| 1. |
- Benoni, Anna-Clara, et al.
(författare)
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Patient-reported outcome after rheumatoid arthritis-related surgery in the lower extremities A report from the Swedish National Register of Rheuma Surgery (RAKIR)
- 2012
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Ingår i: Acta Orthopaedica. - Basingstoke : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 83:2, s. 179-184
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose Although decreasing with the development of effective pharmacological regimes, joint surgery has improved the function and quality of life of patients with rheumatoid arthritis (RA). Few studies have assessed patient-reported outcomes after RA surgery to the lower extremities. Here we report patient-relevant outcome after RA-related surgery based on the first data from the Swedish National Register of Rheuma Surgery (RAKIR). Patients and methods 258 RA patients (212 women) who had joint surgery performed at the Department of Orthopaedics, Spenshult Hospital between September 2007 and June 2009 were included. Mean age at surgery was 64 (20-86) years. The patients completed the SF-36 and HAQ questionnaires preoperatively and 6 months postoperatively, and 165 patients completed them after 12 months. Results Improvement was seen as early as at 6 months. At 12 months, 165 patients (141 women)-including hip (n = 15), knee (n = 27), foot (n = 102), and ankle (n = 21) patients-reported statistically significant improvements from preoperatively to 12 months postoperatively in HAQ (mean change: -0.11) and SF-36 subscales physical function (11), role physical (12), bodily pain (13), social functioning (6.4), and role emotional (9.4). Hip and knee patients reported the greatest improvements. Interpretation Orthopedic RA-related surgery of the lower extremities has a strong effect on pain and physical function. Improvement is evident as early as 6 months postoperatively and remains after 12 months.
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| 2. |
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| 3. |
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| 4. |
- Ageberg, Eva, et al.
(författare)
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Effects of neuromuscular training (NEMEX-TJR) on patient-reported outcomes and physical function in severe primary hip or knee osteoarthritis: a controlled before-and-after study
- 2013
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Background: The benefits of exercise in mild and moderate knee or hip osteoarthritis (OA) are apparent, but the evidence in severe OA is less clear. We recently reported that neuromuscular training was well tolerated and feasible in patients with severe primary hip or knee OA. The aims of this controlled before-and-after study were to compare baseline status to an age-matched population-based reference group and to examine the effects of neuromuscular training on patient-reported outcomes and physical function in patients with severe primary OA of the hip or knee. Methods: 87 patients (60-77 years) with severe primary OA of the hip (n = 38, 55% women) or knee (n = 49, 59% women) awaiting total joint replacement (TJR) had supervised, neuromuscular training (NEMEX-TJR) in groups with individualized level and progression of training. A reference group (n = 43, 53% women) was included for comparison with patients' data. Assessments included self-reported outcomes (HOOS/KOOS) and measures of physical function (chair stands, number of knee bends/30 sec, knee extensor strength, 20-meter walk test) at baseline and at follow-up before TJR. Analysis of covariance (ANCOVA) was used for comparing patients and references and elucidating influence of demographic factors on change. The paired t-test was used for comparisons within groups. Results: At baseline, patients reported worse scores than the references in all HOOS/KOOS subscales (hip 27-47%, knee 14-52%, of reference scores, respectively) and had functional limitations (hip 72-85%, knee 42-85%, of references scores, respectively). NEMEX-TJR (mean 12 weeks (SD 5.6) of training) improved self-reported outcomes (hip 9-29%, knee 7-20%) and physical function (hip 3-18%, knee 5-19%) (p < 0.005). Between 42% and 62% of hip OA patients, and 39% and 61% of knee OA patients, displayed a clinically meaningful improvement (>= 15%) in HOOS/KOOS subscales by training. The improvement in HOOS/KOOS subscale ADL was greater for patients with knee OA than hip OA, while the improvement in subscale Sport/Rec was greater for patients with hip OA than knee OA. Conclusions: Both self-reported outcomes and physical function were clearly worse compared with the reference group. Neuromuscular training with an individualized approach and gradual progression showed promise for improving patient-reported outcomes and physical function even in older patients with severe primary OA of the hip or knee.
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| 5. |
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| 6. |
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| 7. |
- Ali, Abdulemir, et al.
(författare)
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Similar patient-reported outcomes and performance after total knee arthroplasty with or without patellar resurfacing : A randomized study of 74 patients with 6 years of follow-up
- 2016
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Ingår i: Acta Orthopaedica. - : Informa UK Limited. - 1745-3674 .- 1745-3682. ; 87:3, s. 274-279
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose — Knee pain after total knee arthroplasty (TKA) is not uncommon. Patellar retention in TKA is one cause of postoperative knee pain, and may lead to secondary addition of a patellar component. Patellar resurfacing in TKA is controversial. Its use ranges from 2% to 90% worldwide. In this randomized study, we compared the outcome after patellar resurfacing and after no resurfacing. Patients and methods — We performed a prospective, randomized study of 74 patients with primary osteoarthritis who underwent a Triathlon CR TKA. The patients were randomized to either patellar resurfacing or no resurfacing. They filled out the VAS pain score and KOOS questionnaires preoperatively, and VAS pain, KOOS, and patient satisfaction 3, 12, and 72 months postoperatively. Physical performance tests were performed preoperatively and 3 months postoperatively. Results — We found similar scores for VAS pain, patient satisfaction, and KOOS 5 subscales at 3, 12, and 72 months postoperatively in the 2 groups. Physical performance tests 3 months postoperatively were also similar in the 2 groups. No secondary resurfacing was performed in the group with no resurfacing during the first 72 months Interpretation — Patellar resurfacing in primary Triathlon CR TKA is of no advantage regarding pain, physical performance, KOOS 5 subscales, or patient satisfaction compared to no resurfacing. None of the patients were reoperated with secondary addition of a patellar component within 6 years. According to these results, routine patellar resurfacing in primary Triathlon TKA appears to be unnecessary.
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| 8. |
- Berg, Urban, et al.
(författare)
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Fast-Track Programs in Total Hip and Knee Replacement at Swedish Hospitals-Influence on 2-Year Risk of Revision and Mortality
- 2021
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Ingår i: Journal of Clinical Medicine. - : MDPI AG. - 2077-0383. ; 10:8
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: We aimed to study the influence of fast-track care programs in total hip and total knee replacements (THR and TKR) at Swedish hospitals on the risk of revision and mortality within 2 years after the operation. Methods: Data were collected from the Swedish Hip and Knee Arthroplasty Registers (SHAR and SKAR), including 67,913 THR and 59,268 TKR operations from 2011 to 2015 on patients with osteoarthritis. Operations from 2011 to 2015 Revision and mortality in the fast-track group were compared with non-fast-track using Kaplan-Meier survival analysis and Cox regression analysis with adjustments. Results: The hazard ratio (HR) for revision within 2 years after THR with fast-track was 1.19 (CI: 1.03-1.39), indicating increased risk, whereas no increased risk was found in TKR (HR 0.91; CI: 0.79-1.06). The risk of death within 2 years was estimated with a HR of 0.85 (CI: 0.74-0.97) for TKR and 0.96 (CI: 0.85-1.09) for THR in fast-track hospitals compared to non-fast-track. Conclusions: Fast-track programs at Swedish hospitals were associated with an increased risk of revision in THR but not in TKR, while we found the mortality to be lower (TKR) or similar (THR) as compared to non-fast track.
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| 9. |
- Berg, Urban, et al.
