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  • 1.
    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 study2018Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, s. 87-87, artikel-id OP0072Artikel i tidskrift (Refereegranskat)
    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.
    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 perspective2018Ingår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 19, nr 1, s. 1-14Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 3.
    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 study2018Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, s. 1815-1815, artikel-id FRI10737-HPRArtikel i tidskrift (Refereegranskat)
    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.

  • 4.
    Almquist-Tangen, Gerd
    et al.
    Child Health Care Unit, Region Halland, Halmstad, Sweden & Department of Paediatrics, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Dahlgren, Jovanna
    Department of Paediatrics, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Roswall, Josefine
    Department of Paediatrics, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Department of Paediatrics, Halland Hospital, Halmstad, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital, Oskarström, Sweden.
    Alm, Bernt
    Child Health Care Unit, Region Halland, Halmstad, Sweden & Department of Paediatrics, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Milk cereal drink increases BMI risk at 12 and 18 months, but formula does not2013Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, nr 12, s. 1174-1179Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: Infant feeding affects growth, obesity and life-long health. This study examined the impact of dietary patterns on body mass index (BMI) at 12 and 18 months.

    METHODS: We followed a cohort of 2,666 children recruited in 2007-2008. Feeding practices were obtained from parental questionnaires and anthropometric data collected by child health nurses.

    RESULTS: At six months, 58.3% of the infant were breastfed, but only 1.6% exclusively. Many had begun eating solids (91.8%), porridge (87.7%) or milk cereal drink (46.6%). Bottle-feeding at four months was not a risk factor for a high BMI (>1 SD) at 12 or 18 months. Milk cereal drink at six months increased the risk of a high BMI at 12 and 18 months respectively (OR 1.58, 95% CI 1.12-2.22, and 1.52, 1.07-2.17). Milk cereal drink use was increased by low parental education and maternal obesity and reduced by troubled sleep and parental group participation.

    CONCLUSION: Formula at four months did not predict a high BMI at 12 or 18 months. Milk cereal drink use at six months was a risk factor for a high BMI at 12 and 18 months. The choice of milk cereal drink was influenced by parental factors, especially educational levels. ©2013 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd.

  • 5.
    Almquist-Tangen, Gerd
    et al.
    Child Health Care Unit, Region Halland, Kungsbacka, Sweden & Department of Paediatrics, Institute for Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Strömberg, Ulf
    Research and Development Department, Halland, Halmstad, Sweden.
    Holmén, Anders
    Research and Development Department, Halland, Halmstad, Sweden.
    Alm, Bernt
    Child Health Care Unit, Region Halland, Kungsbacka, Sweden & Department of Paediatrics, Institute for Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Roswall, Josefine
    Department of Paediatrics, Halland Hospital, Halmstad, Sweden & Department of Paediatrics, Institute for Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital, Oskarström, Sweden.
    Dahlgren, Jovanna
    Department of Paediatrics, Institute for Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Influence of neighbourhood purchasing power on breastfeeding at four months of age: a Swedish population-based cohort study2013Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, nr 1, artikel-id 1077Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Parental socioeconomic status (SES) is an important determinant in child health, influencing beneficial factors such as breastfeeding. A better understanding of the influence of neighbourhood-level SES measures, relating to spatial determinants, might lead to targeted actions to promote breastfeeding during infancy.

    METHODS: A cross-sectional study analysis the association between breastfeeding at four months of age and neighbourhood purchasing power, taking account of individual-level variables including maternal age, smoking and parental level of education. Data were obtained from a prospective population- based cohort study recruited from birth in 2007-2008 in the Halland region, southwestern Sweden. Questionnaire data on the individual-level variables and the outcome variable of breastfeeding at four months (yes/no) were used (n=2,407). Each mother was geo-coded with respect to her residential parish (there are 61 parishes in the region) and then stratified by parish-level household purchasing power. It emerged that four neighbourhood characteristics were reasonable to use, viz. <10%, 10-19%, 20-29% and ≥ 30% of the resident families with low purchasing power.

    RESULTS: The proportion of mothers not breastfeeding at four months of age showed a highly significant trend across the neighbourhood strata (p=0.00004): from 16.3% (< 10% with low purchasing power) to 29.4% (≥ 30% with low purchasing power), yielding an OR of 2.24 (95% confidence interval: 1.45-3.16). After adjusting for the individual-level variables, the corresponding OR=1.63 (1.07-2.56) was significant and the trend across the strata was still evident (p=0.05). A multi-level analysis estimated that, in the neighbourhoods with ≥ 30% of the families with low purchasing power, 20% more mothers than expected, taking account of the individual-level factors, reported no breastfeeding at four months of age (≥ 95% posterior probability of an elevated observed-to-expected ratio).

    CONCLUSION: The neighbourhood purchasing power provided a spatial determinant of low numbers of mothers breastfeeding at four months of age, which could be relevant to consider for targeted actions. The elevated observed-to-expected ratio in the neighbourhoods with the lowest purchasing power points toward a possible contextual influence. © 2013 Almquist-Tangen et al.; licensee BioMed Central Ltd.

  • 6.
    Almqvist-Tangen, Gerd
    et al.
    Child Healthcare Team, Region Halland, Sweden & Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Arvidsson, Susann
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI), Hälsa och omvårdnad.
    Alm, Bernt
    Child Healthcare Team, Region Halland, Sweden & Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bergman, Stefan
    Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Research and Development Centre Spenshult, Halmstad, Sweden.
    Roswall, Josefine
    Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & County Hospital, Region Halland, Halmstad, Sweden.
    Dahlgren, Jovanna
    Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Nevonen, Lauri
    Örebro University, Örebro, Sweden & Karolinska Institute, Stockholm, Sweden.
    What makes parents act and react? Parental views and considerations relating to ‘child health’ during infancy2017Ingår i: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 21, nr 4, s. 415-423Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Lifestyle factors and behaviours are adopted very early in life and tend to persist throughout life. Considering that the parents are the primary gatekeepers for their child’s health, there is a need to gain more knowledge and deeper understanding about what causes parents to act and react in order for early preventive efforts to have any effect. The aim was to explore the parental views and considerations concerning ‘child health’ among parents with infants 8–10 months old. The sample was strategic and 16 parents (aged 23–41) were recruited from three child health centres in Sweden. Open-ended interviews were conducted and a qualitative, manifest content analysis approach was utilized. The parents described the subject ‘child health’ as a large, multifaceted concept. Three categories emerged during data analysis: developing a sixth sense, being affected by perceptions and believing health and ill health as a continuum. The parents perceived food and feeding issues as one of the most worrying aspects and a significant indicator of ‘child health’. In order to meet the parents on their turf, the ‘healthy health message’ conveyed needs to take the parental perspective into consideration rather than attempting to educate the parents from predetermined assumption, belief and values. © The Author(s) 2017

  • 7.
    Almqvist-Tangen, Gerd
    et al.
    Child Health Care Team, County Council Halland, Sweden & Department of Paediatrics, University of Gothenburg, Gothenburg, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital, Oskarström, Sweden.
    Dahlgren, Jovanna
    Department of Paediatrics, University of Gothenburg, Gothenburg, Sweden.
    Roswall, Josefine
    Department of Paediatrics, County Hospital, Halmstad, Sweden & Department of Paediatrics, University of Gothenburg, Gothenburg, Sweden.
    Alm, Bernt
    Child Health Care Team, County Council Halland, Sweden & Department of Paediatrics, University of Gothenburg, Gothenburg, Sweden.
    Factors associated with discontinuation of breastfeeding before 1 month of age2012Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, nr 1, s. 55-60Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Breastfeeding is associated with many benefits for both mother and child. Initiation rates are high in Sweden. Recently a slight decline is seen.

    AIM: The aim of this study was to assess factors associated with discontinuation of breastfeeding during the first 4 weeks.

    METHOD: A population-based longitudinal birth cohort study recruiting from 2007 to 2008 in south-western Sweden. At the first visit to the child health centre, parents were asked to complete a questionnaire. Also, the infants' height, weight, head and waist circumference were collected. Response rate was 69.2%.

    RESULTS: Twenty-seven per cent of mothers had breastfeeding problems. In a multivariate analysis, there was a negative correlation between breastfeeding and use of pacifier (OR 3.72; CI 2.09-6.63), maternal smoking (OR 2.09; CI 1.08-4.05) and breastfeeding problems (OR 2.54; CI 1.73-3.71). Breastfeeding problems were correlated with poor sucking technique (OR 2.96; CI 2.14-4.07), support from maternity ward (OR 2.56; CI 2.05-3.19) and perceived poor weight gain (OR 1.37; CI 1.00-1.86).

    CONCLUSION: Many mothers reported breastfeeding problems that are associated with an early cessation. This is preventable with support, but the timing is crucial. To promote breastfeeding, the support from the child health centres must be tailored with the maternal perspective in mind.

    © 2011 Foundation Acta Pædiatrica

  • 8.
    Andersson, Maria L. E.
    et al.
    Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden.
    Söderlin, Maria K.
    Spenshult Rheumatology Hospital, Oskarström, Sweden.
    The effect of snuff (smokeless tobacco) on disease activity and function in rheumatoid arthritis: experiences from the Better Anti-Rheumatic FarmacOTherapy, a longitudinal multicenter study on early rheumatoid arthritis.2013Ingår i: Journal of clinical rheumatology, ISSN 1076-1608, E-ISSN 1536-7355, Vol. 19, nr 1, s. 14-18Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: It is not known whether snuff (moist smokeless tobacco) affects disease activity in rheumatoid arthritis (RA).

