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1.	Sjöquist, Emma S., et al. (författare) Physical Activity Coaching of Patients with Rheumatoid Arthritis in Everyday Practice : A Long-term Follow-up 2011 Ingår i: Musculoskeletal Care. - Chichester : John Wiley & Sons. - 1478-2189 .- 1557-0681. ; 9:2, s. 75-85 Tidskriftsartikel (refereegranskat)abstract OBJECTIVES: To investigate the long-term effects on perceived general health, disease activity, pain, activity limitation and cognitive behavioural factors of a one-year coaching programme performed in ordinary physical therapy practice to promote the adoption of health-enhancing physical activity in patients with early rheumatoid arthritis (RA).METHODS: A total of 228 patients with early RA, from 10 rheumatology clinics in Sweden, were randomly assigned to an intervention group (IG; n = 94) or a control group (CG; n = 134). The IG was coached by physical therapists during the first year to adopt health-enhancing levels of physical activity (30 minutes/day, moderately intensive, ≥ 4 days/week). No coaching was given during the subsequent year between post-intervention and follow-up. Follow-up assessment consisted of a postal questionnaire on physical activity and of visual analogue scales for ratings of general health perception and pain. The Health Assessment Questionnaire Disability Index (HAQ) and the Disease Activity Score in 28 joints (DAS 28) were collected at regular medical check-ups.RESULTS: Sixty-five (69%) participants in the IG and 92 (69%) in the CG completed the entire study period by filling in the follow-up questionnaire on physical activity two years after baseline. The intervention seemed to lack any significant influence on long-term outcome. However, different patterns of change in physical activity behaviour were observed in the two groups.CONCLUSIONS: No long-term improvement in perceived general health or other outcomes were found in the follow-up. This may partly be because the intervention lacked several important behavioural elements for physical activity maintenance. Copyright © 2011 John Wiley & Sons, Ltd.
2.	Andersson, Åsa, Professor, 1960-, et al. (författare) Serum Protein Response To A Single High-Intensity Interval Training Bout – Comparison Between Individuals With Spondyloarthritis And Healthy Controls 2022 Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 81:Suppl 1, s. 780-781 Tidskriftsartikel (refereegranskat)abstract Axial spondyloarthritis (axSpA) is a chronic inflammatory disease affecting mainly the axial skeleton. To decrease the risk of cardiovascular comorbidity, aerobic training is recommended as a part of disease management in patients with axSpA. High-intensity interval training (HIIT) interventions are, in addition to other recommended treatments, believed to positively affect the disease activity (1). However, the knowledge about the acute effects of HIIT on the inflammatory process at the molecular level is less studied. Understanding the acute HIIT effects on cytokines and additional serum proteins in axSpA is important for further long-term HIIT interventions and recording of the effect of HIIT on the axSpA disease profile.ObjectivesTo study the acute effects on serum proteins, such as cytokines, myokines, and inflammatory- and bone-related proteins, in response to a single bout of HIIT, and to compare the levels between baseline and post-HIIT in patients with axSpA and healthy controls (HC).MethodsThe pilot study included twenty-one participants (10 female, 11 male), mean (SD) age 40 (7) years, ten with axSpA, and eleven age and sex matched HC, who performed a single HIIT on a cycle ergometer consisting of 4x4 minutes interval (90% heart rate, HR-max) with three minutes active rest in between (70% of HR-max). Disease activity (BASDAI, 0-10) in patients with axSpA was 1.6 (0.8). Health status EuroQol (EQ5D, 0-1) were 0.87 (0.11) for axSpA, and 0.93 (0.10) for HC. The groups were well matched with no difference in baseline data for weight, BMI, EQ5D, blood pressure or aerobic capacity.Blood samples were taken before (baseline) and one hour after the single HIIT. The following serum proteins were analyzed on a Luminex MAGPIX System (Luminex corporation, Austin, TX USA): Interleukin (IL)-6, IL-17, IL-18, TNFαAGPIX System (Luminex corporatiosteoprotegerin, osteocalcin, osteopontin, and FGF-23. A three-way analysis of variance (ANOVA) was used to detect differences between groups, between sexes, and before and after a HIIT bout in a 2(group)2(sex)2(time) design. For main effects or interactions significant at p≤0.05, simple effect t-tests were used to determine the specific effects.ResultsA group main effect (p=0.048) showed that the serum level of IL-6 was increased one hour after the HIIT session primarily in the HC, 0.4 pg/ml (SD±0.4) at baseline vs. post-HIIT 1.8 (2.0). The concentration of the cytokines/chemokine IL-17, IL-18, TNFα group main effect (p=0.048) showed that the serum level of IL-6 was increased one hour after the HIIT session primarily in30) in VEGF-A showed that the axSpA group had significantly lower VEGF-A at baseline, 159 pg/ml (138) vs 326 (184) in the control group (which might be due to anti-inflammatory medication). A sex main effect (p=0.029) was observed from baseline to post-HIIT for the bone hormone osteocalcin, with a more pronounced decrease of serum osteocalcin in women with axSpA, 14.0 ng/ml (8.3) vs. post HIIT 13.2 (6.9). Moreover, the level of the multifunctional protein osteopontin was significantly lower (sex main effect, p=0.021) in women, 10.7 ng/ml (7.0) vs. men 20.4 (10.1), post-HIIT.ConclusionThis pilot study shows that one bout of HIIT influences the expression of proteins involved in inflammation and metabolism, and that sex is an important factor in the response to HIIT. The results should be followed up in longer intervention studies including higher numbers of participants.References[1]Sveaas, S. H. et al. (2019). High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis (axSpA): a multicentre randomised trial of 100 patients. British journal of sports medicine, 54(5), 292-297.Disclosure of InterestsÅsa Andersson: None declared, Emma Haglund Consultant of: Novartis, Emma Berthold: None declared, Elisabeth Mogard Consultant of: Novartis, Anna Torell: None declared, M Charlotte Olsson: None declared
3.	Aili, Katarina, 1980-, et al. (författare) Adding information on widespread pain to the start back screening tool when identifying low back pain patients at increased risk for poor prognosis 2019 Ingår i: Annals of the Rheumatic Diseases. - London, UK : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 78:Suppl 2, s. 1457-1457 Tidskriftsartikel (refereegranskat)
4.	Aili, Katarina, 1980-, et al. (författare) Passive coping strategies but not physical function are associated with worse mental health, in women with chronic widespread pain – a mixed method study 2019 Ingår i: Annals of the Rheumatic Diseases. - London, UK : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 78:Suppl 2, s. 2159-2159 Tidskriftsartikel (refereegranskat)abstract Background: Chronic widespread pain (CWP) is a common condition (approximately 10% prevalence), that affects women twice as often as men. There is a lack of knowledge in how different coping strategies relates to health status during CWP development in a general population.Objectives: To explore different ways of coping with CWP and to relate the different coping strategies to health-related factors, before and after developing CWP.Methods: A sequential explorative mixed methods study including 19 women 45-67 of age, who had reported CWP in a survey 2016, but not in 1995. Individual interviews were analysed with a phenomenographic approach, and resulted in four categories of coping strategies. These categories were further explored with regard to four dimensions of health status (physical function, bodily pain, vitality and mental health) as measured by SF-36 (0-100, a lower score indicates more disability) and sleep problems measured both in 1995, and 2016.Results: The qualitative analysis revealed four categories representing different coping strategies, where each woman was labelled by the most dominant category; the mastering woman, the persistent woman, the compliant woman and the conquered woman. The first two categories emerged as being active coping strategies, and the latter two as passive. Women with passive strategies reported significantly lower vitality (median 57.5 vs 75, p=0.007) and worse mental health (median 54 vs 93, p=0.021) in 1995, before they had developed CWP compared with those with active coping strategies. No differences were seen between the groups on physical function, bodily pain or sleep.In 2016, there were still a difference between the passive and active group regarding mental health (median 56 vs 80, p=0.022), but not for vitality (median 35 vs 40, p=0.707). No differences were seen between the groups on physical function or bodily pain. All eight women with passive strategies reported problems with sleep in 2016, as compared to 6 of the 11 women with active strategies (p=0.045).Conclusion: Women that reported CWP in 2016, but not in 1995, described both active and passive coping strategies. The qualitative findings were associated with differences in vitality and mental health already in 1995, before they had developed CWP. Further, those with passive coping strategies reported worse health with regard to mental health and sleep problems in 2016. Interestingly, the groups did not differ in bodily pain or physical function neither in 1995 nor in 2016, which implicates the importance for the clinician to take the typical coping strategy into consideration, when meeting these patients in clinical settings. © Aili, Bergman, Bremander, Haglund & Larsson 2019. No commercial re-use. See rights and permissions. Published by BMJ.
5.	Aili, Katarina, et al. (författare) Sleep problems and fatigue as a predictor for the onset of chronic widespread painover a 5- and 18-year perspective : a 20-year prospective study 2018 Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 77, s. 87-87 Tidskriftsartikel (refereegranskat)abstract Background: If localised pain represent one end of a pain spectra, with overall better general health, chronic widespread pain (CWP) and fibromyalgia represent the other end of the spectra with worse general health and more comorbidities with other somatic diseases and mental illness. Sleep problems and fatigue are common among individuals reporting CWP and previous research indicate that sleep problems may be an important predictor for pain prognosis.Objectives: The aim of this population-based study was to investigate if sleep problems and fatigue predict the onset of CWP 5 and 18 years later.Methods: In order to get more stable baseline classifications of CWP, a wash-out period was used, including only individuals who had not reported CWP (according to ACR 1990 criteria for fibromyalgia) at baseline (−98) and three years prior baseline (−95). In all, data from 1249 individuals entered the analyses for the 5 year follow-up (−03) and 791 entered for the 18 year follow-up (−16). Four parameters related to sleep (difficulties initiating sleep, maintaining sleep, early morning awakening and non-restorative sleep), and one parameter related to fatigue (SF-36 vitality scale) were investigated as predictors for CWP. Binary logistic regression analysis were used for analyses.Results: All investigated parameters predicted the onset of CWP five years later (problems with initiating sleep (OR 1.91; 1.16–3.14), maintaining sleep (OR 1.85; 1.14–3.01), early awakening (OR 2.0; 1.37–3.75), non-restorative sleep (OR 2.27; 1.37–3.75) and fatigue (OR 3.70; 1.76–7.84)) in a model adjusted for age, gender, socio-economy and mental health. All parameters except problems with early awakening predicted the onset of CWP also 18 years later. In all, 785 individuals did not report any of the sleeping problems at baseline (fatigue not included), 268 reported one of the problems, 167 two, 128 three and 117 subjects reported to have all four sleep problems. Reporting all four sleep problems was significantly associated with CWP at follow-up at both time points when adjusting for age, gender, socio economy and mental health (OR 4.00; 2.03–7.91 and OR 3.95; 1.90–8.20); adjusting for age, gender, socio economy and number of pain regions (OR 2.94; 1.48–5.82 and OR 2.65; 1.24–5.64) and in a model adjusting for age, gender, socio economy and pain severity (OR 2.97;1.53–5.76; and OR 3.02;1.47–6.21) for the 5 year and 18 year follow-up respectively, compared to not reporting any of the sleep problems at baseline.Conclusions: Both sleeping problems and fatigue predicts the onset of CWP 5- and 18 years later. The results highlight the importance of the assessment of sleep quality in the clinic.
6.	Aili, Katarina, 1980-, et al. (författare) Sleep problems and fatigue as predictors for the onset of chronic widespread pain over a 5-and 18-year perspective 2018 Ingår i: Bmc Musculoskeletal Disorders. - London : Springer Science and Business Media LLC. - 1471-2474. ; 19 Tidskriftsartikel (refereegranskat)abstract BackgroundPrevious research suggests that sleep problems may be an important predictor for chronic widespread pain (CWP). With this study we investigated both sleep problems and fatigue as predictors for the onset of CWP over a 5-year and an 18-year perspective in a population free from CWP at baseline.MethodsTo get a more stable classification of CWP, we used a wash-out period, including only individuals who had not reported CWP at baseline (1998) and three years prior baseline (1995). In all, data from 1249 individuals entered the analyses for the 5-year follow-up and 791 entered for the 18-year follow-up. Difficulties initiating sleep, maintaining sleep, early morning awakening, non-restorative sleep and fatigue were investigated as predictors separately and simultaneously in binary logistic regression analyses.ResultsThe results showed that problems with initiating sleep, maintaining sleep, early awakening and non-restorative sleep predicted the onset of CWP over a 5-year (OR 1.85 to OR 2.27) and 18-year (OR 1.54 to OR 2.25) perspective irrespective of mental health (assessed by SF-36) at baseline. Also fatigue predicted the onset of CWP over the two-time perspectives (OR 3.70 and OR 2.36 respectively) when adjusting for mental health. Overall the effect of the sleep problems and fatigue on new onset CWP (over a 5-year perspective) was somewhat attenuated when adjusting for pain at baseline but remained significant for problems with early awakening, non-restorative sleep and fatigue. Problems with maintaining sleep predicted CWP 18years later irrespective of mental health and number of pain regions (OR 1.72). Reporting simultaneous problems with all four aspects of sleep was associated with the onset of CWP over a five-year and 18-yearperspective, irrespective of age, gender, socio economy, mental health and pain at baseline. Sleep problems and fatigue predicted the onset of CWP five years later irrespective of each other.ConclusionSleep problems and fatigue were both important predictors for the onset of CWP over a five-year perspective. Sleep problems was a stronger predictor in a longer time-perspective. The results highlight the importance of the assessment of sleep quality and fatigue in the clinic.
