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  • 51.
    Haglund, Emma
    et al.
    Spenshult Research and Development Center, Spenshult, Oskarström, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Spenshult Research and Development Center, Spenshult, Oskarström, Sweden.
    Bergman, Stefan
    Spenshult Research and Development Center, Spenshult, Oskarström, Sweden.
    Jacobsson, Lennart T H
    Department of Clinical Sciences, Malmö, Section of Rheumatology, Lund University, Lund, Sweden.
    Petersson, Ingemar F
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Work productivity in a population-based cohort of patients with spondyloarthritis2013In: Rheumatology, ISSN 1462-0324, E-ISSN 1462-0332, Vol. 52, no 9, p. 1708-14Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

  • 52.
    Haglund, Emma
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Center, Halmstad, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Center, Halmstad, Sweden & Lund University, Lund, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Center, Halmstad, Sweden; Lund University, Lund, Sweden & ahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing. Spenshult Research and Development Center, Halmstad, Sweden.
    Educational needs in patients with spondyloarthritis in Sweden - a mixed-methods study2017In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 18, no 1, article id 335Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 53.
    Haglund, Emma
    et al.
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden; Spenshult Research and Development Center, Halmstad, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. Spenshult Research and Development Center, Halmstad, Sweden.
    Patient Education in Spondyloarthritis Should be Guiding, Reliable and Available and Presented in Varied Formats2015In: Arthritis & Rheumatology, ISSN 2326-5191, E-ISSN 2326-5205, Vol. 67, no Suppl. S10, article id 1196Article in journal (Refereed)
    Abstract [en]

    Background/Purpose:

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

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

    Methods:

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

    Results:

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

    Conclusion:

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

    References:

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

  • 54.
    Haglund, Emma
    et al.
    Section of Rheumatology, Dept. of Clinical Sciences, Lund University, Lund, Sweden & Spenshult R & D center, Oskarström, Sweden.
    Bremander, Ann
    Section of Rheumatology, Dept. of Clinical Sciences, Lund University, Lund & & Spenshult R & D center, Oskarström, Sweden.
    Petersson, I.F.
    Section of Rheumatology, Dept. of Clinical Sciences, Lund University, Lund, Sweden & Dept. of Orthopedics, Clinical Sciences, Lund University, Lund, Sweden.
    Bergman, Stefan
    Section of Rheumatology, Dept. of Clinical Sciences, Lund University, Lund, Sweden & Spenshult R & D center, Oskarström, Sweden.
    Self-reported disease characteristics do not explain why younger women with SpA are less physically active than older women with the disease2014In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, no Suppl. 2, p. 159-159Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

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

  • 55.
    Haglund, Emma
    et al.
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden & Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Bremander, Ann
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden & Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Petersson, Ingemar F.
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden & Department of Rheumatology, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Strömbeck, Britta
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Jacobsson, Lennart T. H.
    Department of Rheumatology, Clinical Sciences Malmö, Lund University, Lund, Sweden.
    Turkiewicz, Aleksandra
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Geborek, Pierre
    Department of Rheumatology, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Englund, Martin
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden & Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
    Prevalence of spondyloarthritis and its subtypes in southern Sweden2011In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 70, no 6, p. 943-948Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 56.
    Haglund, Emma K.
    et al.
    Research & Development Center, Spenshult Hospital, Oskarström, Sweden.
    Bremander, Ann B.
    Research & Development Center, Spenshult Hospital, Oskarström, Sweden.
    Aerobic capacity in patients with rheumatoid arthritis: A comparison of two submaximal test methods2009In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 7, no 4, p. 288-299Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 57.
    Haglund, Emma
    et al.
    FoU Spenshult, Oskarström, Sweden.
    Malm, Karina
    Bremander, Ann
    Physical activity pattern in chronic inflammatory arthritis – still lots to do!2013In: 21st International Conference on Health Promoting Hospitals and Health Services: Abstract book, Copenhagen: WHO-CC , 2013, p. 102-102Conference paper (Refereed)
  • 58.
    Haglund, Emma
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Center, Halmstad, Sweden.
    Olsson, C.
    The Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Bergman, Stefan
    Spenshult Research and Development Center, Halmstad, Sweden; The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Lund University, Lund, Sweden.
    Improving triage to appropriate treatment level by using a combination of screening tools in patients at risk of developing chronic back pain2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, no Suppl. 2, p. 1531-1532Article in journal (Refereed)
  • 59.
    Haglund, Emma
    et al.
    Spenshult Research and Development Center, Halmstad, Sweden.
    Petersson, Ingemar F.
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Spenshult Research and Development Center, Halmstad, Sweden & Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Bergman, Stefan
    Spenshult Research and Development Center, Halmstad, Sweden & Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Predictors of Presenteeism and Activity Impairment Outside Work in Patients with Spondyloarthritis2015In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 25, no 2, p. 288-295Article in journal (Refereed)
    Abstract [en]

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

  • 60.
    Haglund, Emma
    et al.
    R&D Centre, Spenshult, Oskarström, Sweden & Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Petersson, Ingemar F.
    Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden & Department of Clinical Sciences Lund, Section of Orthopedics, Musculoskeletal Sciences, Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. R&D Centre, Spenshult, Oskarström, Sweden & Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Bergman, Stefan
    R&D Centre, Spenshult, Oskarström, Sweden & Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Predictors of Work Productivity in a Population Based Cohort of Individuals with Spondyloarthritis2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, no Suppl. 3, p. A127-A127Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

  • 61.
    Haglund, Emma
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). RandD Spenshult, Halmstad, Sweden.
    Pinheiro Sant'Anna, Anita
    Halmstad University, School of Information Technology, Halmstad Embedded and Intelligent Systems Research (EIS), CAISR - Center for Applied Intelligent Systems Research.
    Andersson, Maria
    RandD Spenshult, Halmstad, Sweden & Department of Clinical Sciences, Department of Rheumatology, Lund University, Lund,, Sweden.
    Bramander, Ann
    Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
    Aili, Katarina
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Dynamic joint stability measured as gait symmetry in people with symptomatic knee osteoarthritis2019In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, no Suppl. 2, article id A1458Article in journal (Refereed)
    Abstract [en]

    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.

  • 62.
    Karlsson, Jan
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Winroth, Jan
    Högskolan Väst, Trollhättan, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Holmquist, Mats
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Lindgren, Eva-Carin
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Lydell, Marie
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Staland Nyman, Carin
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Förändringsledarskap vid digital transformation inom vård och omsorg: En sammanfattande rapport från kompetensutvecklingsprojektet ”Trygg motivation och inspiration” i Kungsbacka kommun 20182018Report (Other academic)
  • 63.
    Klokkerud, Mari
    et al.
    University of Oslo, Institute of Health and Society, Norway.
    Hagen, Kåre Birger
    University of Oslo, Institute of Health and Society, Norway.
    Kjeken, Ingvild
    University of Oslo, Institute of Health and Society, Norway.
    Bremander, Ann
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Hørslev-Petersen, Kim
    King Christian Xth Hospital for Rheumatic Diseases, Gråsten, Denmark.
    Vlieland, Thea Vliet
    Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands.
    Grotle, Margreth
    FORMI (Communication Unit for Musculoskeletal Disorders), Oslo University Hospital, Ullevaal, Oslo, Norway.
    Development of a framework identifying domains and elements of importance for arthritis rehabilitation2012In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, no 5, p. 406-13Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Rehabilitation is effective and beneficial for patients with arthritis. The lack of a common structure for describing the content of rehabilitation makes it difficult to compare, transfer and implement research evidence into clinical practice.

    OBJECTIVE: To develop a framework comprising domains and elements of importance when describing arthritis rehabilitation.

    METHODS: On the basis of a systematic literature search and review, the framework was developed through a 9-step development process, including 5 Delphi consensus rounds within the Scandinavian Team Arthritis Register - European Team Initiative for Care Research (STAR-ETIC) collaboration, a group of clinicians, researchers and patients from northern Europe.

    RESULTS: Based on Donabedian's healthcare model, the Inter-national Classification of Function, Disability and Health, and a rehabilitation model by D. T. Wade, 4 domains (context, structure, process and outcome) were defined. Within each domain, the most important and relevant key elements for describing rehabilitation were selected. This framework contains 1 key element under context, 9 under structure, 3 under process, and 9 under outcome.

    CONCLUSION: The STAR-ETIC framework can be used to describe arthritis rehabilitation, by emphasizing key elements in 4 main domains. A common framework may facilitate comparisons of rehabilitation programmes across countries and different levels of care, and may improve the implementation of rehabilitation research in clinical practice. © 2012 Foundation of Rehabilitation Information.

  • 64.
    Landgren, Ellen
    et al.
    Spenshult Research and Development Center, Halmstad, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Center, Halmstad, Sweden & Lund University, Lund, Sweden.
    Lindqvist, Elisabet
    Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden.
    van der Elst, Kristien
    University Hospitals Leuven, Leuven, Belgium & KU Leuven, University of Leuven, Leuven, Belgium.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Center, Halmstad, Sweden.
    Patients’ experiences of health in early rheumatoid arthritis – a qualitative study2018In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, p. 1802-1803, article id FRI10707-HPRArticle in journal (Refereed)
    Abstract [en]

    Background: The World Health Organization defines health as ”a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Health changes dramatically when a person becomes ill in a chronic disease as rheumatoid arthritis (RA). RA is a disease with great impact on all aspects of life. Living with RA affects patients’ health including physical, emotional, psychological and social aspects. The purpose of a person-centered care is to see patients as experts; sharing decisions with them and helping them manage their health. Therefore it is important to understand how patients in early disease stage of RA experience the concept of health.

    Objectives: The purpose of this study was to describe patients’ experiences of health in early RA.

    Methods: The study had a descriptive design with a qualitative content analysis approach. Individual interviews were conducted with 24 patients with early RA. In this study the patients had disease duration less than 12 months. A manifest qualitative content analysis was used to analyze the question: “What does health mean to you?”

    Results: In the early stage of RA, patients experienced health as the most important goal in their life. They described health as well-being, independence, life satisfaction and vitality. Health as well-being meant to feel good, be painless and have a good sleep to feel rested. Health as independence meant to have both physical and financial prerequisites to perform everyday activities, to exercise and being able to travel. Health as life satisfaction meant to feel joy in life, enjoy the family and to believe in the future. Health as vitality meant to have the energy, power and strength to cope with everyday life. The patients expressed that their health had been adversely affected by the RA disease and they had a strong desire for full health including well-being, independence, life satisfaction and vitality.

