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

BACKGROUND: The improvement in treatment of pediatric acute lymphatic leukemia (ALL) has introduced new challenges for pediatric oncology care in understanding and handling long-term treatment-related complications later in adult life. The aim of this study was to describe health related quality of life (HRQoL) and the relation to buffering factors among young adult (YA) pediatric ALL survivors and their siblings.

METHODS: This cross-sectional study was performed among 227 adults, treated for pediatric ALL in Sweden between 1985 and 1997 and their siblings (n = 70). Group means of HRQoL (SF-36) were compared between YA ALL survivors and the siblings, as well as to normative values from the general population. Self-efficacy (GSES) and social support (SS-13 subscale AVSI) was considering potential buffering factors for HRQoL and mental health. Associations between HRQoL and mental health respectively and self-efficacy and social support was analyzed.

RESULTS: The YA ALL survivors scored significantly lower on the HRQoL parameters general health (69.6 vs. 78.4, p = 0.004) and role emotional (77.1 vs. 88.1, p = 0.014), than the siblings. Further, they reported significantly lower general health (69.6 vs. 75.8), vitality (56.9 vs. 68.8), social functioning (84.5 vs. 88.6), role emotional (77.1 vs. 85.7) and mental health (71.3 vs. 80.9) compared with Swedish norms. Both YA ALL survivors and the siblings reported lower vitality and worse mental health than the general population. The HRQoL parameters, depression, stress and anxiety were all associated with both self-efficacy and social support among the YA ALL survivors. Among the siblings however, only general health, vitality, role emotional, mental health and depression were associated with social support, and only general health and mental health were associated with general self-efficacy.

CONCLUSION: The results from this study show that buffering factors, like social support and self-efficacy, may play an important role for psychosocial outcomes and HRQoL among YA ALL survivors later in life. The results suggest that this group could benefit from continuous support in adult life to handle consequences of their pediatric disease. © 2021, The Author(s).

Introduction: Acute lymphoblastic leukaemia (ALL) is the most common form of cancer in children. Although treatment methods have improved and resulted in significant improvement of survival and reduction in late effects and late mortality risk, the health-related quality of life (HRQOL) of survivors might be affected. To introduce new interventions in clinical practice with the potential to support positive HRQOL outcomes, more knowledge is needed on how HRQOL in this group is constructed and stimulated. The purpose of this study is to investigate how HRQOL is affected in adults treated for paediatric ALL, in a long-term perspective and possible factors influencing this relationship.

Methods and analysis: This cohort of young adult ALL survivors allows for investigations of factors influencing HRQOL outcomes on a national level. Eligible participants are obtained from the Swedish Childhood Cancer quality registry. Data collection includes both a follow-up of data collected in 2012 (n=224) and recruitment of new eligible participants to the cohort (n=601). The cohort will cover survivors of paediatric ALL, diagnosed between 1985 and 2007, at an age between 0 and 15 years. Data will be collected using validated, multidimensional, self-administered instruments, designed to measure HRQOL (SF-36), social support, sense of coherence and resilience.

Ethics and dissemination: The study will be carried out in accordance with the ethics permit obtained from the Swedish ethics review authority (Dnr 2019-05181). Dissemination of study results will take place through research articles and reports to the national patient organisation and the national network for consultancy nurses for this target group and to the working group for the Swedish national long-term care programme for childhood cancer. Results will also reach practical application within the follow-up clinic for adult childhood cancer survivors at Sahlgrenska Hospital in Gothenburg. © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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

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

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

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

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

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

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

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

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

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

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

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

The Demand and Ability Protocol (DAP) is used in three-party meetings involving an employee, an employer, and a representative from the rehabilitation team. The aim of this study is to investigate the inclusion of an intervention using the DAP in an interdisciplinary pain rehabilitation programme (IPRP) compared to usual care. This non-randomised controlled trial included patients assigned to an IPRP in Sweden. The intervention group received a DAP intervention targeting their work situation in addition to the usual care provided by the IPRP. The control group received IPRP only. Outcome measures were collected from the Swedish Quality Registry for Pain Rehabilitation. Results demonstrated improvements in both groups regarding self-reported anxiety, depression and EQ5D. Sleep was improved in the intervention group but not in the control group. No statistical differences in outcomes were observed between the groups. In conclusion, adding the DAP intervention to IPRP seemed to have the potential to improve sleep among the patients, which may indicate an overall improvement regarding health outcomes from a longer perspective. The results were less clear, however, regarding the work-related outcomes of sickness absence and workability. © 2022 by the authors.

BACKGROUND: Disturbed sleep and pain often co-exist and the relationship between the two conditions is complex and likely reciprocal. This 5-year prospective study examines whether disturbed sleep can predict the onset of multi-site pain, and whether non-disturbed sleep can predict the resolution of multi-site pain.

