| 1. |
- Bondesson, Elisabeth, et al.
(författare)
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Can Baseline Characteristics Predict Successful Outcomes after Individual, Physiotherapist-Led Rehabilitation in Patients with Chronic Musculoskeletal Pain?
- 2023
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Ingår i: Pain research & management. - 1203-6765. ; 2023
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: No strong and consistent variables to predict outcome after pain rehabilitation have been reported in patients with chronic musculoskeletal pain. The aim of the present study was to clarify if baseline variables could predict successful outcome after a unique, individualized, physiotherapist-led rehabilitation of nine sessions.METHODS: In 274 individuals with severe chronic musculoskeletal pain, the risk ratio (RR) and 95% confidence intervals (CIs) were estimated for potentially predictive baseline variables on successful outcomes of pain management, overall health, and pain rating.RESULTS: Statistically significant results show that patients rating moderate or severe baseline pain were in both cases 14% less likely to improve pain management compared to patients rating mild baseline pain (RR = 0.86; 95% CI 0.77-0.97, RR = 0.86; 95% CI 0.74-1.00). Patients with the shortest pain duration were 1.61 times more likely to improve overall health (RR = 1.61; 95% CI 1.13-2.29) compared to patients reporting the longest pain duration (>5 years). Patients reporting anxiety/depression or severe pain were in both cases 1.48 times more likely to improve overall health compared to better baseline presentations (RR = 1.48; 95% CI 1.16-1.88, RR = 1.48; 95% CI 1.03-2.15). Patients with regional/generalized pain were 36% less likely to rate pain reduction (RR = 0.64; 95% CI 0.41-1.00) compared to patients rating localized baseline pain. Of 17 potentially predictive baseline variables, four reached statistical significance for at least one of the three outcomes; although none of them for all three outcomes.CONCLUSIONS: Of 17 potentially predictive baseline variables, mild pain ratings, short pain duration, and localized baseline pain were statistically significantly associated with improvements after individual, physiotherapist-led rehabilitation for patients with chronic musculoskeletal pain. This suggests that this type of rehabilitation probably should be offered early in the pain process. Reporting anxiety/depression or severe pain at the baseline did not hinder the improvements of overall health.
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| 2. |
- Jöud, Anna, et al.
(författare)
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The association between pain characteristics, pain catastrophizing and health care use – Baseline results from the SWEPAIN cohort
- 2017
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Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter GmbH. - 1877-8860 .- 1877-8879. ; 16, s. 122-128
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Tidskriftsartikel (refereegranskat)abstract
- Background and aim Pain is common and adds to the global burden of disease. However, individuals suffering from pain are a heterogeneous group in terms of pain spreading, intensity and duration. While pain influences overall health care consultation not everyone with pain consult health care. To be able to provide health care matching the patients’ needs increased knowledge about what factors determines the decision to consult health care is essential. The aim of this study was to explore the combined importance of pain spreading, intensity, duration and pain catastrophizing for consulting health care. Methods In this cross-sectional study we used population based survey data from southeast Sweden (SWEPAIN) including 7792 individuals’ aged 16–85 reporting pain. We used Modified Poisson regressions to analyse factors of importance related to the decision to consult health care. Results High and moderate pain intensity, as compared to low, increases the probability of consulting health care (High PR = 1.7 [95% CI 1.51–1.88], moderate PR = 1.2 [1.15–1.41]). Having widespread pain, as compared to localised pain, increased the probability of consulting health (PR = 1.2 [1.03–1.36). Pain duration was not associated with increased probability of consulting health care (PR = 1.0 CI0.88–1.07). However an interaction (p = 0.05) between pain duration and pain catastrophizing beliefs was seen indicating a combined importance of the two when consulting health care. Conclusion Our result suggests that pain intensity, pain spreading and pain catastrophizing independently influence the decision to consult health care while there is an interaction effect between pain duration and pain catastrophizing beliefs where the importance of pain catastrophizing believes differ with pain duration; the importance of pain catastrophizing believes differ with pain duration. Implications Treatment and rehabilitation strategies should incorporate this finding in order to meet the individual's needs focusing on the biopsychosocial model within health care focusing not only on actual pain reliefs but also on for example acceptance and behavioural changes.
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| 3. |
- Nilsson, Anna-Lena, 1962-, et al.
