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  • 1.
    Aili, Katarina
    et al.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden & FoU Spenshult, Halmstad, Sweden.
    Andersson, Maria L.E.
    FoU Spenshult, Halmstad, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Innovation and Sustainability, The Rydberg Laboratory for Applied Sciences (RLAS). FoU Spenshult, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability, The Rydberg Laboratory for Applied Sciences (RLAS). FoU Spenshult, Halmstad, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). FoU Spenshult, Halmstad, Sweden.
    Bergman, Stefan
    FoU Spenshult, Halmstad, Sweden & Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
    Sleep problems and fatigue as a predictor for the onset of chronic widespread painover a 5- and 18-year perspective: a 20-year prospective study2018In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, p. 87-87, article id OP0072Article in journal (Refereed)
    Abstract [en]

    Background: If localised pain represent one end of a pain spectra, with overall better general health, chronic widespread pain (CWP) and fibromyalgia represent the other end of the spectra with worse general health and more comorbidities with other somatic diseases and mental illness. Sleep problems and fatigue are common among individuals reporting CWP and previous research indicate that sleep problems may be an important predictor for pain prognosis.

    Objectives: The aim of this population-based study was to investigate if sleep problems and fatigue predict the onset of CWP 5 and 18 years later.

    Methods: In order to get more stable baseline classifications of CWP, a wash-out period was used, including only individuals who had not reported CWP (according to ACR 1990 criteria for fibromyalgia) at baseline (−98) and three years prior baseline (−95). In all, data from 1249 individuals entered the analyses for the 5 year follow-up (−03) and 791 entered for the 18 year follow-up (−16). Four parameters related to sleep (difficulties initiating sleep, maintaining sleep, early morning awakening and non-restorative sleep), and one parameter related to fatigue (SF-36 vitality scale) were investigated as predictors for CWP. Binary logistic regression analysis were used for analyses.

    Results: All investigated parameters predicted the onset of CWP five years later (problems with initiating sleep (OR 1.91; 1.16–3.14), maintaining sleep (OR 1.85; 1.14–3.01), early awakening (OR 2.0; 1.37–3.75), non-restorative sleep (OR 2.27; 1.37–3.75) and fatigue (OR 3.70; 1.76–7.84)) in a model adjusted for age, gender, socio-economy and mental health. All parameters except problems with early awakening predicted the onset of CWP also 18 years later. In all, 785 individuals did not report any of the sleeping problems at baseline (fatigue not included), 268 reported one of the problems, 167 two, 128 three and 117 subjects reported to have all four sleep problems. Reporting all four sleep problems was significantly associated with CWP at follow-up at both time points when adjusting for age, gender, socio economy and mental health (OR 4.00; 2.03–7.91 and OR 3.95; 1.90–8.20); adjusting for age, gender, socio economy and number of pain regions (OR 2.94; 1.48–5.82 and OR 2.65; 1.24–5.64) and in a model adjusting for age, gender, socio economy and pain severity (OR 2.97;1.53–5.76; and OR 3.02;1.47–6.21) for the 5 year and 18 year follow-up respectively, compared to not reporting any of the sleep problems at baseline.

    Conclusions: Both sleeping problems and fatigue predicts the onset of CWP 5- and 18 years later. The results highlight the importance of the assessment of sleep quality in the clinic.

  • 2.
    Aili, Katarina
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Sport. Spenshult Research and Development Center, FoU Spenshult, Halmstad, Sweden & Karolinska Institutet, Stockholm, Sweden.
    Andersson, Maria L.E.
    Spenshult Research and Development Center, FoU Spenshult, Halmstad, Sweden & Lunds Universitet, Lund, Sweden.
    Bremander, Ann
    Spenshult Research and Development Center, FoU Spenshult, Halmstad, Sweden & Lunds Universitet, Lund, Sweden & University of Southern Denmark, Odense, Denmark & Syddansk Universitet, Graasten, Danmark.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Center, FoU Spenshult, Halmstad, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing. Spenshult Research and Development Center, FoU Spenshult, Halmstad, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Sleep problems and fatigue as predictorsfor the onset of chronic widespread painover a 5- and 18-year perspective2018In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 19, no 1, p. 1-14Article in journal (Refereed)
    Abstract [en]

    Background: Previous research suggests that sleep problems may be an important predictor for chronic widespread pain (CWP). With this study we investigated both sleep problems and fatigue as predictors for the onset of CWP over a 5-year and an 18-year perspective in a population free from CWP at baseline.

    Methods: To get a more stable classification of CWP, we used a wash-out period, including only individuals who had not reported CWP at baseline (1998) and three years prior baseline (1995). In all, data from 1249 individuals entered the analyses for the 5-year follow-up and 791 entered for the 18-year follow-up. Difficulties initiating sleep, maintaining sleep, early morning awakening, non-restorative sleep and fatigue were investigated as predictors separately and simultaneously in binary logistic regression analyses.

    Results: The results showed that problems with initiating sleep, maintaining sleep, early awakening and non-restorative sleep predicted the onset of CWP over a 5-year (OR 1.85 to OR 2.27) and 18-year (OR 1.54 to OR 2.25) perspective irrespective of mental health (assessed by SF-36) at baseline. Also fatigue predicted the onset of CWP over the two-time perspectives (OR 3.70 and OR 2.36 respectively) when adjusting for mental health. Overall the effect of the sleep problems and fatigue on new onset CWP (over a 5-year perspective) was somewhat attenuated when adjusting for pain at baseline but remained significant for problems with early awakening, non-restorative sleep and fatigue. Problems with maintaining sleep predicted CWP 18 years later irrespective of mental health and number of pain regions (OR 1.72). Reporting simultaneous problems with all four aspects of sleep was associated with the onset of CWP over a five-year and 18-yearperspective, irrespective of age, gender, socio economy, mental health and pain at baseline. Sleep problems and fatigue predicted the onset of CWP five years later irrespective of each other.

    Conclusion: Sleep problems and fatigue were both important predictors for the onset of CWP over a five-year perspective. Sleep problems was a stronger predictor in a longer time-perspective. The results highlight the importance of the assessment of sleep quality and fatigue in the clinic. © The Author(s). 2018

  • 3.
    Andersson, Maria L E
    et al.
    Lund University, Lund, Sweden; Spenshult Research and Development Centre, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability. Lund University, Lund, Sweden.
    Aili, Katarina
    Halmstad University, School of Health and Welfare. Karolinska Institute, Stockholm, Sweden.
    Bremander, Ann
    University of Southern Denmark, Odense, Denmark; University Hospital of Southern Denmark, Sonderborg, Denmark.
    Bergman, Stefan
    Spenshult Research and Development Centre, Halmstad, Sweden; University of Gothenburg, Gothenburg, Sweden.
    Cohort profile: the Halland osteoarthritis (HALLOA) cohort–from knee pain to osteoarthritis: a longitudinal observational study in Sweden2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 7, article id e057086Article in journal (Refereed)
    Abstract [en]

    Purpose: The overall objective in this study is to investigate the early development of radiographic knee osteoarthritis (OA) and its association with hand or/and knee OA, metabolic diseases, biomarkers, chronic pain, physical function and daily physical activity types.

    Participants: The Halland osteoarthritis (HALLOA) cohort is a longitudinal cohort study that includes individuals with knee pain in the southwest of Sweden. Enrolment took place from 2017 to 2019. The inclusion criteria were current knee pain, with no former known radiographic knee OA and no cruciate ligament rupture or rheumatological disorder. The participants were recruited: (1) when seeking care for knee pain in primary healthcare or (2) by advertisements in local newspapers. There are 306 individuals included in the study, mean age (SD) 51.7 (8.7) years and 69% are women. The baseline and follow-ups include clinical tests, radiographical examinations, blood samples, metabolic measures, pain pressure thresholds, tests of physical functions, daily physical activity types and patient-reported outcomes.

    Findings to date: There were associations between metabolic factors and radiographic knee OA, even in those with normal body mass index at baseline. In addition, clinical hand OA was positively associated with fasting plasma glucose. We also found that modifiable factors as increased visceral fat and total body fat were associated with increased pain sensitivity among individuals with knee pain.

    Future plans: By studying possible pathophysiological mechanisms of OA over time, we aim to provide new insights on OA progression, identify usable preventive measures helping the clinicians in the management of the disease and improve health for the patients. It is also important to study the development of chronic pain in OA, to get tools to identify individuals at risk and to be able to offer them treatment.

     © Author(s) (or their employer(s)) 2022. 

  • 4.
    Andersson, Maria L.E.
    et al.
    Department of Clinical Sciences Lund, Lund, Sweden; Spenshult Research and Development Centre, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability. Department of Clinical Sciences Lund, Lund, Sweden; Spenshult Research and Development Centre, Halmstad, Sweden.
    Aili, Katarina
    Halmstad University, School of Health and Welfare. Spenshult Research and Development Centre, Halmstad, Sweden; Karolinska Institutet, Stockholm, Sweden.
    Bremander, Ann
    Department of Clinical Sciences Lund, Lund, Sweden; Spenshult Research And Development Centre, Halmstad, Sweden; University Of Southern Denmark, Odense, Denmark; University Hospital of Southern Denmark, Sonderborg, Denmark.
    Bergman, Stefan
    Spenshult Research And Development Centre, Halmstad, Sweden; Sahlgrenska Academy, Gothenburg, Sweden.
    Associations between metabolic factors and radiographic knee osteoarthritis in early disease - a cross-sectional study of individuals with knee pain2022In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 23, no 1, article id 938Article in journal (Refereed)
    Abstract [en]

    Objective: Metabolic factors have been shown to be associated to severe radiographic knee osteoarthritis (RKOA). However, more knowledge is needed in early clinical knee osteoarthritis (KOA). The aim was to study associations between metabolic factors and radiographic knee osteoarthritis (OA) in individuals with knee pain. A second aim was to study associations between metabolic factors and RKOA in those with normal BMI and in those overweight/obese, respectively. Method: This cross-sectional study included 282 individuals with knee pain (without cruciate ligament injury) and aged 30–67 years, and 70% women. Waist circumference, body mass index (BMI), proportion of fat and visceral fat area (VFA) were assessed. RKOA was defined as Ahlbäck grade 1 in at least one knee. Fasting blood samples were taken and triglycerides, cholesterol (total, low density lipoprotein (LDL) and high density lipoprotein (HDL)), C-reactive protein (CRP), glucose, HbA1C were analysed. Metabolic syndrome was defined in accordance with the International Diabetes Federation (IDF). Associations were analysed by logistic regression. Results: Individuals with RKOA were older, had higher BMI, higher VFA, larger waist circumference and had increased total cholesterol, triglycerides and LDL-cholesterol, but not fasting glucose. There was no difference between the group with RKOA vs. non-radiographic group regarding the presence of metabolic syndrome. In a subgroup analysis of individuals with normal BMI (n = 126), those with RKOA had higher VFA, more central obesity, higher levels of CRP and total cholesterol, compared with individuals without RKOA. In individuals with obesity, age was the only outcome associated to RKOA. Conclusion: There were clear associations between metabolic factors and RKOA in individuals with knee pain, also in those with normal BMI. In individuals with obesity age was the only variable associated to RKOA. Trial registration:: clinicalTrials.gov Identifier: NCT04928170. © 2022, The Author(s).

