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Gerdle B, Björk M, Rivano Fischer M. Wanted: Robust and Rigorous Scientific Approach to Provide Accurate Insights Into the Effects of IDT on Patients' Outcomes. J Pain 2024; 25:1106-1107. [PMID: 37993031 DOI: 10.1016/j.jpain.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/10/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mathilda Björk
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marcelo Rivano Fischer
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden; Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Turesson C, Liedberg G, Björk M. Evaluating the Clinical Use and Utility of a Digital Support App for Employees With Chronic Pain Returning to Work (SWEPPE): Observational Study. JMIR Hum Factors 2023; 10:e52088. [PMID: 38079212 PMCID: PMC10750230 DOI: 10.2196/52088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The digital app SWEPPE (sustainable worker, a digital support for persons with chronic pain and their employers) was developed to improve the support of people with chronic pain in their return-to-work process after sick leave and includes functions such as the action plan, daily self-rating, self-monitoring graphs, the coach, the library, and shared information with the employer. OBJECTIVE This study aims to describe the use of the smartphone app SWEPPE among people with chronic pain who have participated in an interdisciplinary pain rehabilitation program. METHODS This is a case study including 16 people participating in a feasibility study. The analyses were based on user data collected for 3 months. Quantitative data regarding used functions were analyzed with descriptive statistics, and qualitative data of identified needs of support from the employer were grouped into 8 categories. RESULTS Self-monitoring was used by all participants (median 26, IQR 8-87 daily registrations). A total of 11 (N=16, 69%) participants set a work-related goal and performed weekly evaluations of goal fulfillment and ratings of their work ability. In total, 9 (56%) participants shared information with their employer and 2 contacted the coach. A total of 15 (94%) participants identified a total of 51 support interventions from their employer. Support to adapt to work assignments and support to adapt to work posture were the 2 biggest categories. The most common type of support identified by 53% (8/15) of the participants was the opportunity to take breaks and short rests. CONCLUSIONS Participants used multiple SWEPPE functions, such as daily self-registration, goal setting, self-monitoring, and employer support identification. This shows the flexible nature of SWEPPE, enabling individuals to select functions that align with their needs. Additional research is required to investigate the extended use of SWEPPE and how employers use shared employee information.
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Affiliation(s)
- Christina Turesson
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Gunilla Liedberg
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mathilda Björk
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Castor C, Björk M, Bai J, Berlin H, Kristjansdottir G, Kristjansdottir O, Hansson H, Höök A, Stenström P, Nilsson S. Psychometric evaluation of the electronic faces thermometer scale for pain assessment in children 8-17 years old: A study protocol. Paediatr Neonatal Pain 2023; 5:99-109. [PMID: 38149216 PMCID: PMC10749404 DOI: 10.1002/pne2.12102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 02/13/2023] [Accepted: 02/21/2023] [Indexed: 12/28/2023]
Abstract
It is often a challenge for a child to communicate their pain, and their possibilities to do so should be strengthened in healthcare settings. Digital self-assessment provides a potential solution for person-centered care in pain management and promotes child participation when a child is ill. A child's perception of pain assessment differs when it is assessed using digital or analog formats. As we move into the digital era, there is an urgent need to validate digital pain assessment tools, including the newly developed electronic Faces Thermometer Scale (eFTS). This study protocol describes three studies with the overall aim to evaluate psychometric properties of the eFTS for assessing pain in children 8-17 years of age. A multi-site project design combining quantitative and qualitative methods will be used for three observational studies. Study 1: 100 Swedish-speaking children will report the level of anticipated pain from vignettes describing painful situations in four levels of pain and a think-aloud method will be used for data collection. Data will be analyzed with phenomenography as well as descriptive and comparative statistics. Study 2: 600 children aged 8-17 years at pediatric and dental settings in Sweden, Denmark, Iceland, and USA will be included. Children will assess their pain intensity due to medical or dental procedures, surgery, or acute pain using three different pain Scales for each time point; the eFTS, the Faces Pain Scale Revised, and the Coloured Analogue Scale. Descriptive and comparative statistics will be used, with subanalysis taking cultural context into consideration. Study 3: A subgroup of 20 children out of these 600 children will be purposely included in an interview to describe experiences of grading their own pain using the eFTS. Qualitative data will be analyzed with content analysis. Our pilot studies showed high level of adherence to the study procedure and rendered only a small revision of background questionnaires. Preliminary analysis indicated that the instruments are adequate to be used by children and that the analysis plan is feasible. A digital pain assessment tool contributes to an increase in pain assessment in pediatric care. The Medical Research Council framework for complex interventions in healthcare supports a thorough development of a new scale. By evaluating psychometric properties in several settings by both qualitative and quantitative methods, the eFTS will become a well-validated tool to strengthen the child's voice within healthcare.
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Affiliation(s)
- C. Castor
- Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
| | - M. Björk
- The CHILD Research Group, Department of Nursing, School of Health and WelfareJönköping UniversityJönköpingSweden
| | - J. Bai
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGeorgiaUSA
| | - H. Berlin
- Department of Pediatric Dentistry, Faculty of OdontologyMalmö UniversityMalmöSweden
| | - G. Kristjansdottir
- Faculty of Nursing, School of Health ScienceUniversity of IcelandReykjavikIceland
| | - O. Kristjansdottir
- Faculty of Nursing, School of Health ScienceUniversity of IcelandReykjavikIceland
| | - H. Hansson
- Department of Paediatrics and Adolescent MedicineCopenhagen University Hospital RigshospitaletCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - A. Höök
- Division of Anaesthetics and Sensory Organs Speciality SurgeryLinköping University HospitalLinköpingSweden
| | - P. Stenström
- Department of Pediatric SurgerySkåne University Hospital, Lund UniversityLundSweden
- Department of Paediatrics, Faculty of MedicineLund UniversityLundSweden
| | - S. Nilsson
- Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
- Institute of Health and Care Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
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Högstedt E, Igelström K, Korhonen L, Käcker P, Marteinsdottir I, Björk M. 'It's like it is designed to keep me stressed'-Working sustainably with ADHD or autism. Scand J Occup Ther 2023; 30:1280-1291. [PMID: 36379218 DOI: 10.1080/11038128.2022.2143420] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Adults with attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) face multiple challenges in obtaining and maintaining employment. AIMS To identify and describe how adults with ADHD or ASD experienced their ability to work and what factors affected their ability to find a sustainable work situation over time. METHODS Individual in-depth interviews were performed with 20 purposively sampled participants with ADHD/ASD. Data were analysed inductively using reflexive thematic analysis. RESULTS Three themes were identified, describing (1) one's own cognitive abilities and challenges, (2) enablement by flexibility and acceptance in the work environment, and (3) accumulated stress that makes the work situation unsustainable over time. CONCLUSIONS Over time, a lack of continuity and predictability of support measures caused great stress and exhaustion, with severe consequences for working life and in life in general. Adaptations needed to be individually tailored and include nonoccupational factors. SIGNIFICANCE The study shows that adults with ADHD/ASD need long-term interventions that flexibly adapt to individual needs, as they vary over time. The findings suggest that occupational therapists and other health care providers, employers, employment services and other involved agencies should pay a greater deal of attention to stability and predictability over time.
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Affiliation(s)
- Erika Högstedt
- Community Care Department, The Municipality of Norrköping, Norrköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Kajsa Igelström
- Division of Neurobiology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Laura Korhonen
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Child and Adolescent Psychiatry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Pia Käcker
- Disability Research Division, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Ina Marteinsdottir
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Mathilda Björk
- Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Storm E, Bendelin N, Wessman KB, Johansson MM, Björk M, Dong HJ. Lifestyle changes are burdensome with my body broken by pain and obesity: patients' perspectives after pain rehabilitation. BMC Musculoskelet Disord 2023; 24:840. [PMID: 37880642 PMCID: PMC10599046 DOI: 10.1186/s12891-023-06961-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Despite the existing evidence regarding the interrelated relationship between pain and obesity, knowledge about patients' perspectives of this relationship is scarce, especially from patients with chronic pain and obesity after completing Interdisciplinary Pain Rehabilitation Program (IPRP). AIMS This qualitative study expands the understanding of patients' perspectives on how chronic pain and obesity influence each other and how the two conditions affect the ability to make lifestyle changes. METHOD A purposive sample of patients with Body Mass Index (BMI) ≥ 30 kg/m2 and who had completed an IPRP were recruited for individual semi-structured interviews. The transcribed interviews were analysed using latent content analysis and a pattern of theme and categories was constructed based on the participants' perspectives. RESULTS Sixteen patients (aged 28-63 years, 11 female, BMI 30-43 kg/m2) shared their experiences of chronic pain, obesity and lifestyle changes after IPRP. The analysis revealed one overall theme (lifestyle changes are burdensome with a body broken by both pain and obesity) and four categories (pain disturbing days and nights worsens weight control, pain-related stress makes lifestyle changes harder, a painful and obese body intertwined with negative emotions and the overlooked impact of obesity on chronic pain). Most participants perceived that their pain negatively impacted their obesity, but they were uncertain whether their obesity negatively impacted their pain. Nevertheless, the participants desired and struggled to make lifestyle changes. CONCLUSION After IPRP, patients with chronic pain and obesity perceived difficulties with self-management and struggles with lifestyle changes. They experienced a combined burden of the two conditions. Their perspective on the unilateral relationship between pain and obesity differed from the existing evidence. Future tailored IPRPs should integrate nutritional interventions and address the knowledge gaps as well.
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Affiliation(s)
- Elin Storm
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Nina Bendelin
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Kim Bergström Wessman
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Maria M Johansson
- Department of Activity and Health in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mathilda Björk
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Huan-Ji Dong
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
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Vollertsen J, Björk M, Norlin AK, Ekbladh E. The impact of post-stroke fatigue on work and other everyday life activities for the working age population - a registry-based cohort study. Ann Med 2023; 55:2269961. [PMID: 37851842 PMCID: PMC10586067 DOI: 10.1080/07853890.2023.2269961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/08/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Life after stroke is a comprehensive area that involves engagement in meaningful everyday activities, including work, and can be adversely affected by post-stroke fatigue. This study investigates post-stroke fatigue, its development over time, and its impact on return to work and other everyday life activities. In addition, we investigated whether post-stroke fatigue could predict functioning in everyday life activities one year after stroke. MATERIAL AND METHODS This prospective registry-based study includes 2850 working age (18 - 63 years) patients registered in the Swedish Stroke Register (Riksstroke) during year 2017 and 2018. Post-stroke fatigue and everyday activities were analyzed 3- and 12-months post-stroke. RESULTS The mean age of the included participants was 54 years and the majority, 65%, were men. Three months post-stroke, 43% self-reported fatigue, at 12-months the proportion increased to 48%. About 90% of the patients were independent in basic ADL at 3-month. Dependence in complex activities one year post-stroke was significantly associated with fatigue. Not experiencing fatigue one year after stroke could predict positive functioning in everyday activities, increasing the chance of returning to work (OR = 3.7) and pre-stroke life and everyday activities (OR = 5.7). CONCLUSION Post-stroke fatigue is a common persistent disability that negatively impacts complex activities; therefore, fatigue needs to be acknowledged and addressed long term after discharge.