7.	Aili, Katarina, et al. (författare) Women’s experiences of coping with chronic widespread pain – a qualitative study 2018 Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 77, s. 1815-1815 Tidskriftsartikel (refereegranskat)abstract Background: Approximately ten percent of the population report chronic widespread pain (CWP), the condition is more common among women than men. For most people, the pain interferes with many aspects of every-day life and implies large consequences. However, the group reporting CWP is heterogeneous and there is a need for better understanding of the different strategies used for coping with pain in every-day life.Objectives: The purpose of this study was to describe women’s experiences of how to cope with CWP.Methods: The study had a descriptive design with a qualitative content analysis approach. Individual interviews were conducted with 19 women, 31–66 of age, who had reported CWP in a survey 2016. CWP was defined according to the 1990 ACR criteria for fibromyalgia. To be considered chronic, the pain should have persisted for more than three months during the last 12 months. A manifest qualitative content analysis was used to analyze the main question “How do you cope with your chronic widespread pain?” The analysis resulted in four categories.Results: Women described their coping with CWP in four different ways; to take control, to continue as usual, to follow instructions and to rest. To take control meant to make deliberate decisions to handle everyday day life. It also meant to take care of oneself, to think positive and to exercise at an adequate level. To continue as usual meant not to listen to body signals and either to ignore or accept the pain. To follow instructions meant listening to the health professionals and following advices, but without taking any part of the responsibility for the treatment outcome. To rest meant to perceive an unreasonable need for recovery, to resign and let the pain set the terms for the daily living.Conclusions: Women expressed different ways of coping with CWP including both active and passive strategies. The coping strategies included two dimensions, where one ranged from actively taking control over the pain, to passively following instructions and the other from actively continue as usual by either accepting or ignoring the pain to passively rest and being mastered by pain.
8.	Andersson, Maria L.E. 1968-, et al. (författare) Associations between metabolic factors and radiographic knee osteoarthritis in early disease-a cross-sectional study of individuals with knee pain 2022 Ingår i: Bmc Musculoskeletal Disorders. - London : Springer Science and Business Media LLC. - 1471-2474. ; 23:1 Tidskriftsartikel (refereegranskat)abstract Objective Metabolic factors have been shown to be associated to severe radiographic knee osteoarthritis (RKOA). However, more knowledge is needed in early clinical knee osteoarthritis (KOA). The aim was to study associations between metabolic factors and radiographic knee osteoarthritis (OA) in individuals with knee pain. A second aim was to study associations between metabolic factors and RKOA in those with normal BMI and in those overweight/obese, respectively. Method This cross-sectional study included 282 individuals with knee pain (without cruciate ligament injury) and aged 30-67 years, and 70% women. Waist circumference, body mass index (BMI), proportion of fat and visceral fat area (VFA) were assessed. RKOA was defined as Ahlback grade 1 in at least one knee. Fasting blood samples were taken and triglycerides, cholesterol (total, low density lipoprotein (LDL) and high density lipoprotein (HDL)), C-reactive protein (CRP), glucose, HbA1C were analysed. Metabolic syndrome was defined in accordance with the International Diabetes Federation (IDF). Associations were analysed by logistic regression. Results Individuals with RKOA were older, had higher BMI, higher VFA, larger waist circumference and had increased total cholesterol, triglycerides and LDL-cholesterol, but not fasting glucose. There was no difference between the group with RKOA vs. non-radiographic group regarding the presence of metabolic syndrome. In a subgroup analysis of individuals with normal BMI (n = 126), those with RKOA had higher VFA, more central obesity, higher levels of CRP and total cholesterol, compared with individuals without RKOA. In individuals with obesity, age was the only outcome associated to RKOA. Conclusion There were clear associations between metabolic factors and RKOA in individuals with knee pain, also in those with normal BMI. In individuals with obesity age was the only variable associated to RKOA.
9.	Andersson, Maria L.E., et al. (författare) Cohort profile: the Halland osteoarthritis (HALLOA) cohort-from knee pain to osteoarthritis: a longitudinal observational study in Sweden 2022 Ingår i: Bmj Open. - London : BMJ. - 2044-6055. ; 12:7 Tidskriftsartikel (refereegranskat)abstract Purpose The overall objective in this study is to investigate the early development of radiographic knee osteoarthritis (OA) and its association with hand or/and knee OA, metabolic diseases, biomarkers, chronic pain, physical function and daily physical activity types. Participants The Halland osteoarthritis (HALLOA) cohort is a longitudinal cohort study that includes individuals with knee pain in the southwest of Sweden. Enrolment took place from 2017 to 2019. The inclusion criteria were current knee pain, with no former known radiographic knee OA and no cruciate ligament rupture or rheumatological disorder. The participants were recruited: (1) when seeking care for knee pain in primary healthcare or (2) by advertisements in local newspapers. There are 306 individuals included in the study, mean age (SD) 51.7 (8.7) years and 69% are women. The baseline and follow-ups include clinical tests, radiographical examinations, blood samples, metabolic measures, pain pressure thresholds, tests of physical functions, daily physical activity types and patient-reported outcomes. Findings to date There were associations between metabolic factors and radiographic knee OA, even in those with normal body mass index at baseline. In addition, clinical hand OA was positively associated with fasting plasma glucose. We also found that modifiable factors as increased visceral fat and total body fat were associated with increased pain sensitivity among individuals with knee pain. Future plans By studying possible pathophysiological mechanisms of OA over time, we aim to provide new insights on OA progression, identify usable preventive measures helping the clinicians in the management of the disease and improve health for the patients. It is also important to study the development of chronic pain in OA, to get tools to identify individuals at risk and to be able to offer them treatment.
10.	Andersson, Maria L.E. 1968-, et al. (författare) Metabolic factors associated to clinical hand osteoarthritis in individuals with knee pain 2020 Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 79:Suppl. 1, s. 1734-1734 Tidskriftsartikel (refereegranskat)abstract Background: There is some evidence supporting associations between metabolic factors, clinical hand osteoarthritis (OA) and radiographic knee OA. However, more studies are needed regarding early knee OA.Objectives: The aim was to study associations between metabolic factors and clinical hand OA at baseline in a cohort of individuals with knee pain, with and without radiographic knee OA.Methods: In an ongoing five-year longitudinal study of knee pain, hand OA was assessed by clinical examinations in 296 of the included individuals at baseline [1]. BMI, waist circumference (WC) and blood pressure was measured. Body composition was assessed with Inbody 770. Fasting plasma glucose, triglycerides, cholesterol, HDL-and LDL-cholesterol and HbA1c was analysed. Metabolic syndrome (MetS)was present if central obesity (WC ≥94 cm in men and ≥80cm in women) plus any two of the following factors: raised blood pressure (systolic blood pressure ≥ 130 or diastolic blood pressure ≥ 85 mm Hg or treatment of hypertension), raised triglycerides (≥ 1.7 mmol/L or specific treatment), reduced HDL-cholesterol (men < 1.03 mmol/L and women < 1.29 mmol/L or specific treatment), raised glucose (glucose ≥ 5.6 mmol/L, or type 2 diabetes). Hand strength and self-reported disability of the arm, shoulder and hand (quickDASH) was assessed.The individuals were divided according to having clinical hand OA or not, according to Altman [1]. The associations between background factors and clinical hand OA were calculated by crude logistic regression analyses, adjusting for age and sex.Results: Fifty-five percent of the individuals in the study was overweight or obese, 40% had MetS and 23% had radiographic knee OA. In total 34% of the individuals had clinical hand OA. The group with hand OA were older, had higher proportion of body fat, fasting plasma glucose, HbA1C, worse quickDASH score and lower hand strength, table 1. Clinical hand OA was significantly associated to higher age (OR 1.04, 95%CI 1.01-1.07), higher fasting plasma glucose (1.56, 1.05-2.30), worse quickDASH (1.04, 1.02-1.06) and lower hand strength (0.99, 0.99 -0.998), but not to proportion of body fat and HbA1c.Conclusion: In this cross-sectional study, the only metabolic factor associated with clinical hand OA was fasting plasma glucose. Contrary to other studies, there were no gender differences found. The association between development of clinical hand OA and metabolic factors in individuals with knee pain need to be further assessed in longitudinal studies.
11.	Andersson, Maria L.E. 1968-, et al. (författare) Metabolic Factors Associated to Radiographic Knee Osteoarthritis in Individuals with Knee Pain 2020 Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 79:Suppl. 1, s. 793-793 Tidskriftsartikel (refereegranskat)abstract Metabolic factors have been shown to be associated to radiographic knee osteoarthritis (OA) [1]. More knowledge about associations between metabolic factors and early clinical knee OA is needed.Objectives:The aim was to study associations between metabolic factors and radiographic knee OA in individuals with knee painMethods:In total 272 individuals with radiographs at baseline, from an ongoing longitudinal study of knee pain (without cruciate ligament injury), were included in the present cross-sectional study. At baseline BMI, waist circumference (WC) and visceral fat area (VFA) were assessed. Fasting plasma glucose, triglycerides, cholesterol, HDL-and LDL-cholesterol were analysed. Metabolic syndrome (MetS) was present if central obesity (WC ≥94 cm in men and ≥80cm in women) plus any two of the following factors: raised blood pressure (systolic blood pressure ≥ 130 or diastolic blood pressure ≥ 85 mm Hg or treatment of hypertension), raised triglycerides (≥ 1.7 mmol/L or specific treatment), reduced HDL-cholesterol (men < 1.03 mmol/L and women < 1.29 mmol/L or specific treatment), raised glucose (glucose ≥ 5.6 mmol/L, or type 2 diabetes).The individuals were divided in two groups according to Ahlbäck [2], one group, who had grade I or more in at least one knee (radiographic knee OA, ROA) n=62 and the other group, not fulfilling Ahlbäck criteria (no radiograhic knee OA, No OA) n=211. The associations between metabolic factors and knee OA were calculated by crude logistic regression analyses, adjusting for age and sex.Results:The group with radiographic knee OA were older, had higher BMI, higher amount of visceral fat and more had central obesity, table 1. Ninety- four percent of the group with ROA had central obesity compared to 76%, p=0.002 in the no OA group. There was no difference between the groups regarding MetS, 44% in the ROA group vs. 39%, p=0.5. The group with ROA had increased cholesterol, triglycerides and LDL-cholesterol. There were no differences in fasting glucose between the groups, though both groups had a mean glucose value in the upper range of normal value, table 1. Factors associated to having radiographic knee OA were age (OR 1.11, 95% CI 1.06-1.17), BMI (1.07, 1.003-1.13), central obesity (3.91, 1.32-11.61) and raised triglycerides (2.35, 1.03-5.38).Table 1.Baseline descriptivesNo OAMean (sd)ROAMean(sd)p-valueN21162Age50 (9)56 (4)<0.001Sex, women, %66710.454BMI25.9 (4.7)27.7 (4.7)0.007VFA (cm2)109 (53)126 (52)0.026WC, cm94 (13)99 (13)0.006Raised Blood pressure, %66530.063Cholesterol (mmol/L)5.2 (1.0)5.5 (1.1)0.033Triglycerides (mmol/L)1.0 (0.6)1.2 (0.7)0.035Raised triglycerides, %9210.008LDL-cholesterol (mmol/L)3.4 (1.0)3.7 (1.1)0.027HDL-cholesterol (mmol/L)1.7 (0.4)1.7 (0.5)0.547Reduced HDL11150.460Glucose (mmol/L)5.5 (0.9)5.5 (0.5)0.858Conclusion:There were associations between some metabolic factors and radiographic knee OA in individuals with knee pain. Fasting glucose was increased in both groups. The associations between metabolic risk factors and the development of knee OA needs to be assessed in longitudinal studies.References:[1]Sellam J, Bone Spine 2013;80:568-73.[2]Ahlback S,. Acta Radiol Diagn (Stockh) 1968Suppl 277:7-72.Disclosure of Interests:None declared
