| 1. |
- Kennedy, Beatrice, 1982-, et al.
(författare)
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App-based COVID-19 syndromic surveillance and prediction of hospital admissions in COVID Symptom Study Sweden
- 2022
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Ingår i: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- The app-based COVID Symptom Study was launched in Sweden in April 2020 to contribute to real-time COVID-19 surveillance. We enrolled 143,531 study participants (≥18 years) who contributed 10.6 million daily symptom reports between April 29, 2020 and February 10, 2021. Here, we include data from 19,161 self-reported PCR tests to create a symptom-based model to estimate the individual probability of symptomatic COVID-19, with an AUC of 0.78 (95% CI 0.74-0.83) in an external dataset. These individual probabilities are employed to estimate daily regional COVID-19 prevalence, which are in turn used together with current hospital data to predict next week COVID-19 hospital admissions. We show that this hospital prediction model demonstrates a lower median absolute percentage error (MdAPE: 25.9%) across the five most populated regions in Sweden during the first pandemic wave than a model based on case notifications (MdAPE: 30.3%). During the second wave, the error rates are similar. When we apply the same model to an English dataset, not including local COVID-19 test data, we observe MdAPEs of 22.3% and 19.0% during the first and second pandemic waves, respectively, highlighting the transferability of the prediction model.
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| 2. |
- Ehrencrona, Carolina, 1986, et al.
(författare)
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Do beta-blockers reduce negative intrusive thoughts and anxiety in cancer survivors? – An emulated trial
- 2024
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Ingår i: BMC Cancer. - 1471-2407. ; 24
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Tidskriftsartikel (refereegranskat)abstract
- Background: High rates of negative intrusivethoughts have been reported among cancer patients. Prevalent users of beta-blocker therapy have reported lower levels of cancer related intrusive thoughts than non-user. The aim of this study is to investigate if initiation of beta-blocker therapy reduces the prevalence and severity of intrusive thoughts (co-primary endpoints) and the prevalence of anxiety, depressed mood, and low quality of life (secondary endpoints) in cancer survivors. Methods: Data on patient-reported outcomes from three cohort studies of Swedish patients diagnosed with colon, prostate or rectal cancer were combined with data on beta-blocker prescriptions retrieved from the Swedish Prescribed Drug Register. Two randomized controlled trials were emulated. Trial 1 had follow-up 1year after diagnosis, trial 2 had follow-up 2years after diagnosis, baseline in both trials was 12months before follow-up. Those who initiated beta-blocker therapy between baseline and follow-up was assigned Active group, those who did not was assigned Control group. All endpoints were analysed using Bayesian ordered logistic regression. Results: Trial 1 consisted of Active group, n = 59, and Control group, n = 3936. Trial 2 consisted of Active group, n = 87, and Control group, n = 3132. The majority of participants were men, 83% in trial 1 and 94% in trial 2. The prevalence and severity of intrusive thoughts were lower in the Active group in trial 1, but no significant differences between groups were found in either trial. The prevalence of depressed mood, worse quality of life and periods of anxiety were higher in the Active group in both trials with significant differences for quality of life in trial 1 and anxiety in trial 2. Conclusions: The emulated trials demonstrated no evidence of a protective effect of beta-blocker therapy against intrusive thoughts. The Active group had reduced quality of life and elevated anxiety compared to the Control group. Trial registration: The three cohort studies were registered at isrctn.com/clinicaltrials.gov (ISRCTN06393679, NCT02530593 and NCT01477229).
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| 3. |
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| 4. |
- Grimby-Ekman, Anna, 1967, et al.
(författare)
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Prediction models for planning health care resources. During the first wave of the Covid-19 pandemic 2020
- 2022
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Due to the Covid-19 pandemic, has emphasized a need for planning health care resources based on only a few aggregated data points and little knowledge of the data-generating process. In the first part of the report, we present the process of our work in spring 2020 during the first wave and especially during the first part with the high demands on health care resources. In the second part of the report, we discuss the logistic growth model (LGM), one of our models used to predict the peak height and the peak timing. We present some different approaches to use the LGM, and compare these to a different data set, Belgium data. For the Swedish regional data, the LGM on raw observations gave a good estimate on the peak height. The adjusted LGM, using cumulative new inpatient beds, fitted the Swedish regional data to a satisfying degree. For the Belgium data, the LGM on raw observations gave a good estimate on peak height and timing. The adjusted LGM, using cumulative new inpatient beds, did not work for the Belgium data as it gave a too early peak time and a too low peak height. The experience from our work, in combination with now existing literature, the process in a similar future situation would include better knowledge on how to find and combine data to get as reliable forecasts as possible and to use creativity in combination with theoretical competence.
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| 5. |
- 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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| 6. |
- Löfstrand, Jonas, 1981, et al.
(författare)
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Long-term patient-reported back and shoulder function after delayed breast reconstruction with a latissimus dorsi flap: case-control cohort study.
