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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
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). FoU Spenshult, Halmstad, Sweden.
    Haglund, Emma
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (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 study2018Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, nr Suppl. 2, s. 87-87Artikkel i tidsskrift (Fagfellevurdert)
    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
    FoU Spenshult, Halmstad, Sweden & Department of Clinical Sciences, Lund University, Lund, Sweden.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). FoU Spenshult, Halmstad, Sweden.
    Haglund, Emma
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). FoU Spenshult, Halmstad, Sweden.
    Larsson, Ingrid
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (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 study2018Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, s. 87-87, artikkel-id OP0072Artikkel i tidsskrift (Fagfellevurdert)
    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.
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI), Hälsa och idrott. Spenshult Research and Development Center, FoU Spenshult, Halmstad, Sweden & Karolinska Institutet, Stockholm, Sweden.
    Andersson, Maria
    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
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Spenshult Research and Development Center, FoU Spenshult, Halmstad, Sweden.
    Larsson, Ingrid
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI), Hälsa och omvårdnad. Spenshult Research and Development Center, FoU Spenshult, Halmstad, Sweden.
    Bergman, Stefan
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Sleep problems and fatigue as predictorsfor the onset of chronic widespread painover a 5- and 18-year perspective2018Inngår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 19, nr 1, s. 1-14Artikkel i tidsskrift (Fagfellevurdert)
    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.
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI), Hälsa och idrott.
    Bergman, Stefan
    Göteborgs Universitet.
    Bremander, Ann
    University of Southern Denmark, Odense..
    Haglund, Emma
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS).
    Larsson, Ingrid
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI), Hälsa och omvårdnad.
    Passive coping strategies but not physicalfunction are associated with worse mental health, in women with chronicwidespread pain– a mixed method study2019Inngår i: Annual Annals of the Rheumatic Diseases, 2019, artikkel-id A2159Konferansepaper (Fagfellevurdert)
    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.

  • 5.
    Aili, Katarina
    et al.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bergman, Stefan
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI). FoU Spenshult, Halmstad, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). FoU Spenshult, Halmstad, Sweden & Lund University, Lund, Sweden.
    Haglund, Emma
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). FoU Spenshult, Halmstad, Sweden.
    Larsson, Ingrid
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI). FoU Spenshult, Halmstad, Sweden.
    Women’s experiences of coping with chronic widespread pain: – a qualitative study2018Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, s. 1815-1815, artikkel-id FRI10737-HPRArtikkel i tidsskrift (Fagfellevurdert)
    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.
    Bergman, Stefan
    et al.
    Lund University, Lund, Sweden & University of Gothenburg, Gothenburg, Sweden & RandD centre Spenshult, Halmstad, Sweden.
    Haglund, Emma
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (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
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Lund University, Lund, Sweden & RandD centre Spenshult, Halmstad, Sweden.
    Chronic widespread pain, sleep problems and pressure pain thresholds in a population sample2018Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 7, nr 2, s. 1645-1646Artikkel i tidsskrift (Fagfellevurdert)
  • 7.
    Bremander, Ann
    et al.
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden & R&D centre, Spenshult, Halmstad, Sweden.
    Haglund, Emma
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (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 Pain2018Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, nr Suppl. 2, s. 1829-1830, artikkel-id SAT0737-HPRArtikkel i tidsskrift (Fagfellevurdert)
    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.

  • 8.
    Bremander, Ann
    et al.
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Haglund, Emma
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (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 Spondyloarthritis2017Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, nr Suppl. 2, s. 1495-1496Artikkel i tidsskrift (Fagfellevurdert)
  • 9.
    Bremander, Ann
    et al.
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Haglund, Emma
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (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 assessment2018Inngår i: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 16, nr 2, s. 313-317Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 10.
    Bremander, Ann
    et al.
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Bio- och miljösystemforskning (BLESS), Biomekanik och biomedicin. 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
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Bio- och miljösystemforskning (BLESS), Biomekanik och biomedicin. 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 cohort2015Inngår i: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 34, nr 3, s. 579-583Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 11.
    Bremander, Ann
    et al.
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Bio- och miljösystemforskning (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 Arthritis2012Inngår i: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 64, nr S10, s. S777-S778, artikkel-id 1828Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 12.
    Bremander, Ann
    et al.
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Bio- och miljösystemforskning (BLESS), Biomekanik och biomedicin. 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 Cohort2012Inngår i: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 64, nr S10, s. S43-S43, artikkel-id 95Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 13.
    Brodin, Nina
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Eurenius, Eva
    Karolinska Institutet, Stockholm, Sweden.
    Jensen, Irene
    Karolinska Institutet, Stockholm, Sweden.
    Nisell, Ralph
    Karolinska Institutet, Stockholm, Sweden.
    Opava, Christina H.
    Karolinska Institutet, Stockholm, Sweden.
    Almin, Ingrid
    Örebro University Hospital, Örebro, Sweden.
    Andersson, Britt
    Karolinska University Hospital–Solna, Stockholm, Sweden.
    Bertholds, Gunhild
    Skövde Hospital, Skövde, Sweden.
    Forsberg, Catarina
    Falun Hospital, Falun, Sweden.
    Haglund, Emma
    Spenshult AB, Oskarström, Sweden.
    Holmén-Andersson, Ann-Marie
    Sahlgrenska University Hospital, Mölndal, Sweden.
    Hultman, Anna
    Uppsala University Hospital, Uppsala, Sweden.
    Lennartsson, Claudia
    Karolinska University Hospital–Huddinge, Stockholm, Sweden.
    Norman, Elin
    Danderyd Hospital, Stockholm, Sweden.
    Coaching Patients With Early Rheumatoid Arthritis to Healthy Physical Activity: A Multicenter, Randomized, Controlled Study2008Inngår i: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 59, nr 3, s. 325-331Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    To investigate the effect of a 1-year coaching program for healthy physical activity on perceived health status, body function, and activity limitation in patients with early rheumatoid arthritis.

    Methods

    A total of 228 patients (169 women, 59 men, mean age 55 years, mean time since diagnosis 21 months) were randomized to 2 groups after assessments with the EuroQol visual analog scale (VAS), Grippit, Timed-Stands Test, Escola Paulista de Medicina Range of Motion scale, walking in a figure-of-8, a visual analog scale for pain, the Health Assessment Questionnaire disability index, a self-reported physical activity questionnaire, and the Disease Activity Score in 28 joints. All patients were regularly seen by rheumatologists and underwent rehabilitation as prescribed. Those in the intervention group were further individually coached by a physical therapist to reach or maintain healthy physical activity (≥30 minutes, moderately intensive activity, most days of the week).

    Results

    The retention rates after 1 year were 82% in the intervention group and 85% in the control group. The percentages of individuals in the intervention and control groups fulfilling the requirements for healthy physical activity were similar before (47% versus 51%; P > 0.05) and after (54% versus 44%; P > 0.05) the intervention. Analyses of outcome variables indicated improvements in the intervention group over the control group in the EuroQol VAS (P = 0.025) and muscle strength (Timed-Stands Test; P = 0.000) (Grippit; P = 0.003), but not in any other variables assessed.

    Conclusion

    A 1-year coaching program for healthy physical activity resulted in improved perceived health status and muscle strength, but the mechanisms remain unclear, as self-reported physical activity at healthy level did not change. © 2008, American College of Rheumatology.

