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  • 1.
    Aili, K.
    et al.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden & FoU Spenshult, Halmstad, Sweden.
    Andersson, M.
    FoU Spenshult, Halmstad, Sweden & Department of Clinical Sciences, Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). FoU Spenshult, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). FoU Spenshult, Halmstad, Sweden.
    Bergman, S.
    FoU Spenshult, Halmstad, Sweden & University of Gothenburg, Gothenburg, Sweden.
    Sleep problems and fatigue as a predictor for the onset of chronic widespread pain over 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, no Suppl. 2, p. 87-87Article 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.
    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.

  • 3.
    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

  • 4.
    Aili, Katarina
    et al.
    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.
    Bergman, Stefan
    Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Lund University, Department of Clinical Sciences, Lund, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). RandD Spenshult, Halmstad, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). RandD Spenshult, Halmstad, Sweden.
    Passive coping strategies but not physical function are associated with worse mental health, in women with chronic widespread pain – a mixed method study2019In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, no Suppl 2, p. 2159-2159Article in journal (Refereed)
    Abstract [en]

    Background: Chronic widespread pain (CWP) is a common condition (approximately 10% prevalence), that affects women twice as often as men. There is a lack of knowledge in how different coping strategies relates to health status during CWP development in a general population.

    Objectives: To explore different ways of coping with CWP and to relate the different coping strategies to health-related factors, before and after developing CWP.

    Methods: A sequential explorative mixed methods study including 19 women 45-67 of age, who had reported CWP in a survey 2016, but not in 1995. Individual interviews were analysed with a phenomenographic approach, and resulted in four categories of coping strategies. These categories were further explored with regard to four dimensions of health status (physical function, bodily pain, vitality and mental health) as measured by SF-36 (0-100, a lower score indicates more disability) and sleep problems measured both in 1995, and 2016.

    Results: The qualitative analysis revealed four categories representing different coping strategies, where each woman was labelled by the most dominant category; the mastering woman, the persistent woman, the compliant woman and the conquered woman. The first two categories emerged as being active coping strategies, and the latter two as passive. Women with passive strategies reported significantly lower vitality (median 57.5 vs 75, p=0.007) and worse mental health (median 54 vs 93, p=0.021) in 1995, before they had developed CWP compared with those with active coping strategies. No differences were seen between the groups on physical function, bodily pain or sleep.

    In 2016, there were still a difference between the passive and active group regarding mental health (median 56 vs 80, p=0.022), but not for vitality (median 35 vs 40, p=0.707). No differences were seen between the groups on physical function or bodily pain. All eight women with passive strategies reported problems with sleep in 2016, as compared to 6 of the 11 women with active strategies (p=0.045).

    Conclusion: Women that reported CWP in 2016, but not in 1995, described both active and passive coping strategies. The qualitative findings were associated with differences in vitality and mental health already in 1995, before they had developed CWP. Further, those with passive coping strategies reported worse health with regard to mental health and sleep problems in 2016. Interestingly, the groups did not differ in bodily pain or physical function neither in 1995 nor in 2016, which implicates the importance for the clinician to take the typical coping strategy into consideration, when meeting these patients in clinical settings. © Aili, Bergman, Bremander, Haglund & Larsson 2019. No commercial re-use. See rights and permissions. Published by BMJ.

  • 5.
    Aili, Katarina
    et al.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). FoU Spenshult, Halmstad, Sweden & 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). FoU Spenshult, Halmstad, Sweden & Lund University, Lund, 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.
    Women’s experiences of coping with chronic widespread pain – a qualitative study2018In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, p. 1815-1815, article id FRI10737-HPRArticle in journal (Refereed)
    Abstract [en]

    Background: Approximately ten percent of the population report chronic widespread pain (CWP), the condition is more common among women than men. For most people, the pain interferes with many aspects of every-day life and implies large consequences. However, the group reporting CWP is heterogeneous and there is a need for better understanding of the different strategies used for coping with pain in every-day life.

    Objectives: The purpose of this study was to describe women’s experiences of how to cope with CWP.

    Methods: The study had a descriptive design with a qualitative content analysis approach. Individual interviews were conducted with 19 women, 31–66 of age, who had reported CWP in a survey 2016. CWP was defined according to the 1990 ACR criteria for fibromyalgia. To be considered chronic, the pain should have persisted for more than three months during the last 12 months. A manifest qualitative content analysis was used to analyze the main question “How do you cope with your chronic widespread pain?” The analysis resulted in four categories.

    Results: Women described their coping with CWP in four different ways; to take control, to continue as usual, to follow instructions and to rest. To take control meant to make deliberate decisions to handle everyday day life. It also meant to take care of oneself, to think positive and to exercise at an adequate level. To continue as usual meant not to listen to body signals and either to ignore or accept the pain. To follow instructions meant listening to the health professionals and following advices, but without taking any part of the responsibility for the treatment outcome. To rest meant to perceive an unreasonable need for recovery, to resign and let the pain set the terms for the daily living.

    Conclusions: Women expressed different ways of coping with CWP including both active and passive strategies. The coping strategies included two dimensions, where one ranged from actively taking control over the pain, to passively following instructions and the other from actively continue as usual by either accepting or ignoring the pain to passively rest and being mastered by pain.

  • 6.
    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, Halmstad, Sweden | Karolinska Institutet, Institute of Environmental Medicine, Stockholm, Sweden.
    Campbell, Paul
    Keele University, School for Primary, Community and Social Care, Keele, United Kingdom | Midlands Partnership NHS Foundation Trust, Stafford, United Kingdom.
    Michaleff, Zoe A.
    Keele University, School for Primary, Community and Social Care, Keele, United Kingdom.
    Strauss, Vicky Y.
    University of Oxford, CSM, NDORMS, Oxford, United Kingdom.
    Jordan, Kelvin P.
    Keele University, School for Primary, Community and Social Care, Keele, United Kingdom | Keele University, Centre for Prognosis Research, Keele, United Kingdom.
    Bremander, Ann
    Spenshult Research and Development Center, Halmstad, Sweden | Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
    Croft, Peter
    Keele University, School for Primary, Community and Social Care, Keele, United Kingdom | Keele University, Centre for Prognosis Research, Keele, United Kingdom.
    Bergman, Stefan
    Spenshult Research and Development Center, Halmstad, Sweden | University of Gothenburg, Institute of Medicine, Gothenburg, Sweden.
    Long-term trajectories of chronic musculoskeletal pain: a 21-year prospective cohort latent class analysis2021In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 162, no 5, p. 1511-1520Article in journal (Refereed)
    Abstract [en]

    ABSTRACT: Our knowledge of the prevalence, impact, and outcomes of chronic pain in the general population is predominantly based on studies over relatively short periods of time. The aim of this study was to identify and describe trajectories of the chronic pain status over a period of 21 years. Self-reported population data (n = 1858) from 5 timepoints were analyzed. Pain was categorized by: no chronic pain (NCP), chronic regional pain (CRP), and chronic widespread pain (CWP). Latent class growth analysis was performed for identification of trajectories and logistic regression analysis for identification of predictors for pain prognosis. Five trajectories were identified: (1) persistent NCP (57%), (2) migrating from NCP to CRP or CWP (5%), (3) persistent CRP or migration between CRP and NCP (22%), (4) migration from CRP to CWP (10%), and (5) persistent CWP (6%). Age, sleeping problems, poor vitality, and physical function at baseline were associated with pain progression from NCP. Female gender, seeking care for pain, lack of social support, poor physical function, vitality, and mental health predicted poor pain prognosis among those with CRP. In conclusion, chronic pain was common in the population including 6% reporting persistent CWP, although the majority persistently reported NCP. Most people had stable pain status, but some had ongoing change in pain status over time including people who improved from chronic pain. It was possible to identify clinically relevant factors, characterizing trajectories of chronic pain development, that can be useful for identifying individuals at risk and potential targets for intervention. Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Association for the Study of Pain.

  • 7.
    Aili, Katarina
    et al.
    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.
    Campbell, Paul
    Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom & Midlands Partnership NHS Foundation Trust, Stafford, United Kingdom.
    Michaleff, Zoe
    Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom.
    Strauss, Victoria
    University of Oxford, CSM, NDORMS, Oxford, United Kingdom.
    Jordan, Kelvin
    Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom &Centre for Prognosis Research, Keele University, Keele, United Kingdom.
    Bremander, Ann
    RandD Spenshult, Halmstad, Sweden & University of Southern Denmark, Department of Regional Health Research, Odense, Denmark.
    Croft, Peter
    Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom & Centre for Prognosis Research, Keele University, Keele, United Kingdom.
    Bergman, Stefan
    RandD Spenshult, Halmstad, Sweden & Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Long term trajectories of chronic widespread pain: a 21-year prospective cohort latent class analysis2019In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, no Suppl 2, p. 239-239Article in journal (Refereed)
    Abstract [en]

    Background: Chronic widespread pain (CWP) is common (population prevalence of approximately 10%) and has a significant impact on the individual, healthcare, and society. Currently little is known about the actual course of CWP over time, in particular the pathways to the development and maintenance of CWP. One useful way to understand these pathways is to identify common clusters of people who share pain trajectories. Such information is clinically useful to identify factors that predict development, persistence, and resolution of CWP.

    Objectives: To identify different longitudinal pain trajectories over a period of 21 years.

    Methods: A 21-year longitudinal open-population cohort of n=1858 adults (aged 20-74) who completed surveys relating to their pain status in at least three of the five time points 1995, 1998, 2003, 2007, and 2016. Pain status (presence of persistent pain) was ascertained from a report of painful regions (0-18) on a pain mannequin and categorised into: NCP (No chronic pain), CRP (Chronic regional pain) and CWP (chronic widespread pain). Latent Class Growth Analysis (LCGA) was carried out based on these categories. Participants were assigned to a trajectory cluster where the posterior probability was the highest. Model fit was assessed by statistical indices and clinical interpretations of clusters.

    Results: LCGA identified five clusters describing different pathways of NCP, CRP and CWP over the 21 years. The cluster “Persistent NCP” was the most common pathway (n = 1052, 57%) representing those with no chronic pain over the whole time period. The “Persistent CRP or Migration from CRP to NCP” cluster included 411 individuals (22%) representing a group with stable or improving regional pain. In the groups who were shown to increase pain status, the “Migration from NCP to CRP or CWP” cluster included 92 individuals (5%), and there were 184 individuals (10%) in the cluster “Migration from CRP to CWP” representing a group with regional pain who developed CWP. The final cluster “Persistent CWP” included 119 individuals (6%) representing those with stable CWP throughout the time period. Figure 1 presents the mean number of pain sites over time by cluster.

    Conclusion: This study showed that whilst half of adults report no chronic pain over 21 years, a substantial proportion develop CWP or have persistent CWP over this time period. Whilst a common trajectory was movement from chronic regional pain to no chronic pain, a pattern of improving CWP was not seen suggesting this is an uncommon trajectory. This is the first study to show long-term trajectories for CWP, and further work is now required to understand factors that may identify individuals at risk of worsening pain status and factors that might promote improvement. These identified pathways of chronic pain over a lifespan improve the understanding of long-term development of chronic pain and chronic widespread pain. © Aili et al. 2019. No commercial re-use. See rights and permissions. Published by BMJ.

  • 8.
    Andersson, M.
    et al.
    Lund University, Lund, Sweden; Spenshult Research & Development Centre, Halmstad, Sweden.
    Bremander, Ann
    Lund University, Lund, Sweden; Spenshult Research & Development Centre, Halmstad, Sweden; University of Southern Denmark, Odense, Denmark; University Hospital of Southern Denmark, Sonderborg, Denmark.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare. Spenshult Research & Development Centre, Halmstad, Sweden.
    Empowerment and Associations to Disease Activity and Pain in Patients with Rheumatoid Arthritis2021In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 80, no Supplement 1, p. 197-197Article in journal (Refereed)
  • 9.
    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. 

  • 10.
    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).

  • 11.
    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.

