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Östlund, G., Björk, M., Thyberg, I., Valtersson, E. & Sverker, A. (2018). Womens situation-specific strategies in managing participation restrictions due to early rheumatoid arthritis: A gender comparison. Musculoskeletal Care, 16(2), 251-259
Open this publication in new window or tab >>Womens situation-specific strategies in managing participation restrictions due to early rheumatoid arthritis: A gender comparison
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2018 (English)In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 16, no 2, p. 251-259Article in journal (Refereed) Published
Abstract [en]

Introduction

The present study explored how women describe their use of situation‐specific strategies when managing rheumatoid arthritis (RA). The aim was also to compare women's strategies with those of men, and see the extent to which they used the same strategies.

Methods

The data were collected using semi‐structured interviews based on the critical incident technique. The sample consisted of women with early rheumatic arthritis (n = 34), and the results were compared with data reported in a previous study on men (n = 25) from the same cohort. The patient‐described participation restrictions due to RA were firstly linked to the domains of the International Classification of Functioning, Disability and Health (ICF). The different strategies used were then categorized. The study was approved by the Research Ethics Committee of the Faculty of Health Sciences, Linköping University, Sweden.

Results

The study found that women used four situation‐specific strategies: adjustment, avoidance, interaction and acceptance. The same strategies had been found previously in interviews with men with RA. Women and men used these strategies to a similar extent in the ICF domains of mobility; major life arenas; domestic life; interpersonal interactions and relationships; and community, social and civic life. However, some differences were found, relating to the reported activities in self‐care and domestic life, in which women reported using strategies to a greater extent than men.

Conclusions

Women and men used four types of situation‐specific strategies in managing RA; adjustment, avoidance, interaction and acceptance. These situation‐specific strategies provide useful knowledge, in terms of multidisciplinary rehabilitation and for patients' significant others.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2018
Keywords
chronic disease; coping strategies; gender perspective; rehabilitation; rheumatology
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-152537 (URN)10.1002/msc.1225 (DOI)000435802900002 ()29316201 (PubMedID)2-s2.0-85040178068 (Scopus ID)
Available from: 2019-03-07 Created: 2019-03-07 Last updated: 2019-07-05Bibliographically approved
Thyberg, I., Dahlström, Ö., Björk, M., Stenström, B. & Adams, J. (2017). Hand pains in women and men in early rheumatoid arthritis, a one year follow-up after diagnosis. The Swedish TIRA project. Disability and Rehabilitation, 39(3), 291-300
Open this publication in new window or tab >>Hand pains in women and men in early rheumatoid arthritis, a one year follow-up after diagnosis. The Swedish TIRA project
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2017 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 39, no 3, p. 291-300Article in journal (Refereed) Published
Abstract [en]

Purpose: This research analysed general pain intensity, hand pain at rest and hand pain during activity in women and men in early rheumatoid arhtritis (RA).

Method: Out of the 454 patients that were recruited into the Swedish early RA project "TIRA" the 373 patients (67% women) that remained at 12 months follow-up are reported here. Disease activity 28 joint score (DAS-28), disability (Health Assessment Questionnaire = HAQ) and pain (VAS) were recorded at inclusion and after 3 (M3), 6 (M6) and 12 (M12) months. General pain, hand pain during rest, hand pain during test of grip force as assessed by Grippit™, prescribed disease-modifying anti-inflammatory drugs (DMARDs) and hand dominance were recorded.

Results: DAS-28 and HAQ scores were high at inclusion and improved thereafter in both women and men. There were no significant differences between sexes at inclusion but women had higher DAS-28 and HAQ at all follow-ups. Women were more often prescribed DMARDs than were men. In both women and men all pain types were significantly lower at follow-up compared to at inclusion and women reported higher pain than men at follow-ups. The pain types differed significantly from each other at inclusion into TIRA, general pain was highest and hand pain during rest was lowest. There were no significant differences in hand pain related to hand dominance or between right and left hands.

Conclusions: Disease activity, disability and pain were high at inclusion and reduced over the first year. Despite more DMARDs prescribed in women than in men, women were more affected than were men. General pain was highest and not surprisingly hand pain during active grip testing was higher than hand pain during rest that was lowest in both sexes. Although our cohort was well controlled, it was evident that hand pain remains a problem. This has implications for rehabilitation and suggests potential ongoing activity limitations that should continue to receive attention from a multi-professional team.