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Affiliation(s)
- Jessica Vollertsen
- Department of Rehabilitation, and Department of Health, Medicine and Caring Sciences, Linköping University, Motala, Sweden
| | - Mathilda Björk
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anna-Karin Norlin
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Elin Ekbladh
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Svanholm F, Turesson C, Löfgren M, Björk M. Acceptability of the eHealth Intervention Sustainable Worker Digital Support for Persons With Chronic Pain and Their Employers (SWEPPE): Questionnaire and Interview Study. JMIR Hum Factors 2023; 10:e46878. [PMID: 37768708 PMCID: PMC10570892 DOI: 10.2196/46878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/09/2023] [Accepted: 07/28/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Sick leave and decreased ability to work are the consequences of chronic pain. Interdisciplinary pain rehabilitation programs (IPRPs) aim to improve health-related quality of life and participation in work activities, although implementing rehabilitation strategies at work after IPRPs can be difficult. Employers' knowledge about pain and the role of rehabilitation needs to be strengthened. The self-management of chronic pain can be improved through eHealth interventions. However, these interventions do not involve communicating with employers to improve work participation. To address this deficiency, a new eHealth intervention, Sustainable Worker Digital Support for Persons with Chronic Pain and Their Employers (SWEPPE), was developed. OBJECTIVE This study aimed to describe the acceptability of SWEPPE after IPRPs from the perspective of patients with chronic pain and their employers. METHODS This study included 11 patients and 4 employers who were recruited to test SWEPPE in daily life for 3 months after IPRPs. Data were collected using individual interviews at the end of the 3-month test period and questionnaires, which were completed when SWEPPE was introduced (questionnaire 1) and at a 3-month follow-up (questionnaire 2). Data were also collected on how often SWEPPE was used. Qualitative data were analyzed through a qualitative content analysis using an abductive approach. The framework used for the deductive approach was the theoretical framework of acceptability. Quantitative data were analyzed through descriptive statistics and the differences between the responses to questionnaires 1 and questionnaire 2 using the Wilcoxon signed rank test. RESULTS Both patients and employers reported that SWEPPE increased their knowledge and understanding of how to improve work participation and helped them identify goals, barriers, and strategies for return to work. In addition, participants noted that SWEPPE improved employer-employee communication and collaboration. However, experiences and ratings varied among participants and the different SWEPPE modules. The acceptability of SWEPPE was lower in patients who experienced significant pain and fatigue. A high degree of flexibility and choice of ratings in SWEPPE were generally described as helpful. CONCLUSIONS This study shows promising results on the user acceptability of SWEPPE from both patient and employer perspectives. However, the variations among patients and modules indicate a need for further testing and research to refine the content and identify the group of patients who will best benefit from SWEPPE.
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Affiliation(s)
- Frida Svanholm
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Christina Turesson
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Monika Löfgren
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Mathilda Björk
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Bergström M, Larsson Ranada Å, Sverker A, Thyberg I, Björk M. A dyadic exploration of support in everyday life of persons with RA and their significant others. Scand J Occup Ther 2023; 30:616-627. [PMID: 34846249 DOI: 10.1080/11038128.2021.2007997] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 10/22/2021] [Accepted: 11/13/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Support from significant others is important for participation in everyday life for persons with rheumatoid arthritis (RA). Meanwhile, significant others also experience limitations. AIMS To explore how support is expressed by persons with RA and significant others, and how support relates to participation in everyday life of persons with RA. MATERIAL AND METHODS Sixteen persons with RA and their significant others participated in individual semi-structured interviews. The material was analyzed using dyadic analysis. RESULTS Persons with RA and significant others reported that RA and support had become natural parts of everyday life, especially emotional support. The reciprocal dynamics of support were also expressed as imperative. Also, support from people outside of the dyads and well-functioning communication facilitated everyday life. CONCLUSIONS Significant others and the support they give are prominent factors and facilitators in everyday life of persons with RA. Concurrently, the support persons with RA provide is important, along with support from outside of the dyads. SIGNIFICANCE The results indicate that the interaction between persons with RA and the social environment is central to gain insight into how support should be provided for optimal participation in everyday life. Significant others can preferably be more involved in the rehabilitation process.
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Affiliation(s)
- Maria Bergström
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Åsa Larsson Ranada
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Annette Sverker
- Department of Activity and Health and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ingrid Thyberg
- Department of Rheumatology in Östergötland, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Mathilda Björk
- Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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9
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Ritschl V, Sperl L, Andrews MR, Björk M, Boström C, Cappon J, Davergne T, de la Torre-Aboki J, de Thurah A, Domján A, Dragoi RG, Estévez-López F, Ferreira RJO, Fragoulis GE, Grygielska J, Kõrve K, Kukkurainen ML, Madelaine-Bonjour C, Marques A, Meesters J, Moe RH, Moholt E, Mosor E, Naimer-Stach C, Ndosi M, Pchelnikova P, Primdahl J, Putrik P, Rausch Osthoff AK, Smucrova H, Testa M, van Bodegom-Vos L, Peter WF, Zangi HA, Zimba O, Vliet Vlieland TPM, Stamm TA. Educational readiness among health professionals in rheumatology: low awareness of EULAR offerings and unfamiliarity with the course content as major barriers-results of a EULAR-funded European survey. RMD Open 2023; 9:e003120. [PMID: 37230762 PMCID: PMC10230966 DOI: 10.1136/rmdopen-2023-003120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/29/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Ongoing education of health professionals in rheumatology (HPR) is critical for high-quality care. An essential factor is education readiness and a high quality of educational offerings. We explored which factors contributed to education readiness and investigated currently offered postgraduate education, including the European Alliance of Associations for Rheumatology (EULAR) offerings. METHODS AND PARTICIPANTS We developed an online questionnaire, translated it into 24 languages and distributed it in 30 European countries. We used natural language processing and the Latent Dirichlet Allocation to analyse the qualitative experiences of the participants as well as descriptive statistics and multiple logistic regression to determine factors influencing postgraduate educational readiness. Reporting followed the Checklist for Reporting Results of Internet E-Surveys guideline. RESULTS The questionnaire was accessed 3589 times, and 667 complete responses from 34 European countries were recorded. The highest educational needs were 'professional development', 'prevention and lifestyle intervention'. Older age, more working experience in rheumatology and higher education levels were positively associated with higher postgraduate educational readiness. While more than half of the HPR were familiar with EULAR as an association and the respondents reported an increased interest in the content of the educational offerings, the courses and the annual congress were poorly attended due to a lack of awareness, comparatively high costs and language barriers. CONCLUSIONS To promote the uptake of EULAR educational offerings, attention is needed to increase awareness among national organisations, offer accessible participation costs, and address language barriers.
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Affiliation(s)
- Valentin Ritschl
- Institute for Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Lisa Sperl
- Institute for Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Margaret Renn Andrews
- Institute for Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Wien, Austria
| | - Mathilda Björk
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Carina Boström
- Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institute, Stockholm, Sweden
| | - Jeannette Cappon
- Department of Pediatric Rehabillitation, Reade Centre for Rehabillitation and Rheumatology, Amsterdam, The Netherlands
| | - Thomas Davergne
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | | | - Annette de Thurah
- Rheumatology, Aarhus University Hospital, Århus N, Denmark
- Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andrea Domján
- Department of Rheumatology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
| | - Razvan Gabriel Dragoi
- Department of Balneology, Rehabilitation and Rheumatology, University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania
| | - Fernando Estévez-López
- Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Ricardo J O Ferreira
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Coimbra, Portugal
| | - George E Fragoulis
- Joint Rheumatology Programme, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Katti Kõrve
- Center of Rheumatology, East Tallinn Central Hospital, Tallinn, Estonia
| | | | | | - Andréa Marques
- Health Sciences Research Unit Nursing, Higher School of Nursing of Coimbra, Coimbra, Portugal
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Jorit Meesters
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Rikke Helene Moe
- NKRR, REMEDY, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Ellen Moholt
- NKRR, REMEDY, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Erika Mosor
- Institute for Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Wien, Austria
| | | | - Mwidimi Ndosi
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
- Academic Rheumatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Jette Primdahl
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Polina Putrik
- Department of Rheumatology, Internal Medicine, MUMC and Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Anne-Kathrin Rausch Osthoff
- Institute of Physiotherapy, Zurich University of Applied Sciences; School of Health Professions, Winterthur, Switzerland
- Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Hana Smucrova
- Center of Medical Rehabilitation, Institute of Rheumatology, Prague, Czech Republic
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilfred F Peter
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
- Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands
| | - Heidi A Zangi
- NKRR, REMEDY, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
- Department of Rheumatology and Research, VID Specialized University, Oslo, Norway
| | - Olena Zimba
- Department of Clinical Rheumatology and Immunology, University Hospital in Krakow, Krakow, Poland
- Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Theodora P M Vliet Vlieland
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Tanja A Stamm
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
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Svanholm F, Björk M, Löfgren M, Gerdle B, Hedevik H, Molander P. Work Interventions Within Interdisciplinary Pain Rehabilitation Programs (IPRP) - Frequency, Patient Characteristics, and Association with Self-Rated Work Ability. J Pain Res 2023; 16:421-436. [PMID: 36820016 PMCID: PMC9938662 DOI: 10.2147/jpr.s390747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/17/2023] [Indexed: 02/16/2023] Open
Abstract
Background Interdisciplinary pain rehabilitation programs (IPRPs) help people with chronic pain improve their health and manage their work; however, the way IPRPs address sick leave could be improved. Although work interventions can be a part of IPRP, it is not well known how and to what extent. Aim This study explores the frequency of work interventions and the characteristics of patients who participate in work interventions as part of IPRP at specialist pain rehabilitation departments in Sweden. In addition, this study explores the association between participation in work interventions and change in patients' self-rated work ability after IPRP. Methods Data from the Swedish quality registry for pain rehabilitation (SQRP), which includes 3809 patients between 2016 and 2018, were analysed with descriptive statistics and regression analyses. Results The results indicate a high participation rate in work interventions (90%). Some differences were evident concerning characteristics of patients who participated in different work interventions. The return-to-work (RTW) plan, the most frequently used work intervention, had the strongest association with change in self-rated work ability after IPRP. However, the effect sizes were small, and the initial score best explained the change. Furthermore, there were differences between employed and unemployed patients and employment had a positive association with change in self-rated work ability. Conclusion More research is needed to understand IPRP's mechanisms and work interventions to support patients with chronic pain, reduce sick leave, and manage work. Employment status needs to be considered and interventions should be tailored to match the individual needs.
