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  • 51.
    Bremander, Ann
    et al.
    Spenshult Hosp Rheumat Dis, Ctr Res & Dev, S-31392 Oskarström, Sweden .
    Bergman, Stefan
    Spenshult Hosp Rheumat Dis, Ctr Res & Dev, Oskarström, Sweden .
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Perception of multimodal cognitive treatment for people with chronic widespread pain: changing one's life plan2009In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, no 24, p. 1996-2004Article in journal (Refereed)
    Abstract [en]

    Purpose.

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

    Methods.

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

    Results.

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

    Conclusion.

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

  • 52.
    Bremander, Ann
    et al.
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden & R&D centre, Spenshult, Halmstad, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). R&D centre, Spenshult, Halmstad, Sweden.
    Bergman, Stefan
    Department of Clinical Sciences, Section of Rheumatology, Lund, Sweden & R&D centre, Spenshult, Halmstad, Sweden & Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Measures of Physical Activity and Fear Avoidance in People with Chronic Pain2018In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, no Suppl. 2, p. 1829-1830, article id SAT0737-HPRArticle in journal (Refereed)
    Abstract [en]

    Background Lifestyle factors such as physical activity (PA) has the possibility to contribute to improved health and quality of life in the population as well as in chronic diseases. Most often PA is self-reported while measures of the aerobic capacity are more seldom measured in subjects with chronic pain.

    Objectives To describe physical activity levels (self-reported and aerobic capacity) in people with chronic pain classified as regional or widespread and to compare the findings with a group that report no pain.

    Methods From the 2016 follow-up of the Swedish population based Epipain cohort (n 1321), 146 subjects were invited to a clinical assessment where the aerobic capacity was assessed by using a submaximal bicycle test, the Ekblom-Bak test, together with assessment of the Borg scale for perceived exertion (RPE). Aerobic capacity was also classified as low, average or high according to data from the general population. Self-reported physical activity was coded as MVPArec if recommended levels of PA was reported (physically active on a moderate level ≥150 min/week (MPA) or on an vigorous level ≥75 min/week (VPA) or not). The Fear Avoidance Beliefs Questionnaire for PA (FABQ-PA, 0–24 best to worst) and for work (FABQ-W, 0–48 best to worst) were also assessed. The participants were classified as having chronic widespread pain (CWP), chronic regional pain (CRP) or no chronic pain (NCP) based on a pain mannequin presenting 0–18 pain regions and if pain had lasted for 3 months or more. Chi2 and Kruskal-Wallis tests were performed to study differences between the three pain groups.

    Results 141/146 (97%) subjects (mean (SD) age 59.4 (8.2) years) whereof 61% were women, could be classified into pain groups; 43 as CWP (84% women), 43 as CRP (42% women) and 55 as NCP (58% women). The group with CWP was slightly older than those with CRP (mean (SD) age 57.0 (7.6) years vs. 61.9 (6.9) years, p 0.02). The CWP group also had lower aerobic capacity (mean (SD) 2.2 (0.5) l/min vs. 2.6 (0.6) l/min, p 0.03), and a larger proportion was classified as having low aerobic capacity (CWP 21%, CRP 7% and NCP 10%, p 0.04). The proportion of MVPArec did not differ between the groups; CWP 70%, CRP 81% and NCP 74% (p 0.5). There was neither a difference between the groups in BMI, RPE or in sitting hours/week (p>0.6). However, differences were found in the FABQ where in the PA scale those with CRP had worse scores compared with NCP (mean (SD) 11.2 (7.3) vs. 6.0 (6.0), p<0.001), the difference between CWP (mean (SD) 8.9 (6.7)) and NCP was p 0.06. In the work subscale of FABQ, CWP had worse scores compared with CRP (mean (SD) 18.9 (15.7) vs. 10.0 (12.5), p 0.002) and CRP had worse scores compared to those with NCP (mean (SD) 10.0 (12.5) vs. 6.5 (9.1), p<0.001).

    Conclusions In this sample of subjects with chronic pain or no pain, having widespread pain tended to affect the aerobic capacity negatively while self-reports of reaching recommended levels of physical activity did not differ between groups. Fear avoidance in relation to physical activity and especially in relation to work was more noticeable in subjects with chronic pain compared to those with no pain. Measures of aerobic capacity and information of fear avoidance beliefs might help health professionals to better tailor the non-pharmacological treatment for subjects with chronic pain.

    Disclosure of Interest None declared

    © 2018, Published by the BMJ Publishing Group Limited.

  • 53.
    Bremander, Ann
    et al.
    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.
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Center, Halmstad, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden; Spenshult Research and Development Center, Halmstad, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ndosi, M.
    University of the West of England, Bristol, United Kingdom.
    The Educational Needs of Patients with Undifferentiated Spondyloarthritis2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, no Suppl. 2, p. 1495-1496Article in journal (Refereed)
  • 54.
    Bremander, Ann
    et al.
    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 & 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.
    Bergman, Stefan
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden & Primary Health Care Unit, Department ofPublic Health and Community Medicine,Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ndosi, Mwidimi E.
    Department of Nursing and Midwifery, University of the West of England, Bristol, United Kingdom.
    The educational needs of patients with undifferentiated spondyloarthritis: Validation of the ENAT questionnaire and needs assessment2018In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 16, no 2, p. 313-317Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of the present study was to validate the Swedish version of the educational needs assessment tool (SwENAT) in undifferentiated spondyloarthritis (USpA) and use it to study the educational needs of patients with USpA.

    METHODS: This was a cross-sectional study, recruiting a random sample of patients with USpA from a hospital register in Sweden. Educational needs data were collected, together with disease activity and function indices (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] and Bath Ankylosing Spondylitis Functional Index [BASFI]). Rasch analysis was utilized to evaluate the construct validity, internal consistency and unidimensionality of the SwENAT before studying differences in educational needs between patient subgroups (gender, age and disease severity).

    RESULTS: = 11.488; p = 0.119), including strict unidimensionality. Overall, the mean (SD) SwENAT score was 86 (32). Women reported higher needs than men in the domains of pain (mean [SD] 13.1 [6.8] versus 10.1 [6.0]; p = 0.05); movement (mean [SD] 13.0 [5.5] versus 9.9 [5.7]; p = 0.02) and self-help (mean [SD] 17.0 [5.8] versus 14.1 [5.0]; p = 0.03). Higher disease activity (BASDAI >4) was associated with higher educational needs (mean [SD] 92.6 [31.9] versus 73.7 [29.4]; p = 0.02).

    CONCLUSIONS: These data suggest that the SwENAT is valid in USpA. Women and patients with higher disease activity are more likely to have high levels of educational needs, so special attention and strategies to target patient education are warranted. © 2018 John Wiley & Sons, Ltd.

  • 55.
    Bremander, Ann
    et al.
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Department of Rheumatology, Clinical Sciences Lund, Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Jacobsson, Lennart T. H.
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Department of Clinical Sciences, Section of Rheumatology, Malmö, Lund University, Lund, Sweden.
    Bergman, Stefan
    Department of Rheumatology, Clinical Sciences Lund, 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), Biomechanics and Biomedicine. Department of Rheumatology, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Löfvendahl, Sofia
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Petersson, Ingemar F.
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Smoking is associated with a worse self-reported health status in patients with psoriatic arthritis: data from a Swedish population-based cohort2015In: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 34, no 3, p. 579-583Article in journal (Refereed)
    Abstract [en]

    The aim was to study possible associations between smoking habits and self-reported clinical features in a large population-based cohort of patients with psoriatic arthritis (PsA). All subjects with PsA who had sought health care in the period 2003-2007 were identified using a regional health-care register. In 2009, all those identified who were 18 years of age or more (n = 2,003) were sent a questionnaire with questions on smoking, health-related quality of life [EuroQol five-dimension (EQ-5D)questionnaire], function [Health Assessment Questionnaire (HAQ)], pain, fatigue, and global health. We performed age- and sex-adjusted regression analysis to compare health status outcomes in never and ever smokers. Altogether, 1,185 subjects (59 %) returned the questionnaire. Mean age was 57 years (SD 13.5), and 58 % were women; 38 % were never smokers and 62 % were ever smokers. Mean age at disease onset was 38.2 years (SD 13.2) and 41.2 years (SD 13.6), respectively (p = 0.001). In age- and sex-adjusted data, ever smokers reported worse EQ-5D (p = 0.009); worse reports of global health (p = 0.01), pain (p = 0.01), and fatigue (p = 0.04); and a higher number of painful body regions (p = 0.04) compared to never smokers. In this population-based PsA cohort, patients who were ever smokers reported worse health status than never smokers. Besides being a possible result of a worse PsA in ever smokers, impaired health status could also be an effect of unstudied comorbidities. Further longitudinal studies are needed to gain a better understanding of cause and effect. However, smoking cessation should be recommended because of general health considerations as well as disease-specific issues.

  • 56.
    Bremander, Ann
    et al.
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS).
    Jacobsson, Lennart T. H.
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bergman, Stefan
    Research and Development Centre Spenshult, Halmstad, Sweden.
    Haglund, Emma
    Research and Development Centre Spenshult, Halmstad, Sweden.
    Petersson, Ingemar
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Smoking is Associated with Worse and More Widespread Pain, Worse Fatigue, General Health and Quality of Life in a Swedish population Based Cohort of Patients with Psoriatic Arthritis2012In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 64, no S10, p. S777-S778, article id 1828Article in journal (Refereed)
    Abstract [en]

    Background/Purpose: Smoking has been found to be associated with an increased risk of developing psoriatic arthritis (PsA)1. The purpose of this study was analyse possible associations of smoking habits with self-reported clinical features in a large population based cohort of patients with a diagnosis of PsA.

    Methods: All health care seeking subjects with a diagnose of PsA according to ICD 10 codes (given at least once by a rheumatologist/internist or twice by any other physician) were identified by a regional health care register during 2003-20072. In 2009 all identified subjects aged 18 years or older (n=2003) were invited to participate in a cross sectional questionnaire survey. The questionnaire included self-reported data on smoking (never smokers or ever smokers), age at disease onset, physical function (HAQ, 0-3 best to worst), pain, fatigue and global health (numerical rating scales 0-10 best to worst) health related quality of life (EQ-5D, 0-1 worst to best), and number of painful regions noted on a pain mannequin (0-16, best to worst). Linear regression analysis was performed and all data were controlled for sex and age.

    Results: Response rate was 77% whereof 369 patients (18%) declined participation and 1185 (59%) returned the questionnaire,  mean age 57.5 (SD 13.5) years and 58% were women. 1173 subjects responded to the smoking question whereof 448 (38%) were never smokers and 725 (62%) were ever smokers.