METHODS: The cohort (n = 1599) was stratified by the number of self-reported pain sites: no pain, pain from 1-2 sites and multi-site pain (≥3 pain sites). Sleep was categorized by self-reported sleep disturbance: sleep A (best sleep), sleep B and sleep C (worst sleep). In the no-pain and pain-from-1-2 sites strata, the association between sleep (A, B and C) and multi-site pain 5 years later was analysed. Further, the prognostic value of sleep for the resolution of multi-site pain at follow-up was calculated for the stratum with multi-site pain at baseline. In the analyses, gender, age, body mass index, smoking, physical activity and work-related exposures were treated as potential confounders.

RESULTS: For individuals with no pain at baseline, a significantly higher odds ratio for multi-site pain 5 years later was seen for the tertile reporting worst sleep [odds ratio (OR) 4.55; 95% confidence interval (CI) 1.28-16.12]. Non-disturbed (or less disturbed) sleep had a significant effect when predicting the resolution of multi-site pain (to no pain) (OR 3.96; 95% CI 1.69-9.31).

CONCLUSION: In conclusion, sleep could be relevant for predicting both the onset and the resolution of multi-site pain. It seems to be a significant factor to include in research on multi-site pain and when conducting or evaluating intervention programmes for pain. © 2014 The Authors. European Journal of Painpublished by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC.

BACKGROUND: Musculoskeletal pain is one of the most common causes of sickness absence. Sleep disturbances are often co-occurring with pain, but the relationship between sleep and pain is complex. Little is known about the importance of self-reported sleep, when predicting sickness absence among persons with musculoskeletal pain. This study aims to study the association between self-reported sleep quality and sickness absence 5 years later, among individuals stratified by presence of lower back pain (LBP) and neck and shoulder pain (NSP).

METHODS: The cohort (n = 2286) in this 5-year prospective study (using data from the MUSIC-Norrtälje study) was stratified by self-reported pain into three groups: no LBP or NSP, solely LBP or NSP, and concurrent LBP and NSP. Odds ratios (ORs) for the effect of self-reported sleep disturbances at baseline on sickness absence (> 14 consecutive days), 5 years later, were calculated.

RESULTS: Within all three pain strata, individuals reporting the most sleep problems showed a significantly higher OR for all-cause sickness absence, 5 years later. The group with the most pronounced sleep problems within the concurrent LBP and NSP stratum had a significantly higher OR (OR 2.00; CI 1.09-3.67) also for long-term sickness absence (> 90 days) 5 years later, compared to the group with the best sleep. CONCLUSIONS Sleep disturbances predict sickness absence among individuals regardless of co-existing features of LBP and/or NSP. The clinical evaluation of patients should take possible sleep disturbances into account in the planning of treatments. © 2015, the Nordic Societies of Public Health. All rights reserved.

Purpose: To describe how managers of employees on sick-leave, due to chronic pain conditions, experience participating in a three-party meeting using the Demand and Ability Protocol (DAP) in the return-to-work process.

Materials and methods: This study is based on individual semi-structured interviews with 17 managers of employees with chronic pain. Interviews were conducted after participating in a three-party meeting including the employee, manager, and a representative from the rehabilitation team. The data were analyzed using thematic analysis with an inductive approach.

Results: Two main themes were identified–“to converse with a clear structure and setup” and “to be involved in the employee’s rehabilitation.” The first theme describe experiences from the conversation, and the second theme reflected the managers’ insights when being involved in the employee’s rehabilitation. The themes comprise 11 sub-themes describing how the DAP conversation and the manager′s involvement in the rehabilitation may influence the manager, the manager-employee relationship, and the organization.

Conclusions: This study show, from a manager's perspective, how having a dialogue with a clear structure and an active involvement in the employee’s rehabilitation may be beneficial for the manager-employee relationship. Insights from participating in the DAP may also be beneficial for the organization.

IMPLICATIONS FOR REHABILITATION

* A structured dialogue between the employee, employer, and rehabilitation supports the return to work (RTW) process

* A structured dialogue and collaboration may strengthen the relationship between the manager and employee

* An active engagement of managers in the employeès RTW process is beneficial for the manager-employee relationship, and for the organisation

* Healthcare professionals should collaborate with the workplace to promote participation of managers. © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

STUDY OBJECTIVES: The aim of the study was to investigate how many nights of measurement are needed for a reliable measure of sleep in a working population including adult women and men.

METHODS: In all, 54 individuals participated in the study. Sleep was assessed for 7 consecutive nights using actigraphy as an objective measure, and the Karolinska sleep diary for a subjective measure of quality. Using intra-class correlation and the Spearman-Brown formula, calculations of how many nights of measurements were required for a reliable measure were performed. Differences in reliability according to whether or not weekend measurements were included were investigated. Further, the correlation between objectively (actigraphy) measured sleep and subjectively measured sleep quality was studied over the different days of the week.

RESULTS/CONCLUSIONS: The results concerning actigraphy sleep measures suggest that data from at least 2 nights are to be recommended when assessing sleep percent and at least 5 nights when assessing sleep efficiency. For actigraphy-measured total sleep time, more than 7 nights are needed. At least 6 nights of measurements are required for a reliable measure of self-reported sleep. Fewer nights (days) are required if measurements include only week nights. Overall, there was a low correlation between the investigated actigraphy sleep parameters and subjective sleep quality, suggesting that the two methods of measurement capture different dimensions of sleep.