(författare)
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Landstinget i Kalmar läns Traineeprogram 2006-2007 : Utvärderingsrapport
- 2008
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- September 2006 startade Landstinget i Kalmar län sitt första interna Traineeprogram i syfte att skapa ett fundament av lämpliga ledarkandidater respektive potentiella chefer inom landstinget. Det drygt ettåriga programmet påbörjades av 27 deltagare, med olika profession, från olika delar av länet. Programmet innefattade dels moment inom Landstinget i Kalmar län såsom praktik, mentorskap, interna och externa föreläsningar, dels moment på Handelshögskolan BBS, Högskolan i kalmar, såsom föreläsningar, teori och projektarbeten.Landstinget i Kalmar län gav vid årsskiftet 2006/2007 eHälsoinstitutet i uppdrag att utvärdera Traineeprogrammet med avseende på upplägg och innehåll. Datainsamlingen utfördes i enkätform med eHälsoinstitutets webbaserade enkätsystem. Data samlades in vid tre tillfällen, februari 2007, juni-augusti 2007 och december 2007.Utvärderingen visar att deltagarna uppskattade att de fått möjlighet att delta i Traineeprogrammet. Deltagarna var nöjda med programmets upplägg och innehåll. Flertalet lovordade kursen som hölls av BBS. Under programmets gång var deltagarna mindre positiva till mentorsdelen och praktikdelen, som har fungerat i varierande grad för olika deltagare. Flertalet deltagare uppgav oklarheter i syftet med dessa delar. Deltagarna efterfrågade även tydlighet i det övergripande syftet med programmet; vad kommer programmet att leda till med avseende på framtida chefsuppdrag? Flertalet deltagare uppgav att en stor bonus med programmet var att ha skapat nya nätverk med medarbetar på olika förvaltningar och kliniker inom landstinget.
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| 4. |
- Trulsson Schouenborg, Anna, et al.
(författare)
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Physiotherapist-led rehabilitation for patients with chronic musculoskeletal pain : interventions and promising long-term outcomes
- 2021
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 22:1, s. 910-910
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There is no consensus on best content, set-up, category of involved healthcare professionals or duration of rehabilitation-programs for patients with chronic musculoskeletal pain, and outcomes show varying results. Individual care regimes for sub-groups of patients have been proposed.AIM: To describe the type of interventions used in a physiotherapist-led, rehabilitation-program for patients with chronic musculoskeletal pain, refractory to preceding treatments. A second aim was to report clinical outcomes at 1-year follow-up after the intervention period.METHODS: All patients referred to physiotherapist within a specialist pain-unit due to being refractory to preceding treatments, and deemed fit to undergo physiotherapy-based, individualized rehabilitation during 2014-2018 were consecutively included and followed-up 1 year after ending the program. The inclusion was based on structured 'clinical reasoning' using the referral, examination and on patient-relevant outcome measures. The individual interventions, recorded according to a manual used when reading the patients' medical records, were described. Primary outcomes were clinical results of perceived pain, disability and overall health at start, discharge and 1 year after discharge.RESULTS: In total, 274 patients (mean age 42 years, 71% women) were included, suffering from chronic, severe, musculoskeletal pain (VAS median 7/10, duration median 2.8 years) and moderate disability. The most frequent interventions were education, sensorimotor training, physical activity-advice and interventions for structures/functions (for example manual techniques, stretching) for a median of nine sessions during five months. Despite refractory to preceding treatments, 45% of the patients rated clinically important improvements on pain, 61% on disability and 50% on overall health at discharge and the figures were similar at 1-year follow-up.CONCLUSIONS: A physiotherapist-led, one-to-one, rehabilitation-program of median nine sessions during five months, combining individualized education, sensorimotor training, physical activity-advice and interventions for structures/functions rendered clinically relevant improvements on pain, disability and overall health in half of the patients at 1-year follow-up. Since the cohort consisted of patients refractory to preceding treatments, we believe that these results warrant further studies to identify the subgroups of patients with chronic musculoskeletal pain that will improve from new, distinctive, resource-effective rehabilitation-programs involving individualized rehabilitation.
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| 5. |
- Westergren, Hans, et al.
