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Sökning: WFRF:(Andréll Paulin 1978)

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1.
  • Andréll, Paulin, 1978, et al. (författare)
  • HEALTH-RELATED QUALITY OF LIFE IN FIBROMYALGIA AND REFRACTORY ANGINA PECTORIS: A COMPARISON BETWEEN TWO CHRONIC NON-MALIGNANT PAIN DISORDERS
  • 2014
  • Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 46:4, s. 341-347
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To compare health-related quality of life in 2 different populations with chronic pain: patients with fibromyalgia and patients with refractory angina pectoris. Previous separate studies have indicated that these patient groups report different impacts of pain on health-related quality of life. Methods: The Short-Form 36 was used to assess health-related quality of life. In order to adjust for age and gender differences between the groups, both patient groups were compared with age- and gender-matched normative controls. The difference in health-related quality of life between the 2 patient groups was assessed by transforming the Short-Form 36 subscale scores to a z-score. Results: The patients with fibromyalgia (n=203) reported poorer health-related quality of life in all the subscale scores of Short-Form 36 (p < 0.05-0.0001) than the patients with refractory angina (n = 146) when both groups were compared with their corresponding normal population (z-score). Conclusion: Patients with fibromyalgia experience greater impairment in health-related quality of life compared with the normal population than do patients with refractory angina pectoris, despite the fact that the latter have a potentially life-threatening disease. The great impairment in health-related quality of life in patients with fibromyalgia should be taken into consideration when planning rehabilitation.
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2.
  • Andréll, Paulin, 1978, et al. (författare)
  • Long-term effects of spinal cord stimulation on angina symptoms and quality of life in patients with refractory angina pectoris--results from the European Angina Registry Link Study (EARL)
  • 2010
  • Ingår i: Heart. - 1355-6037. ; 96:14, s. 1132-1136
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To assess the long-term effect of spinal cord stimulation (SCS) on angina symptoms and quality of life in patients with refractory angina pectoris defined as severe angina due to coronary artery disease resistant to conventional pharmacological therapy and/or revascularisation. METHODS: During 2003-2005, all patients with refractory angina referred for SCS treatment at 10 European centres were consecutively included in the European registry for refractory angina (European Angina Registry Link, EARL), a prospective, 3-year follow-up study. In the present study, the SCS-treated patients were followed-up regarding angina symptoms and quality of life assessed was with a generic (Short Form 36, SF-36) and a disease-specific (Seattle Angina Questionnaire, SAQ) quality of life questionnaire. RESULTS: In total, 235 patients were included in the study. After screening, 121 patients were implanted and followed up 12.1 months after implantation. The implanted patients reported fewer angina attacks (p<0.0001), reduced short-acting nitrate consumption (p<0.0001) and improved Canadian Cardiovascular Society class (p<0.0001). Furthermore, quality of life was significantly improved in all dimensions of the SF-36 and the SAQ. Seven (5.8%) of the implanted patients died within 1 year of follow up. CONCLUSIONS: SCS treatment is associated with symptom relief and improved quality of life in patients with refractory angina pectoris suffering from severe coronary artery disease.
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3.
  • Andréll, Paulin, 1978 (författare)
  • Refractory angina pectoris. Patient characteristics, safety and long-term effects of spinal cord stimulation
  • 2005
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Refractory angina pectoris has been defined as severe angina pectoris due to coronary artery disease which cannot be controlled by conventional pharmacological or surgical therapy. The epidemiology of this condition is virtually unknown. During the last decades, additional treatment options have been developed for this condition. One of these is spinal cord stimulation (SCS), which has been used for approximately 20 years as an additional symptom-relieving treatment for patients with severe angina pectoris. SCS has an anti-ischaemic effect and has been shown to be a safe and effective treatment modality. The occurrence of refractory angina pectoris among patients who had undergone coronary angiography was assessed in a defined geographic area. In order to characterise the patients with regard to concurrent diseases, treatment, functional class, quality of life, morbidity and fatality, the refractory angina patients were compared with patients with severe angina pectoris who were accepted for revascularisation. Within three years, 146 patients were identified, comprising 2.1% of all patients undergoing coronary angiography due to stable angina pectoris. The patients with refractory angina pectoris had more severe cardiac disease as well as coronary artery disease than the patients in the revascularisation group. Some of the patients in the refractory group appear to be in a fairly good condition with regard to extracardiac diseases but there is a subpopulation in the refractory group with severe cardiac as well as extracardiac diseases. The main reasons for rejection for revascularisation were unsuitable coronary anatomy and a potential risk of damaging existing grafts. After one year of follow-up the refractory patients had a higher fatality rate but a lower frequency of cerebrovascular morbidity than the revascularisation group. The refractory patients had more severe angina and lower quality of life with regard to physical function and impact of angina symptoms, compared with the revascularisation group. However, the mental health of the refractory patients was not affected compared with the revascularisation group. The patients in the so-called ESBY study (Electrical Stimulation versus Coronary Bypass Surgery in Severe Angina Pectoris, a randomised comparison of SCS and coronary artery bypass grafting (CABG) in 104 patients with severe angina pectoris and increased surgical risk) were followed up with regard to neurological and neuropsychological complications, morbidity and cost-effectiveness. There were more patients in the CABG group who developed neurological and neuropsychological complications than in the SCS group. Furthermore, presence of deep white matter disease on cerebral magnetic resonance imaging was shown to be a predictor of cerebrovascular complications after CABG. During two years of follow-up, health care costs and cardiac morbidity was lower in the SCS group than in the CABG group. However, the groups did not differ with regard to mortality or causes of death. There were no serious complications related to the SCS treatment. CONCLUSION Refractory angina pectoris appears to be a considerable problem. This patient group has a high fatality rate and low quality of life compared with revascularised patients. SCS, which is one of the recommended treatment option for these patients, was found to be safe (in terms of mortality, morbidity and absence of serious complications) and effective (in terms of symptom relief and cost-effectiveness) during long-term treatment. Furthermore, presence of deep white matter disease on cerebral magnetic resonance imaging seems to be a predictor of cerebrovascular complications after CABG.
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6.
  • Andréll, Paulin, 1978, et al. (författare)
  • White matter disease in magnetic resonance imaging predicts cerebral complications after coronary artery bypass grafting
  • 2005
  • Ingår i: The Annals of thoracic surgery. - 1552-6259. ; 79:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The aim of the present study was to assess neurologic and neuropsychologic complications in 104 patients randomized to coronary artery bypass grafting or spinal cord stimulation. An additional objective of the study was to assess whether preoperative white matter disease might predict cerebral complications, as previous studies have shown that there is a relationship between white matter disease and neuropsychologic decline after coronary artery bypass grafting. METHODS: The patients were subjected to neurologic examination before and six months after intervention. The patients underwent a cerebral magnetic resonance imaging before intervention and the presence of white matter disease was related to development of cerebral complications. RESULTS: More patients in the bypass group than in the spinal cord stimulation group developed focal cerebral ischemia (p < 0.05) and astheno-emotional disorder (p < 0.001). More patients with white matter disease undergoing bypass were affected by focal cerebral ischemia (p < 0.01) and astheno-emotional disorder (p < 0.001) after the intervention compared to patients with white matter disease undergoing spinal cord stimulation. In patients with no white matter disease there were no differences between the bypass group and spinal cord stimulation group with regard to cerebral complications. CONCLUSIONS: Patients undergoing bypass had more neurologic and neuropsychologic complications than patients undergoing spinal cord stimulation. Furthermore, patients with white matter disease were affected by cerebral complications in a higher extent after bypass than after spinal cord stimulation. Thus, preoperative assessment of white matter disease before undergoing coronary artery bypass grafting might predict the patient's risk of developing cerebral injury.
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8.
  • Börjesson, Mats, 1965, et al. (författare)
  • Neurostimulering har god effekt vid svår angina pectoris : Neurostimulation is effective in severe angina pectoris
  • 2009
  • Ingår i: Läkartidningen. - 0023-7205 .- 0023-7205. ; 106:4, s. 214-7
  • Tidskriftsartikel (refereegranskat)abstract
    • Svår symtomgivande angina pectoris, trots optimal medikamentell och invasiv terapi, definieras internationellt som refraktär angina pectoris. Ett flertal additiva behandlingsmetoder har utvecklats och visat symtomlindrande effekt i studier av varierande kvalitet. Neurostimulering (spinal cord stimulation, SCS) är mest studerad och har i randomiserade kontrollerade studier visat positiva effekter på symtomlindring, förbättrad funktionell status och höjd livskvalitet.
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9.
  • Börjesson, Mats, 1965, et al. (författare)
  • Spinal cord stimulation for refractory angina.
