The Swedish SF-36 Health Survey--I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden

Reliability and validity of surface EMG assessments combined with isometric muscle strength testing in patients with abdominal rectus diastasis and asymptomatic controls

PURPOSE

Patients with abdominal rectus diastasis (ARD) may have muscular functional impairments, but clinics lack appropriate objective assessment tools. The aim was to establish the relative and absolute reliability, and convergent validity, of muscular activity using Surface Electromyography (SEMG) during isometric abdominal muscle strength testing in patients with ARD and controls without ARD.

METHODS

Twenty-six patients with ARD were matched for age, sex and BMI with controls without ARD. Participants were tested twice during isometric muscular contractions using SEMG located on six abdominal sites. Mean amplitude, fatigue, and recruitment order were analyzed. Relative reliability was evaluated with Intraclass Correlation Coefficients (ICC), while absolute reliability was estimated by calculating the Standard Error of Measurement and Minimal Detectable Change. Convergent validity was addressed in relation to participant characteristics, functional ability, and symptoms.

RESULTS

Mean SEMG amplitude for all abdominal wall muscle contractions showed moderate to excellent relative test-retest reliability, with ICC values ranging from 0.46 to 0.97. In contrast, fatigue and recruitment order displayed poor to moderate relative reliability in both groups. Absolute reliability measures were generally high. A moderate to high convergent validity (ARD: rho-value 0.41-0.70; Controls: rho-value 0.41-0.75) was observed for mean amplitude in relation to a functional sit-to-stand test, abdominal circumference, BMI, back pain, and quality-of-life.

CONCLUSIONS

The results of applying SEMG during isometric abdominal muscle support practicing the method in clinics, although additional development is needed with further standardization and more functional testing. Furthermore, the method demonstrates construct validity in patients with ARD and in age- and sex-matched controls.

Probiotic-Reduced Inflammaging in Older Adults: A Randomized, Double-Blind, Placebo-Controlled Trial

The disparity between increased lifespan and healthy aging, marked by prevalent "inflammaging", highlights the global challenge in care of older persons. This study explored the anti-inflammatory effects of Lactiplantibacillus plantarum HEAL9 (LpHEAL9), alone or combined with berries, on older volunteers with chronic low-grade inflammation (LGI). It was a randomized, double-blind, placebo-controlled trial, with a total of 66 volunteers (> 70 years old), randomly assigned, and equally distributed, to placebo, LpHEAL9 or LpHEAL9 + Berries group. After a 2-week run-in period, participants underwent a 4-week dietary intervention. Intake of LpHEAL9 showed a trend towards reduction in serum CRP but without reaching statistical significance. However, LpHEAL9 significantly decreased fecal calprotectin levels compared to placebo. LpHEAL9+Berries did not show any effect on inflammation. Both probiotic groups showed a trend in improving cognitive function albeit not reaching statistical significance. Our findings suggest that the probiotic strain L. plantarum HEAL9 has a modest impact on LGI in a healthy older population (ClinicalTrials.gov ID: NCT02342496).

Five-Year Follow-Up of Health-Related Quality of Life in Differentiated Thyroid Cancer Patients Treated with Total Thyroidectomy and Radioiodine in Sweden: A Nationwide Prospective Cohort Study

Background: Despite a good prognosis, survivors of differentiated thyroid cancer (DTC) may have reduced health-related quality of life (HRQOL) many years after treatment, and it is unclear how suppression of thyroid-stimulating hormone (TSH) may contribute to HRQOL. This study investigated changes in HRQOL in the 5 years following DTC treatment, the association between HRQOL and TSH suppression, and how HRQOL compares to the general population. Methods: In this nationwide prospective cohort study, 487 patients with DTC were identified between 2012 and 2017 from all Swedish hospitals treating patients with DTC. Patients treated with total thyroidectomy and planned for radioiodine answered the Swedish version of the Short Form-36 Health Survey (SF-36) and a study specific questionnaire at treatment and after 1, 3, and 5 years. Summary measures for physical and mental QOL were derived from the SF-36, and TSH values were collected from patient records. To study changes in HRQOL over time, linear mixed models were fitted on multiply imputed data, with all patients and measurement points included in the model. Results: In total, 351 patients consented to participate in the study. In the 5 years following DTC treatment, physical QOL did not change significantly with time, while mental QOL improved by on average 0.61 (p < 0.001) per year. TSH levels were not predictive of either physical or mental QOL, or their change over time. At 5 years, there was a significant difference in physical and mental QOL compared with the Swedish general population, but effect sizes were small (Cohen's d = 0.29 and -0.21, respectively). The SF-36 domains general health, vitality, social functioning, and mental health were lower at 5 years compared with the general population (difference 8.7-13.3), and these differences were clinically significant. Conclusions: The mental component of HRQOL improves over time following DTC treatment. HRQOL in patients with DTC is not explained by TSH suppression. Although overall differences in physical and mental HRQOL compared with the general population were small 5 years after treatment, several specific psychosocial HRQOL domains were clinically meaningfully reduced. Psychosocial health issues should be screened for during DTC follow-up.

Prognostic subgroups of chronic pain patients using latent variable mixture modeling within a supervised machine learning framework

The present study combined a supervised machine learning framework with an unsupervised method, finite mixture modeling, to identify prognostically meaningful subgroups of diverse chronic pain patients undergoing interdisciplinary treatment. Questionnaire data collected at pre-treatment and 1-year follow up from 11,995 patients from the Swedish Quality Registry for Pain Rehabilitation were used. Indicators measuring pain characteristics, psychological aspects, and social functioning and general health status were used to form subgroups, and pain interference at follow-up was used for the selection and the performance evaluation of models. A nested cross-validation procedure was used for determining the number of classes (inner cross-validation) and the prediction accuracy of the selected model among unseen cases (outer cross-validation). A four-class solution was identified as the optimal model. Identified subgroups were separable on indicators, predictive of long-term outcomes, and related to background characteristics. Results are discussed in relation to previous clustering attempts of patients with diverse chronic pain conditions. Our analytical approach, as the first to combine mixture modeling with supervised, targeted learning, provides a promising framework that can be further extended and optimized for improving accurate prognosis in pain treatment and identifying clinically meaningful subgroups among chronic pain patients.

Psychometric properties of the Swedish version of the international outcome inventory - alternative interventions (IOI-AI) - ear surgery (IOI-AIop)

OBJECTIVE

The aims of this study were to adapt the Swedish version of the International Outcome Inventory for Hearing Aids (IOI-HA) to the International Outcome Inventory for Alternative Interventions (IOI-AI) in the context of ear surgery (IOI-AIop) and to test the psychometric properties.

DESIGN

The validated Swedish questionnaire IOI-HA was adapted to the IOI-AIop by omitting the question about hearing aid use and changing the term "hearing aid" to "surgery" in the remaining items. The validity, component structure and reliability of the IOI-AIop were assessed.

STUDY SAMPLE

Subjects diagnosed with otosclerosis and undergoing stapedotomy were included in the study (n = 162).

RESULTS

High mean scores were noted for all items. Ceiling effects were noted, most pronounced for the satisfaction item. Principal component analysis (PCA) yielded a two-component structure explaining 77.5% of the variance. The test-retest reliability measured by intra class correlation coefficient was >0.9, and the internal consistency coefficient measured by Cronbach's alfa was >0.8.

CONCLUSION

The IOI-AIop showed good psychometric properties. However, ceiling effects were observed. The two-component solution was in line with previous factor analyses of the IOI-HA and the IOI-AI. The comprehensive IOI-AIop is recommended as a useful tool to evaluate patient perspectives after ear surgery.

Association between the COVID-19 pandemic and mental health in very old people in Sweden

BACKGROUND

During the COVID-19 pandemic, Sweden implemented social distancing measures to reduce infection rates. However, the recommendation meant to protect individuals particularly at risk may have had negative consequences. The aim of this study was to investigate the impact of the COVID-19 pandemic on very old Swedish peoples' mental health and factors associated with a decline in mental health.

METHODS

We conducted a cross-sectional study among previous participants of the SilverMONICA (MONItoring of Trends and Determinants of CArdiovascular disease) study. Of 394 eligible participants, 257 (65.2%) agreed to participate. Of these, 250 individuals reported mental health impact from COVID-19. Structured telephone interviews were carried out during the spring of 2021. Data were analysed using the χ2 test, t-test, and binary logistic regression.

RESULTS

Of 250 individuals (mean age: 85.5 ± 3.3 years, 54.0% women), 75 (30.0%) reported a negative impact on mental health, while 175 (70.0%) reported either a positive impact (n = 4) or no impact at all (n = 171). In the binary logistic regression model, factors associated with a decline in mental health included loneliness (odds ratio [95% confidence interval]) (3.87 [1.83-8.17]) and difficulty adhering to social distancing recommendations (5.10 [1.92-13.53]). High morale was associated with positive or no impact on mental health (0.37 [0.17-0.82]).

CONCLUSIONS

A high percentage of very old people reported a negative impact on mental health from the COVID-19 pandemic, primarily from loneliness and difficulty adhering to social distancing measures, while high morale seemed to be a protective factor.

Life's Essential 8 in relation to self-rated health and health-related quality of life in a large population-based sample: the SCAPIS project

PURPOSE

To monitor cardiovascular health, in 2022, the American Heart Association (AHA) updated the construct "Life's Simple 7" (LS7) to "Life's Essential 8" (LE8). This study aims to analyze the associations and capacity of discrimination of LE8 and LS7 in relation to self-rated health (SRH) and health-related quality of life (HRQoL).

METHODS

This study from the Swedish CArdioPulmonary bioImage Study (SCAPIS) included 28 731 Swedish participants, aged 50-64 years. Three different scores were derived from the SF-12 questionnaire: 1-item question SRH ("In general, would you say your health is …?"), mental-HRQoL and physical-HRQoL. Logistic regression, restricted cubic splines, and ROC analysis were used to study the associations between the AHA scores in relation to SRH and HRQoL.