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Affiliation(s)
- Frida Svanholm
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden,Correspondence: Frida Svanholm, Pain and Rehabilitation Centre, County Council of Östergötland, Brigadgatan 22, Linköping, S-58185, Sweden, Tel +46 730-447785, Email
| | - Mathilda Björk
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Monika Löfgren
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden,Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Henrik Hedevik
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Molander
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden,Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
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11
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Tseli E, Sjöberg V, Björk M, Äng BO, Vixner L. Evaluation of content validity and feasibility of the eVISualisation of physical activity and pain (eVIS) intervention for patients with chronic pain participating in interdisciplinary pain rehabilitation programs. PLoS One 2023; 18:e0282780. [PMID: 36897847 PMCID: PMC10004540 DOI: 10.1371/journal.pone.0282780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 02/22/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Chronic pain negatively influences most aspects of life, including aerobic capacity and physical function. The "eVISualisation of physical activity and pain" (eVIS) intervention was developed to facilitate individualized physical activity for treatment in interdisciplinary pain rehabilitation programs (IPRPs). The objective of this study was to evaluate the content validity and feasibility of the eVIS intervention prior to an effectiveness trial. METHODS In order to determine pre-clinical content validity, experts (n = 10) (patients, caregivers, researchers) participated in three assessment rounds using a Likert-scale survey where relevance, simplicity, and safety were rated, whereafter the intervention was revised. Item-content validity index (I-CVI), average, and overall CVI were used to quantify ratings. To determine content validity and feasibility in the clinical context, experts (n = 8) (patients and physiotherapists) assessed eVIS after a 2-3-week test trial, with the feasibility aspects acceptability, demand, implementation, limited efficacy-testing, and practicality in focus. Additional expert interviews (with physiotherapists, physicians) were conducted on two incomplete areas. RESULTS The intervention was iteratively revised and refined throughout the study. After three assessment and revision rounds, the I-CVI ratings for relevance, simplicity, and safety ranged between 0.88 and 1.00 (≥0.78) in most items, giving eVIS "excellent" content validity. In the IPRP context, the intervention emerged as valid and feasible. Additional interviews further contributed to its content validity and clinical feasibility. CONCLUSIONS The proposed domains and features of the eVIS intervention are deemed valid in its content and feasible in the IPRP context. The consecutive step-by-step evaluation process enabled careful intervention development with revisions to be made in close collaboration with stakeholders. Findings implicate a robust base ahead of the forthcoming effectiveness trial.
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Affiliation(s)
- Elena Tseli
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- * E-mail:
| | | | - Mathilda Björk
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Björn O. Äng
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Center for Clinical Research Dalarna—Uppsala University, Falun, Sweden
- The Administration of Regional Board, Department of Research and Higher Education, Region Dalarna, Falun, Sweden
| | - Linda Vixner
- School of Health and Welfare, Dalarna University, Falun, Sweden
- The Administration of Regional Board, Department of Research and Higher Education, Region Dalarna, Falun, Sweden
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12
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Svanholm F, Liedberg GM, Löfgren M, Björk M. Stakeholders' experience of collaboration in the context of interdisciplinary rehabilitation for patients with chronic pain aiming at return to work. Disabil Rehabil 2022; 44:8388-8399. [PMID: 35060831 DOI: 10.1080/09638288.2021.2018051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Chronic pain is a major reason for sick leave worldwide. Interdisciplinary pain rehabilitation programs (IPRPs), workplace interventions, and stakeholder collaboration may support patients in their return to work (RTW). Few studies have examined stakeholders' experiences of important components in the RTW rehabilitation process for patients with chronic pain, especially in the context of IPRP. This study explores and describes stakeholders' experiences with stakeholder collaboration and factors related to RTW for patients with chronic pain who have participated in IPRP. METHODS Six focus groups, three pair and four individual interviews were conducted with a total of 28 stakeholder representatives from three societal and three health care stakeholders. Data were analyzed using qualitative content analysis. RESULTS The participants revealed that stakeholder collaboration and a tailored RTW rehabilitation plan were important strategies although they noted that these strategies were not working sufficiently efficient as presently implemented. The different stakeholders' paradigms and organizational prerequisites were described as hindrances of such strategies and that the degree of tailoring depended on individual attitudes. CONCLUSIONS More knowledge transfer and flexibility, clearer responsibilities, and better coordination throughout the RTW rehabilitation process may increase the efficiency of stakeholder collaboration and support for patients.Implications for rehabilitationStakeholders need to have a close dialogue initiated before IPRP to be able to reach consensus and shared decision making in the RTW rehabilitation plan throughout the RTW rehabilitation process.Individually tailored solutions based on a thorough assessment of each patient's work ability and context are identified during IPRP and shall be included in the shared RTW rehabilitation plan.The responsibilities of the stakeholders need to be clarified and documented in the RTW rehabilitation plan.The role of RCs should be developed to improve the coordination throughout the patients' RTW rehabilitation process.
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Affiliation(s)
- Frida Svanholm
- Department of Health, Medicine and Caring Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden
| | - Gunilla M Liedberg
- Department of Health, Medicine and Caring Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden
| | - Monika Löfgren
- Department of Clinical Sciences, Department of Rehabilitation Medicine, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Mathilda Björk
- Department of Health, Medicine and Caring Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden
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13
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Nyman J, Ekbladh E, Björk M, Johansson P, Sandqvist J. Feasibility of a new homebased ballistocardiographic tool for sleep-assessment in a real-life context among workers. Work 2022; 74:1353-1360. [PMID: 35634838 DOI: 10.3233/wor-211312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: There is a need for simple and suitable tools for assessing sleep in a natural home environment. OBJECTIVES: This study explores the feasibility in terms of implementation and acceptability of a new homebased ballistocardiographic (BCG) tool for objective sleep-assessment in a real-life context. METHODS: The participants included thirty-nine workers, taking part in two seven nights’ sleep-assessment periods. Objective data regarding sleep was collected with BCG. Subjective data regarding sleep was collected with a sleep diary. Implementation was analysed by determining the number of nights with usable signal quality and comparing with the total number of potential nights and by exploring associations between objective and subjective sleep data. Acceptability was analysed by categorizing the participants’ experiences of how the BCG tool impacted the sleep. RESULTS: In terms of implementation, usable BCG data increased from 40% at assessment phase 1 to 70% during assessment phase 2. Moreover, in assessment phase 2, there was a significant moderate correlation between the ‘time in bed’ assessed by the BCG and in sleep diary by participants in the first five nights. In terms of acceptability, almost one third of the participants did not experience any impact of the BCG on the sleep. Two participants experienced a major negative impact on the sleep. CONCLUSIONS: This study indicates that the novel BCG tool could be feasible for objective assessing of sleep in workers natural home-environment in the future, but there is still a need for development of the BCG both regarding technology and implementation process.
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Affiliation(s)
- Jennie Nyman
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
- School of Wellbeing, Metropolia University of Applied Science, Helsinki, Finland
| | - Elin Ekbladh
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Mathilda Björk
- Pain and Rehabilitation Center, Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Jan Sandqvist
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
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14
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Turesson C, Liedberg G, Vixner L, Lofgren M, Björk M. Evidence-based digital support during 1 year after an Interdisciplinary Pain Rehabilitation Programme for persons with chronic musculoskeletal pain to facilitate a sustainable return to work: a study protocol for a registry-based multicentre randomised controlled trial. BMJ Open 2022; 12:e060452. [PMID: 35470201 PMCID: PMC9039404 DOI: 10.1136/bmjopen-2021-060452] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Chronic musculoskeletal pain (CMSP) severely affects the individual's quality of life, functioning and ability to work, and comes with significant societal costs for sick leave and productivity loss. After rehabilitation, patients with CMSP often experience lack of support when responsibility for the return-to-work process is taken over by the employer. Therefore, we aim to evaluate the effectiveness of a digital support (Sustainable WorkEr digital support for Persons with chronic Pain and their Employers (SWEPPE)) for promoting a sustainable return-to-work for persons with CMSP and to facilitate the employers' supportive role and responsibilities in the process. METHODS AND ANALYSIS In this registry-based multicentre randomised controlled trial, 360 patients with CMSP will be randomised to either receive the smartphone application SWEPPE (n=180) or to a control group (n=180). The intervention group will use SWEPPE for 1 year and the control group will not receive any intervention for return to work (RTW). Participants will be recruited from approximately 10 specialist and primary care level units connected to the Swedish National Quality Registry for Pain Rehabilitation providing Interdisciplinary Pain Rehabilitation Programmes (IPRP) for CMSP. Eligibility criteria are age 18-65 years and a need for support in RTW or continued support at work for creating a sustainable work situation. Baseline data will be collected when the participants have completed the IPRP. Final assessment will be performed after 12 months. The primary outcome will be a number of days with sickness cash benefit. Secondary outcomes and explanatory variables including important domains affected by CMSP such as health-related quality of life, functioning and work ability will be collected. ETHICS AND DISSEMINATION The Swedish Ethics Review Board approved the study (Dnr 2020-01593, Dnr 2021-01854). The study findings will be disseminated through publication, national and international conferences, and meetings to be available for patients, healthcare providers or stakeholders. TRIAL REGISTRATION NUMBER NCT05058547.
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Affiliation(s)
- Christina Turesson
- Department of Health Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Gunilla Liedberg
- Department of Health Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Linda Vixner
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Monika Lofgren
- Department of Clinical Sciences and Department of Rehabilitation Medicine Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mathilda Björk
- Department of Health Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
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15
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Sjöberg V, Tseli E, Monnier A, Westergren J, LoMartire R, Äng BO, Hagströmer M, Björk M, Vixner L. Effectiveness of the eVISualisation of physical activity and pain intervention (eVIS) in Swedish Interdisciplinary Pain Rehabilitation Programmes: study protocol for a registry-based randomised controlled clinical trial. BMJ Open 2022; 12:e055071. [PMID: 35428627 PMCID: PMC9014054 DOI: 10.1136/bmjopen-2021-055071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Living with chronic pain often involves negative consequences. Interdisciplinary Pain Rehabilitation Programmes (IPRP) is considered superior to single-treatment measures in patients with chronic pain. Despite this, effects emerge suboptimal and more than 20% of patients deteriorate in patient-reported physical health outcomes after IPRP. A novel e-Health intervention, eVISualisation (eVIS) of physical activity and pain, was systematically developed to facilitate individualisation of physical activity levels. By adding elements of data collection, visualisation and communication of objectively measured physical activity and patient-reported outcomes (pain intensity, interference of pain, pharmaceutical consumption) to existing treatment modalities in IPRP, the IPRP team acquires prerequisites to adapt advice and physical activity prescriptions and to evaluate set activity goals. The overall aim is twofold. First, the aim is to evaluate the feasibility of the subsequent registry-based randomised controlled clinical trial (R-RCT). Second, the aim is to prospectively evaluate the effectiveness of the eVIS-intervention as a supplement to IPRP on our defined primary (physical health) and secondary outcomes. METHODS AND ANALYSIS In the R-RCT, recruitment of 400 patients with chronic pain will be performed at 15 IPRP units. A random allocation to either IPRP + eVIS or to control group that will receive IPRP only will be performed. Data from the initial 30 participants completing the study period (6 months) will be included in a pilot study, where key feasibility outcomes (recruitment, randomisation, implementation, treatment integrity, data collection procedure, preliminary outcome measures) will be evaluated. Outcome variables will be extracted from the web application Pain And TRaining ON-line (PATRON) and from six national registries. Multivariate statistics and repeated measure analyses will be performed. Quality-adjusted life years and incremental cost-effectiveness ratio will be calculated for cost-effectiveness evaluation. ETHICS/DISSEMINATION The Swedish Ethics Review Board granted approval (Dnr 2021/02109). Results will be disseminated through peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05009459. Protocol V.1.