12.	Andersson, Åsa, Professor, 1960-, et al. (författare) Effects on serum protein levels from one bout of high intensity interval training in individuals with axial spondyloarthritis and controls Annan publikation (övrigt vetenskapligt/konstnärligt)abstract Background: Axial spondyloarthritis (axSpA) is a chronic inflammatory disease primarily affecting the axial skeleton causing pain, inflammation, and stiffness. Individuals with axSpA are at greater risk of developing cardiovascular disease, which can be counteracted by physical activity. High-intensity interval training (HIIT) has been shown to improve cardiovascular health, but the effect on disease activity and the level of inflammation in axSpA has been less studied. With the aim of investigating how levels of inflammatory cytokines, myokines, and protein markers for bone metabolism are acutely affected by one bout of HIIT, we studied serum from individuals with axSpA and healthy controls (HC).Methods: Ten participants with axSpA and 11 age- and sex-matched HC performed a single HIIT bout on a cycle ergometer: 4x4 minutes intervals with three minutes active rest in between. Blood samples were taken before and one hour after the HIIT bout. Serum proteins (IL-6, IL-17, IL-18, TNFa, CXCL-10, VEGF-A, BDNF, DKK-1, osteoprotegerin, osteocalcin, osteopontin, BMP-7, CRP) were analyzed with a Luminex system or ELISA. Descriptive data are presented as mean with standard deviation. A two-way ANOVA was used for comparisons.Results: A main effect from baseline to one hour post HIIT showed that both groups had a significant increase in serum levels (pg/ml) of IL-6: axSpA 2.2 (3.0) to 3.2 (1.8) and HC 0.4 (0.4) to 1.9 (2.0), p=0.03. VEGF-A (pg/ml) was significantly lower in the axSpA group: 159 (138) vs. HC 326 (184), p=0.03, but was not affected by the HIIT bout. BMP-7 (ng/ml) increased in both groups after the HIIT: axSpA 61.6 (13.1) to 75.2 (20.0) and HC 64.6 (20.8 to 75.0 (17.8), p<0.001. For the other proteins analyzed, there were no significant differences in serum concentrations between individuals with axSpA and HC, or within the two groups before and after one bout of HIIT.Conclusions: One acute bout of HIIT significantly increases the serum concentrations of IL-6 and BMP-7 after 1 hour in both individuals with axSpA and HC.© Research Square 2024
13.	Bergman, Stefan, 1959-, et al. (författare) CHRONIC WIDESPREAD PAIN, SLEEP PROBLEMS AND PRESSURE PAIN THRESHOLDS IN A POPULATION SAMPLE 2018 Ingår i: ANNALS OF THE RHEUMATIC DISEASES. - London : BMJ Publishing Group Ltd and European League Against Rheumatism. - 0003-4967 .- 1468-2060. ; 77, s. 1645-1646 Konferensbidrag (övrigt vetenskapligt/konstnärligt)
14.	Bremander, Ann, 1957-, et al. (författare) Measures of Physical Activity and Fear Avoidance in People with Chronic Pain 2018 Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 77:Suppl. 2, s. 1829-1830 Tidskriftsartikel (refereegranskat)abstract Background Lifestyle factors such as physical activity (PA) has the possibility to contribute to improved health and quality of life in the population as well as in chronic diseases. Most often PA is self-reported while measures of the aerobic capacity are more seldom measured in subjects with chronic pain.Objectives To describe physical activity levels (self-reported and aerobic capacity) in people with chronic pain classified as regional or widespread and to compare the findings with a group that report no pain.Methods From the 2016 follow-up of the Swedish population based Epipain cohort (n 1321), 146 subjects were invited to a clinical assessment where the aerobic capacity was assessed by using a submaximal bicycle test, the Ekblom-Bak test, together with assessment of the Borg scale for perceived exertion (RPE). Aerobic capacity was also classified as low, average or high according to data from the general population. Self-reported physical activity was coded as MVPArec if recommended levels of PA was reported (physically active on a moderate level ≥150 min/week (MPA) or on an vigorous level ≥75 min/week (VPA) or not). The Fear Avoidance Beliefs Questionnaire for PA (FABQ-PA, 0–24 best to worst) and for work (FABQ-W, 0–48 best to worst) were also assessed. The participants were classified as having chronic widespread pain (CWP), chronic regional pain (CRP) or no chronic pain (NCP) based on a pain mannequin presenting 0–18 pain regions and if pain had lasted for 3 months or more. Chi2 and Kruskal-Wallis tests were performed to study differences between the three pain groups.Results 141/146 (97%) subjects (mean (SD) age 59.4 (8.2) years) whereof 61% were women, could be classified into pain groups; 43 as CWP (84% women), 43 as CRP (42% women) and 55 as NCP (58% women). The group with CWP was slightly older than those with CRP (mean (SD) age 57.0 (7.6) years vs. 61.9 (6.9) years, p 0.02). The CWP group also had lower aerobic capacity (mean (SD) 2.2 (0.5) l/min vs. 2.6 (0.6) l/min, p 0.03), and a larger proportion was classified as having low aerobic capacity (CWP 21%, CRP 7% and NCP 10%, p 0.04). The proportion of MVPArec did not differ between the groups; CWP 70%, CRP 81% and NCP 74% (p 0.5). There was neither a difference between the groups in BMI, RPE or in sitting hours/week (p>0.6). However, differences were found in the FABQ where in the PA scale those with CRP had worse scores compared with NCP (mean (SD) 11.2 (7.3) vs. 6.0 (6.0), p<0.001), the difference between CWP (mean (SD) 8.9 (6.7)) and NCP was p 0.06. In the work subscale of FABQ, CWP had worse scores compared with CRP (mean (SD) 18.9 (15.7) vs. 10.0 (12.5), p 0.002) and CRP had worse scores compared to those with NCP (mean (SD) 10.0 (12.5) vs. 6.5 (9.1), p<0.001).Conclusions In this sample of subjects with chronic pain or no pain, having widespread pain tended to affect the aerobic capacity negatively while self-reports of reaching recommended levels of physical activity did not differ between groups. Fear avoidance in relation to physical activity and especially in relation to work was more noticeable in subjects with chronic pain compared to those with no pain. Measures of aerobic capacity and information of fear avoidance beliefs might help health professionals to better tailor the non-pharmacological treatment for subjects with chronic pain.Disclosure of Interest None declared© 2018, Published by the BMJ Publishing Group Limited.
15.	Bremander, Ann, 1957-, et al. (författare) Smoking Is Associated with Worse and More Widespread Pain, Worse Disease Activity, Function, Fatigue and Health Related Quality of Life in Patients with Axial Spondyloarthritis : Results From a Population Based Cohort 2012 Ingår i: Arthritis and Rheumatism. - Hoboken, NJ : John Wiley & Sons. - 0004-3591 .- 1529-0131. ; 64:S10, s. S43-S43 Tidskriftsartikel (refereegranskat)abstract Background: In subjects with early axial Spondyloarthritis (SpA) smoking has recently been associated with earlier onset of disease, worse lesions of the sacroiliac joints and in later stages syndesmophyte progression. The aim was to study associations of smoking habits with self-reported information in a large population based cohort of patients with axial SpA.Methods: A cross-sectional questionnaire survey performed in 2009 included all health care seeking subjects aged >18 years with a diagnosis of SpA according to ICD 10 codes identified by a regional health care register (n=3711). Smoking habits were studied in patients with ankylosing spondylitis (AS, ICD M45) and in patients who fulfilled criteria for “non AS axial SpA” (without having one of AS). Criteria for non AS axial SpA were based on data from the questionnaire: pain for 3 months or more during the last 12 months together with 2 or more features out of 5 (inflammatory back pain, history of psoriasis, uveitis/tendinitis, inflammatory bowel disease or heredity). The questionnaire included data on smoking (never smokers vs. ever smokers), disease activity (BASDAI) physical function (BASFI), general health (BAS-G) all measured with numerical rating scales 0-10 (best to worst), health related quality of life (EQ-5D, 0-1 worst to best), pain, fatigue (numerical rating scales 0-10 best to worst) and number of painful regions noted on a pain mannequin (0-16 best to worst). Linear regression analysis was performed and all data were controlled for sex and age.Results: Response rate was 76% whereof 2167 (58%) returned the questionnaire and 18% declined participation in the study. 598 subjects had an AS diagnose and 572 fulfilled the criteria for non AS axial SpA.The AS group had a mean age of 54 (SD14) years and 35% were women. Never smokers constituted 48% of the AS group. Ever smokers had worse scores in all studied variables compared with never smokers.The linear regression analysis showed that ever smokers in the AS group had worse self-reported scores in BASDAI with age-sex adjusted parameter estimate (B) = 0.60 (95% CI 0.21 ; 1.00), BASFI B = 0.51 (95% CI 0.11 ; 0.91) and fatigue B = 0.51 (95% CI 0.06 ; 1.00) . There was a tendency to worse scores for ever smokers also in EQ-5D B = -0.04 (95% CI -0.09 ; 0.001)Mean age in the non AS axial SpA group was 55 (SD 14) years and 68% were women. Never smokers constituted 38% of this group. Also in the non AS axial SpA group the linear regression analysis showed that ever smokers had worse self-reported scores in BASDAI with age-sex adjusted parameter estimate (B) = 0.59 (95% CI 0.23 ; 0.94), BASFI B = 0.59 (95% CI 0.17 ; 1.00), pain B = 0.45 (95% CI 0.08 ; 0.82) and fatigue B = 0.43 (95% CI 0.03 ; 0.83), no of painful areas B = 0.73 (95% CI 0.06 ; 1.46) and also in EQ-5D B = -0.06 (95% CI -0.11 ; -0.002). Conclusion: In a large population based axial SpA cohort, both patients with AS and non AS axial SpA who were ever smokers reported worse clinical features compared with never smokers. Further longitudinal studies are needed to better understand cause and effect. However, smoking cessation should be recommended not only due to general health perspectives but also due to disease specific issues.References1Smokers in early axial spondyloarthritis have earlier disease onset, more disease activity, inflammation and damage, and poorer function and health-related quality of life: results from the DESIR cohort. Chung HY, Machado P, van der Heijde D, D'Agostino MA, Dougados M. Ann Rheum Dis. 2012 Jun;71(6):809-16.
16.	Bremander, Ann, 1957-, et al. (författare) Smoking is Associated with Worse and More Widespread Pain, Worse Fatigue, General Health and Quality of Life in a Swedish population Based Cohort of Patients with Psoriatic Arthritis 2012 Ingår i: Arthritis and Rheumatism. - Hoboken, NJ : John Wiley & Sons. - 0004-3591 .- 1529-0131. ; 64:S10, s. S777-S778 Tidskriftsartikel (refereegranskat)abstract Background/Purpose: Smoking has been found to be associated with an increased risk of developing psoriatic arthritis (PsA)1. The purpose of this study was analyse possible associations of smoking habits with self-reported clinical features in a large population based cohort of patients with a diagnosis of PsA.Methods: All health care seeking subjects with a diagnose of PsA according to ICD 10 codes (given at least once by a rheumatologist/internist or twice by any other physician) were identified by a regional health care register during 2003-20072. In 2009 all identified subjects aged 18 years or older (n=2003) were invited to participate in a cross sectional questionnaire survey. The questionnaire included self-reported data on smoking (never smokers or ever smokers), age at disease onset, physical function (HAQ, 0-3 best to worst), pain, fatigue and global health (numerical rating scales 0-10 best to worst) health related quality of life (EQ-5D, 0-1 worst to best), and number of painful regions noted on a pain mannequin (0-16, best to worst). Linear regression analysis was performed and all data were controlled for sex and age.Results: Response rate was 77% whereof 369 patients (18%) declined participation and 1185 (59%) returned the questionnaire, mean age 57.5 (SD 13.5) years and 58% were women. 1173 subjects responded to the smoking question whereof 448 (38%) were never smokers and 725 (62%) were ever smokers. Mean age at disease onset was 42.3 (SD 13.4) years in never smokers vs. 46.0 (SD 13.2) in ever smokers. Never smokers vs. ever smokers had mean HAQ 0.59 (SD 0.6) vs. 0.71 (SD 0.6), mean pain 3.9 (SD 2.4) vs.4.4 (SD 2.5), mean fatigue 4.4 (SD 2.8) vs. 5.0 (SD 2.7), mean global health 3.9 (SD 2.4) vs. 4.4 (SD 2.3), mean EQ-5D 0.68 (SD 0.23) vs. 0.63 (SD 0.26) and mean no of painful regions were 7.2 (SD 4.0) vs. 7.9 (SD 4.3).The regression analysis showed that ever smokers had worse pain with age-sex adjusted parameter estimates (B) = 0.38 (95% CI 0.09 ; 0.67), worse fatigue B = 0.34 (95% CI 0.02 ; 0.66), worse global health B = 0.36 (95% CI 0.09 ; 0.64), worse EQ-5D B = -0.04 (95% CI -0.07 ; -0.01) and an increased no of painful regions B = 0.54 (95% CI 0.02 ; 1.07) compared with never smokers.Conclusion: In this population based PsA cohort, patients who were ever smokers reported worse clinical features compared with never smokers. Further longitudinal studies are needed to better understand cause and effect. However, smoking cessation should be recommended due to general health perspectives and also due to disease specific issues.