- 2024
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Ingår i: The British journal of surgery. - 1365-2168. ; 111:1
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Tidskriftsartikel (refereegranskat)abstract
- Sacrifice of the latissimus dorsi (LD) muscle might entail donor site morbidity when used in delayed breast reconstruction. Previous studies are small, have short follow-up, and demonstrate diverging results. The aims of this study were to evaluate long-term patient-reported effects on shoulder and back function following LD flap harvest, and to investigate predictors for a worse outcome.This is a retrospective observational case-control cohort study. Cases were all patients who had undergone an LD flap reconstruction during the years 2007-2017. Controls were patients reconstructed with a deep inferior epigastric perforator (DIEP) flap during the same time period. Participants completed two validated questionnaires; the BREAST-Q reconstruction LD domains and the Western Ontario Shoulder Osteoarthritis Index (WOOS).A total of 135 cases (75 per cent) and 118 controls (60 per cent) responded to the questionnaires. The mean follow-up time was 7 years. Patients reconstructed with a LD flap were significantly less satisfied with their back and shoulder function when compared to the DIEP controls, as measured with BREAST-Q and WOOS. Predictors for a poor patient-reported back and shoulder function included axillary surgery and axillary radiotherapy, especially when combined, as well as higher age at reconstruction.Patients who have undergone LD flap for delayed breast reconstruction had a lower satisfaction with back and shoulder function, when compared to patients who had undergone a DIEP reconstruction. Delayed LD reconstruction should be used with care, especially in patients who have undergone axillary surgery and axillary radiotherapy.
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| 7. |
- Persson, Carina Ulla, 1970, et al.
(författare)
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Responsiveness of a modified version of the postural assessment scale for stroke patients and longitudinal change in postural control after stroke- Postural Stroke Study in Gothenburg (POSTGOT) -
- 2013
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Ingår i: Journal of neuroengineering and rehabilitation. - : Springer Science and Business Media LLC. - 1743-0003. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: BACKGROUND: Responsiveness data certify that a change in a measurement output represents a real change, not a measurement error or biological variability. The objective was to evaluate the responsiveness of the modified version of the Postural Assessment Scale for Stroke Patients (SwePASS) in patients with a first event of stroke. An additional aim was to estimate the change in postural control during the first 12 months after stroke onset. METHODS: The SwePASS assessments were conducted during the first week and 3, 6 and 12 months after stroke in 90 patients. Svensson's method, Relative Position (RP), Relative Concentration (RC) and Relative Rank Variance (RV), were used to estimate the scale's responsiveness and the patients' change in postural control over time. RESULTS: From the first week to 3 months after stroke, the patients improved in terms of postural control with 2 to 12 times larger systematic changes in Relative Position (RP), for which 9 items and the total score showed a significant responsiveness to change when compared to the interrater reliability measurement error of the SwePASS reported in a previous study. When SwePASS was used to assess change in postural control between the first week and 3 months, 74% of the patients received higher scores while 10% received lower scores, RP 0.31 (95% CI 0.219-0.402). The corresponding figures between 3 and 6 and between 6 and 12 months were 37% and 16%, RP 0.09 (95% CI 0.030-0.152), and 18% and 26%, RP -0.07 (95% CI -0.134- (-0.010)), respectively. CONCLUSIONS: The SwePASS is responsive to change. Postural control evaluated using the SwePASS showed an improvement during the first 6 months after stroke. The measurement property, in the form of responsiveness, shows that the SwePASS scoring method can be considered for use in rehabilitation when assessing postural control in patients after stroke, especially during the first 3 months.
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| 8. |
- Persson, Carina Ulla, 1970, et al.
(författare)
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Timed Up & Go as a measure for longitudinal change in mobility after stroke - Postural Stroke Study in Gothenburg (POSTGOT)
- 2014
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Ingår i: Journal of NeuroEngineering and Rehabilitation. - : Springer Science and Business Media LLC. - 1743-0003. ; 11:83
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background A frequently used clinical test to assess mobility after stroke is the Timed Up & Go. Knowledge regarding whether or not the Timed Up & Go is able to detect change over time in patients with stroke, whether improvements in mobility exist after the first three months and whether or not longitudinal change in mobility after stroke depend on the patients’ age, is limited or unclear. The objectives were to investigate the distribution-based responsiveness of the Timed Up & Go (TUG) during the first three months after a first event of stroke, to measure the longitudinal change in TUG time during the first year after stroke and to establish whether recovery in TUG time differs between different age groups. Methods Ninety-one patients with first-ever stroke were assessed using the Timed Up & Go at the 1st week and at 3, 6 and 12 months after stroke. The non-parametric sign-test, the parametric t-test and a mixed model approach to linear regression for repeated measurements (Proc mixed) were used for the statistical analyses. Results The median TUG time was reduced from 17 to 12 seconds (p < 0.001) between the 1st week and 3 months. No further improvement was seen between 3 and 12 months after stroke. In a mixed model approach to linear regression, there was a significant age difference. Patients at age 80 and above tended to deteriorate in terms of TUG time between 3 and 12 months after stroke, while patients < 80 years did not (p = 0.011 for the interaction between age group and time). Conclusion The Timed Up & Go demonstrates ability to detect change in mobility over time in patients with stroke. A significant improvement in TUG time from the 1st week to 3 months after stroke was found, as expected, but thereafter no statistically significant change was detected. After 3 months, patients ≥80 years tended to deteriorate in terms of TUG time, while the younger patients did not.