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Affiliation(s)
- Veronica Sjöberg
- Department of Sport and Medicin, School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Elena Tseli
- Department of Sport and Medicin, School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Andreas Monnier
- Department of Sport and Medicin, School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Military Academy Karlberg, Swedish Armed Forces, Solna, Sweden
| | - Jens Westergren
- Department of Sport and Medicin, School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Riccardo LoMartire
- Department of Research and Higher Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden
| | - Björn O Äng
- Department of Sport and Medicin, School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Department of Research and Higher Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden
| | - Maria Hagströmer
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Mathilda Björk
- Department for Prevention, Rehabilitation, and Community Medicine, Division of Occupational Therapy, Institution of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Linda Vixner
- Department of Sport and Medicin, School of Health and Welfare, Dalarna University, Falun, Sweden
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16
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Turesson C, Liedberg G, Björk M. Development of a Digital Support Application With Evidence-Based Content for Sustainable Return to Work for Persons With Chronic Pain and Their Employers: User-Centered Agile Design Approach. JMIR Hum Factors 2022; 9:e33571. [PMID: 35285814 PMCID: PMC8961348 DOI: 10.2196/33571] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Persons with chronic pain experience a lack of support after completing rehabilitation and the responsibility for the return-to-work (RTW) process is taken over by the employer. In addition, employers describe not knowing how to support their employees. Smartphone apps have been increasingly used for self-management, but there is a lack of available eHealth apps with evidence-based content providing digital support for persons with chronic pain and their employers when they return to work. OBJECTIVE This study aims to describe the development of a digital support application with evidence-based content that includes a biopsychosocial perspective on chronic pain for sustainable RTW for persons with chronic pain and their employers (SWEPPE [Sustainable Worker Digital Support for Persons With Chronic Pain and Their Employers]). METHODS A user-centered agile design approach was applied. The multidisciplinary project team consisted of health care researchers, a user representative, and a software team. A total of 2 reference groups of 7 persons with chronic pain and 4 employers participated in the development process and usability testing. Mixed methods were used for data collection. The design was revised using feedback from the reference groups. The content of SWEPPE was developed based on existing evidence and input from the reference groups. RESULTS The reference groups identified the following as important characteristics to include in SWEPPE: keeping users motivated, tracking health status and work situation, and following progress. SWEPPE was developed as a smartphone app for the persons with chronic pain and as a web application for their employers. SWEPPE consists of six modules: the action plan, daily self-rating, self-monitoring graphs, the coach, the library, and shared information with the employer. The employers found the following functions in SWEPPE to be the most useful: employees' goals related to RTW, barriers to RTW, support wanted from the employer, and the ability to follow employees' progress. The persons with chronic pain found the following functions in SWEPPE to be the most useful: setting a goal related to RTW, identifying barriers and strategies, and self-monitoring. Usability testing revealed that SWEPPE was safe, useful (ie, provided relevant information), logical, and easy to use with an appealing interface. CONCLUSIONS This study reports the development of a digital support application for persons with chronic pain and their employers. SWEPPE fulfilled the need of support after an interdisciplinary pain rehabilitation program with useful functions such as setting a goal related to RTW, identification of barriers and strategies for RTW, self-monitoring, and sharing information between the employee and the employer. The user-centered agile design approach contributed to creating SWEPPE as a relevant and easy-to-use eHealth intervention. Further studies are needed to examine the effectiveness of SWEPPE in a clinical setting.
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Affiliation(s)
- Christina Turesson
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Gunilla Liedberg
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Mathilda Björk
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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17
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Gerdle B, Björk M, Dahlström Ö, Vixner L, Äng BO. Senior authors' reply to the comment by Andréll et al. Eur J Pain 2021; 26:766-767. [PMID: 34967483 DOI: 10.1002/ejp.1906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mathilda Björk
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Örjan Dahlström
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Linda Vixner
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Björn O Äng
- School of Health and Welfare, Dalarna University, Falun, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Research and Higher Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden
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18
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Gerdle B, Björk M, Dahlström Ö, Vixner L, Äng BO. Senior authors' reply to the comment by Rivano-Fischer and Stålnacke. Eur J Pain 2021; 26:545-546. [PMID: 34845780 DOI: 10.1002/ejp.1891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/01/2021] [Accepted: 11/22/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mathilda Björk
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Örjan Dahlström
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Linda Vixner
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Björn O Äng
- School of Health and Welfare, Dalarna University, Falun, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Research and Higher Education, Center for Clinical Research Dalarna - Uppsala University, Falun, Sweden
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Heijke R, Björk M, Thyberg I, Kastbom A, McDonald L, Sjöwall C. Comparing longitudinal patient-reported outcome measures between Swedish patients with recent-onset systemic lupus erythematosus and early rheumatoid arthritis. Clin Rheumatol 2021; 41:1561-1568. [PMID: 34839415 PMCID: PMC9056441 DOI: 10.1007/s10067-021-05982-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 10/01/2021] [Accepted: 11/01/2021] [Indexed: 11/25/2022]
Abstract
The onset of rheumatic disease affects each patient differently and may impact quality of life with progression. We investigated the relationship between patient-reported outcome measure (PROM) scores and organ damage in patients with recent-onset systemic lupus erythematosus (SLE) and those with early rheumatoid arthritis (RA). Patients with recent-onset SLE without prior organ damage from the Clinical Lupus Register in Northeastern Gothia and patients with early RA from the observational 2nd Timely Interventions in Early RA study, Sweden, were included. Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index (SDI) was used to assess organ damage. PROM (visual analog scale [VAS]: pain, fatigue, well-being, Health Assessment Questionnaire, and EQ-5D-3L) scores were captured at months 0, 6, 12, 24, 36, 48, and 60 after diagnosis. Statistical tests included Pearson correlation coefficients and t-tests. Forty-one patients with recent-onset SLE and 522 with early RA were included. Numerical differences were seen in age and sex. PROMs were worse for patients with RA versus SLE but improved by month 6 following diagnosis, while SLE PROMs remained stable. The incidence of organ damage in SLE was 13.6 per 100 patient-years. SDI significantly correlated with EQ-5D-3L (− 0.48, P = 0.003), VAS fatigue (0.44, P = 0.009), and well-being (0.41, P = 0.01) at month 24. As illustrated, the complexity of disease burden in patients with SLE is clear and may result from disease-related multiorgan system effects and slower symptom resolution compared with RA. This underscores the need for improved multiprofessional interventions to manage all aspects of SLE.
Key Points • We observed an evident discrepancy in patient-reported outcome measures (PROMs) between patients with recent-onset SLE and early RA. • Despite differences in PROMs between patients with recent-onset SLE and early RA, both groups had prominent self-reported disability during the study period. • PROM scores for patients with RA were generally worse than those with SLE but improved by month 6, whereas PROM scores for patients with SLE remained stable over time. • Our findings underline the need of new therapeutic options and interventions for SLE disease management, including pharmacologic and multiprofessional aspects. |
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Affiliation(s)
- Rebecca Heijke
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85, Linköping, Sweden
| | - Mathilda Björk
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Ingrid Thyberg
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85, Linköping, Sweden
| | - Alf Kastbom
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85, Linköping, Sweden
| | - Laura McDonald
- Real-World Research, Bristol Myers Squibb, Uxbridge Business Park, Sanderson Road, Uxbridge, UK
| | - Christopher Sjöwall
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85, Linköping, Sweden.
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Björk M, Dragioti E, Alexandersson H, Esbensen BA, Boström C, Friden C, Hjalmarsson S, Hörnberg K, Kjeken I, Regardt M, Sundelin G, Sverker A, Welin E, Brodin N. Inflammatory Arthritis and the Effect of Physical Activity on Quality of Life and Self-reported Function: A Systematic Review and Meta-analysis - The ENHANCE Study. Arthritis Care Res (Hoboken) 2021; 74:31-43. [PMID: 34632707 DOI: 10.1002/acr.24805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Although physical activity (PA) is an evidence-based intervention that reduces disease-related symptoms and comorbidity in rheumatoid arthritis (RA), PA's effect on self-reported function and Quality of Life (QoL) has not been analyzed. This study synthesizes the evidence for the effectiveness of PA on QoL and self-reported function in adults with RA, spondyloarthritis (SpA), and psoriatic arthritis (PsA). METHODS The databases PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify relevant randomized controlled trials (RCTs). Screening, risk of bias assessment (using RoB 2.0 tool), and data extraction were independently performed by two or more of the authors. The meta-analyses were conducted with a random-effects model. RESULTS The systematic review included 55 RCTs and the meta-analysis included 37 RCTs. In 55 studies included, 76% investigated RA, 20% investigated SpA, and 4% investigated PsA. In RA effects were found on QoL and function compared to inactive controls, effects not sustained in comparison to active controls. In SpA the effects of PA on QoL were in favor of the control group. Effects on function were found compared to inactive controls and sustained in fatigue and pain when compared to active controls. In PsA no effects on QoL were found but on function compared to inactive controls. The effect size was below 0.30 in the majority of the comparisons. CONCLUSION PA may improve QoL and self-reported function in RA, SpA, and PsA. However, larger trials are needed, especially in SpA and PsA.
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Affiliation(s)
- Mathilda Björk
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Unit of Occupational Therapy, Linköping University, Norrköping, Sweden
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Helene Alexandersson
- Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, SE-171 76 Stockholm, and Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Bente Appel Esbensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Denmark and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Carina Boström
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, 23100, 14183 Huddinge, Sweden and affiliated to Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Friden
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, 23100, 14183, Huddinge, Sweden
| | | | - Kristina Hörnberg
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
| | - Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway
| | - Malin Regardt
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm Sweden, and Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet Stockholm, Sweden
| | - Gunnevi Sundelin
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Annette Sverker
- Department of Activity and Health and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Elisabet Welin
- Örebro University, School of Health Sciences, Örebro, Sweden
| | - Nina Brodin
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, 23100, S-141 83, Huddinge, Sweden and Danderyd Hospital Corp., Department of Orthopaedics, Division of Physiotherapy, 18288, Stockholm, Sweden
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LoMartire R, Dahlström Ö, Björk M, Vixner L, Frumento P, Constan L, Gerdle B, Äng BO. Predictors of Sickness Absence in a Clinical Population With Chronic Pain. J Pain 2021; 22:1180-1194. [PMID: 33819574 DOI: 10.1016/j.jpain.2021.03.145] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 03/02/2021] [Accepted: 03/19/2021] [Indexed: 12/12/2022]
Abstract
Chronic pain-related sickness absence is an enormous socioeconomic burden globally. Optimized interventions are reliant on a lucid understanding of the distribution of social insurance benefits and their predictors. This register-based observational study analyzed data for a 7-year period from a population-representative sample of 44,241 chronic pain patients eligible for interdisciplinary treatment (IDT) at specialist clinics. Sequence analysis was used to describe the sickness absence over the complete period and to separate the patients into subgroups based on their social insurance benefits over the final 2 years. The predictive performance of features from various domains was then explored with machine learning-based modeling in a nested cross-validation procedure. Our results showed that patients on sickness absence increased from 17% 5 years before to 48% at the time of the IDT assessment, and then decreased to 38% at the end of follow-up. Patients were divided into 3 classes characterized by low sickness absence, sick leave, and disability pension, with eight predictors of class membership being identified. Sickness absence history was the strongest predictor of future sickness absence, while other predictors included a 2008 policy, age, confidence in recovery, and geographical location. Information on these features could guide personalized intervention in the specialized healthcare. PERSPECTIVE: This study describes sickness absence in patients who visited a Swedish pain specialist interdisciplinary treatment clinic during the period 2005 to 2016. Predictors of future sickness absence are also identified that should be considered when adapting IDT programs to the patient's needs.