(författare)
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Influence of fast-track programs on patient-reported outcomes in total hip and knee replacement (THR/TKR) at Swedish hospitals 2011-2015: an observational study including 51,169 THR and 8,393 TKR operations
- 2020
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 91:3, s. 306-312
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Fast-track care programs have been broadly introduced at Swedish hospitals in elective total hip and knee replacement (THR/TKR). We studied the influence of fast-track programs on patient-reported outcomes (PROs) 1 year after surgery, by exploring outcome measures registered in the Swedish arthroplasty registers. Patients and methods - Data were obtained from the Swedish Knee and Hip Arthroplasty Registers and included TKR and THR operations 2011-2015 on patients with osteoarthritis. Based on questionnaires concerning the clinical pathway and care programs at Swedish hospitals, the patients were divided in 2 groups depending on whether they had been operated in a fast-track program or not. PROs of the fast-track group were compared with not fast-track using regression analysis. EQ-5D, EQ VAS, Pain VAS, and Satisfaction VAS were analyzed for both THR and TKR operations. The PROMs for TKR also included KOOS. Results - The differences of EQ-5D, EQ VAS, Pain VAS, and Satisfaction VAS 1 year after surgery were small but all in favor of fast-track for both THR and TKR, also in subscales of KOOS for TKR except KOOS QoL. However, the effect sizes as measured by Cohens' d formula were < 0.2 for all PROs, in both THR and TKR. Interpretation - Our results indicate that the fast-track programs may be at least as good as conventional care from the perspective of PROs 1-year postoperatively.
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| 10. |
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| 11. |
- Brorsson, Sofia, 1973-, et al.
(författare)
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A new force measurement device for evaluating finger extension function in the healthy and rheumatoid arthritis hand
- 2008
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Ingår i: Technology and Health Care. - Amsterdam : IOS Press. - 0928-7329 .- 1878-7401. ; 16:4, s. 283-292
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Tidskriftsartikel (refereegranskat)abstract
- Although often neglected, finger extension force is of great importance for developing grip strength. This paper describes the design and evaluation of a new finger extension force measurement device (EX-it) based on the biomechanics of the hand. Measurement accuracy and test-retest reliability were analysed. The device allows measurements on single fingers as well as all the fingers (excluding the thumb) of both healthy and deformed hands. The coefficient of variation in the device was 1.8% of the applied load, and the test-retest reliability showed a coefficient of variation no more than 7.1% for healthy subjects. This study also provides reference values for finger extension force in healthy subjects and patients with rheumatoid arthritis (RA). Significant differences were found in extension strength between healthy subject and RA patients (men, p < 0.05 and women, p < 0.001). EX-it provides objective and reliable data on the extension force capacity of normal and dysfunctional hands and can be used to evaluate the outcome of therapeutic interventions after hand trauma or disease
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| 12. |
- Brorsson, Sofia, 1973-, et al.
(författare)
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A six-week hand exercise programme improves strength and hand function in patients with rheumatoid arthritis
- 2009
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Ingår i: Journal of Rehabilitation Medicine. - Basingstoke : Taylor & Francis. - 1650-1977 .- 1651-2081. ; 41:5, s. 338-342
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:To evaluate the effects of hand exercise in patients with rheumatoid arthritis, and to compare the results with healthy controls.METHODS:Forty women (20 patients with rheumatoid arthritis and 20 healthy controls) performed a hand exercise programme. The results were evaluated after 6 and 12 weeks with hand force measurements (with a finger extension force measurement device (EX-it) and finger flexion force measurement with Grippit). Hand function was evaluated with the Grip Ability Test (GAT) and with patient relevant questionnaires (Disability of the Arm, Shoulder, and Hand (DASH) and Short Form-36). Ultrasound measurements were performed on m. extensor digitorum communis for analysis of the muscle response to the exercise programme. RESULTS: The extension and flexion force improved in both groups after 6 weeks (p < 0.01). Hand function (GAT) also improved in both groups (p < 0.01). The rheumatoid arthritis group showed improvement in the results of the DASH questionnaire (p < 0.05). The cross-sectional area of the extensor digitorum communis increased significantly in both groups measured with ultrasound. CONCLUSION:A significant improvement in hand force and hand function in patients with rheumatoid arthritis was seen after 6 weeks of hand training; the improvement was even more pronounced after 12 weeks. Hand exercise is thus an effective intervention for rheumatoid arthritis patients, leading to better strength and function.
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| 13. |
- Brorsson, Sofia, 1973-, et al.
(författare)
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Differences in muscle activity during hand-dexterity tasks between women with arthritis and a healthy reference group
- 2014
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Ingår i: BMC Musculoskeletal Disorders. - London, England : Springer Science and Business Media LLC. - 1471-2474. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background: Impaired hand function is common in patients with arthritis and it affects performance of daily activities; thus, hand exercises are recommended. There is little information on the extent to which the disease affects activation of the flexor and extensor muscles during these hand-dexterity tasks. The purpose of this study was to compare muscle activation during such tasks in subjects with arthritis and in a healthy reference group. Methods: Muscle activation was measured in m. extensor digitorium communis (EDC) and in m. flexor carpi radialis (FCR) with surface electromyography (EMG) in women with rheumatoid arthritis (RA, n = 20), hand osteoarthritis (HOA, n = 16) and in a healthy reference group (n = 20) during the performance of four daily activity tasks and four hand exercises. Maximal voluntary isometric contraction (MVIC) was measured to enable intermuscular comparisons, and muscle activation is presented as %MVIC. Results: The arthritis group used a higher %MVIC than the reference group in both FCR and EDC when cutting with a pair of scissors, pulling up a zipper and-for the EDC-also when writing with a pen and using a key (p < 0.02). The exercise "rolling dough with flat hands" required the lowest %MVIC and may be less effective in improving muscle strength. Conclusions: Women with arthritis tend to use higher levels of muscle activation in daily tasks than healthy women, and wrist extensors and flexors appear to be equally affected. It is important that hand training programs reflect real-life situations and focus also on extensor strength.
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| 14. |
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| 15. |
- Brorsson, Sofia, 1973-, et al.
(författare)
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Hand flexor and extensor muscle activity in daily activities and hand exercises in women with rheumatoid arthritis or hand osteoarthritis
- 2012
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Ingår i: Annals of the Rheumatic Diseases. - London, United Kingdom : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 71:Suppl. 3, s. 754-754
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Tidskriftsartikel (refereegranskat)abstract
- Background: Impaired hand grip function is common and occurs early in the course of disease in patients with rheumatoid arthritis (RA) and hand osteoarthritis (HOA), affecting daily life activities and quality of life.Objectives: To evaluate muscle force and muscle activity in forearm flexors and extensors during daily activities and clinically well-known hand exercises in women with RA and HOA compared with healthy controls Methods: The RA group was consecutively included from a specialist clinic and had a disease duration of at least one year. Women with HOA were allocated from out-patients primary health care clinics in the same area and clinically diagnosed with symptomatic HOA. The age matched control group had no history of hand/arm injuries, inflammatory or muscle disease. Full active finger extension ability was required for all subjects. Hand force (Newton) was measured with EX-it (extension) and Grippit (flexion), both validated instruments. Muscle activity was measured in m. extensor digitorum communis (EDC) and m. flexor carpi radialis (FCR) with surface EMG (S-EMG) on the dominant hand while performing four daily activities (ADL) and four hand exercises and described as percent of maximal voluntary isometric contraction (% MVIC) based on data from EX-it and Grippit. Pain was measured with Visual Analogue Scale (VAS) 0-10 (best to worst). Differences between groups were analyzed and controlled for age.Results: Fifty-six women were included; 20 with RA (age mean (SD) 59.2 (10.7) years, VAS pain 2.2 (1.6)), 16 with HOA (age 67.5 (9.3) years, VAS pain 4.1 (1.9)) and 20 healthy controls (age 56.0 (9.7) years). Women with RA and HOA showed decreased extension and flexion force compared with healthy women (p<0.03).There was a tendency towards higher % MVIC in all tests for women with RA or HOA compared with healthy women, with a statistically significant difference between HOA and healthy women for EDC (p<0.05).ADL activities “writing with a pen”, and “cutting with scissors” showed the highest % MVIC in both EDC and FCR in all groups. The exercises “isolated opposition”, and “rolling the dough with flat hands”, had high % MVIC in EDC, while “squeezing the dough” and “isolated opposition” had high % MVIC in FCR.Conclusions: Women with RA and HOA tend to use a higher % MVIC than healthy women in many daily activities and in hand exercises. Strengthening exercises should include both extensor and flexor specific training.Disclosure of Interest: None Declared
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| 16. |
- Brorsson, Sofia, 1973-, et al.