    Conclusions: Patients in an early stage of RA describe a strong desire to regain health in terms of well-being, independence, life satisfaction and vitality. The concept of health at early RA is similar to health at established RA in terms of well-being, independence and life satisfaction. Unique findings for patients with early RA are the description of health as vitality, and the emphasis of having energy, power and strength to cope with everyday life. Health professionals should have these different ways of experiencing health in mind when providing person-centred care to patients with early RA. Depending on the patients’ perception of health, different support strategies are needed.

  • 65.
    Landgren, Ellen
    et al.
    Lunds Universitet.
    Bremander, Ann
    University of Southern Denmark, Odense..
    Lindqvist, Elisabeth
    Lunds Universitet.
    Van der Elst, Kristien
    KU Leuven–University of Leuven, Leuven, Belgium.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing.
    To regain one’s health” – patients’ preferencesof treatment outcomes in early rheumatoid arthritis – a qualitative study.2019In: Annals of the Rheumatic Diseases, 2019, Vol. 78, article id A648Conference paper (Refereed)
    Abstract [en]

    Background: Rheumatology care strives to identify and meet the needs of the patients, and to understand disease and treatment impact from the patients’ perspective. A better understanding of patients’ expectations from the treatment is needed to enable a patient centered approach in clinical practice and a shared-decision making as recommended in the EULAR treatment recommendations for rheumatoid arthritis (RA). Understanding of patients’ expectations in the early stage of the RA disease may facilitate adherence to treatment, patient independence and prevent unmet needs in the future.

    Objectives: To explore patients’ preferred treatment outcomes in early rheumatoid arthritis (eRA).

    Methods: A qualitative, explorative study. Individual interviews were conducted with 31 patients with eRA, defined as disease duration of ≤ 1 year and disease-modifying antirheumatic drugs (DMARDs) treatment for 3-6 months 1 . Interviews were analyzed using a constant comparison method according to the Qualitative Analysis Guide of Leuven (QUAGOL) and lasted in a core category and four related concepts.

    Results: The patient-preferred treatment outcomes in eRA were described in the core category “to regain one’s health” and the four related concepts: to experience external control of the disease, to experience independence, to regain identity and to experience joy in everyday life. The patients expected to experience external control of the disease by the given treatment to regain one’s health. It was perceived as controlling the symptoms and as absence of disease. Independence was perceived as regaining former activity levels, experiencing autonomy and using active coping strategies. Patients wanted to regain identity through participation, empowerment and their self-image. Joy in everyday life was perceived as vitality and believing in the future.

    Conclusion: Patients’ preferred treatment outcomes in eRA were to regain one’s health including both external and internal control. External control as disease control and independence as well as internal control as identity and joy in everyday life. The results from this study can assist healthcare professionals to better understand patients’ preferred treatment outcomes early in the disease process and to tailor the interventions accordingly to improve long term treatment outcome.

  • 66.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Andersson, M. L. E.
    Spenshult Research and Development Center, Spenshult, Halmstad, Sweden.
    Ajeganova, S.
    Leiden University Medical Center - LUMC, Leiden, Netherlands.
    Bala, V.
    Helsingborgs Lasarett, Department of Medicine, Helsingborg, Sweden.
    Svensson, Björn
    Lunds Universitet, Department of Clinical Sciences, Lund, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Häggström, Åsa
    Keller, Catharina
    Helsingborg Lasarett AB, Helsingborg, Sweden.
    Leden, Ido
    Centralsjukhuset, Kristianstad, Sweden.
    Teleman, Annika
    Spenshult Hospital, Olofstrom, Sweden.
    Theander, Jan
    Kristianstad Central Hospital, Department of Internal Medicine, Kristianstad, Sweden.
    ֖stenson, Anneli
    Reasons to stop drinking alcohol among patients with rheumatoid arthritis in Sweden: A mixed-methods study2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 12, article id e024367Article in journal (Refereed)
    Abstract [en]

    Objectives: The aims were to identify patients with rheumatoid arthritis (RA) who had stopped drinking alcohol and compare them with patients drinking alcohol, and to explore reasons for stopping drinking alcohol. Design: A sequential explanatory mixed methods design was used. Setting: Six rheumatology clinics in Southern Sweden Better Anti-Rheumatic FarmacOTherapy cohort. Participants: A total of 1509 patients completed the questions about alcohol and were included in the study. 86 of these had stopped drinking alcohol and 72 responded to the open question and their answers were analysed with qualitative content analysis. Outcome measures: The quantitative data were from a cross-sectional survey assessing disease severity, physical function (Health Assessment Questionnaire, HAQ) and health-related quality of life (EuroQol five dimensions, EQ5D), pain, fatigue, patient global assessment (PatGA) and lifestyle factors, for example, alcohol. The questions assessing alcohol included an open question ’Why have you stopped drinking alcohol?’ Results: The patients who stopped drinking alcohol were older (median (min-max) 69 (36-90) vs 66 (23-95), p=0.011), had worse HAQ (1.00 (0-2.75) vs 0.50 (0-3.00), p<0.001), worse EQ5D (0.69 (-0.02-1.00) vs 0.76 (-0.58-1.00), p<0.001) worse PatGA (5 (0-10) vs 3 (0-10), p<0.001), more pain (5 (0-10) vs 3 (0-10), p<0.001) and more fatigue (6 (0-10) vs 4 (0-10), p<0.001 compared with patients drinking alcohol. The qualitative content analysis revealed five categories describing reasons for patients with RA to stop drinking alcohol: illness and treatment; health and well-being; work and family; faith and belief; and dependences and abuse. Conclusions: The patients who had stopped drinking had worse physical functioning and higher levels in pain-related variables. Most stopped drinking due to their illness or a desire to improve health. © 2018 Author(s).

  • 67.
    Larsson, Ingrid
    et al.
    R&D Centre, Spenshult, Oskarström, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. R&D Centre, Spenshult, Oskarström, Sweden & Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. R&D Centre, Spenshult, Oskarström, Sweden & Lund University, Lund, Sweden.
    OP0094-HPR Person-Centred Care (PCC) May Improve Health Care Consumer Skills More than Regular Care - an RCT in Patients with CIA Undergoing Biological Therapy2015In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 74, no Suppl. 2, p. 104-104Article in journal (Refereed)
    Abstract [en]

    Background: In person-centred care (PCC) a holistic approach, individualized care, empowerment and self-management are cornerstones. Patients are seen as persons with resources and are encouraged to take an active role in their own health care to become skilled or effective consumers of health care. Little is known of the impact of PCC vs. regular care on patients’ skills as health care consumers.

    Objectives: To study the impact on effective consumers’ skills over 12 months in patients undergoing biological therapy and randomly assigned to either a nurse-led rheumatology clinic (NLC) based on PCC or to a rheumatologist-led clinic (RLC) as measured by the Effective Consumer Scale (EC17).

    Methods: A 12 month RCT in 107 patients with chronic inflammatory arthritis.1 Inclusion criteria were ongoing biological therapy and a DAS28 ≤3.2. All patients met a rheumatologist at inclusion and after 12 months, while the 6 month follow-up was performed in the assigned group, either at a NLC (PCC) or at an RLC (regular care). Outcome measure was the EC17, developed and endorsed by the OMERACT to measure skills in decision-making, navigation and negotiation with health care professionals (0-100, worse to best). Minimally Important Difference (MID) of EC17 was calculated (≥ 0.5 SD of the mean baseline score)2 and patients categorized in three EC17 groups: improvement, no change or deterioration of consumer skills. Differences between intervention groups and EC17 groups were calculated with Chi2. Global health, pain and HAQ were measured for descriptive purposes.

    Results: A total of 101 patients completed the EC17 at baseline (mean 84 SD 10) and after 12 months. Twelve patients had baseline scores higher than 95 and a MID in improvement could not be measured why they were excluded, leaving 89 patients in the trial (mean age 53 SD 12 years, mean disease duration 16 SD 11 years, 54% women, RLC n=44, NLC n=45). At baseline mean (SD) DAS28 was 2.05 (0.68), global health 22 (17), pain 23 (18) and HAQ 0.55 (0.51). A larger proportion of patients improved according to EC17 in the NLC compared with the RLC (42% vs. 23%), and a smaller proportion deteriorated (16% vs. 23%; table). The differences were not statistically significant (p=0.14), probably due to a small sample size.

    Table. Proportion of patients who deteriorated (≥5 units), remained stable or improved (≥5 units) in EC17 over 12 months monitored at a NLC or an RLC, total n= 89.

    EC17 deterioration

    NLC 16%   (n=7)

    RLC 23%    (n=10)

    EC17 stable

    NLC 42%   (n=19)

    RCL 54%   (n=24)

    EC17 improvement

    NLC 42%   (n=19)

    RLC 23%   (n=10)

    Conclusions: A nurse-led rheumatology clinic based on person-centred care resulted in a greater proportion of patients who reported a long term improvement in skills as consumers of health services compared with patients monitored by a rheumatologist-led clinic. Larger studies are needed to confirm the result.

    References: 1. Larsson I, et al. Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy. J Adv Nurs 2014;70(1):164-75.

    2. Strand V, et al. It's good to feel better but it's better to feel good and even better to feel good as soon as possible for as long as possible. Response criteria and the importance of change at OMERACT 10. J Rheumatol 2011;38(8):1720-7.

  • 68.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. FoU Spenshult, Halmstad, Sweden.
    Bergman, Stefan
    FoU Spenshult, Halmstad, Sweden; Lund University, Lund, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. FoU Spenshult, Halmstad, Sweden & Lund University, Lund, Sweden.
    Person-Centred Care Can Help Patients to Become More Effective Consumers in the Use of Health Information than Regular Care – an RCT in Patients with Arthritis Undergoing Biological Therapy2015In: Arthritis & Rheumatology, ISSN 2326-5191, E-ISSN 2326-5205, Vol. 67, no Suppl. S10, article id 1495Article in journal (Refereed)
    Abstract [en]

    Background/Purpose:

    Person-centred care (PCC) is a holistic approach with respectful and individualized care allowing negotiation of care where persons with health problems are empowered to be involved in health decisions. Patients’ illness narratives constitute a starting point for building a collaboration with health care professionals and to empower them to play an active role in their health care. Little is known of the impact of PCC vs. regular care on patients’ skills as health care consumers. The aim was to study the impact on effective consumers’ skills over 6 and 12 months as measured by the Effective Consumer Scale (EC17) in patients undergoing biological therapy and randomly assigned to either a nurse-led rheumatology clinic (NLC) based on PCC or to a rheumatologist-led clinic (RLC) based on regular care.

