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About me

I am an Associate Professor in epidemiology. My background is in clinical work as a licensed manual therapist (naprapath) with musculoskeletal pain and sports injuries and in Public Health. I defended my thesis in epidemiology at Karolinska Institutet in 2007. In 2008 - 2009 I had post doc positions at Toronto University and Uppsala University, and in 2009 I started the research group called MUSIC (Musculoskeletal & Sports Injury Epidemiology Center) at the Institute of Environmental Medicine, Karolinska Institutet, for which I am the research group leader.  The aim with the activities MUSIC is to achieve interdisciplinary and inter-professional clinically relevant research within musculoskeletal disorders and sports medicine. The research concerns prevention, risk and prognosis, diagnosis and interventions. The MUSIC group involves among others caregivers from different professions (physiotherapy, medicine, naprapathy, chiropractic, osteopathy) who work close to clinical settings. I am the research group leader and two more associate professors work in the group (Lena Holm and Eva Rasmussen-Bass). In the group are also one researcher (Tobias Sundberg), three post-docs (Fredrik Johansson, UlrikaTranaeus and Titti Lilje), two PhD-students (Martin Asker and Oscar Pico), five research assistants (Anna Peterson, Victor Lyberg, Martin Samuelsson, Nathan Weiss and Edvin Ambrus) and four masters students and more than 20 magister students.  Also foreign students are associated to our group. Affiliated are experts in the field; professors Margareta Nordin (New York University), Pierre Coté (University of Ontario Institute of Technology), Eva Vingård (Uppsala University) and Per Renström (Karolinska Institutet).

We have high quality scientific data as observational cohort studies and several large clinical trials. Funders are the Swedish Research Council (VR), FORTE, AFA, Folksam, Swedish Research Council for Sport Science, the Swedish and Norwegian Naprapathic Associations, and the Scandinavian College of Naprapathic Manual Medicine. Among ongoing data collections are an RCT about massage and physical training for long lasting neck pain (Stockholm Neck Trial – STONE, n= 620), and cohort studies aiming to identify risk factors for injuries in young elite handball (Karolinska Handball Study, KHAST) tennis (The Swedish young elite tennis cohort) and football players ( Karolinska football Injury Cohort - KIC) in Sweden.  I am also the PI for the AFA financed three year project “Long-lasting and disabling back and/or neck pain and psychological distress – modifiable factors for risk and prognosis in the working population” that aims to investigate how life style factors interact in the development of and recovery from long lasting disabling back and/or neck pain, with or without psychological distress.

 

Other collaborators:

 Professor Cecilia Magnusson, Centrum för Epidemiologi och samhällsmedicin vid Stockholms Läns Landsting, and Institutionen för Folkhälsovetenskap vid Karolinska Institutet.

Professor David Cassidy, Toronto University and University of Southern Denmark

Professor Johan Hallqvist, Uppsala Universitet

Professor Linda Carroll, University of Alberta, Edmonton

Professor Johan Berglund, Blekinge Tekniska Högskola

Professor Ulf Persson, the Swedish Institute for Health Economics

Professor Anne Cools, Ghent University

Professor Grethe Myklebust (physio therapy, sports medicine) at Oslo Sports Trauma Research Center

Assistant Professor Markus Waldén, Linköpings Universitet

Associate Professor Martin Hägglund, Linköpings Universitet

Professor Urban Johnson, Högskolan I Halmstad

Professor Jan Hartvigsen, University of Southern Denmark

MD, PhD Maria Wertli, Horten Center for Patient Oriented Research and Knowledge Transfer University of Zurich

Professor Robert Schleip, Ulm University

Education

Associate Professor/Docent in Epidemiology, Karolinska Institutet, 2014

Doctor in Medical Science (Epidemiology), Karolinska Institutet, 2007. Doctoral thesis:” Back and neck pain. Epidemiological studies on some risk factors and treatments, including Naprapathic manual therapy”. Research education at the Institute of Environmental medicine and Health Care Sciences Postgraduate School, Karolinska Institutet. 

Public Health Karolinska Institutet, 2003

Licensed naprapath since 1994. 

