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  • 1.
    Abou Ghayda, Ramy
    et al.
    Case Western Reserve Univ, OH 44106 USA.
    Lee, Keum Hwa
    Yonsei Univ, South Korea.
    Han, Young Joo
    Inje Univ, South Korea.
    Ryu, Seohyun
    Yonsei Univ, South Korea.
    Hong, Sung Hwi
    Yonsei Univ, South Korea.
    Yoon, Sojung
    Yonsei Univ, South Korea.
    Jeong, Gwang Hum
    Gyeongsang Natl Univ, South Korea.
    Yang, Jae Won
    Yonsei Univ, South Korea.
    Lee, Hyo Jeong
    Yonsei Univ, South Korea.
    Lee, Jinhee
    Yonsei Univ, South Korea.
    Lee, Jun Young
    Yonsei Univ, South Korea.
    Effenberger, Maria
    Med Univ Innsbruck, Austria.
    Eisenhut, Michael
    Luton & Dunstable Univ Hosp NHS Fdn Trust, England.
    Kronbichler, Andreas
    Med Univ Innsbruck, Austria.
    Solmi, Marco
    Univ Ottawa, Canada; Ottawa Hosp, Canada; Univ Ottawa, Canada; Univ Ottawa, Canada.
    Li, Han
    Univ Florida, FL USA.
    Jacob, Louis
    Univ Versailles St Quentin En Yvelines, France; CIBERSAM, Spain.
    Koyanagi, Ai
    CIBERSAM, Spain; ICREA, Spain.
    Radua, Joaquim
    Inst Invest Biomed August Pi & Sunyer IDIBAPS, Spain; Kings Coll London, England; Karolinska Inst, Sweden.
    Park, Myung Bae
    Pai Chai Univ, South Korea.
    Aghayeva, Sevda
    Azerbaijan Med Univ, Azerbaijan.
    Ahmed, Mohamed L. C. B.
    Univ Nouakchott Al Aasriya, Mauritania.
    Al Serouri, Abdulwahed
    Yemen Field Epidemiol Training Program, Yemen.
    Al-Shamsi, Humaid O.
    Univ Sharjah, U Arab Emirates; Burjeel Canc Inst, U Arab Emirates.
    Amir-Behghadami, Mehrdad
    Tabriz Univ Med Sci, Iran; Tabriz Univ Med Sci, Iran; Tabriz Univ Med Sci, Iran.
    Baatarkhuu, Oidov
    Mongolian Natl Univ Med Sci, Mongolia.
    Bashour, Hyam
    Damascus Univ, Syria.
    Bondarenko, Anastasiia
    Shupyk Natl Healthcare Univ Ukraine, Ukraine.
    Camacho-Ortiz, Adrian
    Univ Autonoma Nuevo Leon, Mexico.
    Castro, Franz
    Gorgas Mem Inst Hlth Studies, Panama.
    Cox, Horace
    Minist Hlth Guyana, Guyana.
    Davtyan, Hayk
    TB Res & Prevent Ctr NGO, Armenia.
    Douglas, Kirk
    Univ West Indies, Barbados.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Ebrahim, Shahul
    Univ Sci Tech & Technol, Mali.
    Ferioli, Martina
    IRCCS Azienda Osped Univ Bologna, Italy.
    Harapan, Harapan
    Univ Syiah Kuala, Indonesia.
    Mallah, Saad I
    Royal Coll Surg Ireland Bahrain, Indonesia.
    Ikram, Aamer
    Natl Inst Hlth, Pakistan.
    Inoue, Shigeru
    Tokyo Med Univ, Japan.
    Jankovic, Slobodan
    Univ Kragujevac, Serbia.
    Jayarajah, Umesh
    Univ Colombo, Sri Lanka.
    Jesenak, Milos
    Comenius Univ, Slovakia.
    Kakodkar, Pramath
    Natl Univ Galway Ireland, Ireland.
    Kebede, Yohannes
    Jimma Univ, Ethiopia.
    Kifle, Meron
    Univ Oxford, England.
    Koh, David
    Natl Univ Singapore, Singapore.
    Males, Visnja K.
    Sch Med Split, Croatia.
    Kotfis, Katarzyna
    Pomeranian Med Univ, Poland.
    Lakoh, Sulaiman
    Univ Sierra Leone, Sierra Leone.
    Ling, Lowell
    Chinese Univ Hong Kong, Peoples R China.
    Llibre-Guerra, Jorge
    Washington Univ, MO USA.
    Machida, Masaki
    Tokyo Med Univ, Japan.
    Makurumidze, Richard
    Univ Zimbabwe, Zimbabwe.
    Mamun, Mohammed
    Chinese Univ Hong Kong, Peoples R China; Jahangirnagar Univ, Bangladesh; Daffodil Int Univ, Bangladesh; CHINTA Res Bangladesh, Bangladesh.
    Masic, Izet
    Acad Med Sci Bosnia & Herzegovina, Bosnia & Herceg.
    Van Minh, Hoang
    Hanoi Univ Publ Hlth, Vietnam.
    Moiseev, Sergey
    Sechenov First Moscow State Med Univ, Russia.
    Nadasdy, Thomas
