Hanne Albert

Hanne Albert is a Danish physiotherapist and has a MPH, and a Ph.D. in medical science.[1] She is a researcher within medical science, and her main research interest is in low back pain and pelvic girdle pain.[2] Albert has through her study suggested and later show that the painful condition bone œdema (modic changes) could be caused by a bacterial infection and treated with antibiotics.[3][4]

Career and education

Albert was authorized as a Physiotherapist by Metropolitan University College in Copenhagen, Denmark. In 2000, she was awarded a Master of Public Health, from the Nordic School of Public Health in Gothenburg, Sweden. The subject of her Master thesis was "Group Treatment of women with chronic pelvic pain". In 2004, she was awarded the Ph.D. degree of the Faculty of Health Sciences, University of Southern Denmark based on the thesis "Non-surgical treatment of patients with sciatica. A randomized clinical controlled trial”.[5]

Albert started her career as a Physiotherapist at Odense University Hospital, where she later became a clinical lecture. In 2000 she was employed as a researcher at the research department at The Back Centre in Ringe, Denmark.[6] Having had the title as Associate Professor at the Faculty of Health Sciences, University of Southern, Denmark since 2010. She left the University in 2013 and became the Medical director at the Modic Clinic, Odense, Denmark.[7]

Research and publications

Alberts early research career began within in gynecology and obstetrics, at Odense University Hospital at the gynecology ward. A large clinical problem was women with chronic pelvic pain. Together with another physiotherapist, Tove Boe, she developed a new group treatment for women with chronic pelvic pain with focus on a psychosomatic approach. Combining qualitative actions research methods with quantitative measurements of improvements, the results showed that the patients improved significantly. This research was published in her Master's thesis and a scientific paper.[8]

The large number of pregnant women with pelvic girdle pain, was a challenge at the obstetric department. Little was known about the diagnosis and treatment of this painful condition in pregnant and post-partum women. Together with another physiotherapists Mona Godskesen, she undertook the challenge of attempting to classify the different groups of Pelvic Girdle pain into subgroups which required different treatment. The study (still the largest in the world) included 2269 pregnant women. All of them were examined in their 20. week of pregnancy. The women who suffered from pelvic pain were followed at 1, 3,6,12, 24 months after delivery, or until their pelvic pain subsided. The main findings of the study were, that there are most likely four different subgroups of pelvic girdle pain. Then different groups have different incidence, and there is different clinical characteristics and pain pattern and different prognosis. Most important is the subgroups; Pelvic Girdle Syndrome, 5% of the pregnant women suffer from Pelvic Girdle Syndrome. Unfortunately, these women have a poor prognosis, hence 20% of the women still suffer from pain 2 years after delivery of the child. This research resulted in five scientific papers and three summaries.[9][10][11][12][13][14][15] For this scientific work she was awarded two awards, and a seat in the European Guideline Group.

Disc herniation

In 2000 Albert was employed as a researcher and a Ph.D. student at The Back Centre in Ringe. The aim of her Ph.D. was, to evaluate the possibility of treating to treat patients with severe lumbar disc herniation with exercises. These were patients who would normally be considered surgical candidates. In 2000, this had not previously been shown. The study showed, that there was highly significant improvement in patients of this kind of treatment. It was also possible to specify the patient's prognoses by dividing the patients into different response to Specific exercises and positioning (McKenzie), different personally traits, and different types of herniation and these subgroups required different treatment.[16][17][18][19][20][21]

Modic changes

The Ph.D. study revealed one previously unknown fact. About 50% of the patients developed Modic Changes/bone edema in the vertebrae adjacent to the previously herniated, this was visible one year after their disc herniation. These patients also developed back pain, whereas the main problem that they presented while having the lumbar disc herniation was pain radiating into one or both legs. Hanne Albert was the first to describe this connection between a previous herniation and new Modic changes in the adjacent vertebra. For this research she was awarded a price and these results were published as a scientific paper.[22] This was unknown news and led her together with radiologist, Joan Solgård Sørensen, to develop three theories of the pathogenesis behind Modic changes; a bacterial cause, a mechanical cause and a rheumatological cause. This theory was published in 2007.[23]