  • 14.
    Gossec, L.
    et al.
    Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), Paris, France & Department of rheumatology, AP-HP, Pitié Salpêtrière Hospital, Paris, France.
    Smolen, J. S.
    Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria & Second Department of Medicine, Hietzing Hospital, Vienna, Austria.
    Ramiro, S.
    Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands.
    de Wit, M.
    EULAR, representing People with Arthritis/Rheumatism in Europe (PARE), London, United Kingdom.
    Cutolo, M.
    Research Laboratory and Clinical Division of Rheumatology, Department of Internal Medicine, University of Genova, Viale Benedetto, Italy.
    Dougados, M.
    Medicine Faculty, Paris Descartes University, Paris, France & Rheumatology B Department, APHP, Cochin Hospital, Paris, France.
    Emery, P.
    Leeds NIHR Musculoskeletal Biomedical Research Unit, LTHT, Leeds, United Kingdom & Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.
    Landewé, R.
    Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, Amsterdam, The Netherlands & Atrium Medical Center, Heerlen, The Netherlands.
    Oliver, S.
    North Devon, United Kingdom.
    Aletaha, D.
    Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
    Betteridge, N.
    EULAR, representing People with Arthritis/Rheumatism in Europe (PARE), London, United Kingdom.
    Braun, J.
    Rheumazentrum Ruhrgebiet, Herne and Ruhr-Universität Bochum, Herne, Germany.
    Burmester, G.
    Department of Rheumatology and Clinical Immunology, Charité—University Medicine Berlin, Germany.
    Cañete, J. D.
    Arthritis Unit, Department of Rheumatology, Hospital Clínic and IDIBAPS, Barcelona, Spain.
    Damjanov, N.
    Belgrade University School of Medicine, Belgrade, Serbia.
    FitzGerald, O.
    Department of Rheumatology, St. Vincent's University Hospital and Conway Institute, University College Dublin, Dublin, Ireland.
    Haglund, Emma
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Bio- och miljösystemforskning (BLESS). Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden.
    Helliwell, P.
    Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, United Kingdom.
    Kvien, T. K.
    Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
    Lories, R.
    Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, KU Leuven, Belgium & Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium.
    Luger, T.
    Department of Dermatology, University Hospital Münster, Münster, Germany.
    Maccarone, M.
    A.DI.PSO. (Associazione per la Difesa degli Psoriasici)—PE.Pso.POF (Pan European Psoriasis Patients’ Organization Forum), Rome, Italy.
    Marzo-Ortega, H.
    Leeds NIHR Musculoskeletal Biomedical Research Unit, LTHT, Leeds, United Kingdom & Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.
    McGonagle, D.
    Leeds NIHR Musculoskeletal Biomedical Research Unit, LTHT, Leeds, United Kingdom & Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.
    McInnes, I. B.
    Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom.
    Olivieri, I.
    Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy.
    Pavelka, K.
    Institute and Clinic of Rheumatology Charles University Prague, Czech Republic.
    Schett, G.
    Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany.
    Sieper, J.
    Department of Rheumatology, Campus Benjamin Franklin, Charité, Berlin, Germany.
    van den Bosch, F.
    Ghent University Hospital, Ghent, Belgium.
    Veale, D. J.
    Centre for Arthritis and Rheumatic Disease, Dublin Academic Medical Centre, St. Vincent's University Hospital, Dublin, Ireland.
    Wollenhaupt, J.
    Schoen Klinik Hamburg, Rheumatology and Clinical Immunology, Hamburg, Germany.
    Zink, A.
    Department of Rheumatology and Clinical Immunology, German Rheumatism Research Centre Berlin, Charité—University Medicine Berlin, Germany.
    van der Heijde, D.
    Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands.
    European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update2016Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 75, nr 3, s. 499-510Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Since the publication of the European League Against Rheumatism recommendations for the pharmacological treatment of psoriatic arthritis (PsA) in 2012, new evidence and new therapeutic agents have emerged. The objective was to update these recommendations.

    METHODS: A systematic literature review was performed regarding pharmacological treatment in PsA. Subsequently, recommendations were formulated based on the evidence and the expert opinion of the 34 Task Force members. Levels of evidence and strengths of recommendations were allocated.

    RESULTS: The updated recommendations comprise 5 overarching principles and 10 recommendations, covering pharmacological therapies for PsA from non-steroidal anti-inflammatory drugs (NSAIDs), to conventional synthetic (csDMARD) and biological (bDMARD) disease-modifying antirheumatic drugs, whatever their mode of action, taking articular and extra-articular manifestations of PsA into account, but focusing on musculoskeletal involvement. The overarching principles address the need for shared decision-making and treatment objectives. The recommendations address csDMARDs as an initial therapy after failure of NSAIDs and local therapy for active disease, followed, if necessary, by a bDMARD or a targeted synthetic DMARD (tsDMARD). The first bDMARD would usually be a tumour necrosis factor (TNF) inhibitor. bDMARDs targeting interleukin (IL)12/23 (ustekinumab) or IL-17 pathways (secukinumab) may be used in patients for whom TNF inhibitors are inappropriate and a tsDMARD such as a phosphodiesterase 4-inhibitor (apremilast) if bDMARDs are inappropriate. If the first bDMARD strategy fails, any other bDMARD or tsDMARD may be used.

    CONCLUSIONS: These recommendations provide stakeholders with an updated consensus on the pharmacological treatment of PsA and strategies to reach optimal outcomes in PsA, based on a combination of evidence and expert opinion. © 2015 BMJ Publishing Group Ltd & European League Against Rheumatism.

  • 15.
    Hagel, Sofia
    et al.
    Skåne University Hospital, Lund, Sweden & Lund University, Lund, Sweden.
    Haglund, Emma
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Spenshult Research and Development Center, Halmstad, Sweden.
    Content Validity of the Arthritis Self-Efficacy Scale2017Inngår i: Reumabulletinen, ISSN 2000-2246, nr 119; 4, s. 59-60, artikkel-id 93Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Appropriate evaluation is important to optimize health care interventions and to understand patient’s experiences of their situation. Self-efficacy has been proven to have impact on pain, fatigue, physical activity and on cardiovascular risk in patients with inflammatory arthritides, and adequate evaluation is important. The arthritis self-efficacy scale (ASES) is one patient reported outcome measure recommended for evaluation of self-efficacy in arthritides. The aim of this study was to start analyzing the content validity of the ASES through linking to the International Classification of Functioning (ICF), and by using the proposed structure for personal factors (PF).

    Material and methods: The linking to the ICF was performed through identification of each meaningful concept of heading, introduction and all question including answering options of the ASES subscales for pain and symptoms. Each identified meaningful concept was linked to the third level ICF domain, according to established linking rules. Concepts identified as potential personal factors were sorted into the proposed structure of personal factors (Geyh, 2011) when applicable. The two authors independently identified meaningful concepts and performed the linking to the ICF, and sorted into the structure of personal factors (PF). Disagreements were discussed thoroughly, and reviewed until consensus was reached.    

    Results: The ASES subscales for pain and symptom comprised 5 and 6 questions respectively. All questions were linked to the ICF domain body functions, at a minimum through each answering option that was linked to the b126 “temperament and personality functions”. Other body function domains covered were b130 (energy and drive functions), b134 (sleep functions), b152 (emotional functions), b160 (thought functions) and b280 (pain).

    Seven questions and the introduction of the ASES subscales for pain and symptom were linked to the ICF domain activity and participation (3 and 4 questions respectively).  Five questions were linked to d570 (looking after one’s health), while d220 (undertaking multiple tasks) and d230 (carrying out daily routine) were captured by both subscales although somewhat less well represented.

    Three questions were linked to the ICF domain environmental factors. Two ASES pain questions were linked to e110 (products and substances for personal consumption) while one ASES symptom question was linked to e425 (individual attitudes of acquaintances, peers, colleagues, neighbors and community members).

    Personal factors were identified in both ASES subscales. The answering options for all questions except two could be sorted into the PF concept “feelings”, the headings, introductions and six questions could be sorted into the PF concept “patterns of experience and behavior”, and three questions could be sorted into “thoughts and beliefs”.

    Conclusion: The ASES subscales for pain and symptom showed satisfying content validity since important constructs on all ICF domains (except for body structure) were included. Both ASES subscales also covered PF that contribute with important aspects on health, and impact of the disease, further improving the content validity. 

     

  • 16.
    Haglund, Emma
    et al.
    Spenshult R&D center, Oskarström, Sweden.
    Bergman, Stefan
    Spenshult R&D center, Oskarström, Sweden & Section of Rheumatology, Dept. of Clinical Sciences, Lund University, Lund, Sweden.
    Bremander, Ann
    Spenshult R&D center, Oskarström, Sweden & Section of Rheumatology, Dept. of Clinical Sciences, Lund University, Lund, Sweden.
    Gender differences in educational needs to manage the disease in individuals with spondyloarthritis2014Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, nr Suppl. 2, s. 140-141Artikkel i tidsskrift (Fagfellevurdert)
  • 17.
    Haglund, Emma
    et al.
    Lund University, Lund, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Petersson, Ingemar F.
    Lund University, Lund, Sweden.
    Jacobsson, Lennart T. H.
    Lund University, Lund, Sweden.
    Strömbeck, Britta
    Lund University, Lund, Sweden.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Bio- och miljösystemforskning (BLESS), Biomekanik och biomedicin. Lund University, Lund, Sweden.
    Differences in physical activity patterns in patients with spondylarthritis2012Inngår i: Arthritis Care and Research, ISSN 0893-7524, E-ISSN 1529-0123, Vol. 64, nr 12, s. 1886-1894Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To study patient-reported physical activity in patients with spondylarthritis (SpA) and possible differences in physical activity patterns between the SpA subtypes and sexes.

