Severs skada – paradigmskifte gällande diagnostik och behandling?
Severs skada – paradigmskifte gällande diagnostik och behandling?
Severs skada – paradigmskifte gällande diagnostik och behandling?
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Fig. 2. The heel cup, the foot (in the study always supported<br />
by a sports shoe) and the heel wedge.<br />
were used, the questionnaire was filled in eight times per<br />
person for each activity. A post-treatment phase of 2 weeks<br />
finally followed, without any insoles, when again the pain<br />
questionnaire for pain related to the chosen sport activity was<br />
filled in six times each for the two chosen activities A and B<br />
(Fig. 1). Activity levels were assessed at the start of the study<br />
and in the two phase shifts, three times in total (Fig. 4).<br />
Measurement for the non-treatment group (n 5 5) was<br />
activity level, median and range for the self-assessed pain at<br />
the start and end.<br />
The study was approved by the Regional Ethics Board of<br />
Uppsala (dnr 2004 M-377).<br />
Statistics<br />
Median pain for each boy was calculated for each of the three<br />
phases, pre-treatment, treatment and post-treatment, separately<br />
for activities A and B, and termed the pain variable.<br />
Median pain for the whole study group (n 5 33) was thereafter<br />
calculated from these pain variables, for each phase and<br />
activity. Interquartile range (IQR) (i.e. the numerical difference<br />
between the 25th and 75th centiles) was also calculated.<br />
To analyze the change over time between the different<br />
phases, for activity A and activity B separately, Wilcoxon’s<br />
signed-rank test was used. The pain variables for the group for<br />
activity A and activity B in the pre-treatment phase were<br />
compared with the pain variables in the treatment phase. The<br />
pain variables in the treatment phase were also compared with<br />
the pain variables in the post-treatment phase, and finally the<br />
pain variables in the pre-treatment phase were compared with<br />
the variables in the post-treatment phase (Fig. 3).<br />
To correct for mass significance, Holm’s sequential Bonferroni’ssss<br />
test was used.<br />
Results<br />
There was a significant reduction in pain level during<br />
activity with insoles, when comparing pain levels in<br />
the pre-treatment and treatment phase, for both<br />
activities A and B (Po0.001) (Fig. 3). Median pain<br />
level in the pre-treatment phase was 4.5 in activity A<br />
(IQR 2.5) and 4.0 in activity B (IQR 2.5). During<br />
treatment, pain was reduced to 2.0 (IQR 3.50) in<br />
both activities A and B. After discontinuation of the<br />
38<br />
Median pain values (VAS)<br />
10.00<br />
9.00<br />
8.00<br />
7.00<br />
6.00<br />
5.00<br />
4.00<br />
3.00<br />
2.00<br />
1.00<br />
Sever’s injury: insole treatment<br />
p