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1.
  • Kennedy, Beatrice, 1982-, et al. (författare)
  • App-based COVID-19 syndromic surveillance and prediction of hospital admissions in COVID Symptom Study Sweden
  • 2022
  • Ingår i: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 13:1
  • 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)
  • Do beta-blockers reduce negative intrusive thoughts and anxiety in cancer survivors? – An emulated trial
  • 2024
  • Ingår i: BMC Cancer. - 1471-2407. ; 24:1
  • 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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4.
  • Grimby-Ekman, Anna, 1967, et al. (författare)
  • Prediction models for planning health care resources. During the first wave of the Covid-19 pandemic 2020
  • 2022
  • 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.
  • Hansson, Emma, 1981, et al. (författare)
  • Gothenburg Breast reconstruction (GoBreast) II protocol: a Swedish partially randomised patient preference, superiority trial comparing autologous and implant-based breast reconstruction.
  • 2024
  • Ingår i: BMJ open. - 2044-6055. ; 14:7
  • Tidskriftsartikel (refereegranskat)abstract
    • Although breast reconstruction is an integral part of breast cancer treatment, there is little high-quality evidence to indicate which method is the most effective. Randomised controlled trials (RCTs) are generally thought to provide the most solid scientific evidence, but there are significant barriers to conducting RCTs in breast reconstruction, making both recruitment and achieving unbiased and generalisable results a challenge. The objective of this study is to compare implant-based and autologous breast reconstruction in non-irradiated patients. Moreover, the study aims to improve the evidence for trial decision-making in breast reconstruction.The study design partially randomised patient preference trial might be a way to overcome the aforementioned challenges. In the present study, patients who consent to randomisation will be randomised to implant-based and autologous breast reconstruction, whereas patients with strong preferences will be able to choose the method. The study is designed as a superiority trial based on the patient-reported questionnaire BREAST-Q and 124 participants will be randomised. In the preference cohort, patients will be included until 62 participants have selected the least popular alternative. Follow-up will be 60 months. Embedded qualitative studies and within-trial economic evaluation will be performed. The primary outcome is patient-reported breast-specific quality of life/satisfaction, and the secondary outcomes are complications, factors affecting satisfaction and cost-effectiveness.The study has been approved by the Swedish Ethical Review Authority (2023-04754-01). Results will be published in peer-reviewed scientific journals and presented at peer-reviewed scientific meetings.NCT06195865.
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6.
  • Jöud, Anna, et al. (författare)
  • The association between pain characteristics, pain catastrophizing and health care use – Baseline results from the SWEPAIN cohort
  • 2017
  • Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter GmbH. - 1877-8860 .- 1877-8879. ; 16, s. 122-128
  • 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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7.
  • Löfstrand, Jonas, 1981, et al. (författare)
  • Long-term patient-reported back and shoulder function after delayed breast reconstruction with a latissimus dorsi flap: case-control cohort study.
  • 2024
  • Ingår i: The British journal of surgery. - 1365-2168. ; 111:1
  • 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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8.
  • Persson, Carina Ulla, 1970, et al. (författare)
  • 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
  • Ingår i: Journal of neuroengineering and rehabilitation. - : Springer Science and Business Media LLC. - 1743-0003. ; 10:1
  • 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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9.
  • Persson, Carina Ulla, 1970, et al. (författare)
  • Timed Up & Go as a measure for longitudinal change in mobility after stroke - Postural Stroke Study in Gothenburg (POSTGOT)
  • 2014
  • Ingår i: Journal of NeuroEngineering and Rehabilitation. - : Springer Science and Business Media LLC. - 1743-0003. ; 11:83
  • 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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11.
  • Ahlstrand, Christina, 1957, et al. (författare)
  • Reliabilitetstestning av Purdue Pegboard® (finmotoriktest).
  • 2009
  • 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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12.
  • Ahlstrand, Christina, et al. (författare)
  • Reliabilitetstestning av Purdue Pegboard® (finmotoriktest)
  • 2012
  • 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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13.
  • Björk, Jonas, et al. (författare)
  • Predicting participation in the population-based Swedish cardiopulmonary bio-image study (SCAPIS) using register data
  • 2017
  • Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 45, s. 45-49
  • 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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14.
  • Boström, Maria, 1963, et al. (författare)
  • Experiences of work ability in young workers: an exploratory interview study
  • 2016
  • Ingår i: International Archives of Occupational and Environmental Health. - : Springer Science and Business Media LLC. - 0340-0131 .- 1432-1246. ; 89:4, s. 629-640
  • 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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15.
  • Boström, Maria, 1963, et al. (författare)
  • Opportunities for recovery at work and excellent work ability - a cross-sectional population study among young workers
  • 2016
  • Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 16
  • 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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16.
  • Ekhammar, Annika, 1965, et al. (författare)
  • Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal disorders (PREVSAM): short term effects of a randomised controlled trial in primary care
  • 2024
  • Ingår i: DISABILITY AND REHABILITATION. - 0963-8288 .- 1464-5165.
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To evaluate short-term effects of the PREVention of Sickness Absence for Musculoskeletal disorders (PREVSAM) model on sickness absence and patient-reported health outcomes. Methods: Patients with musculoskeletal disorders were randomised to rehabilitation according to PREVSAM or treatment as usual (TAU) in primary care. Sickness absence and patient-reported health outcomes were evaluated after three months in 254 participants. Results: The proportion of participants remaining in full- or part-time work were 86% in PREVSAM vs 78% in TAU (p = 0.097). The PREVSAM group had approximately four fewer sickness benefit days during three months from baseline (p range 0.078-0.126). No statistically significant difference was found in self-reported sickness absence days (PREVSAM 12.4 vs TAU 14.5; p = 0.634), nor were statistically significant differences between groups found in patient-reported health outcomes. Both groups showed significant improvements from baseline to three months, except for self-efficacy, and only the PREVSAM group showed significantly reduced depression symptoms. Conclusions: The findings suggest that for sickness absence, the PREVSAM model may have an advantage over TAU, although the difference did not reach statistical significance at the p < 0.05 level, and similar positive effects on patient-reported health outcomes were found in both groups. Long-term effects must be evaluated before firm conclusions can be drawn.