    METHODS: In 2009, a questionnaire including inquiries concerning physical activity was sent to patients with a SpA diagnosis (n = 3,711). The World Health Organization (WHO) global recommendations of physical activity for health requiring 150 minutes of moderate-intensity physical activity (MI-PA) or 75 minutes of vigorous-intensity physical activity (VI-PA) per week were used as recommended levels. Standardized risk ratios (RRs) were calculated by using physical activity data from the Swedish population. The association within the SpA group between sex, age, disease-related variables, anxiety, and depression and meeting recommended levels of MI-PA and VI-PA (dependent variables) was studied with multivariate analysis.

    RESULTS: A total of 2,167 patients with SpA (48% men, mean ± SD age 55 ± 14 years) responded to the questionnaire. Sixty-eight percent of the patients met the WHO recommendations, more frequently in women than in men (70% versus 66%). The recommendations were more often met in the SpA group (RR 1.09, 95% confidence interval [95% CI] 1.04-1.15) compared with the Swedish population. There was a tendency for young women to meet the WHO recommendations less often than the Swedish population (RR 0.94, 95% CI 0.63-1.25). Different factors were found to influence whether the patients were exercising with a moderate or vigorous intensity.

    CONCLUSION: Seven of 10 patients with SpA met the WHO recommendations of physical activity for health, but we found sex and disease subtype differences. This information can be useful in clinical practice when coaching patients to have a healthier lifestyle. © 2012 by the American College of Rheumatology.

  • 18.
    Haglund, Emma
    et al.
    R&D Center Spenshult, Oskarström, Sweden.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Bio- och miljösystemforskning (BLESS), Biomekanik och biomedicin.
    Bergman, Stefan
    Department of Rheumatology, Clinical sciences, Skåne University Hospital, Malmö, Sweden.
    Jacobsson, Lennart
    Department of Rheumatology, Clinical sciences, Skåne University Hospital, Malmö, Sweden.
    Strömbeck, Britta
    Musculoskeletal Sciences, Department of Orthopedics, Clinical Sciences, Lund, Sweden.
    Petersson, Ingemar
    Musculoskeletal Sciences, Department of Orthopedics, Clinical Sciences, Lund, Sweden.
    Work productivity in a population based cohort of patients with Spondyloarthritis2012Inngår i: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 64, nr 10, s. S1015-S1015Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Spondyloarthritis (SpA) often causes impaired function, activity limitations, affected health related quality of life and work disability. Work disability has been shown to be affected both in terms of absenteeism and in impaired productivity while working (presenteeism). In this group with increased socioeconomic costs there is also an increase in  the use of expensive pharmacotherapies. Thus, it is important to study factors related to the ability to stay productive while at work.

    Objective: The aim was to study factors associated with presenteeism in patients with SpA. Also to analyse possible differences in age, gender and SpA subtypes (ankylosing spondylitis, psoriatic arthritis and undifferentiated SpA).

    Methods: The analysis was based on 1773 patients seeking health care for SpA aged 18-67 years from southern Sweden, identified by a health care register. A questionnaire survey in 2009 included questions concerning self-reported presenteeism, defined as the percentage of impairment due to SpA while working 0-100, (0=no impact), was answered by 1447 individuals. Patients´ characteristics: disease duration, disease activity (BASDAI), physical function (BASFI), health related quality of life (EQ-5D), anxiety (HAD-a), depression (HAD-d), self-efficacy pain and symptom (ASES) and register based sick leave. The Pearson’s correlation coefficient and univariate analyses with ANOVA were used to study factors associated with presenteeism and t-test was used for group comparisons.

    Results: Fifty-five percent (n=802/1447) reported no impact on work presenteeism, while mean impairment was 20 (95% CI 18-21) (n=1447). Women reported higher impact on work presenteeism than men (mean impairment 23 vs. 17, p<0.001) but no statistically significant differences were found between the SpA subtype groups. Twenty-eight percent (n=504/1773) were registered for any sick leave (absenteeism > 14 days). Worse outcome in quality of life (EQ-5D), disease activity (BASDAI) and physical function (BASFI) all correlated to higher impact on work presenteeism (r >0.5, p <0.001), while sick leave (absenteeism) did not.  In the univariate analyses experiencing worse outcome in EQ-5D (β-est -9.6, p<0.001) BASDAI (β-est 7.8, p<0.001) and BASFI (β-est 7.3, p<0.001) were all associated to higher impact on presenteeism regardless of age, gender and disease subtype. Worse outcome of EQ-5D was associated to a higher degree impact on presenteeism in the younger women (18-52 yrs). Self-efficacy, anxiety, depression, disease duration and education level <12 years were all associated to higher impact on presenteeism but were not significant in all strata for age, gender and disease subtype.

    Conclusion: Quality of life, disease activity and physical function all affect work presenteeism in patients with SpA, regardless of age, gender and disease subtype. The results indicate that work presenteeism is affected in patients with all types of SpA and more affected in women. We also find that presenteeism and register based sick leave (absenteeism) may be related to different dimensions of the individuals and their disease.

  • 19.
    Haglund, Emma
    et al.
    Spenshult Research and Development Center, Spenshult, Oskarström, Sweden.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Bio- och miljösystemforskning (BLESS), Biomekanik och biomedicin. Spenshult Research and Development Center, Spenshult, Oskarström, Sweden.
    Bergman, Stefan
    Spenshult Research and Development Center, Spenshult, Oskarström, Sweden.
    Jacobsson, Lennart T H
    Department of Clinical Sciences, Malmö, Section of Rheumatology, Lund University, Lund, Sweden.
    Petersson, Ingemar F
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Work productivity in a population-based cohort of patients with spondyloarthritis2013Inngår i: Rheumatology, ISSN 1462-0324, E-ISSN 1462-0332, Vol. 52, nr 9, s. 1708-14Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To assess work productivity and associated factors in patients with SpA.

    METHODS: This cross-sectional postal survey included 1773 patients with SpA identified in a regional health care register. Items on presenteeism (reduced productivity at work, 0-100%, 0 = no reduction) were answered by 1447 individuals. Absenteeism was defined as register-based sick leave using data from a national register. Disease duration, disease activity (BASDAI), physical function (BASFI), health-related quality of life (EQ-5D), anxiety (HAD-a), depression (HAD-d), self-efficacy [Arthritis Self-efficacy Scale (ASES) pain and symptom], physical activity and education were also measured.

    RESULTS: Forty-five per cent reported reduced productivity at work with a mean reduction of 20% (95% CI 18, 21) and women reported a higher mean reduction than men (mean 23% vs 17%, P < 0.001). Worse quality of life, disease activity, physical function and anxiety all correlated with reduced productivity (r = 0.52-0.66, P < 0.001), while sick leave did not. Worse outcomes on the EQ-5D (β-est -9.6, P < 0.001), BASDAI (β-est 7.8, P < 0.001), BASFI (β-est 7.3, P < 0.001), ASES pain (β-est -0.5, P < 0.001) and HAD-d (β-est 3.4, P < 0.001) were associated with reduced productivity at work in patients with SpA regardless of age, gender and disease subgroup. ASES symptoms, HAD-a and education level <12 years were associated with reduced productivity but were not significant in all strata for age, gender and disease subgroup.

    CONCLUSION: Work productivity was reduced in patients with SpA and more so in women. Worse quality of life, disease activity, physical function, self-efficacy and depression were all associated with reduced productivity at work in patients with SpA.

    © The Author 2013. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.

  • 20.
    Haglund, Emma
    et al.
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Spenshult Research and Development Center, Halmstad, Sweden.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Spenshult Research and Development Center, Halmstad, Sweden & Lund University, Lund, Sweden.
    Bergman, Stefan
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI). Spenshult Research and Development Center, Halmstad, Sweden; Lund University, Lund, Sweden & ahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Larsson, Ingrid
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI), Hälsa och omvårdnad. Spenshult Research and Development Center, Halmstad, Sweden.
    Educational needs in patients with spondyloarthritis in Sweden - a mixed-methods study2017Inngår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 18, nr 1, artikkel-id 335Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: There is a demand for a flexible and individually tailored patient education to meet patients' specific needs and priorities, but this area has seldom been studied in patients with spondyloarthritis (SpA), a family of inflammatory rheumatic diseases. The aim of the present study was to identify needs and priorities in patient education in patients with SpA. A second aim was to investigate patients' experiences and preferences of receiving patient education.