  • 12.
    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)
  • 13.
    Benoni, Anna Clara
    et al.
    Research and Development Department, Halmstad Central Hospital, Halmstad, Sweden.
    Bremander, Ann
    Department of Orthopedics, Clinical Sciences, Lund University, Lund, Sweden.
    Nilsdotter, Anna
    Department of Orthopedics, Clinical Sciences, Lund University, Lund, Sweden.
    Patient-reported outcome after rheumatoid arthritis-related surgery in the lower extremities: A report from the Swedish National Register of Rheuma Surgery (RAKIR)2012In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 83, no 2, p. 179-84Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: Although decreasing with the development of effective pharmacological regimes, joint surgery has improved the function and quality of life of patients with rheumatoid arthritis (RA). Few studies have assessed patient-reported outcomes after RA surgery to the lower extremities. Here we report patient-relevant outcome after RA-related surgery based on the first data from the Swedish National Register of Rheuma Surgery (RAKIR).

    PATIENTS AND METHODS: 258 RA patients (212 women) who had joint surgery performed at the Department of Orthopaedics, Spenshult Hospital between September 2007 and June 2009 were included. Mean age at surgery was 64 (20-86) years. The patients completed the SF-36 and HAQ questionnaires preoperatively and 6 months postoperatively, and 165 patients completed them after 12 months.

    RESULTS: Improvement was seen as early as at 6 months. At 12 months, 165 patients (141 women)-including hip (n = 15), knee (n = 27), foot (n = 102), and ankle (n = 21) patients-reported statistically significant improvements from preoperatively to 12 months postoperatively in HAQ (mean change: -0.11) and SF-36 subscales physical function (11), role physical (12), bodily pain (13), social functioning (6.4), and role emotional (9.4). Hip and knee patients reported the greatest improvements.

    INTERPRETATION: Orthopedic RA-related surgery of the lower extremities has a strong effect on pain and physical function. Improvement is evident as early as 6 months postoperatively and remains after 12 months. Copyright © 2011 Nordic Orthopaedic Federation.

  • 14.
    Bergman, Stefan
    et al.
    Spenshult Research and Development Center, Halmstad, Sweden.
    Bremander, Ann
    Spenshult Research and Development Center, Halmstad, Sweden.
    Lifestyle factors were seldom discussed with patients visiting a rheumatology clinic2013In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 65, no Special issue, Supplement 10, p. S982-S983, Meeting Abstract: 2307Article in journal (Refereed)
    Abstract [en]

    Background/Purpose: There is increasing evidence that lifestyle factors are of importance for outcome of rheumatic diseases, and lifestyle interventions should be a natural part of management.

    The aim was to study if lifestyle factors (diet, physical activity, smoking and alcohol use) were discussed with patients on a regular visit to a specialized rheumatology clinic.

    Methods: A questionnaire was distributed to 318 patients visiting an outpatient clinic, and 223 (70%) responded. The questionnaire assessed if lifestyle factors (diet, physical activity, smoking and alcohol use) were discussed at the visit. If not, it also assessed if the patients themselves felt that this discussion would have been desirable.

    Results: The questionnaire was answered by 69 (31%) men and 154 (69%) women, and 69% were younger than 65 years. Diet was more frequently discussed with men (14.7% vs. 4.8%) although more women (11.6% vs 4.4%) would have desired it to be discussed. 83% of the patients did not consider that it was needed to discuss at all. Physical activity was discussed with 28% of the patients, without any significant difference between men and women. Only 8% of those not having this discussion thought that they needed it. Smoking was discussed with 15%, without any significant difference between men and women. Alcohol use was discussed with more men than women (15.9% vs. 4.0%). Of those not having this discussion 3% of the women but none of the men thought that they needed it.

    Conclusion: Although recommended as part of management, lifestyle factors are seldom discussed with the patients, and this discussion is not actively thought for by the patients. Lifestyle factors are more frequently discussed with men although women would have desired to have this discussion to a higher extent. There is a need for health care to actively take the initiative and discuss lifestyle as part of regular care.

  • 15.
    Bergman, Stefan
    et al.
    FoU Spenshult, Halmstad, Sweden; The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. FoU Spenshult, Halmstad, Sweden & Lund University, Lund, Sweden.
    Bergman, Anna-Carin
    Sannarpsgymnasiet, Halmstad, Sweden.
    Brorsson, Sofia
    Health and Welfare, Dalarna University, Falun, Sweden.
    Chronic Widespread Pain in Adolescents Is Highly Associated to Stress and Anxiety2015In: Arthritis & Rheumatology, ISSN 2326-5191, E-ISSN 2326-5205, Vol. 67, no Suppl. S10, article id 917Article in journal (Refereed)
    Abstract [en]

    Background/Purpose: Chronic widespread pain (CWP), one of the hallmarks of fibromyalgia, is not uncommon in adolescents and it has previously been shown that adolescents with pain often become young adults with pain. CWP often co-varies with anxiety, depression, and stress symptoms in adults, but the knowledge regarding this is small in youth and young adults.

    The aim was to study the associations between CWP, anxiety, depression and stress in adolescents attending first year of high school.

    Methods: A computerized questionnaire to 296 adolescents attending Swedish high school, with validated questions regarding presence and distribution of pain (Epipain mannequin), stress symptoms (ELO question), anxiety and depression (Hospital Anxiety and Depression Scale – HADS), and health related quality of life (HRQL as measured by EQ5D). Pain was considered chronic when persistent for more than three months, and the subgroup CWP was defined according to the 1990 ACR criteria for fibromyalgia. Statistical analyses in SPSS v21 with comparison of means by Student’s t-test and proportions by chi2-test or Fischer’s exact test.

    Results: 257 (87%) out of 296 eligible students, mean (SD) age 16.1 (0.7) and 65.8% girls, responded to the questionnaire.  Prevalence of chronic pain was 20.8% and that of the subgroup CWP was 4.7%, without any gender differences (boys 18.2% vs girls 22.2%; p=0.224, and 3.4% vs 5.4%; p=0.692). High level (4 or 5 on a 5 point scale) of stress symptoms were less common in boys (16.0% vs 28.2%; p=0.015), as was possible or probable anxiety (17.1% vs 44.4%; p<0.001), but not depression (10.3% vs 12.5%; p=0.764). Students with high level of stress reported CWP five times more often than those with less stress (30.4% vs 5.8%; p=0.001). Students with probable anxiety reported CWP ten times more often than students with no anxiety (17.6% vs 1.8%; p=0.001), and CWP was also more common, but not statistically significant, in students with probable depression (20.0% vs 3.1%; p=0.163). Those reporting CWP had significantly lower HRQL (0.58 vs 0.87; p=0.038) than students with no chronic pain.

    Conclusion: The high prevalence of chronic pain and the strong associations between CWP and reports of stress and anxiety in adolescents highlights that a multifactorial background to chronic pain must be considered early in life. An apparent lower score in EQ5D also indicates that the presence of CWP has an marked impact on HRQL also in adolescents.

  • 16.
    Bergman, Stefan
    et al.
    Lund University, Lund, Sweden & University of Gothenburg, Gothenburg, Sweden & RandD centre Spenshult, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). RandD centre Spenshult, Halmstad, Sweden.
    Aili, Katarina
    RandD centre Spenshult, Halmstad, Sweden & Karolinska Institutet, Stockholm, Sweden.
    Olsson, Cecilia
    University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Lund University, Lund, Sweden & RandD centre Spenshult, Halmstad, Sweden.
    Chronic widespread pain, sleep problems and pressure pain thresholds in a population sample2018In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 7, no 2, p. 1645-1646Article in journal (Refereed)
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  • 17.
    Bremander, A B
    et al.
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarstrom, Sweden.
    Holmström, G
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarstrom, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarstrom, Sweden.
    Depression and age as predictors of patient-reported outcome in a multidisciplinary rehabilitation programme for chronic musculoskeletal pain2011In: Musculoskeletal care, ISSN 1557-0681, Vol. 9, no 1, p. 41-48Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The recommended treatment for chronic musculoskeletal pain is multidisciplinary, with a cognitive approach. The aim of this study was to investigate health-related quality of life (HRQoL) outcome after a multidisciplinary treatment with a cognitive approach.

    METHODS: A total of 131 subjects who participated in a multidisciplinary rehabilitation programme (2005-2008) were studied at baseline and after six months, using the Short Form Short Form 36-item Health Survey questionnaire (SF-36) as primary outcome (HRQoL), and the Hospital Anxiety and Depression Scale (HAD) and pain as secondary outcomes and possible baseline predictors for HRQoL.

    RESULTS: Complete data were available for 97 subjects (85 women, mean age [SD] 44.6 [9.7] years). The SF-36 subscales physical function (PF), general health (GH), vitality (VT), social function (SF) and mental health (MH), the visual analogue scale for pain and the HAD improved significantly (p < 0.05) at follow-up compared with baseline. A pre-treatment probable depression (HAD score ≥11) was associated with a favourable outcome of the SF-36 subscales PF (odds ratio [OR] 5.6; p = 0.01), VT (OR 4.3; p = 0.02) and MH (OR 3.6; p = 0.02). A probable anxiety (HAD score ≥11) was associated with a favourable outcome of PF (OR 2.6; p = 0.05). There was an even stronger association for younger subjects (20-45 years), with probable depression scores at baseline and a favourable HRQoL outcome at follow up.

    CONCLUSION: This multidisciplinary rehabilitation programme, using a non-pharmacological cognitive approach, seemed to yield a better outcome concerning HRQoL measures in younger subjects with higher depression scores at baseline. This information is important for clinics when tailoring a multidisciplinary rehabilitation programme for patients with musculoskeletal chronic pain.

  • 18.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). FoU Spenshult & Lunds universitet, Lund, Sverige.
    Reumatoid artrit2015In: Fysisk aktivitet vid reumatisk sjukdom / [ed] Christina H. Opava, Lund: Studentlitteratur AB, 2015, 1:1, p. 129-139Chapter in book (Other academic)
    Abstract [sv]

    Reumatoid artiri (RA) medför ofta konsekvenser för en persons funktionstillstånd, upplevda hälsa och livskvalitet. Att främja förmågan till fysisk aktivitet är en viktig uppgift för hälso- och sjukvården och ger stora vinster för den enskildes hälsa. Rekommendationer för om fysisk aktivitet och träning har gått från vila och passiv rörelseträning till att idag kunna jämställas med aktiv träning på samma nivå som finns i rekommendationer till befolkningen i allmänhet. Naturligtvis måste träningen anpassas till individens behov, förutsättningar och önskemål.

  • 19.
    Bremander, Ann B
    et al.
    Department of Orthopedics, Lund University Hospital, SE-221 85 Lund, Sweden.
    Dunbar, Michael
    Division of Orthopedics, London Health Sciences Center, London, Ontario, Canada.
    Knutson, Kaj
    Department of Orthopedics, Lund University Hospital, SE-221 85 Lund, Sweden.
    Petersson, Ingemar F
    Department of Orthopedics, Lund University Hospital, SE-221 85 Lund, Sweden.
    Robertsson, Otto
    Department of Orthopedics, Lund University Hospital, SE-221 85 Lund, Sweden.
    Revision in previously satisfied knee arthroplasty patients is the result of their call on the physician, not on pre-planned follow-up: a retrospective study of 181 patients who underwent revision within 2 years2005In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 76, no 6, p. 785-90Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Degree of satisfaction with a knee arthroplasty is said to be correlated to reduced pain and better function. During a validation of the Swedish Knee Arthroplasty Register in 1997, previously operated patients were asked how satisfied they were with their knee. A subgroup of "satisfied" patients was identified who underwent revision within 2 years of having expressed satisfaction. Our aim was to study the revision diagnosis, to determine whether the problem leading to revision had been discovered as a result of routine follow-up, and also to find out when the symptoms leading to revision had started.

    METHODS: We retrospectively studied the medical records of 181 patients (181 knees), with a median age of 74 (31-88) years. 68% were women and the median time between primary operation and revision was 8 (3-21) years.