    OBJECTIVE: This study aims to study the effect of snuff on disease activity and function in Swedish patients with early RA.

    METHODS: Between 1992 and 2005, 2800 adult patients were included in the Better Anti-Rheumatic FarmacOTherapy (BARFOT) early RA study in Sweden. Disease Activity Score 28 joints (DAS28), Health Assessment Questionnaire, visual analog scale for general health, and drug treatment were registered at inclusion and at follow-up after 1, 2, and 5 years. European League Against Rheumatism response and remission criteria were applied at 1 year. In 2010, a self-completed postal questionnaire was sent to 2102 patients in the BARFOT study enquiring about lifestyle factors such as smoking and use of snuff. Three controls for each patient using snuff were identified.

    RESULTS: Fifty-one patients who used snuff were identified, together with 145 controls. When we adjusted for socioeconomic class, disease duration, and previous antirheumatic medication, the snuff users had lower DAS28 values at up to 6 months of follow-up than patients who had never smoked, and they had lower DAS28 values than previous smokers at up to 2 years of follow-up. No effect of snuff use on European League Against Rheumatism response was seen at up to 1 year.

    CONCLUSIONS: Snuff users initially had lower DAS28 levels than never smokers and previous smokers. Copyright © 2013 by Lippincott Williams & Wilkins.

  • 9.
    Andersson, Maria L. E.
    et al.
    Research and Development Centre, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Bergman, Stefan
    Department of Rheumatology, IKVL, Lund University, Lund, Sweden & Research & Development Centre, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Söderlin, Maria K.
    Karlskrona Central Hospital, Karlskrona, Sweden; Department of Rheumatology, IKVL, Lund University, Lund, Sweden & Research and Development Centre, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    The Effect of Socioeconomic Class and Immigrant Status on Disease Activity in Rheumatoid Arthritis: Data from BARFOT, a Multi-Centre Study of Early RA2013Ingår i: Open Rheumatology Journal, ISSN 1874-3129, Vol. 7, s. 105-11Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There have been no reports on the effect of immigrant status and socioeconomic status on outcome in rheumatoid arthritis (RA) in Sweden.

    METHODS: Between 1992 and 2006, 2,800 patients were included in the BARFOT study on early RA in Sweden. Disease Activity Score 28 joints (DAS28), Health Assessment Questionnaire (HAQ), treatment and European League Against Rheumatism (EULAR) response criteria were registered. In 2010, 1,430 patients completed a questionnaire enquiring about demographics and lifestyle factors.

    RESULTS: One hundred and thirty-nine of the 1,430 patients (9.7%) were immigrants. At baseline immigrants had higher mean HAQ (1.2 vs 0.97 for non-immigrants, p=0.001), DAS28 (5.6 vs 5.2, p=0.000), visual analog scale (VAS) pain (56 mm vs 45 mm, p=0.000), VAS global health (53 mm vs 44 mm, p=0.000) and tender joint count (TJC) (10 vs 8, p=0.000). These differences persisted for up to 2 years of follow-up (for HAQ, for up to 8 years of follow-up). Immigrant status did not have any effect on swollen joint count (SJC), ESR, CRP or EULAR response. Socioeconomic class did not have any effect on treatment or outcome.

    CONCLUSIONS: Immigrants scored worse in pain, function and TJC for up to 2 years of follow-up, but they did not differ from non-immigrants in objective measures of inflammation or EULAR outcome. This could be due to different perceptions of health and pain and/or the stress of immigration. Socioeconomic class had no effect on treatment or outcome, and this could be due to the relatively egalitarian society in Sweden.

  • 10.
    Andersson, Maria L. E.
    et al.
    R & D Center, Spenshult Hospital, Oskarström, Sweden & Lund University, Lund, Sweden.
    Svensson, Björn
    Lund University, Lund, Sweden.
    Bergman, Stefan
    R & D Center, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden & Lund University, Lund, Sweden.
    Chronic widespread pain in patients with rheumatoid arthritis and the relation between pain and disease activity measures over the first 5 years2013Ingår i: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 40, nr 12, s. 1977-1985Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To study the prevalence of chronic widespread pain (ChWP), chronic regional pain (ChRP), and fibromyalgia in patients with early rheumatoid arthritis (RA) followed for 5 years after inclusion, and to study the effect of pain on measures of disease activity and function.

    METHODS: A questionnaire was sent to 1910 patients participating in the Better Anti-Rheumatic Pharmacotherapy study. The responders (73%) were divided into 3 groups according to the reported pain duration and distribution - patients having no chronic pain (NChP), ChWP, and ChRP. Outcome measures were the 28-joint Disease Activity Score (DAS28), the Health Assessment Questionnaire (HAQ), and C-reactive protein (CRP).

    RESULTS: Thirty-four percent of respondents reported ChWP, 46% ChRP, and 20% NChP. Patients reporting ChWP were more often women and had more pain and tender joints at inclusion. From 6 months to 5 years of followup, mean DAS28, visual analog scale (VAS) pain, VAS global health, and HAQ were significantly higher in the ChWP group than in the other groups. However, all groups showed a similar pattern in swollen joint count, erythrocyte sedimentation rate (ESR), and CRP. From 12 months the ChWP group was treated with prednisolone to a greater extent than the ChRP group, and it had a rate of treatment with disease-modifying antirheumatic drugs similar to that of the ChRP group.

    CONCLUSION: ChWP is a common feature in RA, more associated with high values for variables related to pain such as the DAS28 and HAQ than to indicators of ongoing inflammation such as swollen joint count, ESR, and CRP. Patients with ChWP should be identified so that adequate treatment also of the noninflammatory pain may be instituted.

  • 11.
    Arvidsson, Susann
    et al.
    Department of Research and Development, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Arvidsson, Barbro
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Fridlund, Bengt
    School of Health Sciences and Social Work, Växjö University, Växjö, Sweden.
    Bergman, Stefan
    Department of Research and Development, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Chronic musculoskeletal pain and sleep disturbances as predictors for lower vitality measured by the short form 36 (SF-36) - A eight-year follow up study2006Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 65, nr Suppl. 2, s. 656-656Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: Subjects with chronic musculoskeletal pain or sleep disturbances have been shown to have a poor healthstatus as measured by the SF-36 health survey. Fatigue is commonly reported by subjects with chronic musculoskeletal pain and sleep disturbances. There is little known about the temporal relationship between chronic pain, sleep disturbances and changes of vitality.

    Objectives: The aim of this study was to evaluate the predictive value of chronic musculoskeletal pain and sleep disturbances with regard to changes in vitality as measured by SF-36 over an eight year period.

    Method: An eight year follow up of 2 425 subjects aged 20-74 from the general population that in 1995 answered the same postal questionnaire. The questionnaire assessed chronic musculoskeletal pain, sleep disturbances, and included the SF-36 health survey. Pain was considered "chronic" if persistent for three months or more. Sleep disturbances assessed were difficulty in falling asleep, frequent awakenings, early awakenings and not feeling rested. Main outcome measure was change of vitality as measured by SF-36 in those that at baseline reported vitality over the median value. Statistical analyses were done with use of logistic regression. Besides the studied variables, the logistic regression analyses also controlled for gender, age, socio-economic group, and the use of analgesics and sleeping pills.

    Results: At baseline 1212 subjects reported a vitality score on SF-36 above the median score of 75. There were 943 subjects (78%) responding at the eight-year follow up. Chronic pain at baseline predicted (OR=1,64, 95% CI 1,14-2,36%, p=0,01) worsening of vitality over time. Loss of vitality was also predicted by moderate problems with falling asleep (OR=2,17, 95% CI 1,31-3,60%, p<0,01), and problems with not feeling rested (moderate problems OR=2,08, 95% CI 1,23-3,50%, p=0,01, and major problems OR=4,76, 95% CI 1,53-14,78%, p=0,01).

    Conclusion: Loss of vitality in SF-36 over an eight-year period was predicted by chronic musculoskeletal pain, problems with falling asleep and problems with not feeling rested. Problems with frequent awakenings and early awakenings did not predict lower value of vitality over an eight-year period. It could thus be important to attend to sleeping problems and especially the feeling of not being rested in subjects with chronic musculoskeletal pain.

  • 12.
    Arvidsson, Susann
    et al.
    FoU Centrum, Spenshult, Halmstad, Sverige & Hälsohögskolan, Jönköping, Sverige.
    Arvidsson, Barbro
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Fridlund, Bengt
    Hälsohögskolan, Jönköping, Sverige.
    Bergman, Stefan
    FoU Centrum, Spenshult, Halmstad, Sverige.
    Factors promoting health-related quality of life in patients with rheumatic diseases 12 months after rehabilitation2010Ingår i: Svenska Läkaresällskapets Riksstämma 2010: Program: Reumatologi, 2010, s. 3-3Konferensbidrag (Refereegranskat)
    Abstract [en]

    Rheumatic diseases have significant adverse impact on the individual from physical, mental and social aspects, resulting in a low estimation of health-related quality of life (HRQL). Patients with rheumatoid arthritis who receive a multi-disciplinary team-based care in a rheumatology clinic could get improved HRQL. Several factors can be supposed to promote health in patients with rheumatic diseases and in health-promoting work within the clinical practice it would be valuable to identify health factors that affect HRQL in a positive direction.

