| 1. |
- Ahlstrand, Inger, et al.
(författare)
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Pain and activity limitations in women and men with contemporary treated early RA compared to 10 years ago: the Swedish TIRA project
- 2015
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Ingår i: Scandinavian Journal of Rheumatology. - : Informa Healthcare. - 0300-9742 .- 1502-7732. ; 44:4, s. 259-264
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To study differences regarding pain and activity limitations during the 3 years following diagnosis in women and men with contemporary treated early RA compared with their counterparts who were diagnosed 10 years earlier. Method: This study was based on patients recruited to the Early Intervention in RA (TIRA) project. In the first cohort (TIRA-1) 320 patients were included in time for diagnosis during 1996-1998 and 463 patients were included in the second cohort (TIRA-2) during 2006-2009. Disease activity, pain intensity (Visual Analogue Scale, VAS), bodily pain (BP) in the 36-item Short Form Health Survey (SF-36), activity limitations (Health Assessment Questionnaire, HAQ), and medication were reported at inclusion and at follow-up after 1, 2, and 3 years. Results: Disease activity, pain, and activity limitations were pronounced at inclusion across both genders and in both cohorts, with some improvement observed during the first year after diagnosis. Disease activity did not differ between cohorts at inclusion but was significantly lower at the follow-ups in the TIRA-2 cohort, in which the patients were prescribed traditional disease-modifying anti-rheumatic drugs (DMARDs) and biological agents more frequently. In TIRA-2, patients reported significantly lower pain and activity limitations at all follow-ups, with men reporting lower pain than women. Women reported significantly higher activity limitations at all time points in TIRA-2. Conclusions: Pain and activity limitations were still pronounced in the contemporary treated early RA cohort compared with their counterparts diagnosed 10 years earlier and both of these factors need to be addressed in clinical settings.
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| 2. |
- Ahlstrand, Inger, et al.
(författare)
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Pain and difficulties performing valued life activities in women and men with rheumatoid arthritis
- 2015
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Ingår i: Clinical Rheumatology. - : Springer Verlag (Germany). - 0770-3198 .- 1434-9949. ; 34:8, s. 1353-1362
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to examine the difficulties with performing valued life activities in relation to pain intensity in women and men with rheumatoid arthritis (RA). In total, 737 persons with RA (73 % women) from three rheumatology units in Sweden responded to a questionnaire measuring performance of 33 valued life activities and self-rated pain. The relationships between performance of valued life activities (VLAs) and pain (measured by visual analogue scale (VAS)) were analysed based on gender. Multiple linear regression analyses were conducted with the total VLA score as dependent variable. Women reported more pain and difficulties in performing valued life activities than men. Across genders, 85 % reported at least one valued life activity affected by RA. Significantly more women than men encountered difficulties in performing some activities such as cooking, gardening and meeting new people. Women reported higher pain intensity (35 mm) than men (31 mm). Almost all 33 difficulty ratings for valued life activities were higher among persons with high pain (greater than 40 mm) than persons with lower pain. Difficulty ratings for valued life activities correlated positively with pain in persons with lower pain, but not among those with high pain. The results highlight the importance of addressing pain, especially among women with RA, as they reported pain to impact on their valued life activities. Interestingly, this was evident also in women with lower levels of pain.
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| 3. |
- Ahlstrand, Inger
(författare)
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Pain and its relation to participation in valued activities in rheumatoid arthritis
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There has been a dramatic change over the past two decades for persons with rheumatoid arthritis (RA) not only due to early diagnosis, structured treatment, and aggressive medication but also due to an increased demand of participation in work life and society. Despite these treatment changes, RA continues to impact these individuals’ participation in valued daily activities. Participation in valued daily activities provides wellbeing and the opportunity for engagement and participation. By persons with RA pain has been highlighted as one of the most restrictive symptoms. This thesis uses the International Classification of Functioning, Disability, and Health (ICF) as a conceptual framework to describe disability and how participation is related to pain.Aims: The overall aim of this thesis was to explore and describe the relationship between pain and participation in valued activities, in RA. Paper I compared pain and activity limitations in women and men with contemporary treated early RA with persons who were diagnosed ten years earlier. Paper II described experiences of pain and pain’s relationship with daily activities. Paper III examined difficulties performing valued life activities in relation to pain intensity. Paper IV described personal factors, including self-efficacy and pain acceptance, and studied whether personal factors are mediators of the relationbetween pain and performance of valued life activities.Methods: Different methodological approaches were used to provide a comprehensive understanding of pain and participation in valued activities in persons with RA. A prospective longitudinal cohort study was used to compare women and men treated with contemporary treated RA (n=276) with their counterparts ten years earlier (n=373) (Paper I). This study was followed by a focus group study where 33 persons with RA participated in seven focus groups (Paper II). Subsequently, Papers III and IV were conducted based on data from The Swedish Rheumatology Quality Registry (SRQ) and data from a postal questionnaire that gathered data on demographics, pain, personal factors, and participation in valued life activities (n=737). In addition, these studies used descriptive and analytical statistics with multiple regression and structural equation modelling (SEM).Results: Pain and activity limitations were still pronounced in women and men with RA despite recent treatment advances (Paper I). The relationship between participation and pain was dynamic and is related to fatigue, stress, and mood, factors that generated difficulties finding a suitable level of activity, resulting in difficulties balancing daily activities (Paper II). Both women and men reported restrictions in participation in valued life activities. Pain was identified as having an important relationship to difficulties performing valued life activities (Paper III). Personal factors were found important as mediators for pain in relation to participation (Paper IV).Conclusions: This thesis found a continued need for multidisciplinary interventions despite current treatments. Pain was identified as related to participation restrictions and had an important relationship to difficulties performing valued life activities. Pain and participation in valued activities needs to be comprehensively analysed and treated in the context of the person’s perspective and needs and demands of persons with RA. The subjective experience of participation, the engagement, must be highlighted. Personal factors mediated the relationship between pain and participation and this finding supports the value of self-management interventions to enable participation in valued activities
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| 4. |
- Ahlstrand, Inger, et al.
