| 1. |
- Arvidsson, Susann, 1965-, et al.
(författare)
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Factors promoting health-related quality of life in patients with rheumatic diseases 12 months after rehabilitation
- 2010
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Ingår i: Svenska Läkaresällskapets Riksstämma 2010. ; , s. 3-3
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Konferensbidrag (refereegranskat)abstract
- Rheumatic diseases have significant adverse impact on the individual from physical, mental and social aspects, resulting in a low estimation of health-related quality of life (HRQL). Patients with rheumatoid arthritis who receive a multi-disciplinary team-based care in a rheumatology clinic could get improved HRQL. Several factors can be supposed to promote health in patients with rheumatic diseases and in health-promoting work within the clinical practice it would be valuable to identify health factors that affect HRQL in a positive direction.This is a longitudinal cohort study in 185 patients with rheumatic diseases with test one week and 12 months after rehabilitation on a Swedish rheumatology clinic. HRQL was assessed by SF-36 together with suggested health factors (chronic musculoskeletal pain, sleep quality, food habits, exercise habits, leisure habits, sexual lust, sense of coherence (SOC), social support and socio-demographic variables). The association between SF-36 subscales and suggested health factors were estimated by OR and 95 % CI calculated by multivariable logistic regressions.Factors predicting better outcome in HRQL in one or several SF-36 subscales were being of younger ages or middle-ages, feeling painless, having good sleep structure, feeling rested after sleep, doing low effort of exercise more than twice a week, having strong SOC, having emotional support and practical assistance, having higher educational level, and having working capacity. The most important factors were having strong SOC, feeling rested after sleep, having working capacity, being of younger ages or middle-ages, and having no/small problem with sleep structure.The most important factors promoting HRQL in patients with rheumatic diseases 12 months after rehabilitation were having strong SOC, feeling rested after sleep, having working capacity, being of younger ages or middle-ages, and having no/small problem with sleep structure. These health factors are important to address in clinical work with rheumatic diseases to optimise treatment strategies.
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| 2. |
- Arvidsson, Susann, 1965-, et al.
(författare)
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Factors promoting health-related quality of life in people with rheumatic diseases : a 12 month longitudinal study
- 2011
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Ingår i: BMC Musculoskeletal Disorders. - London : BioMed Central. - 1471-2474. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Rheumatic diseases have a significant adverse impact on the individual from physical, mental and social aspects, resulting in a low health-related quality of life (HRQL). There is a lack of longitudinal studies on HRQL in people with rheumatic diseases that focus on factors promoting HRQL instead of risk factors. The aim of this study was to investigate the associations between suggested health promoting factors at baseline and outcome in HRQL at a 12 month follow-up in people with rheumatic diseases.Methods: A longitudinal cohort study was conducted in 185 individuals with rheumatic diseases with questionnaires one week and 12 months after rehabilitation in a Swedish rheumatology clinic. HRQL was assessed by SF-36 together with suggested health factors. The associations between SF-36 subscales and the health factors were analysed by multivariable logistic regressions.Results: Factors predicting better outcome in HRQL in one or several SF-36 subscales were being younger or middle-aged, feeling painless, having good sleep structure, feeling rested after sleep, performing low effort of exercise more than twice per week, having strong sense of coherence (SOC), emotional support and practical assistance, higher educational level and work capacity. The most important factors were having strong SOC, feeling rested after sleep, having work capacity, being younger or middle-aged, and having good sleep structure.Conclusions: This study identified several factors that promoted a good outcome in HRQL to people with rheumatic diseases. These health factors could be important to address in clinical work with rheumatic diseases in order to optimise treatment strategies. © 2011 Arvidsson et al; licensee BioMed Central Ltd.
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| 3. |
- Arvidsson, Susann, 1965-, et al.
(författare)
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People with Rheumatic Diseases Experiences of Health-Promoting Self-Care
- 2010
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Books. - 0003-4967 .- 1468-2060. ; 69:Suppl. 3, s. 743-743
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Tidskriftsartikel (refereegranskat)abstract
- Background: People with rheumatic diseases estimate their health status low. The health status and health belief are influencing the choice of self-care behaviours. Self-care behaviours are common and could prevent loss of valued life activities and health. Little is known of how people with rheumatic diseases experience self-care.Objectives: To describe people with rheumatic diseases experiences of health-promoting self-care.Methods: The study had a phenomenological approach based on a reflective life-world perspective. Data were gathered by unstructured and open-ended interviews with 12 individuals with various diagnoses of rheumatic diseases.Results: For people with rheumatic diseases, self-care was a way of life and implied being ready at all times to understand and respond to signals from the lived body. Self-care was experienced as an internal dialogue within the lived body but also as an external dialogue with the immediate environment. Self-care could also be described as a power struggle where the individuals strived and forced themselves to fight the diseases and its concrete consequences. The self-care also required that choices were made. Crucial for the choices were trust in oneself and belief in one's own ability to chosen health-promoting self-care. The individual prioritised self-care that was experienced as a beneficial and/or a reward for the lived body.Conclusion: People with rheumatic diseases experienced self-care as a way of life and that it meant to be ready at all times to understand and respond to signals that the lived body sends out. Self-care required dialogue, power struggle and choice. This knowledge ads to a fuller understanding of factors that from a patient perspective are important for health when living with a chronic rheumatic disease.Disclosure of Interest: None declared
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| 4. |
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| 5. |
- Arvidsson, Susann, 1965-, et al.
