| 1. |
- Bremander, Ann, 1957-, et al.
(författare)
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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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Ingår i: Musculoskeletal Care. - Chichester : John Wiley & Sons. - 1478-2189 .- 1557-0681. ; 10:1, s. 43-50
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Tidskriftsartikel (refereegranskat)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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| 2. |
- Rydholm, M., et al.
(författare)
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Course of Grip Force Impairment in Patients With Early Rheumatoid Arthritis Over the First Five Years After Diagnosis
- 2018
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Ingår i: Arthritis Care and Research. - : Wiley. - 2151-464X. ; 70:4, s. 491-498
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Objective measures of function are important in rheumatoid arthritis (RA). The objective of this study was to investigate grip strength in patients with early RA. Methods: An inception cohort of 225 patients with early RA was followed in accordance with a structured protocol. Average and peak grip force values of the dominant hand (measured using a Grippit device [AB Detektor]) were evaluated and compared to expected age- and sex-specific reference values from the literature. Separate analyses were performed for those with limited self-reported disability (Health Assessment Questionnaire disability index [HAQ DI] score ≤0.5) and clinical remission (Disease Activity Score in 28 joints <2.6). Results: Baseline average grip force among RA patients was significantly lower than the corresponding expected value (mean 105N versus 266N; P < 0.001). Observed average and peak grip force values were significantly reduced compared to those expected in women as well as in men over time and at all time points. The average grip force improved significantly from inclusion to the 12-month visit (age-corrected mean change 34N [95% confidence interval 26–43]). At 5 years, the average grip force was still lower than that expected overall (mean 139N versus 244N; P < 0.001), and also among those with HAQ DI scores ≤0.5 and those in clinical remission. Conclusion: Grip strength improved in early RA patients, particularly during the first year. However, it was still significantly impaired 5 years after diagnosis, even among those with limited self-reported disability and those in clinical remission. This suggests that further efforts to improve hand function are important in early RA. © 2017, American College of Rheumatology
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| 3. |
- Rydholm, Maria, et al.
(författare)
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The relation between upper extremity joint involvement and grip force in early rheumatoid arthritis : a retrospective study
- 2019
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Ingår i: Rheumatology International. - : Springer Science and Business Media LLC. - 0172-8172 .- 1437-160X. ; 39:12, s. 2031-2041
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Tidskriftsartikel (refereegranskat)abstract
- To investigate the relation between joint involvement in the upper extremities and grip force in patients with early rheumatoid arthritis (RA). An inception cohort of 225 patients with early RA was followed according to a structured protocol. The same rheumatologist assessed all patients for swollen joints and joint tenderness. Grip force was measured (Grippit; AB Detektor, Gothenburg, Sweden) at the same visit. Average grip force values for the dominant hand were expressed as % of expected, based on age- and sex-specific reference values from the literature. Associations between grip force and current synovitis or tenderness of individual joints, and other disease parameters measured at the same visit, were examined. Patients with current synovitis of the wrist joint or ≥ 1 metacarpophalangeal (MCP) joint of the dominant hand had a significantly lower grip force at inclusion, at 1 year and at 5 years. Proximal interphalangeal joint tenderness and MCP joint tenderness were consistently associated with reduced grip force. In multivariate analysis, extensive MCP joint synovitis was associated with lower grip force at inclusion (β − 2.8% per joint; 95% CI − 5.3 to − 0.4), and also at the 1-year follow-up. Patient reported pain scores and erythrocyte sedimentation rates had independent negative associations with grip force at all time points. In patients with early RA, extensive synovitis of the MCP joints was associated with reduced grip force, independently of other upper extremity joint involvement. Pain and inflammation have effects on hand function beyond those mediated by local synovitis.
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| 4. |
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| 5. |
- Wikström, Ingegerd, et al.
(författare)
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Difficulties in performing leisure activities among persons with newly diagnosed rheumatoid arthritis: a prospective, controlled study.
- 2006
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Ingår i: Rheumatology. - : Oxford University Press (OUP). - 1462-0332 .- 1462-0324. ; 45:9, s. 1162-1166
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To compare leisure activities and associated factors in a group with recent onset RA and matched community-derived controls, to examine whether leisure activities are altered during the early years of disease and to seek predictors. Methods. One hundred and forty-seven consecutive persons with early RA were followed for 0.9-5.9 yr. One hundred and forty-four RA patients were compared cross-sectionally at baseline with community-derived controls matched for age, gender and residential area. Leisure activities were evaluated with an interest checklist (20 domains). Socio-demographic variables, disease activity (DAS) and disability (HAQ) were evaluated as possible predictors for loss of participation in leisure activities at baseline and longitudinally (using area under the curve analyses). Results. At baseline (mean disease duration 7 months) RA patients performed less (8.2 vs 9.9 domains, P < 0.001) but did not have significantly less interest (10.9 vs 11.4 domains, P=0.15) in leisure activities compared with controls. Decrease in performed leisure activities was only significant in those with a low level of education. At baseline, in RA patients, low education (P=0.035), age (P=0.019) and HAQ (P < 0.001) significantly predicted performed leisure activity. No loss in performed leisure activities was seen during follow-up and no significant predictors were found for individual change. Conclusion. Loss of performed leisure activities occurs early in RA and chiefly in those with low formal education. Disability was associated with early loss, but not with change during follow-up. Other factors, possibly related to individual personality and resources, may be more important for predicting changes in leisure activities.