  • Implications for Rehabilitation
  • General pain and hand pain remain a problem in RA despite today's early intervention and effective disease control with new era biologics.
  • The extent of hand pain evidenced in our work gives a more detailed and comprehensive account of pain status.
  • Higher hand pain during active grip testing than that during rest indicates a potential relationship to ongoing activity limitation.
  • Hand pain assessment can help guiding multi-professional interventions directed to reduce hand pain and thereby probably reduce activity limitations.
Place, publisher, year, edition, pages
Taylor & Francis, 2017
Keywords
Disability, grip force, hand function, pain, rehabilitation, sex
National Category
Occupational Therapy
Identifiers
urn:nbn:se:liu:diva-126437 (URN)10.3109/09638288.2016.1140835 (DOI)000392480400009 ()26965161 (PubMedID)
Note

Funding agencies: Swedish Rheumatism Association

Available from: 2016-03-24 Created: 2016-03-24 Last updated: 2018-04-07Bibliographically approved
Liedberg, G. & Björk, M. (2017). Pain, self-efficacy, anxiety, and quality of life are central for a bad or good night's sleep in persons with fibromyalgia. In: : . Paper presented at 7th Association of South-East Asian Pain Societies Congress February 16-19, Yangon, Myanmar.
Open this publication in new window or tab >>Pain, self-efficacy, anxiety, and quality of life are central for a bad or good night's sleep in persons with fibromyalgia
2017 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-135791 (URN)
Conference
7th Association of South-East Asian Pain Societies Congress February 16-19, Yangon, Myanmar
Available from: 2017-03-22 Created: 2017-03-22 Last updated: 2017-03-27
Ahlstrand, I., Vaz, S., Falkmer, T., Thyberg, I. & Björk, M. (2017). Self-efficacy and pain acceptance as mediators of the relationship between pain and performance of valued life activities in women and men with rheumatoid arthritis. Clinical Rehabilitation, 31(6), 824-834
Open this publication in new window or tab >>Self-efficacy and pain acceptance as mediators of the relationship between pain and performance of valued life activities in women and men with rheumatoid arthritis
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2017 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 31, no 6, p. 824-834Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To study whether personal factors (self-efficacy and pain acceptance) mediate the relationship between pain and performance of valued life activities in persons with rheumatoid arthritis.

METHODS: Persons with rheumatoid arthritis for at least four years (n = 737; 73% women) answered a questionnaire measuring self-efficacy, pain acceptance, performance of valued life activities, and self-rated pain. Relationships among these constructs were explored using univariate and multivariate analyses. Structural equation modelling was then used to examine the mediational role of personal factors on the relationship between pain and performance of valued life activities.

RESULTS: A direct negative association between pain and performance of valued life activities was identified (Beta = .34, P < .001). This suggests that people with rheumatoid arthritis who had higher levels of pain has increased difficulties in performing valued life activities. Self-efficacy and activity engagement component of pain acceptance mediated the relationship between pain and performance of valued life activities, however the pain willingness component of pain acceptance did not influence participation in valued life activities.

CONCLUSION: These findings highlight the importance of considering personal factors, such as pain acceptance and self-efficacy, in facilitating participation in valued life activities.

Place, publisher, year, edition, pages
Sage Publications, 2017
Keywords
Disability, ICF, mediation, pain, personal factors, rheumatoid arthritis, structural equation modelling, valued life activities scale
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:liu:diva-129964 (URN)10.1177/0269215516646166 (DOI)000401719500013 ()27146888 (PubMedID)
Note

Funding agencies: Medical Research Council of Southeast Sweden; Futurum - the academy for healthcare Region Jonkoping County; Swedish Rheumatism Fund; Swedish Association of Occupational Therapy; Axel Fugl-Meyer Memorial fund

Available from: 2016-07-02 Created: 2016-07-02 Last updated: 2018-05-02Bibliographically approved
Östlund, G., Thyberg, I., Valtersson, E., Björk, M. & Sverker, A. (2016). The Use of Avoidance, Adjustment, Interaction and Acceptance Strategies to Handle Participation Restrictions Among Swedish Men with Early Rheumatoid Arthritis.. Musculoskeletal Care, 14(4), 206-218
Open this publication in new window or tab >>The Use of Avoidance, Adjustment, Interaction and Acceptance Strategies to Handle Participation Restrictions Among Swedish Men with Early Rheumatoid Arthritis.
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2016 (English)In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 14, no 4, p. 206-218Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Living with a chronic disease means learning to live under new circumstances and involves a continuous adaptation to new ways of living. There is increasing knowledge about how people cope with stressful life events and adapt to new life situations. Approximately a third of patients diagnosed with rheumatoid arthritis (RA) are men; however, few studies have described the needs and experiences of men living with RA. The aim of the present study was to explore men's strategies for handling challenges related to participation in everyday life.