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

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

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

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

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

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

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

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

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

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

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

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

Purpose: Adults who had acute lymphoblastic leukaemia (ALL) as children and were treated with allogeneic hematopoietic stem cell transplantation (aHSCT) may have been affected in their lives due to several long-term complications. From a clinical point of view, it is of interest to study how survivors describe their perceptions of their childhood today. The aim was therefore to describe how adults perceived their childhood and the influences of being treated for ALL with aHSCT as a child.

Method: Semi-structured telephone interviews were undertaken with 18 adults who had been treated for childhood ALL with aHSCT and were included in a national cohort of childhood ALL survivors, diagnosed between 1985 and 2007 at an age between 0 and 17 years. A phenomenographic analysis was used.

Results: Three categories emerged: Feeling different, Feeling security and Feeling guilty. The informants felt that they had been different from other children but had felt security with the healthcare professionals and in care. They felt guilty because both their siblings’ and parents’ lives had been affected, but at the same time many perceived that they and their family members had become closer to one another.

Conclusions: The results emphasised that adults who had been treated for childhood ALL with aHSCT were affected both in negative and positive ways during their childhood. This indicates the importance for early psychosocial care interventions directed to children during their treatment, but also the need for person-centred psychological care in long-term outpatient clinics. © 2024 The Authors. Published by Elsevier Ltd.

Background: Chronic musculoskeletal pain (CMP) is a common cause of disability and impaired quality of life. In Sweden, chronic pain and mental illness are major causes of sick leave. But sick leave itself is also proposed as a risk factor for prolonged sick leave and disability pension.

Objectives: To study CMP and sick leave as potential risk factors for long term sick leave or disability pension in a 21 year follow up of a general population cohort.

Methods: In a cohort study, with a baseline survey in 1995, 1466 individuals aged 20-67 years were followed for 3 years and 691 for 21 years, or up to the age of 67. CMP (>3 months duration) was reported on a pain mannequin. Sick leave and disability pension were self-reported. Mental health was measured by the mental health (MH) score of the SF-36 health status, and categorized into tertiaries (best, medium and worst). CMP, sick leave, and mental health at baseline, were studied as potential predictors for long term sick leave (disability pension or sick leave >3 months) at a 3 and 21 year follow up. Other potential predictors (socioeconomic group, education, and immigrant status) were introduced in multiple regression analyzes but did not add to the results and were removed from the final models, which were controlled for age and sex.

Results: CMP and mental health predicted long term sick leave at the 3 year follow up (OR 2.11, p=0.010 and OR 3.52, p<0.001). Mental health (OR 1.92, p=0.046), but not CMP (OR 0.77, p=0.409), was also a predictor at the 21 year follow up. Sick leave >3 months, irrespectively if due to pain or not, predicted long term sick leave both at the 3 and the 21 year follow up (Table). Sick leave for ≤3 months also predicted long term sick leave at both follow ups when due to pain (OR 2.70, p=0.008 and OR 2.78, p=0.012), but not when due to other causes (OR 1.52, p=0.212 and OR 1.17, p=0.606).

Conclusion: Sick leave and especially sick leave due to pain predicted long term sick leave up to 21 years later, independently of pain status or mental health at baseline. It is thus important to early identify individuals at risk and minimize sick leave by providing proper rehabilitation.

© Drab, Aili, Haglund & Bergman 2019. No commercial re-use. See rights and permissions. Published by BMJ.

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

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

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

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

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

Sleep problems represent a significant challenge for children with ADHD. However, lack of knowledge about how sleep affects children with ADHD in terms of their health and everyday life prevents the development and implementation of interventions to promote sleep. The aim of this study was to explore parents’ experiences of direct and indirect implications of sleep quality onthe health of children with ADHD. The study used an abductive qualitative design, with Tengland’s two-dimensional theory of health as a deductive analysis framework. Semi-structured interviews were conducted with 21 parents of children aged 6–13 with ADHD and sleep problems. The parents experienced that sleep influenced their children’s abilities to control emotional behaviour relatedto ADHD and to manage everyday life. Sleep also had an impact on the children’s well-being,in relation to both vitality and self-esteem. In conclusion, the results show important direct and indirect implications of sleep quality on the health of children with ADHD. This implies a need forgreater focus on sleep, to target both abilities and well-being in promoting health among childrenwith ADHD. © 2022 by the authors