(författare)
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Relationship between finger flexion and extension force in healthy women and women with rheumatoid arthritis
- 2012
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Ingår i: Journal of Rehabilitation Medicine. - Uppsala, Sweden : Stiftelsen Rehabiliteringsinformation. - 1650-1977 .- 1651-2081. ; 44:7, s. 605-608
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Balance between flexor and extensor muscle activity is essential for optimal function. The purpose of this pilot study was to compare the relationship between maximum finger flexion force and maximum finger extension force in women with rheumatoid arthritis and healthy women.METHODS: Twenty healthy women (median age 61 years) and 20 women with rheumatoid arthritis (median age 59.5 years, median disease duration 16.5 years) were included in the study. Finger extension force was measured with an electronic device, EX-it, and finger flexion force using Grippit. The Grip Ability Test and the score from the patient-reported outcome Disability Arm Shoulder and Hand were used to evaluate activity limitations.RESULTS: Patients with rheumatoid arthritis showed significantly decreased hand function compared with healthy controls. A correlation was found between extension force and flexion force in the healthy group (r = 0.65, p = 0.002),but not in the rheumatoid arthritis group (r = 0.25, p = 0.289).CONCLUSION: Impaired hand function appears to influence the relationship between maximum finger flexion and extension force. This study showed a difference in the relationship between maximum finger flexion and extension force in healthy controls and those with rheumatoid arthritis. © 2012 Foundation of Rehabilitation Information.
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| 17. |
- Brorsson, Sofia, 1973-, et al.
(författare)
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Ultrasound evaluation in combination with finger extension force measurements of the forearm musculus extensor digitorum communis in healthy subjects
- 2008
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Ingår i: BMC Medical Imaging. - London : BioMed Central. - 1471-2342. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Background:The aim of this study was to evaluate the usefulness of an ultrasound-based method of examining extensor muscle architecture, especially the parameters important for force development. This paper presents the combination of two non-invasive methods for studying the extensor muscle architecture using ultrasound simultaneously with finger extension force measurements.Methods:M. extensor digitorum communis (EDC) was examined in 40 healthy subjects, 20 women and 20 men, aged 35-73 years. Ultrasound measurements were made in a relaxed position of the hand as well as in full contraction. Muscle cross-sectional area (CSA), pennation angle and contraction patterns were measured with ultrasound, and muscle volume and fascicle length were also estimated. Finger extension force was measured using a newly developed finger force measurement device.Results:The following muscle parameters were determined: CSA, circumference, thickness, pennation angles and changes in shape of the muscle CSA. The mean EDC volume in men was 28.3 cm3 and in women 16.6 cm3. The mean CSA was 2.54 cm2 for men and 1.84 cm2 for women. The mean pennation angle for men was 6.5° and for women 5.5°. The mean muscle thickness for men was 1.2 cm and for women 0.76 cm. The mean fascicle length for men was 7.3 cm and for women 5.0 cm. Significant differences were found between men and women regarding EDC volume (p < 0.001), CSA (p < 0.001), pennation angle (p < 0.05), muscle thickness (p < 0.001), fascicle length (p < 0.001) and finger force (p < 0.001). Changes in the shape of muscle architecture during contraction were more pronounced in men than women (p < 0.01). The mean finger extension force for men was 96.7 N and for women 39.6 N. Muscle parameters related to the extension force differed between men and women. For men the muscle volume and muscle CSA were related to extension force, while for women muscle thickness was related to the extension force.Conclusion:Ultrasound is a useful tool for studying muscle architectures in EDC. Muscle parameters of importance for force development were identified. Knowledge concerning the correlation between muscle dynamics and force is of importance for the development of new hand training programmes and rehabilitation after surgery.© 2008 Brorsson et al; licensee BioMed Central Ltd.
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| 18. |
- Busija, Lucy, et al.
(författare)
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Magnitude and meaningfulness of change in SF-36 scores in four types of orthopedic surgery
- 2008
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Ingår i: Health and Quality of Life Outcomes. - : Springer Science and Business Media LLC. - 1477-7525. ; 6:55
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Medical Outcomes General Health Survey (SF-36) is a widely used health status measure; however, limited evidence is available for its performance in orthopedic settings. The aim of this study was to examine the magnitude and meaningfulness of change and sensitivity of SF-36 subscales following orthopedic surgery. Methods: Longitudinal data on outcomes of total hip replacement (THR, n = 255), total knee replacement (TKR, n = 103), arthroscopic partial meniscectomy (APM, n = 74) and anterior cruciate ligament reconstruction (ACL, n = 62) were used to estimate the effect sizes (ES, magnitude of change) and minimal detectable change (sensitivity) at the group and individual level. To provide context for interpreting the magnitude of changes in SF-36 scores, we also compared patients' scores with age and sex-matched population norms. The studies were conducted in Sweden. Follow-up was five years in THR and TKR studies, two years in ACL, and three months in APM. Results: On average, large effect sizes (ES >= 0.80) were found after orthopedic surgery in SF-36 subscales measuring physical aspects (physical functioning, role physical, and bodily pain). Small (0.20-0.49) to moderate (0.50-0.79) effect sizes were found in subscales measuring mental and social aspects (role emotional, vitality, social functioning, and mental health). General health scores remained relatively unchanged during the follow-up. Despite improvements, post-surgery mean scores of patients were still below the age and sex matched population norms on physical subscales. Patients' scores on mental and social subscales approached population norms following the surgery. At the individual level, scores of a large proportion of patients were affected by floor or ceiling effects on several subscales and the sensitivity to individual change was very low. Conclusion: Large to moderate meaningful changes in group scores were observed in all SF-36 subscales except General Health across the intervention groups. Therefore, in orthopedic settings, the SF-36 can be used to show changes for groups in physical, mental, and social dimensions and in comparison with population norms. However, SF-36 subscales have low sensitivity to individual change and so we caution against using SF-36 to monitor the health status of individual patients undergoing orthopedic surgery.
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| 19. |
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| 20. |
- CöSter, Maria C., et al.
(författare)
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Minimally important change, measurement error, and responsiveness for the Self-Reported Foot and Ankle Score
- 2017
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Ingår i: Acta Orthopaedica. - Abingdon : TAYLOR & FRANCIS LTD. - 1745-3674 .- 1745-3682. ; 88:3, s. 300-304
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Patient-reported outcome measures (PROMs) are increasingly used to evaluate results in orthopedic surgery. To enhance good responsiveness with a PROM, the minimally important change (MIC) should be established. MIC reflects the smallest measured change in score that is perceived as being relevant by the patients. We assessed MIC for the Self-reported Foot and Ankle Score (SEFAS) used in Swedish national registries. Patients and methods - Patients with forefoot disorders (n = 83) or hindfoot/ankle disorders (n = 80) completed the SEFAS before surgery and 6 months after surgery. At 6 months also, a patient global assessment (PGA) scaleas external criterionwas completed. Measurement error was expressed as the standard error of a single determination. MIC was calculated by (1) median change scores in improved patients on the PGA scale, and (2) the best cutoff point (BCP) and area under the curve (AUC) using analysis of receiver operating characteristic curves (ROCs). Results - The change in mean summary score was the same, 9 (SD 9), in patients with forefoot disorders and in patients with hindfoot/ankle disorders. MIC for SEFAS in the total sample was 5 score points (IQR: 2-8) and the measurement error was 2.4. BCP was 5 and AUC was 0.8 (95% CI: 0.7-0.9). Interpretation - As previously shown, SEFAS has good responsiveness. The score change in SEFAS 6 months after surgery should exceed 5 score points in both forefoot patients and hindfoot/ankle patients to be considered as being clinically relevant.
