulation. Therefore, we inv...

Background Neck- and back- pain are highly prevalent conditions in Sweden and world-wide. Such pain often has consequences on everyday activities, work- and personal life. One consequence is work absence and decreased productivity at work. Adding a workplace dialogue to structured physiotherapy was recently found to lead to increased workability, i...

Background Chiropractic maintenance care (MC) has been found to be effective for patients classified as dysfunctional by the West Haven-Yale Multidimensional Pain Inventory (MPI). Although displaying good psychometric properties, the instrument was not designed to be used in clinical practice to screen patients for stratified care pathways. The aim...

An amendment to this paper has been published and can be accessed via the original article.

Background Low back pain is one of the major causes of disability world-wide. Most back pain sufferers experience pain that is recurrent or persistent, making management of this condition a priority. In a series of previous studies, chiropractic maintenance care has been found to be an effective way of reducing the number of days with pain, particu...

Background Persistent or recurrent neck pain is, together with other chronic conditions, suggested to be associated with disturbances of the Autonomic Nervous System. Acute effects on the Autonomic Nervous System, commonly measured using Heart Rate Variability, have been observed with manual therapy. This study aimed to investigate the effect on He...

Background Recurrent or persistent neck pain affects a vast number of people globally, leading to reduced quality of life and high societal costs. Clinically, it is a difficult condition to manage, and treatment effect sizes are often moderate at best. Activity and manual therapy are first-line treatment options in current guidelines. We aimed to i...

Background Chiropractic Maintenance Care (MC) has been found to be effective for patients classified as dysfunctional (high pain severity, marked interference with everyday life due to pain, high affective distress, low perception of life control, and low activity levels) by the Swedish equivalent of the West Haven-Yale Multidimensional Pain Invent...

Background: Low back pain is one of the major causes of disability world-wide. Most back pain sufferers experience pain that is recurrent or persistent, making management of this condition a priority. In a series of previous studies, chiropractic maintenance care has been found to be an effective way of reducing the number of days with pain, partic...

Objective: To explore perspectives, including social and psychological aspects, of patients seeking manual care for low back pain, in order to understand constructs of functioning that are important across different cultural contexts. The International Classification of Functioning, Disability and Health (ICF) emphasizes the importance of these as...

Background A small proportion of chiropractors, osteopaths, and other manual medicine providers use spinal manipulative therapy (SMT) to manage non-musculoskeletal disorders. However, the efficacy and effectiveness of these interventions to prevent or treat non-musculoskeletal disorders remain controversial. Objectives We convened a Global Summit...

Introduction In order for study results to be relevant for practice, the study participants should represent the source population. A common problem is recruitment of sufficient and representative subjects, threatening the external validity of the study and, ultimately, evidence-based practice. The aim was to highlight common challenges and to pres...

After publication of our article [1] the authors have notified us that their names have been incorrectly tagged.

Background: Low back pain is a common condition among older adults that significantly influences physical function and participation. Compared to their younger counterparts, there is limited information available about the clinical course of low back pain in older people, in particularly those presenting for chiropractic care. Improving our unders...

Background In March 2020, the World Health Organization elevated the coronavirus disease (COVID-19) epidemic to a pandemic and called for urgent and aggressive action worldwide. Public health experts have communicated clear and emphatic strategies to prevent the spread of COVID-19. Hygiene rules and social distancing practices have been implemented...

Introduction: Common mental disorders (CMD) are leading causes of decreased workability in Sweden and worldwide. Effective interventions to prevent or treat such disorders are important for public health. Objective: To synthesize the research literature regarding occupational health service (OHS) interventions targeting prevention or reduction o...

Background: As technology is advancing, so are the possibilities for new data collection methods in research, potentially improving data quality and validity of the results. In Sweden, a system using frequent repeated data collection using text messages, SMS Track, has been used in clinical research for more than a decade. In this paper, complianc...

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...

This rapid review considers materials the WFC is aware have been cited in support of claims of effectiveness for spinal adjustment / manipulation in conferring or enhancing immunity.

Background and objective: Clinical guidelines recommend physical activity to manage neck pain (NP) and low back pain (LBP). However, studies used to support these guidelines are based on self-reports of physical behaviour which are prone to bias and misclassification. This systematic review aimed to investigate associations between objectively mea...

Exploring stress trajectories in detail and over a long time may give valuable information in terms of both understanding and practice. We followed a group of primary health care employees in a randomized controlled trial. The objective was to describe their experience of stress, explore the intra-individual variability and examine the association...

Background Musculoskeletal pain is a major cause of work disability. Many patients with musculoskeletal pain seek care from health care providers other than their general practitioners, including a range of musculoskeletal practitioners. Therefore, these musculoskeletal practitioners may play a key role by engaging in sickness absence management an...