RESULTS

Compared to those with a LE8 score of 80, participants with a LE8 score of 40 were 14.8 times more likely to report poor SRH (OR: 14.8, 95% CI: 13.0-17.0), after adjustments. Moreover, they were more likely to report a poor mental-HRQoL (OR: 4.9, 95% CI: 4.2-5.6) and a poor physical-HRQoL (OR: 8.0, 95% CI: 7.0-9.3). Area under curves for discriminating poor SRH were 0.696 (95% CI: 0.687-0.704), 0.666 (95% CI: 0.657-0.674), and 0.643 (95% CI: 0.634-0.651) for LE8, LS7 (0-14), and LS7 (0-7), respectively, all p values < 0.001 in the DeLong's tests.

CONCLUSION

LE8 and LS7 had strong and inverse associations with SRH, mental-HRQoL, and physical-HRQoL, though LE8 had a somewhat higher capacity of discrimination than LS7. The novel LE8, a construct initially conceived to monitor cardiovascular health, also conveys SRH and HRQoL.

The Impact of Symptoms of Depression, Anxiety, and Low Stress-Coping Capacity on the Effects of Telephone Follow-Up on Recovery Measures After Hysterectomy

Background

To investigate if symptoms of depression, anxiety, and stress-coping capacity have an impact on the effect of telephone follow-up (TFU) on trajectories of six recovery measures after hysterectomy and influence the occurrence of unplanned telephone contacts (uTCs) and unplanned visits (uVs) to health care providers.

Material and Methods

A post hoc nonrandomized analysis of participants enrolled in a randomized, four-armed, single-blinded, controlled multicenter intervention study comprising 487 women where the women were allocated 1:1:1:1 to one of four TFU models. The Swedish Postoperative Symptom Questionnaire (SPSQ) and two health-related quality of life questionnaires, the EuroQoL-5 dimension with three levels (EQ-5 D-3 L) and the Short-Form-Health Survey (SF-36) assessed the recovery measures. The six recovery measures consisted of the EQ-5D-3L health index, the SF-36 physical component summary (PCS) and mental component summary (MCS), and the maximum and average pain intensity, and symptom sum score obtained from the SPSQ. Psychological distress was evaluated by the psychometric forms, the Hospital Anxiety and Depression Scale and the Stress Coping Inventory. The occurrence of uTC and uV within the 6 weeks of follow-up was registered.

Results

Preoperative anxiety, depression, and stress-coping capacity did not modify the effects of the TFU models on the trajectories of the recovery measures, although anxiety and depression were strongly associated with all six recovery measures. uTCs, but not uVs occurred more often in the women with anxiety.

Conclusions

Preoperative anxiety, depression, and stress-coping capacity did not appear to influence the effects of TFU contacts on the recovery measures after hysterectomy. Preoperative anxiety seemed to increase the occurrence of uTC. Clinical Trials Registration: ClinicalTrials.gov (NCT01526668).

The ASAS Health Index and Environmental Factors Item Set: validity and reliability of the Swedish translations in Swedish patients with ankylosing spondylitis

OBJECTIVES

To translate the Assessment of SpondyloArthritis international Society (ASAS) Health Index (HI) Environmental Factors Item Set (EFIS) into Swedish and culturally adapt it for a Swedish context, and to assess the construct validity of the Swedish version of the ASAS HI and test-retest reliability in ASAS HI and EFIS in Swedish patients with ankylosing spondylitis (AS).

METHOD

Translation and cross-cultural adaptation of the EFIS were carried out according to a forward-backward procedure consisting of five steps. The construct validity of the ASAS HI was tested using Spearman correlation with standard health outcomes for axial spondyloarthritis (axSpA). Reliability was analysed by internal consistency with the Cronbach's alpha coefficient for ASAS HI, and test-retest reliability with intraclass correlation coefficients (ICCs) for ASAS HI and kappa agreement for the individual items of EFIS.

RESULTS

The translation of EFIS showed acceptable face and content validity. ASAS HI showed an acceptable internal consistency (Cronbach's alpha 0.79), and excellent test-retest reliability (ICC 0.87). Test-retest reliability for EFIS showed varied results, with kappa agreement for the individual items ranging from poor (-0.027) to good (0.80).

CONCLUSIONS

The Swedish version of ASAS HI proved to be valid and reliable and is recommended for assessing the impact of AS on global functioning and health. A Swedish version of EFIS has been produced and uploaded on the ASAS website. The EFIS proved to have acceptable face and content validity, and may contribute to the contextual interpretation of the ASAS HI.

Sex differences in the impact of musculoskeletal disorders on health-related quality of life: a population-based study, Campinas, SP - ISACamp 2014/15

This article aims to estimate the prevalence of musculoskeletal disorders (MD) on the adult population of Campinas, São Paulo, Brazil, verifying associated demographic and socioeconomic factors, and to analyze their impact on Health-Related Quality of Life (HRQoL) according to sex. A population-based study was conducted with 2,166 individuals using data from the ISACamp 2014/15. The Medical Outcomes Study SF-36-Item Short Form Health Survey (SF-36) was used to measure HRQoL according to MD. Prevalence ratios (PR) were estimated by Poisson regression. Musculoskeletal disorders had a prevalence of 8.5% (6.7% tendonitis and 2.7% work-related musculoskeletal disorders - WMSD). Results showed a higher prevalence of musculoskeletal disorders in women, active or on leave due to illness, and in individuals with higher education levels. Moreover, reduced HRQoL scores were observed in 6 of the 8 domains, due to MD. The mental component and physical component showed greater impairment respectively among women and men after self-reported WMSD. These findings point to substantial damage from musculoskeletal disorders on the population's HRQoL. WMSD affect the HRQoL of men and women distinctly.

Vision-related quality of life among 70-year-olds diagnosed with glaucoma

PURPOSE

To evaluate the effect of glaucoma on vision-related quality of life (VRQoL), lifestyle, physical factors and socioeconomic status in a 70-year-old population in Gothenburg, Sweden.

METHODS

Responses to questionnaires (N = 1182) between groups with and without self-reported glaucoma were analysed. Questionnaires included National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25), Short-Form Health Survey (SF-36), physical activity, socioeconomics, alcohol and tobacco consumption. Balance test and body mass index were also included. About half of the participants were randomized to ophthalmic examination (N = 560), variables were analysed separately according to known and confirmed glaucoma, ocular hypertension and/or cases of previously unknown glaucoma.

RESULTS

Both conventional and Rasch analysis of the NEI VFQ-25 showed that VRQoL was lower for individuals self-reporting glaucoma (p = 0.003/p = 0.024). Regarding general QoL, the participants did not differ apart from people self-reporting glaucoma reported worse general health (p = 0.01). Using logistic regression with lower VRQoL as the dependent variable glaucoma was not a significant predictor of poor VRQoL, odds ratio (OR) 1.83 (95% confidence interval (CI) 0.76-4.39, p = 0.18). Low household income was associated with lower VRQoL (OR 1.63, 95% CI 1.14-2.33, p = 0.01). Socioeconomics, physical activity and lifestyle factors were comparable between the groups (N = 915). Among participants who underwent ophthalmic examination no significant differences were found between glaucoma cases and non-glaucoma cases in relation to VRQoL (N = 560).

CONCLUSIONS

Patients with self-reported glaucoma assessed a lower VRQoL but not lower general quality of life. Poorer household income was associated with worse VRQoL. General health was reported low in the glaucoma population but lifestyle or physical factors did not diverge.

Long-Term Changes to the Microbiome, Blood Lipid Profiles and IL-6 in Female and Male Swedish Patients in Response to Bariatric Roux-en-Y Gastric Bypass

Lipid metabolism dysregulation is a critical factor contributing to obesity. To counteract obesity-associated disorders, bariatric surgery is implemented as a very effective method. However, surgery such as Roux-en-Y gastric bypass (RYGB) is irreversible, resulting in life-long changes to the digestive tract. The aim of the present study was to elucidate changes in the fecal microbiota before and after RYGB in relation to blood lipid profiles and proinflammatory IL-6. Here, we studied the long-term effects, up to six years after the RYGB procedure, on 15 patients' gut microbiomes and their post-surgery well-being, emphasizing the biological sex of the patients. The results showed improved health among the patients after surgery, which coincided with weight loss and improved lipid metabolism. Health changes were associated with decreased inflammation and significant alterations in the gut microbiome after surgery that differed between females and males. The Actinobacteriota phylum decreased in females and increased in males. Overall increases in the genera Prevotella, Paraprevotella, Gemella, Streptococcus, and Veillonella_A, and decreases in Bacteroides_H, Anaerostipes, Lachnoclostridium_B, Hydrogeniiclostridium, Lawsonibacter, Paludicola, and Rothia were observed. In conclusion, our findings indicate that there were long-term changes in the gut microbiota after RYGB, and shifts in the microbial taxa appeared to differ depending on sex, which should be investigated further in a larger cohort.

Interdisciplinary pain rehabilitation for patients with Ehlers-Danlos syndrome and hypermobility spectrum disorders

OBJECTIVE

Chronic pain is a common manifestation of Ehlers-Danlos syndrome and hypermobility spectrum disorders; thus it is often suggested that patients undergo generic interdisciplinary pain rehabilitation, despite there being little evidence to support this decision. The aim of this study is to examine the effectiveness of standard rehabilitation programmes for chronic pain on patients with Ehlers-Danlos syndrome and hypermobility spectrum disorders, compared with patients with other chronic pain disorders.

SUBJECTS

Data, collected between 2008 and 2016, were extracted from a Swedish national registry. The patient data comprised of 406 cases with Ehlers-Danlos syndrome or hypermobility spectrum disorders, 784 cases with a whiplash-related diagnosis, 3713 cases with diagnoses relating to spinal pain, and 2880 cases of fibromyalgia.

METHODS

The differences between groups on key outcome measures from pre- to 1-year follow-up after interdisciplinary pain rehabilitation were analysed using linear mixed effects models. Sensitivity analysis in the form of pattern-mixture modelling was conducted to discern the impact of missing data.

