MUSIC - The Musculoskeletal Intervention Center

The Musculoskeletal Intervention Center (MUSIC) is one of several subgroups within the Unit of Cardiovascular Epidemiology. The research within MUSIC refers to back and neck pain and other musculoskeletal disorders. The research is interdisciplinary and inter-professional and concerns rehabilitation and diagnostics as well as studies on risk factors and prognostic factors.

The research group is multi professional with competence within:

  • Orthopedy
  • Epidemiology
  • Occupational Medicine
  • Naprapathy
  • Chiropractic
  • Physiotherapy
  • Insurance Medicine
  • Public Health

The research is based on high quality research materials; prospective cohorts as well as randomized controlled trials:

Randomized controlled trials on interventions

Evaluation of the effect of naprapathic manual therapy
Evaluation of the effect of information strategies for neck pain after Whiplash (educational interventions).

Cohort studies on risk factors and prognostic factors

The Stockholm Public Health Cohort - a longitudinal study in Stockholm county (n=23 794)


Assessment of psychometric properties of measurements used in research regarding back and neck pain.


Research collaborations

Department of Public Health Sciences, Division of Public Health Epidemiology, Karolinska Institutet, Stockholm (Cecilia Magnusson, associated professor and Johan Hallqvist, professor).

Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm (Sari Ponser, professor and Carin Ottosson, PhD).

Occupational and Environmental medicine (AMM)/Uppsala University (Eva Vingård, professor).

NYU Hospital for Joint Diseases/New York University, USA (Margareta Nordin, professor).

The Centre of Research Expertise in Improved Disability Outcomes (CREIDO) Toronto Western Hospital - University of Toronto, Canada (David Cassidy, Professor and Pierre Coté, Assistant professor).

School of Public Health, University of Alberta, Canada (Linda Carroll, professor)


Research group

Eva Skillgate, PhD, Group leader

Work: +46 8 524 87 995


Lena Holm, PhD, Group leader

Work: +46 8 524 87 023


Eva Rasmussen-Barr, PhD, Post doc


Tony Bohman, Physiotherapist, PhD-student

Work: +46 9 524 87 483


Kari Paanalahti, Naprapath and Nurse, PhD-student

Work: +46 8 524 87 627


Lina Palmlöf, Physiotherapist, PhD-student

Work: +46 8 524 87 506


Maja Stupar, Chiropractor, PhD-student, Visiting from Toronto University

Fredrik Johansson, Naprapath, PhD-student, Visiting from Ghent University

Ulrika Tranaeus, PhD-student, Registered at Stockholm Sports Trauma Research Center, KI

Titti Lilje, Naprapath, Ph-student, Registered at Blekinge Tekniska Högskola (Blekinge Institute of Technology)

Senior researchers

  • Lars Alfredsson, Professor, IMM
  • Anders Ahlbom, Professor, IMM
  • Eva Vingård, Professor, Uppsala University)
  • Irene Jensen, Professor,  IMM


Projects within MUSIC


Evaluation of the effect of naprapathic manual therapy

The BJÖRN-trial: The aim of this randomized controlled trial was to compare naprapathic manual therapy with evidence-based advice to stay active for back or neck pain regarding pain, disability, perceived recovery, health, sick leave, etc. Naprapathy is characterized by manual manipulations with a focus on soft and connective tissues, aiming to decrease pain and disability ín the musculoskeletal system.Four hundred and nine patients with pain and disability in the back or neck lasting for at least 2 weeks, recruited at 2 large public companies in Sweden in 2005 were included in this randomized controlled trial. The 2 interventions were naprapathy, including spinal manipulation/mobilization, massage, and stretching and support and advice to stay active and how to cope with pain, according to the best scientific evidence available, provided by a physician. Outcomes were measured by questionnaires at baseline and after 3, 7, 12, 26 and 52 weeks.

The orthopedic waiting list trial: Orthopedic outpatient waiting lists are long, and many referrals are for conditions that do not respond to interventions available at an orthopedic outpatient department. The overall objective of this trial was to investigate whether it is possible to reduce orthopedic waiting lists through integrative medicine. Specific aims were to compare the effects of naprapathic manual therapy to conventional orthopedic care for outpatients with non-urgent musculoskeletal disorders unlikely to benefit from surgery regarding pain, physical function, and perceived recovery. Methods: Seventy-eight patients referred to an orthopedic outpatient department in Sweden were included in this pragmatic randomized controlled trial. The 2 interventions compared were naprapathic manual therapy and conventional orthopedic care. Pain, physical function, and perceived recovery were measured by questionnaires at baseline and after 12, 24, and 52 weeks. The number of patients being discharged from the waiting lists and the level of agreement concerning management decisions between the naprapath and the orthopedists were also estimated.