Background: Maintenance Care is a traditional chiropractic approach, whereby patients continue treatment after optimum benefit is reached. A review conducted in 1996 concluded that evidence behind this therapeutic strategy was lacking, and a second review from 2008 reached the same conclusion. Since then, a systematic research program in the Nordi...

Background: Recent experimental research has suggested that spinal manipulative therapy (SMT) may reduce pain through modulation of the ascending pain signals and/or the central pain-regulating mechanisms. People with persistent neck pain (NP) have also been found to have disturbances in autonomic nervous system (ANS) regulation. A common way to s...

Background Chiropractic maintenance care is effective as secondary/tertiary prevention of non-specific low back pain (LBP), but the potential effect moderation by psychological characteristics is unknown. The objective was to investigate whether patients in specific psychological sub-groups had different responses to MC with regard to the total num...

Background: Low back pain is a common condition among older adults that significantly influences physical function and participation. Compared to their younger counterparts, there is limited information available about the clinical course of low back pain in older people, in particularly those presenting for chiropractic care. Improving our underst...

Objective. To summarize the evidence of neurophysiological effects of spinal manipulative therapy (SMT) with a high velocity low amplitude thrust (HVLA-SMT) in asymptomatic and symptomatic humans. Summary of Background Data. HVLA-SMT is effective in reducing back pain, but its mode of action is not fully understood. Methods. A systematic literature...

Objectives: To describe the one-year trajectories of disabling subacute or persistent neck pain and to investigate whether baseline age, sex, pain characteristics and depressive symptoms are associated with such trajectories. Study design and setting: Participants (n=617) included in a randomized controlled trial provided weekly pain intensity r...

letter to the editor; no abstract

Background Despite extensive publication of clinical guidelines on how to manage musculoskeletal pain and back pain in particular, these efforts have not significantly translated into decreases in work disability due to musculoskeletal pain. Previous studies have indicated a potential for better outcomes by formalized, early referral to allied heal...

Background For individuals with recurrent or persistent non-specific low back pain (LBP), exercise and exercise combined with education have been shown to be effective in preventing new episodes or in reducing the impact of the condition. Chiropractors have traditionally used Maintenance Care (MC), as secondary and tertiary prevention strategies. T...

Original trial protocol part of the ethical application. (PDF)

Descriptive patient data at the different stages of the inclusion process. LBP, Low Back Pain; A, Inclusion criteria; B, Exclusion criteria; MPI, West-Haven Yale Multidimensional Pain Inventory; AC, Adaptive Coper; ID, Interpersonally Distressed; DYS, Dysfunctional; MC, Chiropractic Maintenance Care; RMDQ, Roland Morris Disability Questionnaire; EQ...

CONSORT 2010 checklist of information to include when reporting a randomized trial. (PDF)

English translation of the key methodological portions of the original trial protocol part of the ethical application. (PDF)

Heat map illustrating the density of number of requited subjects in the trial geographically across Sweden. Red zones represents the highest numbers of requited subjects followed by yellow, green and blue. (TIF)

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Back Complaints in Elders in Chiropractic Care

Workplace involvement in rehabilitation for patients with musculoskeletal pain may improve work ability. Convergence Dialogue Meeting (CDM) is a model aimed at helping the patient, the care giver and the employer to support work ability and return to work. Our aim was to study the effect on work ability when adding a workplace dialogue according to...

Background Exercise is effective in improving non-specific low back pain (LBP). Certain components of physical exercise, such as the type, intensity and frequency of exercise, are likely to influence participation among working adults with non-specific LBP, but the value and relative importance of these components remain unknown. The study’s aim wa...

Choice task questions in English. (DOCX)

Choice task questions in Swedish. (DOCX)

Complementary sub-group analysis. (DOCX)

Background Chiropractors expect the typical patient to recover fully or to improve quickly with treatment if relapses occur. However, a mismatch between expectations and outcome would have a negative effect on both the chiropractors’ professional self-esteem and patients’ satisfaction with care. The prevalence of three types of recovery patterns am...

Introduction Musculoskeletal pain is highly prevalent and a burden to society, recurrent and persistent low back pain (LBP) and neck pain (NP) being the most common conditions. They are associated with other poor health outcomes such as sleep problems. Physical activity (PA) prevents LBP and NP, but the direct effect on sleep is unclear. This study...

Low-back pain is the most important non-fatal disease in Europe and is associated with increasing healthcare costs. These costs are likely to become greater as the population becomes older. Low-back pain, particularly in older people, results in reduced quality of life, reduced social participation and increased isolation, as well as being associat...