    This is a longitudinal cohort study in 185 patients with rheumatic diseases with test one week and 12 months after rehabilitation on a Swedish rheumatology clinic. HRQL was assessed by SF-36 together with suggested health factors (chronic musculoskeletal pain, sleep quality, food habits, exercise habits, leisure habits, sexual lust, sense of coherence (SOC), social support and socio-demographic variables). The association between SF-36 subscales and suggested health factors were estimated by OR and 95 % CI calculated by multivariable logistic regressions.

    Factors predicting better outcome in HRQL in one or several SF-36 subscales were being of younger ages or middle-ages, feeling painless, having good sleep structure, feeling rested after sleep, doing low effort of exercise more than twice a week, having strong SOC, having emotional support and practical assistance, having higher educational level, and having working capacity. The most important factors were having strong SOC, feeling rested after sleep, having working capacity, being of younger ages or middle-ages, and having no/small problem with sleep structure.

    The most important factors promoting HRQL in patients with rheumatic diseases 12 months after rehabilitation were having strong SOC, feeling rested after sleep, having working capacity, being of younger ages or middle-ages, and having no/small problem with sleep structure. These health factors are important to address in clinical work with rheumatic diseases to optimise treatment strategies.

  • 13.
    Arvidsson, Susann
    et al.
    Research and Development Centre Spenshult, Spenshult hospital for rheumatic diseases, Oskarström, Sweden & School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Arvidsson, Barbro
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI). Gjøvik University College, Faculty of Nursing Science, Gjøvik, Norway.
    Fridlund, Bengt
    School of Health Sciences & Social Work, Växjö University, Växjö, Sweden & School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Bergman, Stefan
    Research and Development Centre Spenshult, Spenshult hospital for rheumatic diseases, Oskarström, Sweden.
    Factors promoting health-related quality of life in people with rheumatic diseases: a 12 month longitudinal study2011Ingår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 12, artikel-id 102Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Rheumatic diseases have a significant adverse impact on the individual from physical, mental and social aspects, resulting in a low health-related quality of life (HRQL). There is a lack of longitudinal studies on HRQL in people with rheumatic diseases that focus on factors promoting HRQL instead of risk factors. The aim of this study was to investigate the associations between suggested health promoting factors at baseline and outcome in HRQL at a 12 month follow-up in people with rheumatic diseases.

    Methods: A longitudinal cohort study was conducted in 185 individuals with rheumatic diseases with questionnaires one week and 12 months after rehabilitation in a Swedish rheumatology clinic. HRQL was assessed by SF-36 together with suggested health factors. The associations between SF-36 subscales and the health factors were analysed by multivariable logistic regressions.

    Results: Factors predicting better outcome in HRQL in one or several SF-36 subscales were being younger or middle-aged, feeling painless, having good sleep structure, feeling rested after sleep, performing low effort of exercise more than twice per week, having strong sense of coherence (SOC), emotional support and practical assistance, higher educational level and work capacity. The most important factors were having strong SOC, feeling rested after sleep, having work capacity, being younger or middle-aged, and having good sleep structure.

    Conclusions: This study identified several factors that promoted a good outcome in HRQL to people with rheumatic diseases. These health factors could be important to address in clinical work with rheumatic diseases in order to optimise treatment strategies. © 2011 Arvidsson et al; licensee BioMed Central Ltd.

  • 14.
    Arvidsson, Susann
    et al.
    Research and Development Centre, Spenshult hospital for rheumatic diseases, Oskarström, Sweden.
    Arvidsson, Barbro
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Fridlund, Bengt
    School of Health Sciences and Social Work, Växjö University, Växjö, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult hospital for rheumatic diseases, Oskarström, Sweden.
    Feeling rested predicts good health in subjects with and without chronic musculoskeletal pain2008Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 67, nr Suppl. II, s. 552-552Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Musculoskeletal pain is a public health problem and a common cause for people to seek health care. It has also been shown that people with musculoskeletal pain estimates their health-related quality of life very low compared to a pain free population. Earlier studies have primarily looked at risk factors and there are little known about health predicting factors in a general population.

    Objectives: To investigate the associations between suggested health factors and health-related quality of life at baseline and in an eight-year follow up in subjects with and without chronic musculoskeletal pain.

    Methods: A longitudinal study in a Swedish general population (N=1 849) with a postal questionnaire at baseline 1995 and at a follow up 2003. Subjects were divided into two groups, according to their response about chronic musculoskeletal pain at baseline. Health-related quality of life was assessed by the SF-36 together with suggested health factors. The associations between the dependent variables (SF-36 subscales) and the independent variables (i.e. the suggested health factors; socioeconomic status, immigrant status, emotional support, regularly exercise, sleep structure, feeling rested, smoking and alcohol habits) were estimated by OR and 95% CI calculated by multivariable logistic regressions, with adjustment for all health factors, age, sex and baseline SF-36 values.

    Results: The most consistent finding for subjects with and without chronic musculoskeletal pain at baseline and in the eight-year follow up was a statistical significant (p<0.05) better health outcome in SF-36 subscales for subjects that were feeling rested at baseline. At baseline feeling rested was associated with having a health status better than the mean score in seven SF-36 subscales for both subjects with chronic pain (OR 1.5 (95% CI 1.0-2.3) – OR 4.4 (95% CI 2.9-6.6)) and subjects without chronic pain (OR 2.6 (95% CI 1.6-4.1) – OR 4.4 (95% CI 3.0-6.5)). At the follow up feeling rested predicted a better outcome in five subscales for subjects with chronic pain (OR 1.6 (95% CI 1.0-2.4) – OR 2.2 (95% CI 1.4-3.6)) and in six subscales for subjects without chronic pain (OR 1.6 (95% CI 1.0-2.5) – OR 2.7 (95% CI 1.8-4.1)). Other factors that in some aspects predicted a better outcome were belonging to higher socioeconomic group, being an inborn Swede, having emotional support, having good sleep structure, never being or being a former smoker, and regularly drinking alcohol.

    Conclusion: ''Feeling rested'' was the most consistent factor predicting a good health outcome, both in subjects with and without chronic musculoskeletal pain, and should be attended to in health promotion work. Emotional support, sleep structure, smoking and alcoholic habits also appears to be important health factors to take into account.

  • 15.
    Arvidsson, Susann
    et al.
    Research and Development Centre, Spenshult hospital for rheumatic diseases, Oskarström, Sweden & School of Health Sciences and Social Work, Växjö University, Växjö, Sweden.
    Arvidsson, Barbro
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI). Gjøvik University College, Faculty of Nursing Science, Gjøvik, Norway.
    Fridlund, Bengt
    School of Health Sciences and Social Work, Växjö University, Växjö, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult hospital for rheumatic diseases, Oskarström, Sweden.
    Feeling rested predicts good health in subjects with and without chronic musculoskeletal pain2008Konferensbidrag (Refereegranskat)
  • 16.
    Arvidsson, Susann
    et al.
    Research and Development Centre, Spenshult hospital for rheumatic diseases, Oskarström, Sweden & School of Health Sciences & Social Work, Växjö University, Växjö, Sweden.
    Arvidsson, Barbro
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI). Gjøvik University College, Faculty of Nursing Science, Gjøvik, Norway.
    Fridlund, Bengt
    School of Health Sciences & Social Work, Växjö University, Växjö, Sweden & School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult hospital for rheumatic diseases, Oskarström, Sweden.
    Health predicting factors in a general population over an eight-year period in subjects with and without chronic musculoskeletal pain2008Ingår i: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 6, artikel-id 98Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Many factors are proposed to be associated with health-related quality of life. Knowledge of health factors associated to development of a good health-related quality of life could be of use in clinical practice and public health work. The aim of this study was to investigate the associations between suggested health factors and health-related quality of life at baseline and in an eight-year follow up in subjects with and without chronic musculoskeletal pain in a cohort from a general population.

    Methods: The study was designed as a longitudinal study in a Swedish general population (N = 1 849) with a postal questionnaire at baseline 1995 and at follow up 2003. Subjects were divided into two groups, according to their response about chronic musculoskeletal pain at baseline. Health-related quality of life was assessed by the SF-36 together with suggested health factors. The associations between SF-36 subscales and suggested health factors were estimated by OR and 95% CI calculated by multivariable logistic regressions, with adjustment for all health factors, age, sex and baseline SF-36 values.

    Results: Although subjects without chronic musculoskeletal pain reported better health-related quality of life than subjects with chronic pain, similar health factors were found to be associated to higher scores in SF-36 at baseline and predicted a better outcome in the eight-year follow up. The most consistent finding was a better health outcome in the eight-year follow up for subjects that were feeling rested after sleep. Other factors that in some aspects predicted a better outcome were belonging to higher socioeconomic group, being a native Swede, having emotional support, having good sleep structure, never being or being a former smoker, and regularly drinking alcohol.

    Conclusion: The most important health factor in subjects with and without chronic musculoskeletal pain was feeling rested after sleep, but also emotional support, sleep structure, smoking and alcoholic habits appears to be important components. These health factors could be important to address in clinical work with painful musculoskeletal disorders. Since several health factors are common in both subjects with and without pain there could be a common strategy to be formed in public health programmes.