  • 5.
    Andersson, Maria L.E.
    et al.
    Lund University, Department of Clinical Sciences, Rheumatology, Lund, Sweden | Spenshult research and development centre, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult research and development centre, Halmstad, Sweden | Lund University, Department of Clinical Sciences, Rheumatology, Lund, Sweden.
    Aili, Katarina
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Sport. Spenshult research and development centre, Halmstad, Sweden.
    Bremander, Ann
    Lund University, Department of Clinical Sciences, Rheumatology, Lund, Sweden | Spenshult research and development centre, Halmstad, Sweden | University of Southern Denmark, Department of Regional Health Research, Odense, Denmark.
    Bergman, Stefan
    Spenshult research and development centre, Halmstad, Sweden | Lund University, Department of Clinical Sciences, Rheumatology, Lund, Sweden | The Sahlgrenska Academy, University of Gothenburg, Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, Gothenburg, Sweden.
    Metabolic factors associated to clinical hand osteoarthritis in individuals with knee pain2020In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 79, no Suppl. 1, p. 1734-1734Article in journal (Refereed)
    Abstract [en]

    Background: There is some evidence supporting associations between metabolic factors, clinical hand osteoarthritis (OA) and radiographic knee OA. However, more studies are needed regarding early knee OA.

    Objectives: The aim was to study associations between metabolic factors and clinical hand OA at baseline in a cohort of individuals with knee pain, with and without radiographic knee OA.

    Methods: In an ongoing five-year longitudinal study of knee pain, hand OA was assessed by clinical examinations in 296 of the included individuals at baseline [1]. BMI, waist circumference (WC) and blood pressure was measured. Body composition was assessed with Inbody 770. Fasting plasma glucose, triglycerides, cholesterol, HDL-and LDL-cholesterol and HbA1c was analysed. Metabolic syndrome (MetS)was present if central obesity (WC ≥94 cm in men and ≥80cm in women) plus any two of the following factors: raised blood pressure (systolic blood pressure ≥ 130 or diastolic blood pressure ≥ 85 mm Hg or treatment of hypertension), raised triglycerides (≥ 1.7 mmol/L or specific treatment), reduced HDL-cholesterol (men < 1.03 mmol/L and women < 1.29 mmol/L or specific treatment), raised glucose (glucose ≥ 5.6 mmol/L, or type 2 diabetes). Hand strength and self-reported disability of the arm, shoulder and hand (quickDASH) was assessed.

    The individuals were divided according to having clinical hand OA or not, according to Altman [1]. The associations between background factors and clinical hand OA were calculated by crude logistic regression analyses, adjusting for age and sex.

    Results: Fifty-five percent of the individuals in the study was overweight or obese, 40% had MetS and 23% had radiographic knee OA. In total 34% of the individuals had clinical hand OA. The group with hand OA were older, had higher proportion of body fat, fasting plasma glucose, HbA1C, worse quickDASH score and lower hand strength, table 1. Clinical hand OA was significantly associated to higher age (OR 1.04, 95%CI 1.01-1.07), higher fasting plasma glucose (1.56, 1.05-2.30), worse quickDASH (1.04, 1.02-1.06) and lower hand strength (0.99, 0.99 -0.998), but not to proportion of body fat and HbA1c.

    Conclusion: In this cross-sectional study, the only metabolic factor associated with clinical hand OA was fasting plasma glucose. Contrary to other studies, there were no gender differences found. The association between development of clinical hand OA and metabolic factors in individuals with knee pain need to be further assessed in longitudinal studies.

  • 6.
    Andersson, Maria L.E.
    et al.
    Lund University, Department of Clinical Sciences, Rheumatology, Lund, Sweden; Spenshult Research and Development Centre, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability. Spenshult Research and Development Centre, Halmstad, Sweden; Lund University, Lund, Sweden.
    Aili, Katarina
    Halmstad University, School of Health and Welfare. Spenshult Research and Development Centre, Halmstad, Sweden.
    Bremander, Ann
    Spenshult Research and Development Centre, Halmstad, Sweden; Lund University, Lund, Sweden; University of Southern Denmark, Odense, Denmark.
    Kindberg, F.
    Spenshult Research and Development Centre, Halmstad, Sweden.
    Bergman, Stefan
    Spenshult Research and Development Centre, Halmstad, Sweden; Lund University, Lund, Sweden; The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Metabolic Factors Associated to Radiographic Knee Osteoarthritis in Individuals with Knee Pain2020In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 79, no Suppl. 1, p. 793-793Article in journal (Refereed)
  • 7.
    Andersson, Maria L.E.
    et al.
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Spenshult Research and Development Center, Oskarström, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Center, Oskarström, Sweden.
    Reasons to stop drinking alcohol among patients with rheumatoid arthritis – a mixed method study2016In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 75, no Suppl 2, article id 1295Article in journal (Refereed)
    Abstract [en]

    Background: Studies of alcohol use in patients with rheumatoid arthritis are sparse and studies of why patients choose to stop drinking alcohol in particular.

    Objectives: The aim of the current study was twofold: first to identify patients with RA who stopped drinking alcohol and compare those to patients drinking alcohol, and second, to explore reasons to stop drinking alcohol.

    Methods: In 2010 a self-completion postal questionnaire was sent to all 2,102 prevalent patients in the Better anti-rheumatic farmacotherapy (BARFOT) study enquiring about disease severity, physical function (HAQ) and health related quality of life (EQ5D), pain, fatigue, patient global assessment (PatGA) and lifestyle factors e.g. alcohol. The questions assessing alcohol included the question “Have you stopped drinking alcohol?” and an open question “Why have you stopped drinking alcohol?” A mixed method design was used and 1512 patients had answered the alcohol questions and was included in the study of those 86 had stopped drinking alcohol. Seventy-one patients answered the open question and their answers were analyzed with qualitative content analysis (1).

    Results: Comparing patient with RA using alcohol or not, the patients who stopped drinking alcohol was older median age (min-max) 69 (36–90) vs. 66 (23–95), p=0.011, more men 42% vs. 29%, p=0.015, had worse physical function, median HAQ (min-max) 0.50 (0–3.00) vs. 1.00 (0–2.75), p<0.001, worse health related quality of life, median EQ5D (min-max), 0.69 (-0.59–1.00) vs. 0.76 (-0.02–1.00), p<0.001, worse self-perceived health, median PatGA (min-max) 5 (0–10) vs. 3 (0–10), <0.001, more pain, median (min-max) 5 (0–10) vs. 3 (0–10), p<0.001, and more fatigue median (min-max) 6 (0–10) vs 4 (0–10), p<0.001. There were no differences between the groups regarding disease duration, swollen and tender joints. The qualitative content analysis resulted in five categories describing the reasons for patient with RA to stop drinking alcohol: disease and treatment, health and wellbeing, work and family, faith and belief and dependences and abuse.

    Conclusions: Patients with RA who stopped drinking alcohol have a lower physical function, health related quality of life, self-perceived health and more pain and fatigue comparing to patients with RA drinking alcohol. The reasons to stop drinking alcohol were of different nature such as medical, physical, mental, social and spiritual

  • 8.
    Andersson, Maria L.E.
    et al.
    Spenshult Research and Development Center, Halmstad, Sweden; Lund University, Lund, Sweden.
    Thoren, Emelie
    Spenshult Research and Development Center, Halmstad, Sweden.
    Sylwander, Charlotte
    Halmstad University, School of Health and Welfare. Spenshult Research and Development Center, Halmstad, Sweden.
    Bergman, Stefan
    Spenshult Research and Development Center, Halmstad, Sweden; University of Gothenburg, The Sahlgrenska Academy, Gothenburg, Sweden.
    Associations Between Chronic Widespread Pain, Pressure Pain Thresholds and Leptin in Individuals with Knee Pain2022Conference paper (Other academic)
  • 9.
    Andersson, Maria L.E.
    et al.
    Spenshult Research and Development Centre, Halmstad, Sweden; Lund University, Lund, Sweden.
    Thorén, Emelie
    Spenshult Research and Development Centre, Halmstad, Sweden.
    Sylwander, Charlotte
    Halmstad University, School of Health and Welfare. Spenshult Research and Development Centre, Halmstad, Sweden.
    Bergman, Stefan
    Spenshult Research and Development Centre, Halmstad, Sweden; University of Gothenburg, Gothenburg, Sweden.
    Associations between chronic widespread pain, pressure pain thresholds and leptin in individuals with knee pain2022Conference paper (Other academic)
    Abstract [en]

    Background: Previous studies have reported associations between obesity, chronic pain and increased pain sensitivity. The adipokine leptin has been suggested to be involved in the osteoarthritis process as well as in pain sensitisation.

    Objective: The aim was to study associations between chronic widespread pain, pain sensitivity and leptin in individuals with knee pain.

    Method: In all, 306 individuals with knee pain were included in the Halland osteoarthritis cohort, ClinicalTrials.gov NCT04928170. Of those, 265 were included in this cross-sectional baseline study. The mean age (sd) was 51.6 (8.8) years, and 71% was women. The participants marked their painful areas on a pain figure with 18 predefined areas. According to their answer, they were categorised in three different pain groups according to the modified WP2019 definition (1), with knees excluded (due to highest goodness of fit): Chronic widespread pain (CWP), chronic regional pain (ChRP) if CWP was not met, and no chronic pain (NCP). The groupwith CWP were compared with those reporting no CWP (ChRP and NCP). The pressure pain thresholds (PPT) were measured using a computerised pressure algometry (AlgoMed, Medoc) on eight predefined tender points (trapezius (bilateral), right second rib, right lateral epicondyle, knees, gluteal (bilateral)) out of the total 18 points that are part of the definition of fibromyalgia (2). Increased pain sensitivity was defined as having PPT in the lowest third in all tender points. Obesity was measured via waistline measurement and a bioimpedance (InBody 770) measuring BMI, visceral fat area (VFA), and body fat percentage. Serum-Leptin were analysed with an ELISA method (Alpco). C-reactive protein (CRP) >1.0 mg/L were measured according to the current laboratory standards in Sweden. CRP below 1.0 mg/L, were further analysed with a sensitive CRP enzyme-linked immunosorbent assay (ELISA) method (Abnova). Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to describe the groups.

    Result: In this baseline study, 16% reported CWP, and 15% had low pain pressure thresholds at baseline in the study. Those fulfilling CWP were more often women, had higher BMI, VFA, and increased leptin levels and worse KOOS in four of five subscores, see table 1A. The age and gender-adjusted leptin levels were 21.6 ng/ml (95% CI 18.2-25.0) in the group with no CWP vs. 35.5 ng/ml (95% CI 27.6-43.4) in the CWP group, p=0.002. In a logistic regression adjusting for age and gender, leptin was associated with reporting CWP OR 1.015 (95% CI 1.004-1.027, p= 0.008).The participants with low PPT were younger and had a mean (sd) leptin 31.8 ng/ml (31.6) vs 23.0 (26.0), p=0.061 in the group not having low PPT, table 1B. In a logistic regression adjusting for age and gender, leptin was associated with low PPT OR 1.016 (95% CI 1.004-1.029, p= 0.012).There were no increased CRP levels in any of the pain groups (CWP and low PPT), table 1A and B.

    Conclusion: The pathophysiological mechanism causing widespread pain is probably multifactorial, involving both biological and physical factors. The adipokin leptin could be involved in some of these mechanisms, but longitudinal studies are needed to be able to study causal relationships.