    St Parascheva Clin Hosp Infect Dis, Romania.
    Nahshon, Chen
    Carmel Hosp, Israel.
    Namendys-Silva, Silvio A.
    Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Mexico.
    Yongsi, Blaise N.
    Univ Yaounde II, Cameroon.
    Nielsen, Henning B.
    Zealand Univ Hosp Roskilde, Denmark.
    Nodjikouambaye, Zita A.
    Mobile Lab Hemorrhag & Resp Viruses Ndjamena, Chad.
    Ohnmar, Ohnmar
    Myanmar Hlth Minist, Myanmar.
    Oksanen, Atte
    Tampere Univ, Finland.
    Owopetu, Oluwatomi
    Univ Coll Hosp, Nigeria.
    Parperis, Konstantinos
    Univ Cyprus Med Sch, Cyprus.
    Perez, Gonzalo E.
    Clin Olivos, Argentina.
    Pongpirul, Krit
    Chulalongkorn Univ, Thailand.
    Rademaker, Marius
    Auckland Univ Med Sch, New Zealand.
    Rosa, Sandro
    Fed Fluminense Univ, Brazil; Natl Inst Ind Property, Brazil.
    Sah, Ranjit
    Natl Publ Hlth Lab, Nepal.
    Sallam, Dina
    Ain Shams Univ, Egypt.
    Schober, Patrick
    Vrije Univ Amsterdam, Netherlands.
    Singhal, Tanu
    Kokilaben Dhirubhai Ambani Hosp & Med Res Inst, India.
    Tafaj, Silva
    Univ Hosp Shefqet Ndroqi, Albania.
    Torres, Irene
    Fdn Octaedro, Ecuador.
    Smith Torres-Roman, J.
    Univ Cient Sur, Peru.
    Tsartsalis, Dimitrios
    Hippokrateion Hosp, Greece.
    Tsolmon, Jadamba
    Mongolian Natl Univ Med Sci, Mongolia.
    Tuychiev, Laziz
    Tashkent Med Acad, Uzbekistan.
    Vukcevic, Batric
    Univ Montenegro, Montenegro.
    Wanghi, Guy
    Univ Kinshasa, DEM REP CONGO.
    Wollina, Uwe
    Stadt Klinikum Dresden, Germany.
    Xu, Ren-He
    Univ Macau, Peoples R China.
    Yang, Lin
    Alberta Hlth Serv, Canada; Univ Calgary, Canada; Univ Calgary, Canada.
    Zaidi, Zoubida
    Univ Ferhat Abbas, Algeria.
    Smith, Lee
    Anglia Ruskin Univ, England.
    Shin, Jae Il
    Yonsei Univ, South Korea.
    The global case fatality rate of coronavirus disease 2019 by continents and national income: A meta-analysis2022In: Journal of Medical Virology, ISSN 0146-6615, E-ISSN 1096-9071, Vol. 94, no 6, p. 2402-2413Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to provide a more accurate representation of COVID-19s case fatality rate (CFR) by performing meta-analyses by continents and income, and by comparing the result with pooled estimates. We used multiple worldwide data sources on COVID-19 for every country reporting COVID-19 cases. On the basis of data, we performed random and fixed meta-analyses for CFR of COVID-19 by continents and income according to each individual calendar date. CFR was estimated based on the different geographical regions and levels of income using three models: pooled estimates, fixed- and random-model. In Asia, all three types of CFR initially remained approximately between 2.0% and 3.0%. In the case of pooled estimates and the fixed model results, CFR increased to 4.0%, by then gradually decreasing, while in the case of random-model, CFR remained under 2.0%. Similarly, in Europe, initially, the two types of CFR peaked at 9.0% and 10.0%, respectively. The random-model results showed an increase near 5.0%. In high-income countries, pooled estimates and fixed-model showed gradually increasing trends with a final pooled estimates and random-model reached about 8.0% and 4.0%, respectively. In middle-income, the pooled estimates and fixed-model have gradually increased reaching up to 4.5%. in low-income countries, CFRs remained similar between 1.5% and 3.0%. Our study emphasizes that COVID-19 CFR is not a fixed or static value. Rather, it is a dynamic estimate that changes with time, population, socioeconomic factors, and the mitigatory efforts of individual countries.

