| 1. |
- Revenäs, Åsa, et al.
(author)
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A Mobile Internet Service for Self-Management of Physical Activity in People With Rheumatoid Arthritis : Challenges in Advancing the Co-Design Process During the Requirements Specification Phase
- 2015
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In: JMIR Research Protocols. - : JMIR PUBLICATIONS, INC. - 1929-0748. ; 4:3
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Journal article (peer-reviewed)abstract
- Background: User involvement in the development of health care services is important for the viability, usability, and effectiveness of services. This study reports on the second step of the co-design process. Objective: The aim was to explore the significant challenges in advancing the co-design process during the requirements specification phase of a mobile Internet service for the self-management of physical activity (PA) in rheumatoid arthritis (RA). Methods: A participatory action research design was used to involve lead users and stakeholders as co-designers. Lead users (n=5), a clinical physiotherapist (n=1), researchers (n=2) with knowledge in PA in RA and behavioral learning theories, an eHealth strategist (n=1), and an officer from the patient organization (n=1) collaborated in 4 workshops. Data-collection methods included video recordings and naturalistic observations. Results: The inductive qualitative video-based analysis resulted in 1 overarching theme, merging perspectives, and 2 subthemes reflecting different aspects of merging: (1) finding a common starting point and (2) deciding on design solutions. Seven categories illustrated the specific challenges: reaching shared understanding of goals, clarifying and handling the complexity of participants' roles, clarifying terminology related to system development, establishing the rationale for features, negotiating features, transforming ideas into concrete features, and participants' alignment with the agreed goal and task. Conclusions: Co-designing the system requirements of a mobile Internet service including multiple stakeholders was a complex and extensive collaborative decision-making process. Considering, valuing, counterbalancing, and integrating different perspectives into agreements and solutions (ie, the merging of participants' perspectives) were cmcial for moving the process forward and were considered the core challenges of co-design. Further research is needed to replicate the results and to increase knowledge on key factors for a successful co-design of health care services.
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| 2. |
- Revenäs, Åsa, et al.
(author)
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Development of a Web-Based and Mobile App to Support Physical Activity in Individuals With Rheumatoid Arthritis : Results From the Second Step of a Co-Design Process
- 2015
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In: JMIR Research Protocols. - : JMIR PUBLICATIONS, INC. - 1929-0748. ; 4:1, s. 1-14
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Journal article (peer-reviewed)abstract
- Background: Long-term adherence to physical activity recommendations remains challenging for most individuals with rheumatoid arthritis (RA) despite evidence for its health benefits. Objective: The aim of this study was to provide basic data on system requirement specifications for a Web-based and mobile app to self-manage physical activity. More specifically, we explored the target user group, features of the future app, and correlations between the system requirements and the established behavior change techniques (BCTs). Methods: We used a participatory action research design. Qualitative data were collected using multiple methods in four workshops. Participants were 5 individuals with RA, a clinical physiotherapist, an officer from the Swedish Rheumatism Association, a Web designer, and 2 physiotherapy researchers. A taxonomy was used to determine the degree of correlation between the system requirements and established BCTs. Results: Participants agreed that the future Web-based and mobile app should be based on two major components important for maintaining physical activity: (1) a calendar feature for goal setting, planning, and recording of physical activity performance and progress, and (2) a small community feature for positive feedback and support from peers. All system requirements correlated with established BCTs, which were coded as 24 different BCTs. Conclusions: To our knowledge, this study is the first to involve individuals with RA as co-designers, in collaboration with clinicians, researchers, and Web designers, to produce basic data to generate system requirement specifications for an eHealth service. The system requirements correlated to the BCTs, making specifications of content and future evaluation of effectiveness possible.
