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  • 101.
    Meesters, Jorit J.L.
    et al.
    1ERC Syd, Skåne University Hospital, Lund, Sweden & Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands & Research and Development, Sophia Rehabilitation Center, The Hague, The Netherlands.
    Bergman, Stefan
    Section of Rheumatology, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden & Primary Health Care Unit, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Haglund, Emma
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Spenshult Research and Development Center, Halmstad, Sweden.
    Jacobsson, Lennart Th
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Petersson, Ingemar F.
    Section of Orthopedics, Department of Clinical Sciences, University of Lund, Lund, Sweden.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Section of Rheumatology, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Prognostic factors for change in self-reported anxiety and depression in spondyloarthritis patients: data from the population-based SpAScania cohort from southern Sweden2017Ingår i: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 47, nr 3, s. 185-193Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 102.
    Meesters, Jorit
    et al.
    Epi-centre Skåne, Skåne University Hospital, Lund, Sweden & Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, Netherlands.
    Petersson, Ingemar
    Epi-centre Skåne, Skåne University Hospital, Lund, Sweden & Department of Orthopedics, Clinical Sciences, University of Lund, Lund, Sweden.
    Bergman, Stefan
    Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Haglund, Emma
    Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Jacobsson, Lennart
    Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Factors Associated with Anxiety and Depression in Spondyloarthritis Patients: Results from the Swedish Population Based SpA Scania Cohort2013Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, nr Suppl. 3, s. A531-A532Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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

  • 103.
    Mogard, E.
    et al.
    Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden.
    Lindqvist, E.
    Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Lund University, Lund, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden & Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Risk factors for development and persistence of chronic widespread pain, in ankylosing spondylitis and undifferentiated spondyloarthritis2017Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, nr Suppl. 2, s. 922-922Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Chronic back pain is a prominent symptom in Spondyloarthritis (SpA), and an important contributor to diminished quality of life (1,2). Chronic pain can develop in intensity, become more spread, and progress to chronic widespread pain (2). Mechanisms for this are yet inconsistent (3), and in SpA, knowledge of progression to chronic widespread pain (CWP) is lacking.

    Objectives To study the development of CWP in patients with SpA, and to identify risk factors for development and persistence of CWP.

    Methods A cohort study with baseline and 2.5-year follow-up postal surveys. 644 patients (47% women) with ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (SpA) answered both surveys, and were categorized as no chronic pain (NCP), chronic regional pain (CRP), and CWP. Logistic regression analyses, with CWP as the main outcome were performed. Due to multicollinearity, each risk factor candidate (disease duration, BMI, smoking, and different patient-reported outcome measures; PROMs) were analysed in separate logistic regression models together with a base model (age, sex, and SpA-subgroup).

    Results At follow-up, prevalence estimates for NCP, CRP and CWP were similar to those at baseline, but 38% of the patients had transitioned between the groups. A large group, 72% of the patients with initial CWP, also reported persistent CWP at follow-up (Figure). Risk factors (OR and 95% CI) for development of CWP from initial NCP/CRP were more pain regions (1.36; 1.20–1.53), pain intensity (1.35; 1.20–1.52), fatigue (1.25; 1.13–1.38), global health (1.35; 1.19–1.54), EQ-5D (0.05; 0.01 – 0.19), BASDAI (1.25; 1.07 – 1.45), BASFI (1.32; 1.16 – 1.50), ASES pain (0.97; 0.96 – 0.99), ASES symtom (0.98; 0.97 – 0.99), and HADb (1.10; 1.02 – 1.19). The risk factors for persistent CWP, compared to patients transitioning to NCP or CRP, were similar to those predicting development of CWP, but in addition, also higher age (1.02; 1.00–1.04), and female sex (1.82; 1.06–3.10), predicted the outcome. © 2017 BMJ Publishing Group Limited.

  • 104.
    Mogard, E.
    et al.
    Lund University, Lund, Sweden.
    Olofsson, T.
    Lund University, Lund, Sweden.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS).
    Bergman, Stefan
    Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Kristensen, L-E
    Copenhagen University Hospital Fredriksberg and Bispebjerg, Copenhagen, Denmark.
    Kvistgaard Olsen, J.
    Copenhagen University Hospital Fredriksberg and Bispebjerg, Copenhagen, Denmark.
    Wallman, JK
    Lund University, Lund, Sweden.
    Lindqvist, E.
    Lund University, Lund, Sweden.
    Chronic Pain in Patients With Established Axial Spondyloarthritis and Assessment of Pain Sensitivity by Computerized Pneumatic Cuff Pressure Algometry: Results from the Spartakus Cohort2017Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, nr Suppl. 2, s. 651-651Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Pain is a common symptom in all arthritides, and remains a problem also with better treatment options. In axial spondyloarthritis (ax-SpA), data on chronic pain remain scarce.

    Objectives: To study pain distribution, duration and intensity in ax-SpA, and relate this to disease status and measurement of pressure pain sensitivity.

    Methods: Consecutive patients (n=115) with clinical ax-SpA diagnoses (ankylosing spondylitis (AS) or undifferentiated axial spondyloarthritis (USpA)) were examined and answered pain questionnaires. Patients were categorised as having no chronic pain (NCP), chronic regional pain (CRP) or chronic widespread pain (CWP). Pressure pain sensitivity was assessed by computerized pneumatic cuff pressure algometry (CPA) on the dominant lower leg, and pain threshold, pain tolerance and temporal summation (assessed by the temporal summation index, TSI) were recorded. Differences in disease status and pressure pain sensitivity between patients with CWP versus NCP were assessed (Chi-square or Mann-Whitney U-test). Pressure pain sensitivity was also compared between patients with/without unacceptable pain levels (VAS pain >40 versus ≤40; Mann-Whitney U-test).