  • 10.
    Andersson, Maria L.E.
    et al.
    Halmstad University, School of Business, Innovation and Sustainability. Spenshult Research and Development Centre, Halmstad, Sweden; Lund University, Lund, Sweden.
    Thorén, Emelie
    Spenshult Research and Development Centre, Halmstad, Sweden.
    Sylwander, Charlotte
    Halmstad University, School of Health and Welfare. Spenshult Research and Development Centre, Halmstad, Sweden.
    Bergman, Stefan
    Spenshult Research and Development Centre, Halmstad, Sweden; University of Gothenburg, Gothenburg, Sweden.
    Associations between chronic widespread pain, pressure pain thresholds, leptin, and metabolic factors in individuals with knee pain2023In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 24, no 1, article id 639Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim was to study associations between chronic widespread pain, widespread pain sensitivity, leptin, and metabolic factors in individuals with knee pain. A secondary aim was to study these associations in a subgroup of individuals with normal BMI.

    METHOD: This cross-sectional study included 265 individuals. The participants were categorised into three different pain groups: Chronic widespread pain (CWP), chronic regional pain (ChRP), or no chronic pain (NCP). The pressure pain thresholds (PPTs) were assessed using computerised pressure algometry. Low PPTs were defined as having PPTs in the lowest third of all tender points. Leptin and metabolic factors such as BMI, visceral fat area (VFA), lipids, and glucose were also assessed.

    RESULT: Sixteen per cent reported CWP, 15% had low PPTs, and 4% fulfilled both criteria. Those who fulfilled the criteria for CWP were more often women, more obese, and had increased leptin levels. In logistic regression, adjusted for age and gender, leptin was associated with fulfilling criteria for CWP, OR 1.015 (95% CI 1.004-1.027, p = 0.008). In logistic regression, adjusted for age and gender, leptin was associated with low PPTs, OR 1.016 (95% CI 1.004-1.029, p = 0.012). Leptin was also associated with fulfilling both criteria, adjusted for age, sex, and visceral fat area (VFA), OR 1.030 (95% CI 1.001-1.060), p = 0.040.

    CONCLUSION: Leptin was associated with fulfilling the combined criteria for chronic widespread pain and low PPTs, even after adjusting for the visceral fat area (VFA). Longitudinal studies are needed to study the causal relationships between leptin and the development of widespread pain.

  • 11.
    Andersson, Maria L.E.
    et al.
    Halmstad University, School of Business, Innovation and Sustainability. Spenshult Research and Development Center, Halmstad, Sweden; Lund University, Lund, Sweden.
    Zimmerman, M.
    Helsingborg Hospital, Helsingborg, Sweden; Lund University, Lund, Sweden.
    Brogren, E.
    Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
    Bergman, Stefan
    Spenshult Research and Development Center, Halmstad, Sweden; Lund University, Lund, Sweden; Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Strindberg, L.
    University of Gothenburg, Gothenburg, Sweden.
    Fryk, E.
    University of Gothenburg, Gothenburg, Sweden.
    Jansson, P. A.
    University of Gothenburg, Gothenburg, Sweden.
    Baseline levels of circulating galectin-1 associated with radiographic hand but not radiographic knee osteoarthritis at a two-year follow-up2024In: Osteoarthritis and Cartilage Open, E-ISSN 2665-9131, Vol. 6, no 2, article id 100455Article in journal (Refereed)
    Abstract [en]

    Objective: We tested the potential of circulating galectin-1, interleukin (IL)-1 beta, IL-6, and tumour necrosis factor alpha (TNF alpha) levels at baseline in individuals with knee pain as biomarkers for development of radiographic knee and/or hand osteoarthritis (OA). Design: This study comprised 212 individuals with knee pain from the Halland osteoarthritis cohort (HALLOA). Clinical characteristics and serum/plasma levels of galectin-1, IL-1 beta, IL-6, and TNF alpha were measured at baseline, and knee and hand radiographs were obtained at a two-year follow-up. The predictive value of circulating inflammatory markers and clinical variables at baseline was assessed using multinominal logistic regression for those who developed radiographic OA in knees only (n ​= ​25), in hands only (n ​= ​40), and in both knees and hands (n ​= ​43); the group who did not develop OA (n ​= ​104) was used as reference. Correlations were assessed using Spearman's correlation coefficients. Results: As expected, age was identified as a risk factor for having radiographic knee and/or hand OA at the two-year follow-up. Baseline circulating galectin-1 levels did not associate with developing radiographic knee OA but associated with developing radiographic hand OA (odds ratio (OR) for a 20% increased risk: 1.14, 95% confidence interval (CI) 1.01–1.29) and both radiographic knee and hand OA (OR for a 20% increased risk: 1.18, 95% CI 1.05–1.30). However, baseline IL-1 beta, IL-6, and TNF alpha did not associate with developing radiographic knee and/or hand OA. Conclusion: Non-age adjusted circulating galectin-1 is superior to IL-6, IL-1 beta, and TNF alpha in predicting radiographic hand but not knee OA. © 2024 The Author(s)

  • 12.
    Eberhardt, K.
    et al.
    Section of Rheumatology, Clinical Sciences, Lund University, Lund, Sweden.
    Forslind, Kristina
    Section of Rheumatology, Clinical Sciences, Lund University, Lund, Sweden.
    Bremander, Ann
    Spenshult, Research And Development Centre, Halmstad, Sweden.
    Svensson, Björn
    Section of Rheumatology, Clinical Sciences, Lund University, Lund, Sweden.
    Andersson, Maria L.E.
    Section of Rheumatology, Clinical Sciences, Lund University, Lund, Sweden & Spenshult, Research and Development Centre, Halmstad, Sweden.
    THU0104 Physical Function in Relation to Gender in Patients with Rheumatoid Arthritis – A 15 Year Follow up Study from the Barfot Cohort2015In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 74, p. 230-231Article in journal (Refereed)
    Abstract [en]

    Objectives The aim was to study physical function in individuals with rheumatoid arthritis (RA) as measured by SOFI (observed physical function) and HAQ (self-rated physical function) over 15 years and describe associated variables, with focus on gender differences.

    Methods In all 2558 patients (847 men and 1711 women) age (SD) 58 (16) were recruited from the BARFOT inception cohort of patients with early RA. They had at inclusion a disease duration of one year or less and fulfilled the ACR 1987 criteria. At 15 years follow-up 663 out of 690 patients participated. Physical function was assessed by the SOFI (Signals of functional impairment) test, (scores 0-44, best to worst) which includes 12 performance tests measuring objective physical function, and the HAQ (Health Assessment Questionnaire) (scores 0-3, best to worst) measuring self-reported activity. A logistic regression model was performed to assess if being in the highest quartile of SOFI and HAQ, respectively, at the15 year follow up visit was associated to gender. Age, disease duration at inclusion, disease activity, smoking habits, RF positivity and pain were included in the model.

    Results Women had lower mean SOFI than men at inclusion and during the first study year, p<0.001. HAQ showed a conversed pattern, where women reported worse physical function than men on all occasions, p<0.001. During the first year SOFI and HAQ decreased in both genders, p<0.001. Thereafter throughout the study period mean SOFI and HAQ increased in men and women, p<0.001, figure 1A and B.

    At the 15 year follow up visit being in the highest quartile of SOFI (score ≥10) was not associated with gender while women had a higher risk to be in the highest quartile of HAQ (score ≥1.13) OR (95% CI) 2.86 (1.73-4.74), p<0.001. DAS 28 at inclusion showed a weak association with SOFI, OR (95% CI) 1.36 (1.11-1.68), p=0.003 while pain at inclusion was somewhat closer associated with HAQ, 1.02 (1.01-1.03), p<0.001. The correlation between the two functional test was r=0.54.

    Conclusions Women had an almost three times higher risk of worse outcome of HAQ after 15 years while the outcome of SOFI was not associated with gender. These two measures provide information of different aspects of physical function and should be used concomitantly.

    Disclosure of Interest None declared

  • 13.
    Haglund, Emma
    et al.
    Halmstad University, School of Business, Innovation and Sustainability, The Rydberg Laboratory for Applied Sciences (RLAS). RandD Spenshult, Halmstad, Sweden.
    Pinheiro Sant'Anna, Anita
    Halmstad University, School of Information Technology, Halmstad Embedded and Intelligent Systems Research (EIS), CAISR - Center for Applied Intelligent Systems Research.
    Andersson, Maria L.E.
    RandD Spenshult, Halmstad, Sweden; Department of Clinical Sciences, Department of Rheumatology, Lund University, Lund,, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Innovation and Sustainability, The Rydberg Laboratory for Applied Sciences (RLAS). Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
    Aili, Katarina
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). RandD Spenshult, Halmstad, Sweden & Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Dynamic joint stability measured as gait symmetry in people with symptomatic knee osteoarthritis2019In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, no Suppl. 2, p. -1458Article in journal (Refereed)
    Abstract [en]

    Background: Modern strategies for knee osteoarthritis (OA) treatment and prevention includes early detection and analyses about pain, gait and lower extremity muscle function including both strength and stability. The very first sign of knee OA is pain or perceived knee instability, often experienced during weight bearing activities e.g. walking. Increased muscle strength will provide dynamic joint stability, reduce pain, and disability. Specific measures of gait symmetry (GS) can be assessed objectively by using accelerometers, which potentially is a feasible method when evaluating early symptoms of symptomatic knee OA.

    Objectives: The aim was to study if symptoms of early knee pain affected gait symmetry, and the association between lower extremity muscles function and gait symmetry in patients with symptomatic knee OA.

    Methods: Thirty-five participants (mean age 52 SD 9 years, 66% women) with uni- or bilateral symptomatic knee OA, and without signs of an inflammatory rheumatic disease or knee trauma were included. Pain was assessed by a numeric rating scale (NRS, range 0-10 best to worse), tests of lower extremity muscle function with the maximum number of one leg rises. Dynamic stability was measured as GS by using wearable inertial sensors (PXNordic senseneering platform), during the 6 min walking test to obtain spatio-temporal gait parameters. GS was computed based on stride time (temporal symmetry, TS) and stride length (spatial symmetry, SS). Stride length was normalized by height. Kruskal-Wallis and Spearman’s correlation coefficient were used for analyses.

    Results: Reports of knee pain did not differ between gender (women 4.7, SD 2.4 vs. men 3.9, SD 2.4, p= 0.362), neither did one leg rises or gait symmetry. Participants who reported unilateral knee pain (left/right side n=9/13), had a shorter stride length on the painful side. The mean difference in stride length was 0.7% of the subject’s height (SD 1.3). Participants with unilateral pain also presented less SS gait than those who reported bilateral pain (p=0.005). The higher number of one-leg rises performed, the better TS was observed. We found a significant relationship between TS and one-leg rise for the right r s =-0.39, p=0.006, and left r s =-0.40, p=0.004 left side). No significant relationship was observed between SS and one-leg rises.

    Conclusion: Our results is in line with earlier findings stating that knee pain affects GS negatively and that lower extremity muscle function is an important feature for symmetry and dynamic joint stability in patients with symptomatic knee OA. We also found that pain in one leg was related to impaired GS. Bilateral knee pain was however more symmetrical and will need healthy controls for comparison to better understand the negative impact of symptomatic knee OA.

