| 1. |
- Cronström, Anna, et al.
(författare)
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"I was considering surgery because I believed that was how it was treated" : a qualitative study on willingness for joint surgery after completion of a digital management program for osteoarthritis.
- 2019
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Ingår i: Osteoarthritis and Cartilage. - : Elsevier. - 1063-4584 .- 1522-9653. ; 27:7, s. 1026-1032
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To explore, using a qualitative approach, reasons for patients' continued willingness or their shift in willingness for total joint replacement (TJR) surgery, following participation in Joint Academy, a Swedish, digital, non-surgical treatment program for osteoarthritis (OA).DESIGN: Nineteen patients with hip or knee OA were interviewed after finishing their first six weeks in the treatment program, using a semi-structured interview guide. The interviews were transcribed verbatim and analyzed using a systematic text condensation method.RESULTS: Analysis of the interview data revealed three main categories of reasons provided for the participants' decisions regarding surgery: 1) Various reasons for participating in Joint Academy with three sub-categories: (a) longstanding pain affects daily life, (b) last chance for improvement and (c) mandatory treatment to be eligible for TJR; 2) Willingness for TJR following treatment, which included four sub-categories: (a) surgery - the last resort, (b) reduced pain and improved functioning, (c) no perceived improvements after treatment, and (d) trust in healthcare providers; and 3) Expectations of TJR. The shift in willingness towards or away from TJR was mainly due to the perceived success of Joint Academy in improving their functioning.CONCLUSION: Several patients reconsidered their options and had changed their attitude to TJR after participation in a digital program aimed at reducing OA symptoms and improving functioning. These results highlight the importance of providing patients with adequate information about non-surgical management options to facilitate shared decision-making, and possibly reduce the need for surgery.
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| 2. |
- Dahlberg, Leif, et al.
(författare)
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A Web-Based Platform for Patients With Osteoarthritis of the Hip and Knee: A Pilot Study
- 2016
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Ingår i: Jmir Research Protocols. - : JMIR Publications Inc.. - 1929-0748. ; 5:2
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic conditions are the leading cause of disability throughout the world and the most expensive problem facing the health care systems. One such chronic condition is osteoarthritis (OA), a frequent cause of major disability. Objective: To describe the effect on joint pain for the first users of a newly developed Web-based osteoarthritis self-managing program, Joint Academy, and to examine whether these patients would recommend other OA patients to use the program. Methods: Patients with clinically established knee or hip OA according to national and international guidelines were recruited from an online advertisement. A trained physiotherapist screened the eligible patients by scrutinizing their answers to a standardized questionnaire. The 6-week program consisted of eight 2- to 5-minute videos with lectures about OA, effects of physical activity, self-management, and coping strategies. In addition, exercises to improve lower extremity physical function were introduced in daily video activities. During the course of the program, communication between physiotherapist and patients was based on an asynchronous chat. After 6 weeks, patients were able to continue without support from the physiotherapist. Patients reported their current pain weekly by using a numeric rating scale (range 0-10; 0=no pain, 10=worst possible pain) as long as they were in the program. In addition, after 6 weeks patients answered the question "What is the probability that you would recommend Joint Academy to a friend?" Results: The eligible cohort consisted of 53 individuals (39 women; body mass index: mean 27, SD 5; age: mean 57, SD 14 years). With the continued use of the program, patients reported a constant change in pain score from mean 5.1 (SD 2.1) at baseline to mean 3.6 (SD 2.0) at week 12. Six patients participated for 30 weeks (mean 3.2, SD 2.1). Overall, the patients would highly recommend Joint Academy to other OA patients, suggesting that the platform may be useful for at least some in the vast OA population. Conclusions: Joint Academy, a Web-based platform for OA therapy, has the potential to successfully deliver individualized online treatment to many patients with OA that presently lack access to treatment.
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| 3. |
- Dahlberg, Leif, et al.
(författare)
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Proteoglycan fragments in joint fluid : Influence of arthrosis and inflammation
- 1992
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 0001-6470. ; 63:4, s. 417-423
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Tidskriftsartikel (refereegranskat)abstract
- We determined the concentration of proteoglycan fragments in knee joint fluid collected from knee-ligament injured patients more than 6 months after the trauma and from patients with acute pyrophosphate arthritis and arthrosis or with arthrosis only. Injured patients with normal or only mildly altered cartilage at arthroscopy and with normal radiographs, had twice the average concentration of healthy volunteers. Other injured patients with advanced, radiographic signs of arthrosis, had synovial fluid proteoglycan fragment concentrations within the range of healthy volunteers. Patients with pyrophosphate arthritis had the highest concentrations, substantially increased compared with both arthrosis patients, with or without knee injury and healthy volunteers. Likewise, there was an inverse relation between the degree of arthrosis and the concentration of proteoglycan fragments in the joint fluid in patients with pyrophosphate arthritis and arthrosis or with arthrosis only. We conclude that synovial fluid levels of proteoglycan fragments are influenced by the mass of cartilage matrix remaining in the joint, the inflammatory activity in the joint, and the metabolic activity of the cartilage cells.