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| 6. |
- Wikström, Ingegerd, et al.
(författare)
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How people with rheumatoid arthritis perceive leisure activities : A qualitative study
- 2005
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Ingår i: Musculoskeletal Care. - London : Whurr Publishers. - 1478-2189 .- 1557-0681. ; 3:2, s. 74-84
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To explore how people with rheumatoid arthritis (RA) perceive leisure activities. METHOD: A phenomenographic approach using semi-structured interviews to explore the impact of RA on leisure pursuits was used. RESULTS: Three descriptive categories containing 11 conceptions emerged: (1) Experiencing constraints included four conceptions: seeing limitations, needing time, finding balance, being dependent. (2) Experiencing coherence included four conceptions: accepting feelings participating in a social context, being active, having insight. (3) Finding solutions included three conceptions: choosing, planning, and adapting. CONCLUSIONS: This study emphasizes the limited choices and problems people with RA had participating in leisure activities, as well as its impact on self-esteem.
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| 7. |
- Wikström, Ingegerd
(författare)
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Leisure Activities in Rheumatoid Arthritis. Associated Factors and Assessment
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Leisure Activities in Rheumatoid Arthritis. Associated Factors and Assessment. Leisure activities were considered to give intrinsic pleasure, meaning and value to life already in ancient Greek. It was also performed for its own sake and not by consideration of any external rewards. In the beginning of the 20th century leisure was only possible for wealthy people who could occupy themselves with non-productive consumption of time. It was not until the middle of the 20th century that leisure got more accepted and not seen as an undesirable activity. Participating in leisure activities may prevent from isolation, and give better self-confidence. To be forced to abandon the most important leisure activity may lead to depression. In literature, patients with rheumatoid arthritis (RA) are described as having difficulties in performing leisure activities, and that they quite often change their leisure activities to those of a more sedentary nature, while trying to overcome the obstacles of the disease. Leisure activities quite often lose their value, as they are often diminished then experienced as being difficult to perform. The overall purpose of this thesis was to investigate the perception of leisure activities in patients with RA and to search for associable factors and predictors. Another objective was to validate a new leisure index, namely the Patient-Specific Leisure Scale (PSLS). The first study is a prospective study and includes 80 patients with RA who had participated in a three-week rehabilitation programme. The number of leisure activities was assessed through a structured interview. At follow-up Norling´s index was also used. This is an interest check list which lists 18 domains of leisure activities for which the patients can indicate performance and interest. ?Active? and ?not obviously active or passive? leisure activity according to Norling´s index were investigated together with Health Assessment Questionnaire (HAQ), Signals of Functional Impairment (SOFI), grip strength, Quality of Life Scales (QOLS), the Hospital Anxiety and Depression Scale (HADS), Coping Strategies Questionnaire (CSQ), global pain (visual-analogue scale (VAS)), global assessment of disease activity (VAS), C- reactive protein (CRP), erythrocyte sedimentation rate (ESR) and medication as possible predictors. It was found that ?active? leisure activity had increased, and ?not obviously active or passive? leisure activities were unchanged. The number of ?active? leisure activity was moderately associated with SOFI and HAQ at baseline. Activity were not predicted by socio-demographic variables or variables reflecting disease activity at baseline or during the follow-up period. Depression and the coping strategies self-statement, ignoring sensation and increasing activities were weakly but not significantly correlated to leisure activities. Anxiety did not correlate with performance of leisure activities. Active recreation was one of the most affected domains of QOLS. The second study was a qualitative study using semi-structured interviews to explore the impact of RA on leisure pursuits in 18 strategically chosen patients with RA. Three descriptive categories were found, namely constraints containing four conceptions: experiencing limitations, needing time, finding a balance, and being dependent. Coherence containing four conceptions: accepting feelings, participating in a social context, being active, and having insight. Solutions containing three conceptions: choosing, planning, and adapting. Patients with RA experienced restrictions when performing leisure activities due to constraints and coherence but they tried to find solutions to their problems. The third study is a prospective, controlled study of 196 newly diagnosed patients with RA. One hundred and forty-seven patients were followed longitudinally, and 144 had a matched control from the Swedish population census register at baseline. The following variables were measured at baseline, after 6,12,18,24,36, 60 months and follow-up in RA patients VAS-pain, VAS global assessment, ESR, CRP, rheumatoid factor (RF), swollen and tender joints out of 28, the medical practitioner's judgement of disease activity, and disease activity score (DAS28). The following measures were performed both in RA and control group, HAQ, education, occupation, and NPS-index. Patients with RA diagnosed at an early stage