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| 9. |
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| 10. |
- Ahlstrand, Christina, 1957, et al.
(författare)
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Reliabilitetstestning av Purdue Pegboard® (finmotoriktest).
- 2009
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- I MQ-FAS studien, vars syfte var att ändra muskelspänningsmönstret hos kvinnor med kroniska nackbesvär, ingick ett besticktorkningsmoment som en standardiserad arbetsuppgift i hemmet. För validering av denna besticktorkning har en pilotstudie genomförts, 12 personer torkade bestick vid två tillfällen. I studien, som utfördes av 2 testledare, ingick även ett finmotorikstest (Purdue Pegboard), ansträngningsskattning (Borg RPE-skalan) samt ett frågeformulär. Detta test kan med vissa justeringar troligen vara användbart som ett mått på arbetsförmåga av övre extremiteter vid utförande av arbetssyssla i hemmet, och jämföra individ med sig själv, för att mäta om funktionsnedsättning eller ökning har skett. Dock skall poängteras att detta var en pilotstudie och ytterligare studie av reliabilitet och validitet rekommenderas innan testet används i stor utsträckning för att mäta om funktionsnedsättning eller ökning har skett.
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| 11. |
- Ahlstrand, Christina, et al.
(författare)
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Reliabilitetstestning av Purdue Pegboard® (finmotoriktest)
- 2012
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- För att undersöka hur många upprepade mätningar med Purdue Pegboard som ger tillräckligt bra reliabilitet vid test av finmotorik, genomfördes en pilotstudie på Arbets- och miljömedicin vintern 2010-2011. I studien deltog 28 högerhänta friska personer mellan 20 och 60 år, hälften män och hälften kvinnor. Samtliga försökspersoner gjorde en basmätning och därefter en uppföljande mätning efter en vecka. Höger hand, vänster hand och båda händer testades fem gånger vid varje försökstillfälle som gick ut på att sätta i maximalt antal pinnar på 30 sekunder. Test-retest data för kontinuerliga variabler analyserades med hänsyn till medelvärde av skillnaden mellan basmätning och uppföljning. Resultatet angavs som intervall mellan övre och nedre gräns i ”limits of agreement”( LOA). Efter totalt tio genomförda tester för varje individ (n=28) blev det genomsnittliga antalet isatta pinnar ca 17 för höger hand, 15-16 för vänster hand och ca 13 pinnar för båda händerna. Test nr 1, dvs en enkel test, så som den utförs på AMM (höger + vänster + båda händer), ger ett intervall på 5,6 pinnar för höger hand, 6,4 pinnar för vänster hand och 5,3 pinnar för båda händerna. Medelvärde från tre tester, test nr 1+2+3 ger ett intervall på 4,8 pinnar för höger hand, 4,1 pinnar för vänster hand och 3,5 pinnar för båda händerna. Medelvärde från fem tester, 1+2+3+4+5 ger ett intervall på 4,0 pinnar för höger hand, 2,8 pinnar för vänster hand och 3,8 pinnar för båda händerna. Genom att utöka metoden från en till tre tester uppnås en förbättring av reliabiliteten med närmare två pinnar i genomsnitt vilket ger ett acceptabelt Limits of agreement på mellan tre och en halv pinne (båda händer) till knappt fem pinnar (höger hand). Fyra mätningar ger en ytterligare förbättring av reliabiliteten på ca en halv pinne medan fem mätningar inte ger någon förbättring
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| 12. |
- Björk, Jonas, et al.
(författare)
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Predicting participation in the population-based Swedish cardiopulmonary bio-image study (SCAPIS) using register data
- 2017
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 45, s. 45-49
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To illustrate the importance of access to register data on determinants and predictors of study participation to assess validity of population-based studies. In the present investigation, we use data on sociodemographic conditions and disease history among individuals invited to the Swedish cardiopulmonary bio-image study (SCAPIS) in order to establish a model that predicts study participation. Methods: The pilot study of SCAPIS was conducted within the city of Gothenburg, Sweden, in 2012, with 2243 invited individuals (50% participation rate). An anonymous data set for the total target population (n = 24,502) was made available by register authorities (Statistics Sweden and the National Board of Health and Welfare) and included indicators of invitation to and participation in SCAPIS along with register data on residential area, sociodemographic variables, and disease history. Propensity scores for participation were estimated using logistic regression. Results: Residential area, country of birth, civil status, education, occupational status, and disposable income were all associated with participation in multivariable models. Adding data on disease history only increased overall classification ability marginally. The associations with disease history were diverse with some disease groups negatively associated with participation whereas some others tended to increase participation. Conclusions: The present investigation stresses the importance of a careful consideration of selection effects in population-based studies. Access to detailed register data also for non-participants can in the statistical analysis be used to control for selection bias and enhance generalizability, thereby making the results more relevant for policy decisions.