  • 2010
  • Ingår i: In: Evidence-based chronic pain management. Eds. Stannard C, Kelso E, Ballantyne J.. - : Blackwell, Publ, 2010. ; , s. 400-4
  • Bokkapitel (övrigt vetenskapligt/konstnärligt)
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10.
  • Carlson, Tobias, 1976, et al. (författare)
  • Interference of transcutaneous electrical nerve stimulation with permanent ventricular stimulation: a new clinical problem?
  • 2009
  • Ingår i: Europace. - 1532-2092. ; 11:3, s. 364-9
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS: To assess the compatibility of thoracic TENS and permanent PM treatment and to identify any signs of interference of TENS with the PM function. METHODS AND RESULTS: Twenty-seven patients treated with PM were tested. Transcutaneous electric nerve stimulation electrodes were placed above each mamilla, and the stimulation intensity was increased to the maximum level tolerated for 30 s or until electrocardiogram revealed signs of interference. Transcutaneous electric nerve stimulation of 2 and 80 Hz was tested with the PM ventricular sensing level set to the clinically chosen level as well as to maximal sensitivity. Interference was detected in 22 of 27 patients (81%). Low-frequency (2 Hz) stimulation was more associated with PM interference (52% at normal vs. 81% at maximal ventricular sensitivity) than high-frequency (80 Hz) stimulation (33% at normal vs. 63% at maximal ventricular sensitivity); although the differences were not statistically significant. CONCLUSION: Transcutaneous electric nerve stimulation frequently induces inhibition of the PM function already at the clinically set ventricular sensitivity. Therefore, individual testing is warranted before TENS treatment is considered in patients with a PM. A test protocol for TENS and PM interaction is proposed.
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11.
  • Dahlback, Angelica, et al. (författare)
  • Can physiotherapy in an interdisciplinary pain rehabilitation setting improve physical function? A long-term mixed methods follow-up study
  • 2024
  • Ingår i: PHYSIOTHERAPY THEORY AND PRACTICE. - 0959-3985 .- 1532-5040.
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: The aim of this study was to describe chronic pain patients' perception of their physical function and treatment factors for improving or maintaining physical function long-term after the completion of an Interdisciplinary Pain Rehabilitation Program (IPRP) and to compare physical function before, directly after and at long-term follow-up (16-20 months after treatment). Materials and methods: Patients with severe nonmalignant chronic pain, participating in an IPRP at a specialist clinic, were eligible for inclusion in a convergent mixed methods study. Quantitative data included aerobic capacity, level of physical activity (PA) and self-efficacy for exercise. Qualitative data were collected through semi-structured interviews. Results: The qualitative analysis resulted in one theme: Orientation change and two categories: Permission to feel self-worth and Reclaiming life, which illuminated factors that enabled a sustained increase in PA. The quantitative data (n = 11) showed a significantly increased maximal oxygen uptake (VO(2)max) from 2.46 l/min (SD = 0.9) at baseline to 2.63 l/min (SD = 0.9, p = .03) on completion of the program. VO(2)max was sustained at long-term follow-up (2.56 l/min (SD = 1.0, p = .24). Conclusion: This study indicates that an orientation change process through an IPRP can lead to increased physical function and a sustainable level of PA. Furthermore, it highlights the importance of a person-centered approach to enable sustainable change in patients with chronic pain.
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12.
  • Dahlbäck, Angelica, et al. (författare)
  • Reliability and aspects of validity of the Swedish version of self-efficacy for exercise scale for patients with chronic pain
  • 2023
  • Ingår i: Physiotherapy Theory and Practice. - : Informa UK Limited. - 0959-3985 .- 1532-5040. ; 39:1, s. 163-173
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Active, specific, and professionally led physical exercise is an effective treatment for chronic pain, and self-efficacy is correlated to positive treatment outcomes. At present, there is limited knowledge of self-efficacy for exercise in patients with chronic pain. Purpose To evaluate the reliability and aspects of validity of the Swedish version of the Self-Efficacy for Exercise Scale (SEE-SV) in patients with chronic pain. Methods Patients with chronic pain were recruited from a specialist clinic. The Swedish version of the SEE was used. Reliability was evaluated through internal consistency, test-retest, and measurement error (standard error of measurement, SEM and smallest detectable change, SDC). Construct validity was calculated using the correlation between the SEE-SV and other well-established evaluation instruments. Content validity was evaluated both from a patient and a health-care professional perspective. Results In total, 44 patients, 31 women and 13 men (mean age 40 years), participated in the study. The SEE-SV had good test-retest reliability (intra-class correlation coefficient (ICC) = 0.95) and internal consistency (Cronbach's alpha = 0.97). Regarding measurement error, SEM was 4.9 and SDC 13.5. Moderate correlation was seen between SEE-SV and a pain-specific self-efficacy questionnaire (rs = 0.52). The majority of patients and health-care professionals considered the SEE-SV to be relevant and easy to understand. Conclusion The SEE-SV showed a good internal consistency, item-to-total correlation, and test-retest reliability (ICC). A relatively high SDC indicates an individual variability of the test results. The content validity was satisfactory. Regarding the construct validity, further studies are needed.
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15.
  • Ghafouri, Bijar, et al. (författare)
  • Swedish Chronic Pain Biobank : protocol for a multicentre registry and biomarker project
  • 2022
  • Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:11
  • Tidskriftsartikel (refereegranskat)abstract
    • INTRODUCTION: About 20% of the adult population have chronic pain, often associated with psychological distress, sick leave and poor health. There are large variations in the clinical picture. A biopsychosocial approach is used in investigation and treatment. The concept of personalised medicine, that is, optimising medication types and dosages for individual patients based on biomarkers and other patient-related factors, has received increasing attention in different diseases but used less in chronic pain. This cooperative project from all Swedish University Hospitals will investigate whether there are changes in inflammation and metabolism patterns in saliva and blood in chronic pain patients and whether the changes correlate with clinical characteristics and rehabilitation outcomes.METHODS AND ANALYSIS: Patients at multidisciplinary pain centres at University Hospitals in Sweden who have chosen to participate in the Swedish Quality Registry for Pain Rehabilitation and healthy sex-matched and age-matched individuals will be included in the study. Saliva and blood samples will be collected in addition to questionnaire data obtained from the register. From the samples, proteins, lipids, metabolites and micro-RNA will be analysed in relation to, for example, diagnosis, pain characteristics, psychological distress, body weight, pharmacological treatment and clinical rehabilitation results using advanced multivariate data analysis and bioinformatics.ETHICS AND DISSEMINATION: The study is approved by the Swedish Ethical Review Authority (Dnr 2021-04929) and will be conducted in accordance with the declaration of Helsinki.The results will be published in open access scientific journals and in popular scientific relevant journals such as those from patient organisations. Data will be also presented in scientific meetings, meeting with healthcare organisations and disseminated in different lecturers at the clinics and universities.
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16.
  • Johansson, Birgitta, 1957, et al. (författare)
  • Evaluation of dosage, safety and effects of methylphenidate on post-traumatic brain injury symptoms with a focus on mental fatigue and pain.
  • 2014
  • Ingår i: Brain injury : [BI]. - : Informa UK Limited. - 1362-301X .- 0269-9052. ; 28:3, s. 304-310
  • Tidskriftsartikel (refereegranskat)abstract
    • Abstract Objective: The neurobehavioural symptoms and pain following traumatic brain injury (TBI) can be long-lasting. The condition impairs the persons' ability to function in their work, studies and gatherings with family and friends. The aim of this study was to investigate dosage, safety and effects of methylphenidate on mental fatigue and pain. Methods: Twenty-nine physically-well rehabilitated TBI victims, 28 with a mild TBI and one with TBI and also with pain in the neck, shoulders and head were included in the study. Methylphenidate was tested in each patient using three treatment strategies: no medication, low dose (5mg×3) and normal dose (20mg×3) for 4 weeks using a randomized cross-over design. Results: Twenty-four patients completed the three treatment periods. Five participants discontinued, four females due to adverse reactions and one male due to attenuated motivation. Only minor adverse events were reported. Methylphenidate significantly decreased mental fatigue, as evaluated by the Mental Fatigue Scale (p<0.001), and the effects on mental fatigue were dose-dependent. No effect on pain was detected. Conclusions: Methylphenidate decreased mental fatigue for subjects suffering a traumatic brain injury, the treatment is considered to be safe and is recommended, starting with a low dose.
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17.