  • 2.
    Ahlstrand, I.
    et al.
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. School of Health Sciences, Jönköping University, Jönköping, Sweden; School of Occupational Therapy and Social Work, CHIRI, Curtin University, Perth, WA, Australia.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Björk, Mathilda
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Rehabilitation Center. School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Pain and activity limitations in women and men with contemporary treated early RA compared to 10 years ago: the Swedish TIRA project2015In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 44, no 4, p. 259-264Article in journal (Refereed)
    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.

  • 3.
    Ahlstrand, Inger
    et al.
    Jonköping University, Sweden.
    Björk, Mathilda
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Rehabilitation Center. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Jonköping University, Sweden.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Jonköping University, Sweden; Curtin University, Australia.
    Pain and difficulties performing valued life activities in women and men with rheumatoid arthritis2015In: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 34, no 8, p. 1353-1362Article in journal (Refereed)
    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.

  • 4.
    Ahlstrand, Inger
    et al.
    School of Health and Welfare, Jönköping University, Jönköping, Sweden.
    Vaz, Sharmila
    School of Occupational Therapy & Social Work, CHIRI, Curtin University, Perth, WA, Australia.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. School of Health and Welfare, Jönköping University, Jönköping, Sweden.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Björk, Mathilda
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Self-efficacy and pain acceptance as mediators of the relationship between pain and performance of valued life activities in women and men with rheumatoid arthritis2017In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 31, no 6, p. 824-834Article in journal (Refereed)
    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.

  • 5.
    Akerblom, Sophia
    et al.
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Cervin, Matti
    Lund Univ, Sweden.
    Perrin, Sean
    Lund Univ, Sweden.
    Fischer, Marcelo Rivano
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Gerdle, Björn
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    McCracken, Lance M.
    Uppsala Univ, Sweden.
    A Network Analysis of Clinical Variables in Chronic Pain: A Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)2021In: Pain medicine, ISSN 1526-2375, E-ISSN 1526-4637, Vol. 22, no 7, p. 1591-1602Article in journal (Refereed)
    Abstract [en]