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| 21. |
- Cöster, Maria C., et al.
(författare)
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Patient-reported outcome for 17,648 patients in 5 different Swedish orthopaedic quality registers before and 1 year after surgery: an observational study
- 2023
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 94, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose — The EQ-5D is a patient-reported outcome measure (PROM). To make priorities and allocate resources between patients and surgical procedures it is necessary to evaluate outcome differences, which is why comparing PROMs between registers is important. We compared EQ-5D data and the follow-up rate for selected diag-noses reported to Swedish orthopedic registers before and 1 year after surgery. Patients and methods — Patients from 5 orthopedic registers (Swespine, Swedish Hip Arthroplasty Register, Swedish Knee Arthroplasty Register, Swedankle, and Swe-foot) who, in 2014–2018, underwent surgery in southern Sweden were included in the study. Data on the EQ-5D index, individual questions, and the EQ-VAS at baseline and at the 1-year follow-up was compared. Results — 17,648 patients had completed the EQ-5D pre-and 1-year postoperatively. The follow-up rate ranged from 32% to 88%. All registers showed a statistical and clinically relevant improvement in the EQ-5D index (mean improvement 0.29–0.39), where patients who underwent hip arthro-plasties experienced the largest improvement. The EQ-5D index improvements in patients with foot and ankle surgeries were larger than for patients with knee arthroplasties and spinal surgeries. The dimensions “self-care” and “usual activities” had the largest change in patients reporting “some problems.” Conclusion — All 5 registers showed a clinically relevant improvement 1 year postoperatively regarding the EQ-5D index, supporting continuous resource allocation to these groups of patients and surgical procedures. However, using PROM data to present register differences was chal-lenged by the high number of non-responders.
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| 22. |
- Dieppe, Paul, et al.
(författare)
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Variations in the pre-operative status of patients coming to primary hip replacement for osteoarthritis in European orthopaedic centres
- 2009
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Total hip joint replacement (THR) is a high volume, effective intervention for hip osteoarthritis (OA). However, indications and determinants of outcome remain unclear. The 'EUROHIP consortium' has undertaken a cohort study to investigate these questions. This paper describes the variations in disease severity in this cohort and the relationships between clinical and radiographic severity, and explores some of the determinants of variation. Methods: A minimum of 50 consecutive, consenting patients coming to primary THR for primary hip OA in each of the 20 participating orthopaedic centres entered the study. Pre-operative data included demographics, employment and educational attainment, drug utilisation, and involvement of other joints. Each subject completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC - Likert version 3.1). Other data collected at the time of surgery included the prosthesis used and American Society of Anaesthesiologists (ASA) status. Preoperative radiographs were read by the same three readers for Kellgren and Lawrence (K&L) grading and Osteoarthritis Research Society International (OARSI) atlas features. Regression analyses were carried out. Results: Data from 1327 subjects has been analysed. The mean age of the group was 65.7 years, and there were more women (53.4%) than men. Most (79%) were ASA status 1 or 2. Reported disease duration was 5 years or less in 69.2%. Disease in other joint sites was common. Radiographs were available in 1051 subjects and the K&L grade was 3 or 4 in 95.8%. There was much more variation in clinical severity (WOMAC score); the mean total WOMAC score was 59.2 (SD 16.1). The radiographic severity showed no correlation with WOMAC scores. Significantly higher WOMAC scores (worse disease) were seen in older people, women, those with obesity, those with worse general health, and those with lower educational attainment. Conclusion: 1. Clinical disease severity varies widely at the time of THR for OA. 2. In advanced hip OA clinical severity shows no correlation with radiographic severity. 3. Simple scores of pain and disability do not reflect the complexity of decision-making about who should have a THR.
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| 23. |
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| 24. |
- Hessle, Anna, et al.
(författare)
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Grazing4AgroEcology – europeiskt projekt stödjer lantbrukare i betesbaserad djurhållning
- 2023
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Ingår i: Report from the Department of Crop Production Ecology (VPE). - 1653-5375. ; , s. 182-183
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Konferensbidrag (refereegranskat)abstract
- Grazing4AgroEcology (G4AE) är ett EU-finansierat projekt för att stödja lantbrukare i betesbaserad djurhållning. G4AE kommer att pågå i tre och ett halvt år (september 2022–februari 2026) med deltagare från åtta EU-länder. I projektet tar vi fram goda exempel som förmedlas med faktablad, nyhetsbrev, videor m.m. Olika grupper av lantbrukare och branschfolk får möjlighet att delta i nätverkande och utbyte nationellt och internationellt samt ta del av expertmöten, seminarier, webbinarier och läromedel. Centralt i projektet för svensk del är femton utvalda samarbetsgårdar (partner farms) som representerar hela Sverige samt olika produktionsinriktningar och intresseområden. Unga lantbrukare är en viktig målgrupp för projektet. En utvald grupp kommer att få möjlighet att delta i diskussionsmöten om bete och att vara med på expertmöten utomlands. Vill du vara med och forma framtidens livsmedelsproduktion inom ramen för detta projekt kan du kontakta våra nationella partners inom Sveriges lantbruksuniversitet eller Svenska Vallföreningen.
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| 25. |
- Hopkins, Francis R., et al.
(författare)
-
Major alterations to monocyte and dendritic cell subsets lasting more than 6 months after hospitalization for COVID-19
- 2023
-
Ingår i: Frontiers in Immunology. - : Frontiers Media S.A.. - 1664-3224. ; 13
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: After more than two years the Coronavirus disease-19 (COVID-19) pandemic continues to burden healthcare systems and economies worldwide, and it is evident that the effects on the immune system can persist for months post-infection. The activity of myeloid cells such as monocytes and dendritic cells (DC) is essential for correct mobilization of the innate and adaptive responses to a pathogen. Impaired levels and responses of monocytes and DC to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is likely to be a driving force behind the immune dysregulation that characterizes severe COVID-19.Methods: Here, we followed a cohort of COVID-19 patients hospitalized during the early waves of the pandemic for 6-7 months. The levels and phenotypes of circulating monocyte and DC subsets were assessed to determine both the early and long-term effects of the SARS-CoV-2 infection.Results: We found increased monocyte levels that persisted for 6-7 months, mostly attributed to elevated levels of classical monocytes. Myeloid derived suppressor cells were also elevated over this period. While most DC subsets recovered from an initial decrease, we found elevated levels of cDC2/cDC3 at the 6-7 month timepoint. Analysis of functional markers on monocytes and DC revealed sustained reduction in program death ligand 1 (PD-L1) expression but increased CD86 expression across almost all cell types examined. Finally, C-reactive protein (CRP) correlated positively to the levels of intermediate monocytes and negatively to the recovery of DC subsets.Conclusion: By exploring the myeloid compartments, we show here that alterations in the immune landscape remain more than 6 months after severe COVID-19, which could be indicative of ongoing healing and/or persistence of viral antigens.
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| 26. |
- Iversen, Søren, et al.