  • 14.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Center, Spenshult, Halmstad, Sweden.
    Andersson, Maria L.E.
    Spenshult Research and Development Center, Spenshult, Halmstad, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Reasons to stop drinking alcohol among patients with rheumatoid arthritis in Sweden: a mixed-methods study2018In: BMJ Open, E-ISSN 2044-6055, Vol. 8, no 12, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Objectives: The aims were to identify patients with rheumatoid arthritis (RA) who had stopped drinking alcohol and compare them with patients drinking alcohol, and to explore reasons for stopping drinking alcohol.

    Design: A sequential explanatory mixed methods design was used.

    Setting: Six rheumatology clinics in Southern Sweden Better Anti-Rheumatic FarmacOTherapy cohort.

    Participants: A total of 1509 patients completed the questions about alcohol and were included in the study. 86 of these had stopped drinking alcohol and 72 responded to the open question and their answers were analysed with qualitative content analysis.

    Outcome measures: The quantitative data were from a cross-sectional survey assessing disease severity, physical function (Health Assessment Questionnaire, HAQ) and health-related quality of life (EuroQol five dimensions, EQ5D), pain, fatigue, patient global assessment (PatGA) and lifestyle factors, for example, alcohol. The questions assessing alcohol included an open question 'Why have you stopped drinking alcohol?' Results: The patients who stopped drinking alcohol were older (median (min-max) 69 (36-90) vs 66 (23-95), p=0.011), had worse HAQ (1.00 (0-2.75) vs 0.50 (0-3.00), p<0.001), worse EQ5D (0.69 (-0.02-1.00) vs 0.76 (-0.58-1.00), p<0.001) worse PatGA (5 (0-10) vs 3 (0-10), p<0.001), more pain (5 (0-10) vs 3 (0-10), p<0.001) and more fatigue (6 (0-10) vs 4 (0-10), p<0.001 compared with patients drinking alcohol. The qualitative content analysis revealed five categories describing reasons for patients with RA to stop drinking alcohol: illness and treatment; health and well-being; work and family; faith and belief; and dependences and abuse.

    Conclusions: The patients who had stopped drinking had worse physical functioning and higher levels in pain-related variables. Most stopped drinking due to their illness or a desire to improve health. © 2018 Author(s).

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  • 15.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing. Spenshult Research and Development Centre, Halmstad, Sweden; Lund University, Lund, Sweden.
    Bremander, Ann
    Spenshult Research and Development Center, Halmstad, Sweden; Lund University, Lund, Sweden; University of Southern Denmark, Odense, Denmark; Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.
    Andersson, Maria L.E.
    Spenshult Research and Development Centre, Halmstad, Sweden; Lund University, Lund, Sweden.
    Patient Empowerment and Associations with Disease Activity and Pain‐Related and Lifestyle Factors in Patients With Rheumatoid Arthritis2021In: ACR Open Rheumatology, E-ISSN 2578-5745, Vol. 3, no 12, p. 842-849Article in journal (Refereed)
    Abstract [en]

    Background: Empowerment is important to patients with rheumatoid arthritis (RA) because most care is in the form of self-management. The aim was to study levels of empowerment and associated variables in patients with RA and to investigate longitudinal clinical data in patients with low and high empowerment.

    Methods: A postal survey was sent in 2017 to patients with RA from the BARFOT (Better Anti-Rheumatic Pharmacotherapy) cohort that included questions about disease activity, pain-related factors, lifestyle habits, and contained the Swedish Rheumatic Disease Empowerment Scale (SWE-RES-23). The 844 patients who answered the SWE-RES-23 made up the cohort of the present study. Differences in level of empowerment between groups (low, moderate, and high empowerment) were analyzed with ANOVA. Logistic regression analysis was used to study variables associated with low empowerment. Thirdly, we performed comparisons in longitudinal data (15 years) of disease activity, pain, and physical function between the three empowerment groups (low, moderate, and high empowerment).

    Results: Patients with low empowerment (n = 282) were significantly older, more often women, and reported worse pain-related factors and physical function and lower moderate and vigorous physical activity compared with those with high empowerment (n = 270). An analysis of longitudinal data found that patients with low empowerment had worse pain and physical function at all time points.

    Conclusion: Patients with low empowerment have more pain-related symptoms, poorer physical function, and are less physically active. To promote patient empowerment in rehabilitation interventions it is important to identify and support self-management. © 2021 The Authors.

  • 16.
    Malm, Karina
    et al.
    Lund University, Lund, Sweden; Spenshult Research and Development Center, Oskarström, Sweden; Capio Movement, Halmstad, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Andersson, Maria L.E.
    Lund University, Lund, Sweden; Spenshult Research and Development Center, Oskarström, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. Lund University, Lund, Sweden; Spenshult Research and Development Center, Oskarström, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Lund University, Lund, Sweden; Spenshult Research and Development Center, Oskarström, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. Spenshult Research and Development Center, Oskarström, Sweden.
    THU0628-HPR Lifestyle Habits Relates to Quality of Life in Patient with Longstanding Rheumatoid Arthritis2015In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 74, no Suppl. 2, p. 1318-1318Article in journal (Refereed)
    Abstract [en]

    Background: Fatigue, pain, stiffness, impaired muscle function and impaired physical function are some of the most pronounced symptoms in rheumatoid arthritis (RA) and these may be related to lifestyle habits such as physical activity, diet, smoking and alcohol.There is limited knowledge about how patient with longstanding RA understand their lifestyles habits in relation to their disease and quality of life.

    Objectives: To describe experiences of how lifestyle habits relate to quality of life in patients with longstanding RA.

    Methods: A qualitative study with a deductive content analysis design, including 17 patients from the Swedish BARFOT (Better Anti-Rheumatic FarmacoTherapy) cohort. BARFOT is a long time follow up study of early RA. Informants were strategically selected by gender (ten women and seven men), age (range 30-84 years), disease duration (8-23 years), function as measured by HAQ, and quality of life as measured by EQ5D. Semi-structured interviews focused on four lifestyle habits (main categories); Physical activity, Diet, Smoking, and Alcohol. The interviews were recorded, transcribed verbatim and coded into subcategories within each of the four main categories.

    Results: In patients with longstanding RA quality of life was related to the four given main categories (lifestyle habits). Each main category included two to three subcategories; (1) Physical activity means barrier, opportunities and well-being, (2) Diet means shame, well-being and social relationship, (3) Smoking means reward and fear, and (4) Alcohol means ambivalence and social relationship.

    Conclusions: In longstanding RA, lifestyle habits relates to quality of life through both positive and negative experiences. This has to be taken into account in clinical care for a better understanding of how patients conceive and adherer to advice on lifestyle.

    References: Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010;376(9746):1094-108.

    Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qualitative health research. 2005;15(9):1277-88.

  • 17.
    Malm, Karina
    et al.
    Research and Development Center, Spenshult, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. Research and Development Center, Spenshult, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Andersson, Maria L.E.
    Research and Development Center, Spenshult, Oskarström, Sweden; Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Research and Development Center, Spenshult, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    BARFOT study group,
    Predictors of severe self-reported disability in RA in a long-term follow-up study2014In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 8, p. 686-691Article in journal (Refereed)
    Abstract [en]

    Purpose: Identify factors predictive for severe self-reported disability in patients with rheumatoid arthritis. Methods: Patients (n = 1910) were sent a questionnaire 5-18 years after disease onset. Outcomes were the Health Assessment Questionnaire (HAQ), Rheumatoid Arthritis Outcome Score (RAOS) and physical activity. The tertile of patients most affected by the disease were compared to those less affected. Proposed predictive factors were function, pain, general health, radiographic joint damage, swollen/tender joints and disease activity measures at baseline. Age, gender and disease duration were controlled for in logistic regression analyses. Results: Seventy-three percent (n = 1387) responded to the questionnaire, mean age 65 years (SD 15) and 70% were women. Worse scores in function, pain, general health and tender joints at baseline increased the risk of being in the most affected group, as measured by HAQ and RAOS 5-18 years after disease onset (p < 0.000). Conclusion: High levels of pain and worse reports of function at disease onset were risk factors for being in the most disabled tertile of patients after 5-18 years. Pain and function proved to be predictors of the outcome while some measures of inflammation were not. It is important to recognize these patients who may be in need of multidisciplinary treatments already at disease onset.

    Implications for Rehabilitation

    • Health care providers should be aware of the subgroup of patients with more severe symptoms of pain and impaired function at disease onset since they have an increased risk of being in the most disabled tertile of rheumatoid arthritis patients several years later.
    • Health care providers should assess pain and function and act on high pain and impaired function already at disease onset as they proved to be predictors of patient-reported outcomes controlled for inflammatory parameters.
    • These findings support European guidelines and research findings that patients with high pain and impaired function despite of well-managed inflammatory parameters should early in the disease course be referred to multidisciplinary treatment for supplementary regime.
  • 18.
    Malm, Karina
    et al.
    Research and Development Centre, Spenshult, Oskarström.
    Bergman, Stefan
    Research and Development Centre, Spenshult, Oskarström & Lund University, Lund, Sweden.
    Andersson, Maria L.E.
    Research and Development Centre, Spenshult, Oskarström; Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Innovation and Sustainability, The Rydberg Laboratory for Applied Sciences (RLAS). Research and Development Centre, Spenshult, Oskarström.
    BARFOT Study Group,
    Worse physical function at disease onset predicts a worse outcome in physical function, but not in meeting who physical activity recommendations, nine years later2013Conference paper (Refereed)
    Abstract [en]

    Background: Long term disease impact on physical functioning in the most affected patients with RA is not well described. Impaired function and inability to be physically active are associated features and it is well known that people with RA are less physically active compared with the general population.

    Objectives: To study predictive variables for a worse outcome in physical function and physical activity measures in a long time follow-up study.

    Methods: Between 1992 and 2005 all patients with newly diagnosed RA according to criteria of the American College of Rheumatology were asked to participate in the BARFOT study, a collaboration between six Swedish rheumatology departments. In 2010 all patients (n=2114) included in the study received a follow-up questionnaire 5-18 years after disease onset. Using logistic regression analyses, the dependent variables physical function (dichotomized by their mean value) were measured with the HAQ (scores 0 to 3, best to worst), the RAOS (Rheumatoid Arthritis Outcome Score) subscales ADL and sport/rec (0-100, worst to best) and meeting vs. not meeting WHO recommendations of physical activity (WHOrec) for a healthy life style (moderate intensity ≥150 min/week or higher intensity for at least 30 minutes 2-3 times/week). Possible predictive variables at baseline were function (HAQ and SOFI, Signals of Functional Impairment, 0-44, best to worse), disease activity (CRP, swollen and tender joints), pain (VAS 0-100, best to worst) and age. We also controlled for sex and disease duration in 2010.

    Results: Questionnaire response was 72% (n=1525), mean (m) age 65 years (SD 14), m follow-up time 9 years (SD 3.7) and 70% (n=1069) were women.

    At inclusion the patients reported a disease duration of m 8 (SD 9) months, HAQ m 1.0 (SD 0.6), VAS pain m 46 (SD24), SOFI m 8.0 (SD6.0). Disease activity was CRP m 30.2 (SD 35.9), swollen joints m 10.2 (SD 5.7) and tender joints m 8.2 (SD 6.2).

    In the 2010 survey, time from inclusion was m 9.4 (SD 3.8) years, the HAQ m 0.6 (SD 0.6), and VAS pain m 35.5 (SD 25.6) had decreased (p<0.001). RAOS ADL was m 71,1 (SD 22.0), RAOS sport/rec m 40.0 (SD 30.0) and 61% (N=894) met the WHOrec.