    Mean age at disease onset was 42.3 (SD 13.4) years in never smokers vs. 46.0 (SD 13.2) in ever smokers. Never smokers vs. ever smokers had mean HAQ 0.59 (SD 0.6) vs. 0.71 (SD 0.6),  mean pain 3.9 (SD 2.4) vs.4.4 (SD 2.5),  mean fatigue 4.4 (SD 2.8) vs. 5.0 (SD 2.7),  mean global health 3.9 (SD 2.4) vs. 4.4 (SD 2.3), mean EQ-5D 0.68 (SD 0.23) vs. 0.63 (SD 0.26) and mean no of painful regions were 7.2 (SD 4.0) vs. 7.9 (SD 4.3).

    The regression analysis showed that ever smokers had worse pain with age-sex adjusted parameter estimates (B) = 0.38 (95% CI 0.09 ; 0.67), worse fatigue B = 0.34 (95% CI 0.02 ; 0.66), worse global health B = 0.36 (95% CI 0.09 ; 0.64), worse EQ-5D B = -0.04 (95% CI -0.07 ; -0.01) and an increased no of painful regions B = 0.54 (95% CI 0.02 ; 1.07) compared with never smokers.

    Conclusion: In this population based PsA cohort, patients who were ever smokers reported worse clinical features compared with never smokers. Further longitudinal studies are needed to better understand cause and effect. However, smoking cessation should be recommended due to general health perspectives and also due to disease specific issues.

  • 57.
    Bremander, Ann
    et al.
    Lund University, Lund, Sweden & Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Petersson, Ingemar F.
    Lund University, Lund, Sweden.
    Bergman, Stefan
    Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Englund, Martin
    Lund University, Lund, Sweden & Boston University School of Medicine, Boston, Massachusetts, USA.
    Population-based estimates of common comorbidities and cardiovascular disease in ankylosing spondylitis2011In: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 63, no 4, p. 550-556Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study the rate of common comorbidities and cardiovascular disease in patients with ankylosing spondylitis (AS) compared with the general population seeking health care.

    METHODS: This cohort study included 935 subjects (67% men) ages ≥20 years diagnosed with AS and the adult background population in Southern Sweden. During 2004 to 2007 we recorded the occurrence of physicians' diagnostic codes for a select number of comorbidities commonly associated with AS and cardiovascular disease and risk factors. We obtained standardized morbidity-rate ratios (SMRs) by dividing the observed morbidity rate in AS patients by the expected rate based on the corresponding rate of the disease in the general population of the county seeking health care.

    RESULTS: The highest SMRs were found for uveitis (34.35, 95% confidence interval [95% CI] 28.55-40.98) and inflammatory bowel disease (9.28, 95% CI 7.07-11.97). Also, we found increased SMRs for ischemic heart diseases (2.20, 95% CI 1.77-2.70), hypertension (1.98, 95% CI 1.72-2.28), and diabetes mellitus (1.41, 95% CI 1.10-1.78). Furthermore, the SMRs for psoriasis, osteoporosis, and atrioventricular blocks were also statistically significantly elevated.

    CONCLUSION: Inflammatory diseases affecting the eye and the digestive system were the most notable comorbidities in AS patients, but the rate for cardiovascular disease was also high. Using comprehensive longitudinal population-based register data is a promising tool to evaluate the excess consultation rate and total burden of rheumatic disease on patients and society. Copyright © 2011 by the American College of Rheumatology.

  • 58.
    Bremander, Ann
    et al.
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Petersson, Ingemar F.
    Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Haglund, Emma
    Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Jacobsson, Lennart T.H.
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Smoking Is Associated with Worse and More Widespread Pain, Worse Disease Activity, Function, Fatigue and Health Related Quality of Life in Patients with Axial Spondyloarthritis: Results From a Population Based Cohort2012In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 64, no S10, p. S43-S43, article id 95Article in journal (Refereed)
    Abstract [en]

    Background: In subjects with early axial Spondyloarthritis (SpA) smoking has recently been associated with earlier onset of disease, worse lesions of the sacroiliac joints and in later stages syndesmophyte progression. The aim was to study associations of smoking habits with self-reported information in a large population based cohort of patients with axial SpA.

    Methods: A cross-sectional questionnaire survey performed in 2009 included all health care seeking subjects aged >18 years with a diagnosis of SpA according to ICD 10 codes identified by a regional health care register (n=3711). Smoking habits were studied in patients with ankylosing spondylitis (AS, ICD M45) and in patients who fulfilled criteria for “non AS axial SpA” (without having one of AS). Criteria for non AS axial SpA were based on data from the questionnaire: pain for 3 months or more during the last 12 months together with 2 or more features out of 5 (inflammatory back pain, history of psoriasis, uveitis/tendinitis, inflammatory bowel disease or heredity). The questionnaire included data on smoking (never smokers vs. ever smokers), disease activity (BASDAI) physical function (BASFI), general health (BAS-G) all measured with numerical rating scales 0-10 (best to worst), health related quality of life (EQ-5D, 0-1 worst to best), pain, fatigue (numerical rating scales 0-10 best to worst) and number of painful regions noted on a pain mannequin (0-16 best to worst). Linear regression analysis was performed and all data were controlled for sex and age.

    Results:

    Response rate was 76% whereof 2167 (58%) returned the questionnaire and 18% declined participation in the study. 598 subjects had an AS diagnose and 572 fulfilled the criteria for non AS axial SpA.

    The AS group had a mean age of 54 (SD14) years and 35% were women. Never smokers constituted 48% of the AS group. Ever smokers had worse scores in all studied variables compared with never smokers.

    The linear regression analysis showed that ever smokers in the AS group had worse self-reported scores in BASDAI with age-sex adjusted parameter estimate (B) = 0.60 (95% CI 0.21 ; 1.00), BASFI B = 0.51 (95% CI 0.11 ; 0.91) and fatigue B = 0.51 (95% CI  0.06 ; 1.00) . There was a tendency to worse scores for ever smokers also in EQ-5D B = -0.04 (95% CI -0.09 ; 0.001)

    Mean age in the non AS axial SpA group was 55 (SD 14) years and 68% were women. Never smokers constituted 38% of this group. Also in the non AS axial SpA group the linear regression analysis showed that ever smokers had worse self-reported scores in BASDAI with age-sex adjusted parameter estimate (B) = 0.59 (95% CI 0.23 ; 0.94), BASFI B = 0.59 (95% CI 0.17 ; 1.00), pain B = 0.45 (95% CI 0.08 ; 0.82) and fatigue B = 0.43 (95% CI  0.03 ; 0.83), no of painful areas B = 0.73 (95% CI  0.06 ; 1.46) and also in EQ-5D B = -0.06 (95% CI -0.11 ; -0.002).                                                                                                                                                

    Conclusion: In a large population based axial SpA cohort, both patients with AS and non AS axial SpA who were ever smokers reported worse clinical features compared with never smokers. Further longitudinal studies are needed to better understand cause and effect. However, smoking cessation should be recommended not only due to general health perspectives but also due to disease specific issues.

    References

    1Smokers in early axial spondyloarthritis have earlier disease onset, more disease activity, inflammation and damage, and poorer function and health-related quality of life: results from the DESIR cohort. Chung HY, Machado P, van der Heijde D, D'Agostino MA, Dougados M. Ann Rheum Dis. 2012 Jun;71(6):809-16.

  • 59.
    Bäckhed, Fredrik
    et al.
    The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden & Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Receptology and Enteroendocrinology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
    Roswall, Josefine
    Department of Pediatrics, Hallands Hospital Halmstad, Halmstad, Sweden & Göteborg Paediatric Growth Research Center, Department of Paediatrics, the University of Gothenburg, Queen Silvia Children’s Hospital, Gothenburg, Sweden.
    Peng, Yangqing
    BGI-Shenzhen, Shenzhen, China.
    Feng, Qiang
    BGI-Shenzhen, Shenzhen, China &Department of Biology, University of Copenhagen, Copenhagen, Denmark.
    Jia, Huijue
    BGI-Shenzhen, Shenzhen, China.
    Kovatcheva-Datchary, Petia
    The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
    Li, Yin
    BGI-Shenzhen, Shenzhen, China.
    Xia, Yan
    BGI-Shenzhen, Shenzhen, China.
    Xie, Hailiang
    BGI-Shenzhen, Shenzhen, China.
    Zhong, Huanzi
    BGI-Shenzhen, Shenzhen, China.
    Khan, Muhammad Tanweer
    The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
    Zhang, Jianfeng
    BGI-Shenzhen, Shenzhen, China.
    Li, Junhua
    BGI-Shenzhen, Shenzhen, China.
    Xiao, Liang
    BGI-Shenzhen, Shenzhen, China.
    Al-Aama, Jumana
    BGI-Shenzhen, Shenzhen, China & Princess Al Jawhara Albrahim Center of Excellence in the Research of Hereditary Disorders, King Abdulaziz University, Saudi Arabia.
    Zhang, Dongya
    BGI-Shenzhen, Shenzhen, China.
    Lee, Ying Shiuan
    The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
    Kotowska, Dorota
    Department of Biology, University of Copenhagen, Copenhagen, Denmark.
    Colding, Camilla
    Department of Biology, University of Copenhagen, Copenhagen, Denmark.
    Tremaroli, Valentina
    The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
    Yin, Ye
    BGI-Shenzhen, Shenzhen, China.
    Bergman, Stefan
    Göteborg Paediatric Growth Research Center, Department of Paediatrics, the University of Gothenburg, Queen Silvia Children’s Hospital, Gothenburg & Research and Development Center Spenshult, Oskarström, Sweden.
    Xu, Xun
    BGI-Shenzhen, Shenzhen, China.
    Madsen, Lise
    Department of Biology, University of Copenhagen, Copenhagen, Denmark & National Institute of Nutrition and Seafood Research, Bergen, Norway.
    Kristiansen, Karsten
    BGI-Shenzhen, Shenzhen, China & Department of Biology, University of Copenhagen, Copenhagen, Denmark.
    Dahlgren, Jovanna
    Göteborg Paediatric Growth Research Center, Department of Paediatrics, the University of Gothenburg, Queen Silvia Children’s Hospital, Gothenburg & .
    Wang, Jun
    BGI-Shenzhen, Shenzhen, China, Department of Biology, University of Copenhagen, Copenhagen, Denmark, Princess Al Jawhara Albrahim Center of Excellence in the Research of Hereditary Disorders, King Abdulaziz University, Saudi Arabia, Macau University of Science and Technology, Avenida Wai long, Taipa, China & Department of Medicine and State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong.
    Dynamics and Stabilization of the Human Gut Microbiome during the First Year of Life2015In: Cell Host and Microbe, ISSN 1931-3128, E-ISSN 1934-6069, Vol. 17, no 5, p. 690-703Article in journal (Refereed)
    Abstract [en]

    The gut microbiota is central to human health, but its establishment in early life has not been quantitatively and functionally examined. Applying metagenomic analysis on fecal samples from a large cohort of Swedish infants and their mothers, we characterized the gut microbiome during the first year of life and assessed the impact of mode of delivery and feeding on its establishment. In contrast to vaginally delivered infants, the gut microbiota of infants delivered by C-section showed significantly less resemblance to their mothers. Nutrition had a major impact on early microbiota composition and function, with cessation of breast-feeding, rather than introduction of solid food, being required for maturation into an adult-like microbiota. Microbiota composition and ecological network had distinctive features at each sampled stage, in accordance with functional maturation of the microbiome. Our findings establish a framework for understanding the interplay between the gut microbiome and the human body in early life. © 2015 Elsevier Inc.

