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

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

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

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

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

  • 2.
    Aili, Katarina
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). RandD Spenshult, Halmstad, Sweden & Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bergman, Stefan
    Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Lund University, Department of Clinical Sciences, Lund, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). RandD Spenshult, Halmstad, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). RandD Spenshult, Halmstad, Sweden.
    Passive coping strategies but not physical function are associated with worse mental health, in women with chronic widespread pain– a mixed method study2019In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, no Suppl 2, p. 2159-Article in journal (Refereed)
  • 3.
    Aili, Katarina
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Sport.
    Bergman, Stefan
    Göteborgs Universitet.
    Bremander, Ann
    University of Southern Denmark, Odense..
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing.
    Passive coping strategies but not physicalfunction are associated with worse mental health, in women with chronicwidespread pain– a mixed method study2019In: Annual Annals of the Rheumatic Diseases, 2019, article id A2159Conference paper (Refereed)
    Abstract [en]

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

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

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

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

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

    Conclusion: Women that reported CWP in 2016, but not in 1995, described both active and passive coping strategies. The qualitative findings were associated with differences in vitality and mental health already in 1995, before they had developed CWP. Further, those with passive coping strategies reported worse health with regard to mental health and sleep problems in 2016. Interestingly, the groups did not differ in bodily pain or physical function neither in 1995 nor in 2016, which implicates the importance for the clinician to take the typical coping strategy into consideration, when meeting these patients in clinical settings.

  • 4.
    Aili, Katarina
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Karolinska Institutet, Institute of Environmental Medicine, Stockholm, Sweden & RandD Spenshult, Halmstad, Sweden.
    Bergman, Stefan
    RandD Spenshult, Halmstad, Sweden & Institute of Medicine, The Sahlgrenska Academy, Primary Health Care Unit, Department of Public Health and Community Medicine, Gothenburg, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). RandD Spenshult, Halmstad, Sweden.
    Adding information on widespread pain to the start back screening tool when identifying low back pain patients at increased risk for poor prognosis2019In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, no Suppl 2, p. 1457-1457Article in journal (Refereed)
  • 5.
    Aili, Katarina
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). RandD Spenshult, Halmstad, Sweden & Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Campbell, Paul
    Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom & Midlands Partnership NHS Foundation Trust, Stafford, United Kingdom.
    Michaleff, Zoe
    Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom.
    Strauss, Victoria
    University of Oxford, CSM, NDORMS, Oxford, United Kingdom.
    Jordan, Kelvin
    Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom &Centre for Prognosis Research, Keele University, Keele, United Kingdom.
    Bremander, Ann
    RandD Spenshult, Halmstad, Sweden & University of Southern Denmark, Department of Regional Health Research, Odense, Denmark.
    Croft, Peter
    Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom & Centre for Prognosis Research, Keele University, Keele, United Kingdom.
    Bergman, Stefan
    RandD Spenshult, Halmstad, Sweden & Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Long term trajectories of chronic widespread pain: a 21-year prospective cohort latent class analysis2019In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, no Suppl 2, p. 239-239Article in journal (Refereed)
  • 6.
    Arvidsson, Susann
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Aili, Katarina
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Nygren, Jens M.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Health-Related Quality of Life among Young Adult Acute Lymphoblastic Leukemia Survivors in Sweden2019Conference paper (Refereed)
  • 7.
    Bergman, Stefan
    et al.
    Lund University, Lund, Sweden & University of Gothenburg, Gothenburg, Sweden & RandD centre Spenshult, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). RandD centre Spenshult, Halmstad, Sweden.
    Aili, Katarina
    RandD centre Spenshult, Halmstad, Sweden & Karolinska Institutet, Stockholm, Sweden.
    Olsson, Cecilia
    University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Lund University, Lund, Sweden & RandD centre Spenshult, Halmstad, Sweden.
    Chronic widespread pain, sleep problems and pressure pain thresholds in a population sample2018In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 7, no 2, p. 1645-1646Article in journal (Refereed)
  • 8.
    Drab, Beata
    et al.
    Institute of medicine, University of Gothenburg, Primary Health Care Unit, Department of Public Health and Community Medicine, Gothenburg, Sweden.
    Aili, Katarina
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). RandD Spenshult, Halmstad, Sweden & Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). RandD Spenshult, Halmstad, Sweden.
    Bergman, Stefan
    Institute of medicine, University of Gothenburg, Primary Health Care Unit, Department of Public Health and Community Medicine, Gothenburg, Sweden & RandD Spenshult, Halmstad, Sweden.
    Chronic pain and sick leave in a 21-year follow up2019In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, no Suppl 2, p. 122-122Article in journal (Refereed)
  • 9.
    Svensson, Miriam
    et al.
    Halmstad University.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing.
    Aili, Katarina
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Sport.
    Women’s experience of the journey to chronic widespread pain – a qualitative study2019In: Annals of the Rheumatic Diseases, 2019, Vol. 78, article id A657Conference paper (Refereed)
  • 10.
    Svensson, Miriam
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing.
    Aili, Katarina
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Sport.
    Women’s experience of the journey to chronicwidespread pain – a qualitative study.2019In: Annals of the Rheumatic Diseases, 2019, Vol. 78, article id A657Conference paper (Refereed)
    Abstract [en]

    Background: Chronic widespread pain (CWP) is a major burden to both the person and the community. Non-tumor chronic pain is one of the most common causes for long-term sickness absence in Sweden. The prevalence of CWP in the general population is approximately 10%, and the condition is almost twice as prevalent in women, than in men. Increased understanding of how women with CWP describe triggering factors of pain and pain progress would be of importance when preventing poor pain prognosis, and when customizing the treatment strategy in a setting with person-centered care.