performed fewer leisure activities compared to controls, a difference observed only among persons with low level of education. Factors independently associated and partially correlated with the number of leisure activities domains performed at baseline were age, education, HAQ, and the number of domains interested in. No change on group level was seen during follow-up, but domains of leisure activities changed during follow up and activities performed in outdoor life and exercise in individual sports increased significantly in women. Patients both stopped and started a substantial number of leisure activities on an individual level. The severity of the disease did not at all predict these individual changes at all, although the accumulated burden of disability during follow up tended to. Active recreation beside health was one of the most affected domains of QOLS. In the fourth study a new leisure index the PSLS were evaluated regarding reliability, validity and responsiveness. Forty-nine consecutive RA patients participated in test-retest, 100 RA-patients in construct validity and 25 RA-patients in responsiveness (after three months of TNF inhibitors). The PSLS appeared to be feasible, reliable, valid and responsive for measuring leisure activities. I found in these four studies that commonly used variables for measuring disease activity did not predict change in leisure activities, and that disability only moderately predicts such change. Other predictors must be sought, perhaps more related to personality and individual resources. I also found that patients with RA experienced restrictions when performing leisure activities due to constraint and coherence but that they tried to find solutions to their problems. The PSLS seems reliable and valid for measuring leisure activities among patients with RA. Active recreation beside health was one of the most affected domains of QOLS.
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| 8. |
- Wikström, Ingegerd, et al.
(författare)
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Leisure activities in rheumatoid arthritis: Change after disease onset and associated factors
- 2001
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Ingår i: British Journal of Occupational Therapy. - 1477-6006. ; 64:2, s. 87-92
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this investigation was to examine the relationship between leisure-time occupations, quality of life disease activity among patientswith rheumatoid arthritis. Fifty patients with rheumatoid arthritis-39 females and 11 males, age 30-45 years and belonging to functional class I-III according to Steinbrocker er al (1949)-were recuited from the register at a hospital clinic and from a private outpatient clinic. The participants completed a questionnaire concerning education, occupation, pain, morning stiffness, currentleisure activities and those pursued before the onset of the disease, and including the Quality of Life Scale (QoLS). The patients had given up two-thirds of their leisure activites since the onset of the disease. This decrease wa observed for both aexes. It correlated positivly with present disease activity, measures as pain on a visual analogue scale and as morning stiffness, and negativly with the present QoLS. Longitudinal studies are needed to disenta
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| 9. |
- Wikström, Ingegerd, et al.
(författare)
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Reliability, validity and responsiveness of a new leisure index : The Patient-Specific Leisure Scale (PSLS)
- 2009
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Ingår i: Musculoskeletal Care. - London : Whurr Publishers. - 1478-2189 .- 1557-0681. ; 7:3, s. 178-193
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Tidskriftsartikel (refereegranskat)abstract
- Objectives:To investigate the reliability, validity and responsiveness of a new Patient-Specific Leisure Scale (PSLS), constructed to identify goals and outcomes for individual patients with rheumatoid arthritis (RA).Methods:Forty-nine patients with RA were used to evaluate test-retest reliability, and 100 consecutive RA patients were used for construct validity. Twenty-five RA patients, commencing with treatment on tumour necrosis factor (TNF) inhibitors, were evaluated before the start and after three months of therapy, to test responsiveness. The most important leisure activity (as judged by the patients) was used when evaluating reliability and validity. The perceived difficulty with each activity was scored from 0 to 10 (0 = able to perform activity without difficulty, 10 = unable to perform activity).Results: Test-retest reliability indicated a good agreement (0.62-0.87) using weighted kappa. Construct validity was demonstrated by modest positive correlation between leisure activity and Health Assessment Questionnaire (HAQ) (rs = 0.27, p = 0.005) visual analogue scale (VAS) pain (rs = 0.28, p = 0.004) VAS global (rs = 0.22, p = 0.027), VAS fatigue (rs = 0.24, p = 0.013), joint index of 28 swollen joints (rs = 0.22, p = 0.027) and negative correlations with short-form-36 (SF-36) physical functioning (rs = -0.18, p = 0.008), bodily pain (rs = -0.31, p < 0.001), general health (rs = -0.23, p = 0.019), vitality (rs = -0.31, p < 0.001), social function (rs = -0.24, p = 0.016) and role-emotional (rs = -0.28, p = 0.005). Mean improvement for the most important leisure activity was 1.36, (p = 0.036, 95% confidence interval 0.10-2.62). Standardized response mean and effect size for the most important activity in PSLS was 1.05 and 0.72, respectively, and for HAQ 0.34 and 0.28, respectively.Conclusions:PSLS appears to be feasible, reliable, valid and responsive for measuring leisure activities in RA. It provides both an individual result which is useful in clinical work, and results at a group level.
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