Body postural allocation during daily life is important for health, and can be assessed with thigh-worn accelerometers. An algorithm based on sedentary bouts from the proprietary ActivePAL software can detect lying down from a single thigh-worn accelerometer using rotations of the thigh. However, it is not usable across brands of accelerometers. This algorithm has the potential to be refined. Aim: To refine and assess the validity of an algorithm to detect lying down from raw data of thigh-worn accelerometers. Axivity-AX3 accelerometers were placed on the thigh and upper back (reference) on adults in a development dataset (n = 50) and a validation dataset (n = 47) for 7 days. Sedentary time from the open Acti4-algorithm was used as input to the algorithm. In addition to the thigh-rotation criterion in the existing algorithm, two criteria based on standard deviation of acceleration and a time duration criterion of sedentary bouts were added. The mean difference (95% agreement-limits) between the total identified lying time/day, between the refined algorithm and the reference was +2.9 (-135,141) min in the development dataset and +6.5 (-145,159) min in the validation dataset. The refined algorithm can be used to estimate lying time in studies using different accelerometer brands. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Objective/background: Healthy sleep is particularly important for children with attention deficit hyperactivity disorder (ADHD), as sleep disturbances might aggravate disease symptoms. This review aims to synthesize and report evidence on the effectiveness of sleep interventions in increasing sleep, quality of life (QoL), and ADHD symptoms among children with ADHD. Patients/methods: The systematic literature review follows the Cochrane Collaboration methodology recommendations for literature reviews. Four databases were used based on the population, intervention, control and outcome (PICO) framework. Controlled trials with minimum 20 children in each group, aged 6–18, and published from 2005 and onwards were included. Results from the studies were reported in forest plots and three of the seven review outcomes were synthesized in meta-analyses. Results: The search identified 7710 records; of which 4808 abstracts were screened. After fulltext-screening of 99 papers, eight papers from five studies were included. The studies included behavioral sleep interventions and pharmacological interventions using melatonin and eszopiclone. For six of the seven outcomes, the effect sizes were small to moderate and the certainty of the evidence was low. For one outcome, sleep disturbances, the effect size was a moderate −0.49 standardized mean differences (95% confidence interval −0.65;-0.33), with a moderate certainty of evidence for the behavioral interventions for children aged 5–13 years with ADHD. Conclusions: This review identified few and heterogeneous studies. A moderate certainty of evidence for a moderate effect size was only obtained for sleep disturbances from the behavioral interventions. A low certainty of the evidence for a moderate effect size was found for the total sleep time from the pharmacological intervention using melatonin and one behavioral intervention, which indicates that these sleep interventions impact sleep quantity and quality among children with ADHD. © 2022 The Authors

Sleep disturbances are common among children with attention-deficit/hyperactivity disorder (ADHD). While pharmacological treatment has increased dramatically, parents often prefer non-pharmacological interventions. Research on experiences of weighted blankets and their effect in sleep improvement is scarce. The aim of this study was to explore parents’ experiences of weighted blankets for children with ADHD and sleep problems, and the impact on their children’s sleep. The explorative design was based on qualitative content analysis. Interviews were conducted with a purposeful sample of 24 parents of children with ADHD and sleep problems, after completing a sleep intervention with weighted blankets for 16 weeks. Parents reported that children sleeping with weighted blankets: (1) achieved satisfactory sleep, including improved sleep onset latency, sleep continuity, and sleep routines; (2) achieved overall well-being, including improved relaxation and reduced anxiety; and (3) mastered everyday life, including improved balance in life, family function, and participation in school and leisure activities. This study brings forward novel aspects of the effects of improved sleep among children with ADHD. The findings contribute to the understanding of potential positive effects of an intervention with weighted blankets critical for clinical practice to improve sleep, well-being, and everyday life of children with ADHD and their families. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

INTRODUCTION AND OBJECTIVES: Children with attention deficit hyperactivity disorder (ADHD) have an increased risk of sleep problems. Weighted blankets are one possible non-pharmacological intervention for these problems in this group of children. However, the effectiveness of weighted blankets is insufficiently investigated. This study aims to investigate the effectiveness of weighted blankets in terms of sleep, health-related outcomes and cost-effectiveness as well as to explore children's and parents' experiences of a sleep intervention with weighted blankets.

METHODS AND ANALYSIS: This study is a randomised placebo-controlled crossover trial comparing the effect of weighted fibre blankets (active) with fibre blankets without weight (control). Children aged 6-13 years, recently diagnosed with uncomplicated ADHD with verified sleep problems, were included in the study. The study period is 4 weeks for each condition, respectively, and then an 8-week follow-up. A total of 100 children diagnosed with ADHD and sleep problems will enter the study. The primary outcomes are sleep and cost per quality-adjusted life years. The secondary outcomes are health-related quality of life, ADHD symptoms, psychological distress and anxiety. Interviews with a subsample of the participating children and parents will be conducted for exploring the experiences of the intervention.

ETHICS AND DISSEMINATION: Ethical approval of the trial has been obtained from the Swedish Ethical Review Authority (number 2019--2158) and conforms to the principles outlined in the Declaration of Helsinki (WMA, 2013). Results will be reported as presentations at peer-review conferences, in articles in peer-review journals and meetings with healthcare providers.

TRIAL REGISTRATION NUMBER: NCT04180189. © Author(s) (or their employer(s)) 2022.