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Affiliation(s)
- Riccardo LoMartire
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; School of Health and Welfare, Dalarna University, Falun, Sweden.
| | - Örjan Dahlström
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Mathilda Björk
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Linda Vixner
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Lea Constan
- Department of Arts and Crafts, Konstfack: University of Arts, Crafts and Design, Stockholm, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Björn Olov Äng
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; School of Health and Welfare, Dalarna University, Falun, Sweden; Center for Clinical Research Dalarna-Uppsala University, Falun, Sweden
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22
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LoMartire R, Björk M, Dahlström Ö, Constan L, Frumento P, Vixner L, Gerdle B, Äng BO. The value of interdisciplinary treatment for sickness absence in chronic pain: A nationwide register-based cohort study. Eur J Pain 2021; 25:2190-2201. [PMID: 34189810 DOI: 10.1002/ejp.1832] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Interdisciplinary treatment (IDT) is an internationally recommended intervention for chronic pain, despite inconclusive evidence of its effects on sickness absence. METHODS With data from 25,613 patients in Swedish specialist healthcare, we compared sickness absence, in the form of both sick leave and disability pensions, over a 5-year period between patients either allocated to an IDT programme or to other/no interventions (controls). To obtain population-average estimates, a Markov multistate model with theory-based inverse probability weights was used to compute both the proportion of patients on sickness absence and the total sickness absence duration. RESULTS IDT patients were more likely than controls to receive sickness absence benefits at any given time (baseline: 49% vs. 46%; 5-year follow-up: 36% vs. 35%), and thereby also had a higher total duration, with a mean (95% CI) of 67 (87, 48) more days than controls over the 5-year period. Intriguingly, sick leave was higher in IDT patients (563 [552, 573] vs. 478 [466, 490] days), whereas disability pension was higher in controls (152 [144, 160] vs. 169 [161, 178] days). CONCLUSION Although sickness absence decreased over the study period in both IDT patients and controls, we found no support for IDT decreasing sickness absence more than other/no interventions in chronic pain patients. SIGNIFICANCE In this large study of chronic pain patients in specialist healthcare, sickness absence is compared over a 5-year period between patients in an interdisciplinary treatment programme and other/no interventions. Sickness absence decreased over the study period in bothgroups; however, there was no support forthat it decreased more with interdisciplinary treatment than alternative interventions.
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Affiliation(s)
- Riccardo LoMartire
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Research and Higher Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden
| | - Mathilda Björk
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Örjan Dahlström
- Department of Behavioural, Sciences and Learning, Linköping University, Linköping, Sweden
| | - Lea Constan
- Department of Arts and Crafts, Konstfack: University of Arts, Crafts and Design, Stockholm, Sweden
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Linda Vixner
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Björn O Äng
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Research and Higher Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden.,School of Health and Welfare, Dalarna University, Falun, Sweden
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23
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Stensson M, Norderyd J, Van Riper M, Marks L, Björk M. Parents' perceptions of oral health, general health and dental health care for children with Down syndrome in Sweden. Acta Odontol Scand 2021; 79:248-255. [PMID: 33017197 DOI: 10.1080/00016357.2020.1824015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM To describe parental perceptions of general health, oral health and received dental health care in Swedish children with Down syndrome (DS). METHODS Online questionnaire, quantitative data analysis (Chi-square test). RESULTS Parents of 101 children with DS (52 boys, 49 girls, mean age: 9.6 years) participated. Seventy percent rated their child's general health and 74% their child's oral health as good or very good. Parents, who rated their child's oral health as poor (8%), also reported that dental procedures were difficult. Children received dental care at general (55%) and specialist clinics (53%). Ninety-four percent of parents of children receiving specialist dental health care were satisfied compared to 70% of parents with children in general clinics. The parents most valued characteristics of dental professionals were patience (63%) and their ability to engage the child (68%). Parents wanted multidisciplinary collaboration. CONCLUSION Most parents rated their child's general and oral health as good or very good. Children with poor oral health were also reported to have difficulties coping with dental procedures. Parents wanted dental care to be tailored to meet their child's unique needs. They wanted dental professionals to have knowledge about children with a need for special care. Lastly, they requested multidisciplinary collaboration.
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Affiliation(s)
- M. Stensson
- Centre of Oral Health, School of Health Sciences, Jönköping University, Jönköping, Sweden
- CHILD Research Group, SIDR, Jönköping University, Jönköping, Sweden
| | - J. Norderyd
- CHILD Research Group, SIDR, Jönköping University, Jönköping, Sweden
- National Oral Disability Centre for Rare Disorders, The Institute for Postgraduate Dental Education, Jönköping, Sweden
| | - M. Van Riper
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - L. Marks
- Centre of Special Care in Dentistry, Ghent University Hospital, Gent, Belgium
| | - M. Björk
- CHILD Research Group, SIDR, Jönköping University, Jönköping, Sweden
- Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping, Sweden
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24
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Bergström M, Dahlström Ö, Thyberg I, Björk M. The role of support from significant others in the association between disease-related factors and sickness absence in early rheumatoid arthritis: a longitudinal study. Scand J Rheumatol 2021; 50:427-434. [PMID: 33678129 DOI: 10.1080/03009742.2020.1870712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: The aim of this study was to analyse how support from significant others affects the associations between disease-related variables and sickness absence during the first 2 years after rheumatoid arthritis (RA) diagnosis.Method: Data from 274 people with RA (73% women) of working age (18-63 years) were retrieved from the Swedish early RA cohort TIRA-2. These data concerned disease-related variables (disease activity, activity limitations, pain intensity, and grip force), sickness absence, and perceived support from significant others. Associations of disease-related variables with sickness absence and how these associations were moderated by support from significant others were analysed using zero-inflated negative binomial regression.Results: During the 2 years after diagnosis, higher disease activity was significantly associated with increased odds of sickness absence, a connection strengthened by perceived support from family during the first year. More perceived support was also directly and significantly associated with increased odds of sickness absence during the first year.Conclusions: Support from significant others is related to sickness absence in RA, specifically during the first year after diagnosis. Although patients report high levels of support from significant others, this does not necessarily lead to more positive work outcomes. Therefore, it is important to consider other aspects of support that might influence work outcomes, e.g. type and quality of support. Future research should investigate these forms of support, and when significant others should be encouraged to support in the rehabilitation process to increase the chances of people with RA having a well-functioning and sustainable work life.
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Affiliation(s)
- M Bergström
- Unit of Occupational Therapy, Department of Health, Medicine and Caring Sciences, Faculty of Health Sciences, Linköping University, Norrköping, Sweden
| | - Ö Dahlström
- Department of Behavioural Sciences and Learning, Faculty of Arts and Sciences, Linköping University, Linköping, Sweden
| | - I Thyberg
- Department of Rheumatology in Östergötland, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - M Björk
- Unit of Occupational Therapy, Department of Health, Medicine and Caring Sciences, Faculty of Health Sciences, Linköping University, Norrköping, Sweden.,Department of Rheumatology in Östergötland, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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25
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Björk M, Gerdle B, Liedberg G, Svanholm F, Solmi M, Thompson T, Chaimani A, Dragioti E. Interventions to facilitate return to work in adults with chronic non-malignant pain: a protocol for a systematic review and network meta-analysis. BMJ Open 2020; 10:e040962. [PMID: 33199425 PMCID: PMC7670949 DOI: 10.1136/bmjopen-2020-040962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Work absenteeism due to chronic non-malignant pain (CNMP) is a major societal and individual cause of concern that requires effective treatments. OBJECTIVE We present a protocol for a systematic review and network meta-analysis (NMA) aiming to compare available interventions for return to work (RTW) in adults with CNMP. METHODS AND ANALYSIS PubMed, Embase, PsycINFO, Web of Knowledge and Cochrane Central Register of Controlled Trials databases will be searched till 31 August 2020 for randomised controlled trials (RCTs) examining interventions for RTW outcomes among patients with CNMP. Two independent investigators will search the databases, perform data extraction and assess the methodological quality of the selected RCTs. The primary outcome will be RTW, if possible, full-time or part-time after work absence due to chronic pain from baseline to the last available follow-up. Secondary outcomes will include self-reported workability or work capacity, or self-reported physical functioning and quality of life as measured by any validated scale. Pairwise meta-analysis and NMA will be conducted for each outcome using a random-effects model. For the primary outcomes, we will also obtain the ranking of all competing interventions within each NMA using surface under the cumulative ranking curve. The assumption of coherence (ie, that direct and indirect evidence are in statistical agreement) will be examined using both a local and a global approach. We will also conduct subgroup and meta-regression analyses, whenever feasible, to investigate the unexplained variation in effect size. The comparison-adjusted funnel plot will be used to evaluate small-study effects. The overall quality of evidence will be rated with the Confidence in Network Meta-Analysis tool. Data analysis will be conducted using Stata V.16.0. ETHICS AND DISSEMINATION This systematic review does not require ethical approval since it will not disseminate any private patient data. The results of this study will be disseminated through peer-reviewed publication. PROSPERO REGISTRATION NUMBER CRD42020171429.
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Affiliation(s)
- Mathilda Björk
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Gunilla Liedberg
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Frida Svanholm
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Marco Solmi
- Neurosciences Department, University of Padua, Padua, Italy
| | - Trevor Thompson
- School of Human Sciences, University of Greenwich, London, UK
| | - Anna Chaimani
- Research Center of Epidemiology and Statistics Sorbonne Paris Cité (CRESS UMR1153), INSERM, INRA, Université de Paris, Paris, France
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
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Björk M, Bergström M, Sverker A, Brodin N. Measures of Participation in Persons With Musculoskeletal Conditions. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:486-498. [PMID: 33091247 DOI: 10.1002/acr.24226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/14/2020] [Indexed: 11/07/2022]
Affiliation(s)
- M Björk
- Linköping University, Linköping, Sweden
| | - M Bergström
- Linköping University, Norrköping Campus, Norrköping, Sweden
| | - A Sverker
- Linköping University, Linköping, Sweden
| | - N Brodin
- Karolinska Institutet, Huddinge, Sweden, and Danderyd Hospital, Stockholm, Sweden
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27
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Svanholm F, Liedberg GM, Löfgren M, Björk M. Factors of importance for return to work, experienced by patients with chronic pain that have completed a multimodal rehabilitation program – a focus group study. Disabil Rehabil 2020; 44:736-744. [DOI: 10.1080/09638288.2020.1780479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Frida Svanholm
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Gunilla Margareta Liedberg
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Monika Löfgren
- Department of Clinical Sciences and Department of Rehabilitation Medicine, Karolinska Institute and Danderyd Hospital, Stockholm, Sweden
| | - Mathilda Björk
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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28
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Heijke R, Björk M, Frodlund M, McDonald L, Alemao E, Sjöwall C. Relationship between remission, disease activity and patient-reported outcome measures in patients with recent-onset systemic lupus erythematosus. Lupus 2020; 29:625-630. [PMID: 32188304 PMCID: PMC7184926 DOI: 10.1177/0961203320912338] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 02/19/2020] [Indexed: 11/22/2022]
Abstract
Objective Definitions of remission in systemic lupus erythematosus (SLE; DORIS (1A/1B/2A/2B)), disease activity assessments and patient-reported outcome measures (PROMs) are useful in shared decision making between patients with SLE and physicians. We used longitudinal registry data from well-characterized Swedish patients with recent-onset SLE to explore potential correlations between DORIS status or disease activity, and PROMs. Methods Patients from the Clinical Lupus Register in North-Eastern Gothia, Sweden, who fulfilled the 1982 American College of Rheumatology and/or the 2012 Systemic Lupus International Collaborating Clinics classification criteria without prior organ damage, were enrolled at diagnosis. Data on treatments, serology, remission status (DORIS), disease activity (SLE Disease Activity Index-2000 (SLEDAI-2K)) and PROMs (quality of life: EuroQoL-5 Dimensions (EQ-5D); pain intensity, fatigue and well-being: visual analog scale (VAS) 0–100 mm) were collected during rheumatology clinic visits at months 0 (diagnosis), 6, 12, 24, 36, 48 and 60. Correlations were assessed using Pearson correlation and/or beta regression coefficients. Results A total of 41 patients were enrolled (median age = 39 years, 80% female, 85% white). Achievement of DORIS 1A and 2A (neither of which includes serology) significantly correlated with all PROMs (EQ-5D: p ≤ 0.02; pain: p = 0.0001; fatigue: p = 0.0051; well-being: p < 0.0001). Disease activity measures were correlated with VAS pain intensity (p < 0.03) and VAS well-being (p < 0.04). Conclusions Our findings illustrate the importance of the interplay between remission, disease activity assessments and PROMs. PROMs may be a useful tool in clinical practice, being administered prior to patient visits to streamline clinical care.