    METHODS: Data collection included a questionnaire survey with the Educational Needs Assessment Tool (ENAT) and interviews, using a mixed-methods design. Patients were identified through a specialist clinic register. Descriptive data are presented as mean with standard deviation, or frequencies. Chi-square test and independent-samples t-test were used for group comparisons. A manifest qualitative conventional content analysis was conducted to explore patients' experiences and needs in patient education, based on two focus groups (n = 6) and five individual interviews.

    RESULTS: Almost half (43%) of the 183 SpA patients had educational needs, particularly regarding aspects of self-help, feelings, and the disease process. More educational needs were reported by women and in patients with higher disease activity, while duration of disease did not affect the needs. The qualitative analysis highlighted the importance of obtaining a guiding, reliable, and easily available patient education for management of SpA. Individual contacts with healthcare professionals were of importance, but newer media were also requested.

    CONCLUSION: There are considerable educational needs in patients with SpA, and education concerning self-help, feelings, and the diseases process were raised as important issues. Healthcare professionals need to consider the importance of presenting varied formats of education based on the experiences and preferences of patients with SpA. © 2017 The Author(s).

  • 21.
    Haglund, Emma
    et al.
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Bio- och miljösystemforskning (BLESS). Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Bio- och miljösystemforskning (BLESS), Biomekanik och biomedicin. Lund University, Lund, Sweden & 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.
    Larsson, Ingrid
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI), Hälsofrämjande processer. Spenshult Research and Development Center, Halmstad, Sweden.
    Patient Education in Spondyloarthritis Should be Guiding, Reliable and Available and Presented in Varied Formats2015Inngår i: Arthritis & Rheumatology, ISSN 2326-5191, E-ISSN 2326-5205, Vol. 67, nr Suppl. S10, artikkel-id 1196Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background/Purpose:

    The treatment target for axial spondyloarthritis (SpA) is to maximize health-related quality of life (HRQoL) by controlling disease activity and improving functioning. The treatment cornerstones are a combination of patient education, pharmacological and non-pharmacological treatment. Health professionals are familiar with providing patient education but the knowledge is scarce concerning how this education is experienced by the patients.

    The aim was to describe patients’ experiences of education in SpA management.

    Methods:

    The study had a descriptive design with a qualitative conventional content analysis approach performed in seven steps in accordance with Graneheim & Lundman (1). The analysis aimed to describe and preserve contextual meanings. After coding and subgrouping meaningful parts of the text were merged into categories. Eleven interviews were conducted between 2014-2015 in patients with SpA based on a strategic sampling in order to achieve variation with regard to sex (7 men, 4 women), age (38-66 years), subdiagnoses (5 patients with AS, 6 with USpA), quality of life (EQ5D 0.29-1.0), disease activity (BASDAI 1-6), physical function (BASFI 0-5), and global health (BASG 0-7) .

    Results:

    Three categories representing patients’ experiences of patient education in disease management emerged; guiding education, reliable education and available education. Guiding education comprised SpA management including disease knowledge such as symptoms, prognosis, treatment, self-management, climate impact, heredity, and assisting devices. Reliable education meant how and by whom the education was communicated and was considered reliable if it was based on science and communicated by specialists, for example by physician, nurse, PT, dietician and senior patients with experience of rheumatic diseases. The patients experienced difficulties in assessing the large flow of education coming from various sources. Individualized education also increased the reliability. Available education meant that the education can and should be presented in varied formats, and that the amount of information could be chosen. The education could be given orally (through meetings, videos, lectures), in writing (by pamphlets, e-mails, journals, webpages) or obtained through own personal experiences. There were requests to utilize newer media like skype, video and chat forums. Furthermore, individual contacts with healthcare professionals when needed were of importance.

    Conclusion:

    This study highlights the importance of obtaining a guiding, reliable and available patient education for management of SpA. Health care professionals need to consider the importance of presenting varied formats of education based on patients’ experiences and expectations.

    References:

    1.Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse education today 2004;24(2):105-12.

  • 22.
    Haglund, Emma
    et al.
    Section of Rheumatology, Dept. of Clinical Sciences, Lund University, Lund, Sweden & Spenshult R & D center, Oskarström, Sweden.
    Bremander, Ann
    Section of Rheumatology, Dept. of Clinical Sciences, Lund University, Lund & & Spenshult R & D center, Oskarström, Sweden.
    Petersson, I.F.
    Section of Rheumatology, Dept. of Clinical Sciences, Lund University, Lund, Sweden & Dept. of Orthopedics, Clinical Sciences, Lund University, Lund, Sweden.
    Bergman, Stefan
    Section of Rheumatology, Dept. of Clinical Sciences, Lund University, Lund, Sweden & Spenshult R & D center, Oskarström, Sweden.
    Self-reported disease characteristics do not explain why younger women with SpA are less physically active than older women with the disease2014Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, nr Suppl. 2, s. 159-159Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Exercise is a commonly used treatment for patients with spondyloarthritis (SpA) but younger women reach WHOs recommended level of physical activity (PA) to a less extent than peers in the general population (Haglund, 2012).

    Objectives To study if self-reported disease characteristics in patients with SpA can explain why younger women are less physically active than older women with the disease.

    Methods In a cross-sectional population based cohort study in southern Sweden, 1121 women (51.7% of the total SpAScania cohort) were identified by a health care register and responded to a questionnaire survey in 2009. The primary outcome was self-reported level of physical activity (PA) based on the WHOs recommendation. Self-reported pain (VAS), global health (VASglobal, BASG),health related quality of life (EQ-5D), disease activity (BASDAI), physical function (BASFI), self-efficacy pain and symptoms (ASES), anxiety (HADa), depression (HADd), education level, smoking habits and reported severity of the skin disease psoriasis (NRS) were reported. Younger (≤35 years of age, n=127) and older women (>35, n=994) and the disease subgroups AS/USpA (n=441) and PsA (n=680) were compared with regard to characteristic symptoms. T-test and chi-square test was used to analyze group differences, exact p-values are reported.

    Results Out of the 1121 women in the cohort, 1094 answered the questions concerning PA. There were no significant differences between younger/older women with AS/USpA reaching recommended level of PA (71% vs. 77%, p=0.23). In younger women with PsA there was a trend to not reaching the recommended level of PA to the same extent (58% vs. 70%, p=0.06).

    When comparing younger and older women concerning characteristic variables, there were significant worse self-reported VASglobal (3.9 vs. 4.5, p=0.004), BASDAI (4.2 vs 4.8, p=0.008), BASFI (2.4 vs. 3.8, p<0.001), BASG (3.6 vs. 4.4, p=0.001), ASES pain (53 vs. 49, p=0.02), ASES symptom (59 vs. 55, p=0.04) and HAD depression (3.7 vs. 4.6, p=0.04) in the older women.

    When stratified on the disease subgroups, VASglobal (3.8 vs. 4.3, p=0.05) and BASFI (2.6 vs. 3.6, p=0.002) were significantly worse for older women with AS/USpA (n=372) compared to the younger group (n=69). Older women with PsA (n=622) reported significantly worse VASpain (3.9 vs. 4.7, p=0.02), BASFI (2.2 vs. 3.9, p<0.001), BASG (3.5 vs. 4.5, p=0.004), ASES pain (54 vs. 57, p=0.01) and symptom (61 vs. 53, p=0.01), HAD depression (3.8 vs. 4.7, p=0.04) compared to the younger group (n=58). There was an inverse relationship regarding severity of psoriasis, were younger women with PsA have a tendency to report a more severe skin disease (3.9 vs. 3.2, p=0.09). When comparing characteristics for young women reaching or not reaching healthy PA, no differences were found.

    Conclusions Young women with SpA do not reach recommended level of PA in the same extend as in the population. There were no explanations found when comparing common self-reported variables in younger and older women with SpA in a defined cohort. The relationship needs to be studied further also from a qualitative aspect.

  • 23.
    Haglund, Emma
    et al.
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden & Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Bremander, Ann
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden & Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Petersson, Ingemar F.
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden & Department of Rheumatology, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Strömbeck, Britta
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Jacobsson, Lennart T. H.
    Department of Rheumatology, Clinical Sciences Malmö, Lund University, Lund, Sweden.
    Turkiewicz, Aleksandra
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Geborek, Pierre
    Department of Rheumatology, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Englund, Martin
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden & Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
    Prevalence of spondyloarthritis and its subtypes in southern Sweden2011Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 70, nr 6, s. 943-948Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To estimate the prevalence of spondyloarthritis and its subtypes.