(författare)
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Alteration of Bacterial Communities in Anterior Nares and Skin Sites of Patients Undergoing Arthroplasty Surgery : Analysis by 16S rRNA and Staphylococcal-Specific tuf Gene Sequencing
- 2020
-
Ingår i: Microorganisms. - : MDPI. - 2076-2607. ; 8:12
-
Tidskriftsartikel (refereegranskat)abstract
- The aim was to study alterations of bacterial communities in patients undergoing hip or knee arthroplasty to assess the impact of chlorhexidine gluconate soap decolonisation and systemic antibiotic prophylaxis. A Swedish multicentre, prospective collection of samples obtained from elective arthroplasty patients (n = 83) by swabbing anterior nares, skin sites in the groin and the site of planned surgery, before and after arthroplasty surgery, was analysed by 16S rRNA (V3-V4) gene sequencing and a complementary targeted tuf gene sequencing approach to comprehensively characterise alterations in staphylococcal communities. Significant reductions in alpha diversity was detected for both bacterial (p = 0.04) and staphylococcal (p = 0.03) groin communities after arthroplasty surgery with significant reductions in relative Corynebacterium (p = 0.001) abundance and Staphylococcus hominis (p = 0.01) relative staphylococcal abundance. In nares, significant reductions occurred for Staphylococcus hominis (p = 0.02), Staphylococcus haemolyticus (p = 0.02), and Staphylococcus pasteuri (p = 0.003) relative to other staphylococci. Staphylococcus aureus colonised 35% of anterior nares before and 26% after arthroplasty surgery. Staphylococcus epidermidis was the most abundant staphylococcal species at all sampling sites. No bacterial genus or staphylococcal species increased significantly after arthroplasty surgery. Application of a targeted tuf gene sequencing approach provided auxiliary staphylococcal community profiles and allowed species-level characterisation directly from low biomass clinical samples.
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| 27. |
- Karlsson, Anna-Karin, et al.
(författare)
-
SustAinimal Grazing Living Lab–a survey of grazing management on dairy farms in northern Sweden
- 2024
-
Ingår i: Acta Agriculturae Scandinavica - Section B. - : Taylor and Francis Ltd.. - 0906-4710 .- 1651-1913. ; 74:1, s. 1-6
-
Tidskriftsartikel (refereegranskat)abstract
- A survey was conducted on 302 Sweden dairy farms (response rate 98%) to identify grazing and grassland management strategies and main challenges to grazing in northern Sweden. The most common grazing strategy on all dairy farms was continuous grazing (59%) followed by rotational grazing (45%), while organic dairy farms preferentially adopted rotational grazing (69%). The main challenges reported in grazing dairy cows on temporary grasslands on conventional farms were trampling damage and seasonal variations in grass growth, while for organic dairy farmers, the primary challenge was weed control. Only a few farms had grazing on semi-natural grasslands. Future sustainable grazing should focus on optimising grazing strategy in relation to on-farm grazing locations and nutrient supply for high-yielding dairy cows.
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| 28. |
- Larsson, Glenn, et al.
(författare)
-
Cognitive status following a hip fracture and its association with postoperative mortality and activities of daily living : A prospective comparative study of two prehospital emergency care procedures
- 2019
-
Ingår i: International Journal of Orthopaedic and Trauma Nursing. - : Elsevier BV. - 1878-1241.
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: Early assessment of hip fracture patients’ cognitive function is important for preventing pre- and postoperative complications. The aim of this study was twofold: (1) to assess prehospital cognitive function in hip fracture patients and establish whether cognitive status differs pre- and postoperatively between prehospital fast track care (PFTC) and the traditional emergency department (ED) pathway and (2) whether preoperative cognitive function is associated with postoperative mortality and activities of daily living (ADL) ability. Methods: Three hundred and ninety one hip fracture patients were prospectively included. The Short Portable Mental Status Questionnaire (SPMSQ) was used prehospital, at the orthopaedic ward and three days postoperatively. ADL was followed up after four months. Results: No difference in patients’ cognitive function was observed between PFTC and ED. Four-month mortality was 37% for patients with dementia, 21% for those with cognitive impairment and 10% for patients without cognitive impariment. Only 26% of patients with dementia and 47% with cognitive impairment had full ADL ability, compared with 70% of patients with intact cognitive function (p < 0.001). Conclusion: PFTC did not influence hip fracture patients’ cognitive function. Patients with prehospital cognitive impairment had a poor outcome in terms of mortality and ADL, indicating the need for special care interventions.
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| 29. |
- Larsson, Glenn, et al.
(författare)
-
It was not a hip fracture - you were lucky this time - or perhaps not! A prospective study of clinical outcomes in patients with low-energy pelvic fractures and hip contusions
- 2019
-
Ingår i: Injury-International Journal of the Care of the Injured. - : Elsevier BV. - 0020-1383. ; 50:4, s. 913-918
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: Prehospital and hospital emergency care guidelines have been developed for patients with suspected hip fracture. Initial radiography can identify a number of patients with other injuries, generally pelvic fractures and hip contusions. Little is known about the prognosis for these patients. The aim of this study is twofold: i) to investigate the injury pattern of patients assessed in prehospital emergency care as suffering from a suspected hip fracture and ii) to compare clinical outcomes between patients with verified hip fracture (HF) and those with other hip injuries (OHI). Method: The study design was prospective. Older patients with suspected HF after low-energy trauma were identified in prehospital emergency care. Injury type was determined by radiological imaging. Comparisons of length of stay, adverse events, repeated prehospital emergency care and mortality were made between verified HF and OHI cases. Results: 449 patients were included, 400 in the HF and 149 in the OHI group (86 hip contusions, 46 pelvic fractures and 17 other injuries/diseases). The HF group had a significantly longer hospital stay (9.5 days vs. 6.3 for the OHI group; p < 0.001) and more adverse events while in hospital (34% vs. 19%; p < 0.001). We found no evidence that the groups differed with regard to other outcomes: mortality during hospital stay (4% vs. 2%, p = 0.42), at 4 (16% vs. 13%; p = 0.35) and 12 months (21 vs. 23%; p = 0.64), the proportion that experienced an adverse event (24% vs. 22%; p = 0.65) and the proportion that required another ambulance transport within 6 months after discharge (40% vs. 34%; p = 0.16). The results were not strongly affected by adjustments for possible confounders. Conclusion: Older patients who suffer a low-energy pelvic fracture or a hip contusion are common in prehospital and hospital emergency care. These patients need attention as they have poor outcomes in terms of adverse events, mortality and recurrent need for ambulance transport after discharge from hospital. While individualized multidisciplinary care is recommended for hip fracture patients, it might also be suitable for other geriatric hip injuries. (C) 2019 Elsevier Ltd. All rights reserved.
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| 30. |
- Larsson, Glenn, et al.
(författare)
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Patient satisfaction with prehospital emergency care following a hip fracture : A prospective questionnaire-based study
- 2018
-
Ingår i: BMC Nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 17:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Older patients with a hip fracture require specialized emergency care and their first healthcare encounter before arriving at the hospital is often with the ambulance service. Since 2005 there has been a registered nurse on the crew of every ambulance in Sweden in order to provide prehospital emergency care and to prepare the patients for hospitalization. It is important to investigate patient satisfaction with prehospital emergency care following a hip fracture to ensure that their expectations of good care are met. The aim of this study was to investigate patient satisfaction with prehospital emergency care following a hip fracture by comparing two similar emergency care contexts. Methods: The study was conducted using the Consumer Emergency Care Satisfaction Scale (CECSS) on patients treated for hip fracture in prehospital emergency care. The data were collected within a randomized controlled study for the purpose of comparing prehospital fast track care (PFTC) and the traditional type of transport to an accident and emergency department (A&E). Results: Questionnaire data from 287 patients, 188 women (66%) and 99 men (34%) with a mean age of 80.9years, were analysed. More than 80% of the patients selected the most positive response alternatives, but 16% were dissatisfied with the nursing information provided. Patients in PFTC responded more positively on specific caring behaviour than those transported to the A&E department in the traditional way. Conclusion: Patient satisfaction with prehospital emergency care following a hip fracture is an important outcome and this study highlights the fact that patients expressed a high level of satisfaction with the prehospital emergency care provided by ambulance nurses in both care contexts under study. However, some areas need to be improved in terms of nursing information.
