| 1. |
- Bremander, Ann B, et al.
(författare)
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Revision in previously satisfied knee arthroplasty patients is the result of their call on the physician, not on pre-planned follow-up : a retrospective study of 181 patients who underwent revision within 2 years
- 2005
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 76:6, s. 785-90
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Degree of satisfaction with a knee arthroplasty is said to be correlated to reduced pain and better function. During a validation of the Swedish Knee Arthroplasty Register in 1997, previously operated patients were asked how satisfied they were with their knee. A subgroup of "satisfied" patients was identified who underwent revision within 2 years of having expressed satisfaction. Our aim was to study the revision diagnosis, to determine whether the problem leading to revision had been discovered as a result of routine follow-up, and also to find out when the symptoms leading to revision had started.METHODS: We retrospectively studied the medical records of 181 patients (181 knees), with a median age of 74 (31-88) years. 68% were women and the median time between primary operation and revision was 8 (3-21) years.RESULTS: Aseptic loosening (74/181) was the most common diagnosis. 2 cases were revised as a result of routine follow-up. 44% of the medical records included reports of pain in the replaced knee prior to answering the satisfaction questionnaire.INTERPRETATION: Few patients were admitted to knee revision surgery due to medical findings discovered during routine follow-up. The term "satisfaction" must be interpreted with care, as it seems to have a more complex meaning for the patients than absence of knee pain.
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| 2. |
- Bremander, Ann
(författare)
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Lower Extremity Function in Arthritis
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to develop and apply self-registered and observed measures of physical function in people with arthritis in the lower extremity. In Paper I, 181 subjects from the Swedish Knee Arthroplasty Register who were satisfied with their primary knee arthroplasty were studied. 44% of the medical records included reports of pain in the replaced knee at the same time as the patients had declared that they were satisfied with their primary operation. Most patients can be trusted to decide when there is a problem with the operated knee. Only 2 of 181 satisfied patients with primary knee arthroplasty were revised as a result of routine follow-up, 132/181 called the healthcare services themselves when there was a problem with the revised knee. In Papers II, I adapted a self-administered questionnaire used for people with knee injury and knee osteoarthritis (OA) to patients with chronic inflammatory arthritis and lower extremity problems. Focus groups and 119 in-patients were included for the validation process. The Rheumatoid and Arthritis Outcome Score (RAOS) is a valid, reliable and responsive questionnaire for assessment of multidisciplinary care. In Paper III, validity and reliability of ten functional performance tests were studied in a cohort of 285 meniscectomized subjects at risk of or with early stage knee OA. The tests "maximum number of knee-bendings in 30 seconds" and "one-leg hop for distance" were capable of discrimination with regard to age, sex and symptoms and had good test-retest reliability. In Paper IV, change in observed physical function, and the predictive value of knee pain and radiographic knee OA for change in observed physical function were studied. Observed physical function (the two tests from Paper III) was assessed twice (mean 7 years) in 173 meniscectomized subjects and 47 control subjects. Radiographic knee OA and knee pain predicted worse deterioration in observed physical function, controlled for age, sex and body mass index (BMI). Similar factors influenced a decline in observed physical function whether the subject had a meniscectomy or not. From this thesis I conclude that a single question of satisfaction is not a valid measure of lower extremity function. The Rheumatoid and Arthritis Outcome Score (RAOS) is a valid, reliable and responsive questionnaire for lower extremity function in people with chronic inflammatory arthritis. "One-leg hop for distance" and "maximum number of knee-bendings in 30 sec" are valid and reliable tests for lower extremity function in people with knee injury and knee osteoarthritis. Observed physical function decline already in midlife and the deterioration is predicted by radiographic knee OA and knee pain.
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| 3. |
- Bremander, Ann, et al.
(författare)
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Non-pharmacological management of musculoskeletal disease in primary care
- 2008
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Ingår i: Baillière's Best Practice & Research. - : Elsevier BV. - 1521-6942 .- 1532-1770. ; 22:3, s. 563-77
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Tidskriftsartikel (refereegranskat)abstract
- Musculoskeletal diseases as a group are one of the most common causes of contact in primary care and the most common causes of disability and long-term sick leave in several Western countries. Pain and dysfunction are often present without any specific findings in the musculoskeletal system, and a strictly biomedical approach is often inadequate. Body structure and function interact with personal and environmental factors, affecting the ability to perform activities and participate in society. It is important to meet these needs in primary care, and non-pharmacological principles such as physical activity and patient education with a cognitive approach are cornerstones in a multimodal management model.
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| 4. |
- Bremander, Ann, et al.
(författare)
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Perception of multimodal cognitive treatment for people with chronic widespread pain : changing one's life plan
- 2009
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Ingår i: Disability and Rehabilitation. - London : Informa Healthcare. - 0963-8288 .- 1464-5165. ; 31:24, s. 1996-2004
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Tidskriftsartikel (refereegranskat)abstract
- Purpose.The aim of this study was to gain a deeper understanding of chronic widespread pain patients' perception of a multimodal treatment with a cognitive approach.Methods.A reformulated grounded theory study based on interviews with 16 participants in the programme was conducted at the end of a 6-month treatment period.Results.The result describes a conceptual model of the informants' perception of the treatment. The core category 'changing one's life plan' comprised of three categories: 'changing one's perception of life', 'depending on support' and 'managing one's life'. Changing one's perception of life could be deep and overwhelming 'overall life changes' or more superficial 'life adjustments'. Support by health professionals and the patient group were of importance. At the end of the rehabilitation program managing one's life was perceived as either 'reorientation' or 'stagnation'. The informants who experienced overall life changes achieved reorientation with support by others, while those who experienced life adjustments did not change their way of managing one's life to any great extent.Conclusion.The core category changing one's life plan included the categories; changing one's perception of life, depending on support and managing one's life. Informants experiencing overall life changes were more likely to achieve reorientation than those who experienced life adjustments
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| 5. |
- Bremander, Ann, et al.