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| 3. |
- Stenlund, Therese, 1970-
(author)
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Rehabilitation for patients with burnout
- 2009
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Doctoral thesis (other academic/artistic)abstract
- Stress-related diseases and burnout have increased in Sweden during the last decades. In 2006, the most common diagnoses for new cases of sickness compensation were mental and behavioural disorders in both women and men. In spite of the large group of people seeking care for and on long-term sickness absence due to stress-related diseases and burnout, there is no agreement on which treatment they should be offered. The overall aim of this thesis was to describe patients on longterm sick leave because of burnout and to evaluate rehabilitation programs for this patient group. Two patient samples were recruited from the Stress Clinic at the University Hospital in Umeå, Sweden: REST (Rehabilitation for stressrelated disease and burnout; n=136) and QIST (Qigong for stress-related disease and burnout; n=82). A general population sample was from the 2004 Northern Sweden MONICA survey (n=573). Patients in REST were randomised into a 1-year rehabilitation program to either program A (Cognitively-oriented Behavioural Rehabilitation (CBR) and Qigong), or to program B (Qigong alone). In Paper I, baseline data were compared with data from the MONICA sample. In paper II, programs A and B were compared regarding effects on psychological variables and sick leave rates, and in Paper III, 18 patients from program A and B were interviewed to explore subjective experiences of the rehabilitation programs. Patients in QIST were allocated to an intervention with Qigong twice a week for 12 weeks or a control group. Psychological and physical measurements were assessed in QIST. Data were collected by questionnaires, physical measurements, the register on sick leave, and interviews. Patients with burnout reported a more restricted social network and higher work demands than the general population. In relation to women from a general population, women with burnout more often worked “with people”, reported high job strain, a more sedentary work situation and less emotional support. A per-protocol analysis showed no significant differences in treatment effect between program A and B in REST or between the intervention and control group in QIST. All groups improved significantly over time with reduced levels of burnout, anxiety, depression, and fatigue. In REST, lower scores on obsessive-compulsive symptoms, stress behaviour, and sick leave rates were found in both programs and in QIST both groups increased dynamic balance and physical capacity. In an intention-to-treat analysis, patients in program A in REST had significantly fewer obsessive-compulsive symptoms, and larger effect sizes in stress behaviour and obsessive-compulsive symptoms compared to patients in program B. Patients in both REST programs perceived that the 1-year rehabilitation program gave them specific tools to use in secondary prevention. They also emphasised that the good encounters, affirmation and group cohesiveness they perceived during the 8 rehabilitation was a necessary basis for initiation of a behavioural change leading to recovery. In conclusion, compared to a general population, patients with burnout perceived more demands at work and less social support. Lack of emotional support seemed to be more associated with burnout among women. There were no differences in effect between CBR and Qigong compared to Qigong alone, or between a 12 week Qigong intervention compared to a control condition. Improvements were found in all groups in the rehabilitation programs. CBR combined with Qigong have some advantages compared to Qigong alone. An environment with good encounters and affirmation of the patients was experiences as important by the patients and group rehabilitation had advantages as recognition and support from the group. Early rehabilitation measures are important to prevent long-term sickness absence. In future rehabilitation programs it might be necessary to have a more individualized approach and choose treatments preferred by the patient.
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| 4. |
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| 5. |
- Demmelmaier, Ingrid, et al.
(author)
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Current and Maintained Health-Enhancing Physical Activity in Rheumatoid Arthritis : A Cross-Sectional Study
- 2013
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In: Arthritis Care and Research. - : Wiley. - 0893-7524 .- 1529-0123 .- 2151-464X .- 2151-4658. ; 65:7, s. 1166-1176
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To describe and identify the explanatory factors of variation in current and maintained health-enhancing physical activity (HEPA) in persons with rheumatoid arthritis (RA).METHODS: In this cross-sectional study, current HEPA was assessed with the International Physical Activity Questionnaire and maintained HEPA with the Exercise Stage Assessment Instrument, the latter explicitly focusing on both aerobic physical activity and muscle strength training. Sociodemographic, disease-related, and psychosocial data were retrieved from the Swedish Rheumatology Quality (SRQ) registers and a postal questionnaire. The explained variations in the respective HEPA behaviors were analyzed with logistic regression.RESULTS: In all, 3,152 (58.5%) of 5,391 persons identified as eligible from the SRQ registers responded to the questionnaire. Current HEPA was reported by 69%, and maintained HEPA by 11% of the respondents. The most salient and consistent factors explaining variation in both current and maintained HEPA were self-efficacy, social support, and outcome expectations related to physical activity.CONCLUSION: To our knowledge, this is the first study exploring maintained physical activity in a large well-defined sample of persons with RA. Our results indicate that a minority perform maintained HEPA, including both aerobic physical activity and muscle strength training, and that psychosocial factors are the most salient and consistent in the explanation of HEPA variation.