    Background. Efforts to identify specific variables that impact most on outcomes from interdisciplinary pain rehabilitation are challenged by the complexity of chronic pain. Methods to manage this complexity are needed. The purpose of the study was to determine the network structure entailed in a set of self-reported variables, examine change, and look at potential predictors of outcome, from a network perspective. Methods. In this study we apply network analysis to a large sample of people seeking interdisciplinary pain treatment (N = 2,241). Variables analyzed include pain intensity, pain interference, extent of pain, depression, anxiety, insomnia, and psychological variables from cognitive behavioral models of chronic pain. Results. We found that Acceptance, Pain Interference, and Depression were key, "central," variables in the pretreatment network. Interestingly, there were few changes in the overall network configuration following treatment, specifically with respect to which variables appear most central relative to each other. On the other hand, Catastrophizing, Depression, Anxiety, and Pain Interference each became less central over time. Changes in Life Control, Acceptance, and Anxiety were most strongly related to changes in the remainder of the network as a whole. Finally, no network differences were found between treatment responders and non-responders. Conclusions. This study highlights potential future targets for pain treatment. Further application of a network approach to interdisciplinary pain rehabilitation data is recommended. Going forward, it may be better to next do this in a more comprehensive theoretically guided fashion, and ideographically, to detect unique individual differences in potential treatment processes.

  • 6.
    Alföldi, Peter
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Dragioti, Elena
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Wiklund, Tobias
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    SPREADING OF PAIN AND INSOMNIA IN PATIENTS WITH CHRONIC PAIN: RESULTS FROM A NATIONAL QUALITY REGISTRY (SQRP)2017In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, no 1, p. 63-70Article in journal (Refereed)
    Abstract [en]

    Objective: To explore how demographics, pain, psychosocial factors and insomnia relate to the spread of chronic pain. Methods: The study included 708 patients (68% women; median age 46 years; interquartile range 3557 years) with chronic pain who were referred to a multidisciplinary pain centre. Spreading of pain was assessed using a questionnaire covering 36 anatomically predefined pain regions. Data were collected on demographics, pain symptoms, psychological distress, and insomnia (Insomnia Severity Index). Four sub-categories of chronic pain were established: chronic local pain, chronic regional pain medium, chronic regional pain heavy, and chronic widespread pain. Results: The median number of pain regions was 10 (interquartile range 6-18). Prevalence of chronic pain was as follows: chronic local pain 9%, chronic regional pain medium 21%, chronic regional pain heavy 39%, and chronic widespread pain 31%. In the regression models, being a woman and persistent pain duration had the strongest associations with spreading of pain, but anxiety, pain interference, and insomnia were also important factors. Conclusion: Spreading of chronic pain can only partly be explained by the simultaneous levels of insomnia. Female sex, pain duration, pain interference and anxiety appear to have more significant relationships with the spread of pain. Targeting these factors may lead to improvements in treatment and prevention strategies.

  • 7.
    Almberg, Maria
    et al.
    Mobil Centre Gothenburg, Sweden.
    Selander, Helena
    Mobil Centre Gothenburg, Sweden; University of Gothenburg, Sweden.
    Falkmer, Marita
    Curtin University, Australia; Jonköping University, Sweden.
    Vaz, Sharmila
    Curtin University, Australia.
    Ciccarelli, Marina
    Curtin University, Australia.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin University, Australia.
    Experiences of facilitators or barriers in driving education from learner and novice drivers with ADHD or ASD and their driving instructors2017In: Developmental Neurorehabilitation, ISSN 1751-8423, E-ISSN 1751-8431, Vol. 20, no 2, p. 59-67Article in journal (Refereed)
    Abstract [en]

    Background: Little is known about whether individuals with autism spectrum disorder (ASD) or attention deficit hyperactive disorder (ADHD) experience any specific facilitators or barriers to driving education. Objective: To explore the facilitators or barriers to driving education experienced by individuals with ASD or ADHD who obtained a learners permit, from the perspective of the learner drivers and their driving instructors. Methods: Datawere collected from33 participants with ASD or ADHD, and nine of their driving instructors. Results: Participants with ASD required twice asmany driving lessons andmore on-road tests than those with ADHD. Participants with ADHD repeated the written tests more than those with ASD. Driving license theory was more challenging for individuals with ADHD, whilst individuals with ASD found translating theory into practice and adjusting to "unfamiliar driving situations to be the greatest challenges. Conclusion: Obtaining a driving license was associated with stressful training experience.