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| 4. |
- Lohmander, Stefan, et al.
(författare)
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Increased levels of proteoglycan fragments in knee joint fluid after injury
- 1989
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Ingår i: Arthritis and Rheumatism. - : Wiley. - 0004-3591 .- 1529-0131. ; 32:11, s. 1434-1442
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Tidskriftsartikel (refereegranskat)abstract
- We measured the levels of cartilage proteoglycan (PG) fragments in knee joint synovial fluid obtained from patients with previous trauma of the knee, early gonarthrosis, or pyrophosphate synovitis, and in age-matched control subjects. During the initial 3-4 weeks after rupture of the anterior cruciate ligament or the meniscus (confirmed by arthroscopy), markedly increased PG fragment levels were found. At later times after trauma (up to 4 years), many of these patients still had significantly elevated levels of cartilage PG fragments in the joint fluid. In a group of older patients with gonarthrosis, these levels were only moderately elevated, while in patients with acute pseudogout, greatly increased levels were observed. Although longitudinal studies are needed to validate the significance, PG fragments in joint fluid may be a marker for early posttraumatic arthrosis.
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| 5. |
- Nero, Håkan, et al.
(författare)
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A 6-Week Web-Based osteoarthritis treatment program : Observational quasi-experimental study
- 2017
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 19:12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Osteoarthritis (OA) is one of the most common causes of disability, with a burden of disease estimated to increase over time. Joint Academy, a Web-based treatment for individuals with clinically verified knee or hip OA, was developed to increase access to and facilitate implementation of evidence-based nonsurgical OA treatment in accordance with international guidelines. Objective: The primary aim of this study was to evaluate joint pain, physical function, and health-related quality of life (HRQoL) over time of users of the Joint Academy program. Methods: We enrolled 350 patients who were recruited online and completed the initial health journal in the 6-week program. We asked patients to complete an eHealth journal and e-questionnaires, including pain level assessed by a numerical rating scale, as well as a physical function evaluation using the 30-second chair-stand test. In addition, we assessed HRQoL using the 3-level version of the EQ-5D. We also asked participants whether they experienced difficulty walking and were afraid of physical activity due to their OA and their desire for surgery. We collected descriptive data and compared pre-versus postintervention data. As a reference group, we included results retrieved from the Swedish well-structured face-to-face self-supportive OA management program Better Management of Patients With Osteoarthritis (BOA). Results: Of the study cohort (n=350 patients; 239 women, mean age 62 years, mean body mass index 27 kg/m2), 71.4% (n=250) completed the program and were included in the study. We used the questionnaires to secure a clinical diagnosis of OA and to establish baseline study values. After 6 weeks of treatment, the change in mean numerical rating scale was larger than the minimal clinical difference (5.4 vs 4.1; P<.001), while physical function increased (from 10.88 to 13.14; P<.001). The percentage of participants having walking difficulties decreased from 81.7% (196/240) to 62.1% (149/240; P<.001), those afraid of being physically active decreased from 22.1% (53/240) to 6.7% (16/240; P<.001), and 22.0% (55/250) reported that they had reduced the amount of OA-related medication. After 6 weeks, 24% (13/54) of those desiring surgery at the start of the program were no longer interested. In addition, the comparison between Joint Academy and the BOA program showed similar levels of pain at 3 months, but suggested greater reduction with the use of Joint Academy due to a higher level of pain at baseline. Conclusions: The reported data suggest that participation in Joint Academy is associated with a clinically relevant decrease in pain and an increase in physical function and HRQoL, as well as a decreasing fear of physical activity. This innovative Web-based OA treatment is scalable, is population specific, and can reach a large number of individuals with impaired joints who have Internet access.
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| 6. |
- Adlesic, M., et al.
(författare)
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Histamine in rheumatoid arthritis
- 2007
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Ingår i: Scand J Immunol. - : Wiley. - 0300-9475 .- 1365-3083. ; 65:6, s. 530-7
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Tidskriftsartikel (refereegranskat)abstract
- Rheumatoid arthritis (RA) is an autoimmune disease characterized by a persistent inflammation of the synovium, leading to the erosion of articular cartilage and bone. Synovial mast cells and their effector molecule, histamine, receive increased attention as mediators of joint inflammation. The aim of our study was to analyse levels of free histamine in serum and joint fluid of RA patients and to evaluate the potential inflammatogenic properties of histamine in vivo and in vitro. Histamine levels were measured by an ELISA in synovial fluid and sera of RA patients and of healthy controls. Histamine levels were also assessed in plasma of RA patients undergoing anti-TNF-alpha treatment. In the murine part of the study, histamine was injected intra-articularly in the knee joint of mice and the joints were subsequently analysed with respect to induction of inflammation. RA patients displayed significantly lower levels of histamine in circulation (0.93 +/- 0.16 ng/ml) compared with the healthy controls (1.89 +/- 0.45 ng/ml, P < 0.001). Locally, in synovial fluid the levels of histamine were even lower (0.37 +/- 0.16 ng/ml, P < 0.0006). Long-term anti-TNF-alpha treatment significantly increased circulating levels of histamine in RA patients. Our experiments on animals show that histamine on its own neither induces inflammation in the joint cavity nor influences the course of HMGB1 and peptidoglycan-induced joint inflammation. Based on our experimental and clinical studies we suggest that histamine lacks harmful properties in RA.