  • 60.
    Dobrydnjov, Igor
    et al.
    Department of Rheumasurgery, Spenshult Hospital, Oskarström, Sweden.
    Anderberg, Christian
    Department of Rheumasurgery, Spenshult Hospital, Oskarström, Sweden.
    Olsson, Christer
    Department of Rheumasurgery, Spenshult Hospital, Oskarström, Sweden.
    Shapurova, Olga
    Department of Rheumasurgery, Spenshult Hospital, Oskarström, Sweden.
    Angel, Krister
    Department of Rheumasurgery, Spenshult Hospital, Oskarström, Sweden.
    Bergman, Stefan
    Spenshult Hospital, Oskarström, Sweden.
    Intraarticular vs. extraarticular ropivacaine infusion following high-dose local infiltration analgesia after total knee arthroplasty: a randomized double-blind study2011In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 82, no 6, p. 692-698Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: Ropivacaine infusion following high-volume local infiltration analgesia has been shown to be effective after total knee arthroplasty, but the optimum site of administration of ropivacaine has not been evaluated. We compared the effects of intraarticular and extraarticular adminstration of the local anesthetic for postoperative supplementation of high-volume local infiltration analgesia.

    PATIENTS AND METHODS: In this double-blind study, 36 rheumatic patients aged 51-78 years with physical status ASA 2-3 who were scheduled for total knee arthroplasty were randomized into 2 groups. All patients received wound infiltration at the end of surgery with 300 mg ropivacaine, 30 mg ketorolac, and 0.5 mg epinephrine (total volume 156 mL). A tunneled catheter was randomly placed either extraarticularly or intraarticularly. Continuous infusion of ropivacain (0.5%, 2 mL/h) was started immediately and was maintained during the next 48 h. Pain intensity at rest, on movement, and with mobilization was estimated by the patients and the physiotherapist; rescue morphine consumption was recorded.

    RESULTS: As estimated by the patients, ropivacaine administered intraarticularly did not improve analgesia relative to extraarticular infusion, but improved the first mobilization. The incidence of high intensity of pain (VAS 7-10) was less in the group with intraarticular infusion. Analgesic requirements were similar in the 2 groups (47 mg and 49 mg morphine). No complications of postoperative wound healing were seen and there were no toxic side effects.

    INTERPRETATION: Continuous infusion of ropivacaine intraarticulary did not improve postoperative analgesia at rest relative to extraarticular administration, but it appeared to reduce the incidence of high pain intensity during first exercises, and could therefore be expected to improve mobilization up to 24 h after total knee arthroplasty.

  • 61.
    Drab, Beata
    et al.
    Institute of medicine, University of Gothenburg, Primary Health Care Unit, Department of Public Health and Community Medicine, Gothenburg, Sweden.
    Aili, Katarina
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). RandD Spenshult, Halmstad, Sweden & Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Haglund, Emma
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). RandD Spenshult, Halmstad, Sweden.
    Bergman, Stefan
    Institute of medicine, University of Gothenburg, Primary Health Care Unit, Department of Public Health and Community Medicine, Gothenburg, Sweden & RandD Spenshult, Halmstad, Sweden.
    Chronic pain and sick leave in a 21-year follow up2019In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, no Suppl 2, p. 122-122Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

  • 62.
    Emilson, C.
    et al.
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Åsenlöf, Pernilla
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Pettersson, Susanne
    Division of Physiotherapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden & Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult, Oskarström, Sweden & Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Sandborgh, Maria
    School of Health Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Martin, Cathrin
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Demmelmaier, Ingrid
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Physical therapists’ assessments, analyses and use of behavior change techniques in initial consultations on musculoskeletal pain: direct observations in primary health care2016In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 17, article id 316Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Behavioral medicine (BM) treatment is recommended to be implemented for pain management in physical therapy. Its implementation requires physical therapists (PTs), who are skilled at performing functional behavioral analyses based on physical, psychological and behavioral assessments. The purpose of the current study was to explore and describe PTs' assessments, analyses and their use of behavioral change techniques (BCTs) in initial consultations with patients who seek primary health care due to musculoskeletal pain.

    METHODS: A descriptive and explorative research design was applied, using data from video recordings of 12 primary health care PTs. A deductive analysis was performed, based on a specific protocol with definitions of PTs' assessment of physical and psychological prognostic factors (red and yellow flags, respectively), analysis of the clinical problem, and use of BCTs. An additional inductive analysis was performed to identify and describe the variation in the PTs' clinical practice.

    RESULTS: Red and yellow flags were assessed in a majority of the cases. Analyses were mainly based on biomedical assessments and none of the PTs performed functional behavioral analyses. All of the PTs used BCTs, mainly instruction and information, to facilitate physical activity and improved posture. The four most clinically relevant cases were selected to illustrate the variation in the PTs' clinical practice. The results are based on 12 experienced primary health care PTs in Sweden, limiting the generalizability to similar populations and settings.

    CONCLUSION: Red and yellow flags were assessed by PTs in the current study, but their interpretation and integration of the findings in analyses and treatment were incomplete, indicating a need of further strategies to implement behavioral medicine in Swedish primary health care physical therapy. © 2016 The Author(s).

  • 63.
    Emilson, Christina
    et al.
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Demmelmaier, Ingrid
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Bergman, Stefan
    Research and Development Center Spenshult, Halmstad, Sweden & Department of Public Health, and Community medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lindberg, Per
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Denison, Eva
    School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Åsenlöf, Pernilla
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    A 10-year follow-up of tailored behavioural treatment and exercise-based physiotherapy for persistent musculoskeletal pain2017In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 31, no 2, p. 186-196Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study the long-term outcomes of two interventions targeting patients with sub-acute and persistent pain in a primary care physiotherapy setting.

    DESIGN: A 10-year follow-up of a two-armed randomised controlled trial, initially including 97 participants.

    INTERVENTIONS: Tailored behavioural medicine treatment, applied in a physiotherapy context (experimental condition), and exercise-based physiotherapy (control condition).

    MAIN MEASURES: Pain-related disability was the primary outcome. The maximum pain intensity, pain control, fear of movement, sickness-related absence (register data) and perceived benefit and confidence in coping with future pain problems were the secondary outcomes.

    RESULTS: Forty-three (44%) participants responded to the follow-up survey, 20 in the tailored behavioural medicine treatment group and 23 in the exercise-based physiotherapy group. The groups did not differ in terms of the change in the scores for the primary outcome (p=0.17) of pain-related disability between the experimental group (median: 2.5, Q1-Q3: -2.5-14.25), and the control group (median: 0, Q1-Q3: -5-6). Further, there were also no significant differences found for the secondary outcomes except for sickness-related absence, where the exercise-based physiotherapy group had more days of sickness-related absence three months before treatment (p= 0.02), and at the 10-year follow-up (p=0.03).

    DISCUSSION: The beneficial effects favouring tailored behavioural medicine treatment that observed post-treatment and at the two-year follow-up were not maintained 10 years after treatment. 

    © The Author(s) 2016

  • 64.
    Folkhammar Andersson, Siv
    et al.
    Unit of Rehabilitation, Kalmar County Council, Samrehab, Oskarshamn, Sweden.
    Bergman, Stefan
    The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Lund University, Lund, Sweden & FoU Spenshult, Halmstad, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Lund University, Lund, Sweden & FoU Spenshult, Halmstad, Sweden.
    Arthritis Management in Primary Care and Adherence to National Guidelines – a Swedish Survey Based on the Canadian Physiotherapists Arthritis Care Questionnaire2015In: Arthritis & Rheumatology, ISSN 2326-5191, E-ISSN 2326-5205, Vol. 67, no Suppl. S10, article id 2385Article in journal (Refereed)
    Abstract [en]

    Background/Purpose:

    For patients with osteoarthritis (OA) physical therapy is recommended first line treatment and performed in primary care while patients with rheumatoid arthritis (RA) may be treated in primary care at disease onset and during stable phases of the disease. This requires updated skills and evidence based knowledge of the physical therapists (PTs) in arthritis treatment. The aim of this study was to explore physical therapy arthritis practice in primary care and to study the application of evidence based care given to patients with OA or RA.

    Methods:

    All PTs working in primary care in one health care region in Sweden (n=70) were e-mailed a questionnaire (the Canadian Physiotherapists Arthritis Care Survey1) to assess the frequency of current practice, feeling of confidence, educational needs and adherence to national guidelines in managing patients with OA or RA.  The questionnaire was translated and culturally adapted into Swedish according to international recommendations. Interventions supported by national guidelines were compared with reports of treatment modalities in the questionnaire. Mann-Whitney U test, Chi-square test or Fishers Exact test, were used where appropriate, to analyze differences between groups (PT management of patients with OA vs. RA).

    Results:

    Sixty-four PTs responded (91%), reporting a higher feeling of confidence in assessment, treatment and education for patients with OA than for RA (p<0.001). The total numbers of roles assumed by the PTs were higher in management of OA compared to RA (p<0.001). PTs who assumed a large numbers of roles also reported a higher feeling of confident in assessing OA (p=0.036). PTs who assumed a lower numbers of roles also reported a lower feeling of confidence in RA treatment (p=0.045). The recommendations in the guidelines were reported to be followed by almost all PTs in managing patients with RA and for eight out of eleven treatment modalities for patients with OA. Most PTs did provide joint mobilization and education of proper footwear for patients with OA even though Swedish national guidelines did not recommend this as treatment until further research has proven its effectiveness.