  • 8.
    Alme, Tomas Nordheim
    et al.
    Akershus Univ Hosp, Norway.
    Andreasson, Anna
    Karolinska Inst, Sweden.
    Asprusten, Tarjei Torre
    Vear Gen Practitioner Grp, Norway.
    Bakken, Anne Karen
    VID Specialized Univ, Norway; St Olavs Hosp, Norway.
    Beadsworth, Michael B. J.
    Liverpool Univ Hosp Fdn Trust, England.
    Boye, Birgitte
    Univ Oslo, Norway; Oslo Univ Hosp, Norway.
    Brodal, Per Alf
    Univ Oslo, Norway.
    Brodwall, Elias Myrstad
    Akershus Univ Hosp, Norway; Univ Oslo, Norway.
    Brurberg, Kjetil Gundro
    Norwegian Inst Publ Hlth, Norway.
    Bugge, Ingrid
    Oslo Univ Hosp, Norway.
    Chalder, Trudie
    Inst Psychiat, England.
    Due, Reidar
    Akershus Univ Hosp, Norway.
    Eriksen, Hege Randi
    Western Norway Univ Appl Sci, Norway.
    Fink, Per Klausen
    Aarhus Univ Hosp, Denmark.
    Flottorp, Signe Agnes
    Norwegian Inst Publ Hlth, Norway; Univ Oslo, Norway.
    Fors, Egil Andreas
    Norwegian Univ Sci & Technol NTNU, Norway.
    Jensen, Bard Fossli
    Kreftregisteret, Norway.
    Fundingsrud, Hans Petter
    Univ Hosp North Norway, Norway.
    Garner, Paul
    Univ Liverpool Liverpool Sch Trop Med, England.
    Havdal, Lise Beier
    Akershus Univ Hosp, Norway.
    Helgeland, Helene
    Lovisenberg Diakonale Hosp, Norway.
    Jacobsen, Henrik Borsting
    Oslo Univ Hosp, Norway; Univ Oslo, Norway.
    Johnson, Georg Espolin
    Univ Oslo, Norway.
    Jonsjoe, Martin
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Knoop, Hans
    Amsterdam Univ Med Ctr, Netherlands.
    Landmark, Live
    NTNU, Norway; Univ Oslo, Norway.
    Launes, Gunvor
    Univ Bergen, Norway.
    Lekander, Mats
    Karolinska Inst, Sweden.
    Linnros, Hannah
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Lindsaeter, Elin
    Karolinska Inst, Sweden.
    Liira, Helena
    Helsinki Univ Hosp, Finland.
    Linnestad, Lina
    Genok, Norway.
    Loge, Jon Hvard
    Univ Oslo, Norway.
    Lyby, Peter Solvoll
    CatoSenteret Rehabil Ctr, Norway.
    Malik, Sadaf
    Akershus Univ Hosp, Norway.
    Malt, Ulrik Fredrik
    Univ Oslo, Norway.
    Moe, Trygve
    Norsk Sykepleierforbund, Norway.
    Norlin, Anna-Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Mantorp. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Pedersen, Maria
    Akershus Univ Hosp, Norway; Univ Oslo, Norway.
    Pignatiello, Siv Elin
    Oslo Univ Hosp, Norway.
    Rask, Charlotte Ulrikka
    Aarhus Univ Hosp, Denmark.
    Reme, Silje Endresen
    Oslo Univ Hosp, Norway; Univ Oslo, Norway.
    Roksund, Gisle
    Vear Gen Practitioner Grp, Norway.
    Sainio, Markku
    HUS Helsinki Univ Hosp, Finland.
    Sharpe, Michael
    Univ Oxford, England.
    Thorkildsen, Ruth Foseide
    Diakonhjemmet Hosp, Norway.
    van Roy, Betty
    Akershus Univ Hosp, Norway.
    Vandvik, Per Olav
    Lovisenberg Diaconal Hosp, Norway.
    Vogt, Henrik
    Univ Oslo, Norway.
    Wyller, Hedda Bratholm
    Oslo Univ Hosp, Norway.
    Wyller, Vegard Bruun Bratholm
    Akershus Univ Hosp, Norway; Univ Oslo, Norway.
    Chronic fatigue syndromes: real illnesses that people can recover from2023In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724Article in journal (Refereed)
    Abstract [en]