    Results: Fifty percent of patients reported CWP, irrespective of clinical diagnosis (AS 47%, USpA 53%), and more women than men reported CWP (59% versus 37%, p<0.001). Only 18% of all patients reported NCP. Overall, higher disease activity, pain intensity, worse fatigue, global health and function were observed among patients with CWP compared to those with NCP. There was a trend towards lower pain tolerance in patients with CWP compared to NCP (Table). Lower pain tolerance and higher TSI scores were observed among patients reporting VAS pain >40 versus those with VAS pain scores ≤40 ((mean (SD)) 51.9 (21.2) versus 68.1 (28.1), p=0.007; 0.73 (0.60) versus 0.55 (0.59), p=0.045). 2017, BMJ Publishing Group Limited.

  • 105.
    Mogard, Elisabeth
    et al.
    Lund University, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden & R&D Spenshult, Halmstad, Sweden.
    Bremander, Ann
    Lund University, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden & R&D Spenshult, Halmstad, Sweden & Department of Regional Health Research, University of Southern Denmark, Odense, Denmark & Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.
    Haglund, Emma
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). R&D Spenshult, Halmstad, Sweden.
    The combined effects of lifestyle habits on health-related quality of life, physical and mental functions in patients with spondyloarthritis2019Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, nr Suppl 2, s. 2144-2144Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Earlier studies have found strong correlations between worse health and an unhealthy lifestyle, such as not meeting recommendations of moderate-to-vigorous physical activity, being overweight or obese and the use of tobacco in patients with spondyloarthritis (SpA). The impact of more than one unhealthy lifestyle habit (LsH) is however, scarcely described.

    Objectives: To study the combined effects of unhealthy LsHs on health-related quality of life (HRQoL) and physical and mental functions in patients with SpA. Differences between SpA subgroups and gender were also studied.

    Methods: Postal questionnaires were in 2009 and 2011 sent to all patients diagnosed with SpA and registered in the Skane Healthcare Register. This study included patients who at both time points responded to the survey, were ≥20 years, and had ankylosing spondylitits (AS), psoriatic arthritis (PsA) or undifferentiated spondyloarthritis (USpA). Cross-sectional data from the 2011 questionnaire were available for 1601 patients (AS n=455, PsA n=883, USpA n=263), with a mean age of 58 (13) years (52% women). Self-reported levels of weekly physical activity at moderate or vigorous intensity, (MVPA), use of tobacco (cigarettes and/or snuff) and BMI (overweight or obese) were dichotomized as “healthy” or “unhealthy”. The number of unhealthy LsH were then summarized and stratified into four groups (scoring 0-3, 0=no unhealthy LsH). HRQoL was assessed with EQ-5D (0-1, worst-best), and physical function with BASFI. Disease activity (BASDAI), pain, fatigue (0-10, best-worst), anxiety, and depression (HADa/d) (0-21, no distress-maximum distress) were also measured. Statistical analyses were performed with Chi Square test and ANOVA.

    Results: Fourteen percent (n=226) reported none of the studied unhealthy LsH, while 35% (n=555) reported one, 38% (n=611) two, and 13% (n=209) three unhealthy LsH. Reports of one and more unhealthy LsH had increasing negative impact on HRQoL (from mean 0.74 (SD 0.19) to 0.57 (0.30)), disease activity (from 3.2 (2.1) to 4.5 (2.3)), physical function (2.3 (2.1) to 4.4 (2.6)), VAS-pain (3.4 (2.3) to 4.8 (2.5)), VAS-fatigue (4.2 (2.7) to 5.5 (2.7)), anxiety (4.8 (4.2) to 5.6 (4.4)) and depression (3.3 (3.3) to 4.8 (3.8)) in patients with SpA (p=0.019-<0.001).

    Patients with PsA (p≤0.001) and men (p=0.040) reported more often ≥2 unhealthy LsHs, while patients with USpA were least likely to have ≥2 unhealthy LsHs (Figure 1,2). The negative impact on HRQoL, physical and mental functions still remained significant when stratified into different SpA subgroups and gender, except for anxiety in women, and for patients with PsA or USpA.

    Conclusion: Our findings support that the combined effect of unhealthy lifestyle habits have negative impact on many aspects of health. There is a need for interventions aiming at screening for not only one but several unhealthy lifestyle habits combined, and to offer coaching to increase behavioral change and promote better health. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

  • 106.
    Mogard, Elisabeth
    et al.
    Lund University, Lund, Sweden.
    Lindqvist, Elisabet
    Lund University, Lund, Sweden.
    Bergman, Stefan
    Spenshult Research & Development Center, Halmstad, Sweden.
    Bremander, Ann
    Lund University, Lund, Sweden.
    Differences in spinal mobility measures in relation to disease duration and between subgroups with axial spondylarthritis2013Ingår i: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 65, nr Special issue, Supplement 10, s. S896-S896, Meeting Abstract: 2105Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background/Purpose: Spinal mobility is a core domain for research and clinical practice in Ankylosing Spondylitis (AS) but less studied in undifferentiated SpA (USpA). Our objective was to study the change of commonly used spinal mobility measures stratified on disease duration in patients with AS and differences in these measures in AS vs. USpA.

    Methods: Patients with AS or USpA were identified from a cohort attending a specialist clinic. A cross sectional studie were the first measures of spinal mobility for each patient recorded during 1999 to 2012 were analyzed. Disease duration was split into tertiles, (<17 years (G1), 18-30 years (G2) and >31 years (G3)). Differences between AS G1/G2/G3 were calculated with Kruskal-Wallis. Differences between AS and USpA were controlled for sex and disease duration (ANCOVA).