    Worse scores in the HAQ, VAS pain and SOFI at baseline increased the risk for worse physical function in the 2010 survey measured with the HAQ (VAS pain OR 1.02, SOFI OR 1.09 and HAQ OR 3.98, p<0.000), the RAOS ADL scale (VAS pain OR 1.02, SOFI OR 1,09 and HAQ OR 2.66, p<0.000) and the RAOS sport/rec scale (VAS pain OR 1.02, SOFI OR 1.11 and HAQ OR 2.57, p<0.000). Being a woman, higher age at inclusion and longer disease duration at follow-up also predicted a worse function in the HAQ and both RAOS subscales while none of the studied variables could predict who did/did not meet the WHOrec in 2010.

    Conclusions: Worse physical function and worse pain at disease onset can predict a worse physical function several years later. However, it does not predict the amount of physical activity actually being performed. It is of importance to already at disease onset recognize patients with impaired function and higher pain levels who are in need of multidisciplinary treatments. It is also important to early in the disease recommend a healthy life style according to the WHOrec since measures of function and being physically active are different entities.

    Disclosure of Interest: None Declared

  • 19.
    Malm, Karina
    et al.
    Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden & Spenshult Research and Development Centre, Halmstad, Sweden & Rheumatology, Capio Movement, Halmstad, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden & Spenshult Research and Development Centre, Halmstad, Sweden & Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Innovation and Sustainability, The Rydberg Laboratory for Applied Sciences (RLAS). Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden & Spenshult Research and Development Centre, Halmstad, Sweden & Department of Regional Health Research, University of Southern Denmark, Odense, Denmark & Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Centre, Halmstad, Sweden.
    Andersson, Maria L. E.
    Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden & Spenshult Research and Development Centre, Halmstad, Sweden.
    Discussions of lifestyle habits as an integral part of care management: a cross-sectional cohort study in patients with established rheumatoid arthritis in Sweden2019In: Rheumatology Advances in Practice, E-ISSN 2514-1775, Vol. 3, no 2, article id rkz039Article in journal (Refereed)
    Abstract [en]

    Objectives: The primary aim was to determine whether patients with RA recalled having discussions concerning lifestyle habits during their health-care visits. The secondary aim was to study the association between patients' reported lifestyle and their wish to discuss it.

    Methods: A postal questionnaire sent to 1542 eligible patients from the Better Anti-Rheumatic Pharmacotherapy (BARFOT) study included questions on lifestyle habits (physical activity, diet, smoking and alcohol), on whether these were discussed during health-care visits and on whether there was an interest in such discussions.

    Results: A total of 1061 patients (68%) responded [mean age 67 (s.d. 13) years, 73% women]. Half of the patients (49%) recalled discussions on physical activity, and 23% recalled discussions about diet. Those who reported health-enhancing levels of physical activity were more likely to discuss physical activity with their health professionals. Likewise, patients who reported having a non-traditional mixed diet were more likely to discuss diet. Smoking was discussed with 25% of the patients, more often with current smokers than with non-smokers (32 vs 17%; P < 0.001). Alcohol was discussed with 17% of the patients. Of those patients who reported having hazardous drinking habits, 77% had not discussed alcohol use with any health professional.

    Conclusion: Discussions about lifestyle were recalled by half of the patients with established RA. There is a need for improvement, because lifestyle habits may affect the long-term outcome in a chronic disease, such as RA. Patient education concerning lifestyle habits should be an integral part of care management and an interactive process. © Malm et al. 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology.

  • 20.
    Malm, Karina
    et al.
    Spenshult Research and Development Center, Oskarström, Sweden & Rheumatology, Capio Movement, Halmstad, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Spenshult Research and Development Center, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Andersson, Maria L.E.
    Spenshult Research and Development Center, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Center, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, Gothenburg, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Center, Oskarström, Sweden.
    Quality of Life in Patient with Established Rheumatoid Arthritis: A Qualitative Study2016In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 75, no Suppl 2, article id 1308Article in journal (Refereed)
    Abstract [en]

    Background: Fatigue, pain, stiffness and impaired physical function are some of the most pronounced symptoms in rheumatoid arthritis (RA) that may affect quality of life. Quality of life is an individual experience composed of a wide range of factors, including physical health, psychological state, level of independence, social relationships, and the patients' relationship to salient features of their environment. There is a need to describe and assess quality of life in chronic diseases like established RA. Previous research has mainly focused on disease-specific instruments for assessing quality of life. A deeper understanding of patients' experience of quality of life in established RA is important in both clinical research and daily clinical practice.

    Objectives: To describe variations in patients' experiences of quality of life in established RA.

    Methods: The study had a qualitative design with a phenomenographic approach, including 22 interviews with patients from the Swedish BARFOT (Better Anti-Rheumatic FarmacoTherapy) cohort, BARFOT, a long time follow up study of early RA. Patients were strategically selected by gender (14 women and 8 men), age (30 to 84 years old), disease duration (8–23 years), function as measured by HAQ (0–1.38), and quality of life as measured by EQ5D (0.52–1.00). The interviews were recorded, transcribed verbatim and coded into categories.

    Results: Four categories emerged from the patients' experiences of quality of life in established RA: well-being, freedom, empowerment, and participation. Quality of life as well-being meant pleasure and being physical active. Quality of life as freedom meant dependence or independence in the ability to manage daily life activities. Quality of life as empowerment meant different coping strategies, such as positive thinking and resources to manage fatigue, pain and physical function. Quality of life as participation meant togetherness in different contexts with other people.

    Conclusions: Quality of life in established RA could be understood by the patients in different ways. The patients experienced quality of life as well-being, freedom, empowerment, and participation. This is important knowledge when evaluating the concept of quality of life in RA research, and for health professionals when promoting quality of life in patients with RA.

  • 21.
    Qvarfordt, Maria
    et al.
    Halmstad University, School of Health and Welfare.
    Andersson, Maria L.E.
    Department of Clinical Sciences, Department of Rheumatology, Lund University, Lund, Sweden; FoU Spenshult, Halmstad, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Patients’ experiences of reasons to being physically active in early rheumatoid arthritis – a mixed methods study2019In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, no Suppl 2, p. 1454-1455Article in journal (Refereed)
    Abstract [en]

    Background: The importance of physical activity in rheumatoid arthritis (RA) is well known and patients are informed about the importance of being physically active. Despite this knowledge there is a lack of compliance to this advice. Studies comparing physical activity in different groups of patients with RA and reasons influencing physical activity are needed.

    Objectives: The objectives were to compare physical activity (PA) in workers, retired and patients with sick-leave with early RA and further to explore reasons to being physically active in these patients.

    Methods: A total of 66 patients with early RA were included in the study. A sequential explanatory mixed methods design was used. The groups were compared with clinical data as: disease activity (DAS28); pain (VAS 0-100, best to worst); health-related quality of life (EQ5D, -0.594-1 worse to best) and a physical function (HAQ, 0-3 best to worst). ESR and CRP. Patients were dichotomized as being active on recommended levels of PA (MVPArec; physically active on a moderate level ≥150min/week (MPA) or on an intense level ≥75min/week (VPA)) or not (sedentary). The patients were grouped on self-reported working ability; workers, patients with sick-leave and retired patients.

    Qualitative data was collected by a questionnaire with open-ended questions about reasons influencing PA. The qualitative data was analysed with a manifest qualitative content analysis to gain a greater understanding of patients’ experiences of PA in early RA.

    Results: There were no significant differences between the groups in disease activity, physical function, swollen joints, health-related quality of life or inflammatory parameters (ESR, CRP). Patients on sick-leave had more tender joints median (min-max) 9 (2-18) vs. 4 (0-20) and 3 (0-10), p=0.013. Workers reported higher intensity of pain, though not significant. Retired patients fulfilled MVPA criteria to a higher rate (86%) than workers (42%) or patients with sick-leave (40%), p=0.010.

    The qualitative content analysis resulted in three categories. Reasons to being physically active in patients with early RA were; limitations (pain, physical function, stiffness, limited strength and fatigue), awareness as motivation (fear of movement and health benefits) and external environment (weather, transports to activity, economy and time, especially for workers).

    Conclusion: Knowledge of reasons to being physically active in patients with RA is important to facilitate and support the patients. Joint pain seems to be an issue for patients with sick-leave. This could be associated to fear of movement and in this aspect these patients need to be supported. Time could be a limiting issue for working patients, which need to be highlighted and solved for these patients. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

  • 22.
    Sunesson, Evelina
    et al.
    Spenshult Research and Development Centre, Halmstad, Sweden.
    Sylwander, Charlotte
    Halmstad University, School of Health and Welfare. Spenshult Research and Development Centre, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability. Spenshult Research and Development Centre, Halmstad, Sweden; Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden.
    Andersson, Maria L.E.
    Spenshult Research and Development Centre, Halmstad, Sweden; Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare. Spenshult Research and Development Centre, Halmstad, Sweden; Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden.
    Experiences of How Health and Lifestyle among Individuals with Knee Pain Have Been Influenced during the COVID-19 Pandemic, a HALLOA Study2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 14, article id 8255Article in journal (Refereed)
    Abstract [en]

    The COVID-19 pandemic has affected the health and lifestyles of both the general population and of vulnerable groups. Individuals with knee pain are recommended to lead an active lifestyle to relieve pain but find it difficult to maintain health and lifestyle compared to the general population due to the cause of chronic pain, impaired physical function, and a diminished quality of life. This study aimed to explore experiences of how health and lifestyle among individuals with knee pain have been influenced during the COVID-19 pandemic. Interviews (n = 19) were conducted in 2021 and analysed with qualitative content analysis. The results showed how individuals with knee pain adjusted their behaviour and revalued their life to maintain health and lifestyle during COVID-19. Adjusted behaviours emerged, such as spending more time at home, becoming digital, and spending more time outdoors, while revaluing life emerged as having a positive outlook on life and sharing responsibility. In conclusion, behaviour was adjusted, and life revalued to manage health and lifestyle during the pandemic. However, the findings are probably similar to the general population, i.e., individuals with knee pain live similar lives as the general population despite knee pain. The results may contribute to alternative ways of maintaining health and lifestyle in various vulnerable groups and may be applied in situations other than the pandemic. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

  • 23.
    Sunesson, Evelina
    et al.
    Spenshult Research and Development Centre, Halmstad, Sweden.
    Sylwander, Charlotte
    Halmstad University, School of Health and Welfare. Spenshult Research and Development Centre, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability. Spenshult Research and Development Centre, Halmstad, Sweden; Lund University, Lund, Sweden.
    Andersson, Maria L.E.
    Spenshult Research and Development Centre, Halmstad, Sweden; Lund University, Lund, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare. Spenshult Research and Development Centre, Halmstad, Sweden; Lund University, Lund, Sweden.
    Experiences of how health and lifestyle among individuals with knee pain have been influenced during the Covid-19 pandemic, a halloa study2022In: / [ed] Tomas Bremell, Stockholm: Svensk reumatologisk förening , 2022, Vol. 154, no 4, p. 64-65Conference paper (Other academic)
    Abstract [en]

    Background: The covid-19 pandemic has affected health and lifestyle among the general population and vulnerable groups. Individuals with knee pain are recommended an active lifestyle to reveal pain but find it difficult to maintain health and lifestyle compared to the general population due to the cause of chronic pain, impaired physical function, and a diminished quality of life. This adds to the importance of exploring how to preserve health and lifestyle among individuals with knee pain during the pandemic. 