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| 6. |
- Demmelmaier, Ingrid, et al.
(author)
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Pain rather than self-reported sedentary time explains variation in perceived health and activity limitation in persons with rheumatoid arthritis : a cross sectional study in Sweden
- 2017
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In: Rheumatology International. - : Springer Science and Business Media LLC. - 0172-8172 .- 1437-160X. ; 37:6, s. 923-930
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Journal article (peer-reviewed)abstract
- To investigate (1) the amount of self-reported time spent sedentary among a large cohort of persons with rheumatoid arthritis (RA), and (2) the contribution of sedentary time to explain perceived health and activity limitation in RA beyond that of previously known correlates. This cross-sectional study used data from a postal questionnaire and the Swedish Rheumatology Quality registers (SRQ). The International Physical Activity Questionnaire was used to assess sedentary time (sitting) and moderate, vigorous and walking activity (MVPA). Sociodemographics, pain, fatigue, fear-avoidance beliefs, anxiety/depression, disease duration, MVPA and sedentary time were included in multiple regression models with perceived health (Visual Analogue Scale 0-100) and activity limitation (Stanford Health Assessment Questionnaire) as dependent variables. Results: In all 3152 (59%) of 5391 persons identified as eligible from the SRQ, responded to the questionnaire. 2819 individuals with complete data on all study variables were analysed. Mean time (SD) spent sedentary was 257 (213) minutes per day. Sedentary time did not contribute significantly to explain perceived health and only minimally to explain activity limitation. Instead, variation was mainly explained by pain; for perceived health (Beta = 0.780, p < 0.001) and for activity limitation (Beta = 0.445, p < 0.001).The results indicate a non-significant role of sedentary time and a need for increased focus on pain in the management of RA. Future studies should use prospective designs and objective assessment methods to further investigate the associations between sedentary time and health outcomes in persons with RA.
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| 7. |
- Demmelmaier, Ingrid, et al.
(author)
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Supporting stepwise change : improving health behaviors in rheumatoid arthritis with physical activity as the example
- 2013
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In: International Journal of Clinical Rheumatology. - Stockholm : Karolinska Institutet, Dept of Neurobiology, Care Sciences and Society. - 1758-4272.
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Journal article (peer-reviewed)abstract
- Management of chronic diseases such as rheumatoid arthritis (RA) includes behavior change towards smoking cessation, healthy eating, and sufficient physical activity. To initiate and maintain behavior change over time, individual, behavioral and contextual factors should be included. This paper presents some issues on the implementation of physical activity behavior in rheumatoid arthritis, describing motivational and self-regulatory aspects and how they relate to long-term maintenance. We also point out implications for healthcare and directions for future research.
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| 8. |
- Eurenius, Eva, et al.