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17.
  • Eriksson, Stefanie, et al. (författare)
  • Texture Analysis of Magnetic Resonance Images Enables Phenotyping of Potentially Painful Annular Fissures.
  • 2022
  • Ingår i: Spine. - 1528-1159. ; 47:5, s. 430-437
  • 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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18.
  • Feldthusen, Caroline, 1977, et al. (författare)
  • EXPLANATORY FACTORS AND PREDICTORS OF FATIGUE IN PERSONS WITH RHEUMATOID ARTHRITIS: A LONGITUDINAL STUDY
  • 2016
  • Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 48:5, s. 469-476
  • 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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19.
  • Feldthusen, Caroline, 1977, et al. (författare)
  • Seasonal variations in fatigue in persons with rheumatoid arthritis: a longitudinal study
  • 2016
  • Ingår i: Bmc Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 17
  • 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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20.
  • Feldthusen, Caroline, 1977, et al. (författare)
  • Variations of fatigue in persons with Rheumatoid Arthritis- a 1 year longitudinal study.
  • 2014
  • Ingår i: DOI: 10.1136/annrheumdis-2014-eular.3502. Ann Rheum Dis. ; 73:Suppl2
  • 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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21.
  • Grimby-Ekman, Anna, 1967, et al. (författare)
  • Analyzing musculoskeletal neck pain, measured as present pain and periods of pain, with three different regression models: a cohort study
  • 2009
  • Ingår i: BMC Musculoskelet Disord. - : Springer Science and Business Media LLC. - 1471-2474. ; 10:73
  • 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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22.
  • Grimby-Ekman, Anna, 1967, et al. (författare)
  • 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
  • Ingår i: Bmc Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 16
  • 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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23.
  • Grimby-Ekman, Anna, 1967 (författare)
  • Epidemiological aspects of musculoskeletal pain in the upper body. Analyzing common and recurrent binary outcomes
  • 2010
  • 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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24.
  • Grimby-Ekman, Anna, 1967, et al. (författare)
  • Multidimensional health changes after a multimodal pain rehabilitation program: a registry-based study
  • 2021
  • Ingår i: Pain Reports. - : Ovid Technologies (Wolters Kluwer Health). - 2471-2531. ; 6:2
  • 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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25.
  • Grimby-Ekman, Anna, 1967, et al. (författare)
  • Pain could negatively affect school grades - Swedish middle school students with low school grades most affected
  • 2018
  • Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13
  • 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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26.
  • Grimby-Ekman, Anna, 1967, et al. (författare)
  • Pain intensity and pressure pain thresholds after a light dynamic physical load in patients with chronic neck-shoulder pain
  • 2020
  • Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 21:1
  • 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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27.
  • Grimby-Ekman, Anna, 1967, et al. (författare)
  • Simple neck pain questions used in surveys, evaluated in relation to health outcomes: a cohort study.
  • 2012
  • Ingår i: BMC research notes. - : Springer Science and Business Media LLC. - 1756-0500. ; 5
  • 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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28.
  • Grimby-Ekman, Anna, 1967, et al. (författare)
  • Work ability is influenced by kinesiophobia among patients with persistent pain
  • 2017
  • Ingår i: Physiotherapy Theory and Practice. - : Informa UK Limited. - 0959-3985 .- 1532-5040. ; 33:8, s. 634-643
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose of this study was to investigate how kinesiophobia fluctuates in patients over a four weeks multimodal rehabilitation program and to study the relationship between work ability and kinesiophobia. The study included 112 patients (94 women, 18 men). Measurements were made before, directly after, 2months after, and 12months after the program. The level of work ability was rated by the patients on a scale from 0% to 100%, and kinesiophobia was measured by the Swedish version of the Tampa Scale for Kinesiophobia (TSK-SV). Kinesiophobia decreased between the start of the multimodal rehabilitation program and the follow-up periods. Work ability increased over time, but not between baseline and the 2-month follow-up. Decreases in the TSK-SV score between baseline and the 2-month follow-up were related to the increased probability of improved work ability at the 12-month follow-up. In conclusion, a decrease in kinesiophobia seems to be related to increased work ability of patients participating in a 4-week multimodal rehabilitation program.
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29.
  • Gustafsson, Ewa, 1955, et al. (författare)
  • Texting on mobile phones and musculoskeletal disorders in young adults: A five-year cohort study
  • 2017
  • Ingår i: Applied Ergonomics. - : Elsevier BV. - 0003-6870. ; 58, s. 208-214
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim was to examine whether texting on a mobile phone is a risk factor for musculoskeletal disorders in the neck and upper extremities in a population of young adults.In a longitudinal population-based cohort study with Swedish young adults (aged 20-24 years) data were collected via a web-based questionnaire at baseline (n = 7092) and after one and five years. Cross-sectional associations were found between text messaging and reported ongoing symptoms in neck and upper extremities (odds ratios, ORs 1.3-2.0). Among symptom-free at baseline prospective associations were only found between text messaging and new cases of reported symptoms in the hand/fingers (OR 2.0) at one year follow up. Among those with symptoms at baseline prospective associations were found between text messaging and maintained pain in neck/upper back (OR 1.6). The results imply mostly short-term effects, and to a lesser extent, long-term effects on musculoskeletal disorders in neck and upper extremities. © 2016 The Authors.