    Conclusion:

    PTs reported a lower feeling of confidence and to have assumed a lower numbers of roles in managing patients with RA than OA. There was a good adherence to the national guidelines for almost all listed treatment modalities. However, experienced evidence care and national guidelines did not totally agree. The results indicate a need for education in arthritis care, especially in RA.

    References:

    Li CL, Hurkmans EJ, Sayre EC, Vliet Vlieland TPM (2010). Continuing professional development is associated with increasing physical therapists´ roles in arthritis management in Canada and the Netherlands. Physical Therapy 90:629-42.

  • 65.
    Folkhammar Andersson, Siv
    et al.
    Kalmar County Council, Oskarshamn, Sweden.
    Bergman, Stefan
    Lund University, Lund, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Welin Henriksson, Elisabet
    Karolinska Institutet, Huddinge, Sweden & Linköping University, Linköping, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Lund University, Lund, Sweden.
    Arthritis management in primary care – a study of physiotherapists’ current practice, educational needs, and adherence to national guidelines2017In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 15, no 3, p. 333-340Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: With an increasing number of patients with osteoarthritis (OA) and rheumatoid arthritis (RA) in primary care, our aim was to investigate arthritis-related practice in physiotherapy and to study adherence to evidence-based care.

    METHODS: Seventy physiotherapists (PTs) working in primary care were emailed a questionnaire to investigate current practice and the number of roles assumed by PTs, the degree of confidence, educational needs and adherence to national guidelines in managing patients with OA or RA. Interventions supported by national guidelines were compared with reports of treatment modalities in the questionnaire.

    RESULTS: Sixty-four (91%) PTs responded, and they reported a higher degree of confidence in assessment, treatment and education of patients with OA than for those with RA (p < 0.001). The total number of roles assumed by the PTs was higher in the management of OA than for RA (p < 0.001). PTs who assumed a greater number of roles also reported a stronger degree of confidence in assessing OA (p = 0.036). Those who assumed fewer roles also reported less confidence in RA treatment (p = 0.045). Recommendations in the guidelines were followed by the majority of PTs for eight of 11 treatment modalities in OA and for six of six in RA.

    CONCLUSIONS: PTs reported a lower degree of confidence and the assumption of fewer roles in managing patients with RA compared with OA. There was good adherence to the national guidelines for almost all the treatment modalities listed. Even so, the results indicate a need for education, especially in chronic inflammatory arthritis care.

    Copyright © 2016 John Wiley & Sons, Ltd.

  • 66.
    Haglund, Emma
    et al.
    Spenshult R&D center, Oskarström, Sweden.
    Bergman, Stefan
    Spenshult R&D center, Oskarström, Sweden & Section of Rheumatology, Dept. of Clinical Sciences, Lund University, Lund, Sweden.
    Bremander, Ann
    Spenshult R&D center, Oskarström, Sweden & Section of Rheumatology, Dept. of Clinical Sciences, Lund University, Lund, Sweden.
    Gender differences in educational needs to manage the disease in individuals with spondyloarthritis2014In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, no Suppl. 2, p. 140-141Article in journal (Refereed)
  • 67.
    Haglund, Emma
    et al.
    Lund University, Lund, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Petersson, Ingemar F.
    Lund University, Lund, Sweden.
    Jacobsson, Lennart T. H.
    Lund University, Lund, Sweden.
    Strömbeck, Britta
    Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Lund University, Lund, Sweden.
    Differences in physical activity patterns in patients with spondylarthritis2012In: Arthritis Care and Research, ISSN 0893-7524, E-ISSN 1529-0123, Vol. 64, no 12, p. 1886-1894Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study patient-reported physical activity in patients with spondylarthritis (SpA) and possible differences in physical activity patterns between the SpA subtypes and sexes.

    METHODS: In 2009, a questionnaire including inquiries concerning physical activity was sent to patients with a SpA diagnosis (n = 3,711). The World Health Organization (WHO) global recommendations of physical activity for health requiring 150 minutes of moderate-intensity physical activity (MI-PA) or 75 minutes of vigorous-intensity physical activity (VI-PA) per week were used as recommended levels. Standardized risk ratios (RRs) were calculated by using physical activity data from the Swedish population. The association within the SpA group between sex, age, disease-related variables, anxiety, and depression and meeting recommended levels of MI-PA and VI-PA (dependent variables) was studied with multivariate analysis.

    RESULTS: A total of 2,167 patients with SpA (48% men, mean ± SD age 55 ± 14 years) responded to the questionnaire. Sixty-eight percent of the patients met the WHO recommendations, more frequently in women than in men (70% versus 66%). The recommendations were more often met in the SpA group (RR 1.09, 95% confidence interval [95% CI] 1.04-1.15) compared with the Swedish population. There was a tendency for young women to meet the WHO recommendations less often than the Swedish population (RR 0.94, 95% CI 0.63-1.25). Different factors were found to influence whether the patients were exercising with a moderate or vigorous intensity.

    CONCLUSION: Seven of 10 patients with SpA met the WHO recommendations of physical activity for health, but we found sex and disease subtype differences. This information can be useful in clinical practice when coaching patients to have a healthier lifestyle. © 2012 by the American College of Rheumatology.

  • 68.
    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
    Spenshult Research and Development Center, Halmstad, Sweden & Section of Rheumatology, Lund University, Lund, Sweden & University of Southern Denmark, Odense, Denmark & University Hospital of Southern Denmark, Sønderborg, Denmark.
    Bergman, Stefan
    Spenshult Research and Development Center, Halmstad, Sweden & Section of Rheumatology, Lund University, Lund, Sweden & Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    The StarT back screening tool and a pain mannequin improve triage in individuals with low back pain at risk of a worse prognosis - a population based cohort study2019In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 20, no 1, article id 460Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The STarT Back Screening Tool (SBT) identifies patients with low back pain (LBP) at risk of a worse prognosis of persistent disabling back pain, and thereby facilitates triage to appropriate treatment level. However, the SBT does not consider the pain distribution, which is a known predictor of chronic widespread pain (CWP). The aim of this study was to determine if screening by the SBT and screening of multisite chronic widespread pain (MS-CWP) could identity individuals with a worse prognosis. A secondary aim was to analyze self-reported health in individuals with and without LBP, in relation to the combination of these two screening tools.

    METHODS: One hundred and nineteen individuals (aged 40-71 years, mean (SD) 59 (8) years), 52 with LBP and 67 references, answered two screening tools; the SBT and a pain mannequin - as well as a questionnaire addressing self-reported health. The SBT stratifies into low, medium or high risk of a worse prognosis. The pain mannequin stratifies into either presence or absence of CWP in combination with ≥7 painful areas of pain (0-18), here defined as MS-CWP (high risk of worse prognosis). The two screening tools were studied one-by-one, and as a combined screening. For statistical analyses, independent t-tests and Chi-square tests were used.

    RESULTS: Both the SBT and the pain mannequin identified risk of a worse prognosis in individuals with (p = 0.007) or without (p = 0.001) LBP. We found that the screening tools identified partly different individuals at risk. The SBT identified one individual, while the pain mannequin identified 21 (19%). When combining the two screening methods, 21 individuals (17%) were at high risk of a worse prognosis. When analyzing differences between individuals at high risk (combined SBT and MS-CWP) with those at low risk, individuals at high risk reported worse health (p = 0.013 - < 0.001).

    CONCLUSIONS: Both screening tools identified individuals at risk, but they captured different aspects, and also different number of individuals at high risk of a worse prognosis. Thus, using a combination may improve early detection and facilitate triage to appropriate treatment level with multimodal approach also in those otherwise missed by the SBT. 

    © The Author(s). 2019

  • 69.
    Haglund, Emma
    et al.
    R&D Center Spenshult, Oskarström, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine.
    Bergman, Stefan
    Department of Rheumatology, Clinical sciences, Skåne University Hospital, Malmö, Sweden.
    Jacobsson, Lennart
    Department of Rheumatology, Clinical sciences, Skåne University Hospital, Malmö, Sweden.
    Strömbeck, Britta
    Musculoskeletal Sciences, Department of Orthopedics, Clinical Sciences, Lund, Sweden.
    Petersson, Ingemar
    Musculoskeletal Sciences, Department of Orthopedics, Clinical Sciences, Lund, Sweden.
    Work productivity in a population based cohort of patients with Spondyloarthritis2012In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 64, no 10, p. S1015-S1015Article in journal (Refereed)
    Abstract [en]

    Background: Spondyloarthritis (SpA) often causes impaired function, activity limitations, affected health related quality of life and work disability. Work disability has been shown to be affected both in terms of absenteeism and in impaired productivity while working (presenteeism). In this group with increased socioeconomic costs there is also an increase in  the use of expensive pharmacotherapies. Thus, it is important to study factors related to the ability to stay productive while at work.

    Objective: The aim was to study factors associated with presenteeism in patients with SpA. Also to analyse possible differences in age, gender and SpA subtypes (ankylosing spondylitis, psoriatic arthritis and undifferentiated SpA).

    Methods: The analysis was based on 1773 patients seeking health care for SpA aged 18-67 years from southern Sweden, identified by a health care register. A questionnaire survey in 2009 included questions concerning self-reported presenteeism, defined as the percentage of impairment due to SpA while working 0-100, (0=no impact), was answered by 1447 individuals. Patients´ characteristics: disease duration, disease activity (BASDAI), physical function (BASFI), health related quality of life (EQ-5D), anxiety (HAD-a), depression (HAD-d), self-efficacy pain and symptom (ASES) and register based sick leave. The Pearson’s correlation coefficient and univariate analyses with ANOVA were used to study factors associated with presenteeism and t-test was used for group comparisons.

    Results: Fifty-five percent (n=802/1447) reported no impact on work presenteeism, while mean impairment was 20 (95% CI 18-21) (n=1447). Women reported higher impact on work presenteeism than men (mean impairment 23 vs. 17, p<0.001) but no statistically significant differences were found between the SpA subtype groups. Twenty-eight percent (n=504/1773) were registered for any sick leave (absenteeism > 14 days). Worse outcome in quality of life (EQ-5D), disease activity (BASDAI) and physical function (BASFI) all correlated to higher impact on work presenteeism (r >0.5, p <0.001), while sick leave (absenteeism) did not.  In the univariate analyses experiencing worse outcome in EQ-5D (β-est -9.6, p<0.001) BASDAI (β-est 7.8, p<0.001) and BASFI (β-est 7.3, p<0.001) were all associated to higher impact on presenteeism regardless of age, gender and disease subtype. Worse outcome of EQ-5D was associated to a higher degree impact on presenteeism in the younger women (18-52 yrs). Self-efficacy, anxiety, depression, disease duration and education level <12 years were all associated to higher impact on presenteeism but were not significant in all strata for age, gender and disease subtype.