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| 13. |
- Boström, Maria, 1963, et al.
(författare)
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Experiences of work ability in young workers: an exploratory interview study
- 2016
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Ingår i: International Archives of Occupational and Environmental Health. - : Springer Science and Business Media LLC. - 0340-0131 .- 1432-1246. ; 89:4, s. 629-640
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Purpose The aim of this study was to explore the experiences of and influences on work ability in young workers related to their work and life situation. Methods In a qualitative study of a strategic sample of 12 young female and 12 young male workers, aged 25-30 years, in work or recently left work, recruited from the 5-year follow-up of a Swedish cohort, semi-structured interviews were performed to explore the experiences of work ability in these young workers. Systematic text condensation inspired by phenomenology was used in the analysis. Results Work ability was experienced as complex, consisting of four themes, each with three subthemes. To be alert and have energy, to possess sufficient education, skills and working life experience and experience meaningfulness and engagement in work, were perceived to be fundamental for work ability and were seen as the worker’s own responsibility. Moreover, work ability can be improved or reduced by the psychosocial work climate, the work organization and the private life. Optimal work ability was experienced when all themes integrated in a positive way. Conclusions Work ability was experienced as the worker’s own responsibility that could be influenced by work circumstances and private life. To promote good work ability among young workers, work ability has to be understood in its specific context. Whether the understanding of work ability found in this study is explicit for the group of young adults, needs to be explored in a more general population in further research.
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| 14. |
- Boström, Maria, 1963, et al.
(författare)
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Opportunities for recovery at work and excellent work ability - a cross-sectional population study among young workers
- 2016
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background Better opportunities for recovery at work are thought to be associated with work ability in a young workforce but evidence is scarce to lacking. The aim of this study was to examine cross-sectional associations between opportunities for recovery at work and excellent work ability among young workers and specifically for young workers with high work demands. Methods A study group of 1295 women and 1056 men aged 18–29 years was selected from three biennial years of a population cohort. The subsample reporting high work demands consisted of 439 women and 349 men. The study group had completed a work environment questionnaire in a survey conducted by Statistics Sweden. Associations between opportunities for recovery at work and excellent work ability were assessed by multiple logistic regression models stratified for gender. Results Having varied work was associated with excellent work ability in all young men (p < 0.0006; prevalence ratio [PR] 1.3) and also specifically in men with high work demands (p = 0.019; PR 1.3). For the latter group the possibility of deciding when to perform a work task was also associated with excellent work ability (p = 0.049; PR 1.3). Among young women with high work demands, the possibility of deciding one’s working hours was associated with excellent work ability (p = 0.046; PR 1.2). Conclusions For young men, having varied work can contribute to excellent work ability. In addition, for men with high work demands, the possibility of deciding when to perform a work task may be favourable for excellent work ability. For young women with high work demands, the possibility of deciding one’s working hours can contribute to excellent work ability. Employers could use these opportunities for recovery in promoting work ability among young workers.
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| 15. |
- Eriksson, Stefanie, et al.
(författare)
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Texture Analysis of Magnetic Resonance Images Enables Phenotyping of Potentially Painful Annular Fissures.
- 2022
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Ingår i: Spine. - 1528-1159. ; 47:5, s. 430-437
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Tidskriftsartikel (refereegranskat)abstract
- Retrospective analysis of prospectively collected data.To investigate whether intervertebral disc (IVD) image features, extracted from magnetic resonance (MR) images, can depict the extension and width of annular fissures and associate them to pain.Annular fissures are suggested to be associated with low back pain (LBP). Magnetic resonance imaging (MRI) is a sensitive method, yet fissures are sometimes unobservable in T2-weighted MR-images, even though fissure information is present in the image. Image features can mathematically be calculated from MR-images and might reveal fissure characteristics.44 LBP patients who underwent MRI, low-pressure discography (<50psi) and computed tomography (CT) sequentially in one day, were reviewed. After semi-automated segmentation of 126 discs, image features were extracted from the T2-weighted images. The number of image features were reduced with principle component analysis (PCA). CT-discograms were graded and dichotomized regarding extension and width of fissures. IVDs were divided into fissures extending to outer annulus vs. short/no fissures. Fissure width was dichotomized into narrow (<10%) vs. broad fissures (>10%), and into moderately broad (10%-50%) vs. very broad fissures (>50%). Logistic regression was performed to investigate if image features could depict fissure extension to outer annulus and fissure width. As a sub-analysis, the association between image features used to depict fissure characteristics and discography-provoked pain-response were investigated.Fissure extension could be depicted with sensitivity/specificity=0.97/0.77 and area under curve (AUC)=0.97. Corresponding results for width depiction were sensitivity/specificity=0.94/0.39 and 0.85/0.62, and AUC=0.86 and 0.81 for narrow vs. broad and moderately broad vs. very broad fissures respectively. Pain prediction with image features used for depicting fissure characteristics showed sensitivity/specificity=0.90/0.36, 0.88/0.4, 0.93/0.33; AUC=0.69, 0.75 and 0.73 respectively.Standard MR-images contains fissure information associated to pain that can be depicted with image features, enabling non-invasive phenotyping of potentially painful annular fissures.Level of Evidence: 2.