    Methods:

    A 12 month RCT in 107 patients with chronic inflammatory arthritis1. Inclusion criteria were ongoing biological therapy and a DAS28 ≤3.2. All patients met a rheumatologist at inclusion and after 12 months, while the 6 month follow-up was randomized to either at an NLC (PCC) or at an RLC (regular care). Outcome measure was the EC17, developed and endorsed by the OMERACT, including five subscales; 1. Use of health information, 2. Clarifying personal priorities, 3. Communicating with others, 4. Negotiating roles and 5. Deciding and taking action. EC17 total score ranges from 0-100, worse to best. Differences between and within NLC and RLC were analyzed with Friedmans’ test or Mann Whitney U-test.

    Results:

    After 12 months 97 patients completed the RCT (NLC n=47, RLC n=50), mean (SD) age 55.4 (12.7) years, disease duration 16.7 (11.5) years, DAS28 2.1 (0.7), HAQ 0.54 (0.38), global health 20.4 (17.1), pain 21.1 (18.0) and 56% were women. There were no statistically significant differences within or between the two intervention groups at baseline nor in EC17 total score mean (SD) at baseline (NLC 83.5 (9.4) vs. RLC 83.2 (10.8), 6 months (NLC 85.4 (10.4) vs. RLC 82.9 (10.9) and 12 months (NLC 85.3 (11.1) vs. RLC 82.3 (10.9)). However, in NLC there was a statistically significant improvement in EC17 subscale “1. Use of health information” at both 6 and 12 months (p=0.041 and p=0.004 respectively).

    Conclusion:

    Replacing just one of three visits over 12 months to an NLC based on PCC instead of an RLC based on regular care resulted in more effective consumers concerning the use of health information. Larger studies over longer time frames focusing on PCC are needed to better understand its full impact on effective consumer skills measured by EC17.

    References:

    1. Larsson I, et al. Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy. J Adv Nurs 2014;70:164-75.

  • 69.
    Larsson, Jonas
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Department of Medical Imaging and Physiology, Skåne University Hospital Department of Translational Medicine, Lund University, Lund, Sweden & Swedish Armed Forces, Eksjö, Sweden.
    Dencker, Magnus
    Department of Medical Imaging and Physiology, Skåne University Hospital Department of Translational Medicine, Lund University, Lund, Sweden.
    Olsson, M. Charlotte
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Development and application of a questionnaire to self-rate physical work demands for ground combat soldiers2020In: Applied Ergonomics, ISSN 0003-6870, E-ISSN 1872-9126, Vol. 83, article id 103002Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of the present study was to identify the most physically demanding work tasks for Swedish ground combat soldiers through the development and application of a questionnaire survey. This is the first in a series of studies aiming to describe the development process and validation of physical selection standards in the Swedish armed forces.

    Methods: Based on procedural documentation, combat manuals and job analyses, a questionnaire was developed that defined and rated the perceived physical strain of 30 work tasks for ground combat soldiers. To assess validity, an expert focus group was used and psychometric analysis performed. The questionnaire was then distributed to 231 ground combat soldiers, of whom 165 responded (71%).

    Results: The questionnaire was validated in three steps to achieve face and content validity, and internal consistency was acceptable (Chronbach's alpha ≥0.95). Of the 30 work tasks included in the survey, transport of wounded was rated as the most demanding task for both aerobic capacity and strength. Other highly demanding tasks for aerobic capacity included combat movement (low/high crawl), dismounted attack in close country, urban and rough terrain and carrying heavy loads. There were no gender differences for either aerobic or strength demands in the top five most challenging tasks based on proportions.

    Conclusions: This study identified the most physically demanding tasks performed in the Swedish ground combat forces. Almost all the physically demanding tasks found in the present study contain elements of lifting and carrying, which require muscular strength and muscular endurance, with no gender differences. © 2019 Elsevier Ltd. All rights reserved.

  • 70.
    Larsson, Jonas
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Department of Medical Imaging and Physiology, Skåne University Hospital Department of Translational medicine, Lund University, Lund, Sweden.
    Engberg, Amanda
    Halmstad University, School of Business, Engineering and Science.
    Turnstedt, Max
    Halmstad University, School of Business, Engineering and Science.
    Dencker, Magnus
    Department of Medical Imaging and Physiology, Skåne University Hospital Department of Translational medicine, Lund University, Lund, Sweden.
    Bremander, Ann
    FoU Spenshult, Halmstad, Sweden.
    Olsson, M. Charlotte
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Cardiovascular Effects of Load Carriage in Soldiers; A Pilot Study2019In: Book of Abstracts of the 24th Annual Congress of the European College of Sport Science – 3rd - 6th July 2019, Prague – Czech Republic / [ed] Bunc, V. & Tsolakidis, E., European College of Sport Science , 2019, p. 422-423Conference paper (Refereed)
    Abstract [en]

    Introduction: Previous studies have shown that risk of physical fatigue increases if prolonged average work intensity exceeds 50% of oxygen uptake (VO2). In order to avoid persistent fatigue in a work setting, it is important to conduct suitable work capacity analyses. In physically demanding jobs where wearing protective gear and/or external load is mandatory, monitoring of cardiovascular demands through heart rate (HR) is one way to track the workers’ relative effort.  There are limited studies examining effects of load carrying on cardiovascular capacity where it appears that VO2peak differ when soldiers and firefighters are tested with work-related equipment/clothing compared to light clothing. The aim of this pilot study was to investigate effects of load (combat gear) on HR, VO2 and muscle oxygen saturation (SmO2) compared to no load in soldiers during a graded treadmill protocol.

    Methods: Eight volunteer army soldiers (1 woman, 7 men) performed a graded treadmill test until exhaustion. All soldiers performed the test twice, once with light clothes and no load (NL) and once with added load, their personal combat gear (CG), with at least 48 h between sessions. The treadmill protocol stages included supine and standing positions, followed by marching speeds of 5.4 km/h and 8 km/h at 0 incline (all 5 min) immediately followed by a set marching speed of 8 km/h with a starting incline of 2 % increasing the incline 2 % every third minute until voluntary exhaustion. Measurements of HR, VO2 and SmO2 were collected continuously and the last 30 s of each stage were averaged and used for statistical analyses (paired t-tests).

    Results: The mean added load for all soldiers with CG was 16.8 ± 1.1 kg. All soldiers completed at least 6 stages (range 6-11 stages) with both NL and CG, where time to exhaustion with NL was longer (19.1 ± 3.2 min) compared to CG (9.1 ± 2.9 min; p <0.01). Submaximal HR and VO2 were both significantly higher with CG compared to NL (at absolute intensities) at all marching speeds all soldiers completed (5.4 km/h 0 % grade - 8 km/h 4% grade; all p<0.05). For SmO2, marching with CG compared to NL resulted in increased muscle oxygen utilization, at submaximal stages 8 km/h 0% -4% grade (all p<0.05). For values at maximal effort the CG had a significantly lower VO2peak (3.7 ± 0.5 L/min) compared to NL (4.1 ± 0.6 L/min, p <0.01), whereas there was no difference in HRpeak or the lowest value of SmO2 between CG (193.1 ± 7.2 bpm; 42.4 ± 30.3%) and NL (195.4 ± 8.9 bpm; 47.0 ± 29.2%).

    Conclusions: This pilot study suggests that assessment of aerobic capacity in soldiers should be conducted with combat gear to help determine their actual work capacity during combat and other load carrying tasks. These results suggest that if soldiers’ work performance is determined without added load it overestimates their aerobic capacity (VO2peak) in tasks wearing combat gear, which might lead to added fatigability and deleterious effect on performance.

  • 71.
    Larsson, Jonas
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Lund University, Lund, Sweden & Swedish Armed Forces, Eksjö, Sweden.
    Olsson, M. Charlotte
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Denker, Magnus
    Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Self-rated physical work demands for ground combat soldiers2018In: PES 2018 3rd International Conference on Physical Employment Standards, University of Portsmouth, United Kingdom, 17-19 July 2018: Conference Book of Abstracts, 2018, p. 31-31Conference paper (Refereed)
    Abstract [en]

    Introduction: Military tasks are physically demanding, and the ability to achieve and maintain the physical capacity required to perform all military tasks are important. Previous studies in other countries have identified the most physically demanding work tasks to be carrying, lifting heavy loads, and digging. The aim of the present study was to identify the most physically demanding work tasks for Swedish ground combat soldiers and to study gender differences in perceived difficulty of the tasks.

    Methods: Based on procedural documentation, field manuals and job analyses, a questionnaire was developed that defined 30 work tasks for ground combat soldiers. To assess face and content validity, an expert focus group was used. The questionnaire was distributed to 231 ground combat soldiers, 165 of whom responded (71.4%), rating the perceived physical strain of the identified work tasks.

    Results: Of the 30 item work tasks included in the survey, five were selected as the most physically demanding. Transport of wounded was rated as the most demanding task both for aerobic endurance and strength. Other highly demanding tasks for aerobic capacity were low/high crawl, dismounted attack in close country, urban and rough terrain, and carrying heavy loads. For muscle strength demands there were a total of 11 different work task ranked for hand-, arm-, leg-, and core strength although many of them only occurred in one of the areas of interest. Carrying heavy loads were ranked in second place except for leg and core strength there it was in third place, instead high and low crawl was ranked very strenuous for leg and core strength. Care of wounded were ranked high for hand strength but not so hard for the rest of the areas.

    Conclusions: Swedish ground combat soldiers rate many tasks as physically demanding. Almost all the identified tasks were physically challenging and contains elements of lifting and carrying, which demand personnel’s muscular strength and muscular endurance capabilities for the soldiers. There were no significant differences in ranked physical requirements between male and female soldiers although they sometimes ranked the tasks in different order. 

  • 72.
    Lindholm, Annelie
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Almquist-Tangen, Gerd
    Child Health Care Unit, Region Halland, Halmstad, Sweden.
    Alm, Bernt
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Dahlgren, Jovanna
    Roswall, Josefine
    Staland-Nyman, Carin
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Early life risk factors for an elevated waist-to-height ratio at 5 years of ageManuscript (preprint) (Other academic)
    Abstract [en]

    Objective: To examine early life risk factors for an elevated waist-to-height ratio (WHtR) at 5 years of age. A second aim was to examine if the same risk factors also were associated with overweight or obesity at the same age.

    Methods: A population-based longitudinal birth cohort study of 1,540 children, from the southwestern part of Sweden, born between October 2007 and December 2008. The children were classified as having ≥ 1 or < 1 in WHtR standard deviation scores (SDS) at five years of age, according to Swedish reference values and as having overweight/obesity or normal weight/underweight according to the IOTF. 