  • Johansson, Birgitta, 1957, et al. (författare)
  • Follow-up after 5.5 years of treatment with methylphenidate for mental fatigue and cognitive function after a mild traumatic brain injury
  • 2020
  • Ingår i: Brain Injury. - : Informa UK Limited. - 0269-9052 .- 1362-301X. ; 34:2, s. 229-235
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Prolonged mental fatigue and cognitive impairments are common after a mild traumatic brain injury (TBI). This sets limits for rehabilitation and for regaining the capacity for work and participation in social life. Method: This follow-up study, over a period of approximately 5.5 years was designed to evaluate the effect and safety of methylphenidate treatment for mental fatigue after a mild TBI. A comparison was made between those who had continued, and those who had discontinued the treatment. The effect was also evaluated after a four-week treatment break. Results: Significant improvement in mental fatigue, depression, and anxiety for the group treated with methylphenidate (p < .001) was found, while no significant change was found for the group without methylphenidate. The methylphenidate treatment group also improved their processing speed (p = .008). Withdrawal produced a pronounced and significant deterioration in mental fatigue, depression, and anxiety and a slower processing speed. This indicates that the methylphenidate effect is reversible if discontinued and that continued methylphenidate treatment can be a prerequisite for long-term improvement. The effect was found to be stable and safe over the years. Conclusion: We suggest methylphenidate to be a possible treatment option for patients with post-TBI symptoms including mental fatigue and cognitive symptoms.
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18.
  • Johansson, Birgitta, 1957, et al. (författare)
  • Hjärntrötthet – ett osynligt gissel : Mental fatigue - possible explanations, diagnostic methods and possible treatments
  • 2022
  • Ingår i: Läkartidningen. - 0023-7205. ; 119
  • Tidskriftsartikel (refereegranskat)abstract
    • Mental fatigue or brain fatigue is a pathological and disabling symptom with diminished mental energy. It can be a long-lasting consequence after trauma or disease affecting the brain. The person can do most things in the moment and can be perceived as completely healthy, but the mental energy is insufficient over time and affects the ability to work and participate in social activities. After a conversation, for example, the person can be completely drained of energy and the recovery time is disproportionally long. Here we describe the phenomenon of mental fatigue, provide an explanatory model for how the condition can arise, point out diagnostic methods and possible treatments, which are currently in the research stage but may be implemented in healthcare within the foreseeable future.
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19.
  • Johansson, Birgitta, 1957, et al. (författare)
  • Long-term treatment with methylphenidate for fatigue after traumatic brain injury
  • 2017
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314. ; 135:1, s. 100-107
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives - Traumatic brain injury (TBI) may cause long-lasting post-concussive symptoms, such as mental fatigue and concentration difficulties, and this may become the main hindrance for returning to work and studies. There is currently no effective treatment for longlasting mental fatigue. In this hypothesis generating study, the long-term effects of methylphenidate on mental fatigue, cognitive function, and safety were assessed. Materials & methods - Thirty participants who suffered from long-term post-concussion symptoms after a mild TBI or moderate TBI and who had reported positive effects with methylphenidate during an initial phase of this follow-up study were treated with methylphenidate for a further six months. Results - After six-month follow-up, effects on Mental Fatigue Scale (MFS), depression, anxiety, and cognitive function (processing speed, attention, working memory) were significantly improved compared to baseline data (P < 0.001, respectively). Heart rate was significantly increased (P = 0.01), while blood pressure was not changed. Conclusions - Individuals suffering from prolonged symptoms after TBI reported reduced mental fatigue and improved cognitive functions with long-term methylphenidate treatment. It is suggested that methylphenidate can be a treatment option for long-term mental fatigue and cognitive impairment after a TBI, but further randomized control research is warranted.
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20.
  • Johansson, Birgitta, 1957, et al. (författare)
  • Methylphenidate reduces mental fatigue and improves processing speed in persons suffered a traumatic brain injury.
  • 2015
  • Ingår i: Brain injury. - : Informa UK Limited. - 1362-301X .- 0269-9052. ; 29:6, s. 758-765
  • Tidskriftsartikel (refereegranskat)abstract
    • Post-traumatic brain injury symptoms, such as mental fatigue, have considerable negative impacts on quality-of-life. In the present study the effects of methylphenidate in two different dosages were assessed with regard to mental fatigue, pain and cognitive functions in persons who had suffered a traumatic brain injury.
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22.
  • Karlsson, Ove, et al. (författare)
  • Jaw exercise therapy for the treatment of trismus in head and neck Cancer: a prospective three-year follow-up study
  • 2021
  • Ingår i: Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339. ; 29, s. 3793-3800
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: This study aims to examine effects of jaw exercise on trismus 3years following completion of a post-radiotherapy jaw exercise intervention. Methods: Prospective study including 50 patients with head-and-neck cancer receiving radiotherapy and/or chemotherapy, plus a matched control group. The intervention group underwent 10weeks of jaw exercise training. Patients were followed pre-and postintervention and 3years postintervention completion. Outcome measures were maximal interincisal opening (MIO), trismus-related symptoms, and health-related quality-of-life as measured by Gothenburg Trismus Questionnaire, EORTC QLQ-C30, and EORTC QLQ-H&N35. Results: The intervention group had a statistically significantly higher mean MIO compared with the control group (40.1mm and 33.9mm, respectively, p < 0.001), reported less trismus-related problems and had an improved health-related quality-of-life when compared with the control group at the 3-year follow-up. These differences were all statistically significant. Conclusion: Jaw exercise therapy resulted in increased MIO, less trismus-related symptoms, and improved health-related quality-of-life. Jaw exercise therapy should be initiated early, in a structured manner and continued long-term. © 2020, The Author(s).
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23.
  • Karlsson, Therese, et al. (författare)
  • Effects of voice rehabilitation after radiotherapy for laryngeal cancer: a longitudinal study.
  • 2017
  • Ingår i: Logopedics, phoniatrics, vocology. - : Informa UK Limited. - 1651-2022 .- 1401-5439. ; 42:4, s. 167-177
  • Tidskriftsartikel (refereegranskat)abstract
    • The study aimed to investigate the effects of voice rehabilitation on health-related quality of life (HRQL) and voice function in patients treated for laryngeal cancer six months post-rehabilitation completion. A secondary aim was to identify factors that predict significant communication improvement.Longitudinal follow-up of randomised controlled trial.In total, 33 patients received voice rehabilitation post-radiotherapy and 32 patients constituted the control group. Outcome measures included patient-reported HRQL, communication and voice function (acoustic measures and perceptual analysis). Outcome measures were analysed one (baseline), six and 12 months post-radiotherapy, where voice rehabilitation was conducted between the first two time-points.Patients improved after voice rehabilitation with regard to communication function and HRQL and remained unchanged after 12 months post-radiotherapy. A significant roughness deterioration in the control group occurred between six and 12 months post-radiotherapy, yet remained unchanged in the intervention group. A factors increasing odds of significant communication improvement 12 months post-radiotherapy was voice rehabilitation. Smoking affected communication negatively.Voice rehabilitation appears to have positive effect on voice function and HRQL, which persist up to 12 months of follow-up and appears to prevent deterioration of perceived roughness. Patients who experience voice and communication problems at baseline are most likely to benefit from voice rehabilitation.
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24.
  • Karlsson, Therese, et al. (författare)
  • Effects of voice rehabilitation on health-related quality of life, communication and voice in laryngeal cancer patients treated with radiotherapy: A randomised controlled trial.
  • 2015
  • Ingår i: Acta oncologica (Stockholm, Sweden). - 1651-226X. ; 54:7, s. 1017-1024
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. This study aims to assess the effect of voice rehabilitation on health-related quality of life (HRQL) and communication experience for laryngeal cancer patients treated with radiotherapy. Method. This prospective randomised controlled trial included 74 patients with Tis-T4 laryngeal cancer treated curatively by radiotherapy, of which 37 constituted the intervention group receiving voice rehabilitation and 37 patients as a control group. Patients were followed at one and six months post-radiotherapy, with voice rehabilitation conducted between these time-points. Endpoints included patient reported outcomes, including HRQL as measured by European Organisation for Research and Treatment of Cancer (EORTC) Core30 (C30) and Head & Neck35 (H&N35) as well as communication function as measured by Swedish Self-Evaluation of Communication Experiences after Laryngeal cancer (S-SECEL). Results. The intervention group reported statistically significant improvements in communication experience as measured by S-SECEL environmental, attitudinal and total score domains compared to the control group. Similar improvements were seen in EORTC H&N35 Speech domain and the EORTC C30 domain Global quality of life. Moderate correlations were noted (r = 0.51-0.59) between three of four S-SECEL domains and the EORTC domains Speech and Global quality of life. Conclusion. Laryngeal cancer patients treated with radiotherapy who receive voice rehabilitation appear to experience beneficial effects on communication function and selected HRQL domains. Voice rehabilitation following radiotherapy is recommended but further research investigating potential target groups and long-term effects is required.