17.	Bremander, Ann, 1957-, et al. (författare) The Educational Needs of Patients with Undifferentiated Spondyloarthritis 2017 Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 76:Suppl. 2, s. 1495-1496 Tidskriftsartikel (refereegranskat)
18.	Brodin, N., et al. (författare) Coaching patients with early rheumatoid arthritis to healthy physical activity : A multicenter, randomized, controlled study 2008 Ingår i: Arthritis and Rheumatism. - Hoboken, NJ : Wiley. - 0004-3591 .- 1529-0131. ; 59:3, s. 325-331 Tidskriftsartikel (refereegranskat)abstract Objective. To investigate the effect of a 1-year coaching program for healthy physical activity on perceived health status, body function, and activity limitation in patients with early rheumatoid arthritis. Methods. A total of 228 patients (169 women, 59 men, mean age 55 years, mean time since diagnosis 21 months) were randomized to 2 groups after assessments with the EuroQol visual analog scale (VAS), Grippit, Timed-Stands Test, Escola Paulista de Medicina Range of Motion scale, walking in a figure-of-8, a visual analog scale for pain, the Health Assessment Questionnaire disability index, a self-reported physical activity questionnaire, and the Disease Activity Score in 28 joints. All patients were regularly seen by rheumatologists and underwent rehabilitation as prescribed. Those in the intervention group were further individually coached by a physical therapist to reach or maintain healthy physical activity (=30 minutes, moderately intensive activity, most days of the week). Results. The retention rates after 1 year were 82% in the intervention group and 85% in the control group. The percentages of individuals in the intervention and control groups fulfilling the requirements for healthy physical activity were similar before (47% versus 51%, P > 0.05) and after (54% versus 44%, P > 0.05) the intervention. Analyses of outcome variables indicated improvements in the intervention group over the control group in the EuroQol VAS (P = 0.025) and muscle strength (Timed-Stands Test, P = 0.000) (Grippit, P = 0.003), but not in any other variables assessed. Conclusion. A 1-year coaching program for healthy physical activity resulted in improved perceived health status and muscle strength, but the mechanisms remain unclear, as self-reported physical activity at healthy level did not change. © 2008, American College of Rheumatology.
19.	Drab, Beata, et al. (författare) Chronic pain and sick leave in a 21-year follow up 2019 Ingår i: Annals of the Rheumatic Diseases. - London, UK : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 78:Suppl 2, s. 122-122 Tidskriftsartikel (refereegranskat)abstract Background: Chronic musculoskeletal pain (CMP) is a common cause of disability and impaired quality of life. In Sweden, chronic pain and mental illness are major causes of sick leave. But sick leave itself is also proposed as a risk factor for prolonged sick leave and disability pension.Objectives: To study CMP and sick leave as potential risk factors for long term sick leave or disability pension in a 21 year follow up of a general population cohort.Methods: In a cohort study, with a baseline survey in 1995, 1466 individuals aged 20-67 years were followed for 3 years and 691 for 21 years, or up to the age of 67. CMP (>3 months duration) was reported on a pain mannequin. Sick leave and disability pension were self-reported. Mental health was measured by the mental health (MH) score of the SF-36 health status, and categorized into tertiaries (best, medium and worst). CMP, sick leave, and mental health at baseline, were studied as potential predictors for long term sick leave (disability pension or sick leave >3 months) at a 3 and 21 year follow up. Other potential predictors (socioeconomic group, education, and immigrant status) were introduced in multiple regression analyzes but did not add to the results and were removed from the final models, which were controlled for age and sex.Results: CMP and mental health predicted long term sick leave at the 3 year follow up (OR 2.11, p=0.010 and OR 3.52, p<0.001). Mental health (OR 1.92, p=0.046), but not CMP (OR 0.77, p=0.409), was also a predictor at the 21 year follow up. Sick leave >3 months, irrespectively if due to pain or not, predicted long term sick leave both at the 3 and the 21 year follow up (Table). Sick leave for ≤3 months also predicted long term sick leave at both follow ups when due to pain (OR 2.70, p=0.008 and OR 2.78, p=0.012), but not when due to other causes (OR 1.52, p=0.212 and OR 1.17, p=0.606).Conclusion: Sick leave and especially sick leave due to pain predicted long term sick leave up to 21 years later, independently of pain status or mental health at baseline. It is thus important to early identify individuals at risk and minimize sick leave by providing proper rehabilitation.© Drab, Aili, Haglund & Bergman 2019. No commercial re-use. See rights and permissions. Published by BMJ.
20.	Gossec, L., et al. (författare) European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies : 2015 update 2016 Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Books. - 0003-4967 .- 1468-2060. ; 75:3, s. 499-510 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Since the publication of the European League Against Rheumatism recommendations for the pharmacological treatment of psoriatic arthritis (PsA) in 2012, new evidence and new therapeutic agents have emerged. The objective was to update these recommendations.METHODS: A systematic literature review was performed regarding pharmacological treatment in PsA. Subsequently, recommendations were formulated based on the evidence and the expert opinion of the 34 Task Force members. Levels of evidence and strengths of recommendations were allocated.RESULTS: The updated recommendations comprise 5 overarching principles and 10 recommendations, covering pharmacological therapies for PsA from non-steroidal anti-inflammatory drugs (NSAIDs), to conventional synthetic (csDMARD) and biological (bDMARD) disease-modifying antirheumatic drugs, whatever their mode of action, taking articular and extra-articular manifestations of PsA into account, but focusing on musculoskeletal involvement. The overarching principles address the need for shared decision-making and treatment objectives. The recommendations address csDMARDs as an initial therapy after failure of NSAIDs and local therapy for active disease, followed, if necessary, by a bDMARD or a targeted synthetic DMARD (tsDMARD). The first bDMARD would usually be a tumour necrosis factor (TNF) inhibitor. bDMARDs targeting interleukin (IL)12/23 (ustekinumab) or IL-17 pathways (secukinumab) may be used in patients for whom TNF inhibitors are inappropriate and a tsDMARD such as a phosphodiesterase 4-inhibitor (apremilast) if bDMARDs are inappropriate. If the first bDMARD strategy fails, any other bDMARD or tsDMARD may be used.CONCLUSIONS: These recommendations provide stakeholders with an updated consensus on the pharmacological treatment of PsA and strategies to reach optimal outcomes in PsA, based on a combination of evidence and expert opinion. © 2015 BMJ Publishing Group Ltd & European League Against Rheumatism.
21.	Hagel, Sofia, et al. (författare) Content Validity of the Arthritis Self-Efficacy Scale 2017 Ingår i: Reumabulletinen. - Stockholm : Svensk reumatologisk förening. - 2000-2246 .- 2001-8061. ; :119; 4, s. 59-60 Tidskriftsartikel (refereegranskat)abstract Background: Appropriate evaluation is important to optimize health care interventions and to understand patient’s experiences of their situation. Self-efficacy has been proven to have impact on pain, fatigue, physical activity and on cardiovascular risk in patients with inflammatory arthritides, and adequate evaluation is important. The arthritis self-efficacy scale (ASES) is one patient reported outcome measure recommended for evaluation of self-efficacy in arthritides. The aim of this study was to start analyzing the content validity of the ASES through linking to the International Classification of Functioning (ICF), and by using the proposed structure for personal factors (PF).Material and methods: The linking to the ICF was performed through identification of each meaningful concept of heading, introduction and all question including answering options of the ASES subscales for pain and symptoms. Each identified meaningful concept was linked to the third level ICF domain, according to established linking rules. Concepts identified as potential personal factors were sorted into the proposed structure of personal factors (Geyh, 2011) when applicable. The two authors independently identified meaningful concepts and performed the linking to the ICF, and sorted into the structure of personal factors (PF). Disagreements were discussed thoroughly, and reviewed until consensus was reached. Results: The ASES subscales for pain and symptom comprised 5 and 6 questions respectively. All questions were linked to the ICF domain body functions, at a minimum through each answering option that was linked to the b126 “temperament and personality functions”. Other body function domains covered were b130 (energy and drive functions), b134 (sleep functions), b152 (emotional functions), b160 (thought functions) and b280 (pain).Seven questions and the introduction of the ASES subscales for pain and symptom were linked to the ICF domain activity and participation (3 and 4 questions respectively). Five questions were linked to d570 (looking after one’s health), while d220 (undertaking multiple tasks) and d230 (carrying out daily routine) were captured by both subscales although somewhat less well represented.Three questions were linked to the ICF domain environmental factors. Two ASES pain questions were linked to e110 (products and substances for personal consumption) while one ASES symptom question was linked to e425 (individual attitudes of acquaintances, peers, colleagues, neighbors and community members).Personal factors were identified in both ASES subscales. The answering options for all questions except two could be sorted into the PF concept “feelings”, the headings, introductions and six questions could be sorted into the PF concept “patterns of experience and behavior”, and three questions could be sorted into “thoughts and beliefs”.Conclusion: The ASES subscales for pain and symptom showed satisfying content validity since important constructs on all ICF domains (except for body structure) were included. Both ASES subscales also covered PF that contribute with important aspects on health, and impact of the disease, further improving the content validity.
22.	Haglund, Emma, 1970-, et al. (författare) Differences in physical activity patterns in patients with spondylarthritis 2012 Ingår i: Arthritis Care and Research. - Hoboken : John Wiley & Sons. - 0893-7524 .- 1529-0123 .- 2151-464X .- 2151-4658. ; 64:12, s. 1886-1894 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To study patient-reported physical activity in patients with spondylarthritis (SpA) and possible differences in physical activity patterns between the SpA subtypes and sexes.METHODS: In 2009, a questionnaire including inquiries concerning physical activity was sent to patients with a SpA diagnosis (n = 3,711). The World Health Organization (WHO) global recommendations of physical activity for health requiring 150 minutes of moderate-intensity physical activity (MI-PA) or 75 minutes of vigorous-intensity physical activity (VI-PA) per week were used as recommended levels. Standardized risk ratios (RRs) were calculated by using physical activity data from the Swedish population. The association within the SpA group between sex, age, disease-related variables, anxiety, and depression and meeting recommended levels of MI-PA and VI-PA (dependent variables) was studied with multivariate analysis.RESULTS: A total of 2,167 patients with SpA (48% men, mean ± SD age 55 ± 14 years) responded to the questionnaire. Sixty-eight percent of the patients met the WHO recommendations, more frequently in women than in men (70% versus 66%). The recommendations were more often met in the SpA group (RR 1.09, 95% confidence interval [95% CI] 1.04-1.15) compared with the Swedish population. There was a tendency for young women to meet the WHO recommendations less often than the Swedish population (RR 0.94, 95% CI 0.63-1.25). Different factors were found to influence whether the patients were exercising with a moderate or vigorous intensity.CONCLUSION: Seven of 10 patients with SpA met the WHO recommendations of physical activity for health, but we found sex and disease subtype differences. This information can be useful in clinical practice when coaching patients to have a healthier lifestyle. © 2012 by the American College of Rheumatology.
23.	Haglund, Emma, 1970-, et al. (författare) Dynamic joint stability measured as gait symmetry in people with symptomatic knee osteoarthritis 2019 Ingår i: Annals of the Rheumatic Diseases. - London, UK : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 78:Suppl. 2, s. -1458 Tidskriftsartikel (refereegranskat)abstract Background: Modern strategies for knee osteoarthritis (OA) treatment and prevention includes early detection and analyses about pain, gait and lower extremity muscle function including both strength and stability. The very first sign of knee OA is pain or perceived knee instability, often experienced during weight bearing activities e.g. walking. Increased muscle strength will provide dynamic joint stability, reduce pain, and disability. Specific measures of gait symmetry (GS) can be assessed objectively by using accelerometers, which potentially is a feasible method when evaluating early symptoms of symptomatic knee OA.Objectives: The aim was to study if symptoms of early knee pain affected gait symmetry, and the association between lower extremity muscles function and gait symmetry in patients with symptomatic knee OA.Methods: Thirty-five participants (mean age 52 SD 9 years, 66% women) with uni- or bilateral symptomatic knee OA, and without signs of an inflammatory rheumatic disease or knee trauma were included. Pain was assessed by a numeric rating scale (NRS, range 0-10 best to worse), tests of lower extremity muscle function with the maximum number of one leg rises. Dynamic stability was measured as GS by using wearable inertial sensors (PXNordic senseneering platform), during the 6 min walking test to obtain spatio-temporal gait parameters. GS was computed based on stride time (temporal symmetry, TS) and stride length (spatial symmetry, SS). Stride length was normalized by height. Kruskal-Wallis and Spearman’s correlation coefficient were used for analyses.Results: Reports of knee pain did not differ between gender (women 4.7, SD 2.4 vs. men 3.9, SD 2.4, p= 0.362), neither did one leg rises or gait symmetry. Participants who reported unilateral knee pain (left/right side n=9/13), had a shorter stride length on the painful side. The mean difference in stride length was 0.7% of the subject’s height (SD 1.3). Participants with unilateral pain also presented less SS gait than those who reported bilateral pain (p=0.005). The higher number of one-leg rises performed, the better TS was observed. We found a significant relationship between TS and one-leg rise for the right r s =-0.39, p=0.006, and left r s =-0.40, p=0.004 left side). No significant relationship was observed between SS and one-leg rises.Conclusion: Our results is in line with earlier findings stating that knee pain affects GS negatively and that lower extremity muscle function is an important feature for symmetry and dynamic joint stability in patients with symptomatic knee OA. We also found that pain in one leg was related to impaired GS. Bilateral knee pain was however more symmetrical and will need healthy controls for comparison to better understand the negative impact of symptomatic knee OA.