(author)
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Attitudes toward physical activity among people with rheumatoid arthritis
- 2003
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In: Physiotherapy Theory and Practice. - : Informa UK Limited. - 0959-3985 .- 1532-5040. ; 9:1, s. 10-
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Journal article (peer-reviewed)abstract
- Physical activity confers health benefits in the general population, and this also seems to apply to people with rheumatoid arthritis (RA). Less explicit barriers than pain need to be explored and overcome to initiate and successfully maintain physical activity in individuals with RA. The present aim was to describe variations in attitudes to physical activity in a group of people with RA. Sixteen people with RA were chosen to represent various ages, genders, disease duration, functioning, and health habits. Semi-structured, in-depth interviews were carried out, transcribed, qualitatively analysed, and categorised on the basis of similarities and differences. The analysis indicated that attitudes toward physical activity could not be understood without inclusion of attitudes toward the disease and sometimes to life in general. Two dimensions of attitude, motivation and satisfaction, were identified. Four categories were revealed: motivated and satisfied, unmotivated and satisfied, motivated and dissatisfied, and unmotivated and dissatisfied, each representing different attitudes to physical activity. Our findings stress the importance of developing different educational interventions that address attitudes to physical activity in order to implement a healthy life style in individuals with RA.
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| 9. |
- Eurenius, Eva, et al.
(author)
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Predicting physical activity and general health perception among patients with rheumatoid arthritis
- 2007
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In: Journal of Rheumatology. - 0315-162X .- 1499-2752. ; 34:1, s. 10-15
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To describe changes over one year in physical activity, body functions, and disease activity in patients with rheumatoid arthritis (RA) and to identify predictors for physical activity and general health perception. METHODS: One hundred two patients with RA were recruited for the study (median age 57 yrs, range 19-84; median disease duration 15 mo, range 4-78; 76% women). Self-reported data on physical activity and health locus of control, tests of lower extremity function, grip force, joint range of motion, balance, and measures of disease activity, including pain, general health perception, Health Assessment Questionnaire (HAQ), and Disease Activity Score (DAS28), were collected on 2 occasions, one year apart. Each variable was dichotomized to fit logistic regression models, performed to identify which variables predicted physical activity and general health perception over one year. RESULTS: Physical activity was stable, while lower extremity function, grip force, and range of motion improved and DAS28 decreased significantly over one year. A high physical activity level at baseline was the only predictor of high physical activity (odds ratio 3.85, 95% confidence interval 1.67-9.09) one year later. Low pain (OR 8.47, 95% CI 2.97-24.39), high physical activity (OR 3.72, 95% CI 1.39-10.10), and good lower extremity function (OR 2.94, 95% CI 1.04-8.33) were identified as predictors of good general health perception. CONCLUSION: While pain is a well known predictor of general health perception, to our knowledge, this is the first study to identify predictive factors related to physical activity and lower extremity function as important for perceived health among patients with RA.
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| 10. |
- Fridén, Cecilia, et al.
(author)
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Higher pain sensitivity and lower muscle strength in postmenonpausal women with early rheumatoid arthritis compared with age-matched healthy women--a pilot study.
- 2013
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In: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 35:16, s. 1350-6
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Journal article (peer-reviewed)abstract
- PURPOSE: The purpose of the study was to examine muscle strength and pain sensitivity in postmenopausal women with and without RA.METHODS: Ten women with and ten without early RA were recruited. All were postmenopausal, and did not use hormone replacement therapy. Measurements of isokinetic muscle strength in knee flexors/extensors, hand grip strength, timed standing, pressure pain thresholds (PPT), suprathreshold pressure pain, and segmental and plurisegmental endogenous pain inhibitory mechanisms during muscle contraction were assessed.RESULTS: Participants with early RA were weaker in knee flexors, in hand grip strength and they needed more time for the timed standing. Women with early RA had higher sensitivity to threshold pain and suprathreshold pressure pain compared to women without RA. PPTs increased in the contracting muscle as well as in a distant resting muscle during static contractions in both groups.CONCLUSIONS: Our results indicate differences in muscular strength between postmenopausal women with and without RA. Furthermore, women with RA had decreased PPT and hyperalgesia, but no dysfunction of segmental or plurisegmental pain inhibitory mechanisms during static exercise compared to healthy controls. The normal function of endogenous pain inhibitory mechanisms despite chronic pain in women with RA might contribute to the good effects of physical activity previously reported.
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