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| 31. |
- Larsson, Glenn, et al.
(författare)
-
Prehospital fast track care for patients with hip fracture: Impact on time to surgery, hospital stay, post-operative complications and mortality a randomised, controlled trial.
- 2016
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Ingår i: Injury. - : Elsevier BV. - 1879-0267 .- 0020-1383.
-
Tidskriftsartikel (refereegranskat)abstract
- Ambulance organisations in Sweden have introduced prehospital fast track care (PFTC) for patients with suspected hip fracture. This means that the ambulance nurse starts the pre-operative procedure otherwise implemented at the accident & emergency ward (A&E) and transports the patient directly to the radiology department instead of A&E. If the diagnosis is confirmed, the patient is transported directly to the orthopaedic ward. No previous randomised, controlled studies have analysed PFTC to describe its possible advantages. The aim of this study is to examine whether PFTC has any impact on outcomes such as time to surgery, length of stay, post-operative complications and mortality.
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| 32. |
- Nilsdotter, Anna, et al.
(författare)
-
A 5 year prospective study of patient-relevant outcomes after total knee replacement.
- 2009
-
Ingår i: Osteoarthritis and Cartilage. - : Elsevier BV. - 1063-4584. ; 17, s. 601-606
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To prospectively describe self-reported outcomes up to 5 years after total knee replacement (TKR) in Osteoarthritis (OA) and to study which patient-relevant factors may predict outcomes for pain and physical function (PF). METHODS: 102 consecutive patients with knee OA, 63 women and 39 men, mean age 71 (51-86) assigned for TKR at the Department of Orthopaedics at Lund University Hospital were included in the study. The self-administered questionnaires Knee injury and Osteoarthritis Outcome Score (KOOS) and SF-36 were mailed preoperatively and 6 months, 12 months and at 5 years postoperatively. RESULTS: Response rate at 5 years was 86%. At 6 months significant improvement was seen in all KOOS and SF-36 scores (P<0.001). The percentage of patients performing more demanding functions related to sports and recreation increased postoperatively. The best postoperative result was reported at the 1 year follow-up. Compared to the 1 year follow-up, a significant (P
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| 33. |
- Nilsdotter, Anna, et al.
(författare)
-
Age and waiting time as predictors of outcome after total hip replacement for osteoarthritis
- 2002
-
Ingår i: Rheumatology. - : Oxford University Press (OUP). - 1462-0332 .- 1460-2172. ; 41:11, s. 1261-1267
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate in a prospective study the relationship between age, pre-operative status, waiting time and post-operative outcome in patients assigned for unilateral total hip replacement (THR) due to osteoarthritis (OA). Method. One hundred and forty-eight patients (mean age 71 yr) with primary OA of the hip were investigated pre-operatively and 3, 6 and 12 months post-operatively with the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). For 56 of the patients an additional evaluation was made when they were placed on the waiting list. Results. One hundred and twenty-four patients fulfilled the study criteria (age 50 yr or over and unilateral THR for OA during the study period). Before surgery there were no differences in the WOMAC or SF-36 subscales (except mental health) between patients aged over and under 72 yr. Post-operatively, the younger patients reached a better score than the older patients. There were no differences in pre-operative status or post-operative outcome between the patients who had been on the waiting list more than and less than 3 months. Most pain relief after hip replacement was obtained by 3 months, while it took at least 1 yr to reach the full benefit in improved function. Ninety per cent of the patients had improved by at least 10 points on a 100-point scale for pain and function at 12 months. Conclusion. The age of the patients assigned for THR did not determine their pre-operative status. However, younger patients gained more function post-operatively than older patients and reached higher absolute mean SF-36 values, except for pain. An average difference in time on the waiting list of 3 months did not result in a difference in post-operative outcome. At least 1 yr is required for the average OA patient to gain the full benefit of the THR.
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| 34. |
- Nilsdotter, Anna, et al.
(författare)
-
Hip disability and osteoarthritis outcome score (HOOS) - validity and responsiveness in total hip replacement.
- 2003
-
Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 4:1, s. 1-8
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim of the study was to evaluate if physical functions usually associated with a younger population were of importance for an older population, and to construct an outcome measure for hip osteoarthritis with improved responsiveness compared to the Western Ontario McMaster osteoarthritis score (WOMAC LK 3.0). METHODS: A 40 item questionnaire (hip disability and osteoarthritis outcome score, HOOS) was constructed to assess patient-relevant outcomes in five separate subscales (pain, symptoms, activity of daily living, sport and recreation function and hip related quality of life). The HOOS contains all WOMAC LK 3.0 questions in unchanged form. The HOOS was distributed to 90 patients with primary hip osteoarthritis (mean age 71.5, range 49-85, 41 females) assigned for total hip replacement for osteoarthritis preoperatively and at six months follow-up. RESULTS: The HOOS met set criteria of validity and responsiveness. It was more responsive than WOMAC regarding the subscales pain (SRM 2.11 vs. 1.83) and other symptoms (SRM 1.83 vs. 1.28). The responsiveness (SRM) for the two added subscales sport and recreation and quality of life were 1.29 and 1.65, respectively. Patients 66 years of age (range 67-85) (Pain SRM 2.60 vs. 1.97, other symptoms SRM 3.0 vs. 1.60, activity of daily living SRM 2.51 vs. 1.52, sport and recreation function SRM 1.53 vs. 1.21 and hip related quality of life SRM 1.95 vs. 1.57). CONCLUSION: The HOOS 2.0 appears to be useful for the evaluation of patient-relevant outcome after THR and is more responsive than the WOMAC LK 3.0. The added subscales sport and recreation function and hip related quality of life were highly responsive for this group of patients, with the responsiveness being highest for those younger than 66.
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| 35. |
- Nilsdotter, Anna, et al.
(författare)
-
Knee arthroplasty: are patients' expectations fulfilled?
- 2009
-
Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 80:1, s. 55-61
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose With an aging population expecting an active life after retirement, patients' expectations of improvement after surgery are also increasing. We analyzed the relationship between preoperative expectations and postoperative satisfaction and self-reported outcomes with regard to pain and physical function after knee arthroplasty. Patients and methods 102 patients (39 men) with knee osteoarthritis and who were assigned for TKR (mean age 71 (51-86) years) were investigated with KOOS, SF-36, and additional questions concerning physical activity level, expectations, satisfaction, and relevance of the outcome to the patient. These investigations took place preoperatively and postoperatively after 6 months, 1 year, and 5 years of follow-up. Results Response rate at 5 years was 86%. In general, the patients' preoperative expectations were higher than their postoperative ability. For example, 41% expected to be able to perform activities such as golfing and dancing while only 14% were capable of these activities at 5 years. Having high or low preoperative expectations with regard to walking ability or leisure-time activities had no influence on the KOOS scores postoperatively. 93% of the patients were generally satisfied 5 years postoperatively, while 87% were satisfied with the relief of pain and 80% with their improvement in physical function at that time. Interpretation With an expanding population of mentally alert elderly, we can expect that great demands will be put on joint replacements. This study shows that patients have high preoperative expectations concerning reduction of pain. To a considerable extent, these expectations are fulfilled after one year. Expectations concerning demanding physical activities are not fulfilled to the same degree; however, most patients reported general satisfaction with the outcome indicating that satisfaction is not equivalent to fulfilled expectations. Preoperative counseling should include realistic information on outcomes concerning physical function and pain relief.