    The Oslo Chronic Fatigue Consortium consists of researchers and clinicians who question the current narrative that chronic fatigue syndromes, including post-covid conditions, are incurable diseases. Instead, we propose an alternative view, based on research, which offers more hope to patients. Whilst we regard the symptoms of these conditions as real, we propose that they are more likely to reflect the brains response to a range of biological, psychological, and social factors, rather than a specific disease process. Possible causes include persistent activation of the neurobiological stress response, accompanied by associated changes in immunological, hormonal, cognitive and behavioural domains. We further propose that the symptoms are more likely to persist if they are perceived as threatening, and all activities that are perceived to worsen them are avoided. We also question the idea that the best way to cope with the illness is by prolonged rest, social isolation, and sensory deprivation.Instead, we propose that recovery is often possible if patients are helped to adopt a less threatening understanding of their symptoms and are supported in a gradual return to normal activities. Finally, we call for a much more open and constructive dialogue about these conditions. This dialogue should include a wider range of views, including those of patients who have recovered from them.

  • 9.
    Apostolidi, Dimitra Maria
    et al.
    Univ West Attica, Greece.
    Pantelaki, Nikoletta
    Univ West Attica, Greece.
    Sarantaki, Antigoni
    Univ West Attica, Greece.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Univ Ioannina, Greece.
    Metallinou, Dimitra
    Univ West Attica, Greece.
    Neonatal Palliative Care as an Integral Component of the Greek National Healthcare System: Time to Act2023In: Cureus, E-ISSN 2168-8184, Vol. 15, no 9, article id e45498Article in journal (Other academic)
    Abstract [en]

    Neonatal palliative care aims to provide multidisciplinary support to families and neonates suffering from life-threatening or life-limiting diseases. Many countries worldwide have recognized the importance of enhancing the quality of life in critically ill neonates and thus have created and systematically implemented palliative care protocols in neonatal intensive care units (NICUs). Europe has a very low neonatal mortality rate, which has been steadily decreasing over the last 30 years. Greece in particular, a country located in Southeast Europe, reported a neonatal mortality rate of 2.29/1,000 live births in 2020. Nevertheless, neonatal palliative care facilities are scarce on a national level. In this paper, several reasons are presented to support the integration of neonatal palliative care in the Greek national healthcare system with the vision to ensure that all neonates and their families will receive in the near future the care, support, and dignity they deserve when facing life-threatening or life-limiting illnesses.