  • 17.
    Arvidsson, Susann
    et al.
    Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden & School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Bergman, Stefan
    Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Arvidsson, Barbro
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI). Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden & Faculty of Health Care and Nursing, Gjøvik University College, Gjøvik, Norway.
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Bengtsson-Tops, Anita
    School of Health Sciences and Social Work, Växjö University, Växjö, Sweden.
    Experiences of health-promoting self-care in people living with rheumatic diseases2011Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 67, nr 6, s. 1264-1272Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: This paper is a report of a study that explores and describes the meaning of the phenomenon of health-promoting self-care as experienced by people living with rheumatic diseases.

    Background: People with rheumatic diseases estimate health status as low and health belief and health status influence self-care behaviours. Several self-care behaviours are used in the efforts to mitigate the diseases.

    Method: The study had a descriptive phenomenological approach based on a reflective life-world perspective. Data were gathered in 2007 by unstructured open-ended interviews with 12 individuals living with rheumatic diseases.

    Findings: The meaning of health-promoting self-care as experienced by people living with rheumatic diseases was that self-care takes place against a background of continual hope and belief to influence health in positive ways. Self-care was a way of life and implied being ready to understand and respond to signals from the body. Three inter-related constituents elucidated their experiences: dialogue, power struggle and choice. Self-care was experienced as dialogues with the body and with the immediate environment. In order to respond to signals from the body, power struggles were required to be entered into when fighting the diseases. Choices were required to be made and things that were beneficial for the body were prioritized.

    Conclusion: In this study, the meaning of health-promoting self-care as experienced by people living with rheumatic diseases was that self-care was a way of life. This meant to be ready to understand and respond to signals from the body. Self-care required dialogues, power struggles and choices. © 2011 Blackwell Publishing Ltd.

  • 18.
    Arvidsson, Susann
    et al.
    Research and Development Centre, Spenshult hospital for rheumatic diseases, Oskarström, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult hospital for rheumatic diseases, Oskarström, Sweden.
    Arvidsson, Barbro
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Bengtsson-Tops, Anita
    School of Health Sciences & Social Work, Växjö University, Växjö, Sweden.
    People with Rheumatic Diseases Experiences of Health-Promoting Self-Care2010Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 69, nr Suppl. 3, s. 743-743Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: People with rheumatic diseases estimate their health status low. The health status and health belief are influencing the choice of self-care behaviours. Self-care behaviours are common and could prevent loss of valued life activities and health. Little is known of how people with rheumatic diseases experience self-care.

    Objectives: To describe people with rheumatic diseases experiences of health-promoting self-care.

    Methods: The study had a phenomenological approach based on a reflective life-world perspective. Data were gathered by unstructured and open-ended interviews with 12 individuals with various diagnoses of rheumatic diseases.

    Results: For people with rheumatic diseases, self-care was a way of life and implied being ready at all times to understand and respond to signals from the lived body. Self-care was experienced as an internal dialogue within the lived body but also as an external dialogue with the immediate environment. Self-care could also be described as a power struggle where the individuals strived and forced themselves to fight the diseases and its concrete consequences. The self-care also required that choices were made. Crucial for the choices were trust in oneself and belief in one's own ability to chosen health-promoting self-care. The individual prioritised self-care that was experienced as a beneficial and/or a reward for the lived body.

    Conclusion: People with rheumatic diseases experienced self-care as a way of life and that it meant to be ready at all times to understand and respond to signals that the lived body sends out. Self-care required dialogue, power struggle and choice. This knowledge ads to a fuller understanding of factors that from a patient perspective are important for health when living with a chronic rheumatic disease.

    Disclosure of Interest: None declared

  • 19.
    Arvidsson, Susann
    et al.
    Research and Development Centre, Spenshult hospital for rheumatic diseases, Oskarström, Sweden & School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult hospital for rheumatic diseases, Oskarström, Sweden.
    Arvidsson, Barbro
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI). Research and Development Centre, Spenshult hospital for rheumatic diseases, Oskarström, Sweden & Faculty of Health Care and Nursing, Gjøvik University College, Gjøvik, Norway.
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Bengtsson-Tops, Anita
    School of Health Sciences & Social Work, Växjö University, Växjö, Sweden.
    People with Rheumatic Diseases Experiences of Health-Promoting Self-Care2010Ingår i: QMSH 10: 6th Nordic Interdisciplinary Conference on Qualitative Methods in the Service of Health: May 2-4, 2010 • Uppsala, Sweden: Program and Abstracts, Uppsala: Uppsala universitet, 2010, s. 67-67Konferensbidrag (Refereegranskat)
  • 20.
    Arvidsson, Susann
    et al.
    FoU Centrum, Spenshult, Halmstad, Sverige & Hälsohögskolan, Jönköping, Sverige.
    Bergman, Stefan
    FoU Centrum, Spenshult, Halmstad, Sverige.
    Arvidsson, Barbro
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI). Gjøvik University College, Gjøvik, Norge.
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Bengtsson-Tops, Anita
    School of Health Sciences & Social Work, Växjö University, Växjö, Sweden.
    Upplevelse av hälsobefrämjande egenvård vid reumatisk sjukdom2009Konferensbidrag (Refereegranskat)
    Abstract [en]

    Bakgrund

    Personer med reumatiska sjukdomar skattar sitt hälsostatus lågt. Hälsostatus och tron på den egna förmågan att kunna påverka hälsan påverkar i sin tur valet av egenvårdsbeteenden. Egenvårdsbeteenden är vanliga och kan förhindra försämrad hälsa och förlust av värdefull fysisk och psykisk aktivitet. Kunskaperna är små om hur personer med reumatiska sjukdomar upplever att utföra egenvård. Syftet är därmed att beskriva hur personer med reumatiska sjukdomar erfar att utföra egenvård för att nå hälsa.

    Metod

    Studien har en kvalitativ design med en fenomenlogisk ansats och en livsvärldsteoretisk grund. Data har samlats in genom ostrukturerade och öppna intervjuer med 12 personer med olika diagnostiserade reumatiska sjukdomar.

    Resultat

    Personer med reumatiska sjukdomar upplever att egenvård är ett sätt att leva och att det innebär att ständigt vara redo för att förstå och reagera på signaler från den levda kroppen. Egenvård upplevs som en inre dialog inom den levda kroppen, men också en yttre dialog med närmiljön. Egenvård beskrivs också som en maktkamp där personen strävar efter och tvingar sig att kämpa mot sjukdomen och dess konkreta konsekvenser. Egenvården kräver också att val görs. Avgörande för valet är att personen har tillit till sig själv och tror på sin egen förmåga att välja hälsobefrämjande egenvård. Personer med reumatiska sjukdomar prioriterar egenvård som upplevs som positiv och/eller ger en belöning till den levda kroppen.

    Sammanfattning

    Personer med reumatiska sjukdomar upplever egenvård som ett sätt att leva och det innebär att vara i beredskap för att förstå och reagera på signaler som den levda kroppen sänder ut. Egenvård kräver dialog, maktkamp och val. Denna kunskap bidrar till en mer fullständig förståelse av faktorer som från ett patientperspektiv är viktiga för hälsan vid kronisk reumatisk sjukdom.

  • 21.
    Arvidsson, Susann
    et al.
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Arvidsson, Barbro
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI). Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden & Faculty of Health Care and Nursing, Gjøvik University College, Gjøvik, Norway.
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Tingström, Pia
    The Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Effects of a self-care promoting problem-based learning programme in people with rheumatic diseases: a randomized controlled study2013Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, nr 7, s. 1500-1514Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To evaluate the effects of a self-care promoting problem-based learning programme for people with rheumatic diseases in terms of health-related quality of life, empowerment, and self-care ability.

    Background: Individuals with rheumatoid arthritis express a great need for education and support in adapting to the disease, but the average qualities of studies about patient education interventions are not high. There is no evidence of long-term benefits of patient education.

    Design: Randomized controlled trial.

    Methods: A randomized controlled design was selected with test at baseline, 1-week and 6-month post-interventions after completed the 1-year programme. The tests consisted of validity and reliability tested instruments. The participants were randomly assigned in spring 2009 to either the experimental group (n = 54) or the control group (n = 148). The programme was running alongside the standard care the participants received at a rheumatology unit. Parametric and non-parametric tests were used in the analyses.

    Results: The participants in the experimental group had statistically significant stronger empowerment after participation in the self-care promoting problem-based learning programme compared with the control group, at the 6-month post-intervention. Approximately, two-thirds of the participants in the experimental group stated that they had implemented lifestyle changes due to the programme.

    Conclusion: The self-care promoting problem-based learning programme enabled people with rheumatic diseases to improve their empowerment compared with the control group. It is important to continue to develop problem-based learning in patient education to find the very best way to use this pedagogical method in rheumatology care. © 2012 Blackwell Publishing Ltd.

  • 22.
    Arvidsson, Susann
    et al.
    FoU Centrum, Spenshult, Halmstad, Sverige & Hälsohögskolan, Jönköping, Sverige.
    Bergman, Stefan
    FoU Centrum, Spenshult, Halmstad, Sverige.
    Arvidsson, Barbro
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI). Gjøvik University College, Gjøvik, Norge.
    Fridlund, Bengt
    Hälsohögskolan, Jönköping, Sverige.
    Tingström, Pia
    Linköpings universitet, Linköping, Sverige.
    Psychometric Properties of the Swedish Rheumatic Disease Empowerment Scale, SWE-RES-232010Ingår i: Svenska Läkaresällskapets Riksstämma 2010: Program: Reumatologi, 2010, s. 3-3Konferensbidrag (Refereegranskat)
    Abstract [en]

    Empowerment is a central concept in a patient-focused rheumatology care. WHO describes empowerment as a process in which the person receives more control over decisions and actions that affect the own life and health. Today there is no Swedish empowerment instrument for rheumatic diseases created or transl[...]