    Results: 126 patients with AS vs. 57 with USpA were included in the study, mean (SD) age 48.4 (13.7) vs. 41.6 (11.4) years and 23% vs. 46% were women. In AS, lumbar, and thoracic measures, vital capacity and the BASMI composite score were the first measures to deteriorate in relation to disease duration (G1 vs. G2, p<0.035). Late in the disease all measures had deteriorated (G1 vs. G3, p<0.036). Patients with USpA presented better scores in lumbar, hip and thoracic spinal measures (p<0.05), data controlled for sex and disease duration. In early disease (<17 years) also cervical measures (p<0.05) were less affected compared to patients with AS.

    Conclusion: The first measures to significantly change during the disease course in AS were the lumbar and thoracic mobility measures and the BASMI score. As expected, patients with USpA were less affected in mobility than patients with AS.

  • 107.
    Mogard, Elisabeth
    et al.
    Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden.
    Lindqvist, Elisabet
    Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden; Spenshult Research and Development Center, Halmstad, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Spinal Mobility in Axial Spondyloarthritis: A Cross-Sectional Clinical Study2017Ingår i: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 15, nr 1, s. 36-48Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Research concerning spinal mobility in axial spondyloarthritis (axSpA) has focused on ankylosing spondylitis (AS), and data on the clinical diagnosis of undifferentiated spondyloarthritis (USpA) are limited. The objective was to study differences in spinal mobility between axSpA subgroups AS and USpA, including gender differences.

    METHODS: A total of 183 patients with axSpA from a rheumatology clinic were included in the study. The earliest recorded spinal mobility measures (cervical rotation/flexion/extension/lateral flexion, tragus-to-wall distance, vital capacity, chest expansion, thoracic flexion, thoracolumbar flexion, lateral spinal flexion, lumbar flexion and intermalleolar distance) were obtained by specialized physiotherapists. Differences between subgroups were analysed using analysis of covariance, controlled for gender and disease duration.

    RESULTS: In the USpA group (n = 57), the mean [standard deviation (SD)] age was 41.6 (11.4) years, and disease duration was 13 (10.6) years, with 54% men. In the AS group (n = 126), the mean (SD) age was 48.4 (13.5) years, and disease duration 24.6 (13.3) years, with 77% men. Spinal mobility was less restricted in USpA versus AS patients (p ≤ 0.05), with a median (interquartile range) tragus-to-wall distance of 11 (10-12) cm versus 13 (11.3-18.5) cm; thoracolumbar flexion 9 (7-10) cm versus 6.5 (4-9) cm; lateral spinal flexion 29 (25-36) cm versus 21.3 (12-31) cm; lumbar flexion 4.5 (3.5-5.0) cm versus 3.5 (2.0-4.5) cm and intermalleolar distance 113 (102-121) cm versus 101 (86-114) cm. There were no differences between the subgroups in cervical mobility, vital capacity, chest expansion or thoracic flexion, and there were few gender differences, besides anthropometric measures.

    CONCLUSION: Patients with USpA and AS had similar cervical and chest mobility, while thoracic and lumbar mobility were more severely restricted in AS. There were few gender differences in either subgroup. Further studies, to understand the full impact of USpA on spinal mobility, are needed. Copyright © 2016 John Wiley & Sons, Ltd.

  • 108.
    Mogard, Elisabeth
    et al.
    Lund University, Faculty of Medicine and Skåne University Hospital, Lund, Sweden.
    Olofsson, Tor
    Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden.
    Bergman, Stefan
    University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Spenshult Research and Development Center, Halmstad, Sweden.
    Kristensen, Lars Erik
    Copenhagen University Hospital, Copenhagen, Denmark.
    Kvistgaard Olsen, Jack
    Copenhagen University Hospital, Copenhagen, Denmark.
    Wallman, Johan K.
    Lund University, Lund, Sweden.
    Lindqvist, Elisabet
    Lund University, Faculty of Medicine and Skåne University Hospital, Lund, Sweden.
    Chronic pain and assessment of pain sensitivity in patients with established axial Spondyloarthritis – a cross-sectional study2018Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background/Purpose: Pain remains a common and debilitating symptom in arthritis, despite good options to treat inflammation. In axial spondyloarthritis (axSpA), data on chronic pain remain scarce. 

    Objective: To assess self-reported and observed aspects of pain in subgroups of axial spondyloarthritis (axSpA), and to investigate associations between these pain aspects and different health outcome measures. 

    Methods: A cross-sectional study of patients with axSpA (ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (USpA, based on ICD10 codes)), consecutively enrolled in the SPARTAKUS cohort (n=226). Of 197 patients, for whom all relevant information was available, 173 patients fulfilled the ASAS axSpA criteria, and 115 the modified New York criteria. We investigated self-reported pain (intensity, duration, and distribution) and categorized patients into chronic widespread pain, chronic regional pain and no chronic pain. In addition, pain sensitivity (pain threshold, pain tolerance and temporal summation of pain), was assessed by computerized cuff pressure algometry (CPA). Comparisons between AS and USpA and between women and men were performed using Student`s t-test or Chi-squared test. Associations of pain sensitivity measures and different health outcome measures, adjusted for age and sex, were analyzed by multivariate linear regression. 

    Results: All assessed pain measures, except for number of pain regions, were similar in AS and USpA. Almost 50% of the axSpA patients, reported chronic widespread pain (AS 42%, USpA 53%), which was more pronounced in women (60% vs. 34% for men, p<0.001). For pain sensitivity measures, women had lower pain tolerance as compared to men (AS (p=0.03), USpA (p=0.01)), while pain threshold was lower only for women with USpA (p<0.01) (Table). Furthermore, irrespective of diagnosis subgroup, lower pain tolerance was associated with higher disease activity, more fatigue and less spinal mobility. 