RESULTS

No significant differences were found in improvements from pre- to 1-year follow-up for patients with Ehlers-Danlos syndrome or hypermobility spectrum disorder compared with other diagnostic groups regarding measures of health-related quality of life, mental health, or fatigue. At follow-up, differences in pain interference (d = -0.34 (95% confidence interval [95% CI] -0.5 to -0.18)), average pain (d = 0.22 (95% CI 0.11-0.62)) and physical functioning (d = 2.19 (95% CI 1.61-2.77)) were detected for the group with spinal-related diagnoses in relation to those with EDS/HSD, largely due to pre-treatment group differences. Sensitivity analysis found little evidence for missing data influencing the results.

CONCLUSION

This study suggests that patients with Ehlers-Danlos syndrome/hypermobility spectrum disorders may benefit from inclusion in an interdisciplinary pain rehabilitation programme.

A BIONIC HAND VS. A REPLANTED HAND

Objective

Evaluation of the hand function affected when replacing a malfunctioning hand by a bionic hand.

Design

Case report.

Subjects

One individual that wished for a better quality of life after unsatisfying hand function following a replantation.

Methods

A quantitative and qualitative evaluation of body functions as well as activity performance and participation before and after a planned amputation and prosthetic fitting is presented.

Results

Improvements were seen in the patient-reported outcome measures (PROMs) that were used regarding activity (Disability of the Arm, Shoulder and Hand [DASH] and Canadian Occupational Performance Measure [COPM]), pain (Neuropathic Pain Symptom Inventory [NPSI], Brief Pain Inventory [BPI], Visual Analogue Scale [VAS]), cold intolerance (CISS) and health related quality of life (SF-36), as well as in the standardised grip function test, Southampton Hand Assessment Procedure (SHAP). No referred sensations were seen but the discriminative touch on the forearm was improved. In the qualitative interview, a relief of pain, a lack of cold intolerance, improved appearance, better grip function and overall emotional wellbeing were expressed.

Conclusions

The planned amputation and subsequent fitting and usage of a hand prosthesis were satisfying for the individual with positive effects on activity and participation.

Clinical relevance

When the hand function after a hand replantation does not reach satisfactory levels, a planned amputation and a prosthetic hand can be the right solution.

Work-related stress is associated with low work ability, but not with poor self-rated health: A cross-sectional study in primary healthcare

BACKGROUND

People seeking care at primary healthcare centres may be exposed to work-related stress, increasing the risk of future sick leave. Thus, it is important to identify work-related stress, and to explore how stress relates to work ability and health.

OBJECTIVE

To investigate the association between work-related stress and a) work ability, and b) self-rated health, among working women and men seeking care for physical or mental health complaints.

METHODS

This cross-sectional study analyzed baseline data (n = 232) from a randomized controlled trial investigating the effects of a brief intervention to prevent sick leave. Data regarding work-related stress, work ability and self-rated health were analyzed using binary logistic regression models.

RESULTS

In models adjusted for age, gender and education, high work-related stress measured by the Work Stress Questionnaire was significantly associated with low work ability. The highest odds ratio (OR 3.27, 95% CI 1.66-6.42) was found between the domain "interference between work and leisure time" and work ability, suggesting a more than three times higher odds for low work ability when perceiving that work interferes with leisure time. No significant association was found between work-related stress and self-rated health.

CONCLUSION

Health professionals should explore patients' work-related stress when they seek care for physical or mental complaints in primary healthcare. Patients' perceived balance between work and leisure time seems particularly important to address. Increased awareness might facilitate timely, relevant strategies to reduce stress and promote work ability.

Health-related quality of life in patients discharged from hospital after suicide attempt with violent methods compared to self-poisonings

INTRODUCTION

Suicide attempts by violent methods (VM) can leave the patient with physical and mental trauma affecting health-related quality of life (HRQOL). There is limited knowledge about the impact and HRQOL after a suicide attempt by VM.

AIMS

To compare HRQOL in patients after a suicide attempt by VM, both to self-poisonings (SP) and the general population, and the association of hospital anxiety and depression to the HRQOL in the two groups.

METHODS

Patients admitted to hospital after a suicide attempt were included in this prospective cohort-study from 2010 to 2015. For HRQOL, Short Form Health Survey (SF-36), and Hospital anxiety and depression scale scores (HADS-A and HADS-D) were assessed during study follow-up.

RESULTS

The VM-group scored lower HRQOL for the physical dimensions at 3 months (p<.05), compared to the SP group, and only role limitation physical at 12 months (p<.05). Both groups scored lower HRQOL than the general population (p < .05).At baseline, the VM group scored lower for HADS-A than the SP group (p < .05). Both groups had lower HADS scores one year after (p < .05). In multiple regression analyses, the HADS scores were associated with HRQOL in the VM-group (p < .05). SP group HADS scores were negatively associated with general health, vitality, social functioning, and mental health (p < .05).

CONCLUSION

Both groups scored lower for HRQOL than the general population, and the VM group had worse score than the SP group in physical dimensions. Both groups had less symptoms of anxiety and depression over time, but it`s association to HRQOL was strong.

Sense of coherence and health in women: a 25-year follow-up study

BACKGROUND

Health and Sense of Coherence (SOC) has been shown to be intertwined and argued to have a reciprocal relationship. The theory of SOC implies relatively stable scores during adulthood, however there are few longitudinal studies on the association between SOC and mental and somatic health. The main aim of the present study was to examine how SOC and self-rated health (SRH) are related during 25 years of follow-up.

METHODS

Using paper questionnaires distributed by postal services, 415 mothers were followed from childbirth and 25 years prospectively. SOC was measured at three, 12 and 25 years after inclusion. Self-reports on health status were obtained at the 25-year follow-up. The association between SOC and self-reported health as well as the effect of sociodemographic factors and experience of stressful life events was assessed through regression models.

RESULTS

SOC scores increased between three and 12 years after inclusion, and slightly decreased at the 25-year follow-up. Women of good health had a higher SOC-score at all three measurements compared to women of poor health. Multiple logistic regression showed that the likelihood of reporting good health increased with the number of times the women had reported SOC-scores above the 75th percentile. Moreover, women who had not been through a divorce were close to 60% more likely to report good health compared to women who had been through a divorce, whereas women not reporting stressful life events during the past two years were more than twice as likely to report good health. Symptoms below cut-off for postpartum depression and not having been through a divorce were associated with SOC scores above the 75th percentile.

CONCLUSION

This 25-year follow-up study of a cohort of women reports good stability of SOC assessments in the vast majority of women. There was a stronger and more stable SOC in women with better health. The findings are in line with other studies on the predictive value of SOC and self-perceived health.

Gender differences in health-related quality of life, blood pressure and heart rate among patients with paroxysmal atrial fibrillation after performing MediYoga

Introduction

Patients with paroxysmal atrial fibrillation experience low health-related quality of life which can be improved by performing yoga. The aim of this study was to evaluate gender differences in health-related quality of life, blood pressure and heart rate among patients with paroxysmal atrial fibrillation after performing MediYoga.

Methods

This is a secondary analysis of subgroups, investigating the yoga groups, from two randomized controlled trials (RCT 1: yoga group versus control group, RCT 2: a three-armed randomized study with yoga, control and relaxation groups). The yoga groups performed MediYoga for one hour/week over a 12-week period in both studies. Quality of life (SF-36), blood pressure and heart rate were collected at baseline and end of study.

Results

No differences were found between the women and men. Within the women's group, there were improvements in vitality (p = 0.011), social function (p = 0.022), mental health (p = 0.007) and Mental Components Summary (p = 0.022). There were differences within the men's group in bodily pain (p = 0.005), general health (p = 0.003), vitality (p = 0.026), social function (p = 0.005), role-emotion (p = 0.011) and Mental Components Summary (p = 0.018). Within the women's group, differences were observed in systolic blood pressure (p = 0.010) and diastolic blood pressure (p = <0.001). The men's group also showed improvement in diastolic blood pressure (p = 0.021).

Conclusion

MediYoga improved mental health as well as diastolic blood pressure in both men and women with PAF. This study suggests that both men and women, with PAF, may benefit from complementary treatment such as yoga.Clinical Trial Gov Id: NCT01789372.

Impact of walk advice alone or in combination with supervised or home-based structured exercise on patient-reported physical function and generic and disease-specific health related quality of life in patients with intermittent claudication, a secondary analysis in a randomized clinical trial

BACKGROUND

Supervised exercise is an integral part of the recommended first-line treatment for patients with intermittent claudication (IC). By reflecting the patients' perspectives, patient-reported outcome measurements provide additional knowledge to the biomedical endpoints and are important outcomes to include when evaluating exercise interventions in patients with IC. We aimed to evaluate the one-year impact of three strategies: unsupervised Nordic pole walk advice (WA), WA + six months of home-based structured exercise (HSEP) or WA + six months of hospital-based supervised exercise (SEP) on health-related quality of life and patient-reported physical function in patients with IC.

METHODS

This secondary exploratory analysis of a multi-center, randomized clinical trial compared three exercise strategies. The primary outcome of the secondary analysis was the one-year change in the 36-Item Short-Form (SF-36). Secondary outcomes were three- and six-months SF-36 changes alongside three, six- and 12-months changes in the disease-specific Vascular Quality of Life instrument (VascuQoL) and the Patient-Specific Functional Scale (PSFS). The Kruskal-Wallis test with Bonferroni-adjusted post-hoc tests were used for between-group comparisons. Effect size calculations were used to describe the size of observed treatment effects, and the clinical meaningfulness of observed changes in the VascuQoL summary score at one year was studied using established minimally important difference (MID) thresholds.

RESULTS

A total of 166 patients with IC, mean age: 72.1 (SD 7.4) years, 41% women, were randomized. No significant between-group differences were observed over time for the SF-36 or the PSFS scores whereas some significant between-group differences were observed in the VascuQoL domain and summary scores over time, favoring SEP and/or HSEP over WA. The observed SF-36 and VascuQoL domain and summary score effect sizes were small to moderate, and many domain score effect sizes also remained unchanged over time. A significantly higher proportion of the patients in the SEP group reached the VascuQoL summary score MID of improvement in one year.

CONCLUSION

Clinically important improvements were observed in SEP using the VascuQoL, while we did not observe any significant between-group differences using the SF-36. Whereas effect sizes for the observed changes over time were generally small, a significantly higher proportion of patients in SEP reached the VascuQoL MID of improvement.