    The already existing questionnaire, Swedish Diabetes Empowerment Scale (SWE-DES-23), was adapted for use in patients with rheumatic diseases by exchanging the word diabetes with rheumatic disease in all the questions. No items were added or removed. The adapted questionnaire was called SWE-RES-23. In 2009, 260 patients with rheumatic diseases from a rheumatology unit in the southwest of Sweden completed the questionnaire.

    In order to establish discriminant validity, a question about self-perceived health from SF-36 was used in addition to SWE-RES-23.

    Construct validity was tested by using exploratory factor analysis. In order to determine unidimensionality of the empowerment subscales, inter-item correlations were calculated. Internal consistency reliability was tested by the use of the Cronbach-α coefficient.

    The exploratory factor analysis resulted in five factors (empowerment subscales) with Eigenvalues >1 explaining 64.1% of the variance. The five empowerment subscales were: Goal achievement and overcoming barriers to goal achievement, Self-awareness, Managing stress, Assessing dissatisfaction and readiness to change, and Support for caring. The Cronbach-α values ranged from 0.59 to 0.91 and for the total score 0.92. All inter-item correlations were significant. Patients with very good and good self-reported health scored significantly higher on three empowerment subscales (Goal achievement, Self-awareness and Managing stress). The same patterns were seen in the other two empowerment subscales (Readiness to change and Support for change), but did not reach significance.

    The SWE-RES-23 was a first step in developing a questionnaire for assessment of empowerment of patients with rheumatic diseases. The questionnaire possesses acceptable validity and reliability. To fully validate the SWE-RES-23 further studies are needed, but the instrument is even now possible to use in empowerment education programmes for patients with rheumatic diseases.

  • 23.
    Arvidsson, Susann
    et al.
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Arvidsson, Barbro
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Tingström, Pia
    Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Psychometric Properties of the Swedish Rheumatic Disease Empowerment Scale, SWE-RES-232012Ingår i: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 10, nr 2, s. 101-109Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction. Empowerment is a central concept in both rheumatology and diabetes care. A Swedish empower- ment instrument for patients with rheumatic diseases has not been created before now. The aim of the present study was to determine the psychometric properties of the Swedish Rheumatic Disease Empowerment Scale, SWE-RES-23, such as construct validity, internal consistency reliability, inter-item correlations and discriminant validity.

    Methods. The already existing instrument, the Swedish Diabetes Empowerment Scale (SWE-DES-23), was adapted for use in patients with rheumatic diseases. The adapted instrument was called the SWE-RES-23. In 2009, 260 patients with rheumatic diseases from a rheumatology unit in Sweden completed the instrument. Construct validity was tested by using exploratory factor analysis. Internal consistency reliability was tested by the use of Cronbach’s a-coefficient. In order to determine unidimensionality of the empowerment subscales, inter-item correlations were calculated. To establish discrim- inant validity, an item about self-perceived health from the Short Form (SF) 36 was used in addition to the SWE-RES-23.

    Results. The exploratory factor analysis resulted in five factors (empowerment subscales) with eigenvalues >1, explaining 64.1% of the total variance: Goal achievement and overcoming barriers to goal achievement; Self- knowledge; Managing stress; Assessing dissatisfaction and readiness to change; and Support for caring. Cronbach’s a values ranged from 0.59 to 0.91, and the value for the total score was 0.92.

    Conclusion. The results support the possibility of adapting the SWE-DES-23 for use in patients with rheumatic diseases. The SWE-RES-23 shows acceptable psychometric properties, in terms of construct validity and internal consistency reliability. To validate the SWE-RES-23 fully, further studies are needed, with a focus on test-retest correlations. Copyright © 2012 John Wiley & Sons, Ltd.

  • 24.
    Arvidsson, Susann
    et al.
    Rheumatology, Spenshult Hospital, Oskarström, Sweden.
    Bergman, Stefan
    Rheumatology, Spenshult Hospital, Oskarström, Sweden.
    Petersson, Ingemar
    Rheumatology, Spenshult Hospital, Oskarström, Sweden.
    In Patient Team Care Improved Health-Related Quality of Life for Patients with Rheumatic Diseases over Three and Six Months2006Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 65, nr Suppl. 2, s. 274-275Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: For measuring outcomes in team care, different aspects in the ICF (International Classification of Functioning) are relevant. Health-related quality of life as measured by SF-36 includes aspects of body function as well as activity and participation. HADS (Hospital Anxiety and Depression Scale) reflects more personal factors. Individuals with rheumatic diseases experience lower degree of health-related quality of life, compared with the general population.

    Objectives: To examine health-related quality of life as well as anxiety and depression in patients with rheumatic diseases directly after and three and six months after a period of three weeks in patient team based multiprofessional rehabilitation at a unit specialised for patients with different rheumatic diseases.

    Method: Quasi-experimental design with pre- and post-test in consecutive adult patients (Rheumatoid arthritis n=23, Spondylarthritides n=14, Osteoarthritis n=6, Other inflammatory rheumatic diseases n=10), one week before(n=55), one week after(n=53), three (n=40) and six months (n=36) after a period of three weeks of in patient team based multiprofessional care at a unit for rheumatic diseases. The instruments used for outcome measurements were the Short Form 36 Health questionnaire (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Statistical analysis was done with the SPSS package 13.0. Differences between groups were evaluated with Wilcoxon signed rank test.

    Results: The patients reported worse outcome on the eight health scales in SF-36, at baseline and one week, three and six months after the rehabilitation, when comparing with the norm for the Swedish population. The mean values for SF-36 improved in all eight subscales one week after the rehabilitation period and six of the health scales obtained statistically significant improvement (p<0.05). Three and six months later there was still a statistically (p<0.05 for 3/8 subscales; Role Physical (RP), Vitality(VT) and Mental Health(MH)) and/or clinically significant (5/8 subscales; Physical function(PF), Bodily Pain(BP), General Health(GH), Social Fundtioning(SF) and Role Emotional(RE)) improvement as compared to the levels before the rehabilitation period. The levels for anxiety and depression as measured by HADS improved significantly (p<0.05) one week after the rehabilitation period as compared to baseline. Three and six months after the rehabilitation period, the levels were the same as at baseline.

    Conclusion: Earlier studies and this study have shown that people with rheumatic diseases experience reduced health-related quality of life and increased anxiety and depression. The result from this study showed that after a period of three weeks in patient team based multiprofessional rehabilitation, the experience of health-related quality of life was improved also after three and six months whereas the improvement in anxiety and depression returned to baseline after three and six months. Thus, improvements in health-related quality of life seem to reflect other aspects of the disease consquences than anxiety and depression.

  • 25.
    Arvidsson, Susann
    et al.
    R&D-center, Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Bergman, Stefan
    R&D-center, Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Petersson, Ingemar F.
    R&D-center, Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    In-patient team care improved health-related quality of life for patients with rheumatic diseases over three and six months2006Konferensbidrag (Refereegranskat)
  • 26.
    Arvidsson, Susann
    et al.
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI), Hälsa och omvårdnad.
    Nylander, Maria
    Spenshult Research and Development Centre, Halmstad, Sweden & Swedish Rheumatism Association, Stockholm, Sweden.
    Bergman, Stefan
    Spenshult Research and Development Centre, Halmstad, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Callers´perceptions of their contact with a rheumatology telephone helpline2019Ingår i: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 17, nr 1, s. 105-112Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Telephone helplines are useful for improving patients' access to healthcare services and reducing the need for frequent face‐to‐face contact with healthcare professionals. Little is known about how people who phone a helpline perceive the encounter.

    Objectives: The aims of the present study were to describe the variation in how callers perceive their encounter with a rheumatology telephone helpline.

    Methods: The  study  had  a  descriptive,  qualitative  design  and  used  a phenomenographic approach, comprising 27 semi‐structured telephone interviews with callers to Rheuma Direct, a rheumatology telephone helpline with specially trained nurses. The callers comprised 22 women and five men, aged 22–89 years (mean 54 years).

    Results: The callers phoned Rheuma Direct when they had problems obtaining answers to questions on the internet or from healthcare professionals. Three descriptive categories emerged: constructive dialogue, specialized competence and applicability. The callers perceived that it was a constructive dialogue when they were able to discuss their concerns with someone, received emotional support, felt reassured and were satisfied with the information provided. They perceived specialized competence when the nurses were experienced and skilful, the advice provided complemented previously received information and when they had more knowledge after the call. The callers perceived that Rheuma Direct had applicability because it was easy to access and they could make different choices before, during and after the telephone call. 

    Conclusions: Callers to a rheumatology telephone helpline perceived it as a valuable complement to other sources of information, and felt that it could provide them with the tools to manage their disease better, as well as future contacts with healthcare professionals. © 2018 The Authors Musculoskeletal Care published by John Wiley & Sons Ltd.