24.	Haglund, Emma, 1970-, et al. (författare) Gender differences in educational needs to manage the disease in individuals with spondyloarthritis 2014 Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Books. - 0003-4967 .- 1468-2060. ; 73:Suppl. 2, s. 140-141 Tidskriftsartikel (refereegranskat)
25.	Haglund, Emma, 1970-, et al. (författare) Improving triage to appropriate treatment level by using a combination of screening tools in patients at risk of developing chronic back pain 2017 Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 76:Suppl. 2, s. 1531-1532 Tidskriftsartikel (refereegranskat)
26.	Haglund, Emma K., 1970-, et al. (författare) Aerobic capacity in patients with rheumatoid arthritis : A comparison of two submaximal test methods 2009 Ingår i: Musculoskeletal Care. - Chichester : John Wiley & Sons. - 1478-2189 .- 1557-0681. ; 7:4, s. 288-299 Tidskriftsartikel (refereegranskat)abstract Background: In a clinical setting it is important to evaluate aerobic capacity in individuals with rheumatoid arthritis (RA) and to have a choice between tests, owing to disability of varying severity. Two submaximal tests, a bicycle ergometer test and a treadmill walking test, are commonly used. Despite expected differences in the results, these tests have been used interchangeably. The aim of the current study was to compare the results of the two tests, the size of the difference and factors expected to influence the results.Methods: Fifty-two outpatients with RA performed the two tests. Agreement and correlations between the results of the tests were calculated. Multivariate analysis was used to study the relationships between gender, weight, health assessment questionnaire, global health assessment and the difference between the tests.Results: Sixty per cent of the subjects exhibited a higher estimated value of maximum oxygen uptake (V̇O2max) in the treadmill test. The limits of agreement for the estimated V̇O2max values between the two methods ranged from −13.4 to +18.4 ml × min−1 × kg−1, and the intraclass correlation coefficient (ICCTwo-way mixed) was 0.34 (95% confidence interval [CI] 0.07, 0.56). Body weight was independently associated with the difference between the two tests (regression coefficient 0.3; 95% CI 0.14, 0.42). A higher body weight had a greater impact on the results of the bicycle test (R2 = 0.28; regression coefficient −0.3; 95% CI −0.47, −0.17) than on the treadmill walking test (R2 = 0.02; regression coefficient −0.06; 95% CI −0.14, 0.03).Conclusions: It is not advisable to use the two submaximal methods interchangeably. Weight influenced the difference between the two tests, and to a higher degree in the bicycle test than the treadmill walking test. Copyright © 2008 John Wiley & Sons, Ltd.
27.	Haglund, Emma, 1970-, et al. (författare) Patient Education in Spondyloarthritis Should be Guiding, Reliable and Available and Presented in Varied Formats 2015 Ingår i: Arthritis & Rheumatology. - Hoboken, NJ : John Wiley & Sons. - 2326-5191 .- 2326-5205. ; 67:Suppl. S10 Tidskriftsartikel (refereegranskat)abstract Background/Purpose: The treatment target for axial spondyloarthritis (SpA) is to maximize health-related quality of life (HRQoL) by controlling disease activity and improving functioning. The treatment cornerstones are a combination of patient education, pharmacological and non-pharmacological treatment. Health professionals are familiar with providing patient education but the knowledge is scarce concerning how this education is experienced by the patients.The aim was to describe patients’ experiences of education in SpA management.Methods: The study had a descriptive design with a qualitative conventional content analysis approach performed in seven steps in accordance with Graneheim & Lundman (1). The analysis aimed to describe and preserve contextual meanings. After coding and subgrouping meaningful parts of the text were merged into categories. Eleven interviews were conducted between 2014-2015 in patients with SpA based on a strategic sampling in order to achieve variation with regard to sex (7 men, 4 women), age (38-66 years), subdiagnoses (5 patients with AS, 6 with USpA), quality of life (EQ5D 0.29-1.0), disease activity (BASDAI 1-6), physical function (BASFI 0-5), and global health (BASG 0-7) .Results: Three categories representing patients’ experiences of patient education in disease management emerged; guiding education, reliable education and available education. Guiding education comprised SpA management including disease knowledge such as symptoms, prognosis, treatment, self-management, climate impact, heredity, and assisting devices. Reliable education meant how and by whom the education was communicated and was considered reliable if it was based on science and communicated by specialists, for example by physician, nurse, PT, dietician and senior patients with experience of rheumatic diseases. The patients experienced difficulties in assessing the large flow of education coming from various sources. Individualized education also increased the reliability. Available education meant that the education can and should be presented in varied formats, and that the amount of information could be chosen. The education could be given orally (through meetings, videos, lectures), in writing (by pamphlets, e-mails, journals, webpages) or obtained through own personal experiences. There were requests to utilize newer media like skype, video and chat forums. Furthermore, individual contacts with healthcare professionals when needed were of importance.Conclusion: This study highlights the importance of obtaining a guiding, reliable and available patient education for management of SpA. Health care professionals need to consider the importance of presenting varied formats of education based on patients’ experiences and expectations.References:1.Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse education today 2004;24(2):105-12.
28.	Haglund, Emma, 1970-, et al. (författare) Physical activity pattern in chronic inflammatory arthritis – still lots to do! 2013 Ingår i: 21st International Conference on Health Promoting Hospitals and Health Services. - Copenhagen : WHO-CC. ; , s. 102-102 Konferensbidrag (refereegranskat)
29.	Haglund, Emma, 1970-, et al. (författare) Predictors of Presenteeism and Activity Impairment Outside Work in Patients with Spondyloarthritis 2015 Ingår i: Journal of occupational rehabilitation. - New York, NY : Springer-Verlag New York. - 1053-0487 .- 1573-3688. ; 25:2, s. 288-295 Tidskriftsartikel (refereegranskat)abstract Purposes To assess predictors of presenteeism (reduced productivity at work) and activity impairment outside work in patients with spondyloarthritis (SpA). Methods Multivariate logistic regression analysis was used to study predictors of presenteeism and activity impairment in 1,253 patients with SpA based on a 2.5 year follow-up questionnaire. The Work Productivity and Activity Impairment (WPAI) questionnaire was used as main outcome. Age, gender, lifestyle factors, subgroups, disease duration, and different patient reported outcome measures (PROMs) were studied as possible predictors. The association between presenteeism and WPAI activity impairment outside work was assessed. Results Out of 1,253 patients, 757 reported being in work and of these 720 responded to the WPAI questionnaire. The mean (confidence interval, CI) reported presenteeism was 25 % (23-27 %) and mean activity impairment 33 % (31-35 %) (0-100 %, 0 = no reduction). Significant predictors of presenteeism and activity impairment at follow-up (controlled for gender, age, spondyloarthritis subgroups and presenteeism at baseline) were presenteeism at baseline, poor quality of life, worse disease activity, decreased physical function, lower self-efficacy pain and symptom, higher scores of anxiety, depression, smoking and low education level, and for activity impairment also female sex. There was a strong association between presenteeism and activity impairment outside work (OR 16.7; 95 % CI 11.6-24.3; p < 0.001). Conclusions Presenteeism and activity impairment were not only predicted by presenteeism at baseline, but also by several PROMs commonly used in clinical rheumatology practice. Impaired activity outside work could indicate problems also at work suggesting why both areas need to be addressed in the clinical situation. © 2014, Springer Science+Business Media New York.
30.	Haglund, Emma, 1970-, et al. (författare) Predictors of Work Productivity in a Population Based Cohort of Individuals with Spondyloarthritis 2013 Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Books. - 0003-4967 .- 1468-2060. ; 72:Suppl. 3, s. A127-A127 Tidskriftsartikel (refereegranskat)abstract Background: Spondyloarthritis (SpA) often causes work disability and predictors concerning the ability to stay productive while at work are scarcely studied in this group.Objectives: The aim was to study predictors of reduced productivity while at work and possible differences between gender and the SpA subgroups (Ankylosing Spondylitis (AS), Psoriatic Arthritis (PsA) and Undifferentiated SpA (USpA)) in a defined cohort in southern Sweden.Methods: 1253 out of 1773 health care seeking individuals with SpA age 18-67 years (identified by a health care register in southern Sweden) responded to a questionnaire survey in 2009 and to the follow-up in 2011, 2,5 years later. Self-reported presenteeism, defined as reduced productivity at work (0-100%, 0= no reduction) due to SpA, individual´s characteristics, lifestyle factors, disease duration, health related quality of life (EQ-5D), disease activity (BASDAI), physical function (BASFI), self-efficacy pain and symptom (ASES), anxiety (HADa), depression (HADd) were measured. The main outcome productivity at work was dichotomized based on mean value, with values over 25% regarded as a reduced productivity. The Pearson's correlation coefficient and multivariate logistic regression analyzes were used to study predictors of reduced productivity.Results: At follow up 757 individuals reported that they were working and of those 720 responded to the productivity question. The mean age was 50 years and 49% were men. Based on the health care register 177 (24.6%) were diagnosed with AS, 373 (51.8%) with PsA and 170 (23.6%) with USpA. The mean reduction of productivity was 25% (95% CI 23%>27%) (n=720), women reported higher reduction than men (mean 28% vs. 22%, p<0.001). In the multiple logistic regression analyzes a reduced productivity at follow-up was predicted by a reduced productivity at baseline (OR 1.04, 95% CI 1.03-1.05). Other predictors (controlled for age, sex, disease subgroup and productivity at baseline) were low education level (OR 2.14, 95% CI 1.51-3.04), smoking (1.73; 1.22-2.45), worse score in quality of life (EQ-5D) (0.22; 0.003-0.14), worse disease activity (BASDAI) (1.47; 1.29-1.67), lower physical function (BASFI) (1.42;1.27-1.58), lower self-efficacy (ASES) pain (0.97; 0.97-0.98) and symptom (0.97; 0.96-0.98), higher score of anxiety (HADa) (1.09; 1.05-1.14) and depression (HADd) (1.15; 1.08-1.22). Disease duration, absenteeism and physical activity level had no predictive value.Conclusions: Reduced productivity at follow-up was not only predicted by productivity 2,5 years earlier, but also by other aspects of the individuals whole life situation. These different factors could be of clinical importance in order to influence the ability to maintain productivity at work in individuals with SpA.Disclosure of Interest: E. Haglund Grant/research support from: The project was supported by an unrestricted grant from Abbott., I. Petersson Grant/research support from: The project was supported by an unrestricted grant from Abbott., A. Bremander Grant/research support from: The project was supported by an unrestricted grant from Abbott., S. Bergman Grant/research support from: The project was supported by an unrestricted grant from Abbott.
31.	Haglund, Emma, 1970-, et al. (författare) Self-reported disease characteristics do not explain why younger women with SpA are less physically active than older women with the disease 2014 Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Books. - 0003-4967 .- 1468-2060. ; 73:Suppl. 2, s. 159-159 Tidskriftsartikel (refereegranskat)abstract Background Exercise is a commonly used treatment for patients with spondyloarthritis (SpA) but younger women reach WHOs recommended level of physical activity (PA) to a less extent than peers in the general population (Haglund, 2012).Objectives To study if self-reported disease characteristics in patients with SpA can explain why younger women are less physically active than older women with the disease.Methods In a cross-sectional population based cohort study in southern Sweden, 1121 women (51.7% of the total SpAScania cohort) were identified by a health care register and responded to a questionnaire survey in 2009. The primary outcome was self-reported level of physical activity (PA) based on the WHOs recommendation. Self-reported pain (VAS), global health (VASglobal, BASG),health related quality of life (EQ-5D), disease activity (BASDAI), physical function (BASFI), self-efficacy pain and symptoms (ASES), anxiety (HADa), depression (HADd), education level, smoking habits and reported severity of the skin disease psoriasis (NRS) were reported. Younger (≤35 years of age, n=127) and older women (>35, n=994) and the disease subgroups AS/USpA (n=441) and PsA (n=680) were compared with regard to characteristic symptoms. T-test and chi-square test was used to analyze group differences, exact p-values are reported.Results Out of the 1121 women in the cohort, 1094 answered the questions concerning PA. There were no significant differences between younger/older women with AS/USpA reaching recommended level of PA (71% vs. 77%, p=0.23). In younger women with PsA there was a trend to not reaching the recommended level of PA to the same extent (58% vs. 70%, p=0.06).When comparing younger and older women concerning characteristic variables, there were significant worse self-reported VASglobal (3.9 vs. 4.5, p=0.004), BASDAI (4.2 vs 4.8, p=0.008), BASFI (2.4 vs. 3.8, p<0.001), BASG (3.6 vs. 4.4, p=0.001), ASES pain (53 vs. 49, p=0.02), ASES symptom (59 vs. 55, p=0.04) and HAD depression (3.7 vs. 4.6, p=0.04) in the older women.When stratified on the disease subgroups, VASglobal (3.8 vs. 4.3, p=0.05) and BASFI (2.6 vs. 3.6, p=0.002) were significantly worse for older women with AS/USpA (n=372) compared to the younger group (n=69). Older women with PsA (n=622) reported significantly worse VASpain (3.9 vs. 4.7, p=0.02), BASFI (2.2 vs. 3.9, p<0.001), BASG (3.5 vs. 4.5, p=0.004), ASES pain (54 vs. 57, p=0.01) and symptom (61 vs. 53, p=0.01), HAD depression (3.8 vs. 4.7, p=0.04) compared to the younger group (n=58). There was an inverse relationship regarding severity of psoriasis, were younger women with PsA have a tendency to report a more severe skin disease (3.9 vs. 3.2, p=0.09). When comparing characteristics for young women reaching or not reaching healthy PA, no differences were found.Conclusions Young women with SpA do not reach recommended level of PA in the same extend as in the population. There were no explanations found when comparing common self-reported variables in younger and older women with SpA in a defined cohort. The relationship needs to be studied further also from a qualitative aspect.