METHODS: The present study was associated with the prospective Swedish multicentre early arthritis project (given the Swedish acronym TIRA), which, in 2006-2009, included patients with early RA, contemporarily treated, with a mean disease duration of three years. From this cohort, 25 men, aged 20-63 years, were recruited consecutively. Data were collected in individual interviews, using the critical incident technique. The strategies for dealing with the challenges of RA in everyday life were analysed and categorized using content analysis.

RESULTS: Men with RA described four types of strategy for dealing with participation restrictions in everyday life: (i) Adjustment strategies - adjust behaviour, movements, medication, equipment and clothing to find new ways to conduct tasks or activities; (ii) Avoidance strategies - avoid activities, movements, social contacts and sometimes medication; (iii) Interaction strategies - say no, ask for help and work together to handle participation restrictions; and (iv) Acceptance strategies - learn to accept RA, with the pain, the slower work pace and the extended time needed.

CONCLUSIONS: According to men's lived experiences, a combination of strategies was used to deal with RA, depending on the situation and the experienced restriction. The results provided an understanding of how men with RA manage their disease, to reduce physical, social and emotional challenges. This knowledge may be used further to develop multi-professional interventions and patient education tailored to men with RA.

Place, publisher, year, edition, pages
John Wiley & Sons, 2016
Keywords
Male adaptation; chronic illness; coping; patient perspective
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-126435 (URN)10.1002/msc.1131 (DOI)26880258 (PubMedID)2-s2.0-84959097417 (Scopus ID)
Available from: 2016-03-24 Created: 2016-03-24 Last updated: 2018-03-20Bibliographically approved
Björk, M., Thyberg, M., Valtersson, E. & Katz, P. (2016). Validation and internal consistency of the Swedish version of the Valued Life Activities scale.. Clinical Rehabilitation, 30(12), 1211-1219
Open this publication in new window or tab >>Validation and internal consistency of the Swedish version of the Valued Life Activities scale.
2016 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 30, no 12, p. 1211-1219Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The objective was to create a linguistically and culturally validated Swedish version of the Valued Life Activities scale. The aim was also to describe its content and concurrent validity and its internal consistency in persons with rheumatoid arthritis.

METHODS: The Valued Life Activities scale was translated to Swedish and culturally adapted. In order to describe the content validity, both the Swedish and original Valued Life Activities scale were linked to the International Classification of Functioning, Disability and Health. The concurrent validity and internal consistency were evaluated in 737 patients with rheumatoid arthritis. To establish concurrent validity, the scale was correlated to disease activity, activity limitations, and life satisfaction. Internal consistency was assessed with Cronbach's alpha.

RESULTS: The equivalence of meaning between the Swedish and the original Valued Life Activities scale was ensured by harmonization review. Content validity was high when linked to the International Classification of Functioning, Disability and Health. Concurrent validity showed a strong correlation with the activity limitations (r = 0.87), moderate with life satisfaction (r = -0.61), and weak with disease activity (r = 0.38). Internal consistency was excellent (Cronbach's alpha = 0.97).

CONCLUSIONS: The Swedish Valued Life Activities scale has been tested in a large and well-characterized sample and found to be a linguistically valid and culturally adapted self-reported measure of participation. Content validity of the Valued Life Activities scale was excellent, concurrent validity strong, and the internal consistency excellent. Since both individual preferences and International Classification of Functioning, Disability and Health concepts of disability are taken into account, the Swedish Valued Life Activities scale appears to be a promising new scale addressing important aspects of participation.

Keywords
Activity limitation; Disability and Health; International Classification of Functioning; assessment; participation; patient perspective; validation; valued life activities scale
National Category
Occupational Therapy
Identifiers
urn:nbn:se:liu:diva-126436 (URN)10.1177/0269215515616665 (DOI)000389595500008 ()26603893 (PubMedID)
Note

Funding agencies: Swedish Rheumatism Association [R-309241, R-388161]; Medical Research Council of Southeast [FORSS-307351, FORSS-380281]; County Council of Ostergotland [LIO-356441, LIO-535211]