Bacteria as a cause of back pain

The new idea that was presented was, that through a lesion in the herniated disc the bacteria Propioni Acnes could invade the disc, and that Modic changes/bone edema was the edema surrounding the infected disc. Antibiotic treatment was a relevant treatment of an infection. The first study of antibiotic treatment of Modic changes ever, was published in 2008. Here 32 patients in a pilot study was treated with long term antibiotic and 60% of these became much better or cured for their back pain.[3] In 2013, the first randomized clinically controlled trial (RCT) was published.[4] This study which has received the highest grade in methodology, showed in 162 patients a highly significant and clinically relevant improvement in the patients that received the antibiotic treatment and no change in the patients that received the placebo tablets. This naturally stirred massive international interest.[24][25][26][27] Earlier it was believed, that back pain was either caused by mechanical problems in the tissue or the pain was psychosomatic. Now there was a third cause, that back pain could be caused by bacterial infection this led to another price. Modic changes/bone edema is a very painful disease, and Hanne Albert has led or she has been a part of several teams which have explored this painful condition.[28][29][30][31][32][33]

Publications

Albert has been the head author or co-author of 55 scientific papers published in peer-reviewed papers.[2] She has been the co-author of three books.[34][35][36] Albert has done reviews for scientific journals such as, The Lancet, The European Spine Journal etc. She is also an assistant editor of the European Spine Journal.[37]

Honours, awards and distinctions

2003: Danish Physiotherapists Research Award for; original and innovative research with immediate clinical relevance.[38]
2004: “The Columna price” from The Danish Society for Musculoskeletal Medicine. For comprehensive clinical research in women with pelvic pain related to pregnancy and after delivery, and the extensive educational to implement this new knowledge in all groups of health professionals.
2005: “Modic changes following lumbar disc herniation”. The best scientific presentation at the European Spine conference in Barcelona.[39]
2017: “The German Pain prize” for showing there was a third new cause of back pain due to a by bacterial infection, instead of the early belief, that back pain was either caused by mechanical problems in the tissue or the back pain was psychosomatic.[40][41]

The scientific work that Albert had done within diagnostic of Pelvic Girdle pain, resulted in an invitation to be a part of the group that wrote the European guidelines for diagnostic and treatment of pelvic girdle pain, which was published in 2008.[42]

Albert is also an assistant editor of the European Spine Journal.[37]