    RESULTS: Aseptic loosening (74/181) was the most common diagnosis. 2 cases were revised as a result of routine follow-up. 44% of the medical records included reports of pain in the replaced knee prior to answering the satisfaction questionnaire.

    INTERPRETATION: Few patients were admitted to knee revision surgery due to medical findings discovered during routine follow-up. The term "satisfaction" must be interpreted with care, as it seems to have a more complex meaning for the patients than absence of knee pain.

  • 20.
    Bremander, Ann B
    et al.
    Musculoskeletal Sciences, Department of Orthopedics, Clinical Sciences, Lund University, Lund, Sweden.
    Hubertsson, Jenny
    Musculoskeletal Sciences, Department of Orthopedics, Clinical Sciences, Lund University, Lund, Sweden.
    Petersson, Ingemar F
    Musculoskeletal Sciences, Department of Orthopedics, Clinical Sciences, Lund University, Lund, Sweden.
    Grahn, Birgitta
    Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden.
    Education and benchmarking among physicians may facilitate sick-listing practice2012In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 22, no 1, p. 78-87Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Assessing work ability and sickness certification are considered problematic by many physicians and education and implementation of guidelines to improve knowledge and skills has been requested. Our aim was to study the association between such interventions and physicians' sick-listing practices.

    METHODS: A web-based questionnaire was sent to all physicians working in primary care, psychiatry, orthopedics/rheumatology in the southern region of Sweden before (in 2007 to 1,063 physicians) and after (in 2009 to 1,164 physicians) educational interventions in insurance medicine were offered.

    RESULTS: With a response rate of 58%, half of the physicians (51%) reported to work at a clinic with a sick-listing policy in 2009 compared with 31% in 2007. Primary care physicians (OR 12.4) and physicians who had participated in educational interventions in insurance medicine (OR 2.4) more often had a sick-listing policy at the clinic. Physicians with a longer medical experience (OR 0.7) and those with support at the clinic (OR 0.3) and the possibility to extend time if needed (OR 0.4) were less likely to report of problematic cases while primary care physicians were (OR 2.9). On the contrary, physicians who reported to rarely have the possibility to extend time when handling problematic cases were more likely to issue a higher number of sickness certificates.

    CONCLUSIONS: The sick-listing process is often viewed as problematic and more often by primary care physicians. Benchmarking and education in insurance medicine together with the possibility to allocate extra time if encountering problematic cases may facilitate sick-listing practice.

  • 21.
    Bremander, Ann B I
    et al.
    Center for Research and Development, Spenshult Hosp. for Rheumatic Dis., SE-313 92 Oskarström, Sweden.
    Petersson, Ingemar F
    Center for Research and Development, Spenshult Hosp. for Rheumatic Dis., SE-313 92 Oskarström, Sweden.
    Roos, Ewa M
    Center for Research and Development, Spenshult Hosp. for Rheumatic Dis., SE-313 92 Oskarström, Sweden.
    Validation of the Rheumatoid and Arthritis Outcome Score (RAOS) for the lower extremity2003In: Health and Quality of Life Outcomes, E-ISSN 1477-7525, Vol. 1, p. 55-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients with inflammatory joint diseases tend due to new treatments to be more physically active; something not taken into account by currently used outcome measures. The Rheumatoid and Arthritis Outcome Score (RAOS) is an adaptation of the Knee injury and Osteoarthritis Outcome Score (KOOS) and evaluates functional limitations of importance to physically active people with inflammatory joint diseases and problems from the lower extremities. The aim of the study was to test the RAOS for validity, reliability and responsiveness.

    METHODS: 119 in-patients with inflammatory joint disease (51% RA) admitted to multidisciplinary care, mean age 56 (+/-13), 73% women, mean disease duration 18 (+/-14) yr were consecutively enrolled. They all received the RAOS, the SF-36, the HAQ and four subscales of the AIMS2 twice during their stay for test of validity and responsiveness. Test-retest reliability of the RAOS questionnaire was calculated on 52 patients using the first or second administration and an additional mailed questionnaire.

    RESULTS: The RAOS met set criteria of reliability and validity. The random intraclass correlation coefficient (ICC 2,1) for the five subscales ranged from 0.76 to 0.92, indicating that individual comparisons were possible except for the subscale Sport and Recreation Function. Inter-item correlation measured by Cronbach's alpha ranged from 0.78 to 0.95. When measuring construct validity the highest correlations occurred between subscales intended to measure similar constructs. Change over time (24 (+/- 7) days) due to multidisciplinary care was significant for all subscales (p < 0.001). The effect sizes ranged from 0.30-0.44 and were considered small to medium. All the RAOS subscales were more responsive than the HAQ. Some of the SF-36 subscales and the AIMS2 subscales were more responsive than the RAOS subscales.

    CONCLUSION: It is possible to adapt already existing outcome measures to assess other groups with musculoskeletal difficulties in the lower extremity. The RAOS is a reliable, valid and responsive outcome instrument for assessment of multidisciplinary care. To fully validate the RAOS further studies are needed in other populations.

  • 22.
    Bremander, Ann
    et al.
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, SE 313 92 Oskarström, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, SE 313 92 Oskarström, Sweden.
    Non-pharmacological management of musculoskeletal disease in primary care2008In: Baillière's Best Practice & Research: Clinical Rheumatology, ISSN 1521-6942, E-ISSN 1532-1770, Vol. 22, no 3, p. 563-77Article in journal (Refereed)
    Abstract [en]

    Musculoskeletal diseases as a group are one of the most common causes of contact in primary care and the most common causes of disability and long-term sick leave in several Western countries. Pain and dysfunction are often present without any specific findings in the musculoskeletal system, and a strictly biomedical approach is often inadequate. Body structure and function interact with personal and environmental factors, affecting the ability to perform activities and participate in society. It is important to meet these needs in primary care, and non-pharmacological principles such as physical activity and patient education with a cognitive approach are cornerstones in a multimodal management model.

  • 23.
    Bremander, Ann
    et al.
    Spenshult Hosp Rheumat Dis, Ctr Res & Dev, S-31392 Oskarström, Sweden .
    Bergman, Stefan
    Spenshult Hosp Rheumat Dis, Ctr Res & Dev, Oskarström, Sweden .
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Perception of multimodal cognitive treatment for people with chronic widespread pain: changing one's life plan2009In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, no 24, p. 1996-2004Article in journal (Refereed)
    Abstract [en]

    Purpose.

    The aim of this study was to gain a deeper understanding of chronic widespread pain patients' perception of a multimodal treatment with a cognitive approach.

    Methods.

    A reformulated grounded theory study based on interviews with 16 participants in the programme was conducted at the end of a 6-month treatment period.

    Results.

    The result describes a conceptual model of the informants' perception of the treatment. The core category 'changing one's life plan' comprised of three categories: 'changing one's perception of life', 'depending on support' and 'managing one's life'. Changing one's perception of life could be deep and overwhelming 'overall life changes' or more superficial 'life adjustments'. Support by health professionals and the patient group were of importance. At the end of the rehabilitation program managing one's life was perceived as either 'reorientation' or 'stagnation'. The informants who experienced overall life changes achieved reorientation with support by others, while those who experienced life adjustments did not change their way of managing one's life to any great extent.

    Conclusion.

    The core category changing one's life plan included the categories; changing one's perception of life, depending on support and managing one's life. Informants experiencing overall life changes were more likely to achieve reorientation than those who experienced life adjustments

  • 24.
    Bremander, Ann
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Forslind, K.
    Lund University, Lund and Helsingborg, Sweden & Helsingborg's hospital, Helsingborg, Sweden.
    Eberhardt, K.
    Lund University, Lund, Sweden.
    Andersson, M.
    Lund University, Lund, Sweden & Spenshult Research and Devlopment Centre, Halmstad, Sweden.
    Functional Impairment in Patients with RA in an Eight Year Perspective2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, no Suppl. 2, p. 1513-1514Article in journal (Refereed)
    Abstract [en]

    Background: In people with Rheumatoid arthritis (RA) impaired physical functioning is an acute as well as long term effect of the disease. Observational performance tests reflecting range of motion in upper as well as in lower extremities should be easy to perform in the clinic as well as in research as a complement to self-reported measures of physical functioning. The Signal Of Functional Impairment (SOFI)1 is a performance test which so far has been applied only in Sweden but commonly used in the clinic and in long term follow-up clinical studies.

    Objectives: The aim was to study performance-based function assessed with SOFI over 8 years and, secondly, to study which items included in SOFI that were associated with change in functioning over time.

    Methods: An inception cohort of 1 052 patients with early RA, from the BARFOT-study, recruited 1992–2006 was investigated, mean (SD) age was 54 years (14), 70% were women. The patients were followed by a structured protocol at baseline, 3 and 6 months and at 1, 2, 5, and 8 years. SOFI consists of 3 parts measuring hand, arm (upper), and leg (lower) function (1). Hand function is tested by 4 movements; cylinder grip (H1), pen grip (H2), pincer grip (H3) and opposition of the thumb (H4). Arm function is assessed by 3 movements; hand behind the head and the ability to touch the cervical spine processes with fingers (A1), elbow supination (A2) and elbow extension (A3). Leg function is tested by 4 movements; the ability to touch the opposite knee with the heel while sitting (L1), knee extension in supine position (L2), dorsiflexion of the foot standing on a balance board (L3), and the ability to stand on tip toes without shoes (L4). An assessor scores the patient's ability to perform the different tests on an ordinal scale (0=normal, 1= partly impaired and 2= unable to perform). The range of SOFI scores is 0–44 (best to worst).

    Results: At baseline the mean (SD) SOFI was 7.2 (5.8), and at 1 year follow-up the improvement was 2.75 (5.65), p<0.001. From 1 year to 8 year follow-up the deterioration was 1.5 (4.6), p<0.001. When studying hand, upper and lower function separately, the pen grip and the ability to stand on tip toes improves most during the first year. From 1 to 8 year the pincer grip and the ability to stand on tip toes are the items that deteriorate most (Figure). Assessment of the pen grip, the pincer grip and the ability to stand on tip toes explain 58% to 70% of the SOFI score over time, with the highest rate at 5 (65%) and 8 years follow-up (70%).

    Conclusions: Functioning as assessed by SOFI improved during the first year in patients with early RA and then deteriorated slowly. Over a longer period, pincer grip and the ability to stand on tip toes seemed to be the two most important items to measure when assessing functional impairment over time. © 2017, BMJ Publishing Group Limited

  • 25.
    Bremander, Ann
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Forslind, Kristina
    Lund University, Lund, Sweden & Helsingborg Hospital, Helsingborg, Sweden.
    Eberhardt, Kerstin
    Lund University, Lund, Sweden.
    Andersson, Maria L. E.
    Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Importance of Measuring Hand and Foot Function Over the Disease Course in Rheumatoid Arthritis: An Eight-Year Follow-Up Study2019In: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 71, no 2, p. 166-172Article in journal (Refereed)
    Abstract [en]

    Objective: To assess function using the Signals of Functional Impairment (SOFI) instrument over 8 years, to study clinical variables associated with the change, and to study change over time of the SOFI items.

    Methods: In total, 1,223 patients with early rheumatoid arthritis (RA) from the Better Anti-Rheumatic Farmacotherapy (BARFOT) cohort (mean ± SD age 56.9 ± 15.4 years, 67% women) were included in the analysis. Data from baseline and from 1 and 8 years were studied. The SOFI instrument includes measures of range of motion in the hand, shoulder/arm, and lower extremity (range 0–44, best to worst). The effects of baseline variables (sociodemographic, disease activity, joint destruction, and function) on change in SOFI scores were studied by linear regression analysis.

    Results: During the first year, the improvement in mean ± SD SOFI scores was 2.7 ± 5.7 (P < 0.001). Worse scores in the Disease Activity Score in 28 joints and Health Assessment Questionnaire score at baseline were associated with this improvement (r2 <= 0.11). During the next 7 years, the deterioration in SOFI scores was mean ± SD 1.5 ± 4.9 (P < 0.001). Based on change scores, we found that finger flexion, pincer grip, and toe-standing were the most important items to measure, explaining 58-61% of the total SOFI score, and these items were also associated with radiographic changes at the 8-year follow-up.