  • 10.
    Arango, Celso
    et al.
    Hosp Gen Univ Gregorio Maranon, Spain; Univ Complutense Madrid, Spain; Biomed Res Ctr Mental Hlth CIBERSAM, Spain.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Solmi, Marco
    Kings Coll London, England; Univ Padua, Italy; Univ Ottawa, Canada; Ottawa Hosp, Canada.
    Cortese, Samuele
    Univ Southampton, England; Univ Southampton, England; Univ Nottingham, England; NYU Langone, NY USA.
    Domschke, Katharina
    Univ Freiburg, Germany; Univ Freiburg, Germany; Univ Freiburg, Germany.
    Murray, Robin M.
    Kings Coll London, England.
    Jones, Peter B.
    Univ Cambridge, England; Cambridgeshire & Peterborough Natl Hlth Serv Fdn, England.
    Uher, Rudolf
    Dalhousie Univ, Canada; Nova Scotia Hlth, Canada; IWK Hlth Ctr, Canada; Dalhousie Univ, Canada.
    Carvalho, Andre F.
    Deakin Univ, Australia; Univ Toronto, Canada; Ctr Addict & Mental Hlth, Canada.
    Reichenberg, Abraham
    Icahn Sch Med Mt Sinai, NY 10029 USA; Icahn Sch Med Mt Sinai, NY 10029 USA; Icahn Sch Med Mt Sinai, NY 10029 USA.
    Shin, Jae Ii
    Yonsei Univ, South Korea; Severance Childrens Hosp, South Korea.
    Andreassen, Ole A.
    Univ Oslo, Norway; Oslo Univ Hosp, Norway.
    Correll, Christoph U.
    Northwell Hlth, NY USA; Zucker Sch Med Hofstra Northwell, NY USA; Feinstein Inst Med Res, NY USA; Charite, Germany.
    Fusar-Poli, Paolo
    Kings Coll London, England; South London & Maudsley NHS Fdn Trust, England; Univ Pavia, Italy.
    Risk and protective factors for mental disorders beyond genetics: an evidence-based atlas2021In: World Psychiatry, ISSN 1723-8617, E-ISSN 2051-5545, Vol. 20, no 3, p. 417-436Article in journal (Refereed)
    Abstract [en]

    Decades of research have revealed numerous risk factors for mental disorders beyond genetics, but their consistency and magnitude remain uncer-tain. We conducted a "meta-umbrella" systematic synthesis of umbrella reviews, which are systematic reviews of meta-analyses of individual studies, by searching international databases from inception to January 1, 2021. We included umbrella reviews on non-purely genetic risk or protective factors for any ICD/DSM mental disorders, applying an established classification of the credibility of the evidence: class I (convincing), class II (highly suggestive), class III (suggestive), class IV (weak). Sensitivity analyses were conducted on prospective studies to test for temporality (reverse causation), TRANSD criteria were applied to test transdiagnosticity of factors, and A Measurement Tool to Assess Systematic Reviews (AMSTAR) was employed to address the quality of meta-analyses. Fourteen eligible umbrella reviews were retrieved, summarizing 390 meta-analyses and 1,180 associations between putative risk or protective factors and mental disorders. We included 176 class I to III evidence associations, relating to 142 risk/protective factors. The most robust risk factors (class I or II, from prospective designs) were 21. For dementia, they included type 2 diabetes mellitus (risk ratio, RR from 1.54 to 2.28), depression (RR from 1.65 to 1.99) and low frequency of social contacts (RR=1.57). For opioid use disorders, the most robust risk factor was tobacco smoking (odds ratio, OR=3.07). For non-organic psychotic disorders, the most robust risk factors were clinical high risk state for psychosis (OR=9.32), cannabis use (OR=3.90), and childhood adversities (OR=2.80). For depressive disorders, they were widowhood (RR=5.59), sexual dysfunction (OR=2.71), three (OR=1.99) or four-five (OR=2.06) metabolic factors, childhood physical (OR=1.98) and sexual (OR=2.42) abuse, job strain (OR=1.77), obesity (OR=1.35), and sleep disturbances (RR=1.92). For autism spectrum disorder, the most robust risk factor was maternal overweight pre/during pregnancy (RR=1.28). For attention-deficit/hyperactivity disorder (ADHD), they were maternal pre-pregnancy obesity (OR=1.63), maternal smoking during pregnancy (OR=1.60), and maternal overweight pre/during pregnancy (OR=1.28). Only one robust protective factor was detected: high physical activity (hazard ratio, HR=0.62) for Alzheimers disease. In all, 32.9% of the associations were of high quality, 48.9% of medium quality, and 18.2% of low quality. Transdiagnostic class I-III risk/protective factors were mostly involved in the early neurodevelopmental period. The evidence-based atlas of key risk and protective factors identified in this study represents a benchmark for advancing clinical characterization and research, and for expanding early intervention and preventive strategies for mental disorders.