    Results: At five years of age, 15% of the children had WHtRSDS ³ 1 and 11% had overweight or obesity. In multivariable analyses, RWG during 0-6 months (OR: 1.90, 95% CI: 1.23, 2.95), maternal pre- pregnancy BMI (1.06, 1.01,1.11) and paternal BMI (1.11, 1.01-1.21) were associated with a WHtRSDS ³ 1 at five years. RWG during 0-6 months (2.53, 1.53, 4,20), during 6-12 months (2.82, 1.37, 5.79) and maternal pre-pregnancy BMI (1.12, 1.06,1.17) was associated with overweight or obesity at 5 years of age.

    Conclusions: Risk factors operating early in life are associated with an elevated WHtR and overweight or obesity at 5 years of age. Preventive interventions should especially address early RWG and parental overweight.

  • 73.
    Lindholm, Annelie
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Alm, Bernt
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Dahlgren, Jovanna
    Roswall, Josefine
    Staland-Nyman, Carin
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Almquist-Tangen, Gerd
    Child Health Care Unit, Region Halland, Halmstad, Sweden.
    Nutrition- and feeding practice-related risk factors for rapid weight gain during the first year of lifeManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Rapid weight gain (RWG) during infancy increases the risk of later adiposity and the association between early nutrition and RWG needs to be further studied.

    Objectives: The present study aimed to examine nutrition- and feeding practice-related risk factors for RWG during the first year. 

    Methods: A population-based longitudinal birth cohort study of 1,869 children, classified as having RWG or non-RWG during 0–6 and 6–12 months. RWG was defined as a change > 0.67 in weight standard deviation scores. Associations between nutrition- and feeding practice-related risk factors and RWG were investigated with logistic regression models.

    Results: In the population, 46% had RWG during 0-6 months and 8% during 6-12 months. In the fully adjusted models, bottle feeding at birth, 3-4 and 6 months and nighttime meals containing formula milk at 3-4 months were positively associated with RWG during 0-6 months (p<0.001). Breastfeeding at 3-4 and 6 months was negatively associated with RWG (p<0.01). During 6-12 months, only bottle feeding at 3-4 months was positively associated with RWG (p<0.05).

    Conclusions: RWG was more common during the first 6 months of life, and bottle feeding and formula milk given at night were risk factors for RWG during this period.

  • 74.
    Lindholm, Annelie
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Roswall, Josefine
    Department of Pediatrics, The Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Alm, Bernt
    Department of Pediatrics, The Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Almquist-Tangen, Gerd
    Department of Pediatrics, The Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Dahlgren, Jovanna
    Department of Pediatrics, The Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Staland Nyman, Carin
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bergman, Stefan
    Department of Public Health and Community Medicine, The Primary Health Care Unit at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Body mass index classification misses to identify children with an elevated waist-to-height ratio at 5 years of age2019In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 85, no 1, p. 30-32Article in journal (Refereed)
    Abstract [en]

    Background:  Abdominal adiposity is an important risk factor in the metabolic syndrome. Since BMI does not reveal fat distribution, waist-to-height ratio (WHtR) has been suggested as a better measure of abdominal adiposity in children, but only a few studies cover the preschool population. The aim of the present study was to examine BMI and WHtR growth patterns and their association regarding their ability to identify children with an elevated WHtR at 5 years of age.

    Methods: A population-based longitudinal birth cohort study of 1540 children, followed from 0 to 5 years with nine measurement points. The children were classified as having WHtR standard deviation scores (WHtRSDS) <1 or ≥1 at 5 years. Student’s t-tests and Chi-squared tests were used in the analyses.

    Results: Association between BMISDS and WHtRSDS at 5 years showed that 55% of children with WHtRSDS ≥1 at 5 years had normal BMISDS (p < 0.001). Children with WHtRSDS ≥1 at 5 years had from an early age significantly higher mean BMISDS and WHtRSDS than children with values <1.

    Conclusions: BMI classification misses every second child with WHtRSDS ≥1 at 5 years, suggesting that WHtR adds value in identifying children with abdominal adiposity who may need further investigation regarding cardiometabolic risk factors.

    © 2018, International Pediatric Research Foundation, Inc.

  • 75.
    Lindholm, Annelie
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Roswall, Josefine
    University of Gothenburg, Gothenburg, Sweden.
    Alm, Bernt
    University of Gothenburg, Gothenburg, Sweden.
    Tangen, Gerd Almquist
    University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Dahlgren, Jovanna
    University of Gothenburg, Gothenburg, Sweden.
    Nyman, Carin
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bergman, Stefan
    University of Gothenburg, Gothenburg, Sweden.
    Children with Normal Body Mass Index may have an Increased Waist to Height Ratio2017In: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 88, p. 525-526Article in journal (Other academic)
  • 76.
    Lindqvist, E. K.
    et al.
    Department of clinical sciences, Lund university, section of Rheumatology, Lund, Sweden.
    Bremander, Ann
    Department of clinical sciences, Lund university, section of Rheumatology, Lund, Sweden.
    Hørslev-Pedersen, K.
    King Christian Xth Hospital for Rheumatic Diseases, University of Southern Denmark, Gråsten, Denmark.
    Grotle, M.
    National resource center for rehabilitation in rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
    Vliet Vlieland, T.
    Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands.
    STAR-ETIC group,
    Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands.
    Course and outcome of rehabilitation care in different rheumatological diagnosis groups. A descriptive study using the STAR-ETIC registry2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, no Suppl. 3, p. A784-A785Article in journal (Refereed)
  • 77.
    Lindström, Ulf
    et al.
    Rheumatology and Inflammation Research, Sahlgrenska Academy, Gothenburg, Sweden.
    Bremander, Ann
    Lund University, Lund, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden.
    Haglund, Emma
    Lund University, Lund, Sweden.
    Petersson, Ingemar F.
    Orthopedics, Clinical Sciences, Lund University, Lund, Sweden.
    Jacobsson, Lennart
    Rheumatology and Inflammation Research, Sahlgrenska Academy, Gothenburg, Sweden.
    Patients with Non-AS Axial SpA Have Similar Prevalence Compared to AS, but Worse Perceived Health. Results from a Population Based Study2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, no Suppl. 3, p. A667-A668Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

    Disclosure of Interest: None Declared

  • 78.
    Lindström, Ulf
    et al.
    University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden; Spenshult Research and Development Center, Halmstad, Sweden & Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Petersson, Ingemar F.
    Lund University, Lund, Sweden.
    Jacobsson, Lennart T. H.
    University of Gothenburg, Gothenburg, Sweden & Lund University, Lund, Sweden.
    Back pain and health status in patients with clinically diagnosed ankylosing spondylitis, psoriatic arthritis and other spondyloarthritis: a cross-sectional population-based study2016In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 17, no 1, article id 106Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 79.
    Löfvendahl, S.
    et al.
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Petersson, I.F.
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Haglund, Emma
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Bremander, Ann
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Jacobsson, L.
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Jöud, A.
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Duration between symptom onset and spondyloarthritis diagnosis – Changes over a decade2014In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, no Suppl. 2, p. 431-431Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

    References

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

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

    Disclosure of Interest None declared

  • 80.
    Malm, Karina
    et al.
    Lund University, Lund, Sweden, Spenshult Research and Development Center, Oskarström, Sweden & Capio Movement, Halmstad, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Andersson, Maria
    Lund University, Lund, Sweden & Spenshult Research and Development Center, Oskarström, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. Lund University, Lund, Sweden & Spenshult Research and Development Center, Oskarström, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Lund University, Lund, Sweden & Spenshult Research and Development Center, Oskarström, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. Spenshult Research and Development Center, Oskarström, Sweden.
    THU0628-HPR Lifestyle Habits Relates to Quality of Life in Patient with Longstanding Rheumatoid Arthritis2015In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 74, no Suppl. 2, p. 1318-1318Article in journal (Refereed)
    Abstract [en]

    Background: Fatigue, pain, stiffness, impaired muscle function and impaired physical function are some of the most pronounced symptoms in rheumatoid arthritis (RA) and these may be related to lifestyle habits such as physical activity, diet, smoking and alcohol.There is limited knowledge about how patient with longstanding RA understand their lifestyles habits in relation to their disease and quality of life.

    Objectives: To describe experiences of how lifestyle habits relate to quality of life in patients with longstanding RA.

    Methods: A qualitative study with a deductive content analysis design, including 17 patients from the Swedish BARFOT (Better Anti-Rheumatic FarmacoTherapy) cohort. BARFOT is a long time follow up study of early RA. Informants were strategically selected by gender (ten women and seven men), age (range 30-84 years), disease duration (8-23 years), function as measured by HAQ, and quality of life as measured by EQ5D. Semi-structured interviews focused on four lifestyle habits (main categories); Physical activity, Diet, Smoking, and Alcohol. The interviews were recorded, transcribed verbatim and coded into subcategories within each of the four main categories.

    Results: In patients with longstanding RA quality of life was related to the four given main categories (lifestyle habits). Each main category included two to three subcategories; (1) Physical activity means barrier, opportunities and well-being, (2) Diet means shame, well-being and social relationship, (3) Smoking means reward and fear, and (4) Alcohol means ambivalence and social relationship.

    Conclusions: In longstanding RA, lifestyle habits relates to quality of life through both positive and negative experiences. This has to be taken into account in clinical care for a better understanding of how patients conceive and adherer to advice on lifestyle.

    References: Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010;376(9746):1094-108.

    Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qualitative health research. 2005;15(9):1277-88.

  • 81.
    Malm, Karina
    et al.
    Research and Development Center, Spenshult, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. Research and Development Center, Spenshult, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Andersson, Maria
    Research and Development Center, Spenshult, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Research and Development Center, Spenshult, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    BARFOT study group,
    Predictors of severe self-reported disability in RA in a long-term follow-up study2014In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 8, p. 686-691Article in journal (Refereed)
    Abstract [en]

    Purpose: Identify factors predictive for severe self-reported disability in patients with rheumatoid arthritis. Methods: Patients (n = 1910) were sent a questionnaire 5-18 years after disease onset. Outcomes were the Health Assessment Questionnaire (HAQ), Rheumatoid Arthritis Outcome Score (RAOS) and physical activity. The tertile of patients most affected by the disease were compared to those less affected. Proposed predictive factors were function, pain, general health, radiographic joint damage, swollen/tender joints and disease activity measures at baseline. Age, gender and disease duration were controlled for in logistic regression analyses. Results: Seventy-three percent (n = 1387) responded to the questionnaire, mean age 65 years (SD 15) and 70% were women. Worse scores in function, pain, general health and tender joints at baseline increased the risk of being in the most affected group, as measured by HAQ and RAOS 5-18 years after disease onset (p < 0.000). Conclusion: High levels of pain and worse reports of function at disease onset were risk factors for being in the most disabled tertile of patients after 5-18 years. Pain and function proved to be predictors of the outcome while some measures of inflammation were not. It is important to recognize these patients who may be in need of multidisciplinary treatments already at disease onset.