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| 16. |
- Feldthusen, Caroline, 1977, et al.
(författare)
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EXPLANATORY FACTORS AND PREDICTORS OF FATIGUE IN PERSONS WITH RHEUMATOID ARTHRITIS: A LONGITUDINAL STUDY
- 2016
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 48:5, s. 469-476
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the impact of disease-related aspects on long-term variations in fatigue in persons with rheumatoid arthritis. Methods: Sixty-five persons with rheumatoid arthritis, age range 20-65 years, were invited to a clinical examination at 4 time-points during the 4 seasons. Outcome measures were: general fatigue rated on visual analogue scale (0-100) and aspects of fatigue assessed by the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire. Diseaserelated variables were: disease activity (erythrocyte sedimentation rate), pain threshold (pressure algometer), physical capacity (six-minute walk test), pain (visual analogue scale (0-100)), depressive mood (Hospital Anxiety and Depression scale, depression subscale), personal factors (age, sex, body mass index) and season. Multivariable regression analysis, linear mixed effects models were applied. Results: The strongest explanatory factors for all fatigue outcomes, when recorded at the same time-point as fatigue, were pain threshold and depressive mood. Self-reported pain was an explanatory factor for physical aspects of fatigue and body mass index contributed to explaining the consequences of fatigue on everyday living. For predicting later fatigue pain threshold and depressive mood were the strongest predictors. Conclusion: Pain threshold and depressive mood were the most important factors for fatigue in persons with rheumatoid arthritis.
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| 17. |
- Feldthusen, Caroline, 1977, et al.
(författare)
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Seasonal variations in fatigue in persons with rheumatoid arthritis: a longitudinal study
- 2016
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Ingår i: Bmc Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 17
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Tidskriftsartikel (refereegranskat)abstract
- Background: Fatigue is a prominent symptom in persons with rheumatoid arthritis (RA). Although this symptom has been described to vary in duration and frequency little is known about fluctuations in fatigue over time and season. The aim of this study was to describe monthly and seasonal variations in fatigue, in persons with RA of working age. Methods: Sixty-five participants diagnosed with RA and aged 20-65 years were recruited from a rheumatology clinic in Sweden. The participants provided self-assessments of their fatigue at seven time points during the four seasons using a 0-100 mm visual analogue scale (VAS) and the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ). Multiple regression analysis using mixed models was used to analyze changes in fatigue over time. Results: The mean +/- SD of fatigue rated on the VAS was 51 +/- 13, indicating substantial fatigue. Analysis of monthly variation showed statistically significant variation in fatigue ratings concerning VAS fatigue score (p < 0.01) as well as the BRAF-MDQ total score and Living, Cognition (p < 0.001), and Physical (p < 0.05) sub-scores, but not the BRAF-MDQ Emotional sub-score. The greatest variations were seen from January to September, with higher fatigue ratings in January. The changes in VAS fatigue scores over time were considered to be of clinical importance. Analysis of seasonal variation revealed a statistically significant seasonal variation in fatigue levels, with higher fatigue values during the winter as measured by VAS fatigue score (p < 0.01) as well as BRAF-MDQ total score (p < 0.01) and Physical and Living sub-scores (both p < 0.01). The greatest variation was seen between winter and autumn for VAS fatigue and between winter and summer for BRAF-MDQ total score and Physical and Living sub-scores. There were no statistical differences in fatigue levels, monthly or seasonal, between sexes or age groups. Conclusions: The majority of rating scales used in this study showed fluctuations in fatigue, general and physical fatigue being significantly greater during the winter. As fatigue is a substantial symptom in many persons with RA, this information is important for rheumatology professionals when dealing with persons with RA in routine care.
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| 18. |
- Feldthusen, Caroline, 1977, et al.
(författare)
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Variations of fatigue in persons with Rheumatoid Arthritis- a 1 year longitudinal study.