    Conclusion: Function as assessed with SOFI scores improved during the first year in patients with early RA, but it deteriorated slowly thereafter. Impaired hand and foot function was associated with joint destruction at the 8-year follow-up. Measures of hand and foot function will complement self-reported and medical data, both in clinical work and in long-term research studies. Copyright © 2019, Emerald Publishing Limited

  • 26.
    Bremander, Ann
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden & R&D centre, Spenshult, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). R&D centre, Spenshult, Halmstad, Sweden.
    Bergman, Stefan
    Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden & R&D centre, Spenshult, Halmstad, Sweden & Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Measures of Physical Activity and Fear Avoidance in People with Chronic Pain2018In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, no Suppl. 2, p. 1829-1830, article id SAT0737-HPRArticle in journal (Refereed)
    Abstract [en]

    Background Lifestyle factors such as physical activity (PA) has the possibility to contribute to improved health and quality of life in the population as well as in chronic diseases. Most often PA is self-reported while measures of the aerobic capacity are more seldom measured in subjects with chronic pain.

    Objectives To describe physical activity levels (self-reported and aerobic capacity) in people with chronic pain classified as regional or widespread and to compare the findings with a group that report no pain.

    Methods From the 2016 follow-up of the Swedish population based Epipain cohort (n 1321), 146 subjects were invited to a clinical assessment where the aerobic capacity was assessed by using a submaximal bicycle test, the Ekblom-Bak test, together with assessment of the Borg scale for perceived exertion (RPE). Aerobic capacity was also classified as low, average or high according to data from the general population. Self-reported physical activity was coded as MVPArec if recommended levels of PA was reported (physically active on a moderate level ≥150 min/week (MPA) or on an vigorous level ≥75 min/week (VPA) or not). The Fear Avoidance Beliefs Questionnaire for PA (FABQ-PA, 0–24 best to worst) and for work (FABQ-W, 0–48 best to worst) were also assessed. The participants were classified as having chronic widespread pain (CWP), chronic regional pain (CRP) or no chronic pain (NCP) based on a pain mannequin presenting 0–18 pain regions and if pain had lasted for 3 months or more. Chi2 and Kruskal-Wallis tests were performed to study differences between the three pain groups.

    Results 141/146 (97%) subjects (mean (SD) age 59.4 (8.2) years) whereof 61% were women, could be classified into pain groups; 43 as CWP (84% women), 43 as CRP (42% women) and 55 as NCP (58% women). The group with CWP was slightly older than those with CRP (mean (SD) age 57.0 (7.6) years vs. 61.9 (6.9) years, p 0.02). The CWP group also had lower aerobic capacity (mean (SD) 2.2 (0.5) l/min vs. 2.6 (0.6) l/min, p 0.03), and a larger proportion was classified as having low aerobic capacity (CWP 21%, CRP 7% and NCP 10%, p 0.04). The proportion of MVPArec did not differ between the groups; CWP 70%, CRP 81% and NCP 74% (p 0.5). There was neither a difference between the groups in BMI, RPE or in sitting hours/week (p>0.6). However, differences were found in the FABQ where in the PA scale those with CRP had worse scores compared with NCP (mean (SD) 11.2 (7.3) vs. 6.0 (6.0), p<0.001), the difference between CWP (mean (SD) 8.9 (6.7)) and NCP was p 0.06. In the work subscale of FABQ, CWP had worse scores compared with CRP (mean (SD) 18.9 (15.7) vs. 10.0 (12.5), p 0.002) and CRP had worse scores compared to those with NCP (mean (SD) 10.0 (12.5) vs. 6.5 (9.1), p<0.001).

    Conclusions In this sample of subjects with chronic pain or no pain, having widespread pain tended to affect the aerobic capacity negatively while self-reports of reaching recommended levels of physical activity did not differ between groups. Fear avoidance in relation to physical activity and especially in relation to work was more noticeable in subjects with chronic pain compared to those with no pain. Measures of aerobic capacity and information of fear avoidance beliefs might help health professionals to better tailor the non-pharmacological treatment for subjects with chronic pain.

    Disclosure of Interest None declared

    © 2018, Published by the BMJ Publishing Group Limited.

  • 27.
    Bremander, Ann
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Center, Halmstad, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden; Spenshult Research and Development Center, Halmstad, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ndosi, M.
    University of the West of England, Bristol, United Kingdom.
    The Educational Needs of Patients with Undifferentiated Spondyloarthritis2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, no Suppl. 2, p. 1495-1496Article in journal (Refereed)
  • 28.
    Bremander, Ann
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Center, Halmstad, Sweden.
    Bergman, Stefan
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden & Primary Health Care Unit, Department ofPublic Health and Community Medicine,Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ndosi, Mwidimi E.
    Department of Nursing and Midwifery, University of the West of England, Bristol, United Kingdom.
    The educational needs of patients with undifferentiated spondyloarthritis: Validation of the ENAT questionnaire and needs assessment2018In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 16, no 2, p. 313-317Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of the present study was to validate the Swedish version of the educational needs assessment tool (SwENAT) in undifferentiated spondyloarthritis (USpA) and use it to study the educational needs of patients with USpA.

    METHODS: This was a cross-sectional study, recruiting a random sample of patients with USpA from a hospital register in Sweden. Educational needs data were collected, together with disease activity and function indices (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] and Bath Ankylosing Spondylitis Functional Index [BASFI]). Rasch analysis was utilized to evaluate the construct validity, internal consistency and unidimensionality of the SwENAT before studying differences in educational needs between patient subgroups (gender, age and disease severity).

    RESULTS: = 11.488; p = 0.119), including strict unidimensionality. Overall, the mean (SD) SwENAT score was 86 (32). Women reported higher needs than men in the domains of pain (mean [SD] 13.1 [6.8] versus 10.1 [6.0]; p = 0.05); movement (mean [SD] 13.0 [5.5] versus 9.9 [5.7]; p = 0.02) and self-help (mean [SD] 17.0 [5.8] versus 14.1 [5.0]; p = 0.03). Higher disease activity (BASDAI >4) was associated with higher educational needs (mean [SD] 92.6 [31.9] versus 73.7 [29.4]; p = 0.02).

    CONCLUSIONS: These data suggest that the SwENAT is valid in USpA. Women and patients with higher disease activity are more likely to have high levels of educational needs, so special attention and strategies to target patient education are warranted. © 2018 John Wiley & Sons, Ltd.

  • 29.
    Bremander, Ann
    et al.
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Department of Rheumatology, Clinical Sciences Lund, Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Jacobsson, Lennart T. H.
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Department of Clinical Sciences, Section of Rheumatology, Malmö, Lund University, Lund, Sweden.
    Bergman, Stefan
    Department of Rheumatology, Clinical Sciences Lund, Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Department of Rheumatology, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Löfvendahl, Sofia
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Petersson, Ingemar F.
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Smoking is associated with a worse self-reported health status in patients with psoriatic arthritis: data from a Swedish population-based cohort2015In: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 34, no 3, p. 579-583Article in journal (Refereed)
    Abstract [en]

    The aim was to study possible associations between smoking habits and self-reported clinical features in a large population-based cohort of patients with psoriatic arthritis (PsA). All subjects with PsA who had sought health care in the period 2003-2007 were identified using a regional health-care register. In 2009, all those identified who were 18 years of age or more (n = 2,003) were sent a questionnaire with questions on smoking, health-related quality of life [EuroQol five-dimension (EQ-5D)questionnaire], function [Health Assessment Questionnaire (HAQ)], pain, fatigue, and global health. We performed age- and sex-adjusted regression analysis to compare health status outcomes in never and ever smokers. Altogether, 1,185 subjects (59 %) returned the questionnaire. Mean age was 57 years (SD 13.5), and 58 % were women; 38 % were never smokers and 62 % were ever smokers. Mean age at disease onset was 38.2 years (SD 13.2) and 41.2 years (SD 13.6), respectively (p = 0.001). In age- and sex-adjusted data, ever smokers reported worse EQ-5D (p = 0.009); worse reports of global health (p = 0.01), pain (p = 0.01), and fatigue (p = 0.04); and a higher number of painful body regions (p = 0.04) compared to never smokers. In this population-based PsA cohort, patients who were ever smokers reported worse health status than never smokers. Besides being a possible result of a worse PsA in ever smokers, impaired health status could also be an effect of unstudied comorbidities. Further longitudinal studies are needed to gain a better understanding of cause and effect. However, smoking cessation should be recommended because of general health considerations as well as disease-specific issues.

  • 30.
    Bremander, Ann
    et al.
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS).
    Jacobsson, Lennart T. H.
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bergman, Stefan
    Research and Development Centre Spenshult, Halmstad, Sweden.
    Haglund, Emma
    Research and Development Centre Spenshult, Halmstad, Sweden.
    Petersson, Ingemar
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Smoking is Associated with Worse and More Widespread Pain, Worse Fatigue, General Health and Quality of Life in a Swedish population Based Cohort of Patients with Psoriatic Arthritis2012In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 64, no S10, p. S777-S778, article id 1828Article in journal (Refereed)
    Abstract [en]

    Background/Purpose: Smoking has been found to be associated with an increased risk of developing psoriatic arthritis (PsA)1. The purpose of this study was analyse possible associations of smoking habits with self-reported clinical features in a large population based cohort of patients with a diagnosis of PsA.

    Methods: All health care seeking subjects with a diagnose of PsA according to ICD 10 codes (given at least once by a rheumatologist/internist or twice by any other physician) were identified by a regional health care register during 2003-20072. In 2009 all identified subjects aged 18 years or older (n=2003) were invited to participate in a cross sectional questionnaire survey. The questionnaire included self-reported data on smoking (never smokers or ever smokers), age at disease onset, physical function (HAQ, 0-3 best to worst), pain, fatigue and global health (numerical rating scales 0-10 best to worst) health related quality of life (EQ-5D, 0-1 worst to best), and number of painful regions noted on a pain mannequin (0-16, best to worst). Linear regression analysis was performed and all data were controlled for sex and age.

    Results: Response rate was 77% whereof 369 patients (18%) declined participation and 1185 (59%) returned the questionnaire,  mean age 57.5 (SD 13.5) years and 58% were women. 1173 subjects responded to the smoking question whereof 448 (38%) were never smokers and 725 (62%) were ever smokers.

    Mean age at disease onset was 42.3 (SD 13.4) years in never smokers vs. 46.0 (SD 13.2) in ever smokers. Never smokers vs. ever smokers had mean HAQ 0.59 (SD 0.6) vs. 0.71 (SD 0.6),  mean pain 3.9 (SD 2.4) vs.4.4 (SD 2.5),  mean fatigue 4.4 (SD 2.8) vs. 5.0 (SD 2.7),  mean global health 3.9 (SD 2.4) vs. 4.4 (SD 2.3), mean EQ-5D 0.68 (SD 0.23) vs. 0.63 (SD 0.26) and mean no of painful regions were 7.2 (SD 4.0) vs. 7.9 (SD 4.3).

    The regression analysis showed that ever smokers had worse pain with age-sex adjusted parameter estimates (B) = 0.38 (95% CI 0.09 ; 0.67), worse fatigue B = 0.34 (95% CI 0.02 ; 0.66), worse global health B = 0.36 (95% CI 0.09 ; 0.64), worse EQ-5D B = -0.04 (95% CI -0.07 ; -0.01) and an increased no of painful regions B = 0.54 (95% CI 0.02 ; 1.07) compared with never smokers.

    Conclusion: In this population based PsA cohort, patients who were ever smokers reported worse clinical features compared with never smokers. Further longitudinal studies are needed to better understand cause and effect. However, smoking cessation should be recommended due to general health perspectives and also due to disease specific issues.