32.	Haglund, Emma, 1970-, et al. (författare) Work productivity in a population based cohort of patients with Spondyloarthritis 2012 Ingår i: Arthritis and Rheumatism. - Hoboken : Wiley-Blackwell. - 0004-3591 .- 1529-0131. ; 64:10, s. S1015-S1015 Tidskriftsartikel (refereegranskat)abstract Background: Spondyloarthritis (SpA) often causes impaired function, activity limitations, affected health related quality of life and work disability. Work disability has been shown to be affected both in terms of absenteeism and in impaired productivity while working (presenteeism). In this group with increased socioeconomic costs there is also an increase in the use of expensive pharmacotherapies. Thus, it is important to study factors related to the ability to stay productive while at work.Objective: The aim was to study factors associated with presenteeism in patients with SpA. Also to analyse possible differences in age, gender and SpA subtypes (ankylosing spondylitis, psoriatic arthritis and undifferentiated SpA).Methods: The analysis was based on 1773 patients seeking health care for SpA aged 18-67 years from southern Sweden, identified by a health care register. A questionnaire survey in 2009 included questions concerning self-reported presenteeism, defined as the percentage of impairment due to SpA while working 0-100, (0=no impact), was answered by 1447 individuals. Patients´ characteristics: disease duration, disease activity (BASDAI), physical function (BASFI), health related quality of life (EQ-5D), anxiety (HAD-a), depression (HAD-d), self-efficacy pain and symptom (ASES) and register based sick leave. The Pearson’s correlation coefficient and univariate analyses with ANOVA were used to study factors associated with presenteeism and t-test was used for group comparisons.Results: Fifty-five percent (n=802/1447) reported no impact on work presenteeism, while mean impairment was 20 (95% CI 18-21) (n=1447). Women reported higher impact on work presenteeism than men (mean impairment 23 vs. 17, p<0.001) but no statistically significant differences were found between the SpA subtype groups. Twenty-eight percent (n=504/1773) were registered for any sick leave (absenteeism > 14 days). Worse outcome in quality of life (EQ-5D), disease activity (BASDAI) and physical function (BASFI) all correlated to higher impact on work presenteeism (r >0.5, p <0.001), while sick leave (absenteeism) did not. In the univariate analyses experiencing worse outcome in EQ-5D (β-est -9.6, p<0.001) BASDAI (β-est 7.8, p<0.001) and BASFI (β-est 7.3, p<0.001) were all associated to higher impact on presenteeism regardless of age, gender and disease subtype. Worse outcome of EQ-5D was associated to a higher degree impact on presenteeism in the younger women (18-52 yrs). Self-efficacy, anxiety, depression, disease duration and education level <12 years were all associated to higher impact on presenteeism but were not significant in all strata for age, gender and disease subtype.Conclusion: Quality of life, disease activity and physical function all affect work presenteeism in patients with SpA, regardless of age, gender and disease subtype. The results indicate that work presenteeism is affected in patients with all types of SpA and more affected in women. We also find that presenteeism and register based sick leave (absenteeism) may be related to different dimensions of the individuals and their disease.
33.	Karlsson, Jan, 1959-, et al. (författare) Förändringsledarskap vid digital transformation inom vård och omsorg : En sammanfattande rapport från kompetensutvecklingsprojektet ”Trygg motivation och inspiration” i Kungsbacka kommun 2018 2018 Rapport (övrigt vetenskapligt/konstnärligt)
34.	Lindström, Ulf, et al. (författare) Patients with Non-AS Axial SpA Have Similar Prevalence Compared to AS, but Worse Perceived Health. Results from a Population Based Study 2013 Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Books. - 0003-4967 .- 1468-2060. ; 72:Suppl. 3, s. A667-A668 Tidskriftsartikel (refereegranskat)abstract Background: Non-radiographic axial spondyloarthritis (SpA) is emerging as a treatable disease comparable to ankylosing spondylitis (AS), but less well studied. Previous studies have described a reversed gender distribution, with AS being more prevalent in the male population and non-radiographic axial SpA more prevalent in the female population. Recent studies have also indicated a similar benefit from treatment with TNF-inhibitors.Objectives: The aim of this study was to estimate the prevalence of non-radiographic axial SpA and compare the patient reported outcome measures (PROMS) to that of AS, in Southern Sweden.Methods: All health care seeking individuals, ≥18 years, given a SpA-diagnosis, according to the ICD-10 (M45.9, M072, M460, M461, M468, M469, M074, M705 and L405 or M071 or M073), either in primary or specialized care, (N = 5771), during 2003 - 2007, were identified through the regional health care register in Skåne, a county in Southern Sweden with 1.2 million inhabitants (SpAScania cohort). In 2009 they were all sent a questionnaire (response rate; 48%), including questions concerning inflammatory back pain (IBP), the SpA-associated comorbidities constituting the ASAS-criteria (IBD, Ps, Uveitis/tendinitis, heredity), PROMS (BAS-indices, VAS-pain/fatigue/global, EQ5D) and previous/current medication.Non-AS axial SpA was defined as having an ICD10 code supporting a diagnosis of SpA without having one of AS (M45.9), in combination with > 3 months of back pain the last year and the presence of ≥2 of the SpA associated comorbidities. Record review support the notion of using AS as a substitute for radiographic changes. For the “non imaging arm” of the ASAS criteria for axial disease, we used the ICD10 codes above as a substitute for HLA-B27 status. Assuming similar answers from the questionnaire non-responders, prevalence rates were estimated for non-AS axial SpA and AS.Results: Among responders 742 had an AS-diagnosis and 640 fulfilled the study criteria for non-AS axial SpA. The frequency of men was 60.5% in the AS group and 29.5% in the non-AS axial SpA group. The prevalence of AS was 0.13% (95% CI; 0.115-0.148) and for non-AS axial SpA 0.11 % (95% CI; 0.096-0.130), with a reverse gender distribution. The means of the PROMs and frequency of comorbidities were higher in the non-AS axial SpA vs both the AS, and the subgroup of AS individuals reporting back pain (BP) > 3months during the last year. Self-reported present use of TNF-inhibitors were similar between the groups (Image 1).Conclusions: Prevalence rates for AS and non-AS axial SpA were similar, with a reverse gender distribution. The results suggest that at a population level the proportion with non-AS axial SpA is at least as large as that of AS and report lower levels of perceived health status and similar frequencies of SpA-related comorbidities (except psoriasis) and treatment with TNF-inhibitors, supporting the validity for the used definition in future research.Disclosure of Interest: None Declared
35.	Löfvendahl, S., et al. (författare) Duration between symptom onset and spondyloarthritis diagnosis – Changes over a decade 2014 Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Books. - 0003-4967 .- 1468-2060. ; 73:Suppl. 2, s. 431-431 Tidskriftsartikel (refereegranskat)abstract Background The delay of diagnosis after symptom onset for various subgroups of spondyloarthritis (SpA) is considerable. Increasing focus on this over the last decades may have decreased this delay (1-2).Objectives To study the duration between symptom onset and date of diagnosis of SpA and its subgroups: ankylosing spondylitis (AS), psoriatic arthritis (PsA), and unspecified spondyloarthritis (USpA). A special focus was to study the change over the past decade.Methods The Swedish SpAScania cohort (N=5,771, = all patients diagnosed with SpA between 2003 and 2007 in primary or secondary care in the Skåne region, total n=1.3 million 2013) was used. We analyzed patients (n=952) identified as having AS (n=173), PsA (n=579) or USpA (n=200) by a rheumatologist or internist at least one time or by any other physician twice during 2003 to 2007 responding to a postal survey in 2009 and 2011. The survey included questions on years for start of symptoms and diagnosis. All patients included had a self-reported diagnosis of SpA between 1997 and 2007 in the survey 2009. The information from 2009 was used to calculate the duration between symptom onset and date of diagnosis and the response from the 2011 survey to investigate the reliability of these answers (647 patients responded to the survey in both 2009 and 2011 and were hence eligible for reliability analysis). The mean duration (years) was calculated (95% CI), both unadjusted and adjusted for sex, age and year of diagnosis.Results The overall mean duration between symptom onset and date of a SpA diagnosis was 6.8 years (95% CI: 6.3-7.3), without any obvious secular change up through 2007. The mean duration for AS was 9.0 (95% CI: 7.8-10.3), for PsA 6.0 (5.4-6.6) and USpA 7.2 (95% CI: 6.1-8.3). There was an overall good consistency between the self-assessed year of symptom start, measured in 2009 and in 2011 (ρ=0.58). However, there was a variation between subgroups, consistency being higher in AS (ρ =0.84) and lower in PsA (ρ =0.53).Conclusions The duration between symptom onset and diagnosis was longest for AS and shortest for PsA with USpA in between. Up to 2007 there was no significant trend for any decrease in such delay for any of the subgroups.ReferencesSorensen J, Hetland ML. Duration of symptoms before diagnosis in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Ann Rheum Dis 2013;72(Suppl3):80.Salvadorini G, Bandinelli F, DelleSedie A, Riente L, Candelieri A, Generini S. Ankylosing spondylitis: how diagnostic and therapeutic delay have changed over the last six decades. Clin Exp Rheumatol. 2012 Jul-Aug;30(4):561-5.Disclosure of Interest None declared
36.	Malmborg, Julia, PhD, 1988-, et al. (författare) Musculoskeletal pain in adolescent sportschool students – a two-year follow-up 2021 Konferensbidrag (refereegranskat)
37.	Malmborg, Julia, 1988-, et al. (författare) Risk Factors for Persistence and Development of Frequent Musculoskeletal Pain in Adolescent Athletes 2020 Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 79:Suppl 1, s. 206-206 Tidskriftsartikel (refereegranskat)abstract Physical activity has a positive impact on health, but adolescent athletes often report musculoskeletal pain (MP) which is negative in the aspect of sustaining physical activity over time. There is a lack of longitudinal assessments of MP and potential risk factors, such as timing of physical maturation, in adolescent athletes.Objectives:To identify risk factors associated with the persistence or development of frequent MP at a 2-year follow-up in adolescent sport school students.Methods:Fourteen-year-old sport school students (n=233) were invited to participate in this 2-year longitudinal study. Self-reports of MP was assessed as frequency, distribution, and intensity, and health status by EQ-5D. Physical maturation was calculated by the Mirwald equation (height, weight, and sitting height) (1), and categorized as early (>1 year), average (±1 year), or late (<–1 year). Students were grouped at baseline and follow-up into infrequent (never to monthly) or frequent (weekly to daily) MP groups. Logistic regression analysis was used to study associations between frequent MP at follow-up and baseline variables.Results:131 students (79 boys and 52 girls) were included in the study. Development or persistence of frequent MP at follow-up (n=61) was associated with being a girl, late physical maturation (only boys were categorized as late), non-contact sports participation, frequent MP at baseline, and reporting ≥2 MP sites at baseline. Students with a better health status at baseline were less likely to belong to the frequent MP group at follow-up (Table).Conclusion:Frequent MP is common in sport school students. MP in young athletes may become a future health problem and there is a need for recognition and interventions by coaches and health services to prevent MP from becoming persistent.References:[1]Mirwald, R. L., Baxter-Jones, A. D., Bailey, D. A., & Beunen, G. P. (2002). An assessment of maturity from anthropometric measurements.Med Sci Sports Exerc, 34(4), 689-694.Table.Associations between background variables at baseline and frequent MP at follow-up based on crude logistic regression analysis controlling each variable for sex.Baseline variablesModelInfrequent MP vs. Frequent MPOR(95% CI; p-value)SexBoys1.00Girls2.76(1.34–5.68; p<0.01)Physical maturationAverage (±1 year)1.00Early (>1 year)0.41(0.05–3.65; p=0.42)Late (<–1 year)3.83(1.13–12.95; p=0.03)Sport categoriesContact1.00Non-contact5.16(2.07–12.88; p<0.001)MP groupsInfrequent1.00Frequent2.74(1.31–5.72; p<0.01)MP intensity last week (NRS 0–10, best to worst)1.15(0.98–1.35; p=0.10)Number of MP sites01.0012.32(0.71–7.58; p=0.16)≥22.87(1.32–6.25; p<0.01)EQ-5D (0.00–1.00, worst to best)0.03(0.001–0.58; p=0.02)Disclosure of Interests:None declared
38.	Malmborg, Julia S., 1988-, et al. (författare) Musculoskeletal pain and its association with health status, maturity, and sports performance in adolescent sport school students: a 2-year follow-up 2022 Ingår i: Bmc Sports Science Medicine and Rehabilitation. - London : Springer Science and Business Media LLC. - 2052-1847. ; 14:1 Tidskriftsartikel (refereegranskat)abstract Background Musculoskeletal pain and its risk factors are rarely assessed in studies on adolescent athletes. The aim was to identify risk factors at baseline that were associated with the persistence or development of musculoskeletal pain at a two-year follow-up in adolescent sport school students, and to study cross-sectional associations at follow-up between musculoskeletal pain and sports performance. Methods Sport school students (79 boys and 52 girls, aged 14 years at baseline) were divided into infrequent (never-monthly) or frequent (weekly-almost daily) pain groups, based on frequency of pain using a pain mannequin. Logistic regression analyses were performed to study longitudinal associations between frequent pain at follow-up and baseline variables: pain group, number of regions with frequent pain, health status by EQ-5D, maturity offset (pre, average, or post peak height velocity), and sports (contact or non-contact). Linear regression analyses were used to study cross-sectional associations between pain groups and 20-m sprint, agility T-test, counter-movement jump, and grip strength at follow-up. Results were stratified by sex. Results A higher percentage of girls than boys reported frequent pain at follow-up (62% vs. 37%; p = 0.005). In boys, frequent pain at follow-up was associated with being pre peak height velocity at baseline (OR 3.884, CI 1.146-13.171; p = 0.029) and participating in non-contact sports (OR 3.429, CI 1.001-11.748; p = 0.050). In girls, frequent pain at follow-up was associated with having frequent pain in two or more body regions at baseline (OR 3.600, CI 1.033-12.542; p = 0.044), having a worse health status at baseline (OR 3.571, CI 1.026-12.434; p = 0.045), and participating in non-contact sports (OR 8.282, CI 2.011-34.116; p = 0.003). In boys, frequent pain was associated with worse performances in 20-m sprint and counter-movement jump, but not in agility T-test and grip strength. Conclusions Baseline risk factors for having frequent pain at follow-up were late maturation in boys, frequent pain and worse health status in girls, and participation in non-contact sports in both sexes. Boys with pain performed worse in sports tests. Coaches and school health-care services should pay attention to the risk factors and work towards preventing pain from becoming persistent.