    Conclusion: Quality of life, disease activity and physical function all affect work presenteeism in patients with SpA, regardless of age, gender and disease subtype. The results indicate that work presenteeism is affected in patients with all types of SpA and more affected in women. We also find that presenteeism and register based sick leave (absenteeism) may be related to different dimensions of the individuals and their disease.

  • 70.
    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.

  • 71.
    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).

  • 72.
    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.

  • 73.
    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.

  • 74.
    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.

  • 75.
    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)
  • 76.
    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.

  • 77.
    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.

  • 78.
    Hallberg, Lillemor R.-M.
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bergman, Stefan
    Research and Development Center, Spenshult Hospital, Oskarström, Sweden.
    Minimizing the dysfunctional interplay between activity and recovery: A grounded theory on living with fibromyalgia2011In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 6, no 2, article id 7057Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to generate a substantive theory, based on interviews with women with fibromyalgia, explaining how they manage their main concerns in daily life. The study has an inductive approach in line with classic grounded theory (Glaser, 1992). Twenty-three women living in the southwest region of Sweden were interviewed in-depth about their daily living with fibromyalgia and problems related to this. Probing and follow-up questions were asked by the interviewers when relevant. The interviews were transcribed verbatim and consecutively analysed in line with guidelines for grounded theory. The results showed that the main concern for women with fibromyalgia was to reach a balance in daily life. This concern was resolved by them using different strategies aimed at minimizing the dysfunctional interplay between activity and recovery (core category). This imbalance includes that the women are forcing themselves to live a fast-paced life and thereby tax or exceed their physical and psychological abilities and limits. Generally, the fibromyalgia symptoms vary and are most often unpredictable to the women. Pain and fatigue are the most prominent symptoms. However, pain-free periods occur, often related to intense engagement in some activity, relaxation or joy, but mainly the "pain gaps" are unpredictable. To reach a balance in daily life and manage the dysfunctional interplay between activity and recovery the women use several strategies. They are avoiding unnecessary stress, utilizing good days, paying the price for allowing oneself too much activity, planning activities in advance, distracting oneself from the pain, engaging in alleviating physical activities, and ignoring pain sensations. Distracting from the pain seems to be an especially helpful strategy as it may lead to "pain gaps". This strategy, meaning to divert attention from the pain, is possible to learn, or improve, in health promoting courses based on principles of cognitive behavioural therapy (CBT). We suggest that such courses are offered in primary care for patients with fibromyalgia or other types of longstanding pain. The courses should be led by registered nurses or psychologists, who are experienced in CBT and have extensive knowledge about theories on longstanding pain, stress and coping. Such courses would increase well-being and quality of life in women suffering from fibromyalgia. © 2011 L. R.-M. Hallberg & S. Bergman.

  • 79.
    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).

  • 80.
    Larsson, Ingrid
    et al.
    Jonkoping Univ, Sch Hlth Sci, Jonkoping, Sweden & Spenshult, R&D Ctr, Spenshult, Oskarstrom, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Fridlund, Bengt
    Jonkoping Univ, Sch Hlth Sci, Jonkoping, Sweden.
    Teleman, A.
    Spenshult Hosp, Spenshult Hosp Rheumat Dis, Oskarstrom, Sweden.
    Bergman, Stefan
    Spenshult, R&D Ctr, Spenshult, Oskarstrom, Sweden.
    Nurse-led rheumatology clinic versus rheumatologist clinic in monitoring of biological therapy– a randomised controlled study2012In: Annals of the Rheumatic Diseases, ISSN 0003-4967, Vol. 71, no Suppl. 3, p. 121-121Article in journal (Refereed)
    Abstract [en]

    Background: Patients with rheumatic diseases treated with biological therapy are usually followed up by rheumatologists. Nurse-led rheumatology clinics have been proposed for patients with low disease activity or in remission.

    Objectives: To compare treatment outcomes from a nurse-led rheumatology clinic and a rheumatologist clinic for patients treated with biological therapy with low disease activity or in remission.

    Methods: In a prospective controlled study 107 patients were randomised into two groups with six months follow up to a nurse-led rheumatology clinic (intervention group; n=53) or to a rheumatologist clinic (control group; n=54). Inclusion criteria were ongoing biological therapy and Disease Activity Score 28 (DAS28) ≤3.2. All patients met the rheumatologist at inclusion and after 12 months. In the nurse-led rheumatology clinic the patients´ disease activity was assessed by examination of tender or swollen joints and laboratory tests. The rheumatology nurse also had a dialogue concerning the patient’s needs with regard to drug therapy, smoking habits and psychosocial aspects. Main outcome was disease activity measured by DAS28.

    Results: After 12 months 97 patients completed the study. The patients had mean age of 55.4 years, disease duration of 16.7 years, and DAS28 was 2.1, with no significant differences between the two groups. In change of DAS28 there were no differences (p=0.66) between the intervention group (0.14) or control group (0.20) from inclusion to 12 months. There were no differences (p>0.05) in mean change after 12 months in ESR, swollen and tender joints, global health and pain visual analogue scales (VAS) or Health Assessment Questionnaire (HAQ) between the patients followed up at the nurse-led rheumatology clinic or the rheumatologist clinic, see table.

     Table. Comparison of the two groups intervention group (Nurse-led rheumatology clinic) and control group (Rheumatologist clinic).

  • 81.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Arvidsson, Susann
    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), Health promotion and disease prevention.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Patients’ conceptions of drug information given by a rheumatology nurse - A phenomenographic study2009In: / [ed] Svenska Läkaresällskapet, 2009Conference paper (Refereed)
    Abstract [en]

    Bakgrund Pain, stiffness and functional restriction of the joints are the main problems experienced by patients with inflammatory rheumatic conditions. The majority of patients with rheumatic diseases require several drugs every day. Adherence is highest among patients who have repeatedly been given drug information by a nurse from the start of the treatment. When developing patient information, it is essential to utilise patients' experiences. The aim of this study was to describe variations in how patients with rheumatic diseases conceive drug information given by a rheumatology nurse.

    Metod Fifteen informants who had been prescribed one or several new drugs during the period of hospitalisation were approached, agreed to take part in the study and were interviewed. Strategic sampling was carried out in order to achieve variation in conceptions of the phenomenon in terms of sex, age, marital status, education, type of rheumatic disease, disease duration and type of new drug

    Resultat Three descriptive categories comprising seven conceptions emerged and revealed how the patients conceived the information about new medication provided by a nurse. Drug information led to Autonomy, Power and Security. Autonomy was based on the patients' experiences of taking responsibility and participating. Power meant gaining knowledge and being motivated to take the drug. Security involved trust, experiencing care and access to a rheumatology nurse.

    Sammanfattning Patients with a rheumatic disease experienced that drug information from a rheumatology nurse gave them autonomy, power and security. These factors could explain why information from a nurse increases drug treatment adherence.

  • 82.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Arvidsson, Susann
    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).
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Patients’ conceptions of drug information given by the rheumatology nurse2009In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 68, no Suppl. 3, p. 781-781Article in journal (Refereed)
    Abstract [en]

    Background: Pain, stiffness and functional restriction of the joints are the main problems for patients with inflammatory rheumatic conditions. The majority of patients with rheumatic diseases have a need for daily intake of several drugs. Compliance in drug treatment is higher amongst patients that have been given drug information by a nurse at repeated occasions from the start of the treatment. In the development of patient information, it is essential to take advantage of patients' experiences.

    Objectives: The purpose of this study was to describe variations in how patients with rheumatic diseases conceive drug information given by a rheumatology nurse.

    Methods: The study had a descriptive qualitative design with a phenomenographic approach. When employing such an approach, the main aim is to describe how a phenomenon is conceived by different individuals. Fifteen patients with rheumatic diseases who had received a new drug during a hospital visit were approached, agreed to take part in the study and were interviewed. Strategic sampling in terms of sex, age, marital status, education, rheumatic diseases, and illness duration, was carried out in order to achieve variation in conceptions of the phenomenon.

    Results: Three descriptive categories emerged: (1) Autonomy (own responsibility and participation), (2) Power (knowledge and motivation), (3) Security (trust, care and accessibility). Autonomy was based on the patients' experiences from taking their own responsibility and participation. Power meant to gain knowledge and motivation to take the drug. Security was to receive trust, experience care, and to have accessibility to a rheumatology nurse.

    Conclusion: Patients with rheumatic diseases experiences that drug information from a rheumatology nurse gives them autonomy, power and security. These could be essential for the patients to manage their daily life, where drug treatment is one part.

    Disclosure of Interest: None declared

  • 83.
    Larsson, Ingrid
    et al.
    Spenshult hospital, Oskarström, Sweden.
    Arvidsson, Susann
    Spenshult hospital, Oskarström, Sweden.
    Bergman, Stefan
    Spenshult hospital, Oskarström, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Patients´conceptions of drug information given by a rheumatology nurse: a phenomenographic study2010In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 8, no 1, p. 36-45Article in journal (Refereed)
    Abstract [en]

    Background:

    Pain, stiffness and functional restriction of the joints are the main problems experienced by patients with inflammatory rheumatic conditions. The majority of patients with rheumatic diseases require several drugs every day. Adherence is highest among patients who have repeatedly been given drug information by a nurse from the start of the treatment. When developing patient information, it is essential to utilize patients' experiences.

    Objectives:

    The purpose of this study was to describe variations in how patients with rheumatic diseases perceive drug information given by a rheumatology nurse.

    Methods:

    The study had a descriptive qualitative design with a phenomenographic approach. Fifteen inpatients with rheumatic diseases who had received a new drug agreed to take part in the study and were interviewed.

    Results:

    Three descriptive categories emerged: autonomy, power and security. Autonomy was based on patients' experiences of taking responsibility and participating. Power meant gaining knowledge and being motivated to take the drug. Security involved trust, experiencing care and access to a rheumatology nurse.

    Conclusions:

    For patients with a rheumatic disease, drug information from a rheumatology nurse gave them autonomy, power and security. These factors could explain why information from a nurse increases adherence to drug treatment.

  • 84.
    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.

  • 85.
    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.