    Objective: The aim of this study was to explore experiences of how health and lifestyle among individuals with knee pain have been influenced during the covid-19 pandemic.

    Method: Nineteen participants with current knee pain, with no earlier diagnosed radiographic osteoarthritis, and no rheumatologic disorder or cruciate ligament injury, were recruited from The Halland Osteoarthritis (HALLOA) Cohort Study, twelve females and seven males, between 41-62 (median 51) years of age. Data were collected through individual interviews with open-ended questions: “What impact have you experienced with your health and lifestyle during the covid-19 pandemic?”, and “What activities or strategies have you changed to maintain your health and lifestyle during the covid-19 pandemic? ”. Qualitative content analysis was used, where two categories and five sub-categories emerged (Table 1). 

    Result: The result from this study explored how individuals with knee pain adjusted their behaviour and revalued their life to maintain health and lifestyle during the pandemic. The category adjusted behaviours emerged with the sub-categories: spending more time at home, becoming digitally and spending more time outdoors. These sub-categories determine how a more reclusive behaviour has appeared due to the pandemic, where digital platforms and outdoor activities have facilitated companionship and togetherness when feelings of loneliness and isolation were present. The category revaluing life emerged with the sub-categories: having a positive outlook on life and sharing responsibility. These sub-categories establish the importance of being grateful for maintaining health and lifestyle and being solution-oriented to find the best possible outcomes to continue with everyday life, despite the pandemic. While having a responsibility toward others arose as a facility to manage to keep social distance during the pandemic. 

    Conclusion: In conclusion, individuals with knee pain managed their health and lifestyle during the pandemic by adjusting behaviors and revaluing life. Adapting to restrictions included spending more time at home and outdoors, becoming more digitally, and revaluing life by having a positive outlook on life and supporting others. The result may contribute to alternative ways of preserving health and lifestyle in different vulnerable groups and may be used in situations other than the pandemic.

  • 24.
    Sunesson, Evelina
    et al.
    Spenshult Research and Development Centre, FoU Spenshult, Halmstad, Sweden.
    Sylwander, Charlotte
    Halmstad University, School of Health and Welfare. Spenshult Research and Development Centre, FoU Spenshult, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability. Spenshult Research and Development Centre, FoU Spenshult, Halmstad, Sweden; Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden.
    Andersson, Maria L.E.
    Spenshult Research and Development Centre, FoU Spenshult, Halmstad, Sweden; Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden; Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare. Spenshult Research and Development Centre, FoU Spenshult, Halmstad, Sweden; Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden; Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden.
    The Impact of the Covid-19 pandemic on Health and Lifestyle in Individuals with Knee Pain: a HALLOA study2022Conference paper (Refereed)
    Abstract [en]

    Background: Covid-19 has affected everyday life, health and lifestyle among the general population and vulnerable groups. Individuals with knee pain are recommended an active lifestyle to reveal pain but find it difficult to maintain health and lifestyle compared to the general population due to the cause of chronic pain, impaired physical function and a diminishes quality of life. This adds to the importance of exploring how to preserve health and lifestyle among individuals with knee pain during the pandemic.

    Objectives: The aim of this study was to explore the impact of the covid-19 pandemic on the health and lifestyle in individuals with knee pain.

    Methods: Nineteen participants with current knee pain, and with no earlier diagnosed radiographic osteoarthritis, and no rheumatologic disorder or cruciate ligament injury, were recruited from The Halland Osteoarthritis (HALLOA) Cohort Study, twelve female and seven males, between 41-62 (median 51) years of age. Data were collected through individual interviews with open-ended questions: “What impact have you experienced with your health and lifestyle during covid-19?”, and “What activities or strategies have you changed to maintain your health and lifestyle during covid-19? ”. Qualitative content analysis was used, where two categories and five sub-categories emerged ( Table 1 ).

    Results: The result from this study explored how behaviour and attitude towards valuing life have been adjusted to maintain health and lifestyle among individuals with knee pain during covid-19. The category adjusted behaviours emerged with the sub-categories: spending more time at home, becoming digitally, and spending more time outdoors. These sub-categories determine how a more reclusive behaviour have appeared due to the pandemic, where digital platforms and outdoor activities have facilitated companionship and togetherness when feelings of loneliness and isolation were present. The category valuing life emerged with the sub-categories: having a positive outlook of life and sharing responsibility. These sub-categories establish the importance of trying to be grateful for maintaining health and lifestyle and trying to be solution-oriented to find the best possible outcomes to continue with everyday life, despite the pandemic. While having a responsibility towards others arose as a facility to manage to keep social distance during the pandemic.

    Conclusion: In conclusion, the behaviour was adjusted to continue with everyday life and maintain health and lifestyle among individuals with knee pain during covid-19. Valuing life was also considered important to maintain health and lifestyle as well as supporting others maintain their health and lifestyle. The result may in the future contribute to alternative ways of maintaining health and lifestyle in different vulnerable groups and may be used in situations other than the pandemic.

  • 25.
    Sylwander, Charlotte
    et al.
    Halmstad University, School of Health and Welfare. Spenshult Research and Development Centre, Halmstad, Sweden.
    Andersson, Maria L.E.
    Spenshult Research and Development Centre, Halmstad, Sweden; Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability. Spenshult Research and Development Centre, Halmstad, Sweden; Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden.
    Evelina, Sunesson
    Spenshult Research and Development Centre, Halmstad, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare. Spenshult Research and Development Centre, Halmstad, Sweden; Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden.
    Health Promotion in Individuals with Knee Pain – Different Ways to Enable and Maintain a Balance in Everyday Life Based on the Abilities2022Conference paper (Other academic)
    Abstract [en]

    Background: Most individuals with knee pain develop radiographic knee osteoarthritis over time [1], and up to 30% develop chronic widespread pain (CWP) [2]. Many studies only focus on physical activity or weight loss when it comes to managing knee osteoarthritis (KOA) and chronic pain. There is a challenge to get more individuals to follow the existing recommendations for KOA, including physical activity and weight loss [3]. However, the interaction between the various physical, mental, and social factors regarding health promotion is complex. More research is needed to understand health-promoting activities applied amongst individuals with knee pain.

    Objectives: To explore health-promoting activities in individuals with knee pain.

    Methods: The study was a part of the Halland Osteoarthritis cohort (ClinicalTrials.gov NCT04928170), including 306 individuals with knee pain without earlier diagnosed KOA, cruciate ligament injury or other rheumatological disorder. A purposeful sample of 22 individuals (13 women, 9 men; median age 52 years) participated in the study. Ten had radiographic KOA, 12 had chronic regional pain, 9 reported CWP, 16 were overweight, and 13 met the WHO recommendations for physical activity with moderate intensity. Semi-structured interviews were conducted and followed a pilot-tested interview guide initiated with open-ended questions such as “What do you do to maintain your health?” and “What enables you to keep health?”. The interviewers followed the participants reasoning, and to obtain depth in the data, the participant received follow-up questions such as “Please, can you tell me more about…?”. The interviews were audio-recorded and transcribed verbatim. Data analysis was performed by latent qualitative content analysis and revealed an overall theme including two categories and six sub-categories.

    Results: Health-promoting activities in individuals with knee pain were interpreted in the overall theme; enabling and maintaining a balance in everyday life based on abilities. Two categories explored the content in health-promoting activities as 1) Using facilitators to take care of the body with the sub-categories: being physically active, having a healthy diet, and using external resources. For example, the participants took care of the body by being physically active to decrease pain, reducing sugar intake and using external resources such as online workouts or help from health care. 2) Managing stressors of everyday life with the sub-categories: promoting vitality, allowing for recovery, and safeguarding healthy relationships. The participants managed stressors of life by, for example, being in nature, planning their work- and private life and spending time with friends and family. See Table 1 

    Conclusion: Individuals with knee pain described various health-promoting activities, ranging from physical activity to social interactions, included in the theme of enabling and maintaining a balance in everyday life based on abilities. We suggest that a broader approach to everyday life can be helpful in treatment plans and health promotion to manage and prevent KOA and chronic pain while maintaining a healthy lifestyle.

    REFERENCES:

    [1] Thorstensson et al. Natural course of knee osteoarthritis in middle-aged subjects with knee pain… . ARD, 2009;68:1890-1893.

    [2] Bergman et al. Chronic widespread pain and its associations with quality of life and function at a 20-year follow-up… . BMC Musculoskel, 2019;20:592

    [3] Fernandes et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis . ARD, 2013;72:1128

  • 26.
    Sylwander, Charlotte
    et al.
    Halmstad University, School of Health and Welfare. Spenshult Research and Development Centre, Halmstad, Sweden.
    Andersson, Maria L.E.
    Spenshult Research and Development Centre, Halmstad, Sweden; Lund University, Lund, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability. Spenshult Research and Development Centre, Halmstad, Sweden; Lund University, Lund, Sweden.
    Sunesson, Evelina
    Spenshult Research and Development Centre, Halmstad, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare. Halmstad University, School of Business, Innovation and Sustainability. Spenshult Research and Development Centre, Halmstad, Sweden.
    Health promotion in individuals with knee pain – different ways to enable and maintain a balance in everyday life based on the abilities2022In: / [ed] Tomas Bremell, Stockholm: Svensk reumatologisk förening , 2022, Vol. 154, no 4, p. 60-60Conference paper (Refereed)
    Abstract [en]

    Background: Most individuals with knee pain develop radiographic knee osteoarthritis over time [1], and up to 30% develop chronic widespread pain (CWP) [2]. Many studies only focus on physical activity or weight loss when it comes to managing knee osteoarthritis (KOA) and chronic pain. There is a challenge to get more individuals to follow the existing recommendations for KOA, including physical activity and weight loss [3]. However, the interaction between the various physical, mental, and social factors regarding health promotion is complex. More research is needed to understand health-promoting activities applied amongst individuals with knee pain.

    Objectives: To explore health-promoting activities in individuals with knee pain.

    Methods: The study was a part of the Halland Osteoarthritis cohort (ClinicalTrials.gov NCT04928170), including 306 individuals with knee pain without earlier diagnosed KOA, cruciate ligament injury or other rheumatological disorder. A purposeful sample of 22 individuals (13 women, 9 men; median age 52 years) participated in the study. Ten had radiographic KOA, 12 had chronic regional pain, 9 reported CWP, 16 were overweight, and 13 met the WHO recommendations for physical activity with moderate intensity. Semi-structured interviews were conducted and followed a pilot-tested interview guide initiated with open-ended questions such as “What do you do to maintain your health?” and “What enables you to keep health?”. The interviewers followed the participants reasoning, and to obtain depth in the data, the participant received follow-up questions such as “Please, can you tell me more about…?”. The interviews were audio-recorded and transcribed verbatim. Data analysis was performed by latent qualitative content analysis and revealed an overall theme including two categories and six sub-categories.

    Results: Health-promoting activities in individuals with knee pain were interpreted in the overall theme; enabling and maintaining a balance in everyday life based on abilities. Two categories explored the content in health-promoting activities as 1) Using facilitators to take care of the body with the sub-categories: being physically active, having a healthy diet, and using external resources. For example, the participants took care of the body by being physically active to decrease pain, reducing sugar intake and using external resources such as online workouts or help from health care. 2) Managing stressors of everyday life with the sub-categories: promoting vitality, allowing for recovery, and safeguarding healthy relationships. The participants managed stressors of life by, for example, being in nature, planning their work- and private life and spending time with friends and family. See Table 1.