    METHODS: The Swedish healthcare organisation comprises a system where all inpatient and outpatient care is registered by a personal identifier. For the calendar years 2003-7, all residents aged ≥ 15 years in the southernmost county of Sweden (1.2 million inhabitants) diagnosed by a physician with spondyloarthritis (ankylosing spondylitis (AS), psoriatic arthritis (PsA), inflammatory arthritis associated with inflammatory bowel disease (Aa-IBD) or undifferentiated spondylarthritis (USpA)) were identified. To obtain valid point estimates of prevalence by the end of 2007, identification numbers were cross-referenced with the population register to exclude patients who had died or relocated.

    RESULTS: The authors estimated the prevalence of spondyloarthritis (not including chronic reactive arthritis) as 0.45% (95% CI 0.44% to 0.47%). The mean (SD) age of patients with prevalent spondyloarthritis by the end of 2007 was 53 (15) years. Among the component subtypes, PsA accounted for 54% of cases, AS 21.4%, USpA 17.8% and Aa-IBD 2.3% with a prevalence of 0.25%, 0.12%, 0.10% and 0.015%, respectively. The remaining 6.4% had some form of combination of spondyloarthritis diagnoses. The prevalence of spondyloarthritis at large was about the same in men and women. However, the subtype PsA was more prevalent in women and AS was more prevalent in men.

    CONCLUSION: In Sweden the prevalence of spondyloarthritis leading to a doctor consultation is not much lower than rheumatoid arthritis. PsA was the most frequent subtype followed by AS and USpA, and the two most frequent subtypes PsA and AS also display some distinct sex patterns.

  • 24.
    Haglund, Emma K.
    et al.
    Research & Development Center, Spenshult Hospital, Oskarström, Sweden.
    Bremander, Ann B.
    Research & Development Center, Spenshult Hospital, Oskarström, Sweden.
    Aerobic capacity in patients with rheumatoid arthritis: A comparison of two submaximal test methods2009Inngår i: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 7, nr 4, s. 288-299Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: In a clinical setting it is important to evaluate aerobic capacity in individuals with rheumatoid arthritis (RA) and to have a choice between tests, owing to disability of varying severity. Two submaximal tests, a bicycle ergometer test and a treadmill walking test, are commonly used. Despite expected differences in the results, these tests have been used interchangeably. The aim of the current study was to compare the results of the two tests, the size of the difference and factors expected to influence the results.

    Methods: Fifty-two outpatients with RA performed the two tests. Agreement and correlations between the results of the tests were calculated. Multivariate analysis was used to study the relationships between gender, weight, health assessment questionnaire, global health assessment and the difference between the tests.

    Results: Sixty per cent of the subjects exhibited a higher estimated value of maximum oxygen uptake (O2max) in the treadmill test. The limits of agreement for the estimated O2max values between the two methods ranged from −13.4 to +18.4 ml × min−1 × kg−1, and the intraclass correlation coefficient (ICCTwo-way mixed) was 0.34 (95% confidence interval [CI] 0.07, 0.56). Body weight was independently associated with the difference between the two tests (regression coefficient 0.3; 95% CI 0.14, 0.42). A higher body weight had a greater impact on the results of the bicycle test (R2 = 0.28; regression coefficient −0.3; 95% CI −0.47, −0.17) than on the treadmill walking test (R2 = 0.02; regression coefficient −0.06; 95% CI −0.14, 0.03).

    Conclusions: It is not advisable to use the two submaximal methods interchangeably. Weight influenced the difference between the two tests, and to a higher degree in the bicycle test than the treadmill walking test. Copyright © 2008 John Wiley & Sons, Ltd.

  • 25.
    Haglund, Emma
    et al.
    FoU Spenshult, Oskarström, Sweden.
    Malm, Karina
    Bremander, Ann
    Physical activity pattern in chronic inflammatory arthritis – still lots to do!2013Inngår i: 21st International Conference on Health Promoting Hospitals and Health Services: Abstract book, Copenhagen: WHO-CC , 2013, s. 102-102Konferansepaper (Fagfellevurdert)
  • 26.
    Haglund, Emma
    et al.
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Spenshult Research and Development Center, Halmstad, Sweden.
    Olsson, C.
    The Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS).
    Bergman, Stefan
    Spenshult Research and Development Center, Halmstad, Sweden; The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Lund University, Lund, Sweden.
    Improving triage to appropriate treatment level by using a combination of screening tools in patients at risk of developing chronic back pain2017Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, nr Suppl. 2, s. 1531-1532Artikkel i tidsskrift (Fagfellevurdert)
  • 27.
    Haglund, Emma
    et al.
    Spenshult Research and Development Center, Halmstad, Sweden.
    Petersson, Ingemar F.
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Bio- och miljösystemforskning (BLESS), Biomekanik och biomedicin. Spenshult Research and Development Center, Halmstad, Sweden & Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Bergman, Stefan
    Spenshult Research and Development Center, Halmstad, Sweden & Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Predictors of Presenteeism and Activity Impairment Outside Work in Patients with Spondyloarthritis2015Inngår i: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 25, nr 2, s. 288-295Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purposes To assess predictors of presenteeism (reduced productivity at work) and activity impairment outside work in patients with spondyloarthritis (SpA). Methods Multivariate logistic regression analysis was used to study predictors of presenteeism and activity impairment in 1,253 patients with SpA based on a 2.5 year follow-up questionnaire. The Work Productivity and Activity Impairment (WPAI) questionnaire was used as main outcome. Age, gender, lifestyle factors, subgroups, disease duration, and different patient reported outcome measures (PROMs) were studied as possible predictors. The association between presenteeism and WPAI activity impairment outside work was assessed. Results Out of 1,253 patients, 757 reported being in work and of these 720 responded to the WPAI questionnaire. The mean (confidence interval, CI) reported presenteeism was 25 % (23-27 %) and mean activity impairment 33 % (31-35 %) (0-100 %, 0 = no reduction). Significant predictors of presenteeism and activity impairment at follow-up (controlled for gender, age, spondyloarthritis subgroups and presenteeism at baseline) were presenteeism at baseline, poor quality of life, worse disease activity, decreased physical function, lower self-efficacy pain and symptom, higher scores of anxiety, depression, smoking and low education level, and for activity impairment also female sex. There was a strong association between presenteeism and activity impairment outside work (OR 16.7; 95 % CI 11.6-24.3; p < 0.001). Conclusions Presenteeism and activity impairment were not only predicted by presenteeism at baseline, but also by several PROMs commonly used in clinical rheumatology practice. Impaired activity outside work could indicate problems also at work suggesting why both areas need to be addressed in the clinical situation. © 2014, Springer Science+Business Media New York.

  • 28.
    Haglund, Emma
    et al.
    R&D Centre, Spenshult, Oskarström, Sweden & Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Petersson, Ingemar F.
    Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden & Department of Clinical Sciences Lund, Section of Orthopedics, Musculoskeletal Sciences, Lund University, Lund, Sweden.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Bio- och miljösystemforskning (BLESS), Biomekanik och biomedicin. R&D Centre, Spenshult, Oskarström, Sweden & Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Bergman, Stefan
    R&D Centre, Spenshult, Oskarström, Sweden & Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Predictors of Work Productivity in a Population Based Cohort of Individuals with Spondyloarthritis2013Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, nr Suppl. 3, s. A127-A127Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Spondyloarthritis (SpA) often causes work disability and predictors concerning the ability to stay productive while at work are scarcely studied in this group.

    Objectives: The aim was to study predictors of reduced productivity while at work and possible differences between gender and the SpA subgroups (Ankylosing Spondylitis (AS), Psoriatic Arthritis (PsA) and Undifferentiated SpA (USpA)) in a defined cohort in southern Sweden.

    Methods: 1253 out of 1773 health care seeking individuals with SpA age 18-67 years (identified by a health care register in southern Sweden) responded to a questionnaire survey in 2009 and to the follow-up in 2011, 2,5 years later. Self-reported presenteeism, defined as reduced productivity at work (0-100%, 0= no reduction) due to SpA, individual´s characteristics, lifestyle factors, disease duration, health related quality of life (EQ-5D), disease activity (BASDAI), physical function (BASFI), self-efficacy pain and symptom (ASES), anxiety (HADa), depression (HADd) were measured. The main outcome productivity at work was dichotomized based on mean value, with values over 25% regarded as a reduced productivity. The Pearson's correlation coefficient and multivariate logistic regression analyzes were used to study predictors of reduced productivity.