    Conclusion: In this population-based, cross-sectional study of established axial spondyloarthritis, chronic widespread pain was common, affecting 50% of the patients. A clear sex difference was found, with women reporting worse measures for both self-reported pain and pain sensitivity. Overall, lower pain tolerance was associated with worse disease activity, fatigue and spinal mobility. CPA shows promising results regarding assessment of pain sensitivity and provides additional information in pain evaluation in AxSpA. © 2018 American College of Rheumatology

  • 109.
    Ndosi, M.
    et al.
    University of Leeds, Leeds, United Kingdom.
    Bremander, Ann
    Spenshult Hospital, Oskarström, Sweden.
    Hamnes, B.
    Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway.
    Horton, M.
    University of Leeds, Leeds, United Kingdom.
    Kukkurainen, M. L.
    The Finnish Society of Rheumatology Nurses, Heinola, Finland.
    Machado, P.
    Coimbra University Hospital, Coimbra, Portugal.
    Marques, A.
    Coimbra University Hospital, Coimbra, Portugal.
    Meesters, J.
    Leiden University Medical Center, Leiden, Netherlands.
    Stamm, T.
    Medical University of Vienna, Vienna, Austria.
    Tennant, A.
    University of Leeds, Leeds, United Kingdom.
    Torre-Aboki, J.D.L.
    Alicante’s General and University Hospital, Alicante, Spain.
    Vliet Vlieland, T.
    Leiden University Medical Center, Leiden, Netherlands.
    Zangi, H.
    NKRR, Diakonhjemmet Hospital, Oslo, Norway.
    Hill, J.
    University of Leeds, Leeds, United Kingdom.
    Validation of the Educational Needs Assessment Tool as a Generic Instrument for Rheumatic Diseases in 7 European Countries2013Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, nr Suppl. 3, s. A149-A150Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To validate the educational needs assessment tool (The ENAT) as a generic tool with which to assess the educational needs of patients with rheumatic diseases in European Countries.

    Methods: The study followed a quantitative cross-sectional design. Participants comprised a convenience sample of patients from 7 European countries with each of the following diagnostic group: ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), osteoarthritis (OA) and fibromyalgia syndrome (FMS). Rasch analysis was used to assess the construct validity of the adapted ENATs and cross-cultural invariance.

    Results: The sample comprised 3015 patients with mean (SD) age 52.6 (13.1), disease duration 13.7 (10.7) years, 1996 (66.2%) of which were female. Patient characteristics (stratified by diagnostic group) were comparable across countries except the educational background, which was variable.Initially, the data from each country and diagnostic group was fitted to the Rasch model separately, and then the pooled data from each diagnostic group. On each occasion the data were required to satisfy Rasch model expectations, after correction for local dependency by creating clusters of items known as teslets. The OA group was an exception as it only did so in country-specific datasets, not within the pooled data. There was no significant differential item functioning (DIF) by age, gender, disease duration or educational background, indicating that the ENAT works in the same way across different patient groups. Uniform cross-cultural DIF was present and this was accounted for by 'splitting' the testlets that were affected. Subsequently, DIF-adjusted conversion tables were calibrated, to enable parametric analyses fully adjusted for cross-cultural bias when comparison of multinational data is required.

    Conclusions: The ENAT is a cross-culturally valid and a reliable tool, providing accurate estimation of educational needs of people with rheumatic diseases. Further research is required for its cross-cultural use in OA.

    Disclosure of Interest: None Declared

  • 110.
    Ndosi, Mwidimi
    et al.
    Academic & Clinical Unit for Musculoskeletal Nursing (ACUMeN), Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.
    Bremander, Ann
    Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Hamnes, Bente
    Department of Patient Education, Hospital for Rheumatic Diseases, Lillehammer, Norway.
    Horton, Mike
    Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.
    Kukkurainen, Marja Leena
    The Finnish Society of Rheumatology Nurses, Helsinki, Finland.
    Machado, Pedro
    Rheumatology Department, Coimbra University Hospital, Coimbra, Portugal.
    Marques, Andrea
    Rheumatology Department, Coimbra University Hospital, Coimbra, Portugal.
    Meesters, Jorit
    Department of Rheumatology and Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.
    Stamm, Tanja A.
    Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria.
    Tennant, Alan
    Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.
    de la Torre-Aboki, Jenny
    Department of Rheumatology, Alicante's General and University Hospital, Alicante, Spain.
    Vliet Vlieland, Theodora P. M.
    Department of Rheumatology and Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.
    Zangi, Heidi A.
    Department of Rheumatology, National Resource Center for Rehabilitation in Rheumatology (NRRK), Diakonhjemmet Hospital, Oslo, Norway.
    Hill, Jackie
    Academic & Clinical Unit for Musculoskeletal Nursing (ACUMeN), Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.
    Validation of the educational needs assessment tool as a generic instrument for rheumatic diseases in seven European countries2014Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, nr 12, s. 2122-2129Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To validate the educational needs assessment tool (ENAT) as a generic tool for assessing the educational needs of patients with rheumatic diseases in European Countries.

    METHODS: A convenience sample of patients from seven European countries was included comprising the following diagnostic groups: ankylosing spondylitis, psoriatic arthritis, systemic sclerosis, systemic lupus erythematosus, osteoarthritis (OA) and fibromyalgia syndrome. Translated versions of the ENAT were completed through surveys in each country. Rasch analysis was used to assess the construct validity of the adapted ENATs including differential item functioning by culture (cross-cultural DIF). Initially, the data from each country and diagnostic group were fitted to the Rasch model separately, and then the pooled data from each diagnostic group.