References
  1. PT, Hanne B. AlbertUniversity of Southern Denmark; MPH.; Ph.D. "Hanne B Albert - PT., MPH., Ph.D. - University of Southern Denmark, Odense - SDU". ResearchGate. Retrieved 11 October 2018.
  2. PT, Hanne B. AlbertUniversity of Southern Denmark; MPH.; Ph.D. "Hanne B Albert - PT., MPH., Ph.D. - University of Southern Denmark, Odense - SDU". ResearchGate. Retrieved 11 October 2018.
  3. Albert, HB; Manniche, C; Sorensen, JS. Deleuran BW. (2008). "Antibiotic treatment in patients with low-back pain associated with Modic changes Type 1 (bone oedema): a pilot study". Br J Sports Med. 2008 (42): 969–73. doi:10.1136/bjsm.2008.050369. PMID 18718972. S2CID 966062.
  4. Albert, HB; Sorensen, JS; Christensen, BS; Manniche, C (2013). "Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic Type 1 changes): a double-blind randomized clinical controlled trial of efficacy". Eur Spine J. 22 (4): 697–707. doi:10.1007/s00586-013-2675-y. PMC 3631045. PMID 23404353.
  5. "Ikke-kirurgisk behandling af patienter med radiculære smerter til UE". Fysio.dk. Retrieved 11 October 2018.
  6. "Archived copy". Archived from the original on 2017-02-06. Retrieved 2017-08-13.CS1 maint: archived copy as title (link)
  7. "behandlerne i klinikken". Modicklinikken.dk. Retrieved 11 October 2018.
  8. Albert, H (1999). "Psychosomatic group treatment helps women with chronic pelvic pain". J Psychosom Obstret Gynecol. 20 (4): 216–25. doi:10.3109/01674829909075598. PMID 10656156.
  9. Albert, H; Godskesen, M; Westergaard, JG; Chard, T; Gunn, L (1997). "Circulating levels of relaxin are normal in pregnant women with pelvic pain". Eur J Obstet Gynecol Reproductive Biology. 74 (1): 19–22. doi:10.1016/s0301-2115(97)00076-6. PMID 9243195.
  10. Albert, H; Godskesen, M; Westergaard, JG (2000). "Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain". Eur Spine J. 9 (2): 161–6. doi:10.1007/s005860050228. PMC 3611366. PMID 10823434.
  11. Albert, HB; Godskesen, M; Westergaard, JG (2001). "Prognosis of four classification groups of pregnancy-related pelvic joint pain". Acta Obstet Gynecol Scand. 80: 505–10. doi:10.1034/j.1600-0412.2001.080006505.x. S2CID 26614475.
  12. Albert, HB; Godskesen, M; Westergaard, JG (2002). "Incidence of four syndromes of pregnancy-related pelvic joint pain". Spine. 27 (24): 2831–4. doi:10.1097/00007632-200212150-00020. PMID 12486356. S2CID 28828788.
  13. Albert, HB; Godskesen, M; Korsholm, L; Westergaard, JG (2006). "Risk Factors in developing Pregnancy-Related Pelvic Girdle Pain". Acta Obstetrica et Gynecologica. 85 (5): 539–44. doi:10.1080/00016340600578415. PMID 16752231. S2CID 24963131.
  14. Albert, HB (2002). "Behandling af bækken- og lænderygsmerter hos gravide og post partum kvinder". Muskuloskelatalt Forum. 2: 16–21.
  15. Albert, HB (2012). "Bækkensmerter i graviditeten - forekomst, prognose, risikofaktorer og diagnostisering". Best Practice. 6: 23–25.
  16. Albert HB. Conservative treatment of patients with sciatica- a randomized controlled trial. [Dissertation] Odense: Faculty of Health Sciences, University of Southern Denmark; 2004.[Danish]
  17. Albert, HB; Manniche, C (2012). "The efficacy of systematic active conservative treatment for patients with severe sciatica. A single-blind randomized clinical controlled trial". Spine. 37 (7): 531–42. doi:10.1097/brs.0b013e31821ace7f. PMID 21494193. S2CID 25518989.
  18. Albert, HB; Hauge, E; Manniche, C (2012). "Centralization in patients with sciatica: are pain responses to repeated movement and positioning associated with outcome or types of disc lesions?". Eur Spine J. 21 (4): 630–6. doi:10.1007/s00586-011-2018-9. PMC 3326129. PMID 21947819.
  19. Jensen, TS; Albert, HB; Sorensen, JS; Manniche, C; Leboeuf-Yde, C (2007). "Magnetic Resonance Imaging Findings as Predictors of Clinical Outcome in Patients With Sciatica Receiving Active Conservative Treatment". J Manip Ther Phys. 30 (2): 98–108. doi:10.1016/j.jmpt.2006.12.004. PMID 17320730.
  20. Løgtholt Andreasen, Marianne; Langhoff, Lotte; Secher Jensen, Tue; Albert, Hanne B. (2007). "Reproduction of the Lumbar Lordosis: A Comparison of Standing Radiographs versus Supine MRI obtained with Straightened Lower Extremities". J Manipulative Physiol Ther. 30 (1): 26–30. doi:10.1016/j.jmpt.2006.11.009. PMID 17224352.