    Results: At follow up 757 individuals reported that they were working and of those 720 responded to the productivity question. The mean age was 50 years and 49% were men. Based on the health care register 177 (24.6%) were diagnosed with AS, 373 (51.8%) with PsA and 170 (23.6%) with USpA. The mean reduction of productivity was 25% (95% CI 23%>27%) (n=720), women reported higher reduction than men (mean 28% vs. 22%, p<0.001). In the multiple logistic regression analyzes a reduced productivity at follow-up was predicted by a reduced productivity at baseline (OR 1.04, 95% CI 1.03-1.05). Other predictors (controlled for age, sex, disease subgroup and productivity at baseline) were low education level (OR 2.14, 95% CI 1.51-3.04), smoking (1.73; 1.22-2.45), worse score in quality of life (EQ-5D) (0.22; 0.003-0.14), worse disease activity (BASDAI) (1.47; 1.29-1.67), lower physical function (BASFI) (1.42;1.27-1.58), lower self-efficacy (ASES) pain (0.97; 0.97-0.98) and symptom (0.97; 0.96-0.98), higher score of anxiety (HADa) (1.09; 1.05-1.14) and depression (HADd) (1.15; 1.08-1.22). Disease duration, absenteeism and physical activity level had no predictive value.

    Conclusions: Reduced productivity at follow-up was not only predicted by productivity 2,5 years earlier, but also by other aspects of the individuals whole life situation. These different factors could be of clinical importance in order to influence the ability to maintain productivity at work in individuals with SpA.

    Disclosure of Interest: E. Haglund Grant/research support from: The project was supported by an unrestricted grant from Abbott., I. Petersson Grant/research support from: The project was supported by an unrestricted grant from Abbott., A. Bremander Grant/research support from: The project was supported by an unrestricted grant from Abbott., S. Bergman Grant/research support from: The project was supported by an unrestricted grant from Abbott.

  • 29.
    Karlsson, Jan
    et al.
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Winroth, Jan
    Högskolan Väst, Trollhättan, Sweden.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS).
    Haglund, Emma
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS).
    Holmquist, Mats
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Lindgren, Eva-Carin
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Lydell, Marie
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Staland Nyman, Carin
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Förändringsledarskap vid digital transformation inom vård och omsorg: En sammanfattande rapport från kompetensutvecklingsprojektet ”Trygg motivation och inspiration” i Kungsbacka kommun 20182018Rapport (Annet vitenskapelig)
  • 30.
    Lindström, Ulf
    et al.
    Rheumatology and Inflammation Research, Sahlgrenska Academy, Gothenburg, Sweden.
    Bremander, Ann
    Lund University, Lund, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden.
    Haglund, Emma
    Lund University, Lund, Sweden.
    Petersson, Ingemar F.
    Orthopedics, Clinical Sciences, Lund University, Lund, Sweden.
    Jacobsson, Lennart
    Rheumatology and Inflammation Research, Sahlgrenska Academy, Gothenburg, Sweden.
    Patients with Non-AS Axial SpA Have Similar Prevalence Compared to AS, but Worse Perceived Health. Results from a Population Based Study2013Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, nr Suppl. 3, s. A667-A668Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Non-radiographic axial spondyloarthritis (SpA) is emerging as a treatable disease comparable to ankylosing spondylitis (AS), but less well studied. Previous studies have described a reversed gender distribution, with AS being more prevalent in the male population and non-radiographic axial SpA more prevalent in the female population. Recent studies have also indicated a similar benefit from treatment with TNF-inhibitors.

    Objectives: The aim of this study was to estimate the prevalence of non-radiographic axial SpA and compare the patient reported outcome measures (PROMS) to that of AS, in Southern Sweden.

    Methods: All health care seeking individuals, ≥18 years, given a SpA-diagnosis, according to the ICD-10 (M45.9, M072, M460, M461, M468, M469, M074, M705 and L405 or M071 or M073), either in primary or specialized care, (N = 5771), during 2003 - 2007, were identified through the regional health care register in Skåne, a county in Southern Sweden with 1.2 million inhabitants (SpAScania cohort). In 2009 they were all sent a questionnaire (response rate; 48%), including questions concerning inflammatory back pain (IBP), the SpA-associated comorbidities constituting the ASAS-criteria (IBD, Ps, Uveitis/tendinitis, heredity), PROMS (BAS-indices, VAS-pain/fatigue/global, EQ5D) and previous/current medication.Non-AS axial SpA was defined as having an ICD10 code supporting a diagnosis of SpA without having one of AS (M45.9), in combination with > 3 months of back pain the last year and the presence of ≥2 of the SpA associated comorbidities. Record review support the notion of using AS as a substitute for radiographic changes. For the “non imaging arm” of the ASAS criteria for axial disease, we used the ICD10 codes above as a substitute for HLA-B27 status. Assuming similar answers from the questionnaire non-responders, prevalence rates were estimated for non-AS axial SpA and AS.

    Results: Among responders 742 had an AS-diagnosis and 640 fulfilled the study criteria for non-AS axial SpA. The frequency of men was 60.5% in the AS group and 29.5% in the non-AS axial SpA group. The prevalence of AS was 0.13% (95% CI; 0.115-0.148) and for non-AS axial SpA 0.11 % (95% CI; 0.096-0.130), with a reverse gender distribution. The means of the PROMs and frequency of comorbidities were higher in the non-AS axial SpA vs both the AS, and the subgroup of AS individuals reporting back pain (BP) > 3months during the last year. Self-reported present use of TNF-inhibitors were similar between the groups (Image 1).

    Conclusions: Prevalence rates for AS and non-AS axial SpA were similar, with a reverse gender distribution. The results suggest that at a population level the proportion with non-AS axial SpA is at least as large as that of AS and report lower levels of perceived health status and similar frequencies of SpA-related comorbidities (except psoriasis) and treatment with TNF-inhibitors, supporting the validity for the used definition in future research.

    Disclosure of Interest: None Declared

  • 31.
    Lindström, Ulf
    et al.
    University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Bio- och miljösystemforskning (BLESS). Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Haglund, Emma
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Bio- och miljösystemforskning (BLESS). Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden; Spenshult Research and Development Center, Halmstad, Sweden & Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Petersson, Ingemar F.
    Lund University, Lund, Sweden.
    Jacobsson, Lennart T. H.
    University of Gothenburg, Gothenburg, Sweden & Lund University, Lund, Sweden.
    Back pain and health status in patients with clinically diagnosed ankylosing spondylitis, psoriatic arthritis and other spondyloarthritis: a cross-sectional population-based study2016Inngår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 17, nr 1, artikkel-id 106Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: In the broader spectrum of back pain, inflammatory back pain (IBP) is a symptom that may indicate axial spondyloarthritis (SpA). The objectives of this study were to determine the frequency of current IBP, as a hallmark sign of possible axial SpA, in patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA) and other SpA and to compare self-reported health between the groups with current IBP.

    METHODS: Five-thousand seven hundred seventy one patients identified in the regional healthcare register of the most southern county of Sweden, diagnosed at least once by a physician (based on ICD-codes) with any type of SpA in 2003-2007, were sent a postal survey in 2009. Patients with current IBP were identified, based on self-reported back pain ≥3 months in the preceding year and fulfilling the Berlin criteria for IBP. The frequencies of IBP in AS, PsA and other SpA (including the remaining subgroups of SpA) were determined, and the groups were compared with regard to patient reported outcome measures (PROMs).

    RESULTS: The frequency and proportion of patients with current IBP in AS, PsA and other SpA were 319 (43 %), 409 (31 %) and 282 (39 %) respectively, within the responders to the survey (N = 2785). The proportion was statistically higher in AS, compared to PsA (p < 0.001), but not for AS compared to other SpA (p = 0.112). PsA and other SpA, with current IBP, had similar (BASFI, EQ-5D, patients global assessment, fatigue, spinal pain) or worse (BASDAI) PROMs, compared to AS with current IBP. PsA with current IBP received pharmacological, anti-rheumatic, treatment more frequently than AS with current IBP, while AS and other SpA received treatment to a similar degree.