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26.
  • Lind, Josefine, et al. (författare)
  • Insomnia Symptoms and Chronic Pain among Patients Participating in a Pain Rehabilitation Program-A Registry Study
  • 2021
  • Ingår i: Journal of Clinical Medicine. - : MDPI AG. - 2077-0383. ; 10:18
  • Tidskriftsartikel (refereegranskat)abstract
    • Insomnia and chronic pain are prevalent health complaints. Previous research has shown that they are closely associated, but their interaction and causality are not completely understood. Further research is needed to uncover the extent to which a treatment strategy focusing on one of the conditions affects the other. This study aimed to map the prevalence of insomnia symptoms among patients in interdisciplinary pain rehabilitation program (IPRP) and investigate associations between the degree of insomnia at baseline and the treatment outcome regarding pain intensity, physical function, social function, mental well-being, anxiety, and depression. Of the 8515 patients with chronic pain, aged 15-81 who were registered in the Swedish Quality Registry for Pain Rehabilitation during 2016-2019 and participated in IPRP, 7261 had follow-up data after treatment. Logistic regression analysis was used to investigate associations. The prevalence of clinical insomnia, according to Insomnia Severity Index (ISI), among chronic pain patients in IPRP was 66%, and insomnia symptoms were associated with both country of birth and educational level. After IPRP, the prevalence of clinical insomnia decreased to 47%. There were statistically significant associations between the degree of insomnia symptoms before IPRP and physical function (p < 0.001), social function (p = 0.004) and mental well-being (p < 0.001). A higher degree of insomnia symptoms at baseline was associated with improvement after IPRP. In conclusion, IPRP seem to have beneficial effects on insomnia symptoms in chronic pain patients. Nevertheless, almost half of the patients still suffer from clinical insomnia after IPRP. The possible effect of systematic screening and treatment of insomnia for improving the effect of IPRP on pain is an important area for future research.
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27.
  • Lundin, Åse, 1988, et al. (författare)
  • Suffering out of sight but not out of mind - interpreting experiences of sick leave due to chronic pain in a community setting: a qualitative study
  • 2023
  • Ingår i: BMJ Open. - 2044-6055. ; 13:4
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: Chronic pain is a complex health problem affecting about one-fifth of the European population. It is a leading cause of years lived with disability worldwide, with serious personal, relational and socioeconomic consequences. Chronic pain and sick leave adversely affect health and quality of life. Thus, understanding this phenomenon is essential for reducing suffering, understanding the need for support and promoting a rapid return to work and an active lifestyle. This study aimed to describe and interpret persons' experiences of being on sick leave due to chronic pain. DESIGN: A qualitative study with semistructured interviews analysed using a phenomenological hermeneutic approach. SETTING: Participants were recruited from a community setting in Sweden. PARTICIPANTS: Fourteen participants (12women) with experiences of part-time or full-time sick leave from work due to chronic pain were included in the study. RESULTS: Suffering out of sight but not out of mind was the main theme of the qualitative analysis. This theme implies that the participants' constant suffering was invisible to others, causing them to feel they were not being justly treated in society. Feeling overlooked led to a continuous struggle for recognition. Moreover, the participants' identities and their trust in themselves and their bodies were challenged. However, our study also revealed a nuanced understanding of the experiences of sick leave as a consequence of chronic pain, where the participants learnt important lessons, including coping strategies and re-evaluated priorities. CONCLUSIONS: Being on sick leave due to chronic pain threatens a person's integrity and leads to substantial suffering. An enhanced understanding of the meaning of sick leave due to chronic pain provides important considerations for their care and support. This study highlights the importance of feeling acknowledged and being met with justice in encounters with others.
  •  
28.
  • Montalvo, Charlotte, et al. (författare)
  • Impact of exercise with TheraBite device on trismus and health-related quality of life: A prospective study.
  • 2020
  • Ingår i: Ear, nose, & throat journal. - : SAGE Publications. - 1942-7522 .- 0145-5613.
  • Tidskriftsartikel (refereegranskat)abstract
    • Trismus is a common symptom in patients with head and neck cancer that affects many aspects of daily life negatively. The aim of this study was to investigate the impact of structured exercise with the jaw-mobilizing device TheraBite on trismus, trismus-related symptomatology, and health-related quality of life (HRQL) in patients with head and neck cancer. Fifteen patients with trismus (maximum interincisal opening [MIO] ≤35 mm) after oncologic treatment for head and neck cancer, underwent a 10-week exercise program with the TheraBite device and were followed regularly. Time between oncologic treatment and start of TheraBite exercise ranged from 0.7 to 14.8 years (average 6.2 years). MIO, trismus-related symptoms, and HRQL was assessed before and after exercise and after 6 months. A significant improvement in MIO was observed post-exercise (3.5 mm, 15.3%, p = 0.0002) and after 6-month of follow-up (4.7 mm, 22.1%, p = 0.0029). A statistically significant correlation was found between increased MIO and fewer trismus-related symptoms. In conclusion, exercise with TheraBite improved MIO and trismus-related symptoms in patients with trismus secondary to head and neck cancer. Structured exercise with the jaw-mobilizing device seems to be beneficial for patients with trismus independent of time since oncologic treatment.
  •  
29.
  • Nordahl Amorøe, Torben, et al. (författare)
  • How theories of complexity and resilience affect interprofessional simulation-based education: a qualitative analysis of facilitators' perspectives
  • 2023
  • Ingår i: BMC Medical Education. - 1472-6920. ; 23:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundQuality of care and patient safety rely on the ability of interprofessional teams to collaborate effectively. This can be trained through interprofessional simulation-based education (IPSE). Patient safety also relies on the ability to adapt to the complexity of such situations, an ability termed resilience. Since these needs are not explicitly addressed in IPSE, the aim of this study was to explore how central concepts from complexity-theory and resilience affect IPSE, from facilitators' perspective, when applied in debriefings.MethodsA set of central concepts in complexity-theory and resilience were introduced to facilitators on an IPSE course for nursing and medical students. In five iterations of focus groups interviews the facilitators discussed their application of these concepts by reviewing video recordings of their own debriefings. Video recordings of the interviews were subjected to coding and thematic analysis.ResultsThree themes were identified. The first, Concepts of complexity and resilience are relevant for IPSE, points to the applicability of these concepts and to the fact that students often need to deviate from prescribed guidelines/algorithms in order to solve cases. The second theme, Exploring complexity, shows how uncertainty could be used as a cue to explore complexity. Further, that individual performance needs to account for the context of actions and how this may lead to certain outcomes. Moreover, it was suggested that several ways to approach a challenge can contribute to important insight in the conditions for teamwork. The third theme, Unpacking how solutions are achieved, turns to needs for handling the aforementioned complexity. It illustrates the importance of addressing self-criticism by highlighting how students were often able to overcome challenges and find solutions. Finally, this theme highlights how pre-defined guidelines and algorithms still work as important resources to help students in transforming perceived messiness into clarity.ConclusionsThis study suggests that IPSE provides the possibility to explore complexity and highlight resilience so that such capability can be trained and improved. Further studies are needed to develop more concrete ways of using IPSE to account for complexity and developing resilience capacity and to evaluate to what extent IPSE can provide such an effect.
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30.
  • Odell, Annika, 1960, et al. (författare)
  • Patients expectations and fulfilment of expectations before and after treatment for suspected coronary artery disease assessed with a newly developed questionnaire in combination with established health-related quality of life questionnaires
  • 2017
  • Ingår i: Open Heart. - : BMJ. - 0959-8146 .- 0959-535X .- 2053-3624. ; 4:1
  • Tidskriftsartikel (refereegranskat)abstract
    • ABSTRACT Background Clinical decision-making is often based on evidence of outcome after a specific treatment. Healthcare providers and patients may, however, have different perceptions and expectations of what to achieve from a certain healthcare measure. Aims To evaluate patients’ expectations, perceptions and health related quality of life (HRQoL) before a care process including coronary angiography for suspected coronary artery disease and to evaluate the fulfilment of these expectations in relation to established patient reported outcome measures (PROMs) 6 months later. Furthermore, an aim was to try to define meaningful patient reported experience measures (PREMs) in this population. Methods 544 patients planned for coronary angiography completed a newly developed questionnaire to assess expectations and perceptions of treatment, the expectation questionnaire (ExpQ) and two established HRQoL questionnaires together with the established generic Short-Form 36 (SF36) and the disease specific Seattle Angina Questionnaire (SAQ). Results Patients had before the intervention, in general, high expectations of improvement after investigation and treatment and there was a positive attitude towards life style changes, medication and participation in decision-making regarding their own treatment. Only, 56.4% of the patients, however, reported fulfilment of treatment expectations. Fulfilment of treatment expectations correlated strongly with improvement in HRQoL after the care process. Conclusions To measure patients’ expectations and fulfilments of these may offer simple and meaningful outcomes to evaluate a healthcare process from a patient’s perspective. To approach patients’ expectations may also strengthen patient involvement in the care process with the possibilities of both higher patient satisfaction and medical results of the treatment.
