| 1. |
- Andersson, Maria L.E. 1968-, et al.
(author)
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Associations between metabolic factors and radiographic knee osteoarthritis in early disease-a cross-sectional study of individuals with knee pain
- 2022
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In: Bmc Musculoskeletal Disorders. - London : Springer Science and Business Media LLC. - 1471-2474. ; 23:1
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Journal article (peer-reviewed)abstract
- Objective Metabolic factors have been shown to be associated to severe radiographic knee osteoarthritis (RKOA). However, more knowledge is needed in early clinical knee osteoarthritis (KOA). The aim was to study associations between metabolic factors and radiographic knee osteoarthritis (OA) in individuals with knee pain. A second aim was to study associations between metabolic factors and RKOA in those with normal BMI and in those overweight/obese, respectively. Method This cross-sectional study included 282 individuals with knee pain (without cruciate ligament injury) and aged 30-67 years, and 70% women. Waist circumference, body mass index (BMI), proportion of fat and visceral fat area (VFA) were assessed. RKOA was defined as Ahlback grade 1 in at least one knee. Fasting blood samples were taken and triglycerides, cholesterol (total, low density lipoprotein (LDL) and high density lipoprotein (HDL)), C-reactive protein (CRP), glucose, HbA1C were analysed. Metabolic syndrome was defined in accordance with the International Diabetes Federation (IDF). Associations were analysed by logistic regression. Results Individuals with RKOA were older, had higher BMI, higher VFA, larger waist circumference and had increased total cholesterol, triglycerides and LDL-cholesterol, but not fasting glucose. There was no difference between the group with RKOA vs. non-radiographic group regarding the presence of metabolic syndrome. In a subgroup analysis of individuals with normal BMI (n = 126), those with RKOA had higher VFA, more central obesity, higher levels of CRP and total cholesterol, compared with individuals without RKOA. In individuals with obesity, age was the only outcome associated to RKOA. Conclusion There were clear associations between metabolic factors and RKOA in individuals with knee pain, also in those with normal BMI. In individuals with obesity age was the only variable associated to RKOA.
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| 2. |
- Andersson, Maria L.E., et al.
(author)
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Cohort profile: the Halland osteoarthritis (HALLOA) cohort-from knee pain to osteoarthritis: a longitudinal observational study in Sweden
- 2022
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In: Bmj Open. - London : BMJ. - 2044-6055. ; 12:7
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Journal article (peer-reviewed)abstract
- Purpose The overall objective in this study is to investigate the early development of radiographic knee osteoarthritis (OA) and its association with hand or/and knee OA, metabolic diseases, biomarkers, chronic pain, physical function and daily physical activity types. Participants The Halland osteoarthritis (HALLOA) cohort is a longitudinal cohort study that includes individuals with knee pain in the southwest of Sweden. Enrolment took place from 2017 to 2019. The inclusion criteria were current knee pain, with no former known radiographic knee OA and no cruciate ligament rupture or rheumatological disorder. The participants were recruited: (1) when seeking care for knee pain in primary healthcare or (2) by advertisements in local newspapers. There are 306 individuals included in the study, mean age (SD) 51.7 (8.7) years and 69% are women. The baseline and follow-ups include clinical tests, radiographical examinations, blood samples, metabolic measures, pain pressure thresholds, tests of physical functions, daily physical activity types and patient-reported outcomes. Findings to date There were associations between metabolic factors and radiographic knee OA, even in those with normal body mass index at baseline. In addition, clinical hand OA was positively associated with fasting plasma glucose. We also found that modifiable factors as increased visceral fat and total body fat were associated with increased pain sensitivity among individuals with knee pain. Future plans By studying possible pathophysiological mechanisms of OA over time, we aim to provide new insights on OA progression, identify usable preventive measures helping the clinicians in the management of the disease and improve health for the patients. It is also important to study the development of chronic pain in OA, to get tools to identify individuals at risk and to be able to offer them treatment.
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| 3. |
- Bremander, Ann, 1957-, et al.