(författare)
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Sex-based differences in pain distribution in a cohort of patients with persistent post-traumatic neck pain
- 2018
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 40:9, s. 1085-1091
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To analyze a cohort of 745 consecutive patients referred to a regional specialist clinic for evaluation of post-traumatic neck pain during a five-year period. Methods: A cross-sectional observational study of baseline assessments performed by multi-professional rehabilitation teams according to a standardized checklist. Results: The cohort contained nearly twice as many females as males (64% versus 36%). The type of injury did not differ between sexes. Of the entire cohort, 38% were diagnosed with widespread pain, 50% with regional pain, and 12% with local pain. The pain distribution among the females was 43% widespread, 48% regional, and 9% local, and corresponding figures among males were 29%, 53%, and 18%. Longer time between trauma and assessment did not affect pain distribution among the men, but a tendency towards more widespread pain was observed among the women. Discussion: The importance of "female sex" as risk factor for the development of persistent pain after neck trauma needs to be discussed further. The high frequency of regional and widespread pain among patients with persistent neck pain after trauma calls for both multidisciplinary assessments and treatment strategies. The relationships between different pain distribution patterns, disability, activity, and psychological factors need to be studied further.Implications for rehabilitationPatients suffering from pain and disability after neck trauma constitute a significant proportion of patients with persistent pain.The importance of the risk factor “female sex" should be further discussed in the development of persistent pain after neck trauma.The high frequency of regional and widespread pain among patients with persistent neck pain after trauma calls both for multidisciplinary assessments and treatment strategies.The relationships between different pain distribution patterns, disability, activity, and psychological factors need to be studied further.
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| 6. |
- Agger, Erik, et al.
(författare)
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Negative prognostic impact of tumor deposits in rectal cancer – a national study cohort
- 2023
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Ingår i: Annals of Surgery. - 1528-1140. ; 273:3, s. 526-533
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate whether tumor deposits (TDs) in rectal cancer are associated withincreased recurrence risk and decreased survival.Summary background data: Tumor deposits (TDs) are considered a risk factor forrecurrence after colon cancer resection and presence of TDs prompts adjuvant chemotherapy.The prognostic relevance of TDs in rectal cancer requires further exploration.Methods: All patients treated with abdominal resection surgery for rectal cancer in Swedenbetween 2011 and 2014 were eligible for inclusion in this retrospective cohort-study based onprospectively collected data from the Swedish ColoRectal Cancer Registry. Primary endpointwas local recurrence or distant metastasis. Secondary outcomes were overall and relativesurvival.Results: 5455 patients were identified. 3769 patients were analysed after exclusion. TDs werefound in 404 (10.7%) patients including where 140 (3.7%) patients with had N1c-status. InTD-positive patients, local recurrence and distant metastasis rates at 5 years were 6.3% [95%CI 3.8-8.8%] and 38.9% [95% CI, 33.6-43.5%] compared to 2.7% [95% CI, 2.1-3.3%] and14.3% [95% CI, 13.1-15.5%] in TD-negative patients. In multivariable regression analysis,risk of local recurrence and distant metastasis were increased; HR 1.86 [95% CI, 1.09-3.19;P=0.024] and 1.87 [95% CI, 1.52-2.31; P=was 68.8% [95% CI, 64.4-73.4%] in TD-positive patients and 80.7% [95% CI, 79.4-82.1%] inTD-negative patients. pN1c-patients had similar outcomes regarding local recurrence, distantCopyright © 2022 Wolters Kluwer Health, Inc. Unauthorized reproduction of the article is prohibited.ACCEPTEDmetastasis and survival as pN1a-b stage patients. TD-positive pN1a-b patients hadsignificantly worse outcomes while TDs did not affect outcomes in pN2a-b patients.Conclusion: This study suggests that TDs have a negative impact on prognosis in rectalcancer. Thus, efforts should be made to diagnose TD-positive rectal cancer patientspreoperatively.
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| 7. |
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| 8. |
- Berthold, Elisabet, et al.
(författare)
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The risk of depression and anxiety is not increased in individuals with juvenile idiopathic arthritis - results from the south-Swedish juvenile idiopathic arthritis cohort
- 2022
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Ingår i: Pediatric Rheumatology. - : Springer Science and Business Media LLC. - 1546-0096. ; 20:1, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundChildren with chronic diseases are reported to have increased risk of psychiatric comorbidity. Few studies have investigated this risk in juvenile idiopathic arthritis (JIA), with conflicting results. We performed a population-based, longitudinal cohort study of the risk of depression and anxiety in south-Swedish patients with juvenile arthritis.MethodsThe south-Swedish JIA cohort (n = 640), a population-based cohort with validated JIA diagnosis 1980 – 2010 and comparators, a reference group of 3200 individuals free from JIA, matched for sex, year of birth and residential region, was used. Data on comorbid diagnosis with depression or anxiety were obtained from the Skåne Healthcare Register, containing all healthcare contacts in the region, from 1998 to 2019. We used Cox proportional models for the calculation of hazard ratios.ResultsDuring the study period, 1998 to 2019, 93 (14.5%) of the individuals in the JIA group were diagnosed with depression, and 111 (17.3%) with anxiety. Corresponding numbers among the references was 474 (14.8%) with depression and 557 (17.4%) with anxiety. Hazard ratio for depression was 1.1 (95% CI 0.9 – 1.5) in females and 0.8 (95% CI 0.5 – 1.4) in males, and for anxiety 1.2 (95% CI 0.9 – 1.5) in females and 0.6 (95% CI 0.4 – 1.1) in males. There were no statistically significant hazard ratios when analyzing subgroups of JIA patients with long disease duration or treatment with disease-modifying antirheumatic drugs.ConclusionsIndividuals with JIA do not have any statistically increased risk of being diagnosed with depression or anxiety compared to matched references.