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31.
  • Odenstedt, Jacob, 1968, et al. (författare)
  • Spinal cord stimulation effects on myocardial ischemia, infarct size, ventricular arrhythmia, and noninvasive electrophysiology in a porcine ischemia-reperfusion model.
  • 2011
  • Ingår i: Heart Rhythm. - : Elsevier BV. - 1556-3871 .- 1547-5271. ; Jan:18
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Susceptibility to ventricular arrhythmias and sudden cardiac death can be reduced by modulation of autonomic tone. Spinal cord stimulation (SCS) presumably affects autonomic tone and reduces myocardial ischemia. OBJECTIVE: The purpose of this study was to investigate whether SCS could reduce myocardial ischemia, infarct size, and ventricular arrhythmias as well as repolarization alterations in a porcine ischemia-reperfusion model. METHODS: Anesthetized common Landrace pigs were randomized to SCS (n = 10) or sham treatment (n = 10) before, during, and after 45 minutes of coronary occlusion. Area at risk, infarct size, and spontaneous ventricular arrhythmias were analyzed. Continuous three-dimensional vectorcardiograms was recorded and analyzed with respect to ECG intervals, ST-segment, and T-vector and T-vector-loop morphology. RESULTS: SCS was associated with significantly (P <.04) fewer episodes of nonsustained ventricular tachycardia (NSVT) and sustained ventricular tachycardia (SVT), particularly during mid-left anterior descending artery (LAD) occlusion (SCS vs non-SCS; NSVT, mid- and proximal LAD: 0 vs 22 and 45 vs 72; SVT, mid- and proximal LAD: 3 vs 15 and 5 vs 5). No difference in ventricular fibrillation episodes was observed. The SCS group had significantly less ST elevation (P <.03) but similar area at risk, infarct size, and ratio of infarct size/area at risk. Ischemia induced increases of T(amplitude) and T(area) suggesting increased repolarization gradients, which were significantly reduced by SCS (P <.01 for both). CONCLUSION: SCS appears to have an antiarrhythmic effect on spontaneous NSVT and SVT during ischemia-reperfusion in association with a reduction of repolarization alterations. Vectorcardiography signs of myocardial ischemia were reduced by SCS, but this intervention was not accompanied by any effect on infarct size.
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32.
  • Olausson, Alexander, et al. (författare)
  • Patients' perioperative experiences of an opioid-free versus opioid-based care pathway for laparoscopic bariatric surgery: A qualitative study
  • 2024
  • Ingår i: INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES. - : Elsevier. - 2666-142X. ; 6
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Despite recent evidence supporting the adoption of opioid-free anaesthetic and analgesic alternatives in the perioperative context, opioid-based regimens remain standard of care. There is limited knowledge about the patients ' perioperative experiences of bariatric surgery, with no study yet investigating their experiences within an opioid-free care pathway. Objective: We aimed to describe similarities and differences in patients ' perioperative experiences of undergoing bariatric surgery with either an opioid-free or opioid-based care pathway. Design: A qualitative interview study Setting: A strategic sample of patients enrolled in an ongoing randomized controlled trial investigating the effects of opioid-free anaesthesia for bariatric surgery were recruited. In the randomized controlled trial, participants were randomized to either opioid-based anaesthesia or opioid-free anaesthesia, including transcutaneous electrical nerve stimulation as primary postoperative pain management. Participants: Twenty patients were interviewed 3 months after surgery: 10 participants in the opioid-free group versus 10 in the opioid-based group. Methods: Semi -structured interviews were conducted between December 2020 and February 2022 and analysed with qualitative content analysis. Results: The analysis yielded four categories and 12 subcategories. In Category 1, participants shared diverse emotions before surgery, including anticipation of a healthier life, but also apprehensions and feelings of failure . In Category 2, describing liminality of general anaesthesia , there were similar descriptions of struggling to remember the anaesthesia induction and struggling to surface when recovering from anaesthesia. However, some participants in the opioid-free group shared descriptions of struggling to keep control , describing accentuated memories of the anaesthesia induction. Category 3, managing your pain, showed similar experiences and strategies but different narrations of pain management, with the opioid-free group stating that transcutaneous electrical nerve stimulation works but not when it really hurts , and the opioid-based group describing confidence in but awareness of opioids . Throughout the overall perioperative time period, participants acknowledged Category 4, a patient -professional presence, stating that preparations boost the feeling of confidence before surgery and that they felt confidence in a vulnerable situation although vulnerability challenges communication . Conclusions: We highlighted the overall similarities in perioperative experiences of patients undergoing bariatric surgery. However, the differences in experiences during opioid-free anaesthesia induction need to be addressed in further implementation and research studies investigating strategies to reduce the sense of loss of control. More research is needed to facilitate the implementation of opioid-free treatment strategies into clinical practice and improve the patient care experience.
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33.
  • Olausson, Alexander, et al. (författare)
  • Total opioid-free general anaesthesia can improve postoperative outcomes after surgery, without evidence of adverse effects on patient safety and pain management : a systematic review and meta-analysis
  • 2022
  • Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley-Blackwell Publishing Inc.. - 0001-5172 .- 1399-6576. ; 66:2, s. 170-185
  • Forskningsöversikt (refereegranskat)abstract
    • BACKGROUND:  Opioid-based treatment is used to manage stress responses during surgery and postoperative pain. However, opioids have both acute and long-term side-effects, calling for opioid-free anaesthetic strategies. This meta-analysis compares adverse events, postoperative recovery, discharge time from post-anaesthesia care unit, and postoperative pain, nausea, vomiting, and opioid consumption between strict opioid-free with opioid-based general anaesthesia.METHODS:  We conducted a systematic review and meta-analysis. We searched PubMed, Embase, Cinahl, Cochrane Library, selected reference lists, and Google Scholar. We included randomised controlled trials (RCTs) published between January 2000 and February 2021 with at least one opioid-free study arm, i.e. no opioids administered preoperatively, during anaesthesia induction, before skin closure, or before emergence from anaesthesia.RESULTS:  The study comprised 1934 patients from 26 RCTs. Common interventions included laparoscopic gynaecological surgery, upper gastrointestinal surgery, and breast surgery. There is firm evidence that opioid-free anaesthesia significantly reduced adverse post-operative events (OR 0.32, 95% CI 0.22 to 0.46, I2 =56%, p<0.00001), mainly driven by decreased nausea (OR 0.27, (0.17 to 0.42), p<0,00001) and vomiting (OR 0.22 (0.11 to 0.41), p<0.00001). Postoperative opioid consumption was significantly lower in the opioid-free group (-6.00 mg (-8.52 to -3.48), p<0.00001). There was no significant difference in length of post-anaesthesia care unit stay and overall postoperative pain between groups.CONCLUSIONS:  Opioid-free anaesthesia can improve postoperative outcomes in several surgical settings without evidence of adverse effects on patient safety and pain management. There is a need for more evidence-based non-opioid anaesthetic protocols for different types of surgery as well as postoperative phases.
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34.
  • Pauli, Nina, et al. (författare)
  • Exercise intervention for the treatment of trismus in head and neck cancer.
  • 2014
  • Ingår i: Acta oncologica (Stockholm, Sweden). - 1651-226X. ; 53:4, s. 502-509
  • Tidskriftsartikel (refereegranskat)abstract
    • Background. The aim of this study was to investigate the impact of structured exercise with jaw mobilizing devices on trismus and its effect on trismus symptomatology and health-related quality of life (HRQL) in head and neck (H&N) cancer patients. Material and methods. Fifty patients with H&N cancer and trismus, i.e. maximum interincisal opening (MIO) ≤ 35 mm participated in a structured intervention program with jaw exercise. The patients in the intervention group underwent a 10-week exercise program with regular follow-up. A control group comprising of 50 patients with trismus and H&N cancer were matched to the intervention group according to gender, tumor location, tumor stage, comorbidity and age. HRQL and trismus-related symptoms were assessed. Results. The mean MIO improvement was 6.4 mm (4.8-8.0) and 0.7 (-0.3-1.7) mm in the intervention group and control group respectively, three months post-intervention commencement (p < 0.001). The intervention group demonstrated a statistically significant improvement in Role functioning, Social functioning and Global quality of life (EORTC QLQ C30) and in all Gothenburg Trismus Questionnaire (GTQ) domains, i.e. jaw-related problems (p < 0.001), eating limitation (p < 0.05) and muscular tension (p < 0.001). Conclusion. We found that a structured jaw exercise program was effective and improved the mouth opening capacity significantly. The objective effect on trismus (MIO) was also reflected in the patient-reported outcome questionnaires where the patients who underwent the structured exercise program after cancer treatment reported improvements in HRQL and less trismus-related symptoms compared to the control group.