  • 86.
    Larsson, Ingrid
    et al.
    Research and Development Centre, Spenshult Hospital, Oskarström, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital, Oskarström, Sweden.
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Patients' dependence on a nurse for the administration of their intravenous anti-TNF therapy: A phenomenographic study2009In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 7, no 2, p. 93-105Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pain, stiffness and functional restriction of the joints are the main problems for many patients with inflammatory rheumatic conditions. When conventional drugs fail to delay the development of the disease, the patient may require biological treatment such as anti-TNF therapy. Some biological drugs are administered in the form of intravenous infusions and thus the patient is obliged to attend a clinic in order to receive his/her medication, which can affect everyday life as well as independence. It is therefore important to focus on the patient perspective.

    AIM: The aim of this study was to describe variations in how patients with rheumatic conditions conceive their dependence on a nurse for the administration of their intravenous anti-TNF therapy.

    METHOD: The study had a descriptive qualitative design with a phenomenographic approach. Interviews were conducted with 20 patients.

    RESULT: Three descriptive categories and seven sub-categories emerged: Dependence that affords security (encountering continuity, encountering competence and obtaining information); Dependence that creates involvement (being allowed influence and being given freedom); Dependence that invigorates (obtaining relaxation and encountering the environment).

    CONCLUSION: The patients had not reflected on the fact that they were dependent on a nurse for the administration of their intravenous anti-TNF therapy, which may be due to their possibility to influence the treatment. The patients' needs should constitute the basis for the nurse's role in the provision of care.

  • 87.
    Larsson, Ingrid
    et al.
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital, Oskarström, Sweden.
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Patients’ experiences of a nurse-led rheumatology clinic in Sweden: a qualitative study2012In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 14, no 4, p. 501-507Article in journal (Refereed)
    Abstract [en]

    In this study, patients’ experiences of a nurse-led rheumatology clinic for those undergoing biological therapy are discussed. The study had an explorative design, based on a qualitative content analysis with an inductive approach. Strategic sampling was used in order to achieve variations in experiences of a nurse-led clinic. Interviews were conducted with 20 participants, and the analysis resulted in the theme “the nurse-led rheumatology clinic provided added value to patient care”. The participants’ experiences of the encounter with the nurse led to a sense of security (due to competence and accessibility), familiarity (due to confirmation and sensitivity), and participation (due to exchange of information and involvement). Replacing every second visit to a rheumatologist with one to a nurse added value to the rheumatology care,making it more complete. Nurses and rheumatologists complemented each other,as they approached patients from different perspectives. This study suggests that a nurse-led rheumatology clinic adds value to the quality of care for patients inrheumatology units.

  • 88.
    Larsson, Ingrid
    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), Health promotion and disease prevention.
    Fridlund, Bengt
    Hälsohögskolan Jönköping.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Patients’ experiences of nurse-led follow-up in biological therapy – a qualitative study2011In: / [ed] The European Leage Against Rheumatism, London: BMJ , 2011, p. 755-755Conference paper (Refereed)
    Abstract [en]

    Background: Pain, stiffness and functional restrictions of the joints are the main problems for patients with inflammatory rheumatic diseases. When conventional drugs fail to delay the development of the disease the patients may require biological therapy. These patients usually have rheumatologist follow-up twice a year. Nurse-led clinics have been proposed for patients treated with biological therapy that are in low disease activity or remission (Disease Activity Score, DAS <3.2). In an ongoing study at a Swedish rheumatology clinic every other rheumatologist follow-up has been replaced by a rheumatology nurse-led follow-up. At the nurse-led follow-up the patients' disease activity is assessed by examining tender or swollen joints and laboratory tests.Objectives: The purpose of this study was to describe patients' experiences of nurse-led follow-up in biological therapy.Methods: The study had a descriptive design with a qualitative content analysis approach. In qualitative content analysis the interpretations vary in depth and level of abstraction: the manifest content describes the visible, what the text says and creating categories, the latent content involves an interpretation of the underlying meaning of the text, what the text talks about and creating a theme. Seventeen interviews were conducted based on a strategic sampling in order to achieve variation in experiences of nurse-led follow-up in terms of sex, age, civil status, education, duration of disease and therapy and ways of administration.Results: The content analysis of the interviews resulted in the theme "The rheumatology nurse promotes patients with added value" which was based on four categories: familiarity, security, availability and participatory: Familiarity meant that it was easier to ask the rheumatology nurse about disease, treatment and how to live with a chronic disease than the rheumatologist. Patients experienced security in the rheumatology nurse's knowledge and skill. Availability meant that it was easy to contact the rheumatology nurse who spent time to patients' needs. Patients experienced being participatory in their biological therapy and in the rheumatology nurse's examination of the disease activity.Conclusions: The rheumatology nurse follow-up resulted in that patients experienced familiarity, security, availability and being participatory in their biological therapy. The rheumatology nurse promoted patients from another perspective, than the rheumatologist, in the rheumatology care. By replacing every other rheumatologist follow-up with a rheumatology nurse-led follow-up for patients with biological therapy, who are in low disease activity or remission, the rheumatology care will be more complete. A rheumatology nurse and a rheumatologist have different perspectives and complement each other. When patients are given the opportunity to meet both professions regularly they are able to receive optimal rheumatology care.

    Disclosure of Interest: None Declared

    Citation: Ann Rheum Dis 2011;70(Suppl3):755

  • 89.
    Larsson, Ingrid
    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), Health promotion and disease prevention.
    Fridlund, Bengt
    Hälsohögskolan Jönköping.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Patients’ experiences of rheumatology nurse-led clinic in biological therapy – a qualitative study2011In: / [ed] Svenska Läkaresällskapet, 2011Conference paper (Refereed)
    Abstract [en]

    Bakgrund Nurse-led clinics have been proposed for patients with rheumatic diseases treated with biological therapy who are in low disease activity or remission (Disease Activity Score, DAS <3.2). In an ongoing study at a Swedish rheumatology clinic every other rheumatologist follow-up has been replaced by a rheumatology nurse-led follow-up. At the nurse-led follow-up the patients´ disease activity is assessed by examining tender or swollen joints and laboratory tests. The purpose of this study was to describe patients´ experiences of rheumatology nurse-led follow-up in biological therapy.

    Metod The study had a descriptive design with a qualitative content analysis approach. Strategic sampling was carried out in order to achieve variation in experiences of nurse-led follow-up. Interviews were conducted with 20 patients (10 males and 10 females, 10 i.v infusions and 10 s.c injections as way of administration, 34-76 years of age, and duration of illness 3-41 years).

    Resultat The content analysis of the interviews resulted in the theme "The rheumatology nurse promotes patients with added value" Which was based on four categories: familiarity, security, availability and participatory: Familiarity meant that it was easier to ask the rheumatology nurse about disease, treatment and how to live with a chronic disease than the rheumatologist. Patients experienced security in the rheumatology nurse’s knowledge and skill. Availability meant that it was easy to contact the rheumatology nurse who spent time to patients' needs. Patients experienced being participatory in the biological therapy and in the rheumatology nurse’s examination of the disease activity.

    Sammanfattning The rheumatology nurse-led follow-up resulted in that patients experienced familiarity, security, availability and being participatory in their biological therapy. The rheumatology nurse promoted patients from another perspective, than the rheumatologist. By replacing every other rheumatologist follow-up with a rheumatology nurse-led follow-up for patients with biological therapy, who are in low disease activity or remission, the rheumatology care will be more complete. A rheumatology nurse and a rheumatologist have different perspectives and complement each other. When patients are given the opportunity to meet both professions regularly they are able to receive optimal rheumatology care.

  • 90.
    Larsson, Ingrid
    et al.
    School of Health Sciences, Jönköping University.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital, Oskarström, Sweden.
    Fridlund, Bengt
    School of Health Sciences, Jönköping University.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Patients' independence of a nurse for the administration of subcutaneous anti-TNF therapy: a phenomenographic study2010In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 5, no 2, p. 5146-1-5146-10Article in journal (Refereed)
    Abstract [en]

    Rheumatology nursing supports patients to manage their lives and live as independently as possible without pain, stiffness and functional restrictions. When conventional drugs fail to delay the development of the rheumatic disease, the patient may require biological treatment such as self-administered subcutaneous anti-tumour necrosis factor (TNF) therapy. It is therefore important that the patient perspective focuses on the life-changing situation caused by the administration of regular subcutaneous injections. The aim of this study was to describe variations in how patients with rheumatic diseases experience their independence of a nurse for administration of subcutaneous anti-TNF therapy. The study had a descriptive, qualitative design with a phenomenographic approach and was carried out by means of 20 interviews. Four ways of understanding the patients' experience of their subcutaneous anti-TNF therapy and independence of a nurse emerged: the struggling patient; the learning patient; the participating patient; the independent patient. Achieving independence of a nurse for subcutaneous anti-TNF injections can be understood by the patients in different ways. In their strive for independence, patients progress by learning about and participating in drug treatment, after which they experience that the injections make them independent.

  • 91.
    Larsson, Ingrid
    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), Health promotion and disease prevention.
    Fridlund, Bengt
    Hälsohögskolan Jönköping.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Patients’ independence of a nurse for the administration of their subcutaneous anti-TNF therapy: A phenomenographic study2010Conference paper (Refereed)
    Abstract [en]

    Background: Pain, stiffness and functional restrictions of the joints are the main problems for patients with inflammatory rheumatic diseases. When conventional drugs fail to delay the development of the disease the patient may require biological treatment such as anti-TNF therapy. Some biological drugs are administered in the form of subcutaneous injections by patients themselves. It is therefore important that the patient perspective is focused upon the life-changing situation due to the administration of regular subcutaneous injections.

    Objectives: The purpose of this study was to describe variations in how patients with rheumatic diseases conceive their independence of a nurse for the administration of their subcutaneous anti-TNF therapy.

    Methods: The study had a descriptive qualitative design with a phenomenographic approach. Twenty interviews were conducted based on a strategic sampling in order to achieve variation in conceptions of the phenomenon in terms of sex, age, marital status, education, illness duration, duration of medication, distance between home-hospital, and experience of intravenous infusions.

    Results: Four descriptive categories emerged: 1. Struggling for independence: The patients experienced a struggle and limitations in their lives by the self-administration of the subcutaneous injections. 2. Learning for independence: Patients experienced a learning process by the self-administration of the subcutaneous injections. 3. Participating for independence; Patients experienced control over their lives by themselves administers the subcutaneous injections. 4. Freedom through independence: Patients experienced that they could manage their lives and live as independently as possible by the self-administration of the subcutaneous injections.