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Affiliation(s)
- Rebecca Heijke
- Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Mathilda Björk
- Division of Occupational Therapy, Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Martina Frodlund
- Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Laura McDonald
- Centre for Observational Research and Data Sciences, Bristol-Myers Squibb, Uxbridge, UK
| | - Evo Alemao
- World Wide Health Economics and Outcomes Research, Bristol-Myers Squibb, Princeton, NJ, USA
| | - Christopher Sjöwall
- Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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29
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Wagman P, Ahlstrand I, Björk M, Håkansson C. Occupational balance and its association with life satisfaction in men and women with rheumatoid arthritis. Musculoskeletal Care 2020; 18:187-194. [PMID: 32011082 DOI: 10.1002/msc.1454] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/05/2019] [Accepted: 12/07/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Despite improved treatments and reduced disability, people with rheumatoid arthritis (RA) experience difficulties in daily life, which may negatively affect their balance of everyday life activities (occupational balance). The aim of this study was to describe occupational balance and its association with self-rated life satisfaction in men and women with RA. METHODS A survey, including demographic and health-related questions, was sent to 1,277 people who met the following criteria: with RA >4 years, aged 18-80 years, included in the Swedish Rheumatology Quality Register (SRQ), and had at least one registered visit to the participating rheumatology units in the year before inclusion. The 682 who answered all items in the Occupational Balance Questionnaire (OBQ) were included in the study. Their answers were analysed with descriptive statistics, and logistic regression analyses were conducted on men and women separately. RESULTS Significantly higher occupational balance was identified in those participants who were >65 years, had no children at home, had a lower disease activity score, were not continuously stressed and reported low pain intensity. The results of the logistic regression analyses of both genders showed that higher occupational balance was significantly associated with a higher probability for rating themselves as being satisfied with life as a whole. CONCLUSION Occupational balance was identified as related to satisfaction with life as a whole, which is valuable information for health professionals. Enhanced occupational balance may be achieved in people with RA by working towards reducing their stress and pain.
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Affiliation(s)
- Petra Wagman
- Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Inger Ahlstrand
- Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Mathilda Björk
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Carita Håkansson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
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Ringqvist Å, Dragioti E, Björk M, Larsson B, Gerdle B. Moderate and Stable Pain Reductions as a Result of Interdisciplinary Pain Rehabilitation-A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP). J Clin Med 2019; 8:jcm8060905. [PMID: 31238588 PMCID: PMC6617026 DOI: 10.3390/jcm8060905] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 06/18/2019] [Accepted: 06/20/2019] [Indexed: 12/29/2022] Open
Abstract
Few studies have investigated the real-life outcomes of interdisciplinary multimodal pain rehabilitation programs (IMMRP) for chronic pain. This study has four aims: investigate effect sizes (ES); analyse correlation patterns of outcome changes; define a multivariate outcome measure; and investigate whether the clinical self-reported presentation pre-IMMRP predicts the multivariate outcome. To this end, this study analysed chronic pain patients in specialist care included in the Swedish Quality Registry for Pain Rehabilitation for 22 outcomes (pain, psychological distress, participation, and health) on three occasions: pre-IMMRP, post-IMMRP, and 12-month follow-up. Moderate stable ES were demonstrated for pain intensity, interference in daily life, vitality, and health; most other outcomes showed small ES. Using a Multivariate Improvement Score (MIS), we identified three clusters. Cluster 1 had marked positive MIS and was associated with the overall worst situation pre-IMMRP. However, the pre-IMMRP situation could only predict 8% of the variation in MIS. Specialist care IMPRPs showed moderate ES for pain, interference, vitality, and health. Outcomes were best for patients with the worst clinical presentation pre-IMMRP. It was not possible to predict who would clinically benefit most from IMMRP.
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Affiliation(s)
- Åsa Ringqvist
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, SE-221 85 Lund, Sweden.
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden.
| | - Mathilda Björk
- Department of Social and Welfare Studies, Linköping University, SE-602 21 Norrköping, Sweden.
| | - Britt Larsson
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden.
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden.
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Dragioti E, Björk M, Larsson B, Gerdle B. A Meta-Epidemiological Appraisal of the Effects of Interdisciplinary Multimodal Pain Therapy Dosing for Chronic Low Back Pain. J Clin Med 2019; 8:jcm8060871. [PMID: 31216757 PMCID: PMC6616996 DOI: 10.3390/jcm8060871] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 11/17/2022] Open
Abstract
Using a meta-analysis, meta-regression, and a meta-epidemiological approach, we conducted a systematic review to examine the influence of interdisciplinary multimodal pain therapy (IMPT) dosage on pain, disability, return to work, quality of life, depression, and anxiety in published randomised controlled trials (RCTs) in patients with non-specific chronic low back pain (CLBP). We considered all RCTs of IMPT from a Cochrane review and searched PubMed for additional RCTs through 30 September 2018. A subgroup random-effects meta-analysis by length, contact, and intensity of treatment was performed followed by a meta-regression analysis. Using random and fixed-effect models and a summary relative odds ratio (ROR), we compared the effect sizes (ES) from short-length, non-daily contact, and low-intensity RCTs with long-length, daily contact, and high-intensity RCTs. Heterogeneity was quantified with the I2 metric. A total of 47 RCTs were selected. Subgroup meta-analysis showed that there were larger ES for pain and disability in RCTs with long-length, non-daily contact, and low intensity of treatment. Larger ES were also observed for quality of life in RCTs with short-length, non-daily contact, and low intensity treatment. However, these findings were not confirmed by the meta-regression analysis. Likewise, the summary RORs were not significant, indicating that the length, contact, and intensity of treatment did not have an overall effect on the investigated outcomes. For the outcomes investigated here, IMPT dosage is not generally associated with better ES, and an optimal dosage was not determined.
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Affiliation(s)
- Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden.
| | - Mathilda Björk
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden.
- Division of Occupational Therapy, Department of Social and Welfare Studies, Faculty of Health Sciences, Campus Norrkoping, Linköping University, SE-60174 Linköping, Sweden.
| | - Britt Larsson
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden.
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden.
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Sverker A, Thyberg I, Valtersson E, Björk M, Hjalmarsson S, Östlund G. Time to update the ICF by including socioemotional qualities of participation? The development of a "patient ladder of participation" based on interview data of people with early rheumatoid arthritis (the Swedish TIRA study). Disabil Rehabil 2019; 42:1212-1219. [PMID: 30634866 DOI: 10.1080/09638288.2018.1518494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: The aim of was to identify and illustrate in what situations and with what qualities people with early RA experience participation in every day's life.Methods: Fifty-nine patients (age 18-63 years) were interviewed; 25 men and 34 women. Content analysis was used to identify meaning units that were sorted based on the type of situations described and later on, categories based on quality aspects of participation were developed.Results: Participation was described as: 1. being part of a group, where a sense of belonging arose. 2. In doing activities with others for example at work or in leisure. 3. When sharing everyday chores and responsibilities for example in domestic duties. 4. When experiencing influence on actions such as when being asked for opinions on how to conduct a specific task. 5. When having the possibility to give direction of goals in rehabilitation, or elsewhere. 6. When sharing decision making and experiencing a high degree of influence in the situation.Conclusions: Participation from an individual's perspective is about belonging and having influence that mediates a positive feeling of being included and that you matter as a person. The results are important when using participation as a goal in clinical care. It is important to expand participation beyond the definitions in ICF and guidelines to include the patients' socio-emotional participation in order to promote health.Implications for rehabilitationFacilitation of participation in daily activities is an important part of rehabilitation.Participation is expressed as determined by a person's unique life circumstances often in engagement with others.It is important to expand participation beyond the definitions in ICF and guidelines to include the patients' socio-emotional participation in order to promote health.Collected information about socioemotional participation can serve as a starting point for interventions aimed at the patient's social environment and also provide support for health professions how to involve significant others in the rehabilitation.
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Affiliation(s)
- Annette Sverker
- Department of Activity and Health, Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ingrid Thyberg
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.,Department of Rheumatology, Heart and Medicine Centre, Region, Östergötland
| | - Eva Valtersson
- Department of Activity and Health and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Mathilda Björk
- Division of Occupational Therapy, Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden.,Department of Rheumatology, Heat and Medicine Centre, Region, Östergötland
| | - Sara Hjalmarsson
- Patient Research Partner, Swedish Rheumatism Association, Norrköping, Sweden
| | - Gunnel Östlund
- Division of Social Work, School of Health Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
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Bergström M, Sverker A, Larsson Ranada Å, Valtersson E, Thyberg I, Östlund G, Björk M. Significant others' influence on participation in everyday life - the perspectives of persons with early diagnosed rheumatoid arthritis. Disabil Rehabil 2019; 42:385-393. [PMID: 30634863 DOI: 10.1080/09638288.2018.1499825] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose: To describe the meaning of significant others in relation to participation in everyday life of persons with early diagnosed rheumatoid arthritis (RA).Materials and methods: Fifty-nine persons participated in this interview study. Inclusion criteria were three years' experience of diagnosis and being of working age. Semi-structured interviews were conducted using critical incident technique (CIT), and the material was analysed using content analysis.Results: Four categories were revealed: (1) My early RA causes activity adaptations for us all, referring to the person and significant others modifying activities. (2) Making the significant others balance between shortfalls and participation, where the participants distinguished between needing help and feeling involved in activities. (3) Physical interactions with significant others, referring to both the problematic and manageable impact RA could have on body contact. (4) Emotions in relation to activities with others, where participants described feelings of failing others, and anxiety about future activities.Conclusions: For persons with early diagnosed RA, significant others can be both hindering and facilitating for participation in everyday life. As a clinical implication, it is valuable to identify how significant others can be involved in the rehabilitation process, to enhance participation in everyday life early in the disease process.Implications for rehabilitationSignificant others of persons with rheumatoid arthritis can facilitate as well as hinder participation in everyday life, even early in the disease process.It is important to include the significant others in the rehabilitation process of persons with early diagnosed rheumatoid arthritis.It is of great importance to identify when and how significant others can be facilitators of participation in everyday life for persons with early rheumatoid arthritis.To make it easier for significant others to facilitate participation, there is a need for the healthcare system to explore ways to support significant others with easily accessible information about early rheumatoid arthritis.