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35.
  • Pauli, Nina, et al. (författare)
  • The incidence of trismus and long-term impact on health-related quality of life in patients with head and neck cancer.
  • 2013
  • Ingår i: Acta oncologica (Stockholm, Sweden). - 1651-226X. ; 52:6, s. 1137-1145
  • Tidskriftsartikel (refereegranskat)abstract
    • Background. Trismus is a common symptom related to the treatment of head and neck (H&N) cancer. To date there are few prospective studies regarding the incidence of trismus and the patients' experience of trismus in daily life activities. The aim of the study was to assess the incidence of trismus in H&N cancer patients and the impact on health-related quality of life (HRQL), by evaluating the patients before and after oncological treatment. Material and methods. We used the criteria for trismus of maximum interincisal opening (MIO) ≤ 35 mm and measured the patients at several occasions before and after treatment during one year. The patients answered the HRQL questionnaires EORTC QLQ C30, EORTC QLQ H&N 35, Gothenburg Trismus Questionnaire (GTQ) and the Hospital Anxiety and Depression Scale (HADS). Results. The incidence of trismus was 9% pre-treatment and 28% at the one-year follow-up post-treatment. The highest incidence, 38%, was found six months post-treatment. Patients with tumours of the tonsils were most prone to develop trismus. Patients with trismus reported greater HRQL impairments with regard to the GTQ domains; mouth opening (p < 0.001), jaw-related problems (p < 0.05), eating limitations (p < 0.05) and muscular tension (p < 0.001) six months post-treatment. EORTC QLQ H&N 35 scores indicated clinically significantly more problems with dry mouth, swallowing and pain for patients with trismus, 6-12 months post-treatment. Furthermore, all patients reported pain, anxiety and depression pre- and post-treatment. Conclusion. The incidence of trismus in patients with H&N cancer is non-negligible. Trismus severely impairs HRQL and negatively affects daily life activities in patients with H&N cancer. Further studies regarding symptomatic treatment of patients with trismus are highly warranted. The symptom-specific questionnaire GTQ is useful to identify the problems in this group of patients given it is responsive to showing change over time.
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36.
  •  
37.
  • Peilot, Birgitta, 1947, et al. (författare)
  • Evaluation of treatment with Cognitive therapy and a patient-centered approach in patients with chronic musculoskeletal pain and psychiatric co-morbidity – A pilot study
  • 2019
  • Ingår i: ECRONICON open access. ; 11:8, s. 612-629
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. The aim was to evaluate Cognitive therapy (CT) and a patient-centered-approach in a group of patients with chronic pain and psychiatric co-morbidity in relation to pain, dysfunction, anxiety, depression, burnout and health related quality of life (HRQoL). Design. Pilot study. Setting. Consulting psychiatry. Participants 30 consecutive patients with chronic pain, who had not responded to conventional pain treatment, were recruited during a period of 21 months. Interventions. All patients were offered treatment with cognitive therapy (CT). Twenty patients accepted treatment with CT and 13 patients, the therapy group, completed therapy. The no therapy group consisted of 7 patients who did not complete therapy and 10 patients who were only followed-up at monthly intervals. Main otutcome measures. Patient reported outcome measures (PROM) were administered at baseline and at follow-up after 8-11 months. PROM included Relationship Scales Questionnaire (RSQ ) for attachment pattern, Sense of coherence (SOC), Multidimensional Pain Inventory (MPI) for pain and dysfunction, Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Pines´scale for burnout and Short-Form 36 (SF-36). Statistical tests were conducted at a 5% significance level. Subgroup identification was accomplished by means of Multivariate data analysis (MVDA). Results. At the individualized follow-up the patients (n=25) reported significant improvement of Bodily Pain and Mental Health in Short-Form 36 ( SF-36), life control in MPI, depression, anxiety and SOC. There was a correlation between completed treatment with CT and improvement. Explorative modellings with MVDA suggested that patients with chronic pain and fearful attachment pattern had a better outcome than patients with preoccupied attachment pattern if they were treated with CT. Conclusion.. A patient-centered approach in combination with CT was beneficial for patients with chronic pain and psychiatric co-morbidity. MVDA indicated that the outcome of treatment may differ according to individual vulnerability and severity of burnout, depression and pain interference. Strengths and limitations of the study * This study is a small hypothesis generating pilot study and the results need to be followed up with larger randomized studies. *Patients who dropped out from therapy were followed in the no therapy group * The same therapist/physician (BP) treated the entire group. * In order to compensate for many variables and a limited number of observations explorative modellings with MVDA were performed.
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38.
  •  
39.
  • Peilot, Birgitta, 1947, et al. (författare)
  • Quality of life assessed with Short Form 36 - a comparison between two populations with long-term musculoskeletal pain disorders
  • 2010
  • Ingår i: Disabil Rehabil. - 1464-5165 .- 0963-8288. ; 32:23, s. 1903-9
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: To assess quality of life (QoL) in two groups of patients with long-term musculoskeletal pain with and without psychiatric co-morbidity and to compare them with a reference group of normative controls. The patients in both study groups were sick-listed full or part time for 3 months or more. METHOD: The patients were recruited from a company health service and consulting psychiatry. A generic QoL questionnaire, the SF-36, was used to assess QoL. Each group was compared with age- and gender-matched normative controls. RESULTS: Both groups reported a pronounced impairment of QoL (p < 0.001) compared with their age- and gender-matched populations. The greatest impairment was seen among the patients referred for psychiatric assessment (n = 30). The patients in the company health service (n = 42) reported significantly higher QoL with regard to the dimensions mental health (p < 0.028), social functioning (p < 0.034) and role emotional (p < 0.040) compared with the patients referred for psychiatric assessment. CONCLUSION: Patients with long-term pain in the company health care and patients with psychiatric co-morbidity, sick-listed full or part-time reported severely impaired QoL with regard both to physical, social and mental dimensions. Psychiatric co-morbidity reported even more pronounced impairment of emotional, social and mental dimensions of QoL which might indicate dysfunctional coping strategies.
  •  
40.
  • Peilot, Birgitta, 1947, et al. (författare)
  • Time to gain trust and change-Experiences of attachment and mindfulness-based cognitive therapy among patients with chronic pain and psychiatric co-morbidity
  • 2014
  • Ingår i: International Journal of Qualitative Studies on Health and Well-Being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 9:24420
  • Tidskriftsartikel (refereegranskat)abstract
    • The treatment of patients with chronic pain disorders is complex. In the rehabilitation of these patients, coping with chronic pain is seen as important. The aim of this study was to explore the meaning of attachment and mindfulness-based cognitive therapy (CT) among patients with chronic pain and psychiatric co-morbidity. A phenomenological approach within a lifeworld perspective was used. In total, 10 patients were interviewed after completion of 7-to 13-month therapy. The findings reveal that the therapy and the process of interaction with the therapist were meaningful for the patients' well-being and for a better management of pain. During the therapy, the patients were able to initiate a movement of change. Thus, CT with focus on attachment and mindfulness seems to be of value for these patients. The therapy used in this study was adjusted to the patients' special needs, and a trained psychotherapist with a special knowledge of patients with chronic pain might be required.
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41.
  • Peilot, Birgitta, 1947, et al. (författare)
  • Vulnerability and Resilience in Patients with Chronic Pain in Occupational Healthcare : A Pilot Study with a Patient-Centered Approach.