(författare)
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Validity and reliability of functional performance tests in meniscectomized patients with or without knee osteoarthritis
- 2007
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Ingår i: Scandinavian Journal of Medicine and Science in Sports. - : Wiley. - 0905-7188 .- 1600-0838. ; 17:2, s. 120-7
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Reduced functional performance and muscular dysfunction after knee injury and in knee osteoarthritis (OA) is suggested to be a factor in OA development. Validated functional performance tests applicable in the clinic and large-scale studies are lacking. The aim was to study the reliability and validity of 10 functional performance tests.METHODS: Two hundred and eighty-five subjects, 15-22 years post-meniscectomy, performed 10 functional performance tests. The mean age was 54 years (SD+/-11.2) and 79% were men; 52% had radiographic OA, and 48% were categorized as symptomatic. The tests were evaluated for test-retest reliability, discriminative ability (younger vs older age, men vs women, symptom-free vs symptomatic) and floor and ceiling effects.RESULTS: Two of the 10 tests, maximum number of knee bendings in 30 s and one-leg hop for distance, had good test-retest reliability (ICC 0.92, 95% CI 0.86-0.96 and 0.93, 95% CI 0.87-0.97) and were able to discriminate with regard to age, gender and symptoms, and had acceptable floor effects (9% and 3%, respectively).CONCLUSION: This study suggests the use of two functional performance tests: knee bendings/30 s and one-leg hop for distance, easy to use for evaluation of interventions due to knee injury and knee OA and when attaining long-term data of natural disease history.
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| 6. |
- Haglund, Emma K., 1970-, et al.
(författare)
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Aerobic capacity in patients with rheumatoid arthritis : A comparison of two submaximal test methods
- 2009
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Ingår i: Musculoskeletal Care. - Chichester : John Wiley & Sons. - 1478-2189 .- 1557-0681. ; 7:4, s. 288-299
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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.
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| 7. |
- Roos, Ewa, et al.
(författare)
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Change in self-reported outcomes and objective physical function over 7 years in middle-aged subjects with or at high risk of knee osteoarthritis
- 2008
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Ingår i: Annals of the Rheumatic Diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 67:4, s. 505-510
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Describe the clinical course and predictors of change in self-reported outcomes and objectively assessed physical function over time in middle-aged subjects at high risk of, or with knee osteoarthritis (OA). METHODS: We examined 259 subjects (mean age 52.6 [SD 10.4]) at mean 18 and 25 years after previous meniscectomy and 50 population-based age- and sex-matched reference subjects with the Knee injury and Osteoarthritis Outcome Score (KOOS), one-leg hop for distance and number of knee-bendings in 30 seconds. Radiographic OA was defined as equivalent to Kellgren & Lawrence grade 2 or worse. RESULTS: At first assessment, meniscectomized subjects reported worse pain, function and quality of life compared with the reference group (p<0.001). They also performed fewer knee-bendings per 30 sec (27 vs. 31, p=0.02). The meniscectomized patients worsened over the 4 to 10 year observation time in all measured outcomes (p<0.001), and to a greater extent than the reference group in pain (-5, 95% CI -10,0) and one-leg hop (-11, 95% CI -18,-3). Being a woman, or having radiographic knee OA, enhanced the worsening in both self-reported and objectively assessed outcomes. Older age and a higher BMI influenced objectively assessed physical function, but not self-reported outcomes. CONCLUSION: Worsening over time in knee-related pain and function is greater in meniscectomized subjects compared with reference subjects. Rehabilitative efforts may be warranted in middle-aged meniscectomized patients, especially in women and those who have developed radiographic knee OA, who are at greater risk of worsening.
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| 8. |
- Strömbeck, Britta, et al.
(författare)
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Patients with ankylosing spondylitis have increased sick leave—a registry-based case-control study over 7 yrs
- 2009
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Ingår i: Rheumatology. - Oxford : Oxford University Press. - 1462-0324 .- 1462-0332. ; 48:3, s. 289-292
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Using prospectively collected registry data to investigate sick leave (sickness benefit and sickness compensation) over a 7-yr period in patients with AS in comparison with population-based controls matched for age, sex and residential area.METHODS: We investigated 122 (21 women and 101 men) outpatients with AS in South Sweden, born 1942 or later, from rheumatology specialist care for their sick leave during a 7-yr period. Mean (S.D.) age was 43 (11) yrs and mean (S.D.) disease duration was 20 (11) yrs. Two controls per case, matched for age, sex and residential area were selected from the Swedish National Population Register. Data concerning sick leave for cases and controls, based on the subjects' unique 10-digit personal identification number, were retrieved from the national register of the Swedish Social Insurance Agency.RESULTS: More AS patients than controls were registered for sickness benefit (52 vs 36%, P < 0.01) and sickness compensation (42 vs 11%, P < 0.001). Cases had an increased risk for sick leave compared with controls with a relative risk of 1.8; 95% CI 1.5, 2.1; and cases had more days with sick leave than controls (median number of more days per year 30; 95% CI 2, 72).CONCLUSIONS: Using the Swedish Social Insurance Agency's registers for sick leave, we found that patients with AS in rheumatology specialist care in South Sweden have an increased level of sick leave compared with controls. These population-based registers have a great potential for studies of the effects of different interventions on sick leave. © 2009 The Author(s).
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