    RESULTS: The sample comprised 3015 patients; the majority, 1996 (66.2%), were women. Patient characteristics (stratified by diagnostic group) were comparable across countries except the educational background, which was variable. In most occasions, the 39-item ENAT deviated significantly from the Rasch model expectations (item-trait interaction χ(2) p<0.05). After correction for local dependency (grouping the items into seven domains and analysing them as 'testlets'), fit to the model was satisfied (item-trait interaction χ(2) p>0.18) in all pooled disease group datasets except OA (χ(2)=99.91; p=0.002). The internal consistency in each group was high (Person Separation Index above 0.90). There was no significant DIF by person characteristics. Cross-cultural DIF was found in some items, which required adjustments. Subsequently, interval-level scales were calibrated to enable transformation of ENAT scores when required.

    CONCLUSIONS: The adapted ENAT is a valid tool with high internal consistency providing accurate estimation of the educational needs of people with rheumatic diseases. Cross-cultural comparison of educational needs is now possible. © 2013 BMJ Publishing Group Ltd & European League Against Rheumatism.

  • 111.
    Nilsdotter, Anna
    et al.
    Halmstad Central Hospital, Halmstad, Sweden.
    Bremander, Ann
    Lund University, Lund, Sweden.
    Measures of hip function and symptoms: Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH), and American Academy of Orthopedic Surgeons (AAOS) Hip and Knee Questionnaire2011Ingår i: Arthritis care & research, ISSN 2151-4658, Vol. 63, nr Suppl 11, s. S200-207Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Outcome measures included in this review are the Harris Hip Score, the Hip Disability and Osteoarthritis Outcome Score, the Oxford Hip Score, the Lequesne Index of Sever- ity for Osteoarthritis of the Hip, and the American Acad- emy of Orthopedic Surgeons Hip and Knee Questionnaire.

    The outcome measures chosen are the most common ones in the literature concerning hip function and symp- toms. Most of them are patient-reported. The selected mea- sures meet the basic requirements for an outcome mea- surement, although there are shortcomings in a few of them.

  • 112.
    Nilsdotter, Anna K.
    et al.
    Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden & Department of R&D, Sahlgrenska University Hospital, Göteborg, Sweden.
    Cöster, Maria E.
    Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Departments of Rheumatology and Clinical Sciences Lund, Lund University, Lund, Sweden.
    Cöster, M. C.
    Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
    Patient-reported outcome after hallux valgus surgery — a two year follow up2019Ingår i: Foot and Ankle Surgery, ISSN 1268-7731, E-ISSN 1460-9584, Vol. 25, nr 4, s. 478-481Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Patients with hallux valgus deformity may require surgery but prospective patient-reported data is scarce.

    Methods: We evaluated 53 patients with a mean age of 55.3 years (SD 14.1, 50 women), who underwent surgery due to hallux valgus. They completed the PROMs SEFAS, EQ-5D and SF-36 before and 6, 12 and 24 months after surgery.

    Results: All patient-reported outcomes improved at 6, 12 and 24 months compared with the preoperative status. The greatest improvement occurred at 6 months: SEFAS Δ 10.0 (95% confidence interval 7.8–12.2), EQ-5D Δ 0.22 (0.15–0.29), EQ-VAS Δ 8.4 (4.4–12.4), PF SF-36 Δ 22.0 (14.6–29.3) and BP SF-36 Δ 30.6 (23.1–38.1).

    Conclusions: Hallux valgus surgery considerably reduced pain and improved function already within 6 months after surgery. The improvement between 6 and 24 months’ follow-up was minimal measured with PROMs.

    Level of clinical evidence: III — prospective observational cohort study.

    © 2018 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  • 113.
    Olsson, Charlotte M.
    et al.
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS).
    Bernhardsson, Lina
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS).
    Electromyographic Analysis of Left and Right Side Gluteus Medius in Unilateral and Bilateral Bodyweight Exercises2017Ingår i: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 49, nr 5S, s. 464-465Artikel i tidskrift (Refereegranskat)
  • 114.
    Olsson, Charlotte M.
    et al.
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS).
    Fälth, Jenny
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap.
    Ahlebrand, August
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS).
    Sex-Differences In Bench Press Muscle Activation With Pre-Exhaustion Of Triceps Brachii2018Ingår i: Conference Abstracts, 2018, s. 67-68Konferensbidrag (Refereegranskat)
    Abstract [en]

    Purpose: Pre-exhaustion is a resistance training method which activates a stronger single-joint muscle to momentary exhaustion directly before a multi-joint exercise including the pre-exhausted muscle. This results in greater recruitment of muscles in the multi-joint exercise to further increase muscle strength. The pre-exhaustion method in bench press has mainly been studied in men and it is uncertain if sex-differences exists. Men are stronger than women in absolute strength, especially in the upper body but if this holds true for upper body relative strength is debated. The purpose was to investigate muscle activity by surface electromyography (EMG) between women and men in bench press with and without pre-exhaustion of triceps brachii (TB) and to compare relative strength in 10RM bench press between the sexes.

    Methods: 15 women and 15 men in their 20s with weight lifting experience were recruited to the study. During the first session body composition and 10 repetition maximum (10RM) bench press were determined Participants performed both protocol A and B in a cross-over design on separate days. Protocol A began with 10 RM bench press, five minutes recovery, pre-exhaustion exercise (triceps extensions to failure) immediately followed by a second round of bench press with the same 10RM load as before pre-exhaustion. Protocol B started with triceps extensions to failure immediately before bench press at their before established 10RM, five minutes of recovery then they performed 10RM bench press again. IN both protocols, EMG electrodes were attached to TB), pectoralis major (PM) and deltoideus anterior (DA). EMG values were normalized to maximum voluntary isometric contraction (MVIC) and expressed as % MVIC.