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30.
  • Hadzibajramovic, Emina, 1977, et al. (författare)
  • Affective stress responses during leisure time: Validity evaluation of a modified version of the Stress-Energy Questionnaire
  • 2015
  • Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 43:8, s. 825-832
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Psychosocial stress at work is one of the most important factors behind increasing sick-leave rates. In addition to work stressors, it is important to account for non-work-related stressors when assessing stress responses. In this study, a modified version of the Stress-Energy Questionnaire (SEQ), the SEQ during leisure time (SEQ-LT) was introduced for assessing the affective stress response during leisure time. The aim of this study was to investigate the internal construct validity of the SEQ-LT. A second aim was to define the cut-off points for the scales, which could indicate high and low levels of leisure-time stress and energy, respectively. Methods: Internal construct validity of the SEQ-LT was evaluated using a Rasch analysis. We examined the unidimensionality and other psychometric properties of the scale by the fit to the Rasch model. A criterion-based approach was used for classification into high and low stress/energy levels. Results: The psychometric properties of the stress and energy scales of the SEQ-LT were satisfactory, having accommodated for local dependency. The cut-off point for low stress was proposed to be in the interval between 2.45 and 3.02 on the Rasch metric score; while for high stress, it was between 3.65 and 3.90. The suggested cut-off points for the low and high energy levels were values between 1.73-1.97 and 2.66-3.08, respectively. Conclusions: The stress and energy scale of the SEQ-LT satisfied the measurement criteria defined by the Rasch analysis and it provided a useful tool for non-work-related assessment of stress responses. We provide guidelines on how to interpret the scale values.
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31.
  • Hadzibajramovic, Emina, 1977, et al. (författare)
  • Concurrent and lagged effects of psychosocial job stressors on symptoms of burnout
  • 2019
  • Ingår i: International Archives of Occupational and Environmental Health. - : Springer Science and Business Media LLC. - 0340-0131 .- 1432-1246. ; 92, s. 1013-1021
  • Tidskriftsartikel (refereegranskat)abstract
    • © 2019, The Author(s). Purpose: Burnout is a mental condition described as being a result of long-term stressors commonly related to psychosocial factors at work. The aim of the present study was to investigate longitudinal relationships between job demands, decision authority, effort and reward, and symptoms of burnout, as well as the joint effects of job demands and decision authority, and of effort and reward. Methods: The data came from a four-wave longitudinal cohort study of Swedish health care workers. Longitudinal associations were analysed using mixed effects regression models with random intercept. Results: The concurrent analysis showed that demand and decision authority, as well as effort and reward, were associated with symptoms of burnout over time. Evidence of the lagged effects of workplace factors on burnout symptoms was limited to reward. No clear effect modification was found. Conclusion: An increase in unfavourable working conditions implied increasing scores on the burnout measure over time. The concurrent effects of job demands, decision authority, effort and reward on symptoms of burnout were seen. The evidence of lagged effects was limited to the low-reward condition. Regularly monitoring these work environment conditions at workplaces can help identify risk situations for burnout and thus be useful in the prevention of work-related mental illness. Lastly, a new approach to defining the risk groups was proposed, which is consistent across different populations and time points.
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32.
  • Hadzibajramovic, Emina, 1977, et al. (författare)
  • Internal construct validity of the stress-energy questionnaire in a working population, a cohort study
  • 2015
  • Ingår i: Bmc Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 15
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Psychosocial stress at work has been recognised as one of the most important factors behind the increase in sick leave due to stress-related mental disorders. It is therefore important to be able to measure perceived work stress in a way that is both valid and reliable. It has been suggested that the Stress-Energy Questionnaire (SEQ) could be a useful tool for measuring mood (stress and energy) at work and it has been used in many Scandinavian studies. The aim of the study is to examine the internal construct validity of the SEQ in a working population and to address measurement issues, such as the ordering of response categories and potential differences in how women and men use the scale what is termed differential item functioning (DIF). Methods: The data used in the present study is baseline data from a longitudinal cohort study aimed at evaluating psychosocial working conditions, stress, health and well-being among employees in two human service organisations in Western Sweden. A modern psychometric approach for scale validations, the Rasch model, was used. Results: Stress items showed a satisfactory fit to the model. Problems related to unidimensionality and local dependence were found when the six stress items were fitted to the model, but these could be resolved by using two testlets. As regards the energy scale, although the final analysis showed an acceptable fit to the model some scale problems were identified. The item dull had disordered thresholds and DIF for gender was detected for the item passive. The items were not well targeted to the persons, with skewness towards high energy. This might explain the scale problems that were detected but these problems need to be investigated in a group where the level of energy is spread across the trait, measured by the SEQ. Conclusion: The stress scale of the SEQ has good psychometric properties and provides a useful tool for assessing work-related stress, on both group and individual levels. However, the limitations of the energy scale make it suitable for group evaluations only. The energy scale needs to be evaluated further in different settings and populations.
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33.
  • Halaweh, Hadeel, 1969, et al. (författare)
  • Physical Activity and Health-Related Quality of Life Among Community Dwelling Elderly.