Background: Approximately 7.6% of children are diagnosed with attention deficit/hyperactivity disorder (ADHD), and sleep impairments affect 25–85%. There is a noticeable lack of research on girls and sex differences. The aim of this study was to examine sex differences in children with uncomplicated ADHD and sleep problems. Methods: Cross-sectional baseline data were retrieved from a randomized controlled trial with weighted blankets (55 boys and 41 girls, 6–14 years) on a cohort recently diagnosed with uncomplicated ADHD and sleep problems. Differences between boys and girls in ADHD symptoms, objectively and subjectively measured sleep, anxiety, and functioning were examined via parent- or self-reported validated instruments. Results: Girls reported significantly lower (worse) satisfaction with well-being, life overall, and school, but not for family. Parents reported more sleep anxiety and night-time wakings among boys, but no sex differences in other measures and also not in self-reported measures or objective sleep measures. Children who reported worry, sadness, or unhappiness had more sleep problems. Conclusions: Boys with ADHD and sleep problems may need support with sleep-related anxiety and night-time wakings, while girls may require support with overall functioning. Additionally, children who express feelings of worry, sadness, or unhappiness alongside their ADHD symptoms should have attention given to their sleep. © 2024 by the authors. Licensee MDPI, Basel, Switzerland.

Bakgrund och syfte: Sömnbesvär är vanligt förekommande hos barn med ADHD. Tyngdtäcke förskrivs idag endast i vissa regioner i Sverige för behandling av sömnbesvär pga. bristande evidens. För att öka kunskapen om tyngtäckens effekt på sömnbesvär bland barn med ADHD, utformades ett forskningsprojekt med en randomiserad kontrollerad design (RCT). En delstudie i detta projekt undersöker barnens erfarenheter av att sova med tyngtäcke. Syftet med denna delstudie var att utforska erfarenheter av en sömnintervention med tyngdtäcke hos barn med ADHD som har sömnbesvär.

Metod: Ett ändamålsenligt urval av 21 barn, 6-14 år med ADHD och sömnbesvär, som genomgått sömninterventionen med fibertäcke på 4-10 kg har deltagit i individuella intervjuer. Intervjuerna fokuserar på barnets upplevelse av att sova med tyngdtäcke och hur det påverkade deras sömnbesvär och vardag. Intervjuerna analyserades med en kvalitativ innehållsanalys.

Resultat: Barn med ADHD som sover med tyngdtäcke upplever att täcket ger en trygg och avslappnad känsla, en vilja att ligga kvar i sängen, minskad rörelse i sängen, färre uppvaknanden under natten samt en känsla av att vara mer utvilad i skolan. Tyngtäcket kan ge känslor av obehag och upplevas för tungt. Barn har olika  strategier för att hantera ett tyngdtäcke. De kan kombinera tyngdtäcket med sitt vanliga täcke, sova med öppet fönster och avstå täcket enstaka nätter.

Slutsats och praktisk tillämpning: Denna studie bidrar med kunskap om barns upplevelse av att sova med tyngdtäcke och hur det påverkar deras sömnbesvär. Slutsatsen är att barn med ADHD känner trygghet, ligger stilla, stannar i sängen och sover bättre med ett tyngdtäcke samt att de upplever att det påverkar deras vardag positivt. Barn har olika strategier för att hantera tyngdtäcket,  trots det passar inte tyngdtäcke för alla barn med ADHD. Barnets perspektiv är viktigt och förhoppningen är att resultaten kan tillämpas i det kliniska arbetet för barn med ADHD där rätt insats ges till rätt barn.

Introduction: Weighted blankets are prescribed by occupational therapists in some regions of Sweden but not in all due to the lack of evidence. Children's experiences of sleeping with weighted blankets can increase our knowledge of how this kind of assistive technology can enable sleep among children with Attention-Deficit/Hyperactivity Disorder (ADHD).

Objectives: The aim of this study was to explore the experiences of weighted blankets as a sleep intervention among children with ADHD.

Methodology: This qualitative study was performed as a part of an ongoing randomized controlled trial.  Individual interviews were conducted with 21 children aged 6-14 years.

Results: The qualitative content analysis revealed four themes;

1. the child stays in bed and falls asleep 2. the child is still without restlessness 3. the child feels safe and secure 4. the child is managing the weighted blanket

The children acknowledged weighted blankets as enablers of sleep. Positive as well as negative experiences was expressed in theme 4.

Discussion & Conclusion: The children's experiences imply that weighted blankets affect sleep-related activities as well as anxiety and restlessness. Thus, this study indicates that weighted blankets are enablers of children’s sleep - although the results also implify that weighted blankets are not for all children with ADHD. The effects of weighted blankets are yet to be investigated further in the ongoing randomized controlled study.

Background: Sleep is critical to child development and health. Reaching the United Nations Sustainable Development Goal 3 regarding good health and well-being for all ages, sustainable and long-lasting interventions should be a priority for children. Purpose of the study: The aim was to evaluate the efficacy of weighted blankets on sleep and well-being among children with ADHD and sleeping difficulties. Methods: A randomised controlled trial (RCT) with a cross-over design included 94 children with ADHD and sleeping difficulties. Children were randomised to start with either a weighted blanket or a lighter control blanket. The children used the blankets during 4+4 weeks. Sleep was evaluated objectively with actigraphy and subjectively with child- and parent-rated questionnaires. Findings: Weighted blankets had a significant effect on total sleep time (mean diff: 8.05 min, p<0.05), sleep efficiency (mean diff: 0.83%, p<0.05) and parent-rated sleeping difficulties (mean diff: -1.05, p<0.05), but no significant effect on sleep initiation or child-rated insomnia severity or well-being (p>0.05) when evaluating weighted blankets compared to control blankets. Conclusion: This RCT showed that children with ADHD and sleep problems experienced improved sleep time and parent-rated sleep while using weighted blankets. Thus, weighted blankets are likely effective and an alternative to sleep medication. Good sleep is a significant determinant of health and well-being, especially for children with mental health problems. Consequences on child well-being may be more relevant in a long-term perspective and is yet to be determined.