    CONCLUSION: The proportion of patients with current IBP was substantial in all three groups and health reports in the non-AS groups were similar or worse compared to the AS group supporting the severity of IBP in these non-AS SpA groups. These findings may indicate a room for improvement concerning detection of axial disease within different subtypes of non-AS SpA, and possibly also for treatment.

  • 32.
    Löfvendahl, S.
    et al.
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Petersson, I.F.
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Haglund, Emma
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Bremander, Ann
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Jacobsson, L.
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Jöud, A.
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Duration between symptom onset and spondyloarthritis diagnosis – Changes over a decade2014Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, nr Suppl. 2, s. 431-431Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background The delay of diagnosis after symptom onset for various subgroups of spondyloarthritis (SpA) is considerable. Increasing focus on this over the last decades may have decreased this delay (1-2).

    Objectives To study the duration between symptom onset and date of diagnosis of SpA and its subgroups: ankylosing spondylitis (AS), psoriatic arthritis (PsA), and unspecified spondyloarthritis (USpA). A special focus was to study the change over the past decade.

    Methods The Swedish SpAScania cohort (N=5,771, = all patients diagnosed with SpA between 2003 and 2007 in primary or secondary care in the Skåne region, total n=1.3 million 2013) was used. We analyzed patients (n=952) identified as having AS (n=173), PsA (n=579) or USpA (n=200) by a rheumatologist or internist at least one time or by any other physician twice during 2003 to 2007 responding to a postal survey in 2009 and 2011. The survey included questions on years for start of symptoms and diagnosis. All patients included had a self-reported diagnosis of SpA between 1997 and 2007 in the survey 2009. The information from 2009 was used to calculate the duration between symptom onset and date of diagnosis and the response from the 2011 survey to investigate the reliability of these answers (647 patients responded to the survey in both 2009 and 2011 and were hence eligible for reliability analysis). The mean duration (years) was calculated (95% CI), both unadjusted and adjusted for sex, age and year of diagnosis.

    Results The overall mean duration between symptom onset and date of a SpA diagnosis was 6.8 years (95% CI: 6.3-7.3), without any obvious secular change up through 2007. The mean duration for AS was 9.0 (95% CI: 7.8-10.3), for PsA 6.0 (5.4-6.6) and USpA 7.2 (95% CI: 6.1-8.3). There was an overall good consistency between the self-assessed year of symptom start, measured in 2009 and in 2011 (ρ=0.58). However, there was a variation between subgroups, consistency being higher in AS (ρ =0.84) and lower in PsA (ρ =0.53).

    Conclusions The duration between symptom onset and diagnosis was longest for AS and shortest for PsA with USpA in between. Up to 2007 there was no significant trend for any decrease in such delay for any of the subgroups.

    References

    1. Sorensen J, Hetland ML. Duration of symptoms before diagnosis in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Ann Rheum Dis 2013;72(Suppl3):80.

    2. Salvadorini G, Bandinelli F, DelleSedie A, Riente L, Candelieri A, Generini S. Ankylosing spondylitis: how diagnostic and therapeutic delay have changed over the last six decades. Clin Exp Rheumatol. 2012 Jul-Aug;30(4):561-5.

    Disclosure of Interest None declared

  • 33.
    Meesters, Jorit J. L.
    et al.
    Epi-centre Skåne, Skåne University Hospital, Medicon village, Lund, Sweden & Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, Netherlands.
    Petersson, Ingemar F.
    Epi-centre Skåne, Skåne University Hospital, Medicon village, Lund, Sweden & Department of Orthopedics, Clinical Sciences, University of Lund, Lund, Sweden.
    Bergman, Stefan
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult, Research and Development Center, Oskarström, Sweden.
    Haglund, Emma
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult, Research and Development Center, Oskarström, Sweden.
    Jacobsson, Lennart T. H.
    Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Bio- och miljösystemforskning (BLESS), Biomekanik och biomedicin. Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult, Research and Development Center, Oskarström, Sweden.
    Sociodemographic and disease-related factors are associated with patient-reported anxiety and depression in spondyloarthritis patients in the Swedish SpAScania cohort2014Inngår i: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 33, nr 11, s. 1649-1656Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Anxiety and depression are common among patients with rheumatic diseases. This study aims to explore which factors are associated with self-reported anxiety and depression in a well-defined cohort of spondyloarthritis (SpA) patients. In 2009, 3,711 patients from the SpAScania cohort were sent a postal questionnaire to assess health-related quality of life (HRQoL) and physical and mental functioning. The Hospital Anxiety and Depression Scale measured anxiety (HADS-A) and depression (HADS-D), subscales 0-21, best-worst. HADS ≥8 indicates possible cases of anxiety or depression. One-way ANOVA (p < 0.05) tested for differences among the SpA subtypes in HADS scores. Linear regression analysis adjusted for age, gender, and disease duration was used to test for associations between HADS and independent variables. In total, 2,167 (58 %) patients (52 % females, mean age 55.4 years) returned the questionnaire. In total, 683 (32 %) cases were classified as "possible anxiety" and 305 (14 %) as "possible depression" cases with mean (SD) HADS-A 5.9 (4.3) and HADS-D 4.4 (3.6). There were no differences among the SpA subtypes in HADS-A and HADS-D. HADS-A and HADS-D were associated with lower education, lower physical activity (HADS-D only), chronic pain problems, more fatigue, lower general health, lower HRQoL, lower level of functioning, higher disease activity, and lower self-efficacy. Associations with anxiety and/or depression appear multifactorial in patients with SpA including both personal and disease-related factors. Since these comorbidities are increased in SpA and treatable, they should be screened for in clinical practice, possibly with instruments like the HADS. © 2014, Clinical Rheumatology

  • 34.
    Meesters, Jorit J.L.
    et al.
    1ERC Syd, Skåne University Hospital, Lund, Sweden & Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands & Research and Development, Sophia Rehabilitation Center, The Hague, The Netherlands.
    Bergman, Stefan
    Section of Rheumatology, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden & Primary Health Care Unit, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Haglund, Emma
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Spenshult Research and Development Center, Halmstad, Sweden.
    Jacobsson, Lennart Th
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Petersson, Ingemar F.
    Section of Orthopedics, Department of Clinical Sciences, University of Lund, Lund, Sweden.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Section of Rheumatology, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Prognostic factors for change in self-reported anxiety and depression in spondyloarthritis patients: data from the population-based SpAScania cohort from southern Sweden2017Inngår i: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 47, nr 3, s. 185-193Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: Anxiety and depression symptoms are more common in patients with spondyloarthritis (SpA) than in the general population. This study describes prognostic factors for change in self-reported anxiety and depression over 2 years in a well-defined SpA cohort.

    METHOD: In 2009, 3716 adult patients from the SpAScania cohort received a postal questionnaire to assess quality of life (QoL) and physical and mental functioning. A follow-up survey was performed in 2011. The Hospital Anxiety and Depression Scale indicated 'no', 'possible', and 'probable' cases of anxiety and depression. Transitions between the three different categories were analysed and logistic regression analysis determined prognostic factors (patient-reported outcomes and characteristics) for improvement or deterioration.

    RESULTS: In total, 1629 SpA patients responded to both surveys (44%) (mean ± SD age 55.8 ± 13.1 years, disease duration 14.6 ± 11.7 years); 27% had ankylosing spondylitis, 55% psoriatic arthritis, and 18% undifferentiated SpA. The proportion of patients reporting possible/probable anxiety decreased from 31% to 25% over 2 years, while no changes in depression were seen. Factors associated with deterioration or improvement were largely the same for anxiety as for depression: fatigue, general health, QoL, level of functioning, disease activity, and self-efficacy. However, reporting chronic widespread pain (CWP) at baseline increased the risk of becoming depressed and decreased the probability of recovering from anxiety.

    CONCLUSION: Self-reported anxiety and depression is common and fairly stable over time in SpA patients. The association between mental health and CWP indicates that both comorbidities need to be acknowledged and treated in the clinic. © 2018 The Author(s).

  • 35.
    Meesters, Jorit
    et al.
    Epi-centre Skåne, Skåne University Hospital, Lund, Sweden & Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, Netherlands.
    Petersson, Ingemar
    Epi-centre Skåne, Skåne University Hospital, Lund, Sweden & Department of Orthopedics, Clinical Sciences, University of Lund, Lund, Sweden.
    Bergman, Stefan
    Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Haglund, Emma
    Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Jacobsson, Lennart
    Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Factors Associated with Anxiety and Depression in Spondyloarthritis Patients: Results from the Swedish Population Based SpA Scania Cohort2013Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, nr Suppl. 3, s. A531-A532Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Anxiety and depression are more common among patients with rheumatic diseases and can influence treatment options and outcome. However insight in factors associated with anxiety and depression in patients with Spondyloarthritis (SpA) is scarce.