    Results: Bench press only EMG activity in %MVIC was similar between women and men, but analysis of variance (TB interaction p=0.02) showed that women had higher %MVIC in TB after pre-exhaustion whereas muscle activity decreased in men compared to bench press without pre-exhaustion. Yet, the number of repetitions completed in bench press after pre-exhaustion of TB were the same (women 4.3 ± 2.6 vs men 3.8 ± 2.2; p=0.55). As expected, in 10RM weight men (64.0 ± 7.1 kg) were stronger than women (37.1 ± 6.5 kg; p<0.01), however when related to fat free mass no difference was evident in relative strength between women and men.

    Conclusion: Men and women have similar muscle activation patterns during a 10RM bench press, but TB pre-exhaustion followed by a bench press appears to have a greater effect on TB activation in women compared to men. Absolute strength was greater in men, but normalized to fat free mass women and men had similar upper body relative strength.

  • 115.
    Strömbeck, Britta
    et al.
    Musculoskeletal Sciences, Department of Orthopedics, Lund University Hospital, Klinikgatan 22, SE-221 85 Lund, Sweden.
    Englund, Martin
    Musculoskeletal Sciences, Department of Orthopedics, Lund University Hospital, Klinikgatan 22, SE-221 85 Lund, Sweden.
    Bremander, Ann
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Jacobsson, Lennart T H
    Department of Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden.
    Kedza, Ljuba
    Musculoskeletal Sciences, Department of Orthopedics, Lund University Hospital, Klinikgatan 22, SE-221 85 Lund, Sweden.
    Kobelt, Gisela
    Musculoskeletal Sciences, Department of Orthopedics, Lund University Hospital, Klinikgatan 22, SE-221 85 Lund, Sweden.
    Petersson, Ingemar F
    Musculoskeletal Sciences, Department of Orthopedics, Lund University Hospital, Klinikgatan 22, SE-221 85 Lund, Sweden.
    Cost of illness from the public payers' perspective in patients with ankylosing spondylitis in rheumatological care2010Ingår i: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 37, nr 11, s. 2348-55Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To estimate the incremental costs to public payers for patients with ankylosing spondylitis (AS) of working age compared with reference subjects from the general population.

    METHODS: We investigated total costs for 3 years (2005-2007) in 116 outpatients under 66 years of age with AS attending rheumatological care in Malmö, Sweden. Mean (SD) age was 46 (11) years and mean (SD) disease duration was 24 (11) years. Two subjects per AS patient matched for age, sex, and residential area were selected from the Population Register to serve as a reference group. We retrieved data concerning sick leave, prescription drugs, and healthcare consumption from Swedish health-cost registers by the unique personal identification numbers.

    RESULTS: The mean total cost for the 3-year period 2005-2007 was US $37,095 (SD $30,091) for patients with AS, and $11,071 (SD $22,340) for the reference group. The mean indirect cost was $19,618 and $5905, respectively. Mean cost for healthcare was $8998 for the AS patients and $4187 for the reference subjects, and mean cost for drugs was $8479 and $979, respectively. The patients with AS treated with biological therapy constituted 80% of the total drug cost, but just 40% of the cost for disability pension.

    CONCLUSION: Patients with AS had 3-fold increase in costs compared to reference subjects from the general population, and the drug costs were almost 10 times as high. Production losses (indirect cost) represented more than half of total cost (53%).

  • 116.
    Strömbeck, Britta
    et al.
    Department of Orthopedics, The MORSE project Musculoskeletal Research Center, University Hospital, Lund, Sweden & Department of Rheumatology, University Hospital, Malmö, Sweden.
    Jacobsson, Lennart T. H.
    Department of Orthopedics, The MORSE project Musculoskeletal Research Center, University Hospital, Lund, Sweden & Department of Rheumatology, University Hospital, Malmö, Sweden.
    Bremander, Ann
    Department of Orthopedics, The MORSE project Musculoskeletal Research Center, University Hospital, Lund, Sweden & Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Englund, Martin
    Department of Orthopedics, The MORSE project Musculoskeletal Research Center, University Hospital, Lund, Sweden.
    Heide, Anders
    Department of Orthopedics, The MORSE project Musculoskeletal Research Center, University Hospital, Lund, Sweden & Swedish Social Insurance Agency, Region Skåne, Sweden.
    Turkiewicz, Aleksandra
    Department of Orthopedics, The MORSE project Musculoskeletal Research Center, University Hospital, Lund, Sweden.
    Petersson, Ingemar F.
    Department of Orthopedics, The MORSE project Musculoskeletal Research Center, University Hospital, Lund, Sweden.
    Patients with ankylosing spondylitis have increased sick leave—a registry-based case-control study over 7 yrs2009Ingår i: Rheumatology, ISSN 1462-0324, E-ISSN 1462-0332, Vol. 48, nr 3, s. 289-292Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Using prospectively collected registry data to investigate sick leave (sickness benefit and sickness compensation) over a 7-yr period in patients with AS in comparison with population-based controls matched for age, sex and residential area.

    METHODS: We investigated 122 (21 women and 101 men) outpatients with AS in South Sweden, born 1942 or later, from rheumatology specialist care for their sick leave during a 7-yr period. Mean (S.D.) age was 43 (11) yrs and mean (S.D.) disease duration was 20 (11) yrs. Two controls per case, matched for age, sex and residential area were selected from the Swedish National Population Register. Data concerning sick leave for cases and controls, based on the subjects' unique 10-digit personal identification number, were retrieved from the national register of the Swedish Social Insurance Agency.