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Affiliation(s)
- Maria Bergström
- Division of Occupational Therapy, Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Annette Sverker
- Department of Activity and Health, Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Åsa Larsson Ranada
- Division of Occupational Therapy, Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Eva Valtersson
- Department of Activity and Health, Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ingrid Thyberg
- Department of Clinical and Experimental Medicine, Linköping University, Department of Rheumatology, Heart and Medicine Center, Region Östergötland, Linköping, Sweden
| | - Gunnel Östlund
- School of Health Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Mathilda Björk
- Division of Occupational Therapy, Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Department of Rheumatology, Heart and Medicine Center, Region Östergötland, Linköping, Sweden
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Björk M, Thyberg I, Valtersson E, Östlund G, Stenström B, Sverker A. Foot Barriers in Patients With Early Rheumatoid Arthritis: An Interview Study Among Swedish Women and Men. Arthritis Care Res (Hoboken) 2018; 70:1348-1354. [PMID: 29195001 DOI: 10.1002/acr.23486] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/28/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Foot impairments are related to reduced mobility and participation restrictions in daily activities in patients with established rheumatoid arthritis (RA). The new biologic medications are effective and reduce disease activity, but not disability to the same extent. Foot impairments are assumed to be related to participation restrictions also in patients with early RA, diagnosed after the introduction of biologic medications. Knowledge of foot impairments needs to be explored further after the introduction of biologic disease-modifying antirheumatic drugs (bDMARDs). The aim of this study was to explore the patients' perspective of foot impairments related to early RA. METHODS The sample included 59 patients (ages 20-63 years) who were interviewed about participation dilemmas in daily life using the critical incident technique. The interviews were audio-recorded and transcribed. Data related to foot impairments were extracted and analyzed thematically. A research partner validated the analysis. RESULTS Patients with early RA described a variety of participation restrictions related to foot impairments: foot hindrances in domestic life, foot impairments influencing work, leisure activities restricted by one's feet, struggling to be mobile, and foot impairments as an early sign of rheumatic disease. CONCLUSION There is a need to focus on foot impairments related to early RA, and for health care professionals to understand these signs. A suggestion for future research is to conduct a longitudinal followup of foot impairment related to medication, disease activity, and disability in patients diagnosed after the introduction of bDMARDs.
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Bjurehed L, Brodin N, Nordenskiöld U, Björk M. Improved Hand Function, Self-Rated Health, and Decreased Activity Limitations: Results After a Two-Month Hand Osteoarthritis Group Intervention. Arthritis Care Res (Hoboken) 2018; 70:1039-1045. [PMID: 28973832 DOI: 10.1002/acr.23431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 09/26/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To 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. METHODS Sixty-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. RESULTS Hand 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. CONCLUSION The 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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Affiliation(s)
| | - Nina Brodin
- Karolinska Institutet, Huddinge, Sweden, and Danderyd Hospital, Stockholm, Sweden
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Östlund G, Björk M, Thyberg I, Valtersson E, Sverker A. Women's situation-specific strategies in managing participation restrictions due to early rheumatoid arthritis: A gender comparison. Musculoskeletal Care 2018; 16:251-259. [PMID: 29316201 DOI: 10.1002/msc.1225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/09/2017] [Accepted: 11/12/2017] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The present study explored how women describe their use of situation-specific strategies when managing rheumatoid arthritis (RA). The aim was also to compare women's strategies with those of men, and see the extent to which they used the same strategies. METHODS The data were collected using semi-structured interviews based on the critical incident technique. The sample consisted of women with early rheumatic arthritis (n = 34), and the results were compared with data reported in a previous study on men (n = 25) from the same cohort. The patient-described participation restrictions due to RA were firstly linked to the domains of the International Classification of Functioning, Disability and Health (ICF). The different strategies used were then categorized. The study was approved by the Research Ethics Committee of the Faculty of Health Sciences, Linköping University, Sweden. RESULTS The study found that women used four situation-specific strategies: adjustment, avoidance, interaction and acceptance. The same strategies had been found previously in interviews with men with RA. Women and men used these strategies to a similar extent in the ICF domains of mobility; major life arenas; domestic life; interpersonal interactions and relationships; and community, social and civic life. However, some differences were found, relating to the reported activities in self-care and domestic life, in which women reported using strategies to a greater extent than men. CONCLUSIONS Women and men used four types of situation-specific strategies in managing RA; adjustment, avoidance, interaction and acceptance. These situation-specific strategies provide useful knowledge, in terms of multidisciplinary rehabilitation and for patients' significant others.
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Affiliation(s)
- Gunnel Östlund
- Division of Social Work, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Mathilda Björk
- Department of Rheumatology and Department of Social and Welfare studies, Linköping University, Linköping, Sweden
| | - Ingrid Thyberg
- Departments of Rheumatology and Clinical & Experimental Medicine, Linköping University, Linköping, Sweden
| | - Eva Valtersson
- Departments of Activity and Health and Medical & Health Sciences, Linköping University, Linköping, Sweden
| | - Annette Sverker
- Departments of Activity and Health and Medical & Health Sciences, Linköping University, Linköping, Sweden
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Bergström M, Ahlstrand I, Thyberg I, Falkmer T, Börsbo B, Björk M. 'Like the worst toothache you've had' - How people with rheumatoid arthritis describe and manage pain. Scand J Occup Ther 2017; 24:468-476. [PMID: 28052711 DOI: 10.1080/11038128.2016.1272632] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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 person's social environment.
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Affiliation(s)
- Maria Bergström
- a Department of Social and Welfare Studies , Linköping University , Norrköping , Sweden
| | - Inger Ahlstrand
- b Department of Rehabilitation , School of Health and Welfare, Jönköping University , Jönköping , Sweden
| | - Ingrid Thyberg
- c Department of Rheumatology , Linköping University , Linköping , Sweden.,d Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| | - Torbjörn Falkmer
- b Department of Rehabilitation , School of Health and Welfare, Jönköping University , Jönköping , Sweden.,e School of Occupational Therapy & Social Work , CHIRI, Curtin University , Perth , WA , Australia.,f Department of Medical and Health Sciences , Linköping University , Linköping , Sweden
| | - Björn Börsbo
- g Division of Community Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences , Linköping University, Pain and Rehabilitation Center, Anesthetics, Operations and Specialty Surgery Center, County Council of Östergötland , Linköping , Sweden
| | - Mathilda Björk
- a Department of Social and Welfare Studies , Linköping University , Norrköping , Sweden.,c Department of Rheumatology , Linköping University , Linköping , Sweden
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Björk M, Thyberg M, Valtersson E, Katz P. Validation and internal consistency of the Swedish version of the Valued Life Activities scale. Clin Rehabil 2016; 30:1211-1219. [DOI: 10.1177/0269215515616665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 10/16/2015] [Indexed: 10/22/2022]
Abstract
Objective: The objective was to create a linguistically and culturally validated Swedish version of the Valued Life Activities scale. The aim was also to describe its content and concurrent validity and its internal consistency in persons with rheumatoid arthritis. Methods: The Valued Life Activities scale was translated to Swedish and culturally adapted. In order to describe the content validity, both the Swedish and original Valued Life Activities scale were linked to the International Classification of Functioning, Disability and Health. The concurrent validity and internal consistency were evaluated in 737 patients with rheumatoid arthritis. To establish concurrent validity, the scale was correlated to disease activity, activity limitations, and life satisfaction. Internal consistency was assessed with Cronbach’s alpha. Results: The equivalence of meaning between the Swedish and the original Valued Life Activities scale was ensured by harmonization review. Content validity was high when linked to the International Classification of Functioning, Disability and Health. Concurrent validity showed a strong correlation with the activity limitations (r = 0.87), moderate with life satisfaction (r = –0.61), and weak with disease activity (r = 0.38). Internal consistency was excellent (Cronbach’s alpha = 0.97). Conclusions: The Swedish Valued Life Activities scale has been tested in a large and well-characterized sample and found to be a linguistically valid and culturally adapted self-reported measure of participation. Content validity of the Valued Life Activities scale was excellent, concurrent validity strong, and the internal consistency excellent. Since both individual preferences and International Classification of Functioning, Disability and Health concepts of disability are taken into account, the Swedish Valued Life Activities scale appears to be a promising new scale addressing important aspects of participation.
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Affiliation(s)
- Mathilda Björk
- Department of Rheumatology and Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Mikael Thyberg
- Department of Pain and Rehabilitation Center and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Eva Valtersson
- Department of Activity and Health and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Björk M. SP0082 Disability in Men and Women with RA. Does It Differ and Does It Matter? Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.6396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sverker A, Björk M, Thyberg I, Östlund G. SAT0649-HPR Women with Early RA Prefer To Use Interaction and Adjustment Strategies To Deal with Their Everyday Life Dilemmas: The Tira Project). Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ahlstrand I, Vaz S, Falkmer T, Thyberg I, Björk M. 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. Clin Rehabil 2016; 31:824-834. [PMID: 27146888 DOI: 10.1177/0269215516646166] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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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Affiliation(s)
- Inger Ahlstrand
- 1 School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Sharmila Vaz
- 2 School of Occupational Therapy & Social Work, CHIRI, Curtin University, Perth, WA, Australia
| | - Torbjörn Falkmer
- 1 School of Health and Welfare, Jönköping University, Jönköping, Sweden.,3 Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ingrid Thyberg
- 4 Department of Rheumatology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Mathilda Björk
- 5 Department of Rheumatology and Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
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Thyberg I, Dahlström Ö, Björk M, Stenström B, Adams J. Hand pains in women and men in early rheumatoid arthritis, a one year follow-up after diagnosis. The Swedish TIRA project. Disabil Rehabil 2016; 39:291-300. [PMID: 26965161 DOI: 10.3109/09638288.2016.1140835] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Purpose This research analysed general pain intensity, hand pain at rest and hand pain during activity in women and men in early rheumatoid arhtritis (RA). Method Out of the 454 patients that were recruited into the Swedish early RA project "TIRA" the 373 patients (67% women) that remained at 12 months follow-up are reported here. Disease activity 28 joint score (DAS-28), disability (Health Assessment Questionnaire = HAQ) and pain (VAS) were recorded at inclusion and after 3 (M3), 6 (M6) and 12 (M12) months. General pain, hand pain during rest, hand pain during test of grip force as assessed by Grippit™, prescribed disease-modifying anti-inflammatory drugs (DMARDs) and hand dominance were recorded. Results DAS-28 and HAQ scores were high at inclusion and improved thereafter in both women and men. There were no significant differences between sexes at inclusion but women had higher DAS-28 and HAQ at all follow-ups. Women were more often prescribed DMARDs than were men. In both women and men all pain types were significantly lower at follow-up compared to at inclusion and women reported higher pain than men at follow-ups. The pain types differed significantly from each other at inclusion into TIRA, general pain was highest and hand pain during rest was lowest. There were no significant differences in hand pain related to hand dominance or between right and left hands. Conclusions Disease activity, disability and pain were high at inclusion and reduced over the first year. Despite more DMARDs prescribed in women than in men, women were more affected than were men. General pain was highest and not surprisingly hand pain during active grip testing was higher than hand pain during rest that was lowest in both sexes. Although our cohort was well controlled, it was evident that hand pain remains a problem. This has implications for rehabilitation and suggests potential ongoing activity limitations that should continue to receive attention from a multi-professional team. Implications for Rehabilitation General pain and hand pain remain a problem in RA despite today's early intervention and effective disease control with new era biologics. The extent of hand pain evidenced in our work gives a more detailed and comprehensive account of pain status. Higher hand pain during active grip testing than that during rest indicates a potential relationship to ongoing activity limitation. Hand pain assessment can help guiding multi-professional interventions directed to reduce hand pain and thereby probably reduce activity limitations.