  • 2015
  • Ingår i: Journal of clinical medicine research. - : Elmer Press, Inc.. - 1918-3003 .- 1918-3011. ; 7:11, s. 845-52
  • Tidskriftsartikel (refereegranskat)abstract
    • Physical activity (PA) and health-related quality of life (HRQoL) are important factors for optimal health in the elderly. Studying the association between PA and HRQoL is becoming more essential as the number of elderly people increases worldwide. This study assesses the association between PA and HRQoL among community dwelling elderly above 60 years old.The study included 115 women and 61 men (mean age: 68.15 ± 6.74 years) recruited from the community and from public centers for the elderly. Data were collected using a background characteristics questionnaire (BCQ), a physical activity socio-cultural adapted questionnaire (PA-SCAQ), and the EuroQuol-5Dimensions-5Levels (EQ-5D-5L) questionnaire. Between groups, comparisons were based on the PA-SCAQ by dividing the participants into three PA groups: low (n = 74), moderate (n = 85), and high (n = 17). Kruskal-Wallis tests were performed on the ordinal variables of the three PA groups to determine differences between the groups according to categorical variables such as gender, body mass index (BMI), and the prevalence of comorbid conditions. Mann-Whitney U tests were performed on the ordinal variables of the EuroQuol-5Dimensions (EQ-5D), and the independent sample t-test was performed on the EQ visual analogue scale (EQ-VAS). Spearman's rank correlation coefficient was used to examine the correlation between the EQ-5D and level of PA.Values in all dimensions of HRQoL were significantly higher (P < 0.05) in the moderate and high PA groups compared with the low PA group. Significant correlations were recorded between the five dimensions of HRQoL and the level of PA (P < 0.001). The low PA group showed higher prevalence of hypertension (64%, P < 0.001) and diabetes (50%, P < 0.001).There were strong associations between higher levels of PA and all dimensions of HRQoL. Therefore, adopting a PA lifestyle may contribute to better HRQoL among community dwelling elderly above 60 years old.
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34.
  • Halaweh, Hadeel, 1969, et al. (författare)
  • Physical functioning and fall-related efficacy among community-dwelling elderly people
  • 2016
  • Ingår i: European Journal of Physiotherapy. - : Informa UK Limited. - 2167-9169 .- 2167-9177. ; 18:1, s. 11-17
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: The aim of this study was to assess the association between physical functioning and fall-related efficacy among community-dwelling elderly people.Method: Participants (n = 176) were 60 years old and older. Data were collected using physical functioning tests: hand grip strength, Timed Up and Go (TUG), Short Physical Performance Battery (SPPB), Falls Efficacy Scale-International (FES-I) and History of Falling Checklist (HoFC). Statistical analyses were used to determine group differences with respect to age, gender and fall history, as well as the correlation between the total scores of the FES-I and hand grip strength, TUG and SPPB.Results. Values of physical functioning measures were significantly higher in non-fallers than in fallers (p < 0.05). The FES-I total scores were positively correlated with TUG (rs = 0.615) and negatively correlated with hand grip strength (rs =-0.522) and SPPB scores (rs =-0.727). There were significant differences in the FES-I scores according to TUG and SPPB cut-off values (p < 0.001).Conclusion: Higher physical functioning values were associated with a lower incidence of falling and a lower level of fear of falling. Maintaining and improving physical functioning should be considered as an important factor that may influence fall-related efficacy and risk of falling among elderly people. © 2016 Taylor & Francis.
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35.
  • Kemani, Mike K, et al. (författare)
  • Factor structure and internal consistency of a Swedish version of the Pain Catastrophizing Scale.
  • 2019
  • Ingår i: Acta anaesthesiologica Scandinavica. - : Wiley. - 1399-6576 .- 0001-5172. ; 63:2, s. 259-266
  • Tidskriftsartikel (refereegranskat)abstract
    • Pain catastrophizing is highly relevant to assess in the context of long-standing pain. The Pain Catastrophizing Scale (PCS) is a well-established questionnaire used to measure catastrophizing in individuals with long-standing pain. So far, no Swedish translation has been evaluated in regard to validity and reliability. The aims of this study were to translate the PCS questionnaire from English to Swedish, and to investigate its construct validity (face, content, and structural validity) and reliability (internal consistency).We translated the original English version of the PCS to Swedish and collected item responses from 194 persons suffering from primarily long-standing musculoskeletal pain. We used confirmatory factor analysis to evaluate structural validity, and tested the model fit of a one-factor model, an oblique two-factor model, and an oblique three-factor model. We evaluated the measure's reliability in regard to internal consistency calculated with Cronbach's alpha.A three-factor model comprising a four-item rumination factor, a three-item magnification factor, and a six-item helplessness factor provided the best fit to the data. Internal consistency was adequate and Cronbach's α was 0.92 for the entire scale, 0.84 for the rumination subscale; 0.69 for the magnification subscale, and 0.89 for the helplessness subscale.The results indicated adequacy of a three-factor solution and the questionnaire's internal consistency, and provide initial support for the structural validity and internal consistency of a Swedish version of the PCS. Future studies should replicate the study in larger samples and extend the current evaluation in regard to validity and reliability.
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36.
  • Larsson, B., et al. (författare)
  • Pain Sensitivity and its Relation to Spreading on the Body, Intensity, Frequency, and Duration of Pain A Cross-Sectional Population-based Study (SwePain)
  • 2017
  • Ingår i: Clinical Journal of Pain. - : Ovid Technologies (Wolters Kluwer Health). - 0749-8047. ; 33:7, s. 579-587
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives:Individuals with chronic pain often report increased pain sensitivity compared with pain-free individuals; hence, it is crucial to determine whether and how different pain characteristics influence or interact with pain sensitivity. An alternative to experimental pain sensitivity testing is the self-reported pain sensitivity questionnaire (PSQ), which captures pain sensitivity in various body areas.This study compares PSQ in individuals with and without pain and clarifies how pain sensitivity relates to spreading of pain on the body, and to intensity, frequency, duration of pain and to age and sex.Materials and Methods:A total of 5905 individuals with pain and 572 individuals without pain from the general population in southeastern Sweden completed and returned a postal questionnaire.Results:The mean PSQ score was 3.9 (95% confidence interval [CI], 3.88-3.98) in individuals with pain and 3.5 (95% CI, 3.38-3.64) in pain-free individuals. Hence, PSQ was the highest among individuals with pain, with a difference of 0.4 (95% CI, 0.30-0.56). There was a considerable variation in the PSQ values (mean=3.5; SD=1.54) among pain-free individuals. Pain sensitivity was positively related to spreading, intensity, and frequency of pain, with a correlation coefficient of 0.3. PSQ was higher in widespread pain, 4.5 (95% CI, 4.27-4.69) in women and 4.3 (95% CI, 3.94-4.71) in men, than in local pain, 3.7 (95% CI, 3.61-3.91) in women and 3.8 (95% CI, 3.66-3.95) in men. The score for women with regional pain was between local and widespread pain at 4.0 (95% CI, 3.95-4.11) and that for men with regional pain was 3.8 (95% CI, 3.69-3.87), which is equal to that of local pain.Discussion:The positive association between pain sensitivity and spreading of pain on the body provides some evidence that the extent of spreading may be related to the degree of pain sensitivity. Before clinical use of PSQ, psychometric development and further research are needed.