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| 7. |
- Ali, Abdulemir, et al.
(författare)
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Dissatisfied patients after total knee arthroplasty
- 2014
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 85:3, s. 229-233
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - In 2003, an enquiry by the Swedish Knee Arthroplasty Register (SKAR) 2-7 years after total knee arthroplasty (TKA) revealed patients who were dissatisfied with the outcome of their surgery but who had not been revised. 6 years later, we examined the dissatisfied patients in one Swedish county and a matched group of very satisfied patients. Patients and methods - 118 TKAs in 114 patients, all of whom had had their surgery between 1996 and 2001, were examined in 2009-2010. 55 patients (with 58 TKAs) had stated in 2003 that they were dissatisfied with their knees and 59 (with 60 TKAs) had stated that they were very satisfied with their knees. The patients were examined clinically and radiographically, and performed functional tests consisting of the 6-minute walk and chair-stand test. All the patients filled out a visual analog scale (VAS, 0-100 mm) regarding knee pain and also the Hospital and Anxiety and Depression scale (HAD). Results - Mean VAS score for knee pain differed by 30 mm in favor of the very satisfied group (p < 0.001). 23 of the 55 patients in the dissatisfied group and 6 of 59 patients in the very satisfied group suffered from anxiety and/or depression (p = 0.001). Mean range of motion was 11 degrees better in the very satisfied group (p < 0.001). The groups were similar with regard to clinical examination, physical performance testing, and radiography. Interpretation - The patients who reported poor response after TKA continued to be unhappy after 8-13 years, as demonstrated by VAS pain and HAD, despite the absence of a discernible objective reason for revision.
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| 8. |
- Arvidsson, Matilda, et al.
(författare)
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Foreward / Foreword : Gardens of Justice
- 2013
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Ingår i: Australian Feminist Law Journal. - : Taylor & Francis. - 2204-0064. ; 39:1, s. 2-2
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Tidskriftsartikel (refereegranskat)abstract
- Our Gardens of Justice special themed issue of the Australian Feminist Law Journal grew out of the 2012 Critical Legal Conference in Stockholm and its theme of Gardens of Justice, a conference organised by Matilda Arvidsson, Merima Bruncevic, Leila Brannstrom and Leif Dahlberg. We issued a Call for Papers early in 2013 in which several conference theme questions were repeated. We called for papers devoted to thinking about law and justice as a physical as well as a social environment. The theme suggested a plurality of justice gardens that may function together but at times also may be at odds with each other. We invited authors to think freely and critically about both the concrete and the metaphorical garden, and invited articles that addressed questions of law and justice as spatial and spatializing structures, as social topography and geography, as political cartography on a global scale, as places where symbolic orders and disorders become visible and may be acted out, as mechanisms of inclusion and exclusion, as masculine and feminine and as social utopia. Later in 2013 we re-issued the Call for Papers emphasizing the metaphorical and the juridical linking of gardens and justice: Gardens and Justice have been joined as figurae, genres and topoi in the classical writings of Virgil, in the Old Testament text of Genesis and the Garden of Eden, in Milton's epic of Paradise Lost, in Blackstone in Commentaries on the Laws of England, and not the last, in Neil Young's lyrics 'After the Garden', in his 2006 album Living with War. These and numerous other texts are peopled by figures who live at home, and others who depart from home. Together, and apart, they invite us to continue their genre of living and writing in a world of imperfection, suffering and violence, while maintaining other possibilities and other beginnings. The AFLJ invited articles which investigated the use of garden narratives, whether in jurisprudential writings, in film, in literary works, in political theory, or postcolonial theory, amongst other disciplinary conventions and media. Amongst the numerous questions which could be pursued, we posed the following: How do garden narratives and their figures structure an understanding of Justice, and for what purposes have gardens and justice been linked in national and international law? Are gardens our images of utopia, heaven, peace, or simply a homecoming from the deserts of life? Do gardens help us understand nations and territory? Are gardens ever secular? Are there historic forms of governance encoded in garden narratives? In what ways do Justice narratives in the 21st century understand the figure who leaves the garden as having a persona as stranger, serf, refugee or simply human, or not-human?
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| 9. |
- Arvidsson, Matilda, 1976, et al.
(författare)
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FOREWORD: GARDENS OF JUSTICE
- 2013
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Ingår i: Australian Feminist Law Journal. - : Informa UK Limited. - 1320-0968 .- 2204-0064. ; 39:1
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 10. |
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