TRIAL REGISTRATION

NCT02341716, January 19, 2015 (retrospectively registered).

Exploring cross-sectional and longitudinal symptomatic remission and subjective quality of life in schizophrenia

Achieving symptomatic remission, as defined by the Remission in Schizophrenia Working Group, is intended to be a meaningful outcome for individuals with schizophrenia, resulting in enhanced well-being. Cross-sectional studies have reported an association between symptomatic remission and subjective quality of life (QoL). Longitudinal studies aimed at examining this association have showed mixed results. The aim of this study was to explore the relationship between symptomatic remission and subjective QoL, both cross-sectionally and longitudinally. The study comprised data from what were at most 386 patients with schizophrenia, of whom 122-140 were followed over a period of four years. Based on cross-sectional remission status and longitudinal remission pattern, differences in subjective QoL were explored. Remission status was assessed using the Positive and Negative Syndrome Scale (PANSS), and subjective QoL using the Short Form-36 Health Survey (SF-36). Both the cross-sectional and the longitudinal approach showed that patients in symptomatic remission had significantly higher subjective QoL. Patients who were in non-remission at baseline, but who achieved remission at follow-up, also had significantly higher subjective QoL at follow-up compared with baseline. The results from the study show a clear association between symptomatic remission and subjective QoL. However, achieving symptomatic remission does not appear to be a guarantee of sustained subjective QoL, and only continued stable remission appears to result in such an outcome.

Associations between future health expectations and patient satisfaction after lumbar spine surgery: a longitudinal observational study of 9929 lumbar spine surgery procedures

OBJECTIVE

This study aimed to investigate the associations between general health expectations and patient satisfaction with treatment for the two common spine surgery procedures diskectomy for lumbar disk herniation (LDH) and decompression for lumbar spinal stenosis (LSS).

DESIGN

Register study with prospectively collected preoperative and 1-year postoperative data.

SETTING

National outcome data from Swespine, the national Swedish spine register.

PARTICIPANTS

A total of 9929 patients, aged between 20 and 85 years, who were self-reported non-smokers, and were operated between 2007 and 2016 for one-level LSS without degenerative spondylolisthesis, or one-level LDH, were identified in the national Swedish spine register (Swespine). We used SF-36 items 11c and 11d to assess future health expectations and present health perceptions. Satisfaction with treatment was assessed using the Swespine satisfaction item.

INTERVENTIONS

One-level diskectomy for LDH or one-level decompression for LSS.

PRIMARY OUTCOME MEASURES

Satisfaction with treatment.

RESULTS

For LSS, the year 1 satisfaction ratio among patients with negative future health expectations preoperatively was 60% (95% CI 58% to 63%), while it was 75% (95% CI 73% to 76%) for patients with positive future health expectations preoperatively. The corresponding numbers for LDH were 73% (95% CI 71% to 75%) and 84% (95% CI 83% to 85%), respectively.

CONCLUSIONS

Patients operated for the common lumbar spine diseases LSS or LDH, with negative future general health expectations, were significantly less satisfied with treatment than patients with positive expectations with regard to future general health. These findings are important for patients, and for the surgeons who counsel them, when surgery is a treatment option for LSS or LDH.

Health-related quality of life in gout, psoriatic arthritis, rheumatoid arthritis and ankylosing spondylitis, results from a cross-sectional survey in Western Sweden

OBJECTIVES

Inflammatory joint diseases (IJDs) substantially affect health-related quality of life (HRQoL). We aimed to compare HRQoL between patients with gout, psoriatic arthritis (PsA), rheumatoid arthritis (RA), and ankylosing spondylitis (AS): (i) overall; (ii) stratified by sex; and (iii) between women and men with the same IJD diagnosis.

METHOD

A survey including the RAND36-Item Health Survey for assessing HRQoL was sent to patients with a diagnosis of gout, PsA, RA, or AS, registered at a rheumatology clinic or primary care centre during 2015-2017. HRQoL was compared across IJDs. Because of age differences between diagnoses, age-matched analyses were performed.

RESULTS

In total, 2896/5130 (56.5%) individuals responded to the questionnaire. Of these, 868 had gout, 699 PsA, 742 RA, and 587 AS. Physical component summary (PCS) scores were more affected than mental component summary (MCS) scores for all diagnoses (PCS range: 39.7-41.2; MCS range: 43.7-48.9). Patients with gout reported better PCS scores than patients with PsA, RA, and AS, who reported similar scores in age-matched analysis. MCS scores were close to normative values for the general population and similar across IJDs. When comparing women and men with respective IJDs, women reported worse PCS (range, all IJDs: 34.5-37.4 vs 37.5-42.5) and MCS (PsA: 44.0 vs 46.8; RA: 46.1 vs 48.7) scores.

CONCLUSION

We found that patients with gout reported better PCS scores than patients with other IJDs, for whom the results were similar. Women reported overall worse PCS and MCS scores than men.

Health literacy in individuals with knee pain-a mixed methods study

BACKGROUND

Low health literacy is associated with worse pain and poorer self-management. This study (1) examined the level of health literacy and associations with lifestyle habits, health status, chronic pain, and radiographic knee osteoarthritis; and (2) explored experiences illuminating health literacy among individuals with knee pain.

METHODS

A convergent parallel mixed-methods design was used, including 221 individuals. Health literacy was assessed by HLS-EU-Q16 and eHEALS. The questionnaire included questions on lifestyle habits, health status, and pain distribution. Radiographic knee osteoarthritis was assessed with x-rays. Associations were analysed using logistic regression analyses. Individual semi-structured interviews were conducted (n = 19) and analysed with qualitative content analysis.

RESULTS

The result showed that 71% reported sufficient health literacy. Higher education, healthy lifestyle habits, better general health, and absence of widespread pain were associated with sufficient health literacy. Experiences regarding health literacy influencing the decision-making process toward a decision on action comprised: (1) searching for information actively or passively; (2) processing of the information included being informed, critical, and interpretive; and (3) taking a stand on the information based on trustfulness and motivation.

CONCLUSION

Seven out of 10 reported sufficient health literacy. Despite this, unhealthy lifestyles were common, suggesting that having sufficient HL is not enough for a behavioural change and the decision-making process, including different phases such as searching, processing, and taking a stand on health information is important to consider. More research on health literacy is needed to gain knowledge of how best to develop health promotion in individuals with knee pain.

Outcomes of bariatric surgery for patients with prevalent inflammatory bowel disease: A nationwide registry-based cohort study

BACKGROUND

Obesity is becoming more prevalent in patients with inflammatory bowel disease. Although bariatric surgery is an effective treatment for obesity, questions remain regarding its safety and effectiveness for patients with inflammatory bowel disease. The aim of this study was to evaluate the safety and effectiveness of bariatric surgery in patients with inflammatory bowel disease.

METHOD

This registry-based, propensity-matched cohort study included all patients who had primary Roux-en-Y gastric bypass or sleeve gastrectomy in Sweden from January 2007 to June 2020 who had an inflammatory bowel disease diagnosis and matched control patients without an inflammatory bowel disease diagnosis. The study included data from the Scandinavian Obesity Surgery Registry, the National Patient Register, the Swedish Prescribed Drugs Register, the Total Population Register, and the Education Register from Statistics Sweden.

RESULTS

In total, 71,093 patients who underwent bariatric surgery, including 194 with Crohn's disease and 306 with ulcerative colitis, were 1:5 matched to non-inflammatory bowel disease control patients. The patients with Crohn's disease had a higher readmission rate within 30 days (10.7% vs 6.1%, odds ratio = 1.84, 95% confidence interval 1.02-3.31) than the control patients, with no significant difference between the surgical methods. The patients with ulcerative colitis had a higher risk for serious postoperative complications after Roux-en-Y gastric bypass (8.0% vs 3.7%, odds ratio = 2.64, 95% confidence interval 1.15-6.05) but not after sleeve gastrectomy compared to control patients (0.8% vs 2.3%). No difference was observed in postoperative weight loss or postoperative health-related quality of life.

CONCLUSION

Sleeve gastrectomy appears to be a safe and effective treatment for obesity in patients with inflammatory bowel disease, whereas Roux-en-Y gastric bypass was associated with a higher risk for postoperative complications in patients with ulcerative colitis.

Mental health, self-rated health, risky sexual behaviour, alcohol use, and drug use among students who intend to spend a semester abroad - a cross-sectional study

Aim

Our aim was to investigate potential differences in mental health, self-rated health, risky sexual behaviour, alcohol use, and drug use between (1) Prospective exchange students and campus students separated by sex, and (2) male and female students as a group.

Method

Comparative cross-sectional design using an online survey containing the following instruments: Knowledge, Attitudes, and Sexual Behaviour in Young People in Sweden; Self-Rated Health Questionnaire; and General Health Questionnaire 12. One-hundred and fourteen prospective exchange students and 451 campus students participated in the study.

Results

Male prospective exchange students rated their mental health as being better and had used cannabis more often compared with female prospective exchange students. Male prospective exchange students also rated their mental health as being better than male campus students. Female students, in general, rated their mental health as worse than male students. A larger proportion of male prospective exchange students had sex together with alcohol compared with male campus students, and a larger proportion of female prospective exchange students had sex with a new partner and drank more alcohol compared to female campus students.

Conclusion

The result shows that risky alcohol use and sexually risky behaviour is prominent amongst prospective exchange students. It is possible that they will continue, and even increase their risky behaviour whilst abroad as they find themselves in a new social context, and free from influence of the rules and restrictions that they might have at home. With limited knowledge of the local culture, native language, and in an unfamiliar environment, it is possible that the risks will be enhanced and possibly decrease their health. This highlights the need for proactive interventions, conceivably with some variations in content between sexes.

Tobacco impact on quality of life, a cross-sectional study of smokers, snuff-users and non-users of tobacco

BACKGROUND

Tobacco smoking is a major public health issue, and also affects health-related quality of life. There has been considerable debate as to whether oral moist snuff, a form of tobacco placed in the oral cavity between the upper lip and gum as in sublabial administration, can be considered a safe alternative to smoking. The aim of this study was to investigate the association between health-related quality of life and smoking, snuff use, gender and age.