39.	Meesters, Jorit, et al. (författare) Factors Associated with Anxiety and Depression in Spondyloarthritis Patients : Results from the Swedish Population Based SpA Scania Cohort 2013 Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Books. - 0003-4967 .- 1468-2060. ; 72:Suppl. 3, s. A531-A532 Tidskriftsartikel (refereegranskat)abstract Background: Anxiety and depression are more common among patients with rheumatic diseases and can influence treatment options and outcome. However insight in factors associated with anxiety and depression in patients with Spondyloarthritis (SpA) is scarce.Objectives: To identify factors associated with self-reported anxiety and depression in a well-defined population based cohort of patients with SpA.Methods: In 2009, 3711 adult SpA patients from the SpaScania cohort were identified and involved in a questionnaire survey including patient reported outcome measures (PROMs) to assess quality of life, physical and mental functioning. To assess depression and anxiety the Hospital Anxiety and Depression Scale (HADS-A and HADS-D) was used. Each subscale ranges from 0-21; best to worst. HAD scores of ≥ 8 indicate probable cases of anxiety or depression.Differences in HADS subscale scores among the SpA subgroups were tested by using one-way ANOVA (p<.05). Associations between PROMs and the HADS subscales, were studied with linear regression analysis including each independent variable separately (adjusted for age, gender and disease duration) and presented as β-estimates (95%CI).Results: In total 2851 patients (76%) responded to the study invitation, 684 (18%) declined participation and 2167 (58%) returned the questionnaire. Mean age 55.4 (SD 13.9) years, mean disease duration 14.4 (12.1) years and 52% female. SpA subgroups were: Ankylosing spondylitis 501 (23%), Psoriatic arthritis 1171 (54%), and undifferentiated SpA 495 (23%).Mean HADS-A was 5.9 (4.3) and mean HADS-D 4.4 (3.6) respectively for the whole SpA group. In total 683 (32%) cases were classified as probable anxiety cases and 305 (14%) as probable depression cases. No differences in HADS were found among the different SpA subgroups for anxiety or depression (p>0.6).Higher scoring on HADS-A and HADS-D was associated with (table): lower education, lower physical activity (HADS-D only), chronic pain problems, more fatigue, lower general health, lower HRQoL (EQ-5D), lower level of functioning (BASFI), higher disease activity (BASDAI), lower self-efficacy (ASES).Conclusions: Patients with SpA do report problems with anxiety and/or depression and associations appear highly multifactorial with a profile of impaired health in general. Screening patients with SpA for anxiety and depression in the clinic is important but using a simple proxy is discouraged. Instead HADS or other comprehensive instruments to assess anxiety or depression should be considered.
40.	Mogard, Elisabeth, et al. (författare) A combination of two or more unhealthy lifestyle factors is associated with impaired physical and mental health in patients with spondyloarthritis : a cross-sectional study 2022 Ingår i: BMC Rheumatology. - London : BioMed Central (BMC). - 2520-1026. ; 6:1 Tidskriftsartikel (refereegranskat)abstract Background: There is increasing knowledge of how individual lifestyle factors affect patients with spondyloarthritis, while studies exploring the combination of unhealthy lifestyle factors are lacking. Thus, our aim was to study the frequency of two or more unhealthy lifestyle factors and their associations with physical and mental health in patients with spondyloarthritis (SpA).Methods: A population-based postal survey involving questions on lifestyle factors was completed by 1793 patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA), and undifferentiated spondyloarthritis (USpA). Self-reported physical activity, body mass index, and tobacco use were respectively dichotomized as “healthy” or “unhealthy”, summarized for each patient and stratified into four groups (0–3; 0 = no unhealthy lifestyle factors). Group comparisons were performed with Chi-squared tests, and associations with physical and mental health outcomes were performed with analysis of covariance and logistic regression analysis.Results: Out of 1426 patients (52% women) with complete information for all studied lifestyle factors, 43% reported ≥ two unhealthy lifestyle factors—more frequently patients with PsA (48%) than AS (39%) or USpA (38%)—and with no difference between women and men (p = 0.399). Two or more unhealthy lifestyle factors were associated with worse health-related quality of life, disease activity, physical function, pain, fatigue, anxiety, and depression, adjusted for age and SpA-subgroup. If an unhealthy level of physical activity was one of the two unhealthy lifestyle factors, patients reported worse health outcomes.Conclusion: Reporting two or more unhealthy lifestyle factors were associated with worse physical and mental health in patients with SpA. This highlights the need to screen for a combination of unhealthy lifestyle factors and offer individualized coordinated interventions, and tailored coaching to support behavioral change, in order to promote sustainable health. © 2022, The Author(s).
41.	Mogard, Elisabeth, et al. (författare) The combined effects of lifestyle habits on health-related quality of life, physical and mental functions in patients with spondyloarthritis 2019 Ingår i: Annals of the Rheumatic Diseases. - London, UK : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 78:Suppl 2, s. 2144-2144 Tidskriftsartikel (refereegranskat)abstract Background: Earlier studies have found strong correlations between worse health and an unhealthy lifestyle, such as not meeting recommendations of moderate-to-vigorous physical activity, being overweight or obese and the use of tobacco in patients with spondyloarthritis (SpA). The impact of more than one unhealthy lifestyle habit (LsH) is however, scarcely described.Objectives: To study the combined effects of unhealthy LsHs on health-related quality of life (HRQoL) and physical and mental functions in patients with SpA. Differences between SpA subgroups and gender were also studied.Methods: Postal questionnaires were in 2009 and 2011 sent to all patients diagnosed with SpA and registered in the Skane Healthcare Register. This study included patients who at both time points responded to the survey, were ≥20 years, and had ankylosing spondylitits (AS), psoriatic arthritis (PsA) or undifferentiated spondyloarthritis (USpA). Cross-sectional data from the 2011 questionnaire were available for 1601 patients (AS n=455, PsA n=883, USpA n=263), with a mean age of 58 (13) years (52% women). Self-reported levels of weekly physical activity at moderate or vigorous intensity, (MVPA), use of tobacco (cigarettes and/or snuff) and BMI (overweight or obese) were dichotomized as “healthy” or “unhealthy”. The number of unhealthy LsH were then summarized and stratified into four groups (scoring 0-3, 0=no unhealthy LsH). HRQoL was assessed with EQ-5D (0-1, worst-best), and physical function with BASFI. Disease activity (BASDAI), pain, fatigue (0-10, best-worst), anxiety, and depression (HADa/d) (0-21, no distress-maximum distress) were also measured. Statistical analyses were performed with Chi Square test and ANOVA.Results: Fourteen percent (n=226) reported none of the studied unhealthy LsH, while 35% (n=555) reported one, 38% (n=611) two, and 13% (n=209) three unhealthy LsH. Reports of one and more unhealthy LsH had increasing negative impact on HRQoL (from mean 0.74 (SD 0.19) to 0.57 (0.30)), disease activity (from 3.2 (2.1) to 4.5 (2.3)), physical function (2.3 (2.1) to 4.4 (2.6)), VAS-pain (3.4 (2.3) to 4.8 (2.5)), VAS-fatigue (4.2 (2.7) to 5.5 (2.7)), anxiety (4.8 (4.2) to 5.6 (4.4)) and depression (3.3 (3.3) to 4.8 (3.8)) in patients with SpA (p=0.019-<0.001).Patients with PsA (p≤0.001) and men (p=0.040) reported more often ≥2 unhealthy LsHs, while patients with USpA were least likely to have ≥2 unhealthy LsHs (Figure 1,2). The negative impact on HRQoL, physical and mental functions still remained significant when stratified into different SpA subgroups and gender, except for anxiety in women, and for patients with PsA or USpA.Conclusion: Our findings support that the combined effect of unhealthy lifestyle habits have negative impact on many aspects of health. There is a need for interventions aiming at screening for not only one but several unhealthy lifestyle habits combined, and to offer coaching to increase behavioral change and promote better health. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
42.	Olsson, M. Charlotte, 1967-, et al. (författare) Bench press muscle activation with triceps brachii pre-exhaustion in females and males 2019 Ingår i: Journal of Sports Sciences. - Abingdon : Routledge. - 0264-0414 .- 1466-447X. ; 37:Supp1, s. 71-72 Tidskriftsartikel (refereegranskat)
43.	Reinodt, Sara, et al. (författare) Adolescents’ Long-Term Experiences of Manageability, Comprehensibility, and Meaningfulness of a Group-Based Exercise Intervention for Depression 2022 Ingår i: International Journal of Environmental Research and Public Health. - Basel : MDPI. - 1661-7827 .- 1660-4601. ; 19:5 Tidskriftsartikel (refereegranskat)abstract Physical exercise is a potentially effective treatment for adolescents with mild to moderate depression. However, there is a lack of long-term follow-ups to reveal adolescents’ experiences of exercise as a treatment for depression. The salutogenic concept of sense of coherence (SOC), comprising the domains manageability, comprehensibility, and meaningfulness is important to understand behaviour change. This study aimed to describe adolescents’ long-term experiences of manageability, comprehensibility, and meaningfulness of a group-based exercise intervention for depression. Fourteen adolescents with persistent depression were recruited from a psychiatric outpatient clinic and interviewed one year after participating in a 14-week moderate to vigorous exercise intervention for depression. An abductive qualitative content analysis was conducted, based on the three SOC domains manageability, comprehensibility, and meaningfulness. The results revealed that participation in the intervention was made manageable by a supportive environment, including: the intervention design, togetherness with peer group, and encouragement from adults. The comprehensibility of the intervention emerged through the insights regarding health benefits of exercise and the aim of the intervention. Meaningfulness was achieved through improved health behaviour, well-being and self-esteem, along with strengthened belief in the future and increased commitment to everyday life. The group-based exercise intervention was experienced as manageable, comprehensible, and meaningful. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.