    Objectives: To identify factors associated with self-reported anxiety and depression in a well-defined population based cohort of patients with SpA.

    Methods: In 2009, 3711 adult SpA patients from the SpaScania cohort were identified and involved in a questionnaire survey including patient reported outcome measures (PROMs) to assess quality of life, physical and mental functioning. To assess depression and anxiety the Hospital Anxiety and Depression Scale (HADS-A and HADS-D) was used. Each subscale ranges from 0-21; best to worst. HAD scores of ≥ 8 indicate probable cases of anxiety or depression.Differences in HADS subscale scores among the SpA subgroups were tested by using one-way ANOVA (p<.05). Associations between PROMs and the HADS subscales, were studied with linear regression analysis including each independent variable separately (adjusted for age, gender and disease duration) and presented as β-estimates (95%CI).

    Results: In total 2851 patients (76%) responded to the study invitation, 684 (18%) declined participation and 2167 (58%) returned the questionnaire. Mean age 55.4 (SD 13.9) years, mean disease duration 14.4 (12.1) years and 52% female. SpA subgroups were: Ankylosing spondylitis 501 (23%), Psoriatic arthritis 1171 (54%), and undifferentiated SpA 495 (23%).Mean HADS-A was 5.9 (4.3) and mean HADS-D 4.4 (3.6) respectively for the whole SpA group. In total 683 (32%) cases were classified as probable anxiety cases and 305 (14%) as probable depression cases. No differences in HADS were found among the different SpA subgroups for anxiety or depression (p>0.6).Higher scoring on HADS-A and HADS-D was associated with (table): lower education, lower physical activity (HADS-D only), chronic pain problems, more fatigue, lower general health, lower HRQoL (EQ-5D), lower level of functioning (BASFI), higher disease activity (BASDAI), lower self-efficacy (ASES).

    Conclusions: Patients with SpA do report problems with anxiety and/or depression and associations appear highly multifactorial with a profile of impaired health in general. Screening patients with SpA for anxiety and depression in the clinic is important but using a simple proxy is discouraged. Instead HADS or other comprehensive instruments to assess anxiety or depression should be considered.

  • 36.
    Sjöquist, Emma S.
    et al.
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden & Department of Physiotherapy, Karolinska University Hospital, Huddinge, Sweden.
    Brodin, Nina
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.
    Lampa, Jon
    Department of Rheumatology, Karolinska University Hospital, Solna, Sweden.
    Jensen, Irene
    Department of Public Health Sciences, Division of Intervention and Implementation Research, Karolinska Institutet, Solna, Sweden.
    Opava, Christina H.
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden & Department of Rheumatology, Karolinska University Hospital, Solna, Sweden.
    Algebrandt, Marita
    Linköping University Hospital, Linköping, Sweden.
    Almin, Ingrid
    Örebro University Hospital, Örebro, Sweden.
    Andersson, Britt
    Karolinska University Hospital, Solna, Stockholm, Sweden.
    Bertholds, Gunhild
    Skövde Hospital, Skövde, Sweden.
    Forsberg, Catarina
    Falun Hospital, Falun, Sweden.
    Haglund, Emma
    Spenshult AB, Oskarström, Sweden.
    Holmén-Andersson, Ann‐Marie
    Sahlgrenska University Hospital, Mölndal, Sweden.
    Hultman, Anna
    Uppsala University Hospital, Uppsala, Sweden.
    Lennartsson, Claudia
    Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Norman, Elin
    Danderyd Hospital, Stockholm, Sweden.
    Physical Activity Coaching of Patients with Rheumatoid Arthritis in Everyday Practice: A Long-term Follow-up2011Inngår i: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 9, nr 2, s. 75-85Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To investigate the long-term effects on perceived general health, disease activity, pain, activity limitation and cognitive behavioural factors of a one-year coaching programme performed in ordinary physical therapy practice to promote the adoption of health-enhancing physical activity in patients with early rheumatoid arthritis (RA).

    METHODS: A total of 228 patients with early RA, from 10 rheumatology clinics in Sweden, were randomly assigned to an intervention group (IG; n = 94) or a control group (CG; n = 134). The IG was coached by physical therapists during the first year to adopt health-enhancing levels of physical activity (30 minutes/day, moderately intensive, ≥ 4 days/week). No coaching was given during the subsequent year between post-intervention and follow-up. Follow-up assessment consisted of a postal questionnaire on physical activity and of visual analogue scales for ratings of general health perception and pain. The Health Assessment Questionnaire Disability Index (HAQ) and the Disease Activity Score in 28 joints (DAS 28) were collected at regular medical check-ups.

    RESULTS: Sixty-five (69%) participants in the IG and 92 (69%) in the CG completed the entire study period by filling in the follow-up questionnaire on physical activity two years after baseline. The intervention seemed to lack any significant influence on long-term outcome. However, different patterns of change in physical activity behaviour were observed in the two groups.

    CONCLUSIONS: No long-term improvement in perceived general health or other outcomes were found in the follow-up. This may partly be because the intervention lacked several important behavioural elements for physical activity maintenance. Copyright © 2011 John Wiley & Sons, Ltd.

  • 37.
    Torell, A.
    et al.
    Ängelholms sjukhus, Ängelholm, Sweden.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Lund University, Lund, Sweden & Spenshult R&D center, Halmstad, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden; Spenshult R&D center, Halmstad, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Haglund, Emma
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Spenshult R&D center, Halmstad, Sweden.
    Symptoms of pain, fatigue and self-efficacy in young patients with spondyloarthritis: – a comparison between women and men2017Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, nr Suppl. 2, s. 1515-1515Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background; The disease spondyloarthritis (SpA) have often an early onset, and can debuts already in teenagers or young adults.  Knowledge of how these patients reporting pain, fatigue and self-efficacy can help to better understand the characteristics of women and men with SpA.

    Objectives: To study the differences between young women and men with SpA with regards to self-reported questionnaires on pain, fatigue and self-efficacy.

    A cross sectional population based cohort were used to create a young patients with SpA.

    Methods: The study is created on a cross-sectional population based cohort of patients with SpA.  They were identified through a health care register by searching for ICD-10 codes for SpA between the years 2003-2007, responding to a questionnaire survey in 2009. 201 patients, 18-36, 29% with the diagnosis of ankylosing spondylitis, 39% with psoriatic arthritis, and 32% with undifferentiated spondyloarhtritis form a subgroup of young patients eligible for analysis.  The surveys including questions concerning self-reported pain (NRS 0-10 and pain mannequin), fatigue (NRS 0-10), self-efficacy (ASES 10-100, low-high). The pain mannequin was used to categorize patients into groups; non chronic pain, chronic regional pain or chronic generalized pain. Self-reported disease activity (BASDAI 0-10) and health related quality of life (EQ5D, 0-1) were used to describe the group. Characteristic symptoms are reported as mean, standard deviation (SD) and frequencies. Mann- Whitney U test and Chi2 test were used to study gender differences.

    Results: The mean age (SD) was, 30 (5) years, 60 % were women. The group reported disease activity (BASDAI) of 3.8 (2.3), quality of life 0.75 (0.16), and that they had their diagnosis for 7 (5) years. One third were smokers or former smokers, and 69 % reached WHO’s recommended level of health enhancing physical activity. Women reported higher pain 3.9 (2.4) compared to men 2.9 (2.1), p=0.001. In the group of both women and men 21 % reported regional chronic pain, 41 % generalized chronic pain and the remaining 38 % reported non chronic pain. More women reported regional and generalized chronic pain than men, p=0.026. Women reported more fatigue 5.0 (2.6) compared to men 3.9 (2.7), p=0.003, less self-efficacy for pain 53 (20), compared to men 59 (21), p=0.041 and for symptoms 59 (19) compared to men 65 (20), p=0.045.

    Conclusion: A significant proportion of both women and men reported symptoms consistent with chronic generalized pain. Women reported generally impaired health compared to men, with a greater percentage with chronic pain, higher rates of pain and fatigue and reduced self-efficacy to manage pain and symptoms. This information could be valuable for clinicians in the care of young patients with SpA. 

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