Introduction. Sleeping difficulties are common in children with attention deficit hyperactivity disorder (ADHD). A sleep intervention with weighted blankets was designed to increase current understanding of using weighted blankets to target children’s individual needs in connection with sleep and daytime functioning. Aim. To explore how children with ADHD and sleeping difficulties experience the use of weighted blankets. Methods. An explorative qualitative design in which 26 children with ADHD and sleeping difficulties, 6-15 years old, were interviewed about a sleep intervention with weighted blankets. Four categories emerged from qualitative content analysis. Results. Children’s experiences revealed that the use of weighted blankets 1) requires a commitment, by adjusting according to needs and preferences and adapting to the environment; 2) improves emotional regulation by feeling calm and feeling safe; 3) changes sleeping patterns by creating new routines for sleep and improving sleep quality; and 4) promotes everyday participation by promoting daily function and balancing activity and sleep. Conclusions. Using weighted blankets promoted children’s management of daily life with ADHD and sleeping difficulties. Occupational therapists can improve the assessment and delivery of weighted blankets tailored to individual needs based on increased knowledge from the children themselves. Copyright © 2023 Maria Lönn et al.

Introduction: Difficulties with sleep initiation and sleep maintenance are common in children with attention-deficit/hyperactivity disorder (ADHD). Sleeping difficulties can have consequences on children’s circadian rhythms with decreased daytime functioning and well-being but also family stress. In Sweden, weighted blankets have been used as a sleep intervention in the child and adolescent mental health service (CAMHS) but have recently been discontinued due to lack of evidence. The aim of this study was to evaluate the efficacy of weighted blankets on sleep and wellbeing among children with ADHD and sleeping difficulties.

Method: A randomized controlled trial with a cross-over design (4+4 weeks) was conducted at a CAMHS clinic in Sweden during 2019-2022. Children diagnosed with uncomplicated DSM-5 ADHD with verified sleeping difficulties according to three selected questions from the Children's Sleep Habits Questionnaire (CSHQ) were randomized to start with either a weighted blanket or a lighter control blanket. Data collection was performed in the child’s home environment during measurement weeks (week 0, week 4 and week 8) using actigraphy (Motionware 1.2.47 Camntech), daily sleep diary, as well as questionnaires. Primary outcome was Total Sleep Time (TST) evaluated with actigraphy. Secondary outcomes included; Sleep Onset Latency (SOL), Wake After Sleep Onset (WASO) and Sleep Efficiency (SE) measured with actigraphy as well as child- and parent rated sleep and wellbeing. Parent-rated sleep outcomes included restlessness during sleep onset, restlessness during sleep and sleeping difficulties (CSHQ). Child rated sleep included Insomnia Severity Index (ISI).  Child-rated well-being was evaluated with health-related quality of life (EQ5DY) and Child Outcome Rating Scale (CORS). Paired t-test or Wilcoxon's signed test for non-parametric data was used to evaluate the effect of weighted blankets (α two-sided was set to 0.05).

Results: The study included 94 children with ADHD with mean age 9.0, (sd 2.2), 53 boys and 41 girls. Adherence to both types of blankets (weighted blanket and lighter control blanket) was equally high (89.7% used the blankets during sleep for 6-7 days during measurement weeks). Low drop-out rate (n=3) and high adherence during the trial resulted in cross-over analysis of actigraph data (n=85), daily sleep diary (n=89), child questionnaire data (n=88) and parent questionnaire data (n=81).  Weighted blankets had a significant effect on TST (mean diff. 8.05 min, p<0.05) and SE (mean diff. 0.83%, p<0.05) but not on WASO (p>0.05) or SOL (p>0.05) when evaluating within subject differences of sleep during the period with weighted or control blanket. The daily sleep diary showed decreased restlessness during sleep (mean diff. -0.18, p<0.05) but not during sleep onset (p>0.05). Questionnaire outcomes showed significant effect on parentrated CSHQ (mean diff: -1.05, p<0.05) but not on child-rated ISI (p>0.05).  No significant effect was found on child rated well-being according to EQ5DY or CORS (p>0.05) when comparing periods with weighted or control blankets.

Conclusion: This RCT showed that children with ADHD and sleep problems experienced improved sleep time, sleep habits and less restlessness during sleep while using weighted blankets. Thus, weighted blankets are likely effective and an alternative to sleep medication. Use of weighted blankets as a sleep intervention within CAMHS has the potential to improve child sleep and decrease family stress. Consequence on child well-being may be more relevant in a long-term perspective and is yet to be determined.