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| 36. |
- Nilsdotter, Anna, 1962-, et al.
(författare)
-
Measures of hip function and symptoms : Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH), and American Academy of Orthopedic Surgeons (AAOS) Hip and Knee Questionnaire
- 2011
-
Ingår i: Arthritis care & research. - Hoboken, USA : John Wiley & Sons. - 2151-4658 .- 2151-464X. ; 63:Suppl 11, s. S200-207
-
Tidskriftsartikel (refereegranskat)abstract
- Outcome measures included in this review are the Harris Hip Score, the Hip Disability and Osteoarthritis Outcome Score, the Oxford Hip Score, the Lequesne Index of Sever- ity for Osteoarthritis of the Hip, and the American Acad- emy of Orthopedic Surgeons Hip and Knee Questionnaire.The outcome measures chosen are the most common ones in the literature concerning hip function and symp- toms. Most of them are patient-reported. The selected mea- sures meet the basic requirements for an outcome mea- surement, although there are shortcomings in a few of them.
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| 37. |
- Nilsdotter, Anna, et al.
(författare)
-
Measures of Hip Function and Symptoms
- 2011
-
Ingår i: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 63, s. 200-207
-
Tidskriftsartikel (refereegranskat)
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| 38. |
- Nilsdotter, Anna, et al.
(författare)
-
Patient relevant outcome 7 years after total hip replacement for OA - a prospective study.
- 2010
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 11
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: To investigate prospectively the patient-relevant outcome 7 years after total hip replacement (THR) for osteoarthritis (OA). METHODS: 219 consecutive patients (120 women) with primary OA, mean age 71 (range 50-92) were assigned for THR. They were examined preoperatively, at 3, 6, 12 months, and at 4, 5 and 7 years postoperatively with the self-administered questionnaires SF-36 and WOMAC. Supplementary questions regarding postoperative complications, general co-morbidity, social circumstances and patient satisfaction were asked at the three last follow-ups. A reference group, 117 subjects (67 women), mean age 72 (range 52-92) without hip complaints were recruited from the community and investigated at the same times. RESULTS: 151/170 (89%) of the patients and 65/74 (88%) of the reference group participated at the 7 year follow-up. The best postoperative result was reported one year postoperatively. At the 7 year follow up there was a significant difference between the patients and controls in SF-36 physical function (PF) and role physical (RP) but not of WOMAC function. There was no difference in frequency of co-morbid conditions between those operated and the reference group, but those operated were in greater need of walking aid (46% vs. 8% p < 0.0001) and reported more regional and widespread pain (68% vs. 53% p < 0.05). CONCLUSION: This study shows that in an unselected cohort the patients experience a similar health-related quality of life as a reference group of a similar age and sex structure 7 years after THR except for general physical function where the patients score worse.
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| 39. |
- Nilsdotter, Anna
(författare)
-
Patient Relevant Outcome after Total Hip Replacement in Osteoarthritis
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of the study was to evaluate patient relevant outcome after total hip replacement (THR) in patients with primary osteoarthritis (OA). 247 patients >50 years of age with primary hip OA, operated on with THR (Sept1995—Oct1998), were investigated consecutively and prospectively. 68 of the THR were made with hybrid technique. A preoperative radiographic classification was made. Evaluation with SF-36 and WOMAC was done before surgery and 3, 6, 12 months after surgery. A 3.6-year follow-up was made, which was completed with questions about co-morbidity. An additional functional evaluation for 28 of the patients was made with FAS. For comparison a matched reference group (n=117) was recruited. There was no difference in preoperative or postoperative pain and physical impairment between patients with moderate or severe radiographic OA. The pain and function scores of WOMAC and SF-36 showed greater responsiveness than FAS. Before surgery there were no differences in the WOMAC or SF-36 subscales (except mental health) between patients older or younger than 72. After surgery the younger attained a better score for WOMAC function and all subscales of SF-36 except pain. There were no differences in outcome between patients operated on with hybrid or cemented THR. A higher degree of pain preoperatively and older age predicted a worse outcome in WOMAC function 3.6-years after surgery and low back pain was the only characteristic of the patients with a non-successful result. The patients reached the same level of health related quality of life 3.6 years after THR as a matched reference group, with the exception of physical function. Musculoskeletal co-morbidity was the explanation for this difference. Patients with a poor status before surgery did not attain as good outcome as patients with a better status before surgery. Operative treatment earlier in the course of hip OA could be suggested.
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| 40. |
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| 41. |
- Nilsdotter, Anna, et al.
(författare)
-
Radiographic stage of osteoarthritis or sex of the patient does not predict one year outcome after total hip arthroplasty
- 2001
-
Ingår i: Annals of the Rheumatic Diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 60:3, s. 228-232
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate whether patients with severe radiographic osteoarthritis (OA) have a different outcome at one year after total hip replacement than patients with moderate radiographic OA. To investigate sex related differences in preoperative radiographic and self reported status and in postoperative outcome.METHODS: 184 patients (96 women) with a mean age at surgery of 71.4 years (50-92), with primary OA of the hip were investigated preoperatively and six and 12 months postoperatively with two self administered questionnaires, SF-36 and WOMAC. The radiographs were evaluated by two independent radiologists using an atlas. Minimal joint space narrowing, osteophytes, cysts, sclerosis, and deformity were assessed. A summary grade 0-3 was made, based on joint space, where 3 is severe OA. The reference population for SF-36 consisted of 2901 subjects matched for age and sex from the general Swedish population.RESULTS: 162 patients fulfilled the study criteria. 113 had grade 3, 47 grade 2, and two grade 1 radiographic OA. There was no difference in preoperative or postoperative pain and physical impairment between patients with moderate and severe radiographic OA. There were no sex related differences in preoperative radiographic status, or in postoperative outcome. Neither were any differences in preoperative radiographic status of OA found in patients with previous total hip replacement of the contralateral hip, compared with those who had not been operated on before. All patients, regardless of preoperative radiographic OA stage, showed significant postoperative improvement and at one year achieved a health related quality of life similar to that of the reference group.CONCLUSION: The severity of radiographic changes indicating OA often weighs heavily in the surgeons decision to perform a total hip replacement. Yet, the findings of this study emphasise that the preoperative radiographic stage of OA has no correlation with the postoperative outcome after one year. Furthermore, this study failed to detect any sex related differences in preoperative radiographic and self reported status or in postoperative outcome of hip replacement.
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| 42. |
- Nilsdotter-Linde, Nilla, et al.
(författare)
-
Agro-ecological indicators to assess the effect of grazing at farm level
- 2024
-
Konferensbidrag (refereegranskat)abstract
- The Grazing4AgroEcology (G4AE) project is an EU network to promote grazing and support grazingbased farms on their economic and ecologic performances as well on animal welfare across eight European countries (France, Germany, Ireland, Italy, the Netherlands, Portugal, Romania, Sweden). Five principles of agroecology were adopted by the project and used as the base to determine agro-ecological indicators for the assessment of the grazing capacities at farm level: (1) Adopting management practices that aim to improve animal health, (2) reducing the inputs required for production, (3) reducing the risk of pollution by optimising the biogeochemical functioning of farming systems, (4) enhancing diversity within production systems to strengthen their resilience, and (5) preserving biodiversity in agro-ecosystems by adapting management practices. These indicators were implemented into a self-assessment tool that allows farmers to assess their own farm performance in order to make targeted improvements. The tool was trialled on eight farms in France and four farms in Ireland. The results have provided the farmers with a quantified assessment on the agro-ecological performance of their farms. It provides a basis for the dissemination and implementation of best practices within each farm and gives an insight into the potential to improve on-farm performance.