  • 31.
    Bremander, Ann
    et al.
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund, Sweden & R&D Centre, Spenshult, Halmstad, Sweden.
    Malm, K.
    R&D Centre, Spenshult, Halmstad, Sweden.
    Andersson, M. L.
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund, Sweden & R&D Centre, Spenshult, Halmstad, Sweden.
    Physical Activity in Established RA and Variables Associated with Physical Activity Maintenance Over a Seven Year Period2018In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, no Suppl. 2, p. 188-188, article id OP0280-HPRArticle in journal (Refereed)
    Abstract [en]

    Background: Interventions to promote a healthy lifestyle also in patients with rheumatoid arthritis (RA) have been in focus over the last years. Physical activity (PA) defined as moderate-to-vigorous physical activity (MVPA) has the possibility to reduce disease burden in RA and may contribute to improved quality of life (QoL). It is well known that a large number of patients with RA have a sedentary life style and are less active than their healthy peers. However, less information is known about the long term change of MVPA and possible associated variables.

    Objectives: To study self-reported change of MVPA over seven years in a well-defined RA cohort.

    Methods: A lifestyle questionnaire was sent twice to patients in the BARFOT cohort, in 2010 (n 1525) and in 2017 (n 1046) with a response rate of 73% and 68% respectively and 950 patients responded to both questionnaires. All patients fulfilled the ACR criteria for classification of RA and had a disease duration at inclusion (1992 to 2006) of ≤12 months. Patients were dichotomized as being active on recommended levels of MVPA (MVPArec ;physically active on a moderate level ≥150 min/week (MPA) or on an intense level ≥75 min/week (VPA)) or not (sedentary). The patients reported body mass index, smoking habits, tender (TJC) and swollen joint count (SJC, 28-joints), patient global assessment (PatGA), pain intensity (NRS) and distribution (pain mannequin), fatigue (NRS), physical function (HAQ), health related QoL (EQ5D), comorbidities and medical treatment. Possible associated variables with meeting MVPArec at both time points or not (dependent variable) was studied by using a logistic regression analysis. All variables were adjusted for age, gender and smoking habits.

    Results: Forty-one percent (n 389) of the patients met MVPArec at both occasions, and they reported better EQ5D scores compared with the sedentary group (mean 0.77 (SD 0.18) vs 0.68 (0.27). The patients who met MVPArec were younger, (mean age (SD) 5913 years vs 6213 years, p<0.001) and were to higher extent never smokers 46% vs 38%, p=0.021. There was a negative association with meeting MVPArec and being overweight (OR 0.58, 95% CI: 0.43 to 0.96) or obese (OR 0.38, 95% CI: 0.25 to 0.59), the presence of cardiovascular (OR 0.56, 95% CI: 0.41 to 0.75) and pulmonary diseases (OR 0.51, 95% CI: 0.31 to 0.85), TJC (OR 0.98, 95% CI: 0.95 to 0.995), high pain intensity (OR 0.99, 95% CI: 0.987 to 0.998), and pain distribution (OR 0.93, 95% CI: 0.90 to 0.96), worse fatigue (OR 0.99, 95% CI: 0.998 to 0.997) and a worse physical function (HAQ, OR 0.58, 95% CI: 0.45 to 0.76). Patients with higher values in QoL (EQ5D, OR 3.1, 95% CI: 1.52 to 6.2) were positively associated with meeting MVPArec. In 2010 there were no differences in medical treatment between the groups, p=0.377. In 2017 the group meeting MVPArec included a lower number of untreated patients compared to 2010 (25% vs 34%, p=0.017).

    Conclusions: Only four out of ten patients with established RA reported to maintain recommended levels of PA over a seven year period. Experiencing high quality of life seems to be important for PA maintenance together with lower levels of pain, fatigue and better physical function. Health care professionals need to take the patient perspective into account andsupport maintenance of physical activities accordingly.

    Disclosure of Interest: None declared

  • 32.
    Bremander, Ann
    et al.
    Lund University, Lund, Sweden & Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Petersson, Ingemar F.
    Lund University, Lund, Sweden.
    Bergman, Stefan
    Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Englund, Martin
    Lund University, Lund, Sweden & Boston University School of Medicine, Boston, Massachusetts, USA.
    Population-based estimates of common comorbidities and cardiovascular disease in ankylosing spondylitis2011In: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 63, no 4, p. 550-556Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study the rate of common comorbidities and cardiovascular disease in patients with ankylosing spondylitis (AS) compared with the general population seeking health care.

    METHODS: This cohort study included 935 subjects (67% men) ages ≥20 years diagnosed with AS and the adult background population in Southern Sweden. During 2004 to 2007 we recorded the occurrence of physicians' diagnostic codes for a select number of comorbidities commonly associated with AS and cardiovascular disease and risk factors. We obtained standardized morbidity-rate ratios (SMRs) by dividing the observed morbidity rate in AS patients by the expected rate based on the corresponding rate of the disease in the general population of the county seeking health care.

    RESULTS: The highest SMRs were found for uveitis (34.35, 95% confidence interval [95% CI] 28.55-40.98) and inflammatory bowel disease (9.28, 95% CI 7.07-11.97). Also, we found increased SMRs for ischemic heart diseases (2.20, 95% CI 1.77-2.70), hypertension (1.98, 95% CI 1.72-2.28), and diabetes mellitus (1.41, 95% CI 1.10-1.78). Furthermore, the SMRs for psoriasis, osteoporosis, and atrioventricular blocks were also statistically significantly elevated.

    CONCLUSION: Inflammatory diseases affecting the eye and the digestive system were the most notable comorbidities in AS patients, but the rate for cardiovascular disease was also high. Using comprehensive longitudinal population-based register data is a promising tool to evaluate the excess consultation rate and total burden of rheumatic disease on patients and society. Copyright © 2011 by the American College of Rheumatology.

  • 33.
    Bremander, Ann
    et al.
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Petersson, Ingemar F.
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Haglund, Emma
    Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Jacobsson, Lennart T.H.
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Smoking Is Associated with Worse and More Widespread Pain, Worse Disease Activity, Function, Fatigue and Health Related Quality of Life in Patients with Axial Spondyloarthritis: Results From a Population Based Cohort2012In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 64, no S10, p. S43-S43, article id 95Article in journal (Refereed)
    Abstract [en]

    Background: In subjects with early axial Spondyloarthritis (SpA) smoking has recently been associated with earlier onset of disease, worse lesions of the sacroiliac joints and in later stages syndesmophyte progression. The aim was to study associations of smoking habits with self-reported information in a large population based cohort of patients with axial SpA.

    Methods: A cross-sectional questionnaire survey performed in 2009 included all health care seeking subjects aged >18 years with a diagnosis of SpA according to ICD 10 codes identified by a regional health care register (n=3711). Smoking habits were studied in patients with ankylosing spondylitis (AS, ICD M45) and in patients who fulfilled criteria for “non AS axial SpA” (without having one of AS). Criteria for non AS axial SpA were based on data from the questionnaire: pain for 3 months or more during the last 12 months together with 2 or more features out of 5 (inflammatory back pain, history of psoriasis, uveitis/tendinitis, inflammatory bowel disease or heredity). The questionnaire included data on smoking (never smokers vs. ever smokers), disease activity (BASDAI) physical function (BASFI), general health (BAS-G) all measured with numerical rating scales 0-10 (best to worst), health related quality of life (EQ-5D, 0-1 worst to best), pain, fatigue (numerical rating scales 0-10 best to worst) and number of painful regions noted on a pain mannequin (0-16 best to worst). Linear regression analysis was performed and all data were controlled for sex and age.

    Results:

    Response rate was 76% whereof 2167 (58%) returned the questionnaire and 18% declined participation in the study. 598 subjects had an AS diagnose and 572 fulfilled the criteria for non AS axial SpA.

    The AS group had a mean age of 54 (SD14) years and 35% were women. Never smokers constituted 48% of the AS group. Ever smokers had worse scores in all studied variables compared with never smokers.

    The linear regression analysis showed that ever smokers in the AS group had worse self-reported scores in BASDAI with age-sex adjusted parameter estimate (B) = 0.60 (95% CI 0.21 ; 1.00), BASFI B = 0.51 (95% CI 0.11 ; 0.91) and fatigue B = 0.51 (95% CI  0.06 ; 1.00) . There was a tendency to worse scores for ever smokers also in EQ-5D B = -0.04 (95% CI -0.09 ; 0.001)

    Mean age in the non AS axial SpA group was 55 (SD 14) years and 68% were women. Never smokers constituted 38% of this group. Also in the non AS axial SpA group the linear regression analysis showed that ever smokers had worse self-reported scores in BASDAI with age-sex adjusted parameter estimate (B) = 0.59 (95% CI 0.23 ; 0.94), BASFI B = 0.59 (95% CI 0.17 ; 1.00), pain B = 0.45 (95% CI 0.08 ; 0.82) and fatigue B = 0.43 (95% CI  0.03 ; 0.83), no of painful areas B = 0.73 (95% CI  0.06 ; 1.46) and also in EQ-5D B = -0.06 (95% CI -0.11 ; -0.002).                                                                                                                                                

    Conclusion: In a large population based axial SpA cohort, both patients with AS and non AS axial SpA who were ever smokers reported worse clinical features compared with never smokers. Further longitudinal studies are needed to better understand cause and effect. However, smoking cessation should be recommended not only due to general health perspectives but also due to disease specific issues.

    References

    1Smokers in early axial spondyloarthritis have earlier disease onset, more disease activity, inflammation and damage, and poorer function and health-related quality of life: results from the DESIR cohort. Chung HY, Machado P, van der Heijde D, D'Agostino MA, Dougados M. Ann Rheum Dis. 2012 Jun;71(6):809-16.

  • 34.
    Bremander, Ann
    et al.
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Research and Development Center, Spenshult Hospital, Oskarström, Sweden.
    Wikström, Ingegerd
    Musculoskeletal Sciences, Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Larsson, Ingrid
    Research and Development Center, Spenshult Hospital, Oskarström, Sweden.
    Bengtsson, Maria
    Department of Rheumatology, Clinical Sciences Lund and Malmö, Lund University, Lund, Sweden.
    Hagel, Sofia
    Department of Rheumatology, Clinical Sciences Lund and Malmö, Lund University, Lund, Sweden.
    Strömbeck, Britta
    Musculoskeletal Sciences, Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Cultural adaptation, validity, reliability and responsiveness of the Swedish version of the effective musculoskeletal consumer scale (EC-17)2012In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 10, no 1, p. 43-50Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Endorsed by the Outcome MEasures in Rheumatoid Arthritis in Clinical Trials (OMERACT) group, The Effective Consumer Scale (EC-17) was developed in English for patients with musculoskeletal diseases to assess the skills and perceptions important for participating in and managing health care. The objective of this study was culturally to adapt the questionnaire into Swedish and to study its psychometric properties.

    METHODS: After translation of the questionnaire into Swedish, two different groups of outpatients from two specialist rheumatology departments participated in the study. Face validity was assessed, together with internal consistency, test-retest and responsiveness of the questionnaire. Construct validity was assessed using the Arthritis Self-Efficacy Scale (ASES), and responsiveness to a five day educational intervention was analysed using the standardized response mean (SRM).

    RESULTS: Analyses were based on 124 patients with inflammatory rheumatic diseases, of whom 50 attended the intervention. Data quality met the requirements, with missing values <5%, and floor and ceiling effects <15%. Item total correlations were all >0.4, ranging from 0.49 to 0.88. Cronbach's alpha was 0.93 and 0.95 for the two groups. The test-retest correlation (ICC₂.₁) was 0.94, and there was a significant improvement as a result of the intervention, with an SRM of 0.43. However, the questionnaire had a higher construct validity with the ASES subscale 'other symptoms' than hypothesized a priori (r(s) 0.75).

    CONCLUSION: The Swedish version of the EC-17 met the required recommendations for face validity, internal consistency, test-retest reliability and responsiveness. Its construct validity needs to be further established, and the questionnaire needs further testing in different groups of patients and in different interventions. © 2012 John Wiley & Sons, Ltd.