Background: It has been proposed that an episode of low back pain (LBP) be defined as: "a period of pain in the lower back lasting for more than 24 h preceded and followed by a period of at least 1 month without LBP". Previous studies have tested the definition in the general population and in secondary care populations with distinctly different r...

Background Mobile technology has opened opportunities within health care and research to allow for frequent monitoring of patients. This has given rise to detailed longitudinal information and new insights concerning behaviour and development of conditions over time.Responding to frequent questionnaires delivered through mobile technology has also...

BACKGROUND: Non-specific low back pain (LBP) is often categorised as acute, subacute or chronic by focusing on the duration of the current episode. However, more than twenty years ago this concept was challenged by a recognition that LBP is often an episodic condition. This episodic nature also means that the course of LBP is not well described by...

Background Besides causing ill health, a poor work environment may contribute to production loss. Production loss assessment instruments emphasize health-related consequences but there is no instrument to measure reduced work performance related to the work environment. Aims To examine convergent validity and test–retest reliability of health-rela...

Background: To investigate if psychological and behavioral factors (as determined by the Swedish version of the West Haven-Yale Multidimensional Pain Inventory, MPI-S) can predict the early clinical course of Low Back Pain (LBP). Methods: MPI-S data from patients (18-65 years of age) seeking chiropractic care for recurrent and persistent LBP wer...

Background: Low back pain (LBP) is the world's leading cause of disability and yet poorly understood. Cross-national comparisons may motivate hypotheses about outcomes being condition-specific or related to cultural differences and can inform whether observations from one country may be generalised to another. This analysis of data from three coho...

Background: Psychological, behavioral and social factors have long been considered important in the development of persistent pain. Little is known about how chiropractic low back pain (LBP) patients compare to other LBP patients in terms of psychological/behavioral characteristics. Methods: In this cross-sectional study, the aim was to investig...

Pain has been found to be associated with poor sleep quality, awakenings and shorter sleep time. There is a need to understand the relationship of pain and sleep over time in order to adequately manage the pain disorder and its consequences. The objectives of this study were to establish the prevalence of sleep disturbance in subjects with acute or...

Low back pain (LBP) is a prevalent condition and a socioeconomic problem in many countries. Due to its recurrent nature, the prevention of further episodes (secondary prevention), seems logical. Furthermore, when the condition is persistent, the minimization of symptoms and prevention of deterioration (tertiary prevention), is equally important. Re...

Because low back pain (LBP) is a fluctuating condition, the diversity in the prediction literature may be due to when the outcome is measured. The objective of this study was to investigate the prediction of LBP using an outcome measured at several time points. A multicenter clinical observational study in Sweden. Data were collected on 244 subject...

In Sweden, chiropractic is not included in mainstream health care. In Norway chiropractic is a recognized health care profession. The aim of this study was to explore the perceptions of chiropractic among Swedish and Norwegian General Practitioners (GPs). Eight hundred surveys in each country were distributed randomly by post to Swedish and Norwegi...

Background Low back pain (LBP) is a prevalent condition and has been found to be recurrent and persistent in a majority of cases. Chiropractors have a preventive strategy, maintenance care (MC), aimed towards minimizing recurrence and progression of such conditions. The indications for recommending MC have been identified in the Nordic countries fr...

Introduction Practice-based research is a challenge as clinicians are busy with their patients and any participation in research activities will be secondary to the needs of the patients and the clinic. As a result, it is difficult to obtain high compliance among clinicians. A method to enhance compliance in multicentre practice-based research has...

Low back pain is not a self-limiting problem, but rather a recurrent and sometimes persistent disorder. To understand the course over time, detailed investigation, preferably using repeated measurements over extended periods of time, is needed. New knowledge concerning short-term trajectories indicates that the low back pain episode is short-lived,...

Repeated data collection is desirable when monitoring fluctuating conditions. Mobile phones can be used to gather such data from large groups of respondents by sending and receiving frequently repeated short questions and answers as text messages.The analysis of repeated data involves some challenges. Vital issues to consider are the within-subject...

In order to define the onset of a new episode of low back pain (LBP), the definition of a "non-episode" must be clear. De Vet et al reviewed the scientific literature but found no evidence-based definitions of episodes or non-episodes of LBP. However, they suggested that pain-based episodes should be preceded and followed by a period of at least on...

The use of automated text messages has made it possible to identify different courses of low back pain (LBP), and it has been observed that pain often fluctuates and that absolute recovery is rather rare. The purpose of this study was to describe the prevalence of pain-free weeks and pain-free periods in subjects with non-specific LBP treated by ch...