  21. Jensen, Tue S.; Albert, Hanne B.; Soerensen, Joan S.; Manniche, Claus; Leboeuf-Yde, Charlotte (2006). "Natural course of disc morphology in patients with sciatica: an MRI study using a standardized qualitative classification system". Spine. 31 (14): 1605–12. doi:10.1097/01.brs.0000221992.77779.37. PMID 16778696. S2CID 11759913.
  22. Albert, HB; Manniche, C (2007). "Modic changes following lumbar disc herniation". Eur Spine J. 16 (7): 977–82. doi:10.1007/s00586-007-0336-8. PMC 2219661. PMID 17334791.
  23. Albert, HB; Kjaer, P; Jensen, TS; Sorensen, JS; Bendix, T; Manniche, C (2008). "Modic changes, possible causes and relation to low back pain". Med Hypotheses. 70 (2): 361–8. doi:10.1016/j.mehy.2007.05.014. PMID 17624684.
  24. "Antibiotics could cure 40% of chronic back pain patients", The Guardian, Tuesday 7 May 2013. Retrieved Saturday 5 August 2017.
  25. "Antibiotics may help ease chronic back pain", Wednesday 8 May 2013. Retrieved 5 August 2017.
  26. Laurance, Jeremy. "The stuff of Nobel prizes: Half a million sufferers of back pain could be cured with antibiotics", The Independent, Tuesday 7 May 2013. Retrieved Saturday 5 August 2017.
  27. Moore, Thomas. "Antibiotics 'Can Cure Back Pain', Study Finds", Sky NEWS, Wednesday 8 May 2013. Retrieved Saturday 5 August 2017.
  28. Albert HB, Lambert P, Rollason J, Sorensen JS, Worthington T, Pedersen MB, Nørgaard HS, Vernallis A, Busch F, Manniche S, Elliott T. Is nuclear tissue infected with bacteria following disc herniations which leads to Modic changes in the adjacent vertebrae? Eur Spine J 2013;22:690-6.
  29. Rollason, J; McDowell, A; Albert, HB; Barnard, E; Worthington, T; Hilton, AC; Vernallis, A; Patrick, S; Elliott, T; Lambert, P (2013). "Genotypic and antimicrobial characterisation of Propionibacterium acnes isolates from surgically excised lumbar disc herniations". Biomed Res. Int. 2013: 530382. doi:10.1155/2013/530382. PMC 3771251. PMID 24066290.
  30. "Rygsmerter, radiologi og endepladeforandringer ad modum Modic". Ugeskrift for læger. 168: 1668.
  31. Albert H, Pedersen H, Manniche C, Høilund-Carlsen PF. "PET imaging in patients with Modic changes. Nuklearmedizin. 2009;48(3):110-2. Epub 2009 Mar 23.
  32. Albert, HB; Briggs, AM; Kent, P; Byrhagen, A; Hansen, C; Kjaergaard, K (2011). "The prevalence of MRI-defined spinal pathoanatomies and their association with Modic changes in individuals seeking care for low back pain". Eur Spine J. 20 (8): 1355–62. doi:10.1007/s00586-011-1794-6. PMC 3175840. PMID 21544595.
  33. Kent, P; Briggs, AM; Albert, HB; Byrhagen, A; Hansen, C; Kjaergaard, K; Jensen, TS (2011). "Inexperienced clinicians can extract pathoanatomic information from MRI narrative reports with high reproducibility for use in research/quality assurance". Chiropr Man Ther. 19 (1): 16. doi:10.1186/2045-709x-19-16. PMC 3154850. PMID 21774836.
  34. Albert HB, Johansen S. Bækkensmerter s 607-622 i Klinisk reumatologi for ergo og fysioterapeuter. Red Danneskiold-Samsøe B, Lund H, Avlund K. Munksgård, København.
  35. Albert HB, Lund H, Hovmand B, Winkel A. Case rapport. En grundbog i praksisformidling. Munksgaard, København.
  36. Thomsen K, Albert H, Warren M, Groby L. Ortopædkirurgi for ergoterapeuter og fysioterapeuter; Ryg og bækken, 359-404. Munksgaard, København, 2009.
  37. "Archived copy". Archived from the original on 2017-08-13. Retrieved 2017-08-13.CS1 maint: archived copy as title (link)
  38. Weirsøe, Frank. "Pris til fynsk fysioterapeut", TV 2/Fyn, [DANISH] 19 November 2003. Retrieved 5 August 2017.
  39. "Best podium presentation 2005: Modic Changes, the prevalence and relationship to lumbar disc herniation. A possible new pathogenesis of low back pain." EUROSPINE, Retrieved 5 August 2017.
  40. Zeuner, Nicole. " 'Antibiotika helfen bei Rückenschmerzen' - Deutscher Schmerzpreis für revolutionäre Studien", [GERMAN], 26 March 2017. Retrieved 5 August 2017.
  41. "Deutscher Schmerz- und Palliativtag 2017: Schmerzpreis für revolutionäre Studien zur Behandlung von Rückenschmerzen mit Antibiotika", [GERMAN] 26 March 2017. Retrieved 5 August 2017.
  42. Vleeming A; Albert HB; Ostgaard HC; Stuge B; Sturesson B (June 2008). "European guidelines on the diagnosis and treatment of pelvic girdle pain". European Spine Journal. Epub. 17 (6): 794–819. doi:10.1007/s00586-008-0602-4. PMC 2518998. PMID 18259783.
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