METHOD

This cross-sectional study included 674 women and 605 men aged 18 to 65 recruited through a Swedish population database. Subjects completed a questionnaire about tobacco use and the 36-item Short Form Health Survey (SF-36). Multivariable logistic regression analyses were performed for the association between health-related quality of life and tobacco use, gender and age. The median perceived health-related quality of life (SF-36) for an age-matched Swedish population was used as the cutoff: above the cutoff indicated better-than-average health coded as 1, or otherwise coded as 0. The independent variables were smoking (pack-decades), snuff-use (box-decades), gender and age in decades. The outcome was presented as the Odds Ratio (OR) with a 95% confidence interval (CI) for each independent variable.

RESULTS

The experience of cigarette smoking is associated with decreased physical functioning (PF), general health (GH), vitality (VT), social functioning (SF) and mental health (MH) as well as both lower physical component summary (PCS) and mental component summary (MCS). Further, the experience of snuff use is associated with bodily pain (BP), lower VT, and lower PCS. In the study population older age is associated with lower PF,GH, VT, MH, PCS and MCS. Female gender is associated with lower PF and VT.

CONCLUSION

This study shows that smoking is associated with lower health-related quality of life. The results also illuminate the detrimental health effects of using snuff, implying that snuff too is a health hazard. As studies on the bodily effects of snuff are relatively scarce, it is imperative that we continue to address and investigate the impact on the population using snuff on a regular basis.

TRIAL REGISTRATION

ClinicalTrials.gov ID NCT05409963 05251022 08/06/22.

Effects of interdisciplinary pain rehabilitation programs on neuropathic and non-neuropathic chronic pain conditions - a registry-based cohort study from Swedish Quality Registry for Pain Rehabilitation (SQRP)

BACKGROUND AND AIM

Neuropathic pain arises as a direct consequence of a lesion or disease affecting the somatosensory system. Pharmacological treatments for neuropathic pain often fail despite following guidelines. Interdisciplinary Pain Rehabilitation Programs (IPRP) are an effective intervention for chronic pain conditions. Little research has investigated whether IPRP can benefit patients with chronic neuropathic pain compared to other chronic pain conditions. This study assesses the real-world effects of IPRP on patients with chronic neuropathic pain compared to non-neuropathic patients using Patient-Reported Outcome Measures (PROMs) available in the Swedish Quality Registry for Pain Rehabilitation (SQRP).

METHODS

A neuropathic group of patients (n = 1,654) were identified in two steps. This group was compared to a non-neuropathic group (n = 14,355) composed of common diagnoses (low back pain, fibromyalgia, whiplash associated disorders, and Ehlers-Danlos Syndrome) in relation to background variables, three overall outcome variables, and mandatory outcome variables (pain intensity, psychological distress symptoms, activity/participation aspects and health-related quality of life variables). Of these patients 43-44% participated in IPRP.

RESULTS

At assessment, the neuropathic group reported significantly (with small effect sizes (ES)) more physician visits the previous year, older age, shorter pain durations, and less spatial extent of the pain (moderate ES). Moreover, for the 22 mandatory outcome variables, we found only clinically insignificant differences according to ESs between the groups. For patients participating in IPRP, the neuropathic group displayed equal or in some cases slightly superior results compared to the non-neuropathic group.

DISCUSSION AND CONCLUSION

After assessing the real-world effects of IPRP, this large study found that neuropathic pain patients can benefit from the IPRP intervention. Both registry studies and RCTs are needed to better understand which patients with neuropathic pain are most suitable for IPRP and to what extent special considerations need to be made for these patients within the framework of IPRP.

Comparison of conventional socket attachment and bone-anchored prosthesis for persons living with transfemoral amputation - mobility and quality of life

BACKGROUND

For patients with transfemoral amputation experiencing issues with their sockets, bone-anchored prosthesis systems are an alternative and sometimes the only way to be mobile and independent. The present cross-sectional study aimed to investigate the gait performance and quality of life of a group of patients treated with bone-anchored systems compared to those of participants treated with a conventional socket-suspended prosthesis.

METHODS

A total of 17 participants with a socket-suspended and 20 with a bone-anchored prosthesis were included. Gait patterns were examined for symmetry, and performance was assessed using the six-minute walk test and the timed "Up & Go" test. Magnetic resonance imaging was performed to detect signs of osteoarthritis in both hips. Mobility in everyday life and quality of life were assessed using questionnaires.

FINDINGS

There were no differences between the groups regarding the quality of life, daily mobility, and gait performance. The step width was significantly higher for the patients using socket-suspended prosthesis. The socket-suspended group showed a significant asymmetry regarding the step length. In the socket-suspended group, the prosthetic leg showed significantly higher cartilage abrasion than the contralateral leg did.

INTERPRETATION

Large differences in the measured outcomes in both groups illustrate the very different capabilities of the individual participants, which is apparently not primarily determined by the type of treatment. For patients who are satisfied with the socket treatment and perform well, bone-anchored prosthesis systems may not necessarily improve their functional capabilities and perceived quality of life.

Effect of group education and person-centered support in primary health care on mental health and quality of life in women aged 45-60 years with symptoms commonly associated with stress: a randomized controlled trial

BACKGROUND

Mental illness and somatic symptoms are common causes of long-term sick leave for women during menopause, which usually occurs between the ages of 45 and 55. Many women experience a lack of knowledge about menopause and its associated symptoms. This study evaluates the effect of group education and person-centered individual support in primary health care (PHC) on mental health and quality of life for women in menopause with symptoms that are usually associated with stress.

METHODS

The randomized controlled clinical trial (RCT) with a two-factor design was conducted in PHC in southwestern Sweden, from 2018 to 2019. A total of 370 women aged 45-60 were allocated in four groups: 1, group education (GE) 2, GE and person-centered individual support (PCS) 3, PCS and 4, control group. GE comprised four weekly sessions and PCS included five sessions with topics related to menopause. The effect of the interventions were followed up at 6 and 12 months. Linear and ordinal regression were used to analyse the effect of the intervention, either group education or person-centred individual support.

RESULTS

The main findings: Improved quality of life and physical, psychological, and urogenital symptoms. GE and PCS resulted in improvement of the quality of life at six months. At the 12-month follow-up these results were significantly strengthened for PCS and improved health-related quality of life, and reduced mental, urogenital, and stress-related symptoms with an effect lasting at least 12 months. These results suggest that this intervention could be an effective intervention in PHC for improving women's health in menopause.

CONCLUSIONS

PCS can be an effective intervention in PHC for improving women's health in menopause and possibly also prevent the development of exhaustion syndrome.

TRIAL REGISTRATION

Universal trial number is U1111-1219-6542 and the registration number in ClinicalTrials.gov is NCT03663075, date of registration 10/09/2018.

Swedish exchange students’ alcohol use, drug use, risky sexual behaviour, mental health, and self-rated health: A follow-up study

Aims: To follow up on exchange students’ alcohol use, drug use, mental health, self-rated health, and risky sexual behaviour after a semester abroad and to compare them with students who remained on campus. Methods: The study design was a follow-up study based on a previous baseline survey of 114 prospective exchange students and 451 campus students. Of the original 565 students, 48 (42.1%) prospective exchange students and 209 (43.3%) campus students responded to the follow-up. Both the baseline survey and the follow-up survey included the General Health Questionnaire 12, one single item from Self-Rated Health, and nine items from Knowledge, Attitudes and Sexual Behaviour in Young People in Sweden. Results: We found a statistically significant increase in the weekly consumption of alcohol among exchange students after their semester abroad. A larger proportion of exchange students had sex with a new partner and sex with more than three partners during their semester abroad compared to follow-up campus students. Conclusions: Our findings indicate that exchange students consume alcohol more frequently during their semester abroad and indulge in sexually risky behaviour. Exchange students’ use of alcohol and sexually risky behaviour could be associated with even greater risks due to them being in an unknown environment, unfamiliar culture, and with limited support from family and friends. This highlights the need for further research on exchange students’ experiences, especially concerning alcohol use and sex while abroad.

Cost-Effectiveness of Prolonged Physical Activity on Prescription in Previously Non-Complying Patients: Impact of Physical Activity Mediators

In Sweden, physical activity on prescription (PAP) is used to support patients in increasing their levels of physical activity (PA). The role of healthcare professionals in supporting PA behavior change requires optimization in terms of knowledge, quality and organization. This study aims to evaluate the cost-effectiveness of support from a physiotherapist (PT) compared to continued PAP at a healthcare center (HCC) for patients who remained insufficiently active after 6-month PAP treatment at the HCC. The PT strategy was constituted by a higher follow-up frequency as well as by aerobic physical fitness tests. The analysis was based on an RCT with a three-year time horizon, including 190 patients aged 27-77 with metabolic risk factors. The cost per QALY for the PT strategy compared to the HCC strategy was USD 16,771 with a societal perspective (including individual PA expenses, production loss and time cost for exercise, as well as healthcare resource use) and USD 33,450 with a healthcare perspective (including only costs related to healthcare resource use). Assuming a willingness-to-pay of USD 57,000 for a QALY, the probability of cost-effectiveness for the PT strategy was 0.5 for the societal perspective and 0.6 for the healthcare perspective. Subgroup analyses on cost-effectiveness based on individual characteristics regarding enjoyment, expectations and confidence indicated potential in identifying cost-effective strategies based on mediating factors. However, this needs to be further explored. In conclusion, both PT and HCC interventions are similar from a cost-effectiveness perspective, indicating that both strategies are equally valuable in healthcare's range of treatments.

The TOR concept (training, operation, and rehabilitation) applied to a cohort of postpartum women with training-resistant symptomatic rectus diastasis: evaluation 1 year after surgery

BACKGROUND

Rectus diastasis is a common sequela of pregnancy and is associated with functional disabilities such as back pain, abdominal core instability, abdominal muscle weakness, urinary incontinence, and psychological issues such as a negative body image. The aim of this study was to evaluate the effect of the TOR concept (training, operation, and rehabilitation), a novel concept for treating abdominal wall insufficiency combined with rectus diastasis, after pregnancy. TOR consists of preoperative evaluation of symptoms and custom-designed abdominal core training, tailored rectus diastasis repair, and individual progressive postoperative rehabilitation.