- 2014
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Ingår i: DOI: 10.1136/annrheumdis-2014-eular.3502. Ann Rheum Dis. ; 73:Suppl2
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Beside pain, fatigue is expressed as the most prominent symptom in RA [1,2] and has been described as having a greater impact on daily life than pain [2]. Persons with RA experience that their fatigue vary over time concerning duration and frequency [3]. Longitudinal studies assessing change in fatigue after a period of one year have reported relatively stable fatigue [4] or considerable variations of fatigue [5]. More knowledge is needed about how fatigue in persons with RA vary over time. Objectives: To study variations of fatigue during one year in persons with RA of working age. Methods: Sixty-five participants having RA and being of working age (20-65 years) were recruited from a rheumatology clinic in West Sweden. Questionnaires assessing fatigue were given to the participants every other month during 1 year, in total seven times. Fatigue was assessed using both single-item and multidimensional measures: – VAS for global fatigue (0-100 mm) (endpoints no fatigue and worst imaginable fatigue) – The Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire, (BRAF-MDQ) consisting a global score (Total) and four subscales (Physical, Living, Cognition, Emotion) [6-7]. Results: The fatigue showed statistically significant variation over time for the outcome measures VAS fatigue (p<0.01), BRAF-MDQ Total and the subscales Living, Cognition (p<0.001) and Physical (p<0.05), when analyzed by mixed models. For the subscale Emotion (p=0.08) the variation of fatigue over time was not statistically significant. A statistically significant seasonal variation was shown for global fatigue (VAS p<0.01 and BRAF-MDQ Total p<0.001) and physical aspects of fatigue (BRAF-MDQ Physical and Living p<0.01) indicating less physical fatigue in the summer. No statistical differences over time were seen in fatigue between women and men or between age-groups. Conclusions: This study show that fatigue in persons with RA vary significantly during one year and further acknowledges the dynamic nature of fatigue and the complexity of its different facets. References: Wolfe, F., D.J. Hawley, and K. Wilson, The prevalence and meaning of fatigue in rheumatic disease. J Rheumatol, 1996. 23(8): p. 1407-17. Repping-Wuts, H., et al., Fatigue as experienced by patients with rheumatoid arthritis (RA): a qualitative study. Int J Nurs Stud, 2008. 45(7): p. 995-1002. Hewlett, S., et al., Patients' perceptions of fatigue in rheumatoid arthritis: overwhelming, uncontrollable, ignored. Arthritis Rheum, 2005. 53(5): p. 697-702. Mancuso, C.A., et al., Psychosocial variables and fatigue: a longitudinal study comparing individuals with rheumatoid arthritis and healthy controls. J Rheumatol, 2006. 33(8): p. 1496-502. Treharne, G.J., et al., Predictors of fatigue over 1 year among people with rheumatoid arthritis. Psychol Health Med, 2008. 13(4): p. 494-504. Nicklin, J., et al., Measuring fatigue in rheumatoid arthritis: a cross-sectional study to evaluate the Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional questionnaire, visual analog scales, and numerical rating scales. Arthritis Care Res (Hoboken), 2010. 62(11): p. 1559-68. Dures, E.K., et al., Reliability and sensitivity to change of the Bristol Rheumatoid Arthritis Fatigue Scales. Rheumatology (Oxford), 2013.
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| 19. |
- Grimby-Ekman, Anna, 1967, et al.
(författare)
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Analyzing musculoskeletal neck pain, measured as present pain and periods of pain, with three different regression models: a cohort study
- 2009
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Ingår i: BMC Musculoskelet Disord. - : Springer Science and Business Media LLC. - 1471-2474. ; 10:73
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In the literature there are discussions on the choice of outcome and the need for more longitudinal studies of musculoskeletal disorders. The general aim of this longitudinal study was to analyze musculoskeletal neck pain, in a group of young adults. Specific aims were to determine whether psychosocial factors, computer use, high work/study demands, and lifestyle are long-term or short-term factors for musculoskeletal neck pain, and whether these factors are important for developing or ongoing musculoskeletal neck pain. METHODS: Three regression models were used to analyze the different outcomes. Pain at present was analyzed with a marginal logistic model, for number of years with pain a Poisson regression model was used and for developing and ongoing pain a logistic model was used. Presented results are odds ratios and proportion ratios (logistic models) and rate ratios (Poisson model). The material consisted of web-based questionnaires answered by 1204 Swedish university students from a prospective cohort recruited in 2002. RESULTS: Perceived stress was a risk factor for pain at present (PR = 1.6), for developing pain (PR = 1.7) and for number of years with pain (RR = 1.3). High work/study demands was associated with pain at present (PR = 1.6); and with number of years with pain when the demands negatively affect home life (RR = 1.3). Computer use pattern (number of times/week with a computer session > or = 4 h, without break) was a risk factor for developing pain (PR = 1.7), but also associated with pain at present (PR = 1.4) and number of years with pain (RR = 1.2). Among life style factors smoking (PR = 1.8) was found to be associated to pain at present. The difference between men and women in prevalence of musculoskeletal pain was confirmed in this study. It was smallest for the outcome ongoing pain (PR = 1.4) compared to pain at present (PR = 2.4) and developing pain (PR = 2.5). CONCLUSION: By using different regression models different aspects of neck pain pattern could be addressed and the risk factors impact on pain pattern was identified. Short-term risk factors were perceived stress, high work/study demands and computer use pattern (break pattern). Those were also long-term risk factors. For developing pain perceived stress and computer use pattern were risk factors.
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| 20. |
- Grimby-Ekman, Anna, 1967, et al.