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37.
  • Larsson, Britt, 1953-, et al. (författare)
  • Predictors of chronic pain intensity, spread and sensitivity in the general population: A two-year follow-up study from the swepain cohort
  • 2019
  • Ingår i: Journal of Rehabilitation Medicine. - Uppsala, Sweden : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 51:3, s. 183-192
  • Tidskriftsartikel (refereegranskat)abstract
    • © 2019 Foundation of Rehabilitation Information. Objective: To determine whether the intensity, spread and sensitivity of chronic pain can be predicted using demographic features, socioeconomic conditions and comorbidities. Design: A longitudinal study design was employed. Data was collected at baseline and at 2-year followup. Setting: General population in south-eastern Sweden. Subjects: A representative stratified random sample of 34,000 individuals, between 18 and 85 years of age, selected from a sampling frame of 404,661 individuals based on the Swedish Total Population Register. Methods: Eligible individuals were sent postal surveys in 2013 and 2015. The 2 surveys included the same questions about basic demographic data, comorbidities, and chronic pain intensity, spread and sensitivity. Results: Several socio-demographic features and comorbidities at baseline were significant predictors of characteristics of pain (intensity, spread and sensitivity) at the 2-year follow-up. When characteristics of pain at baseline were included in the regression analyses they were relatively strong significant predictors of characteristics of pain after 2 years. After this adjustment there were fewer socio-demographic and comorbidity predictors; the effect estimates for those significant predictors had decreased. Conclusion: Clinical assessment should focus on several characteristics of pain and include a broad medical screening to capture the overall burden of pain in adults from a longitudinal perspective.
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38.
  • Larsson, Maria E H, 1969, et al. (författare)
  • Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal pain (PREVSAM): a randomised controlled trial protocol
  • 2020
  • Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 21:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundMusculoskeletal pain is globally a leading cause of physical disability. Many musculoskeletal-related pain conditions, such as low back pain, often resolve spontaneously. In some individuals, pain may recur or persist, leading to ong-term physical disability, reduced work capacity, and sickness absence. Early identification of individuals in which this may occur, is essential for preventing or reducing the risk of developing persistent musculoskeletal pain and long-term sickness absence. The aim of the trial described in this protocol is to evaluate effects of an early intervention, the PREVSAM model, on the prevention of sickness absence and development of persistent pain in at-risk patients with musculoskeletal pain.MethodsEligible participants are adults who seek health care for musculoskeletal pain and who are at risk of developing persistent pain, physical disability, and sickness absence. Participants may be recruited from primary care rehabilitation centres or primary care healthcare centres in Region Vastra Gotaland. Participants will be randomised to treatment according to the PREVSAM model (intervention group) or treatment as usual (control group). The PREVSAM model comprises an interdisciplinary, person-centred rehabilitation programme, including coordinated measures within primary health care, and may include collaboration with participants' employers. The primary outcome sickness absence is operationalised as the number and proportion of individuals who remain in full- or part-time work, the number of gross and net days of sickness absence during the intervention and follow-up period, and time to first sickness absence spell. Secondary outcomes are patient-reported short-term sickness absence, work ability, pain, self-efficacy, health-related quality of life, risk for sickness absence, anxiety and depression symptoms and physical disability at 1 and 3months after inclusion (short-term follow-up), and at 6 and 12months (long-term follow-up). A cost-effectiveness analysis is planned and drug consumption will be investigated.DiscussionThe study is expected to provide new knowledge on the effectiveness of a comprehensive rehabilitation model that incorporates early identification of patients with musculoskeletal pain at risk for development of sickness absence and persistent pain. The study findings may contribute to more effective rehabilitation processes of this large patient population, and potentially reduce sickness absence and costs.Trial registrationClinicalTrials.gov Protocol ID: NCT03913325, Registered April 12, 2019.Version 2, 10 July 2020.Version 2 changes: Clarifications regarding trial aim and inclusion process.
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39.
  • 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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40.
  • Lindegård, A., et al. (författare)
  • Can biofeedback training in combination with ergonomic information reduce pain among young adult computer users with neck and upper extremity symptoms? : A randomized controlled intervention study
  • 2024
  • Ingår i: Applied Ergonomics. - : Elsevier. - 0003-6870 .- 1872-9126. ; 114
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this randomized controlled study was to explore if an intervention with biofeedback training in combination with ergonomic discussions, could improve working technique and work postures, and reduce pain intensity and perceived exertion in young adult computer users with ongoing neck and upper extremity symptoms. 39 participants were divided into an intervention group and a control group. The intervention consisted of 4 sessions during a three-month period. Working technique, working postures, rated perceived exertion, pain intensity, and duration of computer use were measured at baseline and follow ups after 6 and 12 months. The intervention did not significantly improve working technique and working postures, nor reduce pain intensity and perceived exertion in the intervention group compared to the control group. However, there was a statistically significant reduction in reported pain intensity in the neck/shoulder for the whole group. Also, there was a trend that time spent with computer work without breaks was more reduced in the intervention group than in the control group.