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Affiliation(s)
- Ingrid Thyberg
- a Department of Rheumatology and Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| | - Örjan Dahlström
- b Swedish Institute for Disability Research, Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden
| | - Mathilda Björk
- c Department of Rheumatology and Department of Social and Welfare Studies , Linköping University , Norrköping , Sweden
| | - Birgitta Stenström
- a Department of Rheumatology and Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| | - Jo Adams
- d Centre for Innovation and Leadership, Faculty of Health Sciences , Faculty of Health Sciences, University of Southampton , Southampton , UK
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Östlund G, Thyberg I, Valtersson E, Björk M, Annette S. The Use of Avoidance, Adjustment, Interaction and Acceptance Strategies to Handle Participation Restrictions Among Swedish Men with Early Rheumatoid Arthritis. Musculoskeletal Care 2016; 14:206-218. [PMID: 26880258 DOI: 10.1002/msc.1131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Living with a chronic disease means learning to live under new circumstances and involves a continuous adaptation to new ways of living. There is increasing knowledge about how people cope with stressful life events and adapt to new life situations. Approximately a third of patients diagnosed with rheumatoid arthritis (RA) are men; however, few studies have described the needs and experiences of men living with RA. The aim of the present study was to explore men's strategies for handling challenges related to participation in everyday life. METHODS The present study was associated with the prospective Swedish multicentre early arthritis project (given the Swedish acronym TIRA), which, in 2006-2009, included patients with early RA, contemporarily treated, with a mean disease duration of three years. From this cohort, 25 men, aged 20-63 years, were recruited consecutively. Data were collected in individual interviews, using the critical incident technique. The strategies for dealing with the challenges of RA in everyday life were analysed and categorized using content analysis. RESULTS Men with RA described four types of strategy for dealing with participation restrictions in everyday life: (i) Adjustment strategies - adjust behaviour, movements, medication, equipment and clothing to find new ways to conduct tasks or activities; (ii) Avoidance strategies - avoid activities, movements, social contacts and sometimes medication; (iii) Interaction strategies - say no, ask for help and work together to handle participation restrictions; and (iv) Acceptance strategies - learn to accept RA, with the pain, the slower work pace and the extended time needed. CONCLUSIONS According to men's lived experiences, a combination of strategies was used to deal with RA, depending on the situation and the experienced restriction. The results provided an understanding of how men with RA manage their disease, to reduce physical, social and emotional challenges. This knowledge may be used further to develop multi-professional interventions and patient education tailored to men with RA.
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Affiliation(s)
- Gunnel Östlund
- Division of Social Work, School of Health, Care and Social Welfare, Mälardalen University, Sweden
| | - Ingrid Thyberg
- Department of Rheumatology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Eva Valtersson
- Department of Activity and Health, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Mathilda Björk
- Department of Rheumatology and Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Sverker Annette
- Department of Activity and Health, Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Social and Welfare Studies, Social Work, Linköping University, Linköping, Sweden
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Abstract
BACKGROUND The aim was to identify differences in self-reported symptoms among working (W) and non-working (NW) women, and to determine the most important biopsychosocial variables in differentiating one group from the other. METHOD A questionnaire was mailed to 524 members of a local chapter of the Swedish Rheumatology Association. A total of 362 persons responded (69%); 96% of which were women. Women older than 64 years and all men were excluded. The final study group consisted of 95 W, and 227 NW women. The questionnaire included data on demographics, employment, support, exercise, daily activities and symptoms. Data were analysed using univariate statistics and a partial least squares discriminant analysis (PLS-DA). RESULTS The results showed that 41% of the W and 42% of the NW women were/had been employed in service,care or business. The NW women reported a significantly higher severity of symptoms compared with the W women. The most important variable when differentiating the W from the NW women was social support from colleagues and employers. CONCLUSION To change prevailing attitudes and values towards persons with a work disability, a process of active intervention involving staff is needed. Educating employers as to how a disability may influence a work situation, and the importance of social support, can be improved.
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Affiliation(s)
- G M Liedberg And
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - M Björk
- Department of Rehabilitation, School of Health Sciences, Jönköping University, Jönköping, Sweden
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Björk M, Dahlström Ö, Wetterö J, Sjöwall C. Quality of life and acquired organ damage are intimately related to activity limitations in patients with systemic lupus erythematosus. BMC Musculoskelet Disord 2015; 16:188. [PMID: 26264937 PMCID: PMC4531389 DOI: 10.1186/s12891-015-0621-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 07/03/2015] [Indexed: 11/24/2022] Open
Abstract
Background Systemic lupus erythematosus (SLE) is an autoimmune multi-organ disease, characterized by episodes of disease flares and remissions over time, which may restrain affected patients’ ability to perform daily activities. The purpose of the present study was to characterize variation in activity limitations among well-defined SLE patients, and to describe disease phenotypes, acquired organ damage and their relations to activity limitation and self-reported health, respectively. Methods The disease phenotypes were organized into 4 different clinical groups and logistic regression analyses were used to identify how an elevated health assessment questionnaire (HAQ) score was related to disease variables such as phenotypes, disease activity and damage accrual. Correlation and multiple linear regression analyses were used to examine the association between each group of variables – background variables, disease variables and self-reported measurements – and the degree of elevated HAQ. Results We found a higher proportion of activity limitation in patients with skin and joint involvement compared to others. The presence of activity limitation, as detected by the HAQ instrument, was significantly associated with quality of life (EuroQol–5D) and accrual of organ damage using the Systemic Lupus International Collaborative Clinics/ACR damage index. Conclusions The findings highlight the differing requirements of the multi-professional rehabilitation interventions for the various SLE phenotypes in order to optimize the clinical care of the patients.
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Affiliation(s)
- Mathilda Björk
- Rehabilitation Center and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. .,Department of Rehabilitation, School of Health Sciences, Jönköping University, Jönköping, Sweden.
| | - Örjan Dahlström
- Swedish Institute for Disability Research, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
| | - Jonas Wetterö
- Rheumatology/AIR, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Christopher Sjöwall
- Rheumatology/AIR, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
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Liedberg GM, Björk M, Börsbo B. Self-reported nonrestorative sleep in fibromyalgia - relationship to impairments of body functions, personal function factors, and quality of life. J Pain Res 2015; 8:499-505. [PMID: 26300656 PMCID: PMC4536834 DOI: 10.2147/jpr.s86611] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of this study was: 1) to determine variables that might characterize good or bad sleep; and 2) to describe the relationship between sleep, impairment of body functions, personal function factors, and quality of life based on quality of sleep in women with fibromyalgia (FM). METHODS This cross-sectional descriptive study included 224 consecutive patients diagnosed at a specialist center. These patients were mailed a questionnaire concerning sleep, body functions, personal factors, and health-related quality of life. In total, 145 completed questionnaires were collected. RESULTS Using sleep variables (sleep quality, waking up unrefreshed, and tiredness when getting up), we identified two subgroups - the good sleep subgroup and the bad sleep subgroup - of women with FM. These subgroups exhibited significantly different characteristics concerning pain intensity, psychological variables (depressed mood, anxiety, catastrophizing, and self-efficacy), impairments of body functions, and generic and health-related quality of life. The good sleep subgroup reported a significantly better situation, including higher employment/study rate. The bad sleep subgroup reported a greater use of sleep medication. Five variables determined inclusion into either a good sleep or a bad sleep subgroup: pain in the evening, self-efficacy, anxiety, and according to the Short Form health survey role emotional and physical functioning. CONCLUSION This study found that it was possible to identify two subgroups of women with FM based on quality of sleep variables. The two subgroups differed significantly with respect to pain, psychological factors, impairments of body functions, and perceived quality of life, where the subgroup with bad sleep had a worse situation.
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Affiliation(s)
- Gunilla M Liedberg
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Mathilda Björk
- Rehabilitation Centre and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Björn Börsbo
- Rehabilitation Medicine, Department of Medicine and Health Sciences (IMH), Linköping University, Linköping, Sweden
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Östlund G, Björk M, Valtersson E, Sverker A. Lived Experiences of Sex Life Difficulties in Men and Women with Early RA - The Swedish TIRA Project. Musculoskeletal Care 2015; 13:248-57. [PMID: 26052885 DOI: 10.1002/msc.1105] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Men and women with rheumatoid arthritis (RA) experience restrictions in everyday life, in spite of the development of new medications. Recent research has described in detail how participation limitations are experienced in everyday life from a patient perspective. However, knowledge of how sex and intimate relationships are affected is still scarce. OBJECTIVES The aim of the present study was to explore sex life experiences in relation to sexual function and sexual relationships in men and women with early RA. METHODS The study formed part of TIRA-2 (the Swedish acronym for the prospective multicentre early arthritis project). The data collection included 45 interviews with 21 men and 24 women, aged 20-63, which were recorded and transcribed verbatim. The critical incident technique was used to collect data, and content analysis to categorize the results. RESULTS Half the participants stated that RA affected their sex life. The general descriptions formed five categories: sex life and tiredness; sex life and ageing; emotional consequences of impaired sexual function; facilitators of sexual function and sexual relationships; and strain on the sexual relationship. CONCLUSIONS Sex life is affected in early RA, in spite of new effective treatment strategies. New strategies of communication, assessment and self-managing interventions concerning the sex lives of patients with RA need to be implemented by a multidisciplinary healthcare team. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Gunnel Östlund
- Department of Social Work, School of Health Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Mathilda Björk
- Rehabilitation Center, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Rehabilitation, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Eva Valtersson
- Department of Rehabilitation and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Annette Sverker
- Department of Rehabilitation and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Social Work, Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
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Björk M, Thyberg I, Lindstrand J, Bodin N, Rosengren J, Nordenskiöld U, Brorsson S. SAT0636-HPR Development of Measuring Devices for Evaluating Hand Force in Rheumatoid Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ostlund G, Björk M, Thyberg I, Valtersson E, Sverker A. AB1221-HPR Adjustment, Avoidance, Interaction, and Acceptance Strategies Where Used by Men with Participation Restrictions Due to Early RA. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Thyberg I, Arvidsson P, Thyberg M, Björk M, Dahlström Ö. OP0230-HPR Increased Health Related Quality of Life in Early Ra Today Compared to Patients Diagnosed During the 1990's. The Swedish TIRA Project. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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