  • 2018
  • Ingår i: Pain Research and Treatment. - : Hindawi Limited. - 2090-1542 .- 2090-1550. ; 2018
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: The aim of this pilot study was to describe vulnerability and resilience and possible subgroups in patients with chronic work related musculoskeletal pain in occupational healthcare. A second aim was to evaluate a patient-centered approach.Methods: This study was based on consecutive patients with chronic pain, seen by the same physician and sick-listed full or part time three months or longer. They were included during a period of three months. Patient reported outcome measures (PROM) were administered at baseline and at follow-up after 8 months. A patient-centered approach was applied where the patient's whole situation was taken into account.Results: A dominance of an insecure dismissing attachment pattern and a subnormal sense of coherence (SOC) was reported both at baseline and at follow-up. The patients (n=38) reported significant improvement of pain severity (p=0.01), pain interference (p=0.001), life control (p=0.01), affective distress (p=0.02), and dysfunction (p=0.001) on the multidimensional pain inventory (MPI) and fewer patients were sick-listed full time at follow-up (13 patients versus 21). By means of multivariate data analyses this change in MPI was confirmed and was also correlated with a significant increase in health related quality of life (HRQoL). Moreover subgroups with different outcome at follow-up were identified according to attachment pattern and subgroups on MPI.Conclusion: A patient-centered approach may be of value for patients with chronic pain in occupational healthcare, improving pain and dysfunction. Patients with chronic pain are a heterogeneous group where outcome of treatment might be influenced by individual resilience and/or vulnerability.
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42.
  • Peilot, Birgitta, 1947, et al. (författare)
  • Vulnerability, Resilience and Pain associated Symptoms in two Groups of Patients with Chronic Pain- a Pilot Study : Vulnerability factors in patients with chronic pain
  • 2019
  • Ingår i: ECRONICON open access. ; 11:11, s. 01-19
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To compare pain and pain associated symptoms, vulnerability factors and factors of resilience in two groups with chronic pain. Design. An explorative and hypothesis generating pilot study. Setting. Consulting psychiatry and occupational health care Participants. 30 consecutive patients in consulting psychiatry with chronic pain, who had not responded to conventional pain treatment, and 42 consecutive patients with chronic pain in occupational health care. Interventions. All patients referred to consulting psychiatry were offered treatment with cognitive therapy (CT). The patients in occupational health care were offered patient-centered treatment and follow-up. Main otutcome measures. Patient reported outcome measures (PROM) were administered at baseline and at follow-up after 8-11 months. PROM included Relationship Scales Questionnaire (RSQ ) for attachment pattern, Sense of coherence (SOC), Multidimensional Pain Inventory (MPI) for pain and dysfunction, Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Pines´scale for burnout and Short-Form 36 (SF-36). Statistical tests were conducted at a 5% significance level. Subgroup identification was accomplished by means of Multivariate data analysis (MVDA). Results. Both patient groups had vulnerability factors in terms of insecure attachment (RSQ), a low SOC and dysfunctional subgroups according to MPI. The occupational health care group reported higher SOC (p=0.02) and less anxiety (p=0.002), depression (p=0.01) and burnout (p<0.001) than the psychiatry group. These findings were further interpreted by using multivariate analyses. Hereby an overlapping between the two patient groups was obtained, indicating that there were patients within the occupational health care group with higher vulnerability than expected. The results of this study also indicated that a strong SOC per se did not seem to protect against chronic pain but may have a positive impact on HRQoL and the ability to handle pain. Conclusion. The impact of vulnerability factors on pain management and rehabilitation in patients with chronic pain in primary care might be underestimated. Thus SOC as well as MPI and RSQ could be important tools for assessing vulnerability and resilience in chronic pain. The role of SOC as well as attachment pattern. in chronic pain could be an aim of further research Strengths and limitations of the study * This study is a small hypothesis generating pilot study and the results need to be validated in further studies of vulnerability and resilience in new groups of patients with chronic pain * In order to compensate for many variables and a limited number of observations explorative modellings with MVDA were performed. * The same therapist/physician (BP) treated both patient groups.
  •  
43.
  • Piasecki, Adam, 1980, et al. (författare)
  • High-frequency, high-intensity transcutaneous electrical nerve stimulation compared with opioids for pain relief after gynecological surgery: A systematic review and meta-analysis
  • 2024
  • Ingår i: Scandinavian Journal of Pain. - 1877-8860 .- 1877-8879. ; 24:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Opioids are important for postoperative analgesia but their use can be associated with numerous side effects. Transcutaneous electrical nerve stimulation (TENS) has been used for acute pain treatment and has dose-dependent analgesic effects, and therefore presents an alternative to intravenous (iv) opioids for postoperative pain relief. The aim of this meta-analysis was to compare high-frequency, high-intensity (HFHI or intense) TENS to iv opioids with regard to postoperative pain intensity, recovery time in the Post Anesthesia Care Unit (PACU) and opioid consumption after elective gynecological surgery. We searched Medline, Embase, Web of Science, Cochrane, Amed and Cinahl for RCTs and quasi-experimental studies (2010-2022), and WHO and ClinicalTrials.gov for ongoing/unpublished studies. Meta-analysis and subsequent Trial Sequential Analysis (TSA) was performed for all stated outcomes. Quality of evidence was assessed according to GRADE. Only three RCTs met the inclusion criteria (362 participants). The surgical procedures involved surgical abortion, gynecologic laparoscopy and hysteroscopy. The applied TENS frequency was 80 Hz and intensity 40-60 mA. There was no difference in pain intensity according to Visual Analogue Scale (VAS) at discharge from PACU between the TENS and opioid group (MD VAS -0.15, 95 % CI -0.38 to 0.09) (moderate level of evidence). Time in PACU was significantly shorter in the TENS group (MD -15.2, 95 % -22.75 to -7.67), and this finding was manifested by TSA (high-level of evidence). Opioid consumption in PACU was lower in the TENS group (MD Morphine equivalents per patient mg -3.42, 95 % -4.67 to -2.17) (high-level of evidence). There was no detectable difference in postoperative pain relief between HFHI TENS and iv opioids after gynecological surgery. Moreover, HFHI TENS decreases recovery time and opioid consumption in PACU. HFHI TENS may be considered an opioid-sparing alternative for postoperative pain relief after gynecological surgery.
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44.
  • Platon, B., et al. (författare)
  • Effects of high-frequency, high-intensity transcutaneous electrical nerve stimulation versus intravenous opioids for pain relief after gynecologic laparoscopic surgery: a randomized controlled study
  • 2018
  • Ingår i: Korean Journal of Anesthesiology. - : The Korean Society of Anesthesiologists. - 2005-6419 .- 2005-7563. ; 71:2, s. 149-156
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The aim of the study was to compare the pain relieving effect and the time spent in the recovery unit after treatment with high frequency, high-intensity transcutaneous electrical nerve stimulation (TENS) or intravenous (IV) opioids after gynecologic laparoscopic surgery. Methods: All patients who postoperatively reported visual analogue scale (VAS) pain score >= 3 were consecutively included in the study. The TENS treatment was given with a stimulus intensity between 40-60 mA during 1 minute, repeated once if insufficient pain relief. In the opioid group, a maximum dose of 10 mg morphine was given IV. If the patient reported insufficient pain relief (VAS = 3) on the assigned treatment, the patient crossed over to the other treatment group. Results: Ninety-three women were randomized to TENS (n = 47) or IV opioids (n = 46). Both groups reported significant pain relief at leave from the recovery unit (TENS group: VAS 5.4 to 1.0, P < 0.001; IV opioid group: VAS 5.2 to 1.1, P < 0.001) with no differences between the groups. When only responders, i.e. patients with VAS < 3 after assigned treatment, were compared the TENS responders spent significantly shorter time in the recovery unit (90 vs. 122 minutes, P = 0.008) compared to the responders in the opioid group. Conclusions: TENS and IV opioids are both effective treatments for pain relief after gynecologic laparoscopic surgery. TENS seems to be preferable for first choice of treatment as the treatment is associated with shorter time spent in recovery unit if the patient responds to the treatment.
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45.
  • Platon, Birgitta, et al. (författare)
  • Effects of high-frequency, high-intensity transcutaneous electrical nerve stimulation versus intravenous opioids for pain relief after hysteroscopy: a randomized controlled study.
  • 2020
  • Ingår i: Obstetrics & gynecology science. - : Korean Society of Obstetrics and Gynecology. - 2287-8572 .- 2287-8580. ; 63:5, s. 660-669
  • Tidskriftsartikel (refereegranskat)abstract
    • To compare the time spent in the Post-Anesthesia Care Unit (PACU) and the pain-relieving effects of treatment with high-frequency, high-intensity transcutaneous electrical nerve stimulation (TENS) or intravenous (IV) opioids after hysteroscopy.All patients who postoperatively reported a visual analogue scale (VAS) pain score of ≥3 were included in the study. TENS treatment was given with a stimulus intensity between 40 and 60 mA for 1 minute and repeated once if there was insufficient pain relief. In the opioid group, a fractionated dose of 5 mg morphine was administered. If the patient reported insufficient pain relief after the assigned treatment, the patient was reassigned to the other treatment group.Seventy-four women were randomized to TENS (n=38) or IV opioids (n=36) for treatment. Both groups reported significant pain relief after discharge from the PACU, with a decrease of VAS scores from 5.6 to 1.4 in the TENS group (P<0.001) and 5.1 to 1.3 in the opioid group (P<0.001). There were no significant differences between the groups. When only the responders in both groups, i.e., patients with VAS scores of <3 on respectively assigned treatments, were compared, the TENS responders (n=22) were found to have spent a significantly shorter time in the PACU (91 vs. 69 minutes, P=0.013) compared to the opioid responders (n=20).Using TENS as first line of pain relief may reduce the need for postoperative opioids. In addition, TENS appears preferable as the first line of treatment due to its association with a shorter time spent in the PACU if the patient responds to the treatment.Västra Götalandsregionen Identifier: 211261.