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41.
  • Lindegård Andersson, Agneta, 1955, et al. (författare)
  • Longitudinal associations between cardiorespiratory fitness and stress-related exhaustion, depression, anxiety and sleep disturbances.
  • 2019
  • Ingår i: BMC public health. - : Springer Science and Business Media LLC. - 1471-2458. ; 19:1
  • Tidskriftsartikel (refereegranskat)abstract
    • In the last few years, so-called "common mental disorders", including adjustment disorder and stress-related exhaustion, have outrivalled musculoskeletal disorders as being the leading cause of long-term sick leave in Sweden. Cardiorespiratory fitness level defined as "the maximal amount of physiological work that an individual can do as measured by oxygen consumption" has in many studies shown to reduce the risk of several life-style related diseases and moreover to improve mood, well-being and physical performance. The aim of the present study was to investigate, longitudinal associations between cardiorespiratory fitness and self-reported physical activity levels and the severity of symptoms connected to stress-related exhaustion, depression, anxiety, and sleep disturbances among women clinically diagnosed with stress-related exhaustion disorder (ED).The study was that of a longitudinal cohort study consisting of women (n=88) diagnosed with stress-related ED in a specialist clinic in Gothenburg, Sweden. Cardiorespiratory fitness was measured with the Åstrand indirect test of maximal oxygen uptake (VO2max) and subjective measures of physical activity levels were rated on 4-graded physical activity scale. To measure and follow symptoms of ED over time the SMBQ-questionnaire (Shirom Melamed Burnout Questionnaire) was used. The Hospital Anxiety and Depression Scale (HADS) was used to measure depression and anxiety. A proxy variable for capturing overall disturbed sleep used to measure sleep. Longitudinal associations for continuous outcome variables and the dichotomous variable sleep were analysed using mixed- effects regression models with random intercepts. Regression coefficients along with the 95% confidence interval (CI) are presented as measures of association. Both exposures and the outcome were measured simultaneously over six waves (T1-T6).The results showed statistically significant associations between level of fitness and reduced symptoms of stress-related exhaustion over time. Best improvements over time were seen in patients having a medium cardiorespiratory fitness level. No associations could be found between cardiorespiratory fitness level over time and anxiety, depression or sleep disturbances.Having medium cardiorespiratory fitness was positivity associated with a more sustained reduction in symptoms of ED overtime compared to those having low or high cardiorespiratory fitness levels. The clinical implication following this result is that an individual recommendation based on a medium level of physical activity in line with the recommendations from ACSM (American College of Sports Medicine) is preferable compared to recommendations including more vigorous physical activity in order to restore and sustainably reduce symptoms of exhaustion disorder over time.
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42.
  • Lindell, Maja, et al. (författare)
  • Stress, non-restorative sleep, and physical inactivity as risk factors for chronic pain in young adults: A cohort study
  • 2022
  • Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 17:1 January
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Chronic pain is a common condition which causes patients much suffering and is very costly to society. Factors known to be associated with chronic pain include female gender, acute pain, depression, and anxiety. This study investigated whether stress, sleep disturbance, and physical inactivity were risk factors for developing chronic pain among young adults, and whether there were any interactions between these. Methods This retrospective longitudinal study was based on an existing database from a cohort study on IT use and health, called Health 24 Years. A questionnaire was sent to students aged 19-24 in Sweden for five consecutive years, containing questions on pain, stress, sleep, physical activity, technology use, health, and more. In logistic regressions, stress, sleep, and physical activity at baseline were potential predictors of chronic pain one and four years later. In addition, a new variable including all possible interactions between potential predictors was created to test for effect modification between risk factors. Results At the one-year follow-up, stress, non-restorative sleep, and physical inactivity showed odds ratios of 1.6 (95% CI: 1.0-2.4), 1.5 (95% CI: 1.0-2.3), and 1.8 (95% CI: 1.1-3.0) respectively after adjusting for confounders, the reference being non-stressed, having restorative sleep and being active. At the four-year follow-up, stress showed an adjusted odds ratio of 1.9 (95% CI: 1.3-2.9), while non-restorative sleep and physical inactivity were statistically insignificant. At the one-year follow-up, the interaction between risk factors were significant. The most clear example of this effect modification was to be inactive and not have -restorative sleep, compared to individuals who were active and had restorative sleep, showing an adjusted odds ratio of 6.9 (95% CI: 2.5-19.2) for developing chronic pain one year after baseline. This in comparison of odds ratios for only inactive respectively only non-restorative sleep being 1.7 (95% CI: 0.6-5.3) respectively 1.6 (95% CI: 0.7-3.5). Conclusions Stress, non-restorative sleep, and physical inactivity were risk factors for developing chronic pain one year after baseline, and stress were also a risk factor four years after baseline. These findings suggest that non-restorative sleep and inactivity are risk factors in the short term while stress is a risk factor in both the short and the long term. In addition to the independent effects of non-restorative sleep and inactivity, their combination seems to further increase the odds of chronic pain. © 2022 Lindell, Grimby-Ekman. 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.
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43.
  • Lundberg, Mari, 1969, et al. (författare)
  • Pain-related fear: a critical review of the related measures.