(author)
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Cultural adaptation, validity, reliability and responsiveness of the Swedish version of the effective musculoskeletal consumer scale (EC-17)
- 2012
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In: Musculoskeletal Care. - Chichester : John Wiley & Sons. - 1478-2189 .- 1557-0681. ; 10:1, s. 43-50
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Journal article (peer-reviewed)abstract
- BACKGROUND: Endorsed by the Outcome MEasures in Rheumatoid Arthritis in Clinical Trials (OMERACT) group, The Effective Consumer Scale (EC-17) was developed in English for patients with musculoskeletal diseases to assess the skills and perceptions important for participating in and managing health care. The objective of this study was culturally to adapt the questionnaire into Swedish and to study its psychometric properties.METHODS: After translation of the questionnaire into Swedish, two different groups of outpatients from two specialist rheumatology departments participated in the study. Face validity was assessed, together with internal consistency, test-retest and responsiveness of the questionnaire. Construct validity was assessed using the Arthritis Self-Efficacy Scale (ASES), and responsiveness to a five day educational intervention was analysed using the standardized response mean (SRM).RESULTS: Analyses were based on 124 patients with inflammatory rheumatic diseases, of whom 50 attended the intervention. Data quality met the requirements, with missing values <5%, and floor and ceiling effects <15%. Item total correlations were all >0.4, ranging from 0.49 to 0.88. Cronbach's alpha was 0.93 and 0.95 for the two groups. The test-retest correlation (ICC₂.₁) was 0.94, and there was a significant improvement as a result of the intervention, with an SRM of 0.43. However, the questionnaire had a higher construct validity with the ASES subscale 'other symptoms' than hypothesized a priori (r(s) 0.75).CONCLUSION: The Swedish version of the EC-17 met the required recommendations for face validity, internal consistency, test-retest reliability and responsiveness. Its construct validity needs to be further established, and the questionnaire needs further testing in different groups of patients and in different interventions. © 2012 John Wiley & Sons, Ltd.
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| 4. |
- Bremander, Ann, 1957-, et al.
(author)
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Importance of Measuring Hand and Foot Function Over the Disease Course in Rheumatoid Arthritis : An Eight-Year Follow-Up Study
- 2019
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In: Arthritis care & research. - Hoboken : John Wiley & Sons. - 2151-464X .- 2151-4658. ; 71:2, s. 166-172
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Journal article (peer-reviewed)abstract
- Objective: To assess function using the Signals of Functional Impairment (SOFI) instrument over 8 years, to study clinical variables associated with the change, and to study change over time of the SOFI items.Methods: In total, 1,223 patients with early rheumatoid arthritis (RA) from the Better Anti-Rheumatic Farmacotherapy (BARFOT) cohort (mean ± SD age 56.9 ± 15.4 years, 67% women) were included in the analysis. Data from baseline and from 1 and 8 years were studied. The SOFI instrument includes measures of range of motion in the hand, shoulder/arm, and lower extremity (range 0–44, best to worst). The effects of baseline variables (sociodemographic, disease activity, joint destruction, and function) on change in SOFI scores were studied by linear regression analysis.Results: During the first year, the improvement in mean ± SD SOFI scores was 2.7 ± 5.7 (P < 0.001). Worse scores in the Disease Activity Score in 28 joints and Health Assessment Questionnaire score at baseline were associated with this improvement (r2 <= 0.11). During the next 7 years, the deterioration in SOFI scores was mean ± SD 1.5 ± 4.9 (P < 0.001). Based on change scores, we found that finger flexion, pincer grip, and toe-standing were the most important items to measure, explaining 58-61% of the total SOFI score, and these items were also associated with radiographic changes at the 8-year follow-up.Conclusion: Function as assessed with SOFI scores improved during the first year in patients with early RA, but it deteriorated slowly thereafter. Impaired hand and foot function was associated with joint destruction at the 8-year follow-up. Measures of hand and foot function will complement self-reported and medical data, both in clinical work and in long-term research studies. Copyright © 2019, Emerald Publishing Limited
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| 5. |
- Bremander, Ann, 1957-, et al.
(author)
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Population-based estimates of common comorbidities and cardiovascular disease in ankylosing spondylitis
- 2011
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In: Arthritis care & research. - Hoboken, NJ : John Wiley & Sons. - 2151-464X .- 2151-4658. ; 63:4, s. 550-556
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Journal article (peer-reviewed)abstract
- 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.
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| 6. |
- Cöster, Maria, et al.
(author)
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Surgery for adult acquired flatfoot due to posterior tibial tendon dysfunction reduces pain, improves function and health related quality of life
- 2015
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In: Foot and Ankle Surgery. - London : Elsevier. - 1268-7731 .- 1460-9584. ; 21:4, s. 286-289
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Journal article (peer-reviewed)abstract
- BACKGROUND: Patients with adult acquired flatfoot deformity (AAFD) due to posterior tibial tendon dysfunction (PTTD) may require surgery but few reports have evaluated the outcome.METHODS: We evaluated 21 patients with a median age of 60 (range 37-72) years who underwent different surgical reconstructions due to stage II AAFD before and 6 and 24 months after surgery by the validated Self-Reported Foot and Ankle Score (SEFAS), Short Form 36 (SF-36) and Euroquol 5 Dimensions (EQ-5D).RESULTS: The improvement from before to 24 months after surgery was in SEFAS mean 12 (95% confidence interval 8-15), SF-36 physical function 21 (10-22), SF-36 bodily pain 28 (17-38), EQ-5D 0.2 (0.1-0.3) and EQ-VAS 11 (2-21).CONCLUSION: Surgery for AFFD due to PTTD results in reduced pain and improved function and health related quality of life. The outcome scores have been demonstrated as useful. It has also been shown, since there is a further improvement between 6 and 24 months after surgery, that a minimum follow-up of 2 years is needed.LEVEL OF CLINICAL EVIDENCE: III - prospective observational cohort study.2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.