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46.
  • Platon, B., et al. (författare)
  • High-frequency, high-intensity transcutaneous electrical nerve stimulation as treatment of pain after surgical abortion
  • 2010
  • Ingår i: Pain. - 0304-3959. ; 148:1, s. 114-119
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of the study was to compare the pain-relieving effect and the time spent in the recovery ward after treatment with high-frequency, high-intensity transcutaneous electrical nerve stimulation (TENS) or intravenous (IV) conventional pharmacological treatment after surgical abortion. Two-hundred women who underwent surgical abortion and postoperatively reported a visual analogue scale (VAS) pain score3 were included. The patients were randomised to TENS or conventional pharmacological treatment for their postoperative pain. The TENS treatment was given with a stimulus intensity between 20 and 60 mA during 1 min and repeated once if insufficient pain relief (VAS3). In the conventional pharmacological treatment group, a maximum dose of 100 microg fentanyl was given IV. There was no difference between the groups with regard to pain relief according to the VAS pain score (TENS=VAS 1.3 vs. IV opioids=VAS 1.6; p=0.09) upon discharge from the recovery ward. However, the patients in the TENS group spent shorter time (44 min) in the recovery ward than the conventional pharmacological treatment group (62 min; p<0.0001). The number of patients who needed additional analgesics in the recovery ward was comparable in both groups, as was the reported VAS pain score upon leaving the hospital (TENS=2.0 vs. conventional pharmacological treatment=1.8, NS). These results suggest that the pain-relieving effect of TENS seems to be comparable to conventional pharmacological treatment with IV opioids. Hence, TENS may be a suitable alternative to conventional pain management with IV opioids after surgical abortion.
  •  
47.
  • Svensson, Carl Johan, 1976, et al. (författare)
  • Opioid consumption in patients undergoing Roux-en-Y bariatric surgery compared with population controls with and without obesity.
  • 2022
  • Ingår i: Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. - : Elsevier BV. - 1878-7533. ; 18:1, s. 107-116
  • Tidskriftsartikel (refereegranskat)abstract
    • Patients with obesity are prescribed more opioids than the general population.To compare opioid consumption in patients with obesity who underwent Roux-en-Y bariatric surgery (RYGB) with population controls with and without obesity, not undergoing bariatric surgery, and to identify characteristics associated with opioid use.This study included all patients with a principal diagnosis of obesity, aged 18-72 years, with a RYGB surgical code in the Swedish Patient Register between 2007 and2013.RYGB patients (n = 23,898) were age- and sex-matched with 1 control patient with obesity (n = 23,898) and 2 population controls without obesity (n = 46,064). Participants were classified as nonconsumers and consumers based on their opioid dispensations during the 12 months before baseline. Opioid consumption was assessed for 24 months.Nonconsumers. Within 24 months, a significantly higher proportion of RYGB patients (16.6%) started using opioids compared with the controls with obesity (14.3%, P < .0001) and population controls (5.4%, P < .0001). RYGB patients and controls with obesity had higher median dailyintake of opioid morphine equivalent (MEQ) (2.8 mg/d) than population controls (2.5 mg/d, P < .0001). Consumers. Within 24 months, the proportion of RYGB patients and controls with obesity that was using opioids were similar (53.1% and 53.4%), but higher compared to population controls (38.0%, P < .0001). The median daily opioid MEQ was higher among RYGB patients than in population controls (10.5 versus 7.8 mg/d, P < .0001). RYGB patients, overall, had higher incidence of bowel surgery and cholecystectomy compared with controls with obesity and population controls, leading to prolonged opioid use in this group. Opioid consumption in general was associated with chronic pain and psychiatric disorder, which were more common in patients with obesity than in the population controls.RYGB surgery increased the risk of prolonged opioid use in patients with obesity who were nonconsumers before surgery but had no effect on overall opioid use among prior consumers. RYGB-associated complications requiring surgery influenced opioid use for both nonconsumers and consumers. Regular reassessments of pain mechanisms and specific treatment owing to type of paincould prevent unnecessary opioid use in this patient group.
  •  
48.
  • Tin, Amy L., et al. (författare)
  • Pain as bad as you can imagine or extremely severe pain? A randomized controlled trial comparing two pain scale anchors
  • 2023
  • Ingår i: Journal of Patient-Reported Outcomes. - 2509-8020. ; 7:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: A common method of pain assessment is the numerical rating scale, where patients are asked to rate their pain on a scale from 0 to 10, where 0 is “no pain” and 10 is “pain as bad as you can imagine”. We hypothesize such language is suboptimal as it involves a test of a cognitive skill, imagination, in the assessment of symptom severity. Methods: We used a large-scale online research registry, ResearchMatch, to conduct a randomized controlled trial to compare the distributions of pain scores of two different pain scale anchors. We recruited adults located in the United States who reported a chronic pain problem (> 3 months) and were currently in pain. Participants were randomized in a 1:1 ratio to receive pain assessment based on a modified Brief Pain Inventory (BPI), where the anchor for a score of 10 was either “extremely severe pain”, or the original BPI, with the anchor “pain as bad as you can imagine”. Participants in both groups also answered additional questions about pain, other symptomatology and creativity. Results: Data were obtained from 405 participants for the modified and 424 for the original BPI. Distribution of responses to pain questions were similar between groups (all p-values ≥ 0.12). We did not see evidence that the relationship between pain score and the anchor text differed based on self-perceived creativity (all interaction p-values ≥ 0.2). However, in the key analysis, correlations between current pain assessments and known correlates (fatigue, anxiety, depression, current pain compared to a typical day, pain compared to other people) were stronger for “extreme” vs. “imaginable” anchor text (p = 0.005). Conclusion: Pain rating scales should utilize the modified anchor text “extremely severe pain” instead of “pain as bad as you can imagine”. Further research should explore the effects of anchors for other symptoms.
  •  
49.
  • Tuomi, Lisa, 1985, et al. (författare)
  • Effects of voice rehabilitation after radiation therapy for laryngeal cancer: a randomized controlled study.
  • 2014
  • Ingår i: International journal of radiation oncology, biology, physics. - : Elsevier BV. - 1879-355X .- 0360-3016. ; 89:5, s. 964-72
  • Tidskriftsartikel (refereegranskat)abstract
    • Patients treated with radiation therapy for laryngeal cancer often experience voice problems. The aim of this randomized controlled trial was to assess the efficacy of voice rehabilitation for laryngeal cancer patients after having undergone radiation therapy and to investigate whether differences between different tumor localizations with regard to rehabilitation outcomes exist.
  •  
50.
  • Tuomi, Lisa, 1985, et al. (författare)
  • Interpretation of the Swedish Self Evaluation of Communication Experiences after Laryngeal cancer (S-SECEL): Cut-off levels and minimum clinically important differences.
  • 2016
  • Ingår i: Head & neck. - : Wiley. - 1097-0347 .- 1043-3074. ; 38:5, s. 689-695
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: To establish minimum clinically important difference (MCID) scores for the Swedish Self Evaluation of Communication Experiences after Laryngeal Cancer (S-SECEL) in order to facilitate clinical interpretation and identify cut-off values for voice rehabilitation. Method: 119 laryngeal cancer patients completed the S-SECEL instrument and an anchor question regarding acceptability of speech in a social context pre and 12 months post oncologic treatment. Receiver operating characteristic curves analysis was used for calculation of cut-off values. Results: Voice rehabilitation cut-off values were identified for all domains (Total 20; General 4; Environmental 16, Attitudinal 5), presenting acceptable sensitivity and specificity. Initial MCID estimates were obtained for all domains; improvement of -13 points (p<0.0001) or a deterioration of +8 points (p=0.035) for the Total domain. Conclusion: MCID and cut-off scores for the S-SECEL have been identified and may be used in clinical practice to help identify laryngeal cancer patients in need of voice rehabilitation. This article is protected by copyright. All rights reserved.
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