  • 35.
    Brorsson, S.
    et al.
    Health and Welfare, Dala Sports Academy, Dalarna University, Falun, Sweden.
    Thorstensson, C.
    Department of Clinical Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
    Nilsdotter, A.
    Department of Research and Education, Halmstad County Hospital, Halmstad, Sweden.
    Bremander, Ann
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Two different sets of handexercises improved grip strength after after eight weeks in patients with arthritis2014In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, no Suppl. 2, p. 1210-1210Article in journal (Refereed)
    Abstract [en]

    Background Hand function measured as grip force and finger extension force is often impaired in patients with rheumatoid arthritis (RA) and hand osteoarthritis (HOA) affecting performance of daily activities why hand exercises are recommended. A number of hand exercises are often used in the clinic but there is little information about “the effects of a minimal set of hand exercises” and if the choice of exercises is important to improve strength and function in the hand.

    Objectives To study the effect on grip- and finger extension strength and patient reported hand function from two different sets of handexercises performed over 8 weeks using a randomized study design.

    Methods Female patients with arthritis (RA and HOA, n=121) were randomly assigned to two different sets of handexercises (HE) for 8 weeks. The four hand exercises applied in the program were exercises commonly used in traditional hand training programs. The exercises were split into two groups depending on if the muscle activation (measured with EMG) were greater in forearm flexor (HE I, n=62) or in extensor muscles (HE II, n=59) (REF). HE I: isolated finger opposition (digits II-V) and rolling the putty with a flat hand, HE II: squeezing the putty and finger extension with putty resistance. The two HE were performed daily and each set was repeated 15 times, training time per day was maximum 5 minutes 7 days/week.

    Grip strength was measured with Grippit and finger extension strength with EX-it both validated instruments (unit: N). Pain was measured with a Visual Analogue Scale (VAS), 0-10 (best to worst). Hand functions were evaluated with the patient reported questionnaire Quick Disability Arm Shoulder and Hand (QuickDASH), 0-100 (best to worst).

    Results Mean grip strength (p=0.01) and mean finger extension force (p=0.004) increased after the training period in the group using HE I. In HE II the mean finger extension force increased (p=0.044), table 1. Hand function was stable over the training period.

    Table 1.

    Descriptive data of finger extension (EXIT) force and grip strength in the right hand, hand function (QuickDASH) and VAS pain presented as mean ± SD (min–max)

    Conclusions Five daily minutes with two hand exercises resulted increased grip strength and finger extension force after eight weeks. We suggest that hand exercises should be combined and selected to improve both flexor and extensor muscle strength of the forearm.

  • 36.
    Brorsson, Sofia
    et al.
    Dalarna University, Falun, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Spenshult Hospital, Oskarström, Sweden.
    Qualitative differences in the muscle activities in the forearm flexor and extensor muscles in healthy men and women in different ages2012In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 71, no Suppl. 3, p. 755-755Article in journal (Refereed)
    Abstract [en]

    Background:

    Balance between flexor and extensor muscle activity is essential for optimal function. This has been demonstrated previously for the lower extremity, trunk and shoulder function, but information on the relationship in hand function is lacking.

    Objectives:

    The purpose of this study was to evaluate whether there are qualitative differences in finger extension force, grip force, force duration, force balance and the muscle activities in the forearm flexor and extensor muscles in healthy men and women in different ages.

    Methods:

    Healthy controls (men, n=65, women, n=40) were included. Primary outcome was muscle activity measured with S-EMG and finger flexion- and finger extension force in Newton (N). The maximal force from the first trial was used as reference value (maximal voluntary isometric contraction, MVIC). The S-EMG activity of the m. extensor digitorum communis (EDC) and the m. flexor carpi radialis (FCR) were measured on the dominant hand when performing seven clinically often used hand exercises. Hand function was also evaluated with the self-reported questioner Quick DASH and VAS pain and VAS stiffness.

    Results:

    The force balance between finger extension and flexion force was statistically significant for both men (r=0.51, p=0.000) and women (r=0.78, p=0.000). The finger extension force was not influenced by age, but flexion force was significantly correlated to age. The coefficient of determination showed that age and gender can explain 45-55% of differences in the force measurements. Muscle activity from hand exercises was significant related to gender for EDC and muscle activity in FCR showed significantly relation to age. Only 3 of the 7 hand exercise were adjustable for both men and women unrelatedly to age. Concerning the muscle activation in EDC and FCR in daily activities, the age and gender explain 31% respectively 19% of the differences.

    Conclusions:

    This study shows that there are differences between men and women's hand force capacity and that gender and age can explain 45-55% of the differences. Furthermore this study shows that the EDC muscle is related to gender and FCR is related to age. In a longer perspective this information is useful for designing optimal training program for adjusted for gender and age.

    References:

    Greig M, Wells R. A systematic exploration of distal arm muscle activity and perceived exertion while applying external forces and moments. Ergonomics. [Research Support, Non-U.S. Gov't]. 2008 Aug;51(8):1238-57.

    Nordenskiold U, Grimby G. Assessments of disability in women with rheumatoid arthritis in relation to grip force and pain. Disabil Rehabil. 1997 Jan;19(1):13-9.

    Kapandji I. The physiology of the joints - annotated diagrams of the mechanics of the human joints. Edingburgh London, Melborne and New York: Churchill Livingstone; 1982.

    Brorsson S, Nilsdotter A, Sollerman C, Baerveldt AJ, Hilliges M. A new force measurement device for evaluating finger extension function in the healthy and rheumatoid arthritic hand. Technol Health Care. 2008;16(4):283-92.

    Disclosure of Interest: None Declared

  • 37.
    Brorsson, Sofia
    et al.
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS).
    Nilsdotter, Anna
    Department of Research and Education, Halmstad County Hospital, Halmstad, Sweden.
    Pedersen, Eja
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS).
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS).
    Thorstensson, Carina
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Relationship between finger flexion and extension force in healthy women and women with rheumatoid arthritis2012In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, no 7, p. 605-608Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Balance between flexor and extensor muscle activity is essential for optimal function. The purpose of this pilot study was to compare the relationship between maximum finger flexion force and maximum finger extension force in women with rheumatoid arthritis and healthy women.

    METHODS: Twenty healthy women (median age 61 years) and 20 women with rheumatoid arthritis (median age 59.5 years, median disease duration 16.5 years) were included in the study. Finger extension force was measured with an electronic device, EX-it, and finger flexion force using Grippit. The Grip Ability Test and the score from the patient-reported outcome Disability Arm Shoulder and Hand were used to evaluate activity limitations.

    RESULTS: Patients with rheumatoid arthritis showed significantly decreased hand function compared with healthy controls. A correlation was found between extension force and flexion force in the healthy group (r = 0.65, p = 0.002),but not in the rheumatoid arthritis group (r = 0.25, p = 0.289).

    CONCLUSION: Impaired hand function appears to influence the relationship between maximum finger flexion and extension force. This study showed a difference in the relationship between maximum finger flexion and extension force in healthy controls and those with rheumatoid arthritis. © 2012 Foundation of Rehabilitation Information.

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  • 38.
    Brorsson, Sofia
    et al.
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Health and Welfare, Dala Sports Academy, Dalarna University, Falun, Sweden.
    Nilsdotter, Anna
    Department of Research and Education, Halmstad County Hospital, Halmstad, Sweden.
    Thorstensson, Carina
    Department of Clinical Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden & Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden & Research and Development Center, Spenshult, Oskarström, Sweden.
    Differences in muscle activity during hand-dexterity tasks between women with arthritis and a healthy reference group2014In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 15, no 1, article id 154Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Impaired hand function is common in patients with arthritis and it affects performance of daily activities; thus, hand exercises are recommended. There is little information on the extent to which the disease affects activation of the flexor and extensor muscles during these hand-dexterity tasks. The purpose of this study was to compare muscle activation during such tasks in subjects with arthritis and in a healthy reference group.

    METHODS: Muscle activation was measured in m. extensor digitorium communis (EDC) and in m. flexor carpi radialis (FCR) with surface electromyography (EMG) in women with rheumatoid arthritis (RA, n = 20), hand osteoarthritis (HOA, n = 16) and in a healthy reference group (n = 20) during the performance of four daily activity tasks and four hand exercises. Maximal voluntary isometric contraction (MVIC) was measured to enable intermuscular comparisons, and muscle activation is presented as %MVIC.

    RESULTS: The arthritis group used a higher %MVIC than the reference group in both FCR and EDC when cutting with a pair of scissors, pulling up a zipper and-for the EDC-also when writing with a pen and using a key (p < 0.02). The exercise "rolling dough with flat hands" required the lowest %MVIC and may be less effective in improving muscle strength.

    CONCLUSIONS: Women with arthritis tend to use higher levels of muscle activation in daily tasks than healthy women, and wrist extensors and flexors appear to be equally affected. It is important that hand training programs reflect real-life situations and focus also on extensor strength. © 2014 Brorsson et al.; licensee BioMed Central Ltd.

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  • 39.
    Brorsson, Sofia
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Lugnet Institute of Sport Science, Dalarna University, Falun, Sweden.
    Nilsdotter, Anna
    Department of Research and Education, Halmstad Central Hospital, Halmstad, Sweden.
    Thorstensson, Carina
    Research and Development Centre, Spenshult, Oskarström, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Research and Development Centre, Spenshult, Oskarström, Sweden.
    Hand flexor and extensor muscle activity in daily activities and hand exercises in women with rheumatoid arthritis or hand osteoarthritis2012In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 71, no Suppl. 3, p. 754-754Article in journal (Refereed)
    Abstract [en]

    Background: Impaired hand grip function is common and occurs early in the course of disease in patients with rheumatoid arthritis (RA) and hand osteoarthritis (HOA), affecting daily life activities and quality of life.

    Objectives: To evaluate muscle force and muscle activity in forearm flexors and extensors during daily activities and clinically well-known hand exercises in women with RA and HOA compared with healthy controls

    Methods: The RA group was consecutively included from a specialist clinic and had a disease duration of at least one year.  Women with HOA were allocated from out-patients primary health care clinics in the same area and clinically diagnosed with symptomatic HOA. The age matched control group had no history of hand/arm injuries, inflammatory or muscle disease. Full active finger extension ability was required for all subjects. Hand force (Newton) was measured with EX-it (extension) and Grippit (flexion), both validated instruments. Muscle activity was measured in m. extensor digitorum communis (EDC) and m. flexor carpi radialis (FCR) with surface EMG (S-EMG) on the dominant hand while performing four daily activities (ADL) and four hand exercises and described as percent of maximal voluntary isometric contraction (% MVIC) based on data from EX-it and Grippit. Pain was measured with Visual Analogue Scale (VAS) 0-10 (best to worst). Differences between groups were analyzed and controlled for age.

    Results: Fifty-six women were included; 20 with RA (age mean (SD) 59.2 (10.7) years, VAS pain 2.2 (1.6)), 16 with HOA (age 67.5 (9.3) years, VAS pain 4.1 (1.9)) and 20 healthy controls (age 56.0 (9.7) years). Women with RA and HOA showed decreased extension and flexion force compared with healthy women (p<0.03).There was a tendency towards higher % MVIC in all tests for women with RA or HOA compared with healthy women, with a statistically significant difference between HOA and healthy women for EDC (p<0.05).

    ADL activities “writing with a pen”, and “cutting with scissors” showed the highest % MVIC in both EDC and FCR in all groups. The exercises “isolated opposition”, and “rolling the dough with flat hands”, had high % MVIC in EDC, while “squeezing the dough” and “isolated opposition” had high % MVIC in FCR.

    Conclusions: Women with RA and HOA tend to use a higher % MVIC than healthy women in many daily activities and in hand exercises. Strengthening exercises should include both extensor and flexor specific training.