    Implications for Rehabilitation

    • Health care providers should be aware of the subgroup of patients with more severe symptoms of pain and impaired function at disease onset since they have an increased risk of being in the most disabled tertile of rheumatoid arthritis patients several years later.
    • Health care providers should assess pain and function and act on high pain and impaired function already at disease onset as they proved to be predictors of patient-reported outcomes controlled for inflammatory parameters.
    • These findings support European guidelines and research findings that patients with high pain and impaired function despite of well-managed inflammatory parameters should early in the disease course be referred to multidisciplinary treatment for supplementary regime.
  • 82.
    Malm, Karina
    et al.
    Research and Development Centre, Spenshult, Oskarström.
    Bergman, Stefan
    Research and Development Centre, Spenshult, Oskarström & Lund University, Lund, Sweden.
    Andersson, Maria
    Research and Development Centre, Spenshult, Oskarström & Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Research and Development Centre, Spenshult, Oskarström.
    BARFOT Study Group,
    Worse physical function at disease onset predicts a worse outcome in physical function, but not in meeting who physical activity recommendations, nine years later2013Conference paper (Refereed)
    Abstract [en]

    Background: Long term disease impact on physical functioning in the most affected patients with RA is not well described. Impaired function and inability to be physically active are associated features and it is well known that people with RA are less physically active compared with the general population.

    Objectives: To study predictive variables for a worse outcome in physical function and physical activity measures in a long time follow-up study.

    Methods: Between 1992 and 2005 all patients with newly diagnosed RA according to criteria of the American College of Rheumatology were asked to participate in the BARFOT study, a collaboration between six Swedish rheumatology departments. In 2010 all patients (n=2114) included in the study received a follow-up questionnaire 5-18 years after disease onset. Using logistic regression analyses, the dependent variables physical function (dichotomized by their mean value) were measured with the HAQ (scores 0 to 3, best to worst), the RAOS (Rheumatoid Arthritis Outcome Score) subscales ADL and sport/rec (0-100, worst to best) and meeting vs. not meeting WHO recommendations of physical activity (WHOrec) for a healthy life style (moderate intensity ≥150 min/week or higher intensity for at least 30 minutes 2-3 times/week). Possible predictive variables at baseline were function (HAQ and SOFI, Signals of Functional Impairment, 0-44, best to worse), disease activity (CRP, swollen and tender joints), pain (VAS 0-100, best to worst) and age. We also controlled for sex and disease duration in 2010.

    Results: Questionnaire response was 72% (n=1525), mean (m) age 65 years (SD 14), m follow-up time 9 years (SD 3.7) and 70% (n=1069) were women.

    At inclusion the patients reported a disease duration of m 8 (SD 9) months, HAQ m 1.0 (SD 0.6), VAS pain m 46 (SD24), SOFI m 8.0 (SD6.0). Disease activity was CRP m 30.2 (SD 35.9), swollen joints m 10.2 (SD 5.7) and tender joints m 8.2 (SD 6.2).

    In the 2010 survey, time from inclusion was m 9.4 (SD 3.8) years, the HAQ m 0.6 (SD 0.6), and VAS pain m 35.5 (SD 25.6) had decreased (p<0.001). RAOS ADL was m 71,1 (SD 22.0), RAOS sport/rec m 40.0 (SD 30.0) and 61% (N=894) met the WHOrec.

    Worse scores in the HAQ, VAS pain and SOFI at baseline increased the risk for worse physical function in the 2010 survey measured with the HAQ (VAS pain OR 1.02, SOFI OR 1.09 and HAQ OR 3.98, p<0.000), the RAOS ADL scale (VAS pain OR 1.02, SOFI OR 1,09 and HAQ OR 2.66, p<0.000) and the RAOS sport/rec scale (VAS pain OR 1.02, SOFI OR 1.11 and HAQ OR 2.57, p<0.000). Being a woman, higher age at inclusion and longer disease duration at follow-up also predicted a worse function in the HAQ and both RAOS subscales while none of the studied variables could predict who did/did not meet the WHOrec in 2010.

    Conclusions: Worse physical function and worse pain at disease onset can predict a worse physical function several years later. However, it does not predict the amount of physical activity actually being performed. It is of importance to already at disease onset recognize patients with impaired function and higher pain levels who are in need of multidisciplinary treatments. It is also important to early in the disease recommend a healthy life style according to the WHOrec since measures of function and being physically active are different entities.

    Disclosure of Interest: None Declared

  • 83.
    Malm, Karina
    et al.
    Lund University, Lund, Sweden; Spenshult Research and Development Center, Halmstad, Sweden; Rheumatology, Capio Movement, Halmstad, Sweden & FoU Spenshult, Halmstad, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Lund University, Lund, Sweden; Spenshult Research and Development Center, Halmstad, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Andersson, Maria LE
    Lund University, Lund, Sweden; Spenshult Research and Development Center, Halmstad, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Lund University, Lund, Sweden; Spenshult Research and Development Center, Halmstad, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing. Spenshult Research and Development Center, Halmstad, Sweden.
    Quality of life in patients with established rheumatoid arthritis: A phenomenographic study2017In: SAGE Open Medicine, E-ISSN 2050-3121, Vol. 5, article id 2050312117713647Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Patients with rheumatoid arthritis perceive reduced quality of life in several domains, such as physical health, level of independence, environment and personal beliefs, compared with the healthy population. There is an increasing interest in quality of life in clinical and medical interventions. Few studies have explored patients' individual conceptions of quality of life, and interviews can thus complement quantitative studies. There is a need for a deeper understanding of the patients' experiences of quality of life, with regard to living with a long-term condition such as rheumatoid arthritis. The aim of this study was to explore the variation of ways in which patients with established rheumatoid arthritis understand the concept of quality of life.

    METHODS: The study had a qualitative design with a phenomenographic approach, which was used to describe variations in how individuals experience their quality of life. The study is based on interviews with 22 patients with established rheumatoid arthritis enrolled in the BARFOT (better anti-rheumatic pharmacotherapy) study.

    RESULTS: The concept of quality of life could be understood in three different ways: (1) independence in terms of physical functioning and personal finances, (2) empowerment in how to manage life and (3) participation as an experience of belonging in a social context.

    CONCLUSION: The different conceptions of quality of life reflect the complexity in the concept, including physical, psychological and social aspects. This complexity is important to have in mind when health professionals support patients in enhancing their quality of life. © The Author(s) 2017

  • 84.
    Malm, Karina
    et al.
    R&D-centre, Spenshult, Halmstad, Sweden & Capio Movement, Halmstad, Sweden.
    Bergman, Stefan
    R&D-centre, Spenshult, Halmstad, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    R&D-centre, Spenshult, Halmstad, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). R&D-centre, Spenshult, Halmstad, Sweden.
    Andersson, Maria L.
    R&D-centre, Spenshult, Halmstad, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden.
    Discussions of lifestyle habits as an integral part of care management in patients with established rheumatoid arthritis2018In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, p. 1817-1817, article id FRI10741-HPRArticle in journal (Refereed)
    Abstract [en]

    Background: Rheumatoid arthritis (RA) is associated with an increased risk of developing comorbidities which are known to be associated with lifestyle-related habits; such as having a sedentary lifestyle, having an unhealthy diet, smoking, and over-consumption of alcohol. In 2010, the European League Against Rheumatism (EULAR) published general guidelines on risk management in patients with RA, with an update 2017 (1,2) in which health professionals are encouraged to prioritize discussions with patients regarding their lifestyle and it is of interest to study the extent to which these discussions actually occur.

    Objectives: To study if lifestyle habits; physical activity, diet, smoking and alcohol had been discussed with patients having RA during health care visits.

    Methods: A cross-sectional postal survey in 2017 included 1542 eligible patients from the BARFOT (Better Anti-Rheumatic Pharmacotherapy) study. All patients received a questionnaire including lifestyle habits (physical activity, diet, smoking, and alcohol), and whether these habits had been discussed during health care visits. There was also a question regarding if they would have wanted such a discussion.

    Results: 1,061 patients (68%) responded to the survey (mean age 67 years (SD 13); 73% women). Physical activity was discussed with 49% of the patients (figure 1A). Those who reported that they were active on a health-enhancing level were more likely to have discussed physical activity with health professionals. Diet had been discussed with 23% of the patients (figure 1B). Patients who reported a non-traditional mixed diet were more likely to have discussed diet. Smoking was discussed with 25% of the patients (figure 1C). Current smokers had more often discussed smoking habits with healthcare professionals compared with never smokers (32% vs. 17%; p=0.000). Alcohol had been discussed with 17% of the patients (figure 1D). Of the patients with hazardous drinking habits, 77% had not had a discussion regarding alcohol.

  • 85.
    Malm, Karina
    et al.
    Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden & Spenshult Research and Development Centre, Halmstad, Sweden & Rheumatology, Capio Movement, Halmstad, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden & Spenshult Research and Development Centre, Halmstad, Sweden & Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden & Spenshult Research and Development Centre, 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.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Centre, Halmstad, Sweden.
    Andersson, Maria L. E.
    Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden & Spenshult Research and Development Centre, Halmstad, Sweden.
    Discussions of lifestyle habits as an integral part of care management: a cross-sectional cohort study in patients with established rheumatoid arthritis in Sweden2019In: Rheumatology Advances in Practice, E-ISSN 2514-1775, Vol. 3, no 2, article id rkz039Article in journal (Refereed)
    Abstract [en]

    Objectives: The primary aim was to determine whether patients with RA recalled having discussions concerning lifestyle habits during their health-care visits. The secondary aim was to study the association between patients' reported lifestyle and their wish to discuss it.

    Methods: A postal questionnaire sent to 1542 eligible patients from the Better Anti-Rheumatic Pharmacotherapy (BARFOT) study included questions on lifestyle habits (physical activity, diet, smoking and alcohol), on whether these were discussed during health-care visits and on whether there was an interest in such discussions.