METHODS

A consecutive series of women diagnosed with rectus diastasis and core dysfunction resistant to training, underwent plication of the linea alba between 2018 and 2020. After surgery, all patients participated in an individually designed rehabilitation programme over a 4-month interval. Physical function was recorded before surgery and 1 year after surgery using the disability rating index questionnaire. Symptoms associated with core instability were recorded before and 1 year after surgery. Quality of life was assessed using the SF-36. The abdominal wall anatomy was assessed with ultrasound before and 1 year after surgery.

RESULTS

Seventy-one women were included and all attended 1-year follow-up. Response rate was 81.7 per cent (58) for the disability rating index, and 59.2 per cent (42) for SF-36. Self-reported physical function (disability rating index) improved in 54 of 58 patients (93.1 per cent), with a median score reduction of 91.3 per cent. Core instability symptoms decreased significantly. All SF-36 subscales improved significantly compared with preoperative scores, reaching levels similar to or higher than the normative Swedish female population. No recurrence of rectus diastasis was seen at the 1-year follow-up.

CONCLUSIONS

Surgical reconstruction within the TOR concept resulted in significant improvements in physical function and quality of life as well as a significant decrease in symptoms of core instability.

Reference Data on the Normal Abdominal Wall Anatomy and Baseline Characteristics in Seventy-One Nulliparous Women

Aims: The aim of this study was to describe the prepartum anatomy of the abdominal wall in a cohort of nulliparous women, for use as a reference for management of patients with postpartum abdominal wall insufficiency with or without rectus diastasis. Materials and Methods: Seventy-one women were examined with ultrasonography of the abdominal wall. The inter-recti distance (IRD), anatomical variations of the linea semilunaris, and the oblique muscles were assessed. The waistline was measured during activation and relaxation of the abdominal core. Participant characteristics were registered. Questionnaires regarding habitual physical activity (Baecke), low back pain (Oswestry), physical functioning (DRI), urinary incontinence (UDI-6 and IIQ-7), and quality-of-life (SF-36) were answered. Results: Mean age was 30.5 years (range 19-50 years) and mean BMI 23.5 kg/m2 (range 18-37). Ultrasonography showed a mean IRD of 10 mm (range 3-24) at the superior border of the umbilicus, 9 mm (4-20) 3 cm above the umbilicus, and 2 mm (-5-10) 2 cm below the umbilicus. The mean thickness of the linea alba was 3 mm (1.5-5) and mean distances between the lateral edge of the rectus muscle and the external, internal, and transverse oblique muscles were 12 mm (-10-28), 1 mm (-14-13) and 15 mm (-14-32) at umbilicus level. Responses to the DRI, UDI-6, IIQ-7 and Oswestry questionnaires showed generally lower scores than the normal population whereas Baecke and SF-36 scores were similar. Conclusion: This study provides baseline data on normal abdominal wall anatomy in a healthy nulliparous female cohort, as well as levels of activity, physical function, disability, and quality-of-life.

Association between attention deficit hyperactivity disorder and outcomes after metabolic and bariatric surgery: a nationwide propensity-matched cohort study

BACKGROUND

The risks and benefits of metabolic and bariatric surgery for patients with attention deficit hyperactivity disorder (ADHD) remain to be investigated.

OBJECTIVE

The aim of this study was to assess short- and long-term outcomes after metabolic and bariatric surgery in patients with previous ADHD compared with matched control individuals.

SETTING

Registry based.

METHODS

This 2-staged matched-cohort study included all adults with a body mass index of ≥30 kg/m² who underwent primary Roux-en-Y gastric bypass or sleeve gastrectomy from 2007 until 2017 registered in the Scandinavian Obesity Surgery Registry. Patients with prescribed medication for ADHD were matched with control individuals without ADHD with a follow-up of up to 11 years after surgery.

RESULTS

Among 1431 patients with ADHD and 2862 control individuals (mean body mass index, 42 kg/m²; mean age, 35 years), no difference in weight loss or follow-up attendance over 2 years was seen. ADHD was associated with a higher risk for early postoperative complications (odds ratio [OR] = 1.31; 95% confidence interval [CI], 1.05-1.63), self-harm (hazards ratio [HR] = 1.39; 95% CI, 1.11-1.75), and substance abuse (HR = 1.34; 95% CI, 1.16-1.55), while associations with overall mortality (HR = 1.42; 95% CI, .99-2.03), major adverse cardiovascular and cerebrovascular events (HR = 1.93; 95% CI, .98-3.83), and effects on obesity-related diseases were uncertain. ADHD was associated with a lower health-related quality of life in all aspects before surgery. These differences increased for mental and obesity-related aspects but remained unchanged over time for physical aspects.

CONCLUSIONS

Compared with patients without ADHD, patients treated pharmacologically for ADHD experience similar weight loss and remission of obesity-related diseases without an increased risk for serious complications but report a lower health-related quality of life and have an increased risk of substance abuse and self-harm. This further emphasizes the need for close follow-up care for this group of individuals.

Incidence of self-harm after bariatric surgery: A nationwide registry-based matched cohort study

The aims of this study were to evaluate the longitudinal risk of self-harm and the risk factors for self-harm after bariatric surgery in patients and control subjects without prior self-harm. This observational cohort study was based on prospectively registered data. Patients 18-70 years at time of surgery, body mass index (BMI) > 30 kg/m² , who underwent a primary Roux-en-Y gastric bypass (RYGB) procedure or a primary sleeve gastrectomy between 2007 and 2019 were considered for inclusion. All patients who met the inclusion criteria were matched 1:10 to the general population in Sweden (69 492 patients vs. 694 920 controls). After excluding patients and controls with previous self-harm, a self-harm event occurred in 1408 patients in the surgical group (incidence rate (IR) 3.54/1000 person-years, 95% confidence interval (CI) 3.36-3.73) versus in 3162 patients in the control group (IR 0.81/1000 person-years, 95% CI 0.78-0.84), with a hazard ratio (HR) of 4.38 (95% CI 4.11-4.66, p < .001). Median follow-up time was 6.1 years. Risk factors were younger age, lower BMI, cardiovascular, and chronic obstructive pulmonary disease, all aspects of psychiatric comorbidities (except neuropsychiatric disorder), lower socioeconomic status, RYGB, lower health-related quality of life, lower postoperative weight loss, and not attending postoperative follow-up visits. Self-harm is clearly higher after bariatric surgery than in the general population. A qualitative follow-up may be particularly important for patients at increased risk.

Reliability and aspects of validity of the Swedish version of self-efficacy for exercise scale for patients with chronic pain

BACKGROUND

Active, specific, and professionally led physical exercise is an effective treatment for chronic pain, and self-efficacy is correlated to positive treatment outcomes. At present, there is limited knowledge of self-efficacy for exercise in patients with chronic pain.

PURPOSE

To evaluate the reliability and aspects of validity of the Swedish version of the Self-Efficacy for Exercise Scale (SEE-SV) in patients with chronic pain.

METHODS

Patients with chronic pain were recruited from a specialist clinic. The Swedish version of the SEE was used. Reliability was evaluated through internal consistency, test-retest, and measurement error (standard error of measurement, SEM and smallest detectable change, SDC). Construct validity was calculated using the correlation between the SEE-SV and other well-established evaluation instruments. Content validity was evaluated both from a patient and a health-care professional perspective.

RESULTS

In total, 44 patients, 31 women and 13 men (mean age 40 years), participated in the study. The SEE-SV had good test-retest reliability (intra-class correlation coefficient (ICC) = 0.95) and internal consistency (Cronbach's alpha = 0.97). Regarding measurement error, SEM was 4.9 and SDC 13.5. Moderate correlation was seen between SEE-SV and a pain-specific self-efficacy questionnaire (rs = 0.52). The majority of patients and health-care professionals considered the SEE-SV to be relevant and easy to understand.

CONCLUSION

The SEE-SV showed a good internal consistency, item-to-total correlation, and test-retest reliability (ICC). A relatively high SDC indicates an individual variability of the test results. The content validity was satisfactory. Regarding the construct validity, further studies are needed.

Pain intensity and psychological distress show different associations with interference and lack of life control: A clinical registry-based cohort study of >40,000 chronic pain patients from SQRP

Background

Both chronic pain and depressive and/or anxiety symptoms are associated with negative impacts on daily living, including interference and lack of life control. However, little is known about how pain and psychological distress affect these impacts.

Aim

The first aim was to assess how pain intensity, psychological distress, and social support interact with interference and lack of life control. A second aim was to investigate whether the strength of these relationships is moderated by the presence or absence of depression and/or anxiety.

Subjects and methods

Patient-Reported Outcome Measures (PROMs), which are available in the Swedish Quality Registry for Pain Rehabilitation (SQRP), were retrieved for patients with chronic pain (N = 40,184). A theoretical model with the constructs/latent variables pain intensity, psychological distress, interference, lack of life control, and social support was proposed and analyzed using Partial Least Squares Structural Equation Modelling (PLS-SEM). Indicators for these constructs were identified from the PROMs of the SQRP. Two models of the total cohort, which differed with respect to the causal relationship between pain intensity and psychological distress, were investigated. The moderating effects of anxiety and/or depression were also analyzed.

Results

Relatively low correlation and explanatory power (R ²= 0.16) were found for the pain intensity-psychological distress relationship. Pain intensity had a stronger effect on interference than on lack of life control. The reverse was found for psychological distress - i.e., psychological distress seemed to have a higher negative influence on function than on interference. The underlying assumption of the causal relationship between pain intensity and psychological distress determined how strong pain intensity and psychological distress influenced interference and lack of life control. Social support showed very similar absolute significant correlations with interference and lack of life control. Interference and lack of life control showed relatively weak associations. The psychological distress level was a moderating factor for several of the paths investigated.

Discussion and conclusion

A clinical treatment consequence of the low correlation between pain intensity and psychological distress may be that clinically treating one may not reduce the effect of the other. The relative importance of pain intensity and psychological distress on interference and lack of life control depends on the underlying assumption concerning the pain intensity-psychological distress relationship. Interference and lack of life control showed relatively weak associations, underscoring the need to clinically assess them separately. Social support influenced both impact constructs investigated. The cohort display heterogeneity and thus presence of definite signs of anxiety and/or depression or not was a moderating factor for several of the associations (paths) investigated. The results are important both for the assessments and the design of treatments for patients with chronic pain.