  • 27.
    Arvidsson, Susann
    et al.
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI). Spenshult Research and Development Centre, Halmstad, Sweden.
    Nylander, Maria
    Spenshult Research and Development Centre, Halmstad, Sweden.
    Bergman, Stefan
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI). Spenshult Research and Development Centre, Halmstad, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    People's perceptions of their phone call with rheuma directly, a rheumatic diseases helpline2017Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, nr Suppl. 2, s. 1544-1545, artikel-id AB1238-HPRArtikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Information on rheumatic diseases is often complex to understand or scary, and additional support is often necessary. Rheuma Directly (RD) is a helpline with specially trained nurses on rheumatic diseases, funded by the Swedish Rheumatism Association and Spenshult Research and Development Centre. Little is known of how people calling a helpline perceive the contact.

    Objectives To describe the variation in how people perceive the contact with the helpline RD.

    Methods The study had a descriptive, qualitative design with a phenomenographic approach and was carried out by means of 27 semi-structured telephone interviews. The informants were 22 female and 5 men, and their ages ranged from 22 to 89 years (mean 54 years).

    Results The informants called RD when they had problems getting answers to their questions through the Internet or from healthcare professionals. Three different description categories emerged: Specific competence, Constructive dialogue, and Applicability. The informants' perceived Specific competence when the nurses were knowledgeable, the call was complementary to previously received information and when the informants had greater knowledge after the contact with RD. They perceived that it was a Constructive dialogue when they got someone to discuss with, a “sounding board”, and perceived emotional support, felt reassured and were satisfied with the answer. The informants perceived Applicability because RD was available and they could make different choices according to their own desire; before (how and when they would contact RD), during (what to tell and what question they would ask) and after (how and what they would do after the contact with RD).

    Conclusions People calling RD perceived that the telephone call with the nurses meant meeting specific competence, gaining constructive dialogue and that the helpline was applicable. This knowledge ad to a fuller understanding of factors that from a caller's perspective, are important when calling a helpline with specially trained nurses on rheumatic diseases. © 2017, Published by the BMJ Publishing Group Limited.

  • 28.
    Bergman, Stefan
    Research & development centre Spenshult, Oskarström, Sweden.
    Co-Ordinating Care: The Role of the General Practitioner2013Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, nr Suppl. 3, s. A20-A20Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    The general practitioner (GP) has a unique role in the care of people with rheumatic disorders. The main possibilities lie within early detection of the rheumatic disease and knowledge in how to diagnose and treat common co-morbidities. The GP could also be a link between specialised rheumatology care and paramedical resources in primary care. There are however great differences in how care is organised in different countries and thus how the possibilities within primary care are utilised. Lessons could be learned from how GPs work in collaboration with rheumatologists and other caregivers in different settings, with the patients' best in focus.

  • 29.
    Bergman, Stefan
    Spenshult Hospital, Oskarström, Sweden.
    Management of musculoskeletal pain2007Ingår i: Baillière's Best Practice & Research: Clinical Rheumatology, ISSN 1521-6942, E-ISSN 1532-1770, Vol. 21, nr 1, s. 153-166Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Chronic musculoskeletal pain is a major public health problem affecting about one third of the adult population. Pain is often present without any specific findings in the musculoskeletal system and a strictly biomedical approach could be inadequate. A biopsychosocial model could give a better understanding of symptoms and new targets for management. Identification of risk factors for chronicity is important for prevention and early intervention. The cornerstones in management of chronic non-specific, and often widespread, musculoskeletal pain are non-pharmacological. Physical exercise and cognitive behavioral therapy, ideally in combination, are first line treatments in e.g. chronic low back pain and fibromyalgia. Analgesics are useful when there is a specific nociceptive component, but are often of limited usefulness in non-specific or chronic widespread pain (including fibromyalgia). Antidepressants and anticonvulsants could be of value in some patients but there is a need for more knowledge in order to give general recommendations.

  • 30.
    Bergman, Stefan
    Research and development centre Spenshult, Oskarström, Sweden & Dept. of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Number of Painful Regions and their Distribution Predicts Outcome of Pain in the General Population2013Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, Suppl. 3, s. A98-A98Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Pain reported by a mannequin or predefined figure with body regions is important in evaluation of pain impact and development in general practice. Such reports are also of importance in classification of pain as being regional or widespread, as part of for example the 1990 ACR criteria for fibromyalgia. New proposed criteria for fibromyalgia have however omitted the evaluation of how painful regions are distributed and only focus on the number of regions.

    Objectives: The aim was to study if the number of painful regions and their distribution (regional or widespread) independently predicted chronic widespread pain in a 12 year follow up of a cohort from the general population.

    Methods: Within the Epipain-project a cohort of 2425 subjects from the general population in south Sweden answered a postal survey on pain and health. The questionnaire included a pain mannequin with 18 predefined regions. The number of regions was calculated and their distribution was analyzed with regard to ACR 1990 criteria for chronic widespread pain (CWP). Subjects were classified as having no chronic pain, chronic regional pain (CRP) or CWP. The survey was repeated after 3, 8 and 12 years. Odds ratios (Ors) for the independent variables pain distribution (NCP, CRP or CWP) and number of painful regions (0-18) with regard to report of CWP at follow up were analyzed with multiple logistic regression.

    Results: Report of CWP vs. NCP at 3, 8 and 12 year follow was independently predicted by both pain distribution and the number of painful regions. ORs for subjects with CWP at baseline were 6.3 (95% CI 2.3-17.2), 5.0 (95% CI 1.9-13.3), and 4.0 (95% CI 1.6-9.7) at respectively follow up. Corresponding ORs for number of painful regions at baseline were 1.4 (1.3-1.6), 1.4 (1.2-1.5), and 1.3 (1.2-1.4).

    Conclusions: Both the number of painful regions and their distribution (widespread or not) independently contributed to the prognosis for reporting chronic widespread pain in a 12 year follow up of pain development in the general population. This added prognostic value of pain distribution should be considered in evaluation of pain mannequins in general practice.

  • 31.
    Bergman, Stefan
    Research and Development Centre, Spenshult, Oskarström, Sweden.
    Psychosocial aspects of chronic widespread pain and fibromyalgia2005Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 27, nr 12, s. 675-683Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To study the impact on health status as measured by SF-36 in groups of subjects having chronic musculoskeletal pain with different degree of generalization: No chronic pain (NCP), chronic regional pain (CRP), chronic widespread pain (CWP), CWP with a stricter 'Manchester' definition (CWP-M), and clinically defined fibromyalgia (FM). The study also examines the association between psychosocial and lifestyle background variables, and these pain-groups.

    METHOD: A cross-sectional study with a postal survey to 3928 subjects, constituting a representative sample of the adult general population, followed by clinical examination in a selected group of subjects with CWP. CWP and FM were diagnosed according to ACR 1990 fibromyalgia criteria. Health status was measured by SF-36 Health Survey.

    RESULTS: Patients with CWP, CWP-M, and FM were found to present with more severe impairment of health status than the other two population groups. Several psychosocial factors, such as belonging to a lower socio-economic group, being an immigrant, living in a compromised housing area, having lower educational level, experiencing lower social support and having a family history of chronic pain, were associated with the populations with CWP and FM.

    CONCLUSIONS: The spectrum of impact on health and association to background variables, with respect to a stricter definition of CWP, indicates that these factors are important to attend to in the understanding and management of CWP and FM.

    © 2005 Taylor & Francis Group Ltd.

  • 32.
    Bergman, Stefan
    Spenshult Hospital, Oskarström, Sweden.
    Public health perspective - how to improve the musculoskeletal health of the population2007Ingår i: Baillière's Best Practice & Research: Clinical Rheumatology, ISSN 1521-6942, E-ISSN 1532-1770, Vol. 21, nr 1, s. 191-204Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Musculoskeletal disorders are the most common cause of long-term sick leave in several western countries and individuals with chronic musculoskeletal pain score very low on health status measurements. Musculoskeletal health is multidimensional and is best understood from a biopsychosocial perspective. Body structure and function interacts with personal and environmental factors, affecting the ability to perform activities and participate in society. Interventions aimed at the whole population must attend to the underlying causes of musculoskeletal disorders and promote a healthy lifestyle. Safe environments and activities could reduce the risk of traumatic events and also make participation possible for those with a disability. Public beliefs about musculoskeletal symptoms and consequences need to be changed in order to minimise fear and avoidance, which, together with other psychosocial factors, could lead to chronicity. Public awareness and identification of those at risk for the development of musculoskeletal problems could lead to early and properly timed management.

  • 33.
    Bergman, Stefan
    et al.
    Spenshult Research and Development Center, Halmstad, Sweden.
    Bremander, Ann
    Spenshult Research and Development Center, Halmstad, Sweden.
    Lifestyle factors were seldom discussed with patients visiting a rheumatology clinic2013Ingår i: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 65, nr Special issue, Supplement 10, s. S982-S983, Meeting Abstract: 2307Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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

  • 34.
    Bergman, Stefan
    et al.
    FoU Spenshult, Halmstad, Sweden; The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Lund University, Lund, Sweden.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Bio- och miljösystemforskning (BLESS), Biomekanik och biomedicin. FoU Spenshult, Halmstad, Sweden & Lund University, Lund, Sweden.
    Bergman, Anna-Carin
    Sannarpsgymnasiet, Halmstad, Sweden.
    Brorsson, Sofia
    Health and Welfare, Dalarna University, Falun, Sweden.
    Chronic Widespread Pain in Adolescents Is Highly Associated to Stress and Anxiety2015Ingår i: Arthritis & Rheumatology, ISSN 2326-5191, E-ISSN 2326-5205, Vol. 67, nr Suppl. S10, artikel-id 917Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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

  • 35.
    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 sample2018Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 7, nr 2, s. 1645-1646Artikel i tidskrift (Refereegranskat)
  • 36.
    Bergman, Stefan
    et al.
    Primary Care Centre Hertig Knut, Halmstad, Sweden.
    Herrström, Per
    Högström, K.
    Petersson, Ingemar F.
    Svensson, Björn
    Jacobsson, Lennart T.
    Chronic musculoskeletal pain, prevalence rates, and sociodemographic associations in a Swedish population study2001Ingår i: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 28, nr 6, s. 1369-1377Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To estimate the prevalence of chronic regional and widespread musculoskeletal pain in a sample of the general adult population and study the association to age, sex, socioeconomic class, immigration, and housing area.