Study objectives: To examine differences in sample characteristics and longitudinal sleep outcomes according to weighted blanket adherence.

Methods: Children with attention-deficit/hyperactivity disorder (ADHD) (n =94), mean age 9.0 (sd 2.2, range 6-14) participated in a 16-week sleep intervention with weighted blankets (WB). Children were classified as WB adherent (use of WB ≥ 4 nights/week) or non-adherent (use of WB ≤ 3 nights/week). Changes in objectively measured sleep by actigraphy, parent-reported sleep problems (Children's Sleep Habits Questionnaire (CSHQ)) and child-reported Insomnia Severity Index (ISI) were evaluated according to adherence with mixed effect models. Gender, age, and ADHD subtype were examined as potential moderators.

Results: Children adherent to WBs (48/94) showed an early response in sleep outcomes and an acceptance of the WB after four weeks of use as well as a decrease in parent- (CSHQ) (-5.73, P = .000) and child-reported sleep problems (ISI) (-4.29, P = .005) after 16 weeks. The improvement in sleep was larger among WB adherent vs. non-adherent (between-group difference: CSHQ: -2.09, P = .038; ISI: -2.58, P =.007). Total sleep time was stable for children adherent to WB but decreased for non-adherent (between-group difference: +16.90, P = .019).

Conclusions: An early response in sleep and acceptance of the WB predicted later adherence to WBs. Improvements in sleep were more likely among WB adherents vs. non-adherents. Children with ADHD may thus benefit from using WBs to handle their sleep problems.

© 2024 American Academy of Sleep Medicine

Weighted blankets are a non-pharmacological intervention for treating sleep and anxiety problems in children with attention-deficit/hyperactivity disorder. However, research on the efficacy of weighted blankets is sparse. The aim of this randomized controlled trial with a crossover design (4 + 4 weeks) was to evaluate the efficacy of weighted blankets on sleep among children with attention-deficit/hyperactivity disorder and sleeping problems. Children diagnosed with uncomplicated Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition attention-deficit/hyperactivity disorder with verified sleep problems were randomized to start with either a weighted blanket or a lighter control blanket. Data collection was performed at weeks 0, 4 and 8 using actigraphy, questionnaires and a daily sleep diary. T-tests were used to evaluate efficacy. The study included 94 children with attention-deficit/hyperactivity disorder (mean age 9.0 [sd 2.2] years; 54 [57.4%] boys). Weighted blankets had a significant effect on total sleep time (mean diff. 7.72 min, p = 0.027, Cohen's d = 0.24), sleep efficiency (mean diff. 0.82%, p = 0.038, Cohen's d = 0.23) and wake after sleep onset (mean diff. −2.79 min, p = 0.015, Cohen's d = −0.27), but not on sleep-onset latency (p = 0.432). According to our exploratory subgroup analyses, weighted blankets may be especially beneficial for improving total sleep time in children aged 11–14 years (Cohen's d = 0.53, p = 0.009) and in children with the inattentive attention-deficit/hyperactivity disorder subtype (Cohen's d = 0.58, p = 0.016). Our results suggest that weighted blankets may improve children's sleep and could be used as an alternative to pharmacological sleep interventions. © 2023 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.

Background: Being a parent of a child with attention deficit hyperactivity disorder (ADHD) and sleep problems can be challenging and stressful. Weighted blankets have the potential to improve sleep and health in these children, but less is known about the potential effects the child's use of a weighted blanket may have on parents' health.

Purpose of the study: To explore parents' health experiences after their child with ADHD and sleep problems underwent a sleep intervention with a weighted blanket.

Methods: This study is a part of a randomized, controlled crossover trial with a 16-week sleep intervention with weighted blankets for children with ADHD and sleep problems. A total of 24 parents of children who preferred sleeping with a weighted blanket were interviewed about how the sleep intervention influenced their health. An inductive qualitative content analysis resulted in seven subcategories and two categories.

Findings: Children's sleep with weighted blankets influenced parents experienced health in terms of 1) coping with everyday life, including finding harmony, nurturing family relationships, and maintaining a sustainable structure, and 2) feeling well-being, including being well rested, sustaining energy, reaching calm, and achieving meaningful leisure time.

Conclusion: A sleep intervention with weighted blankets in children with ADHD and sleep problems influenced parents' health positively by improving management of life and well-being. For parents who struggle to meet the everyday challenges of their child's ADHD, this sleep intervention may contribute to a sustainable health. 