    RESULTS: More AS patients than controls were registered for sickness benefit (52 vs 36%, P < 0.01) and sickness compensation (42 vs 11%, P < 0.001). Cases had an increased risk for sick leave compared with controls with a relative risk of 1.8; 95% CI 1.5, 2.1; and cases had more days with sick leave than controls (median number of more days per year 30; 95% CI 2, 72).

    CONCLUSIONS: Using the Swedish Social Insurance Agency's registers for sick leave, we found that patients with AS in rheumatology specialist care in South Sweden have an increased level of sick leave compared with controls. These population-based registers have a great potential for studies of the effects of different interventions on sick leave. © 2009 The Author(s).

  • 117.
    Torell, A.
    et al.
    Ängelholms sjukhus, Ängelholm, Sweden.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Lund University, Lund, Sweden & Spenshult R&D center, Halmstad, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden; Spenshult R&D center, Halmstad, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Haglund, Emma
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Spenshult R&D center, Halmstad, Sweden.
    Symptoms of pain, fatigue and self-efficacy in young patients with spondyloarthritis: – a comparison between women and men2017Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, nr Suppl. 2, s. 1515-1515Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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

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

  • 118.
    van den Hout, Wilbert B
    et al.
    Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
    Bremander, Ann
    Spenshult Hospital for Rheumatic Diseases, Research and Development Centre, Oskarström, Sweden.
    Vliet Vlieland, Thea P M
    Departments of Rheumatology and Orthopedics, Leiden University Medical Center, Leiden, The Netherlands.
    Recommendations for economic evaluations of non-pharmacological arthritis care: results from the CARE VI meeting 2010.2011Ingår i: Musculoskeletal care, ISSN 1557-0681, Vol. 9, nr 2, s. 120-3Artikel i tidskrift (Refereegranskat)
  • 119.
    Van der Elst, Kristien
    et al.
    Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium & Skeletal Biology and Engineering Research Centre, Department of Development and Regeneration, KU Leuven–University of Leuven, Leuven, Belgium.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Research and Development Centre, Spenshult, Halmstad, Sweden.
    De Groef, An
    Department of Rehabilitation Sciences, KU Leuven – University of Leuven, Leuven, Belgium.
    Larsson, Ingrid
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Mathijssen, Elke G.E.
    Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
    Vriezekolk, Johanna E.
    Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
    Westhovens, Rene
    Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium & Skeletal Biology and Engineering Research Centre, Department of Development and Regeneration, KU Leuven–University of Leuven, Leuven, Belgium.
    van Eijk-Hustings, Yvonne J.L.
    Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands & Department of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands.
    European Qualitative research project on Patient-preferred outcomes in Early Rheumatoid Arthritis (EQPERA): rationale, design and methods of a multinational, multicentre, multilingual, longitudinal qualitative study2019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 3, artikel-id e023606Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Including the patient perspective is important to achieve optimal outcomes in the treatment of rheumatoid arthritis (RA). Ample qualitative studies exist on patient outcomes in RA. A Belgian study recently unravelled what matters most to patients throughout the overwhelming and rapidly evolving early stage of RA. The present study, European Qualitative research project on Patient-preferred outcomes in Early Rheumatoid Arthritis (EQPERA) was created to contribute to a more universal understanding of patient-preferred health and treatment outcomes by integrating the perspectives of patients with early RA from three European countries.

    METHODS AND ANALYSIS: In EQPERA, a qualitative, explorative, longitudinal study will be implemented in The Netherlands and Sweden, parallel to the methods applied in the previously conducted Belgian study. In each country, a purposive sample of patients with early RA will be individually interviewed 3-6 months after start of the initial RA treatment and subsequently, the same participants will be invited to take part in a focus group 12-18 months after RA treatment initiation. Data collection and analysis will be independently conducted by the local research teams in their native language. A meta-analysis of the local findings will be performed to explore and describe similarities, differences and patterns across countries.

    ETHICS AND DISSEMINATION: Ethics approval was granted by the responsible local ethics committees. EQPERA follows the recommendations of the Declaration of Helsinki. Two main papers are foreseen (apart from the data reporting on the local findings) for peer-reviewed publication.

    © Author(s) (or their employer(s)) 2019.

  • 120.
    Van der Elst, Kristien
    et al.
    University Hospitals Leuven, Leuven, Belgium.
    Bremander, Ann
    Lund University, Lund, Sweden.
    De Groef, Ann
    University Hospitals Leuven, Leuven, Belgium.
    Grønning, Kjerstin
    Norwegian University of Science and Technology, Trondheim, Norway.
    Larsson, Ingrid
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI), Hälsa och omvårdnad. Spenshult Research and Development Center, Halmstad, Sweden.
    Mathijssen, Elke
    Sint Maartenskliniek, Nijmegen, Netherlands.
    Vriezekolk, Joke
    Sint Maartenskliniek, Nijmegen, Netherlands.
    Westhovens, René
    University Hospitals Leuven, Leuven, Belgium.
    van Eijk-Hustings, Yvonne
    Maastricht University Medical Center, Maastricht, Netherlands.
    European Qualitative Research Project on Patient-preferred Outcomes in Early Rheumatoid Arthritis (EQPERA): Rationale, Design and Methods of a Multi-country, Multi-center, Multi-language, Longitudinal Qualitative Study2017Ingår i: European Congress of Qualitative Inquiry: Abstracts, 2017, s. 117-117Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background: A successful medical outcome is no guarantee for patient perception of treatment success. Unraveling the patient’s perspective on outcome preferences is therefore crucial to deliver patient-centered, high-quality chronic illness care. Furthermore, the earliest stage of a chronic disease, such as in Rheumatoid Arthritis (RA), can be considered as a critical phase in the patient pathway for achieving optimal long-term outcomes. A Belgian qualitative study provided a first glimpse on what matters most to patients with recently diagnosed RA (1). However, there was a need for an international data set to better understand this complex phenomenon being studied, and to investigate whether the Belgian findings could be transferred to contexts with different national healthcare systems, practices and values. To this end, EQPERA –European Qualitative research collaboration on Patient-preferred outcomes in Early Rheumatoid Arthritis– was founded.