The treatment lottery of chronic back pain? A case series at a multidisciplinary pain centre

OBJECTIVES

Despite the number of people affected by chronic back pain, and the many available treatment options, even the best modalities provide limited pain reduction on a group level, often without simultaneous improvements in functioning or health-related quality of life. The objective was to provide an overview of the treatment of chronic back pain in clinical practice at a multidisciplinary pain centre, and to study patient and pain characteristics in different treatment groups.

METHODS

104 chronic back pain patients (primary ICD-10-SE-diagnosis M53.0-M54.9 excluding M54.1 and M54.3), referred to the Pain and Rehabilitation Centre, University Hospital, Linköping in 2015, were studied using data from the Swedish Quality Registry for Pain Rehabilitation, self-reported medication data, and a retrospective medical record review.

RESULTS

The following treatment groups were identified: rehabilitation (n=21), analgesics (n=33), invasive intervention (n=14), and no treatment (n=35). Significant differences between groups were found with regards to age, sick leave, education level, persisting pain duration, punishing responses by significant other, previous invasive intervention, receiving sub-clinic, physician speciality and referring care level.

CONCLUSIONS

Overall, patient demographics were associated with treatment strategy to a higher degree than patient-reported outcome measures. Moreover, physician speciality and organisational factors seemed to play a role in treatment choice.

The relationship between six-minute walked distance and health-related quality of life in patients with chronic heart failure

Objectives. To assess the relationship between the six-minute walk test (6MWT) and health-related quality of life (HRQL) in patients with chronic heart failure. Methods. Forty-six patients (37 men and 9 women) with chronic heart failure, mean age 68 (SD 9), NYHA II-III and EF 29 (9) % were included. They performed 6MWT and assessed HRQL using two tools, a Swedish version of the 36-item Short Form (SF-36) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). This was performed repeatedly during a study period of one year. Results. Patients with a walking distance lower than median experienced a lower HRQL than the higher performing half of the cohort, in four dimensions of the SF-36 and the summary of physical and mental components, but not in the dimensions of MLHFQ. Conclusion. Patients with heart failure with a short walking distance assessed their quality of life as inferior in half of the dimensions in the SF-36 but not in the dimensions measured with the MLHFQ. Thus, different aspects of the symptomatology are uncovered using the 6MWT and the different HRQL tools.

Patient Reported Outcome and Quality of Life After Delayed Breast Reconstruction - An RCT Comparing Different Reconstructive Methods in Radiated and Non-radiated Patients

BACKGROUND

Health-related quality of life (HRQoL) is one of the core outcomes for breast reconstruction. The aim of this study was to evaluate whether the method of delayed breast reconstruction affects long-term HRQoL.

METHODS

Participants were divided into 2 arms depending on previous radiotherapy, and subsequently randomized between 2 methods of breast reconstruction: a latissimus dorsi flap or a deep inferior epigastric artery perforator flap in the radiated arm and a thoracodorsal flap and implant or an expander in the non-radiated arm. Validated HRQoL instruments were used: BREAST-Q to evaluate breast specific HRQoL and satisfaction, RAND-36 and EQ-5D to evaluate generic HRQoL, and BDI-21 to measure symptoms of depression and anxiety.

RESULTS

During the recruitment period (2009-2015), 233 patients were randomized. After opt-outs and exclusions, the remaining 107 participants comprise the study sample. Postoperative HrQoL was measured on average 7to 8years post-operatively. Response rates varied between 60 and 82 per cent. The BREAST-Q scores were higher after the reconstruction than before for the great majority of domains in both arms; albeit statistically significant only between the 2 methods for physical well-being chest in the radiated arm. Most participants in both arms had minimal or mild depression both before and after the operation.

CONCLUSION

No distinct differences in long-term HrQoL could be seen for different methods There was a clear improvement in HrQoL compared to pre-reconstruction in all groups, but the effect of specific reconstructive methods on scores could not be reliably demonstrated.

A qualitative study of the long-term consequences and adaptation in daily life after replantation surgery at a young age

Introduction

Impaired functioning is seen in patients following replantation surgery to the thumb or fingers. Our aim was to explore long-term consequences and adaptation in daily life after a thumb and/or multiple finger amputation followed by replantation surgery during young age.

Methods

Semi-structured interviews were conducted with nine recruited individuals and analysed using content analysis. The participants were asked to describe their hand function, pain, appearance, emotional consequences, impact on daily life and strategies for overcoming daily challenges.

Results

The interviews revealed five main categories: memories of the injury and concerns for the future; hand function, pain and cold sensitivity; feelings about having a visibly different hand; adaptation to impairments and challenges in daily life; and key messages to healthcare professions and advice to future patients.The circumstances of the injury were well remembered. Pain at rest was rare but occurred when grasping. Cold sensitivity was a major issue. Appearance-related concerns varied from none to a major problem. Despite impaired hand function, solutions were found to challenges in daily life. Compensatory strategies, personal resources and support from others were important in this adaptation process.

Conclusions

Patients with replantation surgery after an amputation during young age adapt to challenges in daily life over time. Healthcare professionals should offer adequate support to enable emotional processing of trauma experience. Appearance-related concerns should be addressed to prevent distress. Information about alleviating strategies to overcome long-term problems with cold sensitivity should be emphasized.

The General Self-Efficacy Scale in a population planned for bariatric surgery in Sweden: a psychometric evaluation study

OBJECTIVES

This study psychometrically evaluated General Self-Efficacy (GSE) Scale in patients planned for bariatric surgery in Sweden.

DESIGN

A cross-sectional psychometric study. The psychometric evaluation was guided by the COnsensus-based Standards for the selection of health status Measurement Instruments checklist for health-related reported-patient outcomes.

SETTING

Three bariatric centres in Sweden.

PARTICIPANTS

Adult patients≥18 years old scheduled for primary bariatric surgery (with sleeve gastrectomy or Roux-en-Y gastric bypass).

PRIMARY AND SECONDARY MEASURES

Psychometric properties of the GSE.

RESULTS

In total, 704 patients were included in the analysis. Mean values for GSE items were 2.9-3.4 and the mean GSE sum score was 31.4 (SD 4.7). There were no floor or ceiling effects. Cronbach's alpha was 0.89. Men reported a higher mean GSE than did women, that is, 31.2 (SD 4.8) for women versus 32.1 (SD 4.3) for men, p=0.03. Correlation coefficients were weak or negligible: GSE and mental component summary score of 36-Item Short Form Health Survey (SF-36)/RAND 36, r=0.18 (p<0.00); GSE and physical component summary score of SF-36/RAND 36, r=0.07 (p=0.138); GSE and obesity-related problem scale r=-0.15 (p=0.001) and GSE and level of education, r=0.04 (p=0.35). Confirmatory factor analysis indicated a one-factor construct with a satisfactory goodness of fit, that is, Comparative Fit Index=0.927, root mean square error of approximation=0.092 and standardised root mean square residual=0.045. The factor GSE explained almost half or over half of the variance of each item (0.45-0.75, p-values<0.001).

CONCLUSIONS

The GSE scale is a valid and reliable scale that can be used to assess general self-efficacy in patients undergoing bariatric surgery.

The effects of a 5-year physical activity on prescription (PAP) intervention in patients with metabolic risk factors

BACKGROUND

Increased physical activity (PA) has positive effects on health and longevity. In Swedish healthcare, the physical activity on prescription (PAP) method reportedly increases patients' PA levels for up to 12 months, but long-term follow ups are lacking. As it remains difficult to maintain lifestyle changes, our aim was to evaluate adherence and clinical effects at a 5-year follow-up of PAP treatment in primary healthcare.

METHODS

This longitudinal, prospective cohort study included 444 patients, (56% female), aged 27-85 years, with at least one metabolic risk factor. Participants were offered PAP by nurses or physiotherapists. The PAP intervention included an individualised dialogue, a PA recommendation by written prescription, and individually adjusted follow-up over 5 years, according to the Swedish PAP model. Patient PA level, metabolic risk factors, and health related quality of life (HRQoL) were measured at baseline and at the 6-month, 1.5-year, 2.5-year, 3.5-year, and 5-year follow-ups. Estimated latent growth curves were used to examine levels and rates of change in the outcomes.

RESULTS

The study dropout rate was 52%, with 215 of 444 patients completing the 5-year follow-up. At follow-up, the mean PA level had increased by 730 MET-minutes per week or 3 hours of moderate-intensity PA/week when compared to baseline. During the 5-year intervention, we observed significant positive changes (p ≤ 0.05) in 9 of 11 metabolic risk factors and HRQoL parameters: body mass index, waist circumference, systolic and diastolic blood pressure, fasting plasma glucose, triglycerides, cholesterol, high-density lipoprotein, and mental component summary.

CONCLUSION

This first evaluation of a 5-year PAP intervention in primary care demonstrated positive long-term (5 years) effects regarding PA level, metabolic health, and HRQoL. The recorded long-term adherence was ~50%, which is in line with medical treatment. Despite limitations, PAP can have long-term effects in an ordinary primary care setting.

Do reasons for undergoing bariatric surgery influence weight loss and health-related quality of life?-A Swedish mixed method study

Background

A wish for improved health or avoidance of ill health is often given as reason for wanting to undergo bariatric surgery. How such reasons relate to postoperative outcome is unclear.

Objective

The aim was to explore Swedish patients’ reasons for undergoing bariatric surgery. Also, we wanted to analyze if there were sex and age differences and associations with weight loss and health-related quality of life (HRQoL).

Settings

This was a single-center study conducted at a university hospital.

Method

Data on 688 patients (528 women and 160 men) including a free text response was analyzed inductively and deductively using predefined statements and was merged with data from the Scandinavian Obesity Surgery Registry. All data was analyzed using descriptive and analytic statistics.