    METHODS: A cross sectional survey with a postal questionnaire to 3928 inhabitants on the west coast of Sweden.

    RESULTS: The age and sex adjusted prevalence of chronic regional pain (CRP) was 23.9% and chronic widespread pain (CWP) 11.4% among 2425 subjects who responded to the complete questionnaire. Odds ratio (OR) for CWP showed a systematic increasing gradient with age and was highest in the age group 59-74 yrs (OR 6.36, 95% CI 3.85-10.50) vs age group 20-34 yrs. CWP was also associated with female sex (OR 1.91, 95% CI 1.41-2.61), being an immigrant (OR 1.83, 95% CI 1.22-2.77), living in a socially compromised housing area (OR 3.05, 95% CI 1.48-6.27), and being an assistant nonmanual lower level employee (OR 1.92, 95% CI 1.09-3.38) or manual worker (OR 2.72, 95% CI 1.65-4.49) vs being an intermediate/higher nonmanual employee. OR for CRP showed a systematic increasing gradient with age and was highest in the age group 59-74 yrs (OR 2.22, 95% CI 1.62-3.05) vs age group 20-34 yrs. CRP was also associated with being a manual worker (OR 1.63, 95% CI 1.19-2.23) vs being an intermediate/higher nonmanual employee.

    CONCLUSION: Chronic musculoskeletal pain is common in the general population. Sociodemographic variables were overall more frequently and strongly associated with CWP than with CRP, which indicates different pathophysiology in the development or preservation of pain in the 2 groups.

  • 37.
    Bergman, Stefan
    et al.
    Primary Care Centre Hertig Knut, Halmstad, Sweden.
    Herrström, Per
    Jacobsson, Lennart T
    Petersson, Ingemar F
    Chronic widespread pain: a three year followup of pain distribution and risk factors2002Ingår i: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 29, nr 4, s. 818-825Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To describe the change of pain reports over time in 3 cohorts derived from the general population: (1) no chronic pain (NCP; n = 1156); (2) chronic regional pain (CRP; n = 502); and (3) chronic widespread pain (CWP; n = 242). To identify risk factors that predict the development or persistence of chronic widespread pain.

    METHODS: A 3-year followup from 1995 to 1998 with postal questionnaire to 2425 subjects of both sexes aged 20-74 years on the west coast of Sweden.

    RESULTS: At followup, a larger proportion of subjects with initial CRP compared to initial NCP reported CWP (16.4 and 2.2%, respectively; p < 0.001). The majority of subjects (56.9%) who primarily reported CWP remained in that group at followup, but 26.8% had changed status to CRP and 16.3% to NCP. The number of painful regions (7-12 vs 0 regions) reported at baseline was the strongest predictor for the development of CWP with an odds ratio (OR) of 12.13 (95% CI 4.47-32.88). The development of CWP was also predicted by higher age (OR = 3.13, 95% CI 1.47-6.69, age-group 59-74 years vs age-group 20-34 years), and a family history of chronic pain (OR = 1.87, 95% CI 1.14-3.07). A habit of drinking alcohol weekly (OR = 0.42, 95% CI 0.21-0.85) compared to the habit of never or seldom drinking alcohol was protective, as well as having personal social support (OR = 0.49, 95% CI 0.28-0.85). The persistence of CWP was predicted by the number of painful regions (13-18 vs 1-6 regions) at baseline (OR = 7.56, 95% CI 2.17-26.30), and being an immigrant (OR = 3.22, 95% CI 1.33-7.77).

    CONCLUSION: Although the overall prevalence of CWP was stable over a 3-year period there was a considerable variation on an individual basis. This variability in expressing CWP was moderately predicted by a combination of risk factors, the most important being the number of painful regions at baseline. Future research will need to show how useful the identified factors are in clinical practice and whether intervention aimed at changing these factors will improve pain outcome. 

  • 38.
    Bergman, Stefan
    et al.
    Research and Development Centre, Spenshult, Oskarström, Sweden.
    Jacobsson, Lennart T.H.
    Herrström, Per
    Petersson, Ingemar F.
    Health status as measured by SF‐36 reflects changes and predicts outcome in chronic musculoskeletal pain: a 3‐year follow up study in the general population2004Ingår i: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 108, nr 1-2, s. 115-123Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The SF-36 is a well-validated health status instrument measuring eight different health concepts. One aim of this study was to compare health status as measured by SF-36 in subjects from the general population with no chronic pain (NCP), chronic regional pain (CRP), and chronic widespread pain (CWP). A second aim was to assess if SF-36 could reflect changes in pain status over time. A third aim was to study if health status at baseline, measured by SF-36, could predict pain status 3 years later. The study was designed as a 3-year follow up with a postal questionnaire, including the SF-36 health survey, to 2357 subjects from the general population aged 20-74 years. The results were controlled for age, sex, co-morbidity, and socio-economic status. At baseline, all eight health concepts of SF-36 discriminated between subgroups with NCP, CRP and CWP. Changes in SF-36 over the 3-year follow up time coincided with improvement or deterioration of pain status. Baseline SF-36 scores predicted pain outcome 3 years later. These results support that both physical and mental aspects of health status as measured by SF-36 are affected by the burden of musculoskeletal pain, are sensitive to changes in pain status, and also predict the further development of pain. Published by Elsevier B.V. All rights reserved.

  • 39.
    Bergman, Stefan
    et al.
    Lund University, Lund, Sweden & Research & Development Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Symeonidou, Sofia
    Research & Development Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Andersson, Maria L.
    Research & Development Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Söderlin, Maria K.
    Research & Development Center, Spenshult Rheumatology Hospital, Oskarström, Sweden.
    Alcohol consumption is associated with lower self-reported disease activity and better health-related quality of life in female rheumatoid arthritis patients in Sweden: data from BARFOT, a multicenter study on early RA2013Ingår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 14, s. Article 218-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Earlier studies have found a positive effect of alcohol consumption, with a reduced disease activity in rheumatoid arthritis (RA). The aim of this study was to assess alcohol consumption and its association with disease activity and health related quality of life (HRQL) in Swedish RA patients.

    METHODS: Between 1992 and 2005, 2,800 adult patients were included in the BARFOT study of early RA in Sweden. In 2010 a self-completion postal questionnaire was sent to all 2,102 prevalent patients in the BARFOT study enquiring about disease severity, HRQL, and lifestyle factors. Alcohol consumption was assessed using the validated AUDIT-C questionnaire.

    RESULTS: A total of 1,238 out of 1,460 patients answering the questionnaire had data on alcohol consumption: 11% were non-drinkers, 67% had a non-hazardous drinking, and 21% were classified as hazardous drinkers. Women who drank alcohol reported lower disease activity and better HRQL, but there were no association between alcohol consumption and disease activity in men. For current smokers, alcohol use was only associated with fewer patient-reported swollen joints. The outcome was not affected by kind of alcohol consumed.

    CONCLUSIONS: There was an association between alcohol consumption and both lower self-reported disease activity and higher HRQL in female, but not in male, RA patients. © 2013 Bergman et al.; licensee BioMed Central Ltd.

  • 40.
    Bergsten, Ulrika
    et al.
    Spenshult Hospital for Rheumatic diseases, Oskarström, Sweden & Sahlgrenska University Hospital, Gothenburg, Sweden.
    Andrey, A-M
    Swedish Rheumatism Association, Stockholm, Sweden.
    Bottner, L.
    Swedish Rheumatism Association, Stockholm, Sweden.
    Nylander, Maria
    Swedish Rheumatism Association, Stockholm, Sweden.
    Persson, G.
    Swedish Rheumatism Association, Stockholm, Sweden.
    Petersson, E.
    Swedish Rheumatism Association, Stockholm, Sweden.
    Bergman, Stefan
    Spenshult Hospital for Rheumatic diseases, Oskarström, Sweden.
    Patient-Initiated Research in Rheumatic Diseases in Sweden – Dignity, Identity and Quality of Life in Focus When Patients Set the Research Agenda2014Ingår i: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 12, nr 3, s. 194-197Artikel i tidskrift (Refereegranskat)
  • 41.
    Bergsten, Ulrika
    et al.
    Rheumatology unit, Sahlgrenska University Hospital, Göteborg, Sweden & R&D-Centre, Spenshult, Oskarström, Sweden.
    Bagge, Jan
    The Sweden Rheumatism Association, Stockholm, Sweden.
    Åkerhielm, Caroline
    The Sweden Rheumatism Association, Stockholm, Sweden.
    Bergman, Stefan
    R&D-Centre, Spenshult, Oskarström, Sweden.
    Dignity, Identity and Quality of Life – In Focus when Patients Set the Research Agenda2013Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, nr Suppl. 3, s. A776-A776Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The rheumatic diseases are usually long lasting and affect the daily life in form of pain, stiffness and fatigue. Patients' perceptions of their illness and its consequences differ to some extent from the established medical view. This also means that there could be unidentified areas of research that could be of great value for the patients. The Swedish Rheumatism Association (the national patient organization) and Research- and Development-center Spenshult decided to carry out a joint project to develop patient initiated research in order to increase knowledge and to improve the care of the rheumatic diseases.