(författare)
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Self-efficacy and pain acceptance as mediators of the relationship between pain and performance of valued life activities in women and men with rheumatoid arthritis
- 2017
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Ingår i: Clinical Rehabilitation. - : Sage Publications. - 0269-2155 .- 1477-0873. ; 31:6, s. 824-834
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study whether personal factors (self-efficacy and pain acceptance) mediate the relationship between pain and performance of valued life activities in persons with rheumatoid arthritis.METHODS: Persons with rheumatoid arthritis for at least four years (n = 737; 73% women) answered a questionnaire measuring self-efficacy, pain acceptance, performance of valued life activities, and self-rated pain. Relationships among these constructs were explored using univariate and multivariate analyses. Structural equation modelling was then used to examine the mediational role of personal factors on the relationship between pain and performance of valued life activities.RESULTS: A direct negative association between pain and performance of valued life activities was identified (Beta = .34, P < .001). This suggests that people with rheumatoid arthritis who had higher levels of pain has increased difficulties in performing valued life activities. Self-efficacy and activity engagement component of pain acceptance mediated the relationship between pain and performance of valued life activities, however the pain willingness component of pain acceptance did not influence participation in valued life activities.CONCLUSION: These findings highlight the importance of considering personal factors, such as pain acceptance and self-efficacy, in facilitating participation in valued life activities.
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| 5. |
- Bergström, Maria, et al.
(författare)
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Like the worst toothache you've had - How people with rheumatoid arthritis describe and manage pain
- 2017
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Ingår i: Scandinavian Journal of Occupational Therapy. - : TAYLOR & FRANCIS LTD. - 1103-8128 .- 1651-2014. ; 24:6, s. 468-476
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Tidskriftsartikel (refereegranskat)abstract
- Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease often associated with disability. Despite new treatments, pain and activity limitations are still present. Objectives: To describe how persons with RA experience and manage pain in their daily life. Methods: Seven semi-structured focus groups (FGs) were conducted and analyzed using content analysis. Results: The analysis revealed four categories: 1) Pain expresses itself in different ways referred to pain as overwhelming, aching or as a feeling of stiffness. 2) Mitigating pain referred to the use of heat, cold, medications and activities as distractions from the pain. 3) Adapting to pain referred to strategies employed as coping mechanisms for the pain, e.g. planning and adjustment of daily activities, and use of assistive devices. 4) Pain in a social context referred to the participants social environment as being both supportive and uncomprehending, the latter causing patients to hide their pain. Conclusions: Pain in RA is experienced in different ways. This emphasizes the multi-professional team to address this spectrum of experiences and to find pain management directed to the individual experience that also include the persons social environment.
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| 9. |
- Bjurehed, Linda, et al.
(författare)
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Improved Hand Function, Self-Rated Health, and Decreased Activity Limitations: Results After a Two-Month Hand Osteoarthritis Group Intervention
- 2018
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Ingår i: Arthritis Care & Research. - : Wiley. - 2151-464X .- 2151-4658. ; 70:7, s. 1039-1045
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo evaluate the effects on hand function, activity limitations, and self-rated health of a primary care hand osteoarthritis (OA) group intervention. Hand OA causes pain, impaired mobility, and reduced grip force, which cause activity limitations. OA group interventions in primary care settings are sparsely reported. MethodsSixty-four individuals with hand OA agreed to participate; 15 were excluded due to not fulfilling the inclusion criteria. The 49 remaining (90% female) participated in an OA group intervention at a primary care unit with education, paraffin wax bath, and hand exercise over a 6-week period. Data were collected at baseline, end of intervention, and after 1 year. Instruments used were the Grip Ability Test (GAT), the Signals of Functional Impairment (SOFI), dynamometry (grip force), hand pain at rest using a visual analog scale (VAS), the Patient-Specific Functional Scale (PSFS), the Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH), and the EuroQol VAS (EQ VAS). Data were analyzed using nonparametric statistics. ResultsHand function, activity limitation, and self-rated health significantly improved from baseline to end of intervention, grip force (right hand: P < 0.001; left hand: P = 0.008), SOFI (P = 0.011), GAT (P < 0.001), hand pain at rest (P < 0.001), PSFS (1: P = 0.008, 2: P < 0.001, and 3: P = 0.004), Quick-DASH (P = 0.001), and EQ VAS (P = 0.039), and the effects were sustained after 1 year. ConclusionThe hand OA group intervention in primary care improves hand function, activity limitation, and self-rated health. The benefits are sustained 1 year after completion of the intervention.
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