    Objectives: To explore experiences of factors influencing the progress and severity of pain among women who have developed CWP within the last 21 years.

    Methods: This is a descriptive study, using a qualitative content analysis with an abductive approach 1 . Nineteen women reporting CWP in a survey 2016, between 45-67 (median 57) years of age, who had not reported CWP in a survey 1995, participated in the study. Data were collected through individual interviews with open-ended questions: “Can you describe how your CWP has developed the last 20 years?”, “How did your CWP change over time?” and “Have you experienced any important events that have influenced the development of your CWP?” Data were analyzed through a manifest qualitative content analysis and six categories emerged.

    Results: The women described their journey to CWP in terms of triggering, aggravating and consolidating factors. Six different categories emerged; physical strain, emotional strain, social strain, work-related strain, biological strain and environmental strain.  Physical strain included strenuous physical activities in leisure time, having muscle tension, inactivity or sleeping problems.  Emotional strain included being depressed, worried and stressed, as well as neglecting the pain.  Social strain included to prioritize other people before oneself and to meet distrust from the social surroundings.  Work-related strain included heavy, monotonous and stressful work but also sedentary work.  Biological strain referred to heredity, age and infections.  Environmental strain meant that the climate or weather aggravated the pain.

    Conclusion: The women in the study described how their journey to CWP was influenced by both external and internal strains. The six categories representing different types of strains were recurrent in a context describing triggering, aggravating and consolidating factors. This highlights the complexity of individual pain progress and argues for the importance of person-centred care approaches and rehabilitation programs. The fact that women with CWP feel mistrust from healthcare professionals indicates that the current care approach needs to be changed.

  • 11.
    Westergården, Malin
    et al.
    Halmstad University, School of Health and Welfare.
    Aili, Katarina
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). RandD Spenshult, Halmstad, Sweden & Karolinska Institutet, Unit of occupational medicine, Institute of Environmental Medicine, Stockholm, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). RandD Spenshult, Halmstad, Sweden.
    Living every-day life in the shadow of pain or live every-day life with the pain in the shadow – A constant balancing2019In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, no Suppl 2, p. 1063-1064Article in journal (Refereed)
    Abstract [en]

    Background: Approximately 10% of the population report chronic widespread pain (CWP), the condition is more common in women than in men. Long-term pain is a public health problem. For most women, the pain interferes with many aspects of every-day life and implies large consequences. Thus, knowledge about how to facilitate life for these women is important.

    Objectives: To explore women’s experiences of how CWP influence their daily life

    Methods: The study has a latent qualitative content analysis design 1 . Individual interviews were conducted in 19 women 45-67 of age, who had reported CWP in a survey 2016. CWP was defined according to the 1990 ACR criteria for fibromyalgia. Pain that had lasted for more than three months, during the last 12 months, was considered chronic. A latent qualitative content analysis was used to analyze the main questions “Can you describe your experiences of living with CWP?” and “How do the CWP influence your life today?” The interviews were recorded, transcribed verbatim and coded into eight subcategories and three categories; represent the manifest content, and a latent theme exploring the interpreted content of women’s experiences of how CWP influence their every-day life.

    Results: The interviewed women expressed a life with CWP as “Living every-day life in the shadow of pain or live every-day life with the pain in the shadow” including three categories; the experience of alienation, limitations and plasticity. 1) The experiences of alienation appeared in the subcategories; suspicion and loneliness. Suspicion meant a feeling of not be taken seriously by healthcare and authorities and loneliness meant not being able to participate in social contexts. 2) The experiences of limitations in daily life includes the subcategories; barriers, stress, and dependence of other people. Barriers meant that fatigue limits the activities in every-day life, stress that constitutes limitations in life and dependence on other people’ support. 3) The experiences of plasticity referred to the subcategories resignation, adjustment and resistance. Resignation meant refraining from activities that could affect the pain, such as gardening, walking and dancing. Adjustment were manifested by making the best of the situation, and resistance meant to resist letting the pain set the terms, to give the pain a fight.

    Conclusion: Women with CWP have to deal with their physical, mental, social and spiritual environment in every-day life. They express a constant balancing in their life between mastering the pain in order to continue living as normal, and allowing the pain to set the terms, i.e. living every-day life in the shadow of pain or live every-day life with the pain in the shadow. Healthcare professionals may consider supporting the patients in finding their individual counterweight to manage life in order to reach better treatment outcome. © Westergården, Aili & Larsson 2019. No commercial re-use. See rights and permissions. Published by BMJ.

  • 12.
    Westergården, Malin
    et al.
    Halmstad University.
    Aili, Katarina
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Sport.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing.
    Living every-day life in the shadow of pain or live every-day life with the pain in the shadow – a constant balancing2019In: Annals of the Rheumatic Diseases, 2019, article id A1063Conference paper (Refereed)
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