    Results: A total of 1061 patients (68%) responded [mean age 67 (s.d. 13) years, 73% women]. Half of the patients (49%) recalled discussions on physical activity, and 23% recalled discussions about diet. Those who reported health-enhancing levels of physical activity were more likely to discuss physical activity with their health professionals. Likewise, patients who reported having a non-traditional mixed diet were more likely to discuss diet. Smoking was discussed with 25% of the patients, more often with current smokers than with non-smokers (32 vs 17%; P < 0.001). Alcohol was discussed with 17% of the patients. Of those patients who reported having hazardous drinking habits, 77% had not discussed alcohol use with any health professional.

    Conclusion: Discussions about lifestyle were recalled by half of the patients with established RA. There is a need for improvement, because lifestyle habits may affect the long-term outcome in a chronic disease, such as RA. Patient education concerning lifestyle habits should be an integral part of care management and an interactive process. © Malm et al. 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology.

  • 86.
    Malm, Karina
    et al.
    Spenshult Research and Development Center, Oskarström, Sweden & Rheumatology, Capio Movement, Halmstad, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Spenshult Research and Development Center, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Andersson, Maria
    Spenshult Research and Development Center, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Center, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, Gothenburg, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Center, Oskarström, Sweden.
    Quality of Life in Patient with Established Rheumatoid Arthritis: A Qualitative Study2016In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 75, no Suppl 2, article id 1308Article in journal (Refereed)
    Abstract [en]

    Background: Fatigue, pain, stiffness and impaired physical function are some of the most pronounced symptoms in rheumatoid arthritis (RA) that may affect quality of life. Quality of life is an individual experience composed of a wide range of factors, including physical health, psychological state, level of independence, social relationships, and the patients' relationship to salient features of their environment. There is a need to describe and assess quality of life in chronic diseases like established RA. Previous research has mainly focused on disease-specific instruments for assessing quality of life. A deeper understanding of patients' experience of quality of life in established RA is important in both clinical research and daily clinical practice.

    Objectives: To describe variations in patients' experiences of quality of life in established RA.

    Methods: The study had a qualitative design with a phenomenographic approach, including 22 interviews with patients from the Swedish BARFOT (Better Anti-Rheumatic FarmacoTherapy) cohort, BARFOT, a long time follow up study of early RA. Patients were strategically selected by gender (14 women and 8 men), age (30 to 84 years old), disease duration (8–23 years), function as measured by HAQ (0–1.38), and quality of life as measured by EQ5D (0.52–1.00). The interviews were recorded, transcribed verbatim and coded into categories.

    Results: Four categories emerged from the patients' experiences of quality of life in established RA: well-being, freedom, empowerment, and participation. Quality of life as well-being meant pleasure and being physical active. Quality of life as freedom meant dependence or independence in the ability to manage daily life activities. Quality of life as empowerment meant different coping strategies, such as positive thinking and resources to manage fatigue, pain and physical function. Quality of life as participation meant togetherness in different contexts with other people.

    Conclusions: Quality of life in established RA could be understood by the patients in different ways. The patients experienced quality of life as well-being, freedom, empowerment, and participation. This is important knowledge when evaluating the concept of quality of life in RA research, and for health professionals when promoting quality of life in patients with RA.

  • 87.
    Malm, Karina
    et al.
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden & Rheumatology, Capio Movement, Halmstad, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden .
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Andersson, Maria L E
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden & Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    The influence of lifestyle habits on quality of life in patients with established rheumatoid arthritis: A constant balancing between ideality and reality2016In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 11, article id 30534Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Rheumatoid arthritis (RA) is a chronic, inflammatory, and systemic disease with symptoms that limit activities and affect quality of life. RA is associated with an increased risk of developing comorbidities, some of which are also known to be associated with lifestyle habits such as physical activity, diet, smoking, and alcohol. There has been an augmented focus on the implementation and maintenance of healthy lifestyle habits even for patients with RA in the past decade, but little is known about the link between patients' experiences of lifestyle habits and quality of life. The aim of the study was thus to describe and explore how patients with established RA experience the influence of lifestyle habits on quality of life.

    METHODS: The study had a descriptive and explorative design, based on qualitative content analysis. Strategic sampling was used in order to achieve variations in experiences. Twenty-two patients with RA (14 women and 8 men) from 30 to 84 years old, with a disease duration ranging from 8 to 23 years, were interviewed.

    RESULTS: The analysis of the influence of lifestyle habits on quality of life resulted in the theme balancing between ideality and reality. Three categories emerged about how lifestyle habits influenced quality of life by limitations (including insufficiency and adaptation), self-regulation (including guilt and motivation), and companionship (including belonging and pleasure).

    CONCLUSIONS: Quality of life for patients with established RA was influenced by the balance between ideality and reality in the lifestyle habits: physical activity, diet, smoking, and alcohol. This is important new knowledge for health professionals when discussing lifestyle habits with RA patients.

  • 88.
    Malmborg, Julia
    et al.
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS).
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. FoU Spenshult, Halmstad, Sverige.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). FoU Spenshult, Halmstad, Sverige.
    Orthorexic Eating Behavior in Relation to Health Status and Physical Activity: A Comparison Between Students in Two University Programs2015In: Book of Abstracts of the 20th Annual Congress of the European College of Sport Science - 24th - 27th June 2015, Malmö - Sweden / [ed] Radmann, A., Hedenborg, S., Tsolakidis, E., Cologne: SporTools , 2015, p. 497-498Conference paper (Refereed)
    Abstract [en]

    Background

    Orthorexia nervosa (ON) is a condition described as ‘unhealthy’ behaviors regarding diet and physical activity. There is an ongoing discussion if ON is more common among adolescents studying in the area of health care and exercise. The research on ON is scarce and few studies assess ON and its association to health related quality of life (HRQoL).

    Aim

    The aim was to study orthorexic eating behavior, levels of physical activity and HRQoL in students enrolled at university programs focusing on health and exercise compared to those enrolled in business programs.

    Method

    128 subjects, 32 men and 38 women from Biomedicine – Athletic Training (Biomedicine) and 22 men and 36 women from Construction and Real Estate Business (Business) participated in this cross-sectional study. The subjects completed the Short Form-36 Health Survey (SF-36) to measure HRQoL, the International Physical Activity Questionnaire (IPAQ) to measure levels of physical activity and ORTO-15 which examines eating behavior. A score less than 40 on ORTO-15 (score ranging from 0-60, worst to best) indicated an unhealthy relation to diet and was considered as ON in this study (Donini et al., 2005). Differences between groups were analyzed with t-tests and chi-square test.

    Results

    A total of 105 out of 128 (82%) subjects had a score indicating ON. Students from Biomedicine had a higher frequency of ON in comparison to Business (p < 0.000) and in the SF-36 subscale bodily pain, Biomedicine students reported a higher frequency of pain (p = 0.006). Results from measurements of physical activity did not differ significantly between Biomedicine and Business students, but there was a trend for high-intensity physical activity to occur more frequently in men than in women in general (p = 0.014).

    Conclusion

    ON is a common condition in university students and even more frequent in students enrolled in a program directed towards health and nutrition. The high frequency of ON seen in Biomedicine students could be a problem that needs to be addressed since the students, after graduation, are expected to coach other people to a healthy living. Further studies are needed to explore associations with ON to health and physical activity. There is also a need to develop valid and reliable instruments for assessing the condition.

  • 89.
    Malmborg, Julia
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Olsson, Charlotte M.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Pain and its association to health, orthorexia nervosa, sports performance, and physical maturity in sport school adolescents2017In: Proceedings of the Nordic Sport Science Conference – ‘The Double-Edged Sword of Sport: Health Promotion Versus Unhealthy Environments’ / [ed] Hertting, K. & Johnson, U., Halmstad: Halmstad University Press, 2017, p. 56-57Conference paper (Refereed)
  • 90.
    Malmborg, Julia
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Center, Halmstad, Sweden & Lund University, Lund, Sweden.
    Olsson, Charlotte M.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). University of Gothenburg, Gothenburg, Sweden; Spenshult Research and Development Center, Halmstad, Sweden & Lund University, Lund, Sweden.
    Health status, physical activity, and orthorexia nervosa: A comparison between exercise science students and business students2017In: Appetite, ISSN 0195-6663, E-ISSN 1095-8304, Vol. 109, p. 137-143Article in journal (Refereed)
    Abstract [en]

    Orthorexia nervosa is described as an exaggerated fixation on healthy food. It is unclear whether students in health-oriented academic programs, highly focused on physical exercise, are more prone to develop orthorexia nervosa than students in other educational areas. The aim was to compare health status, physical activity, and frequency of orthorexia nervosa between university students enrolled in an exercise science program (n = 118) or a business program (n = 89). The students completed the Short Form-36 Health Survey (SF-36), the International Physical Activity Questionnaire (IPAQ), and ORTO-15, which defines orthorexia nervosa as a sensitive and obsessive behavior towards healthy nutrition. The SF-36 showed that exercise science students scored worse than business students regarding bodily pain (72.8 vs. 82.5; p = 0.001), but better regarding general health (83.1 vs. 77.1; p = 0.006). Of 188 students, 144 (76.6%) had an ORTO-15 score indicating orthorexia nervosa, with a higher proportion in exercise science students than in business students (84.5% vs. 65.4%; p = 0.002). Orthorexia nervosa in combination with a high level of physical activity was most often seen in men in exercise science studies and less often in women in business studies (45.1% vs. 8.3%; p < 0.000). A high degree of self-reporting of pain and orthorexia nervosa in exercise science students may cause problems in the future, since they are expected to coach others in healthy living. Our findings may be valuable in the development of health-oriented academic programs and within student healthcare services. © 2016 Elsevier Ltd

  • 91.
    Malmborg, Julia
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Olsson, M. Charlotte
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Bergman, A.-C.
    Spenshult Research and Development Center, Halmstad, Sweden.
    Brorsson, Sofia
    Spenshult Research and Development Center, Halmstad, Sweden.
    Bergman, Stefan
    Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Sleeping Problems and Anxiety is Associated to Chronic Multisite Musculoskeletal Pain in Swedish High School Students2018In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, no Suppl. 2, p. 226-226, article id OP0361-HPRArticle in journal (Refereed)
    Abstract [en]

    Background: The relationship between chronic multisite musculoskeletal pain (CMP) and sleep is complex, where pain can lead to sleeping problems and lack of sleep can intensify the pain perception. Most previous studies relates to adults, but adolescents may also suffer from CMP, and there is a need for more knowledge regarding the relationships between CMP and sleeping problems, stress, anxiety, depression, and health status.