    Conclusion: Individuals with knee pain described various health-promoting activities, ranging from physical activity to social interactions, included in the theme of enabling and maintaining a balance in everyday life based on abilities. We suggest that a broader approach to everyday life can be helpful in treatment plans and health promotion to manage and prevent KOA and chronic pain while maintaining a healthy lifestyle.

  • 27.
    Sylwander, Charlotte
    et al.
    Halmstad University, School of Health and Welfare. Spenshult Research and Development Centre, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability. Spenshult Research and Development Centre, Halmstad, Sweden; Lund University, Lund, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare. Spenshult Research and Development Centre, Halmstad, Sweden; Lund University, Lund, Sweden.
    Andersson, Maria L.E.
    Halmstad University, School of Business, Innovation and Sustainability. Spenshult Research and Development Centre, Halmstad, Sweden; Lund University, Lund, Sweden.
    The impact of health status and lifestyle habits on chronic pain in individuals with knee pain – a 2-year follow-up studyManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Knee pain increases the risk of developing knee osteoarthritis (KOA) and chronic widespread pain (CWP). The prevalence of KOA and CWP has increased, and there is a need for early prevention. Thus, the aim was to examine whether or not health status and lifestyle habits have an impact on reporting chronic pain at a two-year follow-up in individuals with knee pain.

    Method: A two-year longitudinal cohort study including 251 individuals aged 30-60 years reporting knee pain at baseline. Health status was measured via SF-36, and lifestyle habits were overweight, physical activity, diet, alcohol, and tobacco use. Pain was assessed with a pain mannequin. Differences in health status and lifestyle habits over time were analysed with the Kruskal Wallis test with pairwise comparisons. Multinominal regression analysis was performed to study associations with reporting chronic pain at follow-up.

    Results: The prevalence of overweight/obesity was overall high but highest in those reporting CWP. Many met the physical activity recommendations but reported an unhealthy diet. No significant changes in health status or lifestyle habits were reported after two years, and most remained at the same pain status as in baseline. Reporting worse health status and overweight/obesity at baseline were associated with reporting CWP after two years.

    Conclusion: The combination of knee pain, overweight/obesity or lower health status should be given greater attention in healthcare to prevent the development of chronic pain and CWP. Future studies should investigate the associations further.

  • 28.
    Sylwander, Charlotte
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Centre, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Centre, Halmstad, Sweden & Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Centre, Halmstad, Sweden & Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden.
    Bergman, Stefan
    Spenshult Research and Development Centre, Halmstad, Sweden & Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden & The Sahlgrenska Academy, University of Gothenburg, Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, Gothenburg, Sweden.
    Andersson, Maria L.E.
    Spenshult Research and Development Centre, Halmstad, Sweden & Lund University, Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden.
    Pressure pain thresholds and the associations with chronic widespread pain, knee osteoarthritis and obesity in individuals with knee pain2020Conference paper (Refereed)
  • 29.
    Sylwander, Charlotte
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Centre, Halmstad, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing. Spenshult Research and Development Centre, Halmstad, Sweden.
    Andersson, Maria L.E.
    Spenshult Research and Development Centre, Halmstad, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Bergman, Stefan
    Spenshult Research and Development Centre, Halmstad, Sweden & Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    The impact of chronic widespread pain on health status and long-term health predictors: a general population cohort study2020In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 21, no 1, article id 36Article in journal (Refereed)
    Abstract [en]

    Background: Chronic widespread pain (CWP) has a negative impact on health status, but results have varied regarding gender-related differences and reported health status. The aim was to study the impact of CWP on health status in women and men aged 35-54 years in a sample of the general population. The aim was further to investigate lifestyle-related predictors of better health status in those with CWP in a 12- and 21-year perspective.

    Method: A general population cohort study including 975 participants aged 35‒54 years, with a 12- and 21-year follow-up. CWP was measured with a pain mannequin, and the questionnaire included questions on lifestyles factors with SF-36 for measurement of health status. Differences in health status were analysed with independent samples t-test and health predictors with logistic regression analysis.

    Results: The prevalence of CWP was higher in women at all time points, but health status was reduced in both women and men with CWP (p < 0.001) with no gender differences of clinical relevance. At the 12-year follow-up, a higher proportion of women than men had developed CWP (OR 2.04; CI 1.27‒3.26), and at the 21-year follow-up, a higher proportion of men had recovered from CWP (OR 3.79; CI 1.00‒14.33). In those reporting CWP at baseline, a better SF-36 health status (Physical Functioning, Vitality or Mental Health) at the 12-year follow-up was predicted by male gender, having personal support, being a former smoker, and having no sleeping problems. In the 21-year follow-up, predictors of better health were male gender, a weekly intake of alcohol, and having no sleeping problems.

    Conclusion: Women and men with CWP have the same worsening of health status, but men recover from CWP to a greater extent in the long-term. Being male, having social support, being a former smoker, and having no sleeping problems were associated with better health status in those with CWP. © 2020 The Author(s).

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  • 30.
    Sylwander, Charlotte
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Centre, Halmstad, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Centre, Halmstad, Sweden; Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Centre, Halmstad, Sweden; Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden .
    Bergman, Stefan
    Spenshult Research and Development Centre, Halmstad, Sweden; Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Andersson, Maria L.E.
    Halmstad University, School of Business, Innovation and Sustainability. Spenshult Research and Development Centre, Halmstad, Sweden; Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden .
    Pressure pain thresholds in individuals with knee pain: a cross-sectional study2021In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 22, article id 516Article in journal (Refereed)
    Abstract [en]

    Background: Knee osteoarthritis (KOA), chronic widespread pain (CWP) and overweight/obesity are public health problems that often coincide, and there is a multifactorial and unclear relationship between them. The study aimed to (1) investigate pain sensitivity, assessed by pressure pain thresholds (PPTs), among women and men with knee pain and (2) associations with, respectively, radiographic KOA (rKOA), CWP, and overweight/obesity.

    Methods: Baseline data from an ongoing longitudinal study involving 280 individuals with knee pain in the 30–60 age group. Pain sensitivity was assessed by PPTs on eight different tender points using a pressure algometer. The participants' knees were x-rayed. Self-reported CWP and number of pain sites were assessed with a pain figure, and overweight/obesity was measured using body mass index (BMI), visceral fat area (VFA), and body fat percentage, assessed with a bioimpedance. Associations were analysed using regression analyses.

    Results: Women reported lower PPTs than men (p < 0.001), but no PPTs differences were found between those with and without rKOA. Low PPTs was associated with female sex, more pain sites, CWP, and a higher VFA and body fat percentage. The tender points second rib and the knees were most affected. The prevalence of CWP was 38 %.

    Conclusions: The modifiable factors, increased VFA, and body fat could be associated with increased pain sensitivity among individuals with knee pain. Longitudinal studies are needed to further investigate the associations. © 2021, The Author(s).

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  • 31.
    Sylwander, Charlotte
    et al.
    Halmstad University, School of Health and Welfare.
    Sunesson, Evelina
    Spenshult Research and Development Centre, Halmstad, Sweden.
    Andersson, Maria L.E.
    Spenshult Research and Development Centre, Halmstad, Sweden; Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability. Spenshult Research and Development Centre, Halmstad, Sweden; Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare. Spenshult Research and Development Centre, Halmstad, Sweden; Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden.
    Experiences of Health-Promoting Activities among Individuals with Knee Pain: The Halland Osteoarthritis Cohort2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 17, article id 10529Article in journal (Refereed)
    Abstract [en]

    Knee pain is an early sign of knee osteoarthritis (KOA) and a risk factor for chronic widespread pain (CWP). Early prevention is vital, and more research is needed to understand health-promoting activities for individuals with knee pain from a patient perspective. This study aimed to explore how individuals with knee pain experienced health-promoting activities. Explorative qualitative design with inductive approach was applied to explore the experiences of 22 individuals (13 women, 9 men; median age: 52). Semi-structured interviews were conducted and analysed using latent qualitative content analysis. The results revealed health-promoting activities in individuals with knee pain and were interpreted in the overall theme, striving for balance in everyday life. Two categories explored the content in health-promoting activities: (1) Caring for the body—being physically active, having a healthy diet, and utilising support; and (2) Managing life stressors—allowing for recovery, promoting vitality, and safeguarding healthy relationships. In conclusion, individuals with knee pain described various health-promoting activities. They strived for balance in everyday life by caring for the body and managing life stressors. We suggest that a broader approach to everyday life can be helpful in treatment plans and health promotion to manage and prevent KOA and CWP, while striving for a healthy lifestyle.

  • 32.
    Sylwander, Charlotte
    et al.
    Halmstad University, School of Health and Welfare. Spenshult Research and Development Centre, Halmstad, Sweden.
    Wahl, Astrid Klopstad
    University of Oslo, Oslo, Norway.
    Andersson, Maria L.E.
    Halmstad University, School of Business, Innovation and Sustainability. Spenshult Research and Development Centre, Halmstad, Sweden, Lund University, Lund, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability. Spenshult Research and Development Centre, Halmstad, Sweden, Lund University, Lund, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare. Spenshult Research and Development Centre, Halmstad, Sweden, Lund University, Lund, Sweden.
    Health literacy in individuals with knee pain-a mixed methods study2023In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, p. 1-16, article id 1656Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Low health literacy is associated with worse pain and poorer self-management. This study (1) examined the level of health literacy and associations with lifestyle habits, health status, chronic pain, and radiographic knee osteoarthritis; and (2) explored experiences illuminating health literacy among individuals with knee pain.

    METHODS: A convergent parallel mixed-methods design was used, including 221 individuals. Health literacy was assessed by HLS-EU-Q16 and eHEALS. The questionnaire included questions on lifestyle habits, health status, and pain distribution. Radiographic knee osteoarthritis was assessed with x-rays. Associations were analysed using logistic regression analyses. Individual semi-structured interviews were conducted (n = 19) and analysed with qualitative content analysis.

    RESULTS: The result showed that 71% reported sufficient health literacy. Higher education, healthy lifestyle habits, better general health, and absence of widespread pain were associated with sufficient health literacy. Experiences regarding health literacy influencing the decision-making process toward a decision on action comprised: (1) searching for information actively or passively; (2) processing of the information included being informed, critical, and interpretive; and (3) taking a stand on the information based on trustfulness and motivation.

    CONCLUSION: Seven out of 10 reported sufficient health literacy. Despite this, unhealthy lifestyles were common, suggesting that having sufficient HL is not enough for a behavioural change and the decision-making process, including different phases such as searching, processing, and taking a stand on health information is important to consider. More research on health literacy is needed to gain knowledge of how best to develop health promotion in individuals with knee pain. © 2023, BioMed Central Ltd., part of Springer Nature.

  • 33.
    Söderlin, Maria
    et al.
    R&D Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Bergman, Stefan
    R&D Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Andersson, Maria L.E.
    R&D Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    The Effect of Socioeconomic Class and Immigrant Status on Disease Activity in Rheumatoid Arthritis. Data from BARFOT, A Multicenter Study of Early RA2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, no Suppl. 3, p. A395-A395Article in journal (Refereed)
    Abstract [en]

    Background: There are no studies reporting the effect of immigrant status and socioeconomic status on outcome in rheumatoid arthritis (RA) in Sweden.