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| 43. |
- Nilsdotter-Linde, Nilla, et al.
(författare)
-
Grazing4AgroEcology – EU-projekt för ökad betesdrift
- 2023
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Ingår i: Svenska vallbrev. - 1653-8064. ; , s. 5-6
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Grazing4AgroEcology (G4AE) är ett EU-finansierat projekt för att stödja lantbrukare i betesbaserad djurhållning och sprida kunskap om framgångsrika metoder för effektiv betesdrift. Målet är att vända trenden med minskande bete. G4AE pågår september 2022–februari 2026 med deltagare från åtta EU-länder. Svenska partners är SLU och Svenska Vallföreningen. Genom projektet finns stora möjligheter att öka kunskapsnivån inom såväl rådgivning, forskning som praktiskt genomförande gällande bete.
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| 44. |
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| 45. |
- Strömholm, Christer, et al.
(författare)
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Christer Strömholm. Fotografen som kom in från kylan
- 2022
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Ingår i: Christer Strömholm. Porträtt i Paris. - Stockholm : Nationalmuseum. - 9789171009173
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- En text om hur fotografen Christer Strömholms karriär och etablering som en central person i svensk fotografi.
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| 46. |
- Törnblom, Margareta, et al.
(författare)
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Development of radiographic knee osteoarthritis and the associations to radiographic changes and baseline variables in individuals with knee pain : a 2-year longitudinal study
- 2024
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Ingår i: BMJ Open. - London : BMJ Publishing Group Ltd. - 2044-6055. ; 14:3
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim was to study the development of radiographic knee osteoarthritis (RKOA) in individuals with knee pain over 2 years, and the associations between radiographic changes and baseline variables.Design: Longitudinal cohort study.Participants and setting: This study is part of the Halland Osteoarthritis cohort. The included 178 individuals, aged 30-67, had knee pain, without cruciate ligament injury or radiographic findings and 67% were women. The presence of RKOA was defined as Ahlbäck score of ≥1 in ≥1 knee. (Ahlbäck grade 1: joint space narrowing in the tibiofemoral joint <3 mm). Diagnosis of clinical KOA was based on the clinical guideline from the National Institute for Health and Care Excellence (NICE). Knee injury and Osteoarthritis Outcome Score (KOOS), pain intensity, physical function, body mass index (BMI) and visceral fat area (VFA) were measured. Associations to RKOA were analysed with logistic regression (OR).Results: In all, 13.8% (n=24) developed RKOA in 2 years whereof all had clinical KOA at baseline, as defined by NICE. Deterioration to RKOA was significantly associated with higher BMI, OR 1.119 (95% CI 1.024 to 1.223; p=0.013), and VFA, 1.008 (95% CI 1.000 to 1.016; p=0.049), worse knee pain intensity, 1.238 (95% CI 1.028 to 1.490; p=0.024), worse scores for KOOS Pain, 0.964 (95% CI 0.937 to 0.992; p=0.013) and KOOS Symptoms, 0.967 (95% CI 0.939 to 0.996; p=0.027), KOOS Activities of daily living 0.965 (95% CI 0.935 to 0.996; p=0.026) and KOOS Quality of Life 0.973 (95% CI 0.947 to 0.999; p=0.044), at baseline.Conclusions: One out of seven individuals with clinical KOA developed RKOA in only 2 years. Baseline variables associated with RKOA after 2 years may possibly be detected early by using the NICE guideline, assessment of obesity and self-reported data of symptoms to support first-line treatment: education, exercise and weight control. © Author(s) (or their employer(s)) 2024.
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- Törnblom, M., et al.
(författare)
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Prevalence of Early Symptomatic Knee Osteoarthritis According to Three Clinical Classification Criteria
- 2021
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 80, s. 1330-1330
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Tidskriftsartikel (refereegranskat)abstract
- Knee osteoarthritis (KOA) is a heterogeneous disease. Different classification criteria for symptomatic KOA (SKOA) have been proposed. Determining the prevalence and comparing the different criteria of SKOA in patients with knee pain will serve as a base when studying the predictive ability of these criteria in a longer perspective.Objectives:To study the prevalence of SKOA in individuals with knee pain according to three different classification criteria: the American College of Rheumatology (ACR), (1), the European League Against Rheumatism (EULAR)(2), and the National Institute for Health and Care Excellence (NICE) (3).Methods:Baseline data from an ongoing longitudinal study (HALLOA) including 296 individuals with knee pain, recruited by advertisement, were analysed. The individuals were categorized according to the classification criteria of SKOA (ACR, EULAR and NICE) based on age, clinical examination (crepitation), and self-reported data from KOOS (pain, symptoms, ADL, and sport/recreation), and dichotomized as fulfilling the criteria (SKOA) or not (no SKOA). BMI was measured (kg/m2). Radiographic KOA (RKOA) was assessed according to Ahlbäck criteria (1-5), defined as RKOA with grade 1 or more in at least one knee. Prevalence was calculated (frequencies, %) for each criterion, and Chi-Square test or the Independent-Samples t-test were used for comparisons between individuals fulfilling SKOA or not.Results:The mean age was 52 (min-max 24-73) years, 70% were women and 22% were classified with RKOA. The prevalence of SKOA according to each criterion was 57% (ACR), 51% (EULAR) and 73% (NICE) respectively. In total, 48% had SKOA according to all three criteria and whereof 32% had RKOA, compared to 10% RKOA among individuals with no SKOA. Regardless of the criterion, significantly more individuals classified with SKOA also had RKOA compared to individuals with no SKOA, p<0.001. Those classified as SKOA were significantly older and had higher BMI compared with no SKOA (Table 1).Conclusion:Approximately 50-70% of the individuals with knee pain were classified as having SKOA, where EULAR criteria had the lowest prevalence. A better understanding of early knee pain classification according to different clinical criteria is essential for the ability to capture and follow the long-term prognosis of early SKOA. Further longitudinal studies are needed.References:[1]Altman R et al. Arthritis Rheum. 1986;29(8):1039-49.[2]Zhang W et al. Ann Rheum Dis. 2010;69(3):483-9.[3]Health NIf, Excellence C. UK: National Institute for Clinical Excellence. 2014.Table 1.Comparisons between the ACR, EULAR and NICE criteria of symptomatic knee osteoarthritis, stratified for symptomatic knee osteoarthritis or notACREULARNICETotalOANo OAP-valueOANo OAP-valueOANo OAP-valueN(%)296 (100)170 (57.4)98 (33.1)152 (51.4)114 (38.5)215 (72.6)58 (19.6)Age(Y), Mean (SD)51.6 (8.7)53.3 (7.0)49.0 (10.3)<0.00154.5 (5.1)48.1 (10.8)<0.00154.7 (4.9)40.5 (9.8)<0.001Gender, female (%)208 (70.3)121 (71.2)66 (67.3)0.511108 (58.4)77 (67.5)0.538154 (71.6)36 (62.1)0.160BMI(kg/m2), Mean (SD)26.4 (4.6)26.5 (4.5)25.8 (4.3)0.17926.9 (4.5)25.4 (4.2)0.00526.7 (4.5)24.8 (3.8)0.004RKOA, n (%)64 (21.6) 45 (26.5)12 (12.2)0.00347 (30.9)10 (8.7)<0.00158 (27.0)1 (1.7)<0.001Independent-samples t-test and Chi-2-test. Bold=Significant correlation (p≤0.05). OA = Osteoarthritis. ACR = American College of Rheumatology. EULAR = the European League Against Rheumatism. NICE = the National Institute of Care and Excellence. BMI = Body Mass Index. RKOA = Radiographic Knee Osteoarthritis (Ahlbäck, with grade ≥1 in ≥1 knee).Disclosure of Interests:None declared.
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