    Disclosure of Interest: None Declared

  • 40.
    Cöster, Maria C.
    et al.
    Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
    Bremander, Ann
    Department of Rheumatology, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Rosengren, Björn E.
    Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
    Magnusson, Håkan
    Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
    Carlsson, Åke
    Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
    Karlsson, Magnus K.
    Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
    Validity, reliability, and responsiveness of the Self-reported Foot and Ankle Score (SEFAS) in forefoot, hindfoot, and ankle disorders2014In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 85, no 2, p. 187-194Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: The self-reported foot and ankle score (SEFAS) is a questionnaire designed to evaluate disorders of the foot and ankle, but it is only validated for arthritis in the ankle. We validated SEFAS in patients with forefoot, midfoot, hindfoot, and ankle disorders.

    PATIENTS AND METHODS: 118 patients with forefoot disorders and 106 patients with hindfoot or ankle disorders completed the SEFAS, the foot and ankle outcome score (FAOS), SF-36, and EQ-5D before surgery. We evaluated construct validity for SEFAS versus FAOS, SF-36, and EQ-5D; floor and ceiling effects; test-retest reliability (ICC); internal consistency; and agreement. Responsiveness was evaluated by effect size (ES) and standardized response mean (SRM) 6 months after surgery. The analyses were done separately in patients with forefoot disorders and hindfoot/ankle disorders.

    RESULTS: Comparing SEFAS to the other scores, convergent validity (when correlating foot-specific questions) and divergent validity (when correlating foot-specific and general questions) were confirmed. SEFAS had no floor and ceiling effects. In patients with forefoot disorders, ICC was 0.92 (CI: 0.85-0.96), Cronbach's α was 0.84, ES was 1.29, and SRM was 1.27. In patients with hindfoot or ankle disorders, ICC was 0.93 (CI: 0.88-0.96), Cronbach's α was 0.86, ES was 1.05, and SRM was 0.99.

    INTERPRETATION: SEFAS has acceptable validity, reliability, and responsiveness in patients with various forefoot, hindfoot, and ankle disorders. SEFAS is therefore an appropriate patient- reported outcome measure (PROM) for these patients, even in national registries.

  • 41.
    Cöster, Maria C.
    et al.
    Kalmar Hospital, Kalmar, Sweden.
    Bremander, Ann
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Rosengren, Björn
    Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital Malmö, Sweden.
    Magnusson, Håkan
    Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital Malmö, Sweden.
    Carlsson, Åke S.
    Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital Malmö, Sweden.
    Karlsson, Magnus K.
    Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital Malmö, Sweden.
    Validation of Two Foot and Ankle Scores – SEFAS (Self-reported Foot And Ankle Score) and AOFAS2014Conference paper (Refereed)
    Abstract [en]

    INTRODUCTION: The American Orthopedic Foot and Ankle Score (AOFAS) is for many foot and ankle surgeons the gold standard for evaluation of foot and ankle disorders. The score comprises of four different questionnaires depending on which region is evaluated, and covers three different constructs; pain, function and range of motion and alignment. AOFAS however, requires clinical examination, and can therefore not be used as a patient-reported outcome measure (PROM). In contrast, the Self-Reported Foot and Ankle Score (SEFAS) is a PROM that recently has been validated with good results in patients with foot and ankle disorders. The SEFAS contains 12 questions and covers different constructs such as pain, function and limitation of function. The aim of this study was to compare the SEFAS and AOFAS in patients with disorders in the great toe, the hindfoot and ankle, taking psychometric properties for scores into account.PATIENTS AND METHODS: The SEFAS and AOFAS scores were completed by 73 patients with disorders in the great toe and by 89 patients with disorders in the hindfoot or ankle. The time it took to complete the questionnaire was measured in 17 patients. In all patients, construct validity for SEFAS versus AOFAS was estimated by Spearman´s correlation coefficient and we also evaluated if there were any floor and ceiling effects. Test-retest reliability (intra-observer reliability) was measured for SEFAS in 68 patients and for AOFAS in 33 patients with intra-class correlation coefficient (ICC). Inter-observer reliability was calculated in nine patients for AOFAS using ICC. Responsiveness, i.e. the ability of a score to detect changes after a surgical intervention, was estimated by effect size (ES) and standardized response mean (SRM) in 120 patients for SEFAS and in 112 patients for AOFAS.RESULTS: The SEFAS was completed more than three times faster than AOFAS (165 seconds versus 515 seconds). SEFAS had good convergent validity (strong correlation) with AOFAS with a Spearman´s correlation coefficient of 0.64 in patients with great toe disorders and 0.65 in patients with hind foot/ankle disorders. There were no floor or ceiling effects in either of the scores. ICC was in patients with great toe disorders 0.94 (95% CI: 0.87-0.97) for SEFAS and 0.77 (95% CI: 0.39-0.93) for AOFAS, and in patients with hindfoot/ankle disorders 0.92 (95%CI: 0.85-0.95) for SEFAS and 0.52 (95%CI: 0.13-0.77) for AOFAS. ES was 1.4 for SEFAS and 1.8 for AOFAS and SRM 1.4 for SEFAS and 1.6 for AOFAS in patients with great toe disorders. ES was 1.2 for SEFAS and 1.1 for AOFAS and SRM 1.1 for SEFAS and 0.9 for AOFAS in patients with hindfoot/ ankle disorders. Inter-observer reliability was 0.43 (95% CI: 0.0-0.84) for AOFAS.DISCUSSION AND CONCLUSION: In this study there was a strong correlation between SEFAS and AOFAS indicating good construct validity for SEFAS. Both scores had good responsiveness and no floor or ceiling effects. The test-retest reliability was better for SEFAS than AOFAS while the inter-observer reliability was low for AOFAS. Finally, SEFAS was completed three times faster than AOFAS. In conclusion we consider SEFAS at least equal to AOFAS for evaluation of patients with foot and ankle disorders, and as no clinical examination is demanded in SEFAS, it is an ideal instrument for evaluation of clinical patient outcome in national registers.

  • 42.
    Cöster, Maria C.
    et al.
    Department of Orthopedics and Clinical Sciences, SUS Malmö, Malmö, Sweden.
    Nilsdotter, Anna
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Brudin, Lars
    Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden & Department of Medicine and Health Sciences, Linköping University Hospital, Linköping, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Minimally important change, measurement error, and responsiveness for the Self-Reported Foot and Ankle Score2017In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 88, no 3, p. 300-304Article in journal (Refereed)
    Abstract [en]

    Background and purpose: Patient-reported outcome measures (PROMs) are increasingly used to evaluate results in orthopedic surgery. To enhance good responsiveness with a PROM, the minimally important change (MIC) should be established. MIC reflects the smallest measured change in score that is perceived as being relevant by the patients. We assessed MIC for the Self-reported Foot and Ankle Score (SEFAS) used in Swedish national registries.

    Patients and methods: Patients with forefoot disorders (n = 83) or hindfoot/ankle disorders (n = 80) completed the SEFAS before surgery and 6 months after surgery. At 6 months also, a patient global assessment (PGA) scaleas external criterionwas completed. Measurement error was expressed as the standard error of a single determination. MIC was calculated by (1) median change scores in improved patients on the PGA scale, and (2) the best cutoff point (BCP) and area under the curve (AUC) using analysis of receiver operating characteristic curves (ROCs).

    Results: The change in mean summary score was the same, 9 (SD 9), in patients with forefoot disorders and in patients with hindfoot/ankle disorders. MIC for SEFAS in the total sample was 5 score points (IQR: 2-8) and the measurement error was 2.4. BCP was 5 and AUC was 0.8 (95% CI: 0.7-0.9).

    Interpretation: As previously shown, SEFAS has good responsiveness. The score change in SEFAS 6 months after surgery should exceed 5 score points in both forefoot patients and hindfoot/ankle patients to be considered as being clinically relevant.

    © 2017 The Author(s). Published by Taylor & Francis on behalf of the Nordic Orthopedic Federation.

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  • 43.
    Cöster, Maria C
    et al.
    Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
    Rosengren, Björn E.
    Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital Malmö, Sweden.
    Bremander, Ann
    Departments of Rheumatology and Clinical Sciences, Lund University, Lund, Sweden.
    Brudin, Lars
    Department of Clinical Physiology, Kalmar Hospital, Kalmar and Department of Medicine and Health Sciences, University Hospital Linköping, Linköping, Sweden.
    Karlsson, Magnus K.
    Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
    Comparison of the Self-Reported Foot and Ankle Score (SEFAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS)2014In: Foot & ankle international, ISSN 1071-1007, E-ISSN 1944-7876, Vol. 35, no 10, p. 1031-1036Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Self-reported Foot and Ankle Score (SEFAS) is a patient-reported outcome measure, while the American Orthopedic Foot and Ankle Society Score (AOFAS) is a clinician-based score, both used for evaluation of foot and ankle disorders. The purpose of this study was to compare the psychometric properties of these 2 scoring systems.

    METHODS: A total of 95 patients with great toe disorders and 111 patients with ankle or hindfoot disorders completed the 2 scores before and after surgery. We evaluated time to complete the scores in seconds, correlations between scores with Spearman's correlation coefficient (rs), floor and ceiling effects by proportion of individuals who reached the minimum or maximum values, test-retest reliability and interobserver reliability by intraclass correlation coefficient (ICC), internal consistency by Cronbach's coefficient alpha (CA), and responsiveness by effect size (ES). Data are provided as correlation coefficients, means, and standard deviations.

    RESULTS: SEFAS was completed 3 times faster than AOFAS. The scores correlated with an rs of .49 for great toe disorders and .67 for ankle/hindfoot disorders (both P < .001). None of the scores had any floor or ceiling effect. SEFAS test-retest ICC values measured 1 week apart were .89 for great toe and .92 for ankle/hindfoot disorders, while the corresponding ICC values for AOFAS were .57 and .75. AOFAS interobserver reliability ICC values were .70 for great toe and .81 for ankle/hindfoot disorders. SEFAS CA values were .85 for great toe and .86 for ankle/hindfoot disorders, while the corresponding CA values for AOFAS were .15 and .42. SEFAS ES values were 1.15 for great toe and 1.39 for ankle/hindfoot disorders, while the corresponding ES values for AOFAS were 1.05 and 1.73.

    CONCLUSION: As SEFAS showed similar or better outcome in our tests and was completed 3 times faster than AOFAS, we recommend SEFAS for evaluation of patients with foot and ankle disorders.

    LEVEL OF EVIDENCE: Level II, prospective comparative study. © The Author(s) 2014.

  • 44.
    Cöster, M.C.
    et al.
    Lund University, Skåne University Hospital Malmö, Sweden.
    Rosengren, B.E.
    Lund University, Skåne University Hospital Malmö, Sweden.
    Bremander, Ann
    Lund University, Lund, Sweden.
    Karlsson, M.K.
    Lund University, Skåne University Hospital Malmö, Sweden.
    Surgery for adult acquired flatfoot due to posterior tibial tendon dysfunction reduces pain, improves function and health related quality of life2015In: Foot and Ankle Surgery, ISSN 1268-7731, E-ISSN 1460-9584, Vol. 21, no 4, p. 286-289Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients with adult acquired flatfoot deformity (AAFD) due to posterior tibial tendon dysfunction (PTTD) may require surgery but few reports have evaluated the outcome.

    METHODS: We evaluated 21 patients with a median age of 60 (range 37-72) years who underwent different surgical reconstructions due to stage II AAFD before and 6 and 24 months after surgery by the validated Self-Reported Foot and Ankle Score (SEFAS), Short Form 36 (SF-36) and Euroquol 5 Dimensions (EQ-5D).

    RESULTS: The improvement from before to 24 months after surgery was in SEFAS mean 12 (95% confidence interval 8-15), SF-36 physical function 21 (10-22), SF-36 bodily pain 28 (17-38), EQ-5D 0.2 (0.1-0.3) and EQ-VAS 11 (2-21).

    CONCLUSION: Surgery for AFFD due to PTTD results in reduced pain and improved function and health related quality of life. The outcome scores have been demonstrated as useful. It has also been shown, since there is a further improvement between 6 and 24 months after surgery, that a minimum follow-up of 2 years is needed.

    LEVEL OF CLINICAL EVIDENCE: III - prospective observational cohort study.