Research description

Some of the projects within MUSIC

I. Randomized controlled trials (RCT) of interventions for back and neck pain:

We perform clinical trials with the overall aim to evaluate the effect of commonly used treatment strategies including manual therapy as Naprapathy, on musculoskeletal disorders. Specific aims are to deepen the knowledge of the effect of treatments on back/neck pain regarding pain, disability, perceived recovery, cost utility and adverse reactions.

1. The BJÖRN-trial (n=409) about the effect of naprapathic manual therapy on unspecific back and neck pain. Data from the trial is also used to identified prognostic factors for back and neck pain and to evaluate the cost effectiveness

2. The MINT-trial (Manual Intervention Trial) (n=1 057) about the treatment effects of combinations of manual therapy (naprapathy) as well as the occurrence and severity of adverse events directly after manual therapy. Data from the trial is also used to identified prognostic factors for back and neck pain.

3. Three smaller RCTs (n= 100, 46 and 33 respectively) in collaboration with Ulm University, aiming to evaluate the effect of specific receptor stimulation with manual therapy on the calf muscle, the lower back, and the shoulder.

4. The STONE-trial (Stockholm Neck trial) (n = 620) in collaboration with University of Ontario Institute of Technology, to explore the effect of massage therapy and physical training on sub-acute and long lasting neck pain, and to study the course of neck pain. Data will also be used to identify prognostic factors for future secondary prevention strategies and to perform a health economic evaluation. This trial is ongoing and is funded by VR, FORTE and KI.  

II. Cohort studies of factors of importance for the prognosis of back/neck pain.

1. The Stockholm Public Health Cohort (SPHC): I am the PI for the research regarding musculoskeletal pain in the SPHC, a prospective cohort set within the framework of the Stockholm County Council Public Health Surveys. The cohorts includes in total more than  100 000 persons, which provide statistical power for interaction analyses on risk and prognostic factors for pain/recovery for back pain, neck pain and comorbidity with psychological distress. SPHC is resident in the Department of Public Health and the PI is Professor Cecilia Magnusson. The research is performed in collaboration with them and with Uppsala University.

2. Whiplash pain cohorts: We have access to several cohorts of patients from Sweden and Canada with neck pain after Whiplash. The research about prognostic factors for neck pain after is performed in collaboration with University of Ontario Institute of Technology, Toronto University, University of Southern Denmark and Edmonton University.

 

III. Sports injury studies

1. The Swedish young elite tennis cohort: This is a PhD-student project (Fredrik Johansson) about shoulder injuries and adaptations in young Swedish elite tennis players in collaboration with Ghent University.

 

2. The KHAST-study (Karolinska Handball study) is a PhD-student project (Martin Asker) aiming to deepen the knowledge about injuries and the functional status in the shoulder in adolescent elite handball players. A cohort of 400 players, 15-17 years, recruited from handball profiled high schools in Sweden, is followed for two seasons regarding shoulder injuries. The project is discussed and approved by the Swedish Handball association. The study is funded by Folksam insurance.

 

3. The Karolinska Football Injury Cohort (KIC study): This project is an innovative collaboration between epidemiology, medicine, psychology, orthopedics, physiotherapy and naprapathy, composed of research groups at four universities, in order to identify risk factors for overuse and traumatic injuries. In an extensive cohort study, 600 young female footballers from Academies and elite football gymnasiums (NIU) in the Stockholm, Göteborg and Malmö will be included. Players free from injuries/pain in the hip, back and/or head/neck will be followed prospectively one year regarding incident cases of injuries to the to the hip, back and head/neck.  Players answer an extensive questionnaire, are screened clinically at baseline and after 6 months, and followed prospectively with weekly web-based questionnaires regarding match and training exposure and new injuries during one year. Risk factors and factors of importance for no injury will be identified by comparing exposed and unexposed with an extensive confounding control.

The project has a unique holistic and multidisciplinary perspective that potentially can answer a long row of research questions, separately for common but unexplored risk factors and pain sights. This will contribute considerably to the research area. The project is located at the Musculoskeletal & Sports Injury Epidemiology Center, and is performed in collaboration with Linköping University, Halmstad University, The Swedish School of Sport and Health Sciences (GIH) and the Scandinavian College of Naprapathic Manual Medicine. It is partly funded by Swedish and Norwegian Naprapathic Associations.

Teaching portfolio

I teach regularly at courses on bachelor, master and doctoral levels.

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