Result

The most common reason for undergoing bariatric surgery was pain in different body parts. A wish for an improved medical condition was reported by most patients (59%, n = 408), followed by physical limitations making daily life difficult (42%, n = 288). Men and women reported similar reasons. Younger patients were more distressed about physical appearance (p = 0.001) and older patients wanted to improve their medical condition (p = 0.013). Health-related quality of life improved irrespective of reasons for undergoing surgery.

Conclusion

The most reported reasons for undergoing bariatric surgery were a wish for improved medical condition and to make daily life easier. Factors associated with the decision for surgery showed that there were few sex differences, but age seemed to be a factor. The HRQoL trajectory showed improvement regardless of reasons for undergoing surgery.

Long-term quality of life, work limitation, physical activity, economic cost and disease burden following ACL and meniscal injury: a systematic review and meta-analysis for the OPTIKNEE consensus

OBJECTIVE

Determine the long-term health-related quality-of-life (HRQoL), work limitation, physical activity, health/economic cost and disease burden of traumatic ACL and/or meniscal injury. Findings will inform OPTIKNEE evidence-based consensus recommendations.

DESIGN

Random-effects meta-analysis evaluated HRQoL (SF-36/SF-12/VR-12 Physical Component Scores (PCS) and Mental Component Scores (MCS), EuroQol-5D (EQ-5D)) stratified by time postinjury, and pooled mean differences (95% CI) between ACL-injured and uninjured controls. Other outcomes were synthesised descriptively. Risk-of-bias (RoB) and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation) were assessed.

DATA SOURCES

MEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched inception: 22 November 2021.

ELIGIBILITY

Studies reporting HRQoL, work limitations, physical activity levels, health/economic costs or disease burden, ≥2 years post-ACL and/or meniscal injury.

RESULTS

Fifty studies were included (10 high-RoB, 28 susceptible-to-some-bias and 12 low-RoB). Meta-analysis (27 studies, very low certainty of evidence) estimated a pooled mean (95% CI) PCS of 52.4 (51.4 to 53.4) and MCS of 54.0 (53.0 to 55.0) 2-14 years post-ACL injury. Pooled PCS scores were worse >10 years (50.8 (48.7 to 52.9)) compared with 2-5 years (53.9 (53.1 to 54.7)) postinjury. Excluding high-RoB studies, PCS scores were worse in ACL-injured compared with uninjured controls (-1.5 (-2.9 to -0.1)). Six studies (low certainty of evidence) informed a pooled EQ-5D score of 0.83 (0.81 to 0.84). Some individuals experienced prolonged work absenteeism and modified activities ≥2 years post-ACL injury. ACL injury was associated with significant direct and indirect costs, and early ACL reconstruction may be less cost-effective than rehabilitation. Only three studies evaluated meniscal injury outcomes (all evaluated HRQoL).

CONCLUSION

There is a very-low certainty of evidence that PCS scores ≥2 years post-ACL injury are worse than uninjured controls and decline over time, whereas MCS scores remain high. ACL injury can result in prolonged work absenteeism and high health/economic costs. Further studies are needed to determine the long-term burden of traumatic meniscal injury.

Alcohol Use among Swedish Patients with Stress-Induced Exhaustion Disorder, and Its Relation to Anxiety, Depression, and Health-Related Quality of Life

Harmful drinking may be a cause and an effect of psychological distress, and compromises the effects of treatment for psychiatric conditions. There is a paucity of studies investigating patterns of alcohol consumption among patients with stress-induced exhaustion disorder (SED). The aims of this investigation were (1) to assess the prevalence of self-rated hazardous drinking in a sample of 808 Swedish patients with SED (mean age 43 ± 9 years, 84% women), and (2) to investigate differences in sociodemographic variables, psychological symptoms, health-related quality of life, and sleep variables between patients with different drinking patterns The design was cross-sectional and data were collected with questionnaires at pre-treatment. Twelve percent of female and 13% of male patients reported Alcohol Use Disorder Identification Test (AUDIT) scores indicating hazardous drinking. Female patients with hazardous drinking reported higher levels of anxiety and depression and lower mental wellbeing, than other women. Female patients reporting no drinking reported poorer physical function and more pain, than other women. No differences were seen between male patients with different drinking patterns. Although patients with SED report a lower frequency of harmful drinking than other psychiatric samples, alcohol consumption needs to be addressed in the assessment and treatment of this condition.

Quality of life in mothers and fathers of children treated for acute lymphoblastic leukaemia in Sweden, Finland and Denmark

Acute lymphoblastic leukaemia (ALL) has a high survival rate, but treatment is lengthy with risk of severe side‐effects, which may also impact parents' health‐related quality of life (HRQOL). We present data on 526 parents of 310 children treated for ALL according to the NOPHO ALL2008‐protocol, in Sweden, Finland and Denmark. Parents were asked to complete the 36‐Item Short Form Survey (SF‐36) at least 6 months after end of treatment and data were compared with Norwegian reference data. Parental background factors were collected via a study‐specific questionnaire. Participating parents scored significantly lower than the reference population on both physical and mental summary indexes, but only surpassed a minimal clinically important difference for the mental summary index (Mental Component Summary [MCS]). Mothers scored lower than fathers in the MCS and stopped working and took care of the affected child more often than the fathers. Higher mental HRQOL was associated with male gender and living in Finland or Denmark (compared to Sweden). Correlations within spouses in physical and mental scores were weak to moderate. In conclusion, ALL negatively affects parental HRQOL, especially the mental domains, even after treatment. Findings suggest that mothers are more affected than fathers and may require extra support.

Cohort profile: the Halland osteoarthritis (HALLOA) cohort-from knee pain to osteoarthritis: a longitudinal observational study in Sweden

PURPOSE

The overall objective in this study is to investigate the early development of radiographic knee osteoarthritis (OA) and its association with hand or/and knee OA, metabolic diseases, biomarkers, chronic pain, physical function and daily physical activity types.

PARTICIPANTS

The Halland osteoarthritis (HALLOA) cohort is a longitudinal cohort study that includes individuals with knee pain in the southwest of Sweden. Enrolment took place from 2017 to 2019. The inclusion criteria were current knee pain, with no former known radiographic knee OA and no cruciate ligament rupture or rheumatological disorder. The participants were recruited: (1) when seeking care for knee pain in primary healthcare or (2) by advertisements in local newspapers. There are 306 individuals included in the study, mean age (SD) 51.7 (8.7) years and 69% are women. The baseline and follow-ups include clinical tests, radiographical examinations, blood samples, metabolic measures, pain pressure thresholds, tests of physical functions, daily physical activity types and patient-reported outcomes.

FINDINGS TO DATE

There were associations between metabolic factors and radiographic knee OA, even in those with normal body mass index at baseline. In addition, clinical hand OA was positively associated with fasting plasma glucose. We also found that modifiable factors as increased visceral fat and total body fat were associated with increased pain sensitivity among individuals with knee pain.

FUTURE PLANS

By studying possible pathophysiological mechanisms of OA over time, we aim to provide new insights on OA progression, identify usable preventive measures helping the clinicians in the management of the disease and improve health for the patients. It is also important to study the development of chronic pain in OA, to get tools to identify individuals at risk and to be able to offer them treatment.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov (NCT04928170).

The minimal important change for the EQ VAS based on the SF-36 health transition item: observations from 25772 spine surgery procedures

PURPOSE

The EQ VAS is an integral part of EQ-5D, a commonly used instrument for health-related quality of life assessment. This study aimed to calculate the minimal important change (MIC) thresholds for the EQ VAS for improvement and deterioration after surgery for disk herniation or spinal stenosis.

METHODS

Patients, who were surgically treated for disk herniation or spinal stenosis between 2007 and 2016, were recruited from the Swedish spine register. Preoperative and 1-year postoperative data for a total of 25772 procedures were available for analysis. We used two anchor-based methods to estimate MIC for EQ VAS: (1) a predictive model based on logistic regression and (2) receiver operating characteristics (ROC) curves. The SF-36 health transition item was used as anchor.

RESULTS

The EQ VAS MIC threshold for improvement after disk herniation surgery ranged from 8.25 to 11.8 while the corresponding value for deterioration ranged from - 6.17 to 0.5. For spinal stenosis surgery the corresponding MIC values ranged from 10.5 to 14.5 and - 7.16 to - 6.5 respectively. There were moderate negative correlations (disk herniation - 0.47, spinal stenosis - 0.46) between the 1 year change in the EQ VAS and the SF-36 health transition item (MIC anchor).

CONCLUSIONS

For EQ VAS, we recommend a MIC threshold of 12 points for improvement after surgery for disk herniation or spinal stenosis, whereas the corresponding threshold for deterioration is - 7 points. There are marked differences between the EQ VAS MIC for improvement and deterioration after surgery for disk herniation or spinal stenosis. The MIC value varied depending on the method used for MIC estimation.

Risk for partners’ depression and anxiety during pregnancy and up to one year postpartum: A longitudinal cohort study

INTRODUCTION

Families may benefit from increased focus on partner emotional well-being during pregnancy and the perinatal period. Our aim was to explore the risk for depression and anxiety during pregnancy and one year postpartum in relation to partners’ self-reported health, sense of coherence, social support, and lifestyle factors.

METHODS

This is a longitudinal cohort study using three questionnaires that were answered twice during pregnancy and at one year postpartum. Participants (n=532) were recruited between April 2012 and September 2013, and follow-up was between April 2012 and March 2015, in Sweden.

RESULTS

In late pregnancy, 8.9% of the prospective partners were at high risk for depression and 8.3% one year postpartum. An increased risk for depression was found amongst those reporting ‘fair or very poor’ sexual satisfaction and those reporting ‘fair or very poor’ health during pregnancy and postpartum. High anxiety was reported by 10.8% during late pregnancy and 12.4% one year postpartum. Partners who were unemployed, had financial difficulties, and who scored low on a Sense of Coherence scale, showed significantly higher anxiety in late pregnancy and postpartum. Social support has a significant and positive impact concerning signs of depression and anxiety, both during pregnancy and postpartum.

CONCLUSIONS

More than 10% of partners in this study showed depressive symptoms and anxiety, indicating a problem in need of attention by stakeholders. Strengthening social support is of greatest importance. It is time for the introduction of family-focused care aimed at prevention of depression and anxiety, and maintenance of family well-being.