(författare)
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Psychometric Properties of the Swedish Rheumatic Disease Empowerment Scale, SWE-RES-23
- 2010
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Ingår i: Svenska Läkaresällskapets Riksstämma 2010. ; , s. 3-3
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Konferensbidrag (refereegranskat)abstract
- Empowerment is a central concept in a patient-focused rheumatology care. WHO describes empowerment as a process in which the person receives more control over decisions and actions that affect the own life and health. Today there is no Swedish empowerment instrument for rheumatic diseases created or transl[...]The already existing questionnaire, Swedish Diabetes Empowerment Scale (SWE-DES-23), was adapted for use in patients with rheumatic diseases by exchanging the word diabetes with rheumatic disease in all the questions. No items were added or removed. The adapted questionnaire was called SWE-RES-23. In 2009, 260 patients with rheumatic diseases from a rheumatology unit in the southwest of Sweden completed the questionnaire.In order to establish discriminant validity, a question about self-perceived health from SF-36 was used in addition to SWE-RES-23.Construct validity was tested by using exploratory factor analysis. In order to determine unidimensionality of the empowerment subscales, inter-item correlations were calculated. Internal consistency reliability was tested by the use of the Cronbach-α coefficient.The exploratory factor analysis resulted in five factors (empowerment subscales) with Eigenvalues >1 explaining 64.1% of the variance. The five empowerment subscales were: Goal achievement and overcoming barriers to goal achievement, Self-awareness, Managing stress, Assessing dissatisfaction and readiness to change, and Support for caring. The Cronbach-α values ranged from 0.59 to 0.91 and for the total score 0.92. All inter-item correlations were significant. Patients with very good and good self-reported health scored significantly higher on three empowerment subscales (Goal achievement, Self-awareness and Managing stress). The same patterns were seen in the other two empowerment subscales (Readiness to change and Support for change), but did not reach significance.The SWE-RES-23 was a first step in developing a questionnaire for assessment of empowerment of patients with rheumatic diseases. The questionnaire possesses acceptable validity and reliability. To fully validate the SWE-RES-23 further studies are needed, but the instrument is even now possible to use in empowerment education programmes for patients with rheumatic diseases.
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| 6. |
- Larsson, Ingrid, 1968-, et al.
(författare)
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Biological therapy can be monitored more cost effectively by a nurse-led rheumatology clinic
- 2014
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Books. - 0003-4967 .- 1468-2060. ; 72, Suppl. 3, s. 139-140
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Tidskriftsartikel (refereegranskat)abstract
- 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.ReferencesLarsson et al. (2014). Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy. J Adv Nurs, 70(1): 164-175.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.
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| 7. |
- Larsson, Ingrid, 1968-, et al.
(författare)
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Biological therapy could be monitored by a rheumatology nurse-led clinic without any differences in outcome – a randomised controlled study
- 2012
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Konferensbidrag (refereegranskat)abstract
- 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.
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| 8. |
- Larsson, Ingrid, 1968-, et al.
(författare)
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Sjuksköterskemottagning för patienter med en reumatisk sjukdom behandlade med biologiska läkemedel – ett randomiserat, kontrollerat försök jämförande sjuksköterskemottagning med läkarmottagning
- 2012
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Konferensbidrag (refereegranskat)abstract
- 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.
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| 9. |
- Larsson, Ingrid, 1968-, et al.
(författare)
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Treatment Outcomes From a Nurse-Led Rheumatology Clinic in Monitoring of anti-TNF Therapy – a Randomised Controlled Trial
- 2012
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Ingår i: Arthritis and Rheumatism. - Hoboken, NJ : John Wiley & Sons. - 0004-3591 .- 1529-0131. ; 64:10, s. S667-S667
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 10. |
- Rask, Mikael, 1958-, et al.
(författare)
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Validity and reliability of a Swedish version of the Relationship Assessment Scale (RAS) : a pilot study
- 2010
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Ingår i: Canadian journal of cardiovascular nursing. - Ottawa : Canadian Council of Cardiovascular Nurses. - 0843-6096. ; 20:1, s. 16-21
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There is a need for a short and easily administered scale, in the Swedish language, for assessing partner relationships in the health care of persons with cardiac disease. PURPOSE: To establish the reliability and validity of the Swedish version of the Relationship Assessment Scale (RAS). DESIGN: The present pilot study has a methodological design. FINDINGS: Content validity has been tested for relevance, clarity and readability. The scale was tested for construct validity with explorative factor analysis. The reliability was tested by internal consistency and test-retest analysis. The result showed a two-factor solution, which does not correspond to the original proposed one-factor solution. The factor analyses revealed two quite distinct factors of RAS, labelled "Relationship built on expectations and satisfaction of needs" and "Relationship built on love and devotion". CONCLUSIONS: The scale has satisfactory psychometric properties in terms of content validity, construct validity, homogeneity and stability in a population of persons with cardiac disease. Wider evaluations of the RAS for other populations and settings are recommended.
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