The MINT-Trial (The Manual Intervention Trial): Earlier trials show that Naprapathy is effective for patients with unspecific back/neck pain. The current trial aims to compare the effect of three different combinations of Naprapathic manual therapy (NMT) on such pain, to examine prevalence, severity and duration of adverse reactions after NMT, and to identify subgroups of patients who have greater benefit from the treatments. The method is a randomized controlled trial with three arms (target number: 1 050 patients). Inclusion criteria: Patients 18-65 years at the student clinic at The Scandinavian College of Naprapathic Manual Medicine with a new episode of non-specific neck and/or back pain (duration e one week). Exclusion criteria: Pain d 2 on an 11 point NRS, pregnancy, contraindication for spinal manipulation, recent trauma, specific diagnosis, red flags, recent treatment. Treatment arms: 1. NMT (a combination of soft tissue techniques, stretching, and spinal manipulation/mobilization), 2. NMT but not spinal manipulation and 3. NMT but not stretching (treatment or advice). Patients will get up to 6 treatments within 6 weeks. They will get questionnaires about adverse reactions at new appointments and web based or postal questionnaires regarding the outcomes four times within a year. Primary outcomes: Pain/disability and prevalence, duration and intensity of adverse reactions. Secondary outcomes: Perceived recovery and health related quality of life.


Evaluation of the effect of information strategies for neck pain after Whiplash (educational interventions)

The WAD Information trial: In this project, the data is collected at the research center at Södersjukhuset. In one year around 120 study subjects have been recruited from two Swedish insurance companies. In the first phase, a validation study will be performed, assessing predictors for slow recovery. In the second phase, additional insurance companies will be involved and around 700 participants will be included in a randomized controlled trial with the research question; Is there a difference in effect with regard to perceived recovery between individuals who receive an educational DVD and individuals who have received written information included in care as usual? In the DVD, explanations to pain and normal reactions following an injury are given as well as advice on how to adopt and instructions on home exercises.


The Stockholm Public Health Cohort - a longitudinal study in Stockholm county

The Stockholm Public Health Cohort is a recently established prospective study, set within the framework of the Stockholm County Council Public Health Surveys with the aim to collect data for regional public and occupational health reports. In 2002, 49,909 individuals that were randomly selected from 1.4 million eligible residents in Stockholm County aged 18-84 years, were sent a postal questionnaire. Responders (n=31,182; 62.4%) were resurveyed in 2007 via a mixed mode postal/web based questionnaire. Participants in both surveys (n=23,794, corresponding to a 76.3 % retention rate) constitute the cohort. The questionnaires cover health parameters, tobacco use, physical activity, alcohol consumption, labor market position, physical and psychosocial work environment, anthropometry, and other life circumstances. In 2010 a new questionnaire was sent out to the participants in the cohort. Simultaneously, a new cohort was created when the participants in the Stockholm County Council Public Health Surveys in 2006 received a second questionnaire (app 34,000 persons). This questionnaire was equal to the one sent to the participants in the first cohort.

Several PhD-student projects in which risk and prognostic factors for back and neck pain is studied, are based on the Stockholm Public Health Cohort.

Pain of the body, pain of the soul: This project investigates the occurrence, aetiology and prognosis of neck pain and common mental disorders of depression and anxiety (CMD) in women, separately of as a comorbid condition. These disorders have a large and unexplained female over male predominance - and are important contributors to the global burden of disease, especially among women. We investigate neck pain and CMD in parallel, based on the truism that physiological and psychological processes are involved in all symptom production and perception, and that these disorders might have a common aetiology. The project is based on The Public Health Cohort. The self-reported data are complemented by two unique clinical databases on utilization of adult and adolescent mental health services in Stockholm County. Furhtermore, data from longitudinal health and socio-demographic data registries are used. The project is part of a larger programme on women's health, initiated and financed by the Swedish government. The Swedish council for working life and social research (FAS) is funding the project, and the primary investigator is Cecilia Magnusson, KI.

Long-term problems and sick leave due to back and neck pain. This project about disabling work related injuries is funded by AFA jubileumsstiftelse postdoc scholarship. It is a prospective cohort study of factors of importance for the course and for sick leave due to pain in the back and neck. The overall aim is to study the factors of importance for the course of pain in the back and neck, the risk for sick-leave and how these factors interact. The project is based on The Stockholm Public Health Cohort.


Assessment of psychometric properties of measurements used in research regarding back and neck pain

The psychometric properties of the Whiplash disability Questionnaire, based on the BJÖRN-Trial. This is a collaboration project with Toronto University.

The psychometric properties of a questionnaire of patients satisfaction with care. This is a collaboration project with New York University.

Musculoskeletal disorders