    Objectives: To study background factors associated to CMP in first year Swedish high school students.

    Methods: First year Swedish high school students (n=296) were invited to complete questionnaires on chronic pain (mannequin with 18 body regions), sleeping problems (Uppsala Sleep Inventory, four items scored from 1–5), stress (ELO questions, scored from 1–5), anxiety and depression (Hospital Anxiety and Depression Scale, scored from 0–21), health status (EQ-5D, scored from 0 to 1, worst to best) and physical activity (International Physical Activity Questionnaire, categorised into low, moderate and high levels). Stress and sleeping items were dichotomized into 1–3 points (best) vs 4–5 points (worst). Individuals scoring at least severe problems (4 points) at one or more sleeping items were classified as having severe sleeping problems. HADS were categorised as non-cases (0–7), possible7–10 and probable cases (11–21 points). Students were grouped as having CMP (pain present in ≥3 regions) or not (no chronic pain or chronic pain in 1–2 regions). Multiple logistic regression analyses (adjusted for sex) with CMP as dependent variable were performed in SPSS, version 24.

    Results: 254 students (86% of total sample, 87 boys and 167 girls) with a mean age of 16.1 (SD 0.6) years participated in the study. CMP was present in 25 (9.8%) students with no differences between boys and girls (8.0% vs 10.8%; p=0.488). Having CMP was associated with reporting severe sleeping problems (OR 2.49, 95% CI: 1.06 to 5.81, p=0.035) with initiating sleep, maintaining sleep, early morning awakenings and/or not feeling restored after sleep in comparison to the other students. Students with CMP were more likely to be categorised as probable cases for anxiety (OR 3.06, 95% CI: 1.09 to 8.61, p=0.034), but there were no associations for possible cases for anxiety (OR 1.15, 95% CI: 0.38 to 3.51, p=0.800), possible cases (OR 2.03, 95% CI: 0.63 to 6.54), or probable cases for depression (OR 3.35, 95% CI: 0.33 to 33.83). There was a nearly significant association between stress and belonging to the CMP group (OR 2.31, 95% CI: 0.97 to 5.53, p=0.059). A higher self-reported health status was associated to a lower likelihood for CMP (OR 0.04, 95% CI: 0.01 to 0.27, p=0.001). Distribution of physical activity levels of low, moderate and high was not significantly associated to having CMP in comparison with not having it.

    Conclusions: One in ten high school students fulfilled criteria for having chronic multisite musculoskeletal pain. CMP was associated to sleeping problems, anxiety, and a worse health status. The results from this study may be used by school health-care professionals in their preventive work to promote student’s health.

    Disclosure of Interest: None declared

  • 92.
    Malmborg, Julia
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Olsson, Charlotte M.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Bergman, Stefan
    Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Daily Musculoskeletal Pain Affects Health And Sports Performance Negatively In Youth Athletes2017In: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 49, p. 972-972Article in journal (Refereed)
    Abstract [en]

    In sports, musculoskeletal pain (MSP) is often studied from the perspective of sport specific injuries, why little is known about the prevalence of daily or multisite MSP that does not affect participation in sports. It is also unclear if daily or multisite MSP is a risk factor for worse health-related quality of life (HRQoL) and worse sports performance in youth athletes.

    PURPOSE: To study how HRQoL and sports performance is affected by daily MSP in youth athletes that are able to participate in sports.

    METHODS: 136 Swedish youth athletes attending a sport school (13 to 14 years, boys n=83, girls n=53) completed the EQ-5D measuring HRQoL (range 0 to 1, worst to best), a pain questionnaire including current pain (yes/no), pain in 18 body regions (never to rarely/monthly to weekly/more than once a week to almost daily), and pain intensity in the last week (0 to 10, best to worst), anthropometric measures to estimate biological age, and sports performance tests (grip strength, 20 meter sprint, and countermovement jump(CMJ)).

    RESULTS: 109 to 117 of the 136 students answered the different pain questions. 53 of 113 (47%) reported current MSP, and 28 of 109 (26%) experienced MSP ‘more than once a week to almost daily’ from one or more body regions (frequent MSP group), while 28% (n=30) stated ‘never to rarely’ in MSP (no MSP group). Boys in the frequent MSP group reported worse HRQoL, higher pain intensity, performed worse in all sports performance tests, and had a younger biological age than boys in the no MSP group. Girls in the frequent MSP group reported worse HRQoL and higher pain intensity than the girls in the no MSP group. No other differences were found (table).

    CONCLUSIONS: Every other youth athlete attending a sport school reported current MSP and one out of four reported almost daily MSP. MSP affects HRQoL negatively in both boys and girls, and sports performance negatively in boys. The prevalence of MSP in youth athletes is concerning since pain in younger ages may predict pain in adult ages.

    © 2017 American College of Sports Medicine

  • 93.
    Malmborg, Julia
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Center, Halmstad, Sweden.
    Olsson, M Charlotte
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Malmö Sports Academy, Malmö, Sweden.
    Bergman, Stefan
    The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Lund University, Lund, Sweden.
    Musculoskeletal pain and its association with maturity and sports performance in 14-year-old sport school students2018In: BMJ Open Sport & Exercise Medicine, ISSN 2055-7647, Vol. 4, no 1, article id e000395Article in journal (Refereed)
    Abstract [en]

    Objectives: In youth sports, musculoskeletal pain is often studied from the standpoint of sports injuries, but little is known about pain conditions in which athletes still participate. The aim was to study the frequency of pain and associations with maturity offset, health status and sports performance in 14-year-old sport school students.

    Methods: Cross-sectional design. One hundred and seventy-eight students (108 boys and 70 girls) completed anthropometric measures for maturity offset (height, weight and sitting height), questionnaires (pain mannequin and EQ-5D for health status) and sports performance tests (sprint, agility, counter-movement jump and grip strength). Differences between groups were analysed with Student’s t-test and analysis of covariance.

    Results: Thirty-one students (18.6%) reported infrequent pain, 85 (50.9%) frequent pain and 51 (30.5%) constant pain. Students in the constant pain group had worse health status than those in the infrequent pain group. Boys with constant pain (n=27) had a lower mean maturity offset (–0.38 vs 0.07 years; p=0.03) than boys with infrequent pain (n=22), and pain was associated with worse sports performance. There was no difference in maturity or sports performance between girls with constant pain (n=24) and girls with infrequent pain (n=9).

    Conclusion: Musculoskeletal pain is common in sport school students and coincides with worse health status and with a younger biological age in boys. The high prevalence of pain should be acknowledged by coaches and student healthcare workers in order to promote a healthy and sustainable development in young athletes. © Author(s) (or their employer(s)) 2018.

  • 94.
    Malmborg, Julia S
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Center, Halmstad, Sweden.
    Bremander, Ann
    University of Southern Denmark, Odense, Denmark & University Hospital of Southern Denmark, Sønderborg, Denmark & Lund University, Lund, Sweden.
    Olsson, M. Charlotte
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS).
    Bergman, Anna-Carin
    Spenshult Research and Development Center, Halmstad, Sweden.
    Brorsson, A Sofia
    Spenshult Research and Development Center, Halmstad, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden..
    Worse health status, sleeping problems, and anxiety in 16-year-old students are associated with chronic musculoskeletal pain at three-year follow-up2019In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, no 1, article id 1565Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Chronic musculoskeletal pain is common in adolescents, and it has been shown that adolescents with pain may become young adults with pain. Pain often coincides with psychosomatic symptoms in adults, but little is known about longitudinal associations and predictors of pain in adolescents. The aim was to investigate chronic musculoskeletal pain and its associations with health status, sleeping problems, stress, anxiety, depression, and physical activity in 16-year-old students at baseline, and to identify risk factors using a three-year follow-up.

    METHODS: This was a longitudinal study of 256 students attending a Swedish upper secondary school. Questionnaires regarding chronic musculoskeletal pain and distribution of pain (mannequin), health status (EQ-5D-3 L), sleeping problems (Uppsala Sleep Inventory), stress symptoms (single-item question), anxiety and depression (Hospital Anxiety and Depression Scale), and physical activity (International Physical Activity Questionnaire) were issued at baseline and follow-up. Student's t-test and chi2 test were used for descriptive statistics and logistic regression analyses were used to study associations between chronic pain and independent variables.

    RESULTS: Fifty-two out of 221 students at baseline (23.5%) and 39 out of 154 students at follow-up (25.3%) were categorized as having chronic musculoskeletal pain. Chronic musculoskeletal pain at follow-up was separately associated with reporting of an EQ-5D value below median (OR 4.06, 95% CI 1.83-9.01), severe sleeping problems (OR 3.63, 95% CI 1.69-7.82), and possible anxiety (OR 4.19, 95% CI 1.74-10.11) or probable anxiety (OR 3.82, 95% CI 1.17-12.48) at baseline. Similar results were found for associations between chronic musculoskeletal pain and independent variables at baseline. In multiple logistic regression analysis, chronic musculoskeletal pain at baseline was a predictor of chronic musculoskeletal pain at follow-up (OR 2.99, 95% CI 1.09-8.24, R2 = 0.240).

    CONCLUSION: Chronic musculoskeletal pain at baseline was the most important predictor for reporting chronic musculoskeletal pain at the three-year follow-up, but a worse health status, severe sleeping problems, and anxiety also predicted persistence or development of chronic musculoskeletal pain over time. Interventions should be introduced early on by the school health services to promote student health.

  • 95.
    Mavropalias, Georgios
    et al.
    Halmstad University, School of Business and Engineering (SET).
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine.
    Changes in muscle activation during 72 hours following an acute plyometric bout2014In: Book of Abstracts of the 19th Annual Congress of the European College of Sport Science – 2nd - 5th July 2014, Amsterdam – The Netherlands / [ed] De Haan, A., De Ruiter, C. J., Tsolakidis, E., European College of Sport Science , 2014, p. 71-71Conference paper (Refereed)
    Abstract [en]

    Introduction

    Plyometric training (PT) has been used widely in sport training to improve characteristics such as power, strength and to induce beneficial neuromuscular improvements. Previous evidence has demonstrated a significant impact of this training method on muscle activation patterns during training, however there is a lack in research literature of studies examining its follow up effects in the recovery period. The purpose of this study was to examine any possible changes in the muscle activation of the lower extremities up to 72 hours after high intensity PT.