Available from: 2016-03-24 Created: 2016-03-24 Last updated: 2018-03-23
Sverker, A., Östlund, G., Thyberg, M., Thyberg, I., Valtersson, E. & Björk, M. (2015). Dilemmas of participation in everyday life in early rheumatoid arthritis: a qualitative interview study (The Swedish TIRA Project). Disability and Rehabilitation, 37(14-15), 1251-1259
Open this publication in new window or tab >>Dilemmas of participation in everyday life in early rheumatoid arthritis: a qualitative interview study (The Swedish TIRA Project)
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2015 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 14-15, p. 1251-1259Article in journal (Refereed) Published
Abstract [en]

Abstract Purpose: To explore the experiences of today's patients with early rheumatoid arthritis (RA) with respect to dilemmas of everyday life, especially regarding patterns of participation restrictions in valued life activities. Methods: A total of 48 patients, aged 20-63, three years post-RA diagnosis were interviewed using the Critical Incident Technique. Transcribed interviews were condensed into meaningful units describing actions/situations. These descriptions were linked to ICF participation codes according to the International Classification of Functioning, Disability and Health (ICF) linking rules. Results: Dilemmas in everyday life were experienced in domestic life, interpersonal interactions and relationships, community, social and civic life. Most dilemmas were experienced in domestic life, including participation restrictions in, e.g. gardening, repairing houses, shovelling snow, watering pot plants, sewing or walking the dog. Also many dilemmas were experienced related to recreation and leisure within the domain community, social and civic life. The different dilemmas were often related to each other. For instance, dilemmas related to community life were combined with dilemmas within mobility, such as lifting and carrying objects. Conclusions: Participation restrictions in today's RA patients are complex. Our results underline that the health care needs to be aware of the patients' own preferences and goals to support the early multi-professional interventions in clinical practice. Implications of Rehabilitation Today's rheumatoid arthritis (RA) patients experience participation restrictions in activities not included in International Classification of Functioning, Disability and Health (ICF) core set for RA or in traditionally questionnaires with predefined activities. The health care need to be aware of the patients' own preferences and goals to meet the individual needs and optimize the rehabilitation in early RA in clinical practice.

Place, publisher, year, edition, pages
Informa Healthcare, 2015
National Category
Clinical Medicine Basic Medicine
Identifiers
urn:nbn:se:liu:diva-113134 (URN)10.3109/09638288.2014.961658 (DOI)000357763700006 ()25243767 (PubMedID)
Available from: 2015-01-12 Created: 2015-01-12 Last updated: 2018-01-11
Östlund, G., Björk, M., Valtersson, E. & Sverker, A. (2015). Lived Experiences of Sex Life Difficulties in Men and Women with Early RA - The Swedish TIRA Project.. Musculoskeletal Care, 13(4), 248-257
Open this publication in new window or tab >>Lived Experiences of Sex Life Difficulties in Men and Women with Early RA - The Swedish TIRA Project.
2015 (English)In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 13, no 4, p. 248-257Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Men and women with rheumatoid arthritis (RA) experience restrictions in everyday life, in spite of the development of new medications. Recent research has described in detail how participation limitations are experienced in everyday life from a patient perspective. However, knowledge of how sex and intimate relationships are affected is still scarce.

OBJECTIVES: The aim of the present study was to explore sex life experiences in relation to sexual function and sexual relationships in men and women with early RA.

METHODS: The study formed part of TIRA-2 (the Swedish acronym for the prospective multicentre early arthritis project). The data collection included 45 interviews with 21 men and 24 women, aged 20-63, which were recorded and transcribed verbatim. The critical incident technique was used to collect data, and content analysis to categorize the results.

RESULTS: Half the participants stated that RA affected their sex life. The general descriptions formed five categories: sex life and tiredness; sex life and ageing; emotional consequences of impaired sexual function; facilitators of sexual function and sexual relationships; and strain on the sexual relationship.

CONCLUSIONS: Sex life is affected in early RA, in spite of new effective treatment strategies. New strategies of communication, assessment and self-managing interventions concerning the sex lives of patients with RA need to be implemented by a multidisciplinary healthcare team. Copyright © 2015 John Wiley & Sons, Ltd.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2015
Keywords
Sex life; patient perspective; quality of life; rehabilitation
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-126434 (URN)10.1002/msc.1105 (DOI)26052885 (PubMedID)
Available from: 2016-03-24 Created: 2016-03-24 Last updated: 2018-03-22
Ahlstrand, I., Thyberg, I., Falkmer, T., Dahlström, Ö. & Björk, M. (2015). Pain and activity limitations in women and men with contemporary treated early RA compared to 10 years ago: the Swedish TIRA project. Scandinavian Journal of Rheumatology, 44(4), 259-264
Open this publication in new window or tab >>Pain and activity limitations in women and men with contemporary treated early RA compared to 10 years ago: the Swedish TIRA project
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2015 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 44, no 4, p. 259-264Article in journal (Refereed) Published
Abstract [en]