    Objectives: We wanted to study the effect of immigration and socioeconomic class on outcome in RA in Sweden.

    Methods: Between 1992 and 2005, 2,800 adult patients were included in the BARFOT early RA study in Sweden. Disease Activity Score 28 joints (DAS28), Health Assessment Questionnaire (HAQ), drug treatment and European League Against Rheumatism (EULAR) response criteria were applied up to 8 years. The patients completed in 2010 a questionnaire enquiring about demographics and lifestyle factors

    Results: A total of 139/1430 (9.5%) of the patients were immigrants. Immigrants had higher baseline mean HAQ (immigrants 1.2 vs. non-immigrants 0.97, p=0.001), DAS28 (5.6 vs. 5.2, p=0.0001), visual analog scale (VAS) pain (56 mm vs. 45 mm, p=0.0001), VAS global health (53 mm vs. 44 mm, p=0.0001) and tender joint count (TJC) (10 vs. 8, p=0.0001), these differences persisting up to 2 years of follow-up and for HAQ up to 8 years of follow-up. Immigrant status did not have effect on swollen joint count (SJC), ESR, CRP or EULAR response. Socioeconomic class did not have impact on treatment or outcome.

    Conclusions: Immigrants scored worse in pain, function and TJC up to 2 years of follow-up, but did not differ in objective measures of inflammation or EULAR outcome as compared to non-immigrants. This could be due to different perceptions of health and pain and/or the stress of immigration. Socioeconomic class did not have impact on treatment or outcome and this could be due to the relatively egalitarian society in Sweden.

    Disclosure of Interest: M. Söderlin Consultant for: Pfizer, Speakers bureau: Abbott, MSD, BMS, Pfizer, S. Bergman: None Declared, M. Andersson: None Declared

  • 34.
    Söderlin, Maria K.
    et al.
    Research and Development Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Andersson, Maria L.E.
    Research and Development Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Bergman, Stefan
    Research and Development Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Second-hand exposure to tobacco smoke and its effect on disease activity in Swedish rheumatoid arthritis patients. Data from BARFOT, a multicenter study of RA2013In: Clinical and Experimental Rheumatology, ISSN 0392-856X, E-ISSN 1593-098X, Vol. 31, no 1, p. 122-124Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We studied the prevalence and effect on disease activity of ever having had second-hand exposure to tobacco smoke in Swedish rheumatoid arthritis (RA) patients who had never smoked.

    METHODS: Between 1992 and 2005, 2,800 patients were included in the BARFOT early-RA study in Sweden. Disease Activity Score 28 joints (DAS28), C-reactive protein (CRP), Health Assessment Questionnaire (HAQ), rheumatoid factor (RF), general health and pain visual analogue scales (VAS), and drug treatment were registered at inclusion and at follow-up at 3, 6, and 12 months and 2 and 5 years. EULAR response criteria were applied at the same follow-up points. In 2010, a self-completion postal questionnaire was sent to 2,102 patients in the BARFOT study enquiring about lifestyle habits such as whether they had ever been exposed to tobacco smoke as a result of someone else smoking.

    RESULTS: A total of 963/1,421 patients (68%) had had second-hand exposure to tobacco smoke. At 3, 6, and 12 months, at 2 years, and at 5 years of follow-up, there were no differences in EULAR response between patients who had never smoked and who had been exposed or had not been exposed second-hand to tobacco smoke (p=0.91, p=0.88, p=0.84, p=0.61 and p=0.85, respectively).

    CONCLUSIONS: We did not find any association between second-hand exposure to tobacco smoke and disease activity in RA. © Clinical and Experimental Rheumatology 2013.

  • 35.
    Törnblom, M.
    et al.
    Helsingborg Hospital, Department of Rehabilitation, Helsingborg, Sweden; Spenshult, Research and Development Centre, Halmstad, Sweden.
    Bremander, Ann
    Spenshult, Research and Development Centre, Halmstad, Sweden; University of Southern Denmark, Odense, Denmark; Lund University, Lund, Sweden; University Hospital of Southern Denmark, Sønderborg, Denmark.
    Aili, Katarina
    Halmstad University, School of Health and Welfare. Spenshult, Research and Development Centre, Halmstad, Sweden; Karolinska Institutet, Stockholm, Sweden.
    Andersson, Maria L.E.
    Spenshult, Research and Development Centre, Halmstad, Sweden; Lund University, Lund, Sweden.
    Nilsdotter, Anna
    Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden; Sahlgrenska University Hospital, Göteborg, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability. Spenshult, Research and Development Centre, Halmstad, Sweden; Lund University, Lund, Sweden.
    Prevalence of Early Symptomatic Knee Osteoarthritis According to Three Clinical Classification Criteria2021In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 80, p. 1330-1330Article in journal (Refereed)
  • 36.
    Törnblom, Margareta
    et al.
    Helsingborg Hospital, Department of Occupational Therapy and Physiotherapy, Helsingborg, Sweden & RandD Spenshult, Halmstad, Sweden.
    Andersson, Maria L.E.
    RandD Spenshult, Halmstad, Sweden; Lund University, Department of Clinical Sciences, Department of Rheumatology, Lund, Sweden.
    Trulsson Schouenborg, Anna
    Skåne University Hospital, Department of Pain Rehabilitation, Lund, Sweden & Lund University, Department of Health Sciences, Physiotherapy, Lund, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability, The Rydberg Laboratory for Applied Sciences (RLAS). RandD Spenshult, Halmstad, Sweden.
    Validation of the Test for Substitution Patterns - in individuals with symptomatic knee osteoarthritis2019In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, no Suppl 2, p. 0712-0712Article in journal (Refereed)
    Abstract [en]

    Background: Few tools evaluates quality of movements in individuals with knee osteoarthritis (OA). The Test for Substitution Patterns (TSP) is developed to measure the ability to perform five functional movements regarding postural control and altered movement patterns (1). TSP is validated and reliable in individuals with anterior cruciate ligament injury, but has not yet been evaluated in individuals with knee OA.

    Objectives: To study the relationships between the OA modified TSP (OA-TSP) and self-reported knee function as measured with the Knee Injury and osteoarthritis Outcome Score (KOOS) and the 30-s chair stand test (30-s CST) in individuals with symptomatic knee OA. A second aim was to study the discriminative ability of the OA-TSP for unilateral knee pain.

    Methods: Sixty-two individuals with symptomatic knee osteoarthritis were included using consecutive sampling. Health status was assessed with the EuroQol five dimension scale (EQ5D, 0-1 worst-best), and knee function in five subscales for KOOS (pain, symptoms, ADL, quality of life and sport/recreation, 0-100 worst-best). The 30-s CST-test measured the number of rises in 30 seconds. In the OA-TSP, substitution patterns are observed and scored from 0-3 (no substitution pattern-poorly performed) during five standardized functional movements. The maximum score is 54 points/side with score of 108 points. Median and min-max were used for all descriptive data. Spearman´s correlation and Wilcoxon signed rank test were used for analyzes. A correlation coefficient rs ≥±0.50 is considered large, ±0.30 to < 0.50 moderate and ±0.10 < 0.30 small.

    Results: The median age was 54 years (30-61), 76% were women. The median Body Mass Index was 25 (18-48) and EQ5D 0.8 (0.29-1.00). There were no significant differences between the gender regarding BMI and EQ5D. Median OA-TSP total score was 29 (10-70). Median KOOS pain was 75 (36-100), symptoms 71 (21-96), ADL 87 (30-100), and sport/rec 50 (0-100). In the 30-s CST the median was 16 raises (5-32). Moderate, significant correlations were observed between TSP total score and KOOS pain and KOOS ADL (rs=-0.30; p=0.03, rs=-0.35; p=0.01 respectively) and small correlations between TSP and KOOS sport/recreation and KOOS symptoms (rs=-0.13; p=0.36, rs=-0.22; p=0.11 respectively). There was a moderate, significant correlation between TSP total score and 30-s CST (rs=-0.34; p<0.01). Discriminative ability for the TSP for unilateral knee pain was found to be significant worse in the painful side, with median 18 (2-36) vs. 14 (7-37) in the not painful side, p=0.001.

    Conclusion: The OA-TSP could be used as a functional test to detect altered knee alignment interpreted as an early sign of knee OA and assist the physiotherapist in functional testing during the rehabilitation of individuals with symptomatic knee OA.

  • 37.
    Törnblom, Margareta
    et al.
    Halmstad University, School of Business, Innovation and Sustainability.
    Bremander, Ann
    Halmstad University, School of Business, Innovation and Sustainability. FoU-Spenshult.
    Aili, Katarina
    Halmstad University, School of Health and Welfare.
    Andersson, Maria L E
    Halmstad University, School of Business, Innovation and Sustainability. FoU-Spenshult.
    Nilsdotter, Anna
    Halmstad University, School of Business, Innovation and Sustainability. Region Västra Götaland, Sahlgrenska.
    Haglund, Emma
    Halmstad University, School of Business, Innovation and Sustainability.
    Development of radiographic knee osteoarthritis and the associations to radiographic changes and baseline variables in individuals with knee pain: a 2-year longitudinal study2024In: BMJ Open, E-ISSN 2044-6055, Vol. 14, no 3, p. e081999-e081999Article in journal (Refereed)
    Abstract [en]

     Objectives:  The aim was to study the development of radiographic knee osteoarthritis (RKOA) in individuals with knee pain over 2 years, and the associations between radiographic changes and baseline variables.

     Design:  Longitudinal cohort study.

     Participants and setting:  This study is part of the Halland Osteoarthritis cohort. The included 178 individuals, aged 30-67, had knee pain, without cruciate ligament injury or radiographic findings and 67% were women. The presence of RKOA was defined as Ahlbäck score of ≥1 in ≥1 knee. (Ahlbäck grade 1: joint space narrowing in the tibiofemoral joint <3 mm). Diagnosis of clinical KOA was based on the clinical guideline from the National Institute for Health and Care Excellence (NICE). Knee injury and Osteoarthritis Outcome Score (KOOS), pain intensity, physical function, body mass index (BMI) and visceral fat area (VFA) were measured. Associations to RKOA were analysed with logistic regression (OR).

     Results:  In all, 13.8% (n=24) developed RKOA in 2 years whereof all had clinical KOA at baseline, as defined by NICE. Deterioration to RKOA was significantly associated with higher BMI, OR 1.119 (95% CI 1.024 to 1.223; p=0.013), and VFA, 1.008 (95% CI 1.000 to 1.016; p=0.049), worse knee pain intensity, 1.238 (95% CI 1.028 to 1.490; p=0.024), worse scores for KOOS Pain, 0.964 (95% CI 0.937 to 0.992; p=0.013) and KOOS Symptoms, 0.967 (95% CI 0.939 to 0.996; p=0.027), KOOS Activities of daily living 0.965 (95% CI 0.935 to 0.996; p=0.026) and KOOS Quality of Life 0.973 (95% CI 0.947 to 0.999; p=0.044), at baseline.

     Conclusions:  One out of seven individuals with clinical KOA developed RKOA in only 2 years. Baseline variables associated with RKOA after 2 years may possibly be detected early by using the NICE guideline, assessment of obesity and self-reported data of symptoms to support first-line treatment: education, exercise and weight control.

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