  • 2011
  • Ingår i: Pain research and treatment. - : Hindawi Limited. - 2090-1550 .- 2090-1542. ; 2011
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: In regards to pain-related fear, this study aimed to: (1) identify existing measures and review their measurement properties, and (2) identify the optimum measure for specific constructs of fear-avoidance, pain-related fear, fear of movement, and kinesiophobia. Design: Systematic literature search for instruments designed to measure fear of pain in patients with persistent musculoskeletal pain. Psychometric properties were evaluated by adjusted Wind criteria. Results: Five questionnaires (Fear-Avoidance Beliefs Questionnaire (FABQ), Fear-Avoidance of Pain Scale (FAPS), Fear of Pain Questionnaire (FPQ), Pain and Anxiety Symptoms Scale (PASS), and the Tampa Scale for Kinesiophobia (TSK)) were included in the review. The main findings were that for most questionnaires, there was no underlying conceptual model to support the questionnaire's construct. Psychometric properties were evaluated by diverse methods, which complicated comparisons of different versions of the same questionnaires. Construct validity and responsiveness was generally not supported and/or untested. Conclusion: The weak construct validity implies that no measure can currently identify who is fearful. The lack of evidence for responsiveness restricts the current use of the instruments to identify clinically relevant change from treatment. Finally, more theoretically driven research is needed to support the construct and thus the measurement of pain-related fear.
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44.
  •  
45.
  • Reinholdsson, Malin, et al. (författare)
  • Association between pre-stroke physical activity and mobility and walking ability in the early subacute phase: A registry-based study
  • 2021
  • Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1651-2081. ; 53:10 October
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To investigate associations between pre-stroke physical activity and mobility, walking ability, and self-perceived upper extremity function during stroke unit care. DESIGN: A longitudinal, registry-based study with a consecutively collected cohort. SUBJECTS/PATIENTS: A total of 1,092 adults with stroke admitted to 3 Swedish stroke units between 2017 and 2018. METHODS: Logistic mixed effects regression models were performed to investigate associations (adjusted for age and sex). Pre-stroke physical activity was assessed with Saltin-Grimby Physical Activity Level Scale on admission. Mobility, walking ability, and self-perceived upper extremity function were assessed at admission and discharge from the stroke units and compared between pre-stroke physically active (45%) and inactive (55%) groups. RESULTS: All groups of patients showed improvements in mobility (p<0.001), walking ability (p<0.001), and upper extremity function (p<0.001). The chang-es over time tended to differ between the physically inactive and active groups for mobility (p<0.062) and walking ability (p<0.056), but the differences were not significant. CONCLUSION: Pre-stroke physically active people show-ed a tendency to be more independent in physical functioning early after stroke. Regardless of pre-stroke physical activity, all patients showed improvements in mobility, walking ability, and self-perceived upper extremity function during inpatient care.
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46.
  • Samulowitz, Anke, 1965, et al. (författare)
  • General self-efficacy and social support in men and women with pain – irregular sex patterns of cross-sectional and longitudinal associations in a general population sample
  • 2022
  • Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 23
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The study of sex and gender patterns in psychosocial resources is a growing field of interest in pain research with importance for pain rehabilitation and prevention. The aims of this study were first, to estimate cross-sectional differences in psychosocial resources (general self-efficacy and social support) across men and women in a population with frequent musculoskeletal pain (pain in the back or neck/shoulder nearly every day or now and again during the week for the last 12 months) and to compare these differences with a population with no frequent pain. Second, to examine if psychosocial resources at baseline were associated with pain at follow-up among men and women in the frequent pain population. Methods: This study was based on survey data from the Swedish Health Assets Project, including The General Self-Efficacy Scale and social support questions. Participants (n = 4010, 55% women) were divided into no frequent pain (n = 2855) and frequent pain (n = 1155). General self-efficacy and social support were analyzed (cross-sectional and longitudinal data) with linear and logistic regressions. Results: Men, with and without frequent pain, had higher general self-efficacy than the corresponding groups in women. Women, with and without frequent pain, had stronger emotional social support than the corresponding groups in men. Men with no frequent pain had weaker instrumental social support than women with no frequent pain (OR = 0.64 (95% CI 0.47–0.87)), men with frequent pain did not (OR = 1.32 (95% CI 0.86–2.01)). In the frequent pain population, the interaction between sex and strong (compared to weak) emotional social support was statistically significant (p = 0.040) for no frequent pain at follow-up, with women having OR = 1.81 and men OR = 0.62. Among women, strong emotional social support was associated with no frequent pain at follow-up. Among men, strong emotional social support was associated with frequent pain at follow-up. Conclusion: Some of the associations between general self-efficacy, social support and musculosceletal pain showed unexpected sex patterns. Gendered expectations might have relevance for some of the results.
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47.
  • Samulowitz, Anke, 1965, et al. (författare)
  • Psychosocial resources predict frequent pain differently for men and women: A prospective cohort study
  • 2023
  • Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 18:3
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction Psychosocial resources, psychological and social factors like self-efficacy and social support have been suggested as important assets for individuals with chronic pain, but the importance of psychosocial resources for the development of pain is sparsely examined, especially sex and gender differences. The aim of this study was to investigate associations between psychosocial resources and sex on the development of frequent pain in a general population sample, and to deepen the knowledge about sex and gender patterns. Methods A sample from the Swedish Health Assets Project, a longitudinal cohort study, included self-reported data from 2263 participants, 53% women, with no frequent pain at baseline. The outcome variable was frequent pain at 18-months follow-up. Psychosocial resources studied were general self-efficacy, instrumental and emotional social support. Log binomial regressions in a generalised linear model were used to calculate risk ratios (RRs), comparing all combinations of men with high psychosocial resources, men with low psychosocial resources, women with high psychosocial resources and women with low psychosocial resources. Results Women with low psychosocial resources had higher risk of frequent pain at follow-up compared to men with high resources: general self-efficacy RR 1.82, instrumental social support RR 2.33 and emotional social support RR 1.94. Instrumental social support was the most important protective resource for women, emotional social support was the most important one for men. Results were discussed in terms of gender norms. Conclusions The psychosocial resources general self-efficacy, instrumental and emotional support predicted the risk of developing frequent pain differently among and between men and women in a general population sample. The results showed the importance of studying sex and gender differences in psychological and not least social predictors for pain.