    2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  • 45.
    Drake af Hagelsrum, Klara
    et al.
    Halmstad University, School of Health and Welfare.
    Mogard, Elisabeth
    Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Skane University Hospital, Department of Rheumatology, Lund, Sweden.
    Bremander, Ann
    Lund University, Section of Rheumatology, Department of Clinical Sciences Lund, Lund, Sweden; Spenshult, Research and Development Centre, Halmstad, Sweden; University of Southern Denmark, Department of Regional Health Research, Odense, Denmark; University Hospital of Southern Denmark, Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark.
    Lindqvist, Elisabet
    Lund University, Section of Rheumatology, Department of Clinical Sciences Lund, Lund, Sweden; Skane University Hospital, Department of Rheumatology, Lund, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare. Lund University, Section of Rheumatology, Department of Clinical Sciences Lund, Lund, Sweden; Spenshult, Research and Development Centre, Halmstad, Sweden.
    Healthcare professionals’ experiences of lifestyle management in patients with early rheumatoid arthritis: A qualitative study2022In: Annals of the Rheumatic Diseases, London: BMJ Publishing Group Ltd, 2022, Vol. 81, Suppl 1, p. 239-240Conference paper (Refereed)
    Abstract [en]

    Background: Rheumatoid Arthritis (RA) is a chronic inflammatory systemic disease that mainly affects joints and with symptoms such as stiffness, pain, and increased fatigue. RA also appears to be an independent risk factor for accelerated atherosclerosis with an increased risk of cardiovascular diseases, why national and international guidelines recommend proper pharmacological treatment together with a healthy lifestyle (1). Supporting people with early RA to achieve and maintain a healthy lifestyle is therefore of great importance. However, few studies have explored healthcare professionals’ views of working with lifestyle management. A healthy lifestyle does not only have the potential to lower cardiovascular risk but may also improve a person’s quality of life.

    Objectives: The aim of this study was to explore healthcare professionals´ experiences of lifestyle management in patients with early RA.

    Methods: In this explorative qualitative study, individual interviews were conducted with 20 healthcare professionals who had a mean of 16 years of professional experience in the field of working with patients with RA. An interview guide with open-ended questions was used e.g.: “How do you work with lifestyle changes in patients with RA?” and “What theories do you use to support lifestyle changes?” Qualitative content analysis was used, where three categories emerged: “The importance of a well-functioning organization”, “The importance of teamwork” and “The importance of person-centered care” and nine subcategories, representing the overall content of the interviews ( Table 1 ). 

  • 46.
    Drake af Hagelsrum, Klara
    et al.
    Halmstad University, School of Health and Welfare.
    Mogard, Elisabeth
    Lunds universitet, Lund, Sverige; Skåne University Hospital, Lund, Sweden.
    Bremander, Ann
    Lunds universitet, Lund, Sverige; Spenshult Research and Development Centre, Halmstad, Sweden; University of Southern Denmark, Odense, Denmark; University Hospital of Southern Denmark, Sønderborg, Denmark.
    Lindqvist, Elisabet
    Lunds universitet, Lund, Sverige; Skåne University Hospital, Lund, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare. Lunds universitet, Lund, Sverige; Spenshult, Research and Development Centre, Halmstad, Sweden.
    Healthcare Professionals’ Experiences Of Lifestyle management In Patients With Early Rheumatoidarthritis – A Qualitative Study2022In: ReumaBulletinen, ISSN 2000-2246, Vol. 154, no 4, p. 60-61Article in journal (Refereed)
    Abstract [en]

    Background: Rheumatoid Arthritis (RA) is a chronic inflammatory systemicdisease that mainly affects joints and with symptoms such asstiffness, pain, and increased fatigue. RA also appears to be anindependent risk factor for accelerated atherosclerosis withan increased risk of cardiovascular diseases, why national andinternational guidelines recommend proper pharmacologicaltreatment together with a healthy lifestyle (1). Supportingpeople with early RA to achieve and maintain a healthy lifestyleis therefore of great importance. However, few studies haveexplored healthcare professionals’ views of working with lifestylemanagement. A healthy lifestyle does not only have the potential tolower cardiovascular risk but may also improve a person’s qualityof life.

    Objectives: The aim of this study was to explore healthcare professionals´experiences of lifestyle management in patients with early RA.

    Methods: In this explorative qualitative study, individual interviews wereconducted with 20 healthcare professionals who had a mean of 16years of professional experience in the field of working with patientswith RA. An interview guide with open-ended questions was usede.g.: “How do you work with lifestyle changes in patients withRA?“ and “What theories do you use to support lifestyle changes?”Qualitative content analysis was used, where three categoriesemerged: “The importance of a well-functioning organization“,“The importance of teamwork“ and “The importance of personcenteredcare” and nine subcategories, representing the overallcontent of the interviews (table 1).

    Results: Healthcare professionals’ experiences of lifestyle managementin patients with early RA included the importance of a wellfunctioningorganization with supportive leadership, priority oflifestyle management, and competence development in lifestylemanagement. The importance of teamwork was emphasizedincluding interdisciplinary team, professional expertise in lifestylehabits, and structured approach to lifestyle management. The healthcare professionals also highlighted the importance of personcenteredcare with individually tailored lifestyle management,shared decision-making, and patient engagement.

    Conclusion: Healthcare professionals’ experiences of lifestyle managementin patients with early RA reveal that commitment from both themanagement, the team, and the patient is important.

    References: 1. Agca R, Heslinga SC, Rollefstad S, et al. EULAR recommendationsfor cardiovascular disease risk management in patients withrheumatoid arthritis and other forms of inflammatory jointdisorders: 2015/2016 update. Ann Rheum Dis 2017;76:17-28.

  • 47.
    Drake af Hagelsrum, Klara
    et al.
    Halmstad University, School of Health and Welfare. Skåne University Hospital, Lund, Sweden.
    Mogard, Elisabeth
    Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden.
    Bremander, Ann
    Lund University, Lund, Sweden; Spenshult Research and Development Centre, Halmstad, Sweden; University of Southern Denmark, Odense, Denmark; University Hospital of Southern Denmark, Sonderborg, Denmark.
    Lindqvist, Elisabet
    Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare. Lund University, Lund, Sweden; Spenshult Research and Development Centre, Halmstad, Sweden.
    Healthcare professionals' perceptions of working on lifestyle management for patients with early rheumatoid arthritis – a qualitative study2023In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 18, no 1, article id 2241225Article in journal (Refereed)
    Abstract [en]

    AIM: To explore HPs' perceptions of working on lifestyle management for patients with early rheumatoid arthritis (RA). METHODS: In this qualitative study, individual interviews were conducted with 20 HPs. Qualitative content analysis was used, and three categories and six subcategories were identified. RESULTS: HPs' perceptions of working on lifestyle management for patients with early RA revealed a need for commitment from different levels. This included commitment from healthcare managers and organizations prioritizing work on lifestyle management and providing competence development for HPs. Commitment within the team regarding coordination of interdisciplinary teamwork and development of a structured lifestyle management approach, and commitment to involving patients in lifestyle management, by facilitating patient engagement and a person-centred approach. CONCLUSIONS: HPs' perceptions of working on lifestyle management for patients with early RA revealed that commitment from healthcare managers, organizations, and the interdisciplinary team was essential to facilitate collaboration, patient involvement, and a person-centred approach. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

  • 48.
    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

  • 49.
    Folkhammar Andersson, Siv
    et al.
    Unit of Rehabilitation, Kalmar County Council, Samrehab, Oskarshamn, Sweden.
    Bergman, Stefan
    The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Lund University, Lund, Sweden & FoU Spenshult, Halmstad, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Lund University, Lund, Sweden & FoU Spenshult, Halmstad, Sweden.
    Arthritis Management in Primary Care and Adherence to National Guidelines – a Swedish Survey Based on the Canadian Physiotherapists Arthritis Care Questionnaire2015In: Arthritis & Rheumatology, ISSN 2326-5191, E-ISSN 2326-5205, Vol. 67, no Suppl. S10, article id 2385Article in journal (Refereed)
    Abstract [en]

    Background/Purpose:

    For patients with osteoarthritis (OA) physical therapy is recommended first line treatment and performed in primary care while patients with rheumatoid arthritis (RA) may be treated in primary care at disease onset and during stable phases of the disease. This requires updated skills and evidence based knowledge of the physical therapists (PTs) in arthritis treatment. The aim of this study was to explore physical therapy arthritis practice in primary care and to study the application of evidence based care given to patients with OA or RA.

    Methods:

    All PTs working in primary care in one health care region in Sweden (n=70) were e-mailed a questionnaire (the Canadian Physiotherapists Arthritis Care Survey1) to assess the frequency of current practice, feeling of confidence, educational needs and adherence to national guidelines in managing patients with OA or RA.  The questionnaire was translated and culturally adapted into Swedish according to international recommendations. Interventions supported by national guidelines were compared with reports of treatment modalities in the questionnaire. Mann-Whitney U test, Chi-square test or Fishers Exact test, were used where appropriate, to analyze differences between groups (PT management of patients with OA vs. RA).

    Results:

    Sixty-four PTs responded (91%), reporting a higher feeling of confidence in assessment, treatment and education for patients with OA than for RA (p<0.001). The total numbers of roles assumed by the PTs were higher in management of OA compared to RA (p<0.001). PTs who assumed a large numbers of roles also reported a higher feeling of confident in assessing OA (p=0.036). PTs who assumed a lower numbers of roles also reported a lower feeling of confidence in RA treatment (p=0.045). The recommendations in the guidelines were reported to be followed by almost all PTs in managing patients with RA and for eight out of eleven treatment modalities for patients with OA. Most PTs did provide joint mobilization and education of proper footwear for patients with OA even though Swedish national guidelines did not recommend this as treatment until further research has proven its effectiveness.

    Conclusion:

    PTs reported a lower feeling of confidence and to have assumed a lower numbers of roles in managing patients with RA than OA. There was a good adherence to the national guidelines for almost all listed treatment modalities. However, experienced evidence care and national guidelines did not totally agree. The results indicate a need for education in arthritis care, especially in RA.

    References:

    Li CL, Hurkmans EJ, Sayre EC, Vliet Vlieland TPM (2010). Continuing professional development is associated with increasing physical therapists´ roles in arthritis management in Canada and the Netherlands. Physical Therapy 90:629-42.

  • 50.
    Folkhammar Andersson, Siv
    et al.
    Kalmar County Council, Oskarshamn, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Welin Henriksson, Elisabet
    Karolinska Institutet, Huddinge, Sweden & Linköping University, Linköping, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Lund University, Lund, Sweden.
    Arthritis management in primary care – a study of physiotherapists’ current practice, educational needs, and adherence to national guidelines2017In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 15, no 3, p. 333-340Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: With an increasing number of patients with osteoarthritis (OA) and rheumatoid arthritis (RA) in primary care, our aim was to investigate arthritis-related practice in physiotherapy and to study adherence to evidence-based care.

    METHODS: Seventy physiotherapists (PTs) working in primary care were emailed a questionnaire to investigate current practice and the number of roles assumed by PTs, the degree of confidence, educational needs and adherence to national guidelines in managing patients with OA or RA. Interventions supported by national guidelines were compared with reports of treatment modalities in the questionnaire.

    RESULTS: Sixty-four (91%) PTs responded, and they reported a higher degree of confidence in assessment, treatment and education of patients with OA than for those with RA (p < 0.001). The total number of roles assumed by the PTs was higher in the management of OA than for RA (p < 0.001). PTs who assumed a greater number of roles also reported a stronger degree of confidence in assessing OA (p = 0.036). Those who assumed fewer roles also reported less confidence in RA treatment (p = 0.045). Recommendations in the guidelines were followed by the majority of PTs for eight of 11 treatment modalities in OA and for six of six in RA.

    CONCLUSIONS: PTs reported a lower degree of confidence and the assumption of fewer roles in managing patients with RA compared with OA. There was good adherence to the national guidelines for almost all the treatment modalities listed. Even so, the results indicate a need for education, especially in chronic inflammatory arthritis care.

    Copyright © 2016 John Wiley & Sons, Ltd.

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