    Objectives: The aim of the project was to develop and describe new research areas from a patient perspective that not had been adequately covered previously and to initiate projects that patients consider to be of importance for development of rheumatology care.

    Methods: A project team was formed consisting of five research partners (specially educated people with personal experience of a rheumatic disease) and a project manager. The project team used a structured method throughout the project in order to maintain focus at the patient perspective. The structured method that was used – The dialogue model – is developed with the purpose to promote the dialogue between different stakeholders such as patients and researchers. During the project there were other members of the local rheumatic association engaged in the form of focus groups. Experiences were communicated in four focus group interviews and by individuals that had experience of rheumatic disease. The material was analyzed by content analysis research method.

    Results: The analysis resulted in several research ideas and research areas that were important from the patient perspective. Most of them focused on the patient's dignity, identity and quality of life. The repeated theme was: How can a person maintain or improve their quality of life despite chronic illness? Persons who participated in the focus groups communicated their experiences of having a rheumatic disease and the central point was how life changes when you suffer from a chronic disease and that the “whole life” was affected to different degrees. It was also clear that there are shortcomings in health care and society in terms of providing support and assistance to the person with a rheumatic disease.

    Conclusions: A structured approach involving research partners and members of patient associations generated several new research ideas that now are planned to be developed further. The patient initiated research agenda complements the established medical view and could improve the knowledge and understanding of having a rheumatic disease and an opportunity to develop rheumatology care to be more person-centered.

  • 42.
    Bergsten, Ulrika
    et al.
    Jonkoping Univ, Sch Hlth Sci, Jonkoping.
    Bergman, Stefan
    Spenshult Hosp, Ctr Res & Dev, Oskarstrom.
    Fridlund, Bengt
    Jonkoping Univ, Sch Hlth Sci, Jonkoping.
    Alfredsson, Lars
    Karolinska Inst, Inst Environm Med, S-10401 Stockholm.
    Berglund, Anita
    Karolinska Inst, Inst Environm Med, S-10401 Stockholm.
    Arvidsson, Barbro
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Petersson, Ingemar
    Univ Lund Hosp, Dept Rheumatol, S-22185 Lund.
    Patterns of background factors related to early RA patients conceptions of the cause of their disease2011Ingår i: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 30, nr 3, s. 347-352Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of the present study was to identify patterns of background factors related to the early RA patients' conceptions of the cause of the disease. Conceptions from a qualitative study formed the basis for the stratification of 785 patients from the Swedish EIRA study answering a question about their own thoughts about the cause to RA. Logistic regression analyses were used to explore the associations between patients' conceptions and relevant background factors: sex, age, civil status, educational level, anti-cyclic citrullinated peptide antibody (anti-CCP) and smoking habits. The results were presented as odds ratios (OR) with 95% confidence intervals (CI). A conception of family-related strain was strongly associated with being young (OR 0.50; 95% CI 0.33-0.78 for age 58-70 vs. 17-46), female (OR 0.38; 95% CI 0.25-0.60 for male vs. female) and having a high level of education (OR 2.15; 95% CI 1.54-3.01 for university degree vs. no degree). A conception of being exposed to climate changes was associated with being male (OR 1.99; 95% CI 1.24-3.22 for male vs. female), having a low level of education (OR 0.33; 95% CI 0.18-0.58 for university degree vs. no degree) and positive Anti-CCP (OR 1.72; 95% CI 1.03-2.87 for positive vs. negative Anti-CCP). Linking patients' conceptions of the cause of their RA to background factors potentially could create new opportunities for understanding the complexity of the aetiology in RA. Furthermore, this information is important and relevant in the care of patients with early RA.

  • 43.
    Bergsten, Ulrika
    et al.
    Research and Development Centre at Spenshult Hospital, Oskarström, Swede.
    Bergman, Stefan
    Research and Development Centre at Spenshult Hospital, Oskarström, Swede.
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Berglund, Anita
    Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Petersson, Ingemar F.
    Lund University Hospital, Lund, Sweden.
    Arvidsson, Barbro
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Patients’ conceptions of the cause of their Rheumatoid Arthritis: A qualitative study2009Ingår i: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 7, nr 4, s. 243-255Artikel i tidskrift (Refereegranskat)
  • 44.
    Bergsten, Ulrika
    et al.
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Bergman, Stefan
    Spenshult Hosp, Ctr Res & Dev, Oskarstrom, Sweden .
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Arvidsson, Barbro
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    “Delivering knowledge and advice”: Healthcare providers’ experiences of their interaction with patients’ management of rheumatoid arthritis2011Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 6, nr 4, artikel-id 8473Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Rheumatic diseases are often chronic and involve a lifetime of suffering. The focus of rheumatology care is to support patients to manage their lives and master their disease. Healthcare providers and patients have different views on the consequences of living with rheumatic diseases and patients are reporting unmet healthcare needs. There is a need to integrate providers’ perspective to develop the quality of rheumatology care. The aim was to explore healthcare providers’ experiences of their interaction with patients in their management of RA. Interviews with 18 providers from different clinical settings were analysed in accordance with the grounded theory method. A core category; Delivering knowledge and advice was found to be the most important task and involved providing the patient with information about the disease and appropriate forms of treatment. Healthcare providers’ attitudes and patients’ responses influenced the outcome of the delivery of knowledge and advice and three dimensions emerged; completed delivery, adjusted delivery and failed delivery. There were differences in the providers’ experiences in their interaction with patients as well as in reflections on their role as the delivering part. There could be difficulties in the interaction when patients’ expectations and preferences were not taken into account when giving advice. These findings highlight the importance of developing rheumatology care, as no provider or patient benefits if the delivery of knowledge and advice becomes a failed delivery. The healthcare organization must acknowledge the difficulties involved in the interaction with patients in their management of RA and find methods to develop a more person-centred approach to care.

  • 45.
    Bergsten, Ulrika
    et al.
    Jönköping University, Jönköping, Sweden.
    Bergman, Stefan
    Spenshult Hospital, Oskarström, Sweden.
    Fridlund, Bengt
    Jönköping University, Jönköping, Sweden.
    Arvidsson, Barbro
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    "Striving for a good life" - the management of reumatoid arthritis as experienced by patients2011Ingår i: Open Nursing Journal, ISSN 1874-4346, E-ISSN 1874-4346, Vol. 5, s. 95-101Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim:

    To generate a theoretical model how patients experience their management of rheumatoid arthritis (RA) in everyday life.

    Method:

    An explorative design with the grounded theory approach was used by interviewing 16 informants with RA.

    Results:

    The generated theoretical model emerged in a core category-Striving for a good life with two categories; making use of personal resources and grasping for support from others, which formed the base of managing RA. When relating these categories together, four dimensions emerged which characterised patients' different ways of managing RA: mastering, relying, struggling and being resigned.

    Discussion:

    The management of RA incorporated the use of personal resources and the grasping for support from others. Both self-management strategies and patients' need of support were highlighted as aspects that were of importance when managing RA. Patients' experiences of their need of support to manage RA give extended knowledge that is of importance for nurses and other healthcare providers. The relationship between patients and healthcare providers is always the key to a good encounter. Interventions to increase self-management in RA have to incorporate this knowledge when trying to increase patients' self-efficacy and with their experience of support.

  • 46.
    Bremander, A B
    et al.
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarstrom, Sweden.
    Holmström, G
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarstrom, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarstrom, Sweden.
    Depression and age as predictors of patient-reported outcome in a multidisciplinary rehabilitation programme for chronic musculoskeletal pain2011Ingår i: Musculoskeletal care, ISSN 1557-0681, Vol. 9, nr 1, s. 41-48Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 47.
    Bremander, Ann
    et al.
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, SE 313 92 Oskarström, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, SE 313 92 Oskarström, Sweden.
    Non-pharmacological management of musculoskeletal disease in primary care2008Ingår i: Baillière's Best Practice & Research: Clinical Rheumatology, ISSN 1521-6942, E-ISSN 1532-1770, Vol. 22, nr 3, s. 563-77Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 48.
    Bremander, Ann
    et al.
    Spenshult Hosp Rheumat Dis, Ctr Res & Dev, S-31392 Oskarström, Sweden .
    Bergman, Stefan
    Spenshult Hosp Rheumat Dis, Ctr Res & Dev, Oskarström, Sweden .
    Arvidsson, Barbro
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Perception of multimodal cognitive treatment for people with chronic widespread pain: changing one's life plan2009Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, nr 24, s. 1996-2004Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose.

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

    Methods.

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

    Results.

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

    Conclusion.

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

  • 49.
    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 Pain2018Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, nr Suppl. 2, s. 1829-1830, artikel-id SAT0737-HPRArtikel i tidskrift (Refereegranskat)
    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.

  • 50.
    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 Spondyloarthritis2017Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, nr Suppl. 2, s. 1495-1496Artikel i tidskrift (Refereegranskat)
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