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48.
  • Severinsson, Yvonne, 1957, et al. (författare)
  • Components of primary care multimodal rehabilitation and their association with changes in sick leave: An observational study.
  • 2023
  • Ingår i: Work (Reading, Mass.). - 1875-9270. ; 74:3, s. 907-917
  • Tidskriftsartikel (refereegranskat)abstract
    • To address the increase in sick leave for nonspecific chronic pain and mental illness, the Swedish government and the Swedish Association of Local Authorities and Regions entered into an agreement on a "Rehabilitation Guarantee" to carry out multimodal rehabilitation (MMR).To investigate whether components of primary care MMR are associated with changes in sick leave.A web-based survey was conducted in conjunction with a retrospective cross-sectional observational study of 53 MMR units. Sick leave data for the years before and after MMR completion was collected for 846 individuals.There was great disparity in how MMR was delivered. The average duration of rehabilitation was 4-8 weeks, and 74% of the MMR teams reported having fewer patients than recommended (≥20/year). Only 58% of the teams met the competence requirements. In-depth competence in pain relief and rehabilitation was reported by 45% of the teams and was significantly associated with fewer sick leave days after MMR (26.53, 95% CI: 3.65; 49.42), as were pain duration (17.83, 95% CI: -9.20; 44.87) and geographic proximity (23.75, 95% CI: -5.25; 52.75) of the health care professionals included in the MMR unit.In-depth competence and knowledge about the complex health care needs of patients seem essential to MMR teams' success in reducing sickness benefits for patients with nonspecific chronic pain and mental illness. Further research is needed to elucidate the optimal combination of primary care MMR components for increasing the return-to work rate and to determine whether involvement of the Social Insurance Agency or employers could support and further contribute to recuperation and help patients regain their previous work capacity.
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49.
  • Stensson, Niclas, et al. (författare)
  • Altered relationship between anandamide and glutamate in circulation after 30 min of arm cycling: A comparison of chronic pain subject with healthy controls
  • 2019
  • Ingår i: Molecular Pain. - : SAGE Publications. - 1744-8069. ; 15
  • Tidskriftsartikel (refereegranskat)abstract
    • The insufficient knowledge of biochemical mechanisms behind the emergence and maintenance of chronic musculoskeletal pain conditions constrains the development of diagnostic and therapeutic tools for clinical use. However, physical activity and exercise may improve pain severity and physical function during chronic pain conditions. Nevertheless, the biochemical consequences of physical activity and exercise in chronic pain need to be elucidated to increase the precision of this therapeutic tool in chronic pain treatment. The endocannabinoid system has been suggested to play an important role in exercise-induced reward and pain inhibition. Moreover, glutamatergic signalling has been suggested as an important factor for sensation and transmission of pain. In addition, a link has been established between the endocannabinoid system and glutamatergic pathways. This study examines the effect of dynamic load arm cycling (30 min) on levels of lipid mediators related to the endocannabinoid system and glutamate in plasma of chronic pain subjects and pain-free controls. Pain assessments and plasma levels of arachidonoylethanolamide (anandamide), 2-aracidonoylglycerol, oleoylethanolamide, palmitoylethanolamide, stearoylethanolamide and glutamate from 21 subjects with chronic neck pain (chronic pain group) and 11 healthy controls were analysed pre and post intervention of dynamic load arm cycling. Pain intensity was significantly different between groups pre and post exercise. Post exercise, anandamide levels were significantly decreased in health controls but not in the chronic pain group. A strong positive correlation existed between anandamide and glutamate in the control group post exercise but not in the chronic pain group. Moreover, the glutamate/anandamide ratio increased significantly in the control group and differed significantly with the chronic pain group post exercise. The altered relationship between anandamide and glutamate after the intervention in the chronic pain group might reflect alterations in the endocannabinoid-glutamate mechanistic links in the chronic pain group compared to the pain-free control group.
  •  
50.
  • Susoliakova, O., et al. (författare)
  • Salivary cortisol in two professions: Daily cortisol profiles in school teachers and firefighters
  • 2014
  • Ingår i: Neuroendocrinology Letters. - 0172-780X. ; 35:4, s. 314-321
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND; It's indicated negative-perceived stress could induce worse health status and change of cortisol secretion. OBJECTIVES: To assess salivary cortisol levels in two occupations with a high psychosocial workload, but different features, teachers and firefighters. METHODS: The study population consisted of 142 school teachers and 136 firefighters. Four saliva samples were collected from pedagogical participants during their busiest workday. The cortisol measures used were: morning values, evening values, slope of decline, ratio (evening value divided by morning value), and area under the curve (AUC). RESULTS: The salivary cortisol measurements in both genders were almost equal regarding morning values, slope, and AUC increase. Evening values were lower and the relative reactivity was higher (lower ratio) for female teachers, compared to male teachers. There was a tendency of a lower total daytime output of cortisol (AUC ground) among female teachers. Firefighters had lower levels of cortisol, lower total daytime output, and higher relative reactivity (lower ratio), but lower absolute reactivity, regarding both slope and AUC increase. CONCLUSION: Overall, male teachers might be the group most affected by stress in this study, even if some of their cortisol values were almost equal to the female teachers' values. Male teachers also seemed to be more affected by stress, according to salivary cortisol, compared to male firefighters, even if there were some inconsistencies. © 2014 Neuroendocrinology Letters.
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