    Conclusion: Independence of a nurse at the subcutaneous anti-TNF injections is a process. There is a striving for independence in which patients are taking themselves further by learning and participating in drug treatment and then experience the injection provides independence. Patients under treatment with subcutaneous anti-TNF injections are at different phases in the process of independence; this is not depending on how long they have self-administered subcutaneous injections.

    Disclosure of Interest: None declared

    Citation: Ann Rheum Dis 2010;69(Suppl3):730

    Nursing

  • 92.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bergman, Stefan
    Spenshult, Oskarström, Sweden.
    Fridlund, Bengt
    Hälsohögskolan Jönköping.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Patients with rheumatic diseases and their conceptions of regular self-administered subcutaneous anti-TNF injections2010In: / [ed] International Journal of Qualitative Studies on Health and Well-being, 2010Conference paper (Refereed)
    Abstract [en]

    Background: Pain, stiffness and functional restrictions of the joints are the main problems for patients with inflammatory rheumatic diseases. When conventional drugs fail to delay the development of the disease the patient may require biological treatment such as anti-TNF therapy. Some biological drugs are administered in the form of subcutaneous injections by patients themselves. It is therefore important that the patient perspective is focused upon the life-changing situation due to the administration of regular subcutaneous injections.

    Aim: The aim of this study was to describe variations in how patients with rheumatic diseases experience the self-administration of their subcutaneous anti-TNF therapy.

    Methods: The study had a descriptive qualitative design with a phenomenographic approach. Twenty interviews were conducted based on a strategic sampling in order to achieve variation in conceptions of the phenomenon in terms of sex, age, marital status, education, illness duration, duration of medication, distance between home-hospital, and experience of intravenous infusions.

    Results: Four descriptive categories emerged: 1. The struggling patient: The patients experienced a struggle and limitations in their lives by the self-administration of the subcutaneous injections. 2. The learning patient: Patients experienced a learning process by the self-administration of the subcutaneous injections. 3. The participating patient: Patients experienced control over their lives by themselves administers the subcutaneous injections. 4. The independent patient: Patients experienced that they could manage their lives and live as independently as possible by the self-administration of the subcutaneous injections.

    The administration of regular subcutaneous anti-TNF injections is a process. The striving for independence in which patients are taking themselves further by learning and participating in drug treatment and then experience that the injection provides independence. Patients under treatment with subcutaneous anti-TNF injections are at different phases in the process of independence; this is not depending on how long they have self-administered subcutaneous injections.

  • 93.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Fridlund, Bengt
    Jönköping University, Jönköping, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bergman, Stefan
    Spenshult, Oskarström, Sweden.
    Biological therapy could be monitored by a rheumatology nurse-led clinic without any differences in outcome – a randomised controlled study2012Conference paper (Refereed)
    Abstract [en]

    Background: Patients with rheumatic diseases treated with biological therapy are usually followed up by rheumatologists. Nurse-led rheumatology clinics have been proposed for patients who are in low disease activity or remission.

    Objectives: To compare treatment outcomes from a nurse-led rheumatology clinic and a rheumatologist clinic for patients treated with biological therapy with low disease activity or in remission.

    Methods: In a prospective controlled study 107 patients were randomised into two groups with six months follow up to a rheumatology nurse (intervention group; n=53) or to a rheumatologist (control group; n=54). Inclusion criteria were ongoing biological therapy and Disease Activity Score 28 (DAS28) ≤3.2. All patients met the rheumatologist at inclusion and after 12 months. In the nurse-led rheumatology clinic the patients´ disease activity was assessed by examination of tender or swollen joints and laboratory tests. The rheumatology nurse also had a dialogue concerning the patient’s needs with regard to drug therapy, smoking habits and psychosocial aspects. After 12 months 97 patients completed the study. Main outcome was disease activity measured by DAS28.

    Results: Patients had mean age of 55.4 years and disease duration of 16.7 years. DAS28 was 2.1. At inclusion there were no significant differences in DAS28 between the groups. There were no differences (p=0.67) in change of DAS28 between the intervention group (0.14) or control group (0.20) from inclusion to 12 months.

    Conclusions: In patients with low disease activity biological therapy could be monitored by a nurse-led rheumatology clinic without any differences in outcome as measured by DAS28.

  • 94.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Fridlund, Bengt
    Hälsohögskolan Jönköping, Jönköping, Sverige.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bergman, Stefan
    Spenshult, Oskarström, Sverige.
    Sjuksköterskemottagning för patienter med en reumatisk sjukdom behandlade med biologiska läkemedel – ett randomiserat, kontrollerat försök jämförande sjuksköterskemottagning med läkarmottagning2012Conference paper (Refereed)
    Abstract [sv]

    Bakgrund Målet med behandling av reumatiska sjukdomar är att ta kontroll över ledsmärta och svullnad, reducera ledskador samt förebygga funktionsnedsättningar. För patienter med otillräcklig respons på traditionella läkemedel har forskningen inom reumatologin varit av stor betydelse och medfört utveckling av biologiska läkemedel. Behandling med biologiska läkemedel för patienter med reumatisk sjukdom följs vanligtvis upp av en reumatolog. För patienter som är lågaktiva i sin sjukdom eller i remission har uppföljning via en sjuksköterskemottagning föreslagits. Syfte var att jämföra sjuksköterskemottagning med läkarmottagning avseende behandlingsresultat för patienter behandlade med biologiska läkemedel med låg eller ingen sjukdomsaktivitet.

    Metod Ett randomiserat kontrollerat öppet försök med 12 månaders uppföljning genomfördes mellan oktober 2009 och augusti 2011. Avsikten var att ersätta ett av de två årliga läkarbesöken med ett sjuksköterskebesök. En sjuksköterskemottagning utformades utifrån en personcentrerad vård med patientens behov i fokus. Inklussionskriterier var patienter med en reumatisk sjukdom behandlade med biologiskt läkemedel och en sjukdomsaktivitet, Disease Active Score 28 (DAS28) ≤3.2. Av 107 patienter randomiserades 53 patienter till uppföljning av sjuksköterska och 54 patienter till uppföljning av läkare. Hypotesen var att behandlingsresultatet på en sjuksköterskemottagning inte skulle vara sämre än på en läkarmottagning vid 12 månaders uppföljning. Huvudutfallsmått var DAS28.

    Resultat Efter 12 månader hade 47 patienter i sjuksköterskegruppen och 50 patienter i läkargruppen fullföljt studien. Patienterna hade en medelålder på 55.4 år, sjukdomsduration på 16.7 år och DAS28 var 2.1. Det fanns ingen statistiskt signifikant skillnad mellan grupperna. Efter 12 månader var det inte någon statistisk signifikant skillnad (p=0.66) i förändring av DAS28 mellan sjuksköterskegruppen (0.14) eller läkargruppen (0.20). I utfallsmåtten sänka, svullna och ömma leder, global hälsa och smärta (VAS) eller Health Assessment Questionnaire (HAQ) var det inte heller någon statistisk signifikant skillnad i förändring efter 12 månader mellan grupperna. Båda grupperna var lika nöjda med vården och säkra på att få hjälp från reumatologmottagningen vid problem med lederna.

    Sammanfattning Patienter med en stabil reumatisk sjukdom behandlade med biologiskt läkemedel kan följas upp vid en sjuksköterskemottagning utan någon skillnad i behandlingsresultat med avseende på DAS28.

  • 95.
    Larsson, Ingrid
    et al.
    Jönköping University, Jönköping, Sweden.
    Fridlund, Bengt
    Jönköping University, Jönköping, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bergman, Stefan
    Spenshult Hospital, R&D Center, Spenshult Hospital, Oskarström, Sweden.
    Treatment Outcomes From a Nurse-Led Rheumatology Clinic in Monitoring of anti-TNF Therapy – a Randomised Controlled Trial2012In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 64, no 10, p. S667-S667, article id 1559Article in journal (Refereed)
    Abstract [en]

    Background: Patients with chronic inflammatory arthritis (CIA) treated with anti-TNF therapy are usually followed up by rheumatologists. Nurse-led rheumatology clinics have been proposed for patients with low disease activity or in remission. The purpose of this trial was to compare treatment outcomes from a nurse-led rheumatology clinic and a rheumatologist clinic for patients undergoing anti-TNF therapy with low disease activity or in remission.

    Methods: A randomized controlled trial (RCT) with a 12-month follow-up was conducted with 107 patients randomised into two groups with a 6-month follow up to a nurse-led rheumatology clinic based on a person-centred care (intervention group; n=53) or to a rheumatologist-led clinic (control group; n=54). The intention of the interventional trial was to replace one of the two annual rheumatologist monitoring visits by a nurse-led rheumatology monitoring visit for patients undergoing anti-TNF therapy. Inclusion criteria were patients undergoing anti-TNF therapy and Disease Activity Score 28 (DAS28) ≤3.2. The hypothesis was that the outcomes from nurse-led clinic will not be inferior to those obtained by rheumatologist-led clinic at 12-month follow-up. Primary outcome was disease activity measured by DAS28.

    Results: After 12 months 47 patients in the intervention group and 50 patients in the control group completed the trial and there were no differences (p=0.66) in mean change of DAS28 between the intervention or control group. There were no differences (p>0.05) in mean change in Visual Analogue Scales (VAS) for pain, Health Assessment Questionnaire (HAQ), satisfaction or security with the rheumatology care  between the two groups, see table.

    Conclusion: In monitoring of anti-TNF therapy treatment outcomes for patients at a nurse-led rheumatology clinic are not inferior to those obtained by rheumatologist-led clinic at 12-month follow-up. The follow-up care of anti-TNF therapy may advantageously be performed by a nurse-led clinic based on a person-centred care. The results from this trial demonstrated that patients with CIA undergoing anti-TNF therapy, with low disease activity or in remission, could be monitored by a nurse-led rheumatology clinic without any differences in outcome as measured by DAS28.

  • 96.
    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. R&D Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad.
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). R&D Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad.
    Teleman, Annika
    R&D Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad.
    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 Hospital for Rheumatic Diseases, Halmstad.
    Biological therapy can be monitored more cost effectively by a nurse-led rheumatology clinic2014In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, Suppl. 3, p. 139-140Article in journal (Refereed)
    Abstract [en]

    Background: Patients with chronic inflammatory arthritis (CIA) treated with biological therapy are usually monitored by rheumatologists. Research shows that a nurse-led rheumatology clinic is safe and effective in monitoring biological therapy (1) and contributed added value in patients within rheumatology care, because the encounter with the nurse led to a sense of security, familiarity and participation (2).