44.	Ryman Augustsson, Sofia, et al. (författare) Jump height as performance indicator for the selection of youth football players to national teams 2019 Ingår i: Journal of Sports Medicine and Physical Fitness. - Turin : Edizioni Minerva Medica. - 0022-4707 .- 1827-1928. ; 59:10, s. 1669-1675 Tidskriftsartikel (refereegranskat)abstract Background: Different jump tests such as the Countermovement Jump (CMJ), Abalakov Jump (AJ) and Standing Long Jump (SLJ) are often used in practice to evaluate muscular power and functional performance in football. These tests are also used in different selection processes and talent identification, but the significance of the tests for the selection of youth players to national teams are relatively unknown. The aim of this study was to compare jump ability between youth football players selected or not selected for the national team.Methods: In this cross-sectional study, 22 players (aged 17±2 years), 11 national players (NP) and 11 non-national players (NNP) were evaluated in three different jump tests; CMJ, AJ and SLJ. Mean scores for the tests were analyzed and compared.Results: Significant differences were found between the groups regarding jump height in favor of the NP group in both the CMJ (NP 39.9±5.0 cm vs. NNP 34.2±4.9 cm, P=0.013) and the AJ (NP 47.1±5.4 vs. NNP 40.9±4.7, P=0.010). No group difference was found regarding jump length in SLJ (NP 246.2±17.9 vs. NNP 232.9±16.5, P=0.084).Conclusions: The results suggest that tests, measuring jump height, could be used as a performance indicator and part of the selection process of youth football players to national teams, whereas the use of jump length could be questioned. Copyright © 2019 Edizioni Minerva Medica
45.	Ryman Augustsson, Sofia, et al. (författare) Short-term effects of postural taping on pain and forward head posture : a randomized controlled trial 2022 Ingår i: BMC Musculoskeletal Disorders. - London : BioMed Central. - 1471-2474. ; 23:1 Tidskriftsartikel (refereegranskat)abstract Background: Balance Body Tape (BBT) is a recently developed taping-method with the aim to reduce pain and improve posture through change in movement behavior. However, the potential efects of a treatment with BBT are scarcely documented. Therefore, the aim with this study was to investigate the efect of a three-week Balance body tape-treatment on the intensity of perceived neck, shoulder and back pain and forward head posture.Methods: In this RCT study, subjects (n=26), who reported being university students or having a sedentary work and experiencing pain in neck, back or shoulders, were randomized to either an intervention (n=12) or control group (n=14). The intervention group received a three-week treatment with BBT, the control group received no treatment. A questionnaire regarding pain, including a Numeric Rating Scale (NRS) measuring pain intensity, and a Photographic posture analysis measurement (PPAM) regarding the craniovertebral (CV) angle were assessed before and after the intervention for both groups. Wilcoxon’s signed rank test and Mann-Whitney U test was used to assess intra- and between group diferences respectively. The relationship between pain intensity and CV angle was assessed using Spearman’s correlation.Results: No diference in demographic and physical characteristics between the groups were noted at baseline (p>0.05). Pain intensity at baseline was 5 for the intervention group and 4 for the control group (p=0.330). At follow up, the intervention group reported a lower score (NRS=2.5, p=0.003) whereas the control group had no signifcant diference in pain intensity (NRS=3, p=0.086). No signifcant change was found in the CV angle (p=0.058) and no correlation was found between NRS and the CV angle (r=0.102, p=0.619).Conclusion: A short treatment period with BBT may, compared to no treatment, have a small reducing efect on pain intensity in neck, back and/or shoulders. However, no efect was found on forward head posture in this study.Trial registration: Registered retrospectively on 08/11/2021. NCT05111704.Trial registration page link:
46.	Sunesson, Evelina, et al. (författare) Experiences of How Health and Lifestyle among Individuals with Knee Pain Have Been Influenced during the COVID-19 Pandemic, a HALLOA Study 2022 Ingår i: International Journal of Environmental Research and Public Health. - Basel : MDPI. - 1661-7827 .- 1660-4601. ; 19:14 Tidskriftsartikel (refereegranskat)abstract The COVID-19 pandemic has affected the health and lifestyles of both the general population and of vulnerable groups. Individuals with knee pain are recommended to lead an active lifestyle to relieve pain but find it difficult to maintain health and lifestyle compared to the general population due to the cause of chronic pain, impaired physical function, and a diminished quality of life. This study aimed to explore experiences of how health and lifestyle among individuals with knee pain have been influenced during the COVID-19 pandemic. Interviews (n = 19) were conducted in 2021 and analysed with qualitative content analysis. The results showed how individuals with knee pain adjusted their behaviour and revalued their life to maintain health and lifestyle during COVID-19. Adjusted behaviours emerged, such as spending more time at home, becoming digital, and spending more time outdoors, while revaluing life emerged as having a positive outlook on life and sharing responsibility. In conclusion, behaviour was adjusted, and life revalued to manage health and lifestyle during the pandemic. However, the findings are probably similar to the general population, i.e., individuals with knee pain live similar lives as the general population despite knee pain. The results may contribute to alternative ways of maintaining health and lifestyle in various vulnerable groups and may be applied in situations other than the pandemic. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.
47.	Sunesson, Evelina, et al. (författare) Experiences of how health and lifestyle among individuals with knee pain have been influenced during the Covid-19 pandemic, a halloa study 2022 Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract Background: The covid-19 pandemic has affected health and lifestyle among the general population and vulnerable groups. Individuals with knee pain are recommended an active lifestyle to reveal pain but find it difficult to maintain health and lifestyle compared to the general population due to the cause of chronic pain, impaired physical function, and a diminished quality of life. This adds to the importance of exploring how to preserve health and lifestyle among individuals with knee pain during the pandemic. Objective: The aim of this study was to explore experiences of how health and lifestyle among individuals with knee pain have been influenced during the covid-19 pandemic.Method: Nineteen participants with current knee pain, with no earlier diagnosed radiographic osteoarthritis, and no rheumatologic disorder or cruciate ligament injury, were recruited from The Halland Osteoarthritis (HALLOA) Cohort Study, twelve females and seven males, between 41-62 (median 51) years of age. Data were collected through individual interviews with open-ended questions: “What impact have you experienced with your health and lifestyle during the covid-19 pandemic?”, and “What activities or strategies have you changed to maintain your health and lifestyle during the covid-19 pandemic? ”. Qualitative content analysis was used, where two categories and five sub-categories emerged (Table 1). Result: The result from this study explored how individuals with knee pain adjusted their behaviour and revalued their life to maintain health and lifestyle during the pandemic. The category adjusted behaviours emerged with the sub-categories: spending more time at home, becoming digitally and spending more time outdoors. These sub-categories determine how a more reclusive behaviour has appeared due to the pandemic, where digital platforms and outdoor activities have facilitated companionship and togetherness when feelings of loneliness and isolation were present. The category revaluing life emerged with the sub-categories: having a positive outlook on life and sharing responsibility. These sub-categories establish the importance of being grateful for maintaining health and lifestyle and being solution-oriented to find the best possible outcomes to continue with everyday life, despite the pandemic. While having a responsibility toward others arose as a facility to manage to keep social distance during the pandemic. Conclusion: In conclusion, individuals with knee pain managed their health and lifestyle during the pandemic by adjusting behaviors and revaluing life. Adapting to restrictions included spending more time at home and outdoors, becoming more digitally, and revaluing life by having a positive outlook on life and supporting others. The result may contribute to alternative ways of preserving health and lifestyle in different vulnerable groups and may be used in situations other than the pandemic.
48.	Sunesson, Evelina, et al. (författare) The Impact of the Covid-19 pandemic on Health and Lifestyle in Individuals with Knee Pain : a HALLOA study 2022 Konferensbidrag (refereegranskat)abstract Background: Covid-19 has affected everyday life, health and lifestyle among the general population and vulnerable groups. Individuals with knee pain are recommended an active lifestyle to reveal pain but find it difficult to maintain health and lifestyle compared to the general population due to the cause of chronic pain, impaired physical function and a diminishes quality of life. This adds to the importance of exploring how to preserve health and lifestyle among individuals with knee pain during the pandemic.Objectives: The aim of this study was to explore the impact of the covid-19 pandemic on the health and lifestyle in individuals with knee pain.Methods: Nineteen participants with current knee pain, and with no earlier diagnosed radiographic osteoarthritis, and no rheumatologic disorder or cruciate ligament injury, were recruited from The Halland Osteoarthritis (HALLOA) Cohort Study, twelve female and seven males, between 41-62 (median 51) years of age. Data were collected through individual interviews with open-ended questions: “What impact have you experienced with your health and lifestyle during covid-19?”, and “What activities or strategies have you changed to maintain your health and lifestyle during covid-19? ”. Qualitative content analysis was used, where two categories and five sub-categories emerged ( Table 1 ).Results: The result from this study explored how behaviour and attitude towards valuing life have been adjusted to maintain health and lifestyle among individuals with knee pain during covid-19. The category adjusted behaviours emerged with the sub-categories: spending more time at home, becoming digitally, and spending more time outdoors. These sub-categories determine how a more reclusive behaviour have appeared due to the pandemic, where digital platforms and outdoor activities have facilitated companionship and togetherness when feelings of loneliness and isolation were present. The category valuing life emerged with the sub-categories: having a positive outlook of life and sharing responsibility. These sub-categories establish the importance of trying to be grateful for maintaining health and lifestyle and trying to be solution-oriented to find the best possible outcomes to continue with everyday life, despite the pandemic. While having a responsibility towards others arose as a facility to manage to keep social distance during the pandemic.Conclusion: In conclusion, the behaviour was adjusted to continue with everyday life and maintain health and lifestyle among individuals with knee pain during covid-19. Valuing life was also considered important to maintain health and lifestyle as well as supporting others maintain their health and lifestyle. The result may in the future contribute to alternative ways of maintaining health and lifestyle in different vulnerable groups and may be used in situations other than the pandemic.
49.	Sylwander, Charlotte, 1992-, et al. (författare) Experiences of Health-Promoting Activities among Individuals with Knee Pain : The Halland Osteoarthritis Cohort 2022 Ingår i: International Journal of Environmental Research and Public Health. - Basel : MDPI. - 1661-7827 .- 1660-4601. ; 19:17 Tidskriftsartikel (refereegranskat)abstract Knee pain is an early sign of knee osteoarthritis (KOA) and a risk factor for chronic widespread pain (CWP). Early prevention is vital, and more research is needed to understand health-promoting activities for individuals with knee pain from a patient perspective. This study aimed to explore how individuals with knee pain experienced health-promoting activities. Explorative qualitative design with inductive approach was applied to explore the experiences of 22 individuals (13 women, 9 men; median age: 52). Semi-structured interviews were conducted and analysed using latent qualitative content analysis. The results revealed health-promoting activities in individuals with knee pain and were interpreted in the overall theme, striving for balance in everyday life. Two categories explored the content in health-promoting activities: (1) Caring for the body—being physically active, having a healthy diet, and utilising support; and (2) Managing life stressors—allowing for recovery, promoting vitality, and safeguarding healthy relationships. In conclusion, individuals with knee pain described various health-promoting activities. They strived for balance in everyday life by caring for the body and managing life stressors. We suggest that a broader approach to everyday life can be helpful in treatment plans and health promotion to manage and prevent KOA and CWP, while striving for a healthy lifestyle.
50.	Sylwander, Charlotte, 1992-, et al. (författare) Health literacy in individuals with knee pain-a mixed methods study 2023 Ingår i: BMC Public Health. - London : BioMed Central (BMC). - 1471-2458. ; 23, s. 1-16 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Low health literacy is associated with worse pain and poorer self-management. This study (1) examined the level of health literacy and associations with lifestyle habits, health status, chronic pain, and radiographic knee osteoarthritis; and (2) explored experiences illuminating health literacy among individuals with knee pain.METHODS: A convergent parallel mixed-methods design was used, including 221 individuals. Health literacy was assessed by HLS-EU-Q16 and eHEALS. The questionnaire included questions on lifestyle habits, health status, and pain distribution. Radiographic knee osteoarthritis was assessed with x-rays. Associations were analysed using logistic regression analyses. Individual semi-structured interviews were conducted (n = 19) and analysed with qualitative content analysis.RESULTS: The result showed that 71% reported sufficient health literacy. Higher education, healthy lifestyle habits, better general health, and absence of widespread pain were associated with sufficient health literacy. Experiences regarding health literacy influencing the decision-making process toward a decision on action comprised: (1) searching for information actively or passively; (2) processing of the information included being informed, critical, and interpretive; and (3) taking a stand on the information based on trustfulness and motivation.CONCLUSION: Seven out of 10 reported sufficient health literacy. Despite this, unhealthy lifestyles were common, suggesting that having sufficient HL is not enough for a behavioural change and the decision-making process, including different phases such as searching, processing, and taking a stand on health information is important to consider. More research on health literacy is needed to gain knowledge of how best to develop health promotion in individuals with knee pain. © 2023, BioMed Central Ltd., part of Springer Nature.

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