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| 9. |
- Bondesson, Elisabeth, et al.
(författare)
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Health care utilization among individuals who die by suicide as compared to the general population : a population-based register study in Sweden
- 2022
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Globally, 700 000 people die every year by suicide. Health care consultation patterns the period before suicide could be one potential way to identify people at risk for suicide. Therefore, this study examines health care patterns up to one year prior to the suicide by age, sex and prior diagnoses and specifically investigates if and how this differs from the general population of Skåne, Sweden.METHODS: This cohort study includes all individuals, aged 15 and older, that died by suicide in Region Skåne, Sweden from 2004 to 2015 (n = 1653). The individuals were identified through the Cause of death register and then linked to the Skåne healthcare register. Health care data was analyzed as proportions consulting different types of health care the month and year preceding the suicide, we also investigated the impact of age, sex and the occurrence of prior psychiatric and pain diagnoses. Additionally, we compared the proportion of consulting care among the suicide victims and the general population of Skåne.RESULTS: In the month before their death, 53% of the suicide victims had any health care consultation, compared with 20% in the general population of Skåne, a given month (p < 0.0001). The corresponding figures for the year prior to suicide was 86% among those who died by suicide, compared to 69% in the general population of Skåne, a given year (p < 0.0001). Women, and those having a documented history of psychiatric diagnosis were more likely to have health care consultations in the month and year preceding suicide (p < 0.001), compared to men and suicide victims without a history of psychiatric disease. Older adults that died by suicide, were less likely to consult psychiatric care compared to the younger suicide victims (p < 0.001).CONCLUSION: A majority of the suicide victims consulted health care in the near time before death and the proportion of seeking health care was significantly higher than in the general population of Skåne and higher among female suicide victims as compared to males. Alternative preventive screening measures should be considered for individuals consulting health care, especially for older people and individuals outside the psychiatric care.
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| 10. |
- Bondesson, Elisabeth, et al.
(författare)
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Utilization of healthcare and prescription medicines after non-pharmacological interventions for depression - A 3-year register follow-up of an RCT in primary care
- 2022
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Ingår i: Preventive Medicine Reports. - : Elsevier. - 2211-3355. ; 25
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Tidskriftsartikel (refereegranskat)abstract
- Depression is a common, recurrent disorder. There is a need for readily available treatments with few negative side effects, that demands little resources and that are effective both in the short- and long term. Our aim was to investigate the long-term effectiveness of two different interventions; physical exercise and internet-based cognitive behavioural therapy (internet-CBT), compared to usual care in patients with mild to moderate depression in a Swedish primary care setting. We performed a register-based 3-year follow-up study of participants in the randomized controlled trial REGASSA (n = 940) using healthcare utilization and dispensed medicines as outcomes. We found no difference between the three groups regarding proportion of participants consulting healthcare due to mental illness or pain during follow-up. Regarding number of consultations, there was no difference between the groups, except for consultations related to pain. For this outcome both treatment arms had significantly fewer consultations compared to usual care, during year 2-3, the risk ratio (RR) for physical exercise and internet-CBT was 0.64 (95% CI = 0.43-0.95) and 0.61 (95% CI = 0.41-0.90), respectively. A significantly lower proportion of patients in both treatment arms were dispensed hypnotics and sedatives year 2-3 compared to the usual care arm, RR for both physical exercise and internet-CBT was 0.72 (95% CI = 0.53-0.98). No other differences between the groups were found. In conclusion, considering long-term effects, both physical exercise and internet-CBT, being resource-efficient treatments, could be considered as appropriate additions for patients with mild to moderate depression in primary care settings.
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