(författare)
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Comorbidities, intensity, frequency and duration of pain, daily functioning and health care seeking in local, regional, and widespread pain-a descriptive population-based survey (SwePain)
- 2015
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Ingår i: Bmc Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- Background: The clinical knowledge of factors related to the spread of pain on the body has increased and understanding these factors is essential for effective pain treatment. This population-based study examines local (LP), regional (RP), and widespread pain (WSP) on the body regarding comorbidities, pain aspects, and impact of pain and elucidates how the spread of pain varies over time. Material and methods: A postal questionnaire that addressed pain aspects (intensity, frequency, duration and anatomical spreading on a body manikin), comorbidities and implications of pain (i.e., work situation, physical activity, consumption of health care and experience of hospitality and treatment of health care) was sent to 9000 adults living in southeastern Sweden. Of these, 4774 (53 %) completed and returned the questionnaire. After 9 weeks, a follow-up questionnaire was sent to the 2983 participants who reported pain in the first questionnaire (i.e. 62 % of 4774 subjects). Of these, 1940 completed and returned the questionnaire (i.e. 65 % of 2983 subjects). The follow-up questionnaire included the same items as the first questionnaire. Results: This study found differences in intensity, frequency and duration of pain, comorbidities, aspects of daily functioning and health care seeking in three pain categories based on spreading of pain: LP, RP and WSP. Compared to the participants with RP and LP, the participants with WSP had lower education and worse overall health, including more frequent heart disease and hypertension. In addition, participants with WSP had more intense, frequent, and long-standing pain, required more medical consultations, and experienced more impact on work. The participants with RP constituted an intermediate group regarding frequency and intensity of pain, and impact on work. The participants with LP were the least affected group regarding these factors. A substantial transition to RP had occurred by the 9-week follow-up. Conclusions: This study shows an association between increased spread of pain and prevalence of heart disease, hypertension, more severe pain characteristics (i.e., intensity, frequency and duration), problems with common daily activities and increased health care seeking. The WSP group was the most affected group and the LP group was the least affected group. Regarding these factors, RP was an obvious intermediate group. The transitions between the pain categories warrant research that broadly investigates factors that increase and decrease pain.
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| 21. |
- Grimby-Ekman, Anna, 1967
(författare)
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Epidemiological aspects of musculoskeletal pain in the upper body. Analyzing common and recurrent binary outcomes
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis is to gain epidemiological knowledge about musculoskeletal pain in the upper body in light physical work, in relation to gender, psychosocial factors, and computer use; and to compare different methods for analyzing common and recurrent binary outcomes. Two study groups were investigated using questionnaire data: (a) computer users in the Swedish workforce and (b) a cohort of university students. Regression models used were ordinary logistic model, Cox model (for calculating prevalence ratios), marginal logistic model (GEE), random intercept logistic model (GLMM), Markov logistic model and Poisson model. Effect measures used were odds ratio, risk ratio and risk difference. Musculoskeletal pain in the upper body was more prevalent among women than among men, even among young adults. Risk factors among computer users in the workforce were high work demands, and using the computer most of the work-day (women). Protective factors were work control and to learn and develop at work, and for women support from superiors. In the university cohort stress, high work/study demands and computer use break pattern were identified as risk factors for neck pain. Stress was a risk factor associated both with developing and ongoing neck pain, and had an impact on both the group-average risk and the subject-specific risk of neck pain. Computer use break pattern had an impact on the group-average risk for neck pain, but on the subject-specific risk only for women. Among women stress and computer use break pattern interacted. The effect of presence of both factors exceeded the additive effect of each. Simple questions, about present neck pain and neck pain period past year, captured features of pain, such as general health, sleep disturbance, stress, and general performance. Neck pain period past year did not reflect more serious pain compared to present neck pain. The choice of statistical model should be based on whether a group-average risk or a subject-specific risk is of clinical relevance. Women and men differed more in the absolute effect measures than in the relative, regarding neck pain. The causality between risk factors and neck pain may differ between women and men.
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| 22. |
- Grimby-Ekman, Anna, 1967, et al.
(författare)
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Multidimensional health changes after a multimodal pain rehabilitation program: a registry-based study
- 2021
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Ingår i: Pain Reports. - : Ovid Technologies (Wolters Kluwer Health). - 2471-2531. ; 6:2
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Chronic pain is treated with multimodal rehabilitation programs, targeting improvement in several health aspects. These treatments must be evaluated multidimensionally, which is a methodological challenge. Objectives: This study investigated factors (demographic, pain-related, and individual- vs group-based treatment) predicting successful outcomes after multimodal pain rehabilitation programs. Methods: Data from 3 outpatient clinics were retrieved from the Swedish Quality Registry for Pain Rehabilitation, for 314 patients (218 women). Outcome variables were dichotomized as binary change (improved or not improved) based on clinical thresholds. Total improvement grouped outcomes into 0 to 2, 3 to 4, and 5 to 6 improved variables. Binary logistic regression analyses investigated the association between the baseline predictors and change variables. Results: Patients improving after treatment ranged from 34% (pain intensity) to 80% (depression) for women and 34% to 76% for men, respectively. Total improvement outcome was consistent (after treatment and 1 year) with 28% of patients improving on 5 to 6 outcomes. The baseline predictor related to most improved outcomes was pain intensity, with positive correlation to improvement in pain intensity (P < 0.001) and negative correlation with improvements in anxiety (P = 0.075) and depression (P = 0.002). Individual-based treatment, compared with group-based treatment, was associated with improvement in pain intensity (P = 0.008). Conclusions: About a third of patients improved in several outcomes by the end of a multimodal program, with most improvement for depression and least for pain intensity. Generally, patients with more severe health status at baseline improve most directly after treatment, but these findings could not suggest treatment adjustments that would improve overall success rates.