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| 7. |
- Cöster, Maria, et al.
(author)
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Validity, reliability, and responsiveness of the Self-reported Foot and Ankle Score (SEFAS) in forefoot, hindfoot, and ankle disorders
- 2014
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In: Acta Orthopaedica. - London : Informa Healthcare. - 1745-3674 .- 1745-3682. ; 85:2, s. 187-194
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Journal article (peer-reviewed)abstract
- BACKGROUND AND PURPOSE: The self-reported foot and ankle score (SEFAS) is a questionnaire designed to evaluate disorders of the foot and ankle, but it is only validated for arthritis in the ankle. We validated SEFAS in patients with forefoot, midfoot, hindfoot, and ankle disorders.PATIENTS AND METHODS: 118 patients with forefoot disorders and 106 patients with hindfoot or ankle disorders completed the SEFAS, the foot and ankle outcome score (FAOS), SF-36, and EQ-5D before surgery. We evaluated construct validity for SEFAS versus FAOS, SF-36, and EQ-5D; floor and ceiling effects; test-retest reliability (ICC); internal consistency; and agreement. Responsiveness was evaluated by effect size (ES) and standardized response mean (SRM) 6 months after surgery. The analyses were done separately in patients with forefoot disorders and hindfoot/ankle disorders.RESULTS: Comparing SEFAS to the other scores, convergent validity (when correlating foot-specific questions) and divergent validity (when correlating foot-specific and general questions) were confirmed. SEFAS had no floor and ceiling effects. In patients with forefoot disorders, ICC was 0.92 (CI: 0.85-0.96), Cronbach's α was 0.84, ES was 1.29, and SRM was 1.27. In patients with hindfoot or ankle disorders, ICC was 0.93 (CI: 0.88-0.96), Cronbach's α was 0.86, ES was 1.05, and SRM was 0.99.INTERPRETATION: SEFAS has acceptable validity, reliability, and responsiveness in patients with various forefoot, hindfoot, and ankle disorders. SEFAS is therefore an appropriate patient- reported outcome measure (PROM) for these patients, even in national registries.
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| 8. |
- Drake Af Hagelsrum, Klara, et al.
(author)
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Healthcare professionals' perceptions of working on lifestyle management for patients with early rheumatoid arthritis – a qualitative study
- 2023
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In: International Journal of Qualitative Studies on Health and Well-being. - Abingdon : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 18:1
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Journal article (peer-reviewed)abstract
- AIM: To explore HPs' perceptions of working on lifestyle management for patients with early rheumatoid arthritis (RA). METHODS: In this qualitative study, individual interviews were conducted with 20 HPs. Qualitative content analysis was used, and three categories and six subcategories were identified. RESULTS: HPs' perceptions of working on lifestyle management for patients with early RA revealed a need for commitment from different levels. This included commitment from healthcare managers and organizations prioritizing work on lifestyle management and providing competence development for HPs. Commitment within the team regarding coordination of interdisciplinary teamwork and development of a structured lifestyle management approach, and commitment to involving patients in lifestyle management, by facilitating patient engagement and a person-centred approach. CONCLUSIONS: HPs' perceptions of working on lifestyle management for patients with early RA revealed that commitment from healthcare managers, organizations, and the interdisciplinary team was essential to facilitate collaboration, patient involvement, and a person-centred approach. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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| 9. |
- Haglund, Emma, 1970-, et al.
(author)
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Differences in physical activity patterns in patients with spondylarthritis
- 2012
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In: Arthritis Care and Research. - Hoboken : John Wiley & Sons. - 0893-7524 .- 1529-0123 .- 2151-464X .- 2151-4658. ; 64:12, s. 1886-1894
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Journal article (peer-reviewed)abstract
- 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.
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| 10. |
- Haglund, Emma, 1970-, et al.
(author)
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Predictors of Presenteeism and Activity Impairment Outside Work in Patients with Spondyloarthritis
- 2015
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In: Journal of occupational rehabilitation. - New York, NY : Springer-Verlag New York. - 1053-0487 .- 1573-3688. ; 25:2, s. 288-295
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Journal article (peer-reviewed)abstract
- 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.
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