    Methods

    An experimental study design with repeated measures was used. Twelve (n=12) male subjects (mean age 24.33 ± 2.6) executed a high intensity PT protocol for the lower extremities. Countermovement jump test (CMJ) was performed pre, immediately post, 24, 48 and 72 hours after the PT. Surface electromyography (sEMG) evaluation examined the activation of Gluteus Maximus (GM), Vastus Lateralis (VL), Biceps Femoris (BF) and Gastrocnemius (GAS) during the CMJ in all the time points of the recovery. A one way ANOVA with repeated measures was used to analyze differences between the five time points (p≤0.05).

    Results

    The results indicated a statistical significant decrease in CMJ performance at 24 and 48 hours, compared with the baseline, that peaked at 24 hours (-7.16%), and recovered at 72 hours. Muscle activation levels for GM, VL and BF followed the same pattern, decreasing significantly post training compared to the baseline, recovering at 72 hours post. Muscle activation decrease peaked immediately post training for GM (-21.8%), VL (-14.04%) and BF (-19.82%). Muscle activation for GAS decreased significantly post training (-6.77%), recovering faster than the other muscle groups, at 48 hours.

    Discussion

    CMJ jump performance impairment was in accordance with previous research, peaking at 24-48 hours and recovering at 72 hours after the bout (Chatzinikolaou et al., 2010). The impairment pattern observed in the sEMG values peaked immediately post training, recovering at 72 hours; however the magnitude of the decrease was not as extended as observed after eccentric training (Hortobágyi et al, 1998). GAS activation recovered 24 hours faster than the rest of the tested muscle groups probably due to the higher percentage of slow twitch fibers which are less susceptible to muscle damage than fast twitch. In conclusion PT significantly decreases muscle activation and jump performance up to 72 hours after the bout in GM, VL and BF, while GAS recovered in 48 hours.

    References

    Chatzinikolaou A, Fatouros IG, Gourgoulis V, Avloniti A, Jamurtas AZ, Nikolaidis MG, et al.. (2010). J Strength Cond Res, 24, 1389–98.

    Hortobágyi T, Houmard J, Fraser D, Dudek R, Lambert J, Tracy J. (1998). J Appl Physiol, 84, 492–8.

    Contact georgios.mavropalias@gmail.com

  • 96.
    Meesters, Jorit
    et al.
    Epidemiology and Register Centre South Skåne, Skåne University Hospital, Lund, Sweden & Department of Orthopaedics, Leiden University Medical Centre, Leiden, the Netherlands.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult, Research and Development Center, Oskarström, Sweden.
    Bergman, Stefan
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult, Research and Development Center, Oskarström, Sweden.
    Petersson, Ingemar F.
    Epidemiology and Register Centre South Skåne, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden & Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Turkiewicz, Aleksandra
    Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Englund, Martin
    Epidemiology and Register Centre South Skåne, Skåne University Hospital, Lund, Sweden; Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden & Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, MA, USA.
    The risk for depression in patients with ankylosing spondylitis: a population-based cohort study2014In: Arthritis Research & Therapy, ISSN 1478-6354, E-ISSN 1478-6362, Vol. 16, no 5, article id 418Article in journal (Refereed)
    Abstract [en]

    Introduction: Depression is frequent in ankylosing spondylitis (AS) patients. However, epidemiological data about the potential increase in risk are lacking. This study compares the rate of doctor-diagnosed depression in a well defined cohort of AS patients to the general population seeking care.

    Methods: The Skåne Healthcare Register comprises healthcare data of each resident in Region Skåne, Sweden (population 1.2 million), including ICD-10 diagnoses. Using physician coded consultation data from years 1999 to 2011, we calculated depression consultation rates for all AS patients. We obtained standardized depression-rate ratios by dividing the observed depression rate in AS patients by the expected rate based on the corresponding age- and sex-specific rates of depression in the general population seeking care. A ratio >1 equals a higher rate of depression among AS patients.

    Results: The AS cohort consisted of 1738 subjects (65% men) with a mean age of 54 years. The reference population consisted of 967,012 subjects. During the 13-year observation period 10% (n = 172) of the AS cohort had a doctor-diagnosed depression compared to 6% (n = 105) to be expected. The standardized estimate of depression-rate ratio was 1.81 (95% confidence interval 1.44 to 2.24) in women men and 1.49 (1.20 to 1.89) in men.

    Conclusions: The rate of doctor-diagnosed depression is increased about 80% in female and 50% in male AS patients. Future challenges are to timely identify and treat the AS patients who suffer from depression. © 2014 Meesters et al.; licensee BioMed Central Ltd.

  • 97.
    Meesters, Jorit
    et al.
    Epi-centre Skåne, Skåne University Hospital, Lund, Sweden & Department of Orthopaedics, Rehabilitation and Physical Therapy, LUMC, Leiden, Netherlands.
    Bremander, Ann
    Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Petersson, Ingemar
    Epi-centre Skåne, Skåne University Hospital, Lund, Sweden & Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Bergman, Stefan
    Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Englund, Martin
    Epi-centre Skåne, Skåne University Hospital, Lund, Sweden; Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden & Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, MA, United States.
    Depression is More Common in Patients with Ankylosing Spondylitis as Compared to the General Population Seeking Health-Care2013In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, no Suppl. 3, p. A556-A556Article in journal (Refereed)
    Abstract [en]

    Background: Ankylosing spondylitis (AS) affects physical function and health related quality of life. Depression has been reported to be frequent in AS patients. However, available epidemiological data are limited and estimates of the potentially increase in risk are lacking.

    Objectives: To compare the rate of doctor-diagnosed depression in a well-defined cohort of AS patients to the general health-care seeking population.

    Methods: The Skåne Health Care Register comprises data from each single health care consultation in the Skåne County, Sweden (population 1.2 million). Data include information about date of consultation and all ICD-10 diagnoses. Linking this register to the Swedish population register adds data regarding death and residency. We studied all patients who were registered with an AS diagnosis (ICD-10 code M45) at least once during 4 calendar years (2004 to 2007). To obtain depression rates we calculated the person-time from the day after the first occurrence of the AS diagnosis within the study period until the day of diagnosis of depression (F32 or F33) or another censoring event (death/relocation). We then obtained standardized depression-rate ratios by dividing the observed depression rate in AS patients by the expected rate based on the corresponding age- and sex specific rates of doctor-diagnosed depression in the general population of the county seeking care (reference population). A ratio >1 equals a higher rate of depression among AS patients than in the reference population of corresponding age and sex distribution.

    Results: We identified 935 AS patients, 67.2% men, mean age (SD) 52.3 (14.8) years. The reference population consisted of 761,210 subjects. During the 4-year observation period 10% (n=94) of the AS cohort had a doctor-diagnosed depression compared to 7% (n=66) to be expected based on data from the reference population. The standardized depression-rate ratio in men (1.41, 95% CI 1.04–1.87) and women with AS (1.43, 95% CI 1.05–1.91) were both significantly elevated in the same order of magnitude (Table).

    Conclusions: The rate of doctor-diagnosed depression was increased by about 40% in both male and female AS patients compared to the general population seeking care. Future challenges are to identify and treat the AS patients who suffer from depression as early as possible.

  • 98.
    Meesters, Jorit
    et al.
    Department of Clinical Sciences in Lund, Orthopaedics, Lund University.
    Hagel, Sofia
    Department of Clinical Sciences in Lund, Orthopaedics, Lund University.
    Klokkerud, Mari
    National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
    Stovgaard, Inger
    University of South Denmark, Graasten, Denmark.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Spenshult Hospital.
    Grotle, Margreth
    FORMI (Communication Unit for Musculoskeletal Disorders), Oslo University Hospital, Norway.
    Hørslev-Petersen, Kim
    University of South Denmark, Graasten, Denmark.
    Petersson, Ingemar F
    Department of Clinical Sciences in Lund, Orthopaedics, Lund University.
    Hagen, Kåre Birger
    Institute of Health and Society, University of Oslo, Norway.
    Pont, Winke
    Department of Orthopaedics Rehabilitation Medicine & Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands.
    Vlieland, Thea Vliet
    Department of Orthopaedics Rehabilitation Medicine & Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands.
    Goal-setting in multidisciplinary team care for patients with rheumatoid arthritis: an international multi-center evaluation of the contents using the International Classification of Functioning, Disability and Health as a reference.2013In: Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine, ISSN 1651-2081, Vol. 45, no 9, p. 888-899Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To make a cross-cultural comparison of the contents of rehabilitation goals of patients admitted for rehabilitation and to compare the contents with the comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for rheumatoid arthritis, by linking their contents to the ICF. PATIENTS: A random sample of 80 patients with rheumatoid arthritis was retrieved from rehabilitation clinics in 4 countries. METHODS: Rehabilitation goals were extracted from the medical records and linked to the ICF using standardized linking rules. RESULTS: A total of 495 rehabilitation goals were identified and linked to 952 ICF codes, resulting in 151 unique ICF codes. Two-hundred and seventy-five (29%) of the 952 ICF codes were related to "Body Functions" (b-codes), 80 (8%) to "Body Structures" (s-codes), 419 (44%) to "Activities and Participation" (d-codes) and 178 (19%) to "Environmental Factors" (e-codes). Thirty-five of the 151 unique ICF codes (23%) were not in the comprehensive ICF Core Set for RA, whereas 23 of the ICF codes in this Core Set (24%) were not in the rehabilitation goals. CONCLUSION: The goals set in a team rehabilitation setting for patients with rheumatoid arthritis are related to all ICF components, with "Activities and Participation" being the most frequently addressed. The contents of the goals are, to a considerable extent, covered by the comprehensive ICF Core Set for RA, but additional evaluation is required before the ICF Core Set is used as a rehabilitation tool in rheumatoid arthritis.

  • 99.
    Meesters, Jorit J. L.
    et al.
    Epi-centre Skåne, Skåne University Hospital, Medicon village, Lund, Sweden & Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, Netherlands.
    Petersson, Ingemar F.
    Epi-centre Skåne, Skåne University Hospital, Medicon village, Lund, Sweden & Department of Orthopedics, Clinical Sciences, University of Lund, Lund, Sweden.
    Bergman, Stefan
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult, Research and Development Center, Oskarström, Sweden.
    Haglund, Emma
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult, Research and Development Center, Oskarström, Sweden.
    Jacobsson, Lennart T. H.
    Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult, Research and Development Center, Oskarström, Sweden.
    Sociodemographic and disease-related factors are associated with patient-reported anxiety and depression in spondyloarthritis patients in the Swedish SpAScania cohort2014In: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 33, no 11, p. 1649-1656Article in journal (Refereed)
    Abstract [en]

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

  • 100.
    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
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (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
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (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 Sweden2017In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 47, no 3, p. 185-193Article in journal (Refereed)
    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).

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