Background: Acute lymphoblastic leukemia (ALL) is the most common malignancy in childhood, but the prognosis has remarkably improved over the last 50 years in high-income countries, and thus, there is a focus on long-term health outcomes following survival and how to best provide health care support to adult long-term survivors of childhood ALL to prevent and handle potential health problems. Digital health interventions are promising to deliver feasible health promotion and prevention programs. This is particularly relevant for ensuring long-term follow-up in cases where continuous contact with oncology care may be disrupted. Moreover, these interventions are beneficial in reaching geographically dispersed target groups and overcoming the time constraints of everyday life that often hinder participation in such programs. Objective: This study aimed to fill the gaps in existing research on adult long-term survivors of childhood ALL and provide formative data that can inform the development of formalized follow-up services designed to meet the needs of these survivors in ways that align with their preferences for digital health interventions. Methods: In this cross-sectional national study, adult survivors (aged ≥18 years) of childhood ALL for over 10 years after diagnosis were compared to their siblings in terms of mental and physical health-related factors, including sleep, stress, anxiety, and depression (Depression Anxiety and Stress Scale 21 [DASS-21]); several dimensions of fatigue (Multidimensional Fatigue Inventory 20 [MFI-20]); work ability (Work Ability Index); chronic pain; and prevalences of diabetes, cardiovascular disease, headache or migraine, and rheumatic disease. Results: Overall, 426 of 855 eligible ALL survivors responded (mean age 30.9, SD 7.7 years), and they participated at an average of 24 (SD 6.9) years after ALL diagnosis. Siblings (n=135; mean age 31.5, SD 7.7 years) acted as controls. Sleep quality, sleep quantity, and mean work ability scores were significantly lower, and physical fatigue, reduced motivation, and reduced activity scores were higher in ALL survivors than in siblings. There were no significant differences between the groups in terms of BMI and prevalence of chronic pain, depression, anxiety, or stress. Physical and psychological complications were more frequent among adult ALL survivors who had received hematopoietic stem cell transplantation (HSCT) than among those who had not received HSCT. Conclusions: Our nationwide cross-sectional study addressed the scarcity of knowledge regarding the self-reported health outcomes of adult long-term survivors of childhood ALL. We highlighted significant disparities within this population and emphasized the potential of comprehensive digital interventions that target vitality, sleep quality, fatigue, and psychosocial well-being to enhance well-being and bolster the capacity for managing chronic health conditions in this target group. Such an intervention would align with the needs of this target group, which is a prerequisite for successfully incorporating technology into the daily lives of survivors of childhood ALL. © 2024 JMIR Publications Inc.. All rights reserved.

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.

Background: Chronic widespread pain (CWP) is a musculoskeletal disorder that affects approximately 10% of the population. It is more common in women than in men. It is important to understand how CWP develops and how it is maintained in order to prevent poor pain prognosis. Long term studies have shown that a mere part improves over time or fluctuates in their CWP condition. Female gender is one of the factors associated with persistence of CWP, suggesting men and women may experience their journey to CWP differently. The aim of the study was to explore women’s experiences of the journey to CWP.

Methods: 19 women between 45 and 67 years of age who had not reported CWP in the EPIPAIN survey in 1995, but reported CWP in 2016, participated in the study. Data was collected through individual interviews, where open-ended questions were used to explore the women’s experiences of their pain journey. The interviews were analyzed with a manifest qualitative content analysis.

Results: The women described their journey to CWP in terms of triggering, aggravating, and consolidating factors, from which three different categories emerged. Experiencing that environmental circumstances affect the pain journey refers to factors outside the women’s immediate control, which appeared as unmanageable work-related demands, lack of social support, unfavorable physical environments, and traumatic events. Experiencing that lifestyle affects the pain journey refers to events that are consciously or unconsciously carried out by the women, including different levels of physical efforts and unfavorable behaviors. Experiencing that personal attributes affect the pain journey refers to the women’s characteristics in terms of an anxious state of mind and adverse biological impact.

Conclusions: The women experienced that environmental circumstances, lifestyle, and personal attributes affected their CWP. How these adversities influenced the pain journey varied among the women. These findings show that women are conscious of the complexity of the condition and can describe the broad context of their pain journey. This study confirms the complexity of pain progress and highlights the individual’s awareness of this complexity, which is important to consider when introducing interventions, and when expecting compliance to interventions. © 2020 The Author(s).

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

Design: Longitudinal cohort study.

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

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

Conclusions: One out of seven individuals with clinical KOA developed RKOA in only 2 years. Baseline variables associated with RKOA after 2 years may possibly be detected early by using the NICE guideline, assessment of obesity and self-reported data of symptoms to support first-line treatment: education, exercise and weight control. © Author(s) (or their employer(s)) 2024.

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.

Purpose: Long-term pain is a public health problem but few studies have focused on experiences among women with CWP. This study aimed to explore women's experiences of the impact of CWP on daily life.Method: The participants were 19 women between 45-67 years old, who had developed CWP between 1995 and 2016. Individual interviews were conducted and analysed with qualitative content analysis.Results: Daily life with CWP was expressed in the main theme "Moving between living in the shadow of pain or living a life with the pain in the shadows" including three themes and eight subthemes; 1) living with invisible challenges by feeling neglected as a person and feeling lonely among other people; 2) struggling with limitations by moving between ability and inability, stress and worries, and being dependent on others; and 3) encountering daily life with varying degrees of flexibility by standing still and giving up, moving back and forth by adapting and striving forward with resistance.Conclusions: Women experienced different ways of how CWP influenced their daily life with challenges, limitations, and flexibility. Daily life with CWP entails moving between living in the shadow of pain and living a life with the pain in the shadows. © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.