    Objectives: The overall research objective of EQPERA is to unravel longitudinally preferences for treatment and health outcomes among patients with early RA across Belgium, the Netherlands, Sweden and Norway, placing findings in a context broader than Belgium. Furthermore, EQPERA aims to add to qualitative methodology research.

    Methods: EQPERA applies a qualitative, explorative, longitudinal research design, which was developed in collaboration with patient research partners and the patient perspective in mind. In each country, a purposive sample of patients with early RA will be individually interviewed between 3-6 months after start of the initial RA treatment and subsequently, the same participants will be invited to take part in a focus group about 1 year after RA treatment initiation. Interviews will be analyzed using the constant comparison method as described in Qualitative Analysis Guide of Leuven. The longitudinal analysis will be guided by Saldaña’s steps for analyzing change through time in longitudinal qualitative research. To study the multinational findings, we will carry out a meta-synthesis of all locally gathered and interpreted data. The local research teams will independently employ a qualitative study, while the project leader will monitor the research as it unfolds and evolves. Moreover, to support consistency in data collection and the inter-coder reliability across countries, we will implement a detailed research protocol, a structured cultural translation and validation process of the interview guides, data collection templates, a quality assurance reporting tool and specific training sessions.

    Added value: Our innovative, qualitative, longitudinal research design goes beyond the abilities of the frequently used cross-sectional designs in qualitative research. A European research context allows to uncover subtle cultural differences in patient-preferred outcomes across more or less similar organized countries. This project is thus a first step in gathering widely applicable findings in a research area where evidence-based knowledge is lacking, yet, highly needed to tailor care processes and optimize patient outcomes. Various data management strategies are applied to ensure quality and trustworthiness of our findings, and to promote a smooth European collaboration.

  • 121.
    Van der Elst, Kristien
    et al.
    University Hospitals Leuven, Leuven, Belgium.
    Bremander, Ann
    Spenshult Research and Development Center, Spenshult Hospital, Halmstad, Sweden.
    De Groef, Ann
    University Hospitals Leuven, Leuven, Belgium.
    Larsson, Ingrid
    Spenshult Research and Development Center, Spenshult Hospital, Halmstad, Sweden.
    Mathijssen, Elke
    Sint-Maartenskliniek, Nijmegen, Netherlands.
    Vriezekolk, Joke
    Sint-Maartenskliniek, Nijmegen, Netherlands.
    Westhovens, Renee
    University Hospitals Leuven, Leuven, Belgium.
    van Eijk-Hustings, Yvonne
    Maastricht University Medical Center, Maastricht, Netherlands.
    European Qualitative Research Project on Patient-preferred Outcomes in Early Rheumatoid Arthritis (EQPERA): Rationale, Design and Methods of a Multi-country, Multi-center, Multi-language, Longitudinal Qualitative Study2017Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, nr Suppl. 2, s. 1488-1489Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Ample studies exist on outcome assessment from the patient perspective in Rheumatoid Arthritis (RA), but little is known about health and treatment preferences of recently diagnosed patients, and how these evolve over time. A Belgian qualitative study has set the scene (1), but knowledge on cross-cultural nuances in patient-preferred outcomes is lacking. To this end, EQPERA – European Qualitative research collaboration on Patient-preferred outcomes in Early Rheumatoid Arthritis– was founded.

    Objectives: EQPERA aims to unravel longitudinally preferences for treatment and health outcomes among patients with early RA across Belgium, the Netherlands and Sweden. To yield sound results, specific preparations for this cross-country qualitative study are reported here.

    Methods: Several steps have been undertaken to ensure trustworthiness of findings and consistency across countries in sampling, interviewing, analysis and project management: a detailed research protocol has been written; the interview guides have been translated following a structured forward-backward linguistic validation process; templates for data collection and a quality assurance reporting tool have been developed; and local staff has been trained and supervised by the project leader in implementing the study protocol. Each country will document changes with sufficient detail in their research logbook.

    Results: EQPERA will be a qualitative, explorative, longitudinal study with active involvement of patient researchers. In each country, a purposive sample of patients with early RA will be individually interviewed 3–6 months after start of the initial RA treatment and subsequently, the same participants will be invited back to take part in a focus group 12–18 months after RA treatment initiation. Data collection and analysis will be independently conducted by the local research teams in their native language. The local teams will analyze their interview data using the constant comparison method as detailed in Qualitative analysis guide of Leuven, after which Saldana's guiding questions will be adopted for analyzing change over time. Afterwards, a meta-synthesis of all locally gathered and interpreted data will be conducted to explore and describe patterns, similarities and differences across countries.

    Conclusions: This European project is a first step in gathering contextual findings on patient-preferred outcomes in early RA. Such knowledge is of crucial importance for tailoring therapeutic approaches in a timely and meaningful way. Our innovative, qualitative, longitudinal research design goes beyond the abilities of the frequently used cross-sectional designs in qualitative research. Large, multi-national qualitative projects are scarce in rheumatology research, thus applied data management and quality assurance strategies could be of interest to other researchers. © 2017, BMJ Publishing Group Limited

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