    Objectives: To compare the cost of monitoring biological therapy in a nurse-led rheumatology clinic with those of a rheumatologist-led clinic in patients with low disease activity or in remission.

    Methods: Cost comparison was based on data from a 12 month randomised controlled trial (1). A total of 107 patients were randomly assigned to either a rheumatologist-led clinic or to a nurse-led rheumatology clinic. The purpose of the intervention was to replace one of two annual monitoring visits at the rheumatologist-led clinic (control group; n=54) by a visit to a nurse-led rheumatology clinic (intervention group; n=53), based on person-centred care. Inclusion criteria were ongoing biological therapy and Disease Activity Score 28 (DAS28) ≤3.2. All patients met the rheumatologist at inclusion and after 12 months. All outpatient visits, team rehabilitation and all the telephone advice at the Rheumatology Clinic were registered for the patients who participated in the trial. Main outcome measures were direct costs related to rheumatology care during the 12 month follow-up period.

    Results: After 12 months 97 patients completed the study. At the inclusion the patients had mean age of 55.4 years, disease duration of 16.7 years, and DAS28 was 2.1, with no significant differences between the two groups. There was no mean difference in changes in clinical outcome between the two groups (DAS28 -0.06; p=0.66). The total annual cost of team rehabilitation in rheumatology care, per patient monitored by the nurse-led rheumatology clinic was €580 compared with €1278 for monitoring by a rheumatologist-led clinic, translating in a €698 (55%) lower annual cost. The annual cost of just the outpatient rheumatology care provided by rheumatologist and rheumatology nurse, per patient was €457 for monitoring by the nurse-led rheumatology clinic compared with €598 for monitoring by a rheumatologist-led clinic, translating in a €141 (24%) lower annual cost.

    Conclusions: Patients with stable CIA undergoing biological therapy can be monitored more cost effectively by a nurse-led rheumatology clinic compared to a rheumatologist-led clinic, with no difference in clinical outcome as measured by DAS28.

    References

    1. Larsson et al. (2014). Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy. J Adv Nurs, 70(1): 164-175.
    2. Larsson et al. (2012). Patients’ experiences of a nurse-led rheumatology clinic in Sweden – a qualitative study in patients undergoing biological therapy. Nurs Health Sci, 14(4): 501-507.
  • 97.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Jönköping University, School of Health Sciences, Jönköping, Sweden & Spenshult Hospital, Oskarström, Sweden.
    Fridlund, Bengt
    Jönköping University, School of Health Sciences, Jönköping, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Hospital, Oskarström, Sweden.
    Teleman, Annika
    Spenshult Hospital, Oskarström, Sweden.
    Bergman, Stefan
    Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy2013In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 70, no 1, p. 164-175Article in journal (Refereed)
    Abstract [en]

    AIM: To compare and evaluate the treatment outcomes of a nurse-led rheumatology clinic and a rheumatologist-led clinic in patients with low disease activity or in remission who are undergoing biological therapy.

    BACKGROUND: Patients with chronic inflammatory arthritis treated with biological therapy are usually monitored by rheumatologists. Nurse-led rheumatology clinics have been proposed in patients with low disease activity or in remission.

    DESIGN: Randomized controlled trial.

    METHODS: A 12-month follow-up trial was conducted between October 2009 and August 2011, where 107 patients were randomized into two groups with a 6-month follow-up to a nurse-led rheumatology clinic based on person-centred care (intervention group; n = 53) or to a rheumatologist-led clinic (control group; n = 54). The hypothesis was that the nurse-led clinic outcomes would not be inferior to those obtained from a rheumatologist-led clinic at the 12-month follow-up. The primary outcome was disease activity measured by Disease Activity Score 28.

    RESULTS: A total of 47 patients in the intervention group and 50 in the control group completed the 12-month trial. The trial revealed no statistically significant differences between groups in mean change of Disease Activity Score 28, Visual Analogue Scales for pain, the Health Assessment Questionnaire, satisfaction with or confidence in obtaining rheumatology care.

    CONCLUSION: Patients with stable chronic inflammatory arthritis undergoing biological therapy could be monitored by a nurse-led rheumatology clinic without difference in outcome as measured by the Disease Activity Score 28. © 2013 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.

  • 98.
    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. Spenshult Research and Development Centre, Halmstad, Sweden.
    Fridlund, Bengt
    School of Health and Welfare, Jönköping University, Jönköping, Sweden .
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Teleman, Annika
    Capio Movement Hospital, Halmstad, Sweden.
    Svedberg, Petra
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention.
    Bergman, Stefan
    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 Centre, Halmstad, Sweden & University of Gothenburg, Gothenburg, Sweden.
    A nurse-led rheumatology clinic versus rheumatologist-led clinic in monitoring of patients with chronic inflammatory arthritis undergoing biological therapy: a cost comparison study in a randomised controlled trial2015In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 16, article id 354Article in journal (Refereed)
    Abstract [en]

    Background: Recommendations for rheumatology nursing management of chronic inflammatory arthritis (CIA) from European League Against Rheumatism (EULAR) states that nurses should take part in the monitoring patients’ disease and therapy in order to achieve cost savings. The aim of the study was to compare the costs of rheumatology care between a nurse-led rheumatology clinic (NLC), based on person-centred care (PCC), versus a rheumatologist-led clinic (RLC), in monitoring of patients with CIA undergoing biological therapy.

    Methods: Patients with CIA undergoing biological therapy (n = 107) and a Disease Activity Score of 28 ≤ 3.2 were randomised to follow-up by either NLC or RLC. All patients met the rheumatologist at inclusion and after 12 months. In the intervention one of two annual monitoring visits in an RLC was replaced by a visit to an NLC. The primary outcome was total annual cost of rheumatology care.

    Results: A total of 97 patients completed the RCT at the 12 month follow-up. Replacing one of the two annual rheumatologist monitoring visits by a nurse-led monitoring visit, resulted in no additional contacts to the rheumatology clinic, but rather a decrease in the use of resources and a reduction of costs. The total annual rheumatology care costs including fixed monitoring, variable monitoring, rehabilitation, specialist consultations, radiography, and pharmacological therapy, generated €14107.7 per patient in the NLC compared with €16274.9 in the RCL (p = 0.004), giving a €2167.2 (13 %) lower annual cost for the NLC.

    Conclusions: Patients with CIA and low disease activity or in remission undergoing biological therapy can be monitored with a reduced resource use and at a lower annual cost by an NLC, based on PCC with no difference in clinical outcomes. This could free resources for more intensive monitoring of patients early in the disease or patients with high disease activity.

    Trial registration: The trial is registered as a clinical trial at the ClinicalTrials.gov (NCT01071447). Registration date: October 8, 2009.

    © 2015 Larsson et al.

  • 99.
    Lindell, Lisa
    et al.
    Primary Care Centre Hertig Knut, Halmstad, Sweden.
    Bergman, Stefan
    Primary Care Centre Hertig Knut, Halmstad, Sweden.
    Petersson, Ingemar F.
    Spenshult Hospital, Oskarström, Sweden.
    Jacobsson, Lennart T.H.
    Department of Rheumatology, University Hospital, Malmö, Sweden.
    Herrström, Per
    Primary Care Centre Hertig Knut, Halmstad, Sweden.
    Prevalence of fibromyalgia and chronic widespread pain2000In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 18, no 3, p. 149-153Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To explore the prevalence of fibromyalgia and chronic widespread musculoskeletal pain in a general population using the criteria of the American College of Rheumatology from 1990.

    DESIGN: Structured interview and clinical examination, including tender-point count and pain threshold measured with a dolorimeter, of subjects with suspected chronic widespread musculoskeletal pain.

    SETTING: The general population in south-west Sweden 1995-1996.

    SUBJECTS: 303 individuals with suspected chronic widespread pain were identified in a previously defined cohort containing 2425 men and women aged 20-74 years. 202 individuals were invited and 147 agreed to participate.

    MAIN OUTCOME MEASURES: Tenderpoint count, pain threshold and prevalence of chronic widespread pain and fibromyalgia.

    RESULTS: The prevalence of fibromyalgia was estimated to 1.3% (95% CI 0.8-1.7; n = 2425) and that of all chronic widespread pain to 4.2% (95% CI 3.4-5.0; n = 2425). The mean pain threshold measured with a dolorimeter was lower in subjects with chronic widespread pain (p < 0.01) and correlated with the number of tender points (r = -0.59, p < 0.01) but could not be used to distinguish the subjects with fibromyalgia.

    CONCLUSION: Compared to other studies, fibromyalgia and chronic widespread musculoskeletal pain seemed to be relatively rare conditions in the south-west of Sweden.

  • 100.
    Lindgren, H.
    et al.
    Faculty of Medicine, Lund University, Lund, Sweden & Department of Radiology, Helsingborg Hospital, Helsingborg, Sweden.
    Gottsäter, A.
    Vascular Centre, Skåne University Hospital, Malmö, Sweden.
    Hermansson, K.
    Department of Radiology, Helsingborg Hospital, Helsingborg, Sweden.
    Qvarfordt, P.
    Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital, Oskarström, Sweden.
    Gender differences in outcome after stent treatment of lesions in the femoropopliteal segment2012In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 101, no 3, p. 177-183Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: Although endovascular stent treatment is increasingly used in infrainguinal atherosclerotic occlusive disease, outcome with focus on gender differences has not been reported in detail.

    MATERIAL AND METHODS: One hundred and twelve consecutive patients (67 [60%]) women, undergoing endovascular nitinol stent treatment of atherosclerotic lesions in the femoropopliteal segment were analysed concerning improvement in ankle brachial index (ABI), reinterventions, complications, amputation and survival rates up to 12 months after intervention. Risk factors for amputation and death were analyzed with logistic regression.

    RESULTS: At presentation, women showed critical limb ischemia (CLI) more often than men (87% vs. 58 %; P = 0.001). After 12 months ABI had improved (from 0.40 ± 0.26 at baseline to 0.86 ± 0.22 after 12 months, P < 0.001), but 16 patients (15%) had been amputated and 27 patients (24 %) had died. After adjustment for age, diabetes mellitus and smoking, female gender was an independent risk factor for amputation (OR 9.0; 95% CI 1.1-76.5; P = 0.045).

    CONCLUSIONS: Stent treatment of lesions in the femoropopliteal segment had favourable effects on ABI and limb salvage. Treated women more often had CLI and ran a higher risk for amputation within 12 months than men. This might reflect failure of clinicians to adequately appreciate symptoms of atherosclerotic leg artery disease in women.

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