Objectives: To study differences regarding pain and activity limitations during the 3 years following diagnosis in women and men with contemporary treated early RA compared with their counterparts who were diagnosed 10 years earlier. Method: This study was based on patients recruited to the Early Intervention in RA (TIRA) project. In the first cohort (TIRA-1) 320 patients were included in time for diagnosis during 1996-1998 and 463 patients were included in the second cohort (TIRA-2) during 2006-2009. Disease activity, pain intensity (Visual Analogue Scale, VAS), bodily pain (BP) in the 36-item Short Form Health Survey (SF-36), activity limitations (Health Assessment Questionnaire, HAQ), and medication were reported at inclusion and at follow-up after 1, 2, and 3 years. Results: Disease activity, pain, and activity limitations were pronounced at inclusion across both genders and in both cohorts, with some improvement observed during the first year after diagnosis. Disease activity did not differ between cohorts at inclusion but was significantly lower at the follow-ups in the TIRA-2 cohort, in which the patients were prescribed traditional disease-modifying anti-rheumatic drugs (DMARDs) and biological agents more frequently. In TIRA-2, patients reported significantly lower pain and activity limitations at all follow-ups, with men reporting lower pain than women. Women reported significantly higher activity limitations at all time points in TIRA-2. Conclusions: Pain and activity limitations were still pronounced in the contemporary treated early RA cohort compared with their counterparts diagnosed 10 years earlier and both of these factors need to be addressed in clinical settings.

Place, publisher, year, edition, pages
Informa Healthcare, 2015
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-121326 (URN)10.3109/03009742.2014.997285 (DOI)000359960100001 ()25786818 (PubMedID)
Note

Funding Agencies|Medical Research Council of Southeast Sweden (FORSS); Academy for Health and Care Jonkoping County Council (Futurum)

Available from: 2015-09-14 Created: 2015-09-14 Last updated: 2018-04-07Bibliographically approved
Ahlstrand, I., Björk, M., Thyberg, I. & Falkmer, T. (2015). Pain and difficulties performing valued life activities in women and men with rheumatoid arthritis. Clinical Rheumatology, 34(8), 1353-1362
Open this publication in new window or tab >>Pain and difficulties performing valued life activities in women and men with rheumatoid arthritis
2015 (English)In: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 34, no 8, p. 1353-1362Article in journal (Refereed) Published
Abstract [en]

This study aimed to examine the difficulties with performing valued life activities in relation to pain intensity in women and men with rheumatoid arthritis (RA). In total, 737 persons with RA (73 % women) from three rheumatology units in Sweden responded to a questionnaire measuring performance of 33 valued life activities and self-rated pain. The relationships between performance of valued life activities (VLAs) and pain (measured by visual analogue scale (VAS)) were analysed based on gender. Multiple linear regression analyses were conducted with the total VLA score as dependent variable. Women reported more pain and difficulties in performing valued life activities than men. Across genders, 85 % reported at least one valued life activity affected by RA. Significantly more women than men encountered difficulties in performing some activities such as cooking, gardening and meeting new people. Women reported higher pain intensity (35 mm) than men (31 mm). Almost all 33 difficulty ratings for valued life activities were higher among persons with high pain (greater than 40 mm) than persons with lower pain. Difficulty ratings for valued life activities correlated positively with pain in persons with lower pain, but not among those with high pain. The results highlight the importance of addressing pain, especially among women with RA, as they reported pain to impact on their valued life activities. Interestingly, this was evident also in women with lower levels of pain.

Place, publisher, year, edition, pages
Springer Verlag (Germany), 2015
Keywords
Disability; Gender; HAQ; Participation restrictions; VAS; VLA
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-120864 (URN)10.1007/s10067-015-2874-5 (DOI)000359267100006 ()25618175 (PubMedID)
Note

Funding Agencies|Medical Research Council of Southeast Sweden (FORSS); Academy for Health and Care, Jonkoping County Council (Futurum); Swedish Rheumatism Association

Available from: 2015-08-28 Created: 2015-08-28 Last updated: 2018-03-17
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1607-187X

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