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| 23. |
- Grimby-Ekman, Anna, 1967, et al.
(författare)
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Pain could negatively affect school grades - Swedish middle school students with low school grades most affected
- 2018
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- © 2018 Grimby-Ekman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Recurrent headache, abdominal and musculoskeletal pain are common in adolescents and it is therefore important to understand their impact on the transitional period from childhood to adulthood. However, studies of the prevalence over time and implications on educational outcomes are still limited, especially regarding multiple pain symptoms. The present study material consists of questionnaire surveys, completed in 2000 and 2008, including two study populations of 9th grade adolescents aged 15 living in West Sweden (n = 20 877). Pain symptoms and demographic variables were based on self-reports from the questionnaires, and school grades were obtained from Statistics Sweden after the student had finished their 9th grade. Between 2000 and 2008, the prevalence of abdominal pain increased among Swedish adolescents (largest increase in girls); the prevalence of headache increased only in girls; the prevalence of pain in upper body decreased only in boys. School grades were significantly lower among those with headache or abdominal pain. Among students with low school grades (10th percentile) the estimated difference between those having any of the symptoms or none were -27 school grade units (95% confidence interval for girls (-27.8; -26.0), for boys (-27.6; -25.5). Both symptoms being present pronounced the association. Low parental education increased the negative effect of symptoms on school grades, most pronounced in the group with the lowest grades. In conclusion, identification of pain symptoms may improve academic achievements, especially in students with multiple symptoms and with parents having low education. Further intervention studies are need.
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| 24. |
- Grimby-Ekman, Anna, 1967, et al.
(författare)
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Pain intensity and pressure pain thresholds after a light dynamic physical load in patients with chronic neck-shoulder pain
- 2020
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background To investigate the development of pain intensity and pressure pain thresholds during and 24 h after a light dynamic physical load among patients with chronic neck-shoulder pain. Methods Twenty-six patients with chronic neck-shoulder pain and 12 healthy controls were included. The participants arm-cycled on an ergometer. Effort was rated with the Borg Rating of Perceived Exertion scale (RPE), and pain intensity with an numeric rating scale (NRS). Pressure pain thresholds were measured by an algometer. Participants started a pain diary 1 week before the physical exercise and continued until 1 week after. Pain intensity was assessed before, during and the following two evenings after arm-cycling. Pressure pain thresholds were assessed before, 15 min after, 105 min after and 24 h after. Results The chronic pain group showed increased pain intensity during, and the following two evenings after the arm cycling, and decreased pain thresholds immediately after the arm cycling involving painful regions. In the patient group there were no impact on pain thresholds in the neck the following day. Conclusions Patients with chronic neck-shoulder pain reported increased pain intensity during and in the evenings after a light dynamic load involving painful regions. In addition, they showed decreased pain thresholds close to the exercise, indicating mechanical hyperalgesia.
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| 25. |
- Grimby-Ekman, Anna, 1967, et al.
(författare)
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Simple neck pain questions used in surveys, evaluated in relation to health outcomes: a cohort study.
- 2012
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Ingår i: BMC research notes. - : Springer Science and Business Media LLC. - 1756-0500. ; 5
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: BACKGROUND: The high prevalence of pain reported in many epidemiological studies, and the degree to which this prevalence reflects severe pain is under discussion in the literature. The aim of the present study was to evaluate use of the simple neck pain questions commonly included in large epidemiological survey studies with respect to aspects of health. We investigated if and how an increase in number of days with pain is associated with reduction in health outcomes. METHODS: A cohort of university students (baseline age 19-25 years) were recruited in 2002 and followed annually for 4 years. The baseline response rate was 69% which resulted in 1200 respondents (627 women, 573 men). Participants were asked about present and past pain and perceptions of their general health, sleep disturbance, stress and energy levels, and general performance. The data were analyzed using a mixed model for repeated measurements and a random intercept logistic model. RESULTS: When reporting present pain, participants also reported lower prevalence of very good health, higher stress and sleep disturbance scores and lower energy score. Among those with current neck pain, additional questions characterizing the pain such as duration (categorized), additional pain sites and decreased general performance were associated with lower probability of very good health and higher amounts of sleep disturbance. Knowing about the presence or not of pain explains more of the variation in health between individuals, than within individuals. CONCLUSION: This study of young university students has demonstrated that simple neck pain survey questions capture features of pain that affect aspects of health such as perceived general health, sleep disturbance, mood in terms of stress and energy. Simple pain questions are more useful for group descriptions than for describing or following pain in an individual.
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