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  • 11.
    Arrondo, Gonzalo
    et al.
    Univ Navarra, Spain; Univ Southampton, England.
    Solmi, Marco
    Univ Southampton, England; Univ Ottawa, Canada; Ottawa Hosp, Canada; Kings Coll London, England.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Univ Ioannina, Greece.
    Eudave, Luis
    Univ Navarra, Spain.
    Ruiz-Goikoetxea, Maite
    Serv Navarro Salud Osasunbidea, Spain.
    Ciaurriz-Larraz, Amaia M.
    Univ Navarra, Spain.
    Magallon, Sara
    Univ Navarra, Spain.
    Carvalho, Andre F.
    Deakin Univ, Australia.
    Cipriani, Andrea
    Univ Oxford, England; Warneford Hosp, England.
    Fusar-Poli, Paolo
    Kings Coll London, England; South London & Maudsley NHS Fdn Trust, England; South London & Maudsley NHS Fdn Trust, England; Univ Pavia, Italy.
    Larsson, Henrik
    Karolinska Inst, Sweden; Orebro Univ, Sweden.
    Correll, Christoph U.
    Northwell Hlth, NY USA; Donald & Barbara Zucker Sch Med Hofstra Northwell, NY USA; Charite, Germany.
    Cortese, Samuele
    Univ Southampton, England; Univ Southampton, England; Solent NHS Trust, England; Univ Nottingham, England; NYU, NY USA.
    Associations between mental and physical conditions in children and adolescents: An umbrella review2022In: Neuroscience and Biobehavioral Reviews, ISSN 0149-7634, E-ISSN 1873-7528, Vol. 137, article id 104662Article, review/survey (Refereed)
    Abstract [en]

    We mapped the evidence on the type and strength of associations between a broad range of mental and physical conditions in children and adolescents, by carrying out an umbrella review, i.e., a quantitative synthesis of previous systematic reviews and meta-analyses. We also assessed to which extent the links between mental and physical conditions vary across disorders or, by contrast, are transdiagnostic. Based on a pre-established protocol, we retained 45 systematic reviews/meta-analyses, encompassing around 12.5 million of participants. In analyses limited to the most rigorous estimates, we found evidence for the following associations: ADHD-asthma, ADHDobesity, and depression-asthma. A transdiagnostic association was confirmed between asthma and anxiety/ASD/depression/bipolar disorder, between obesity and ADHD/ASD/depression, and between dermatitis and ASD/ADHD. We conclude that obesity and allergic conditions are likely to be associated with mental disorders in children and adolescents. Our results can help clinicians explore potential links between mental and physical conditions in children/adolescent and provide a road map for future studies aimed at shading light on the underlying factors.

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  • 12.
    Assenhöj, Maria
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Occupational and Environmental Medicine Center.
    Ward, Liam J.
    Karolinska Inst, Sweden.
    Ghafouri, Bijar
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Graff, Pal
    Natl Inst Occupat Hlth, Norway.
    Ljunggren, Stefan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Occupational and Environmental Medicine Center.
    Metal exposure from additive manufacturing and its effect on the nasal lavage fluid proteome - a pilot study2021In: PLOS ONE, E-ISSN 1932-6203, Vol. 16, no 8, article id e0256746Article in journal (Refereed)
    Abstract [en]

    The use of metal additive manufacturing (AM) is steadily increasing and is an emerging concern regarding occupational exposure. In this study, non-invasive sampled nasal lavage fluid (NLF) from the upper airways was collected from metal AM operators at the beginning and end of a workweek during two consecutive years with preventive interventions in the occupational setting in-between (n = 5 year 1, n = 9 year 2). During year one, NLF was also collected from welders (n = 6) from the same company to get a comparison with a traditional manufacturing technique with known exposure and health risks. The samples were investigated using untargeted proteomics, as well as using multi-immunoassay to analyze a panel of 71 inflammatory protein markers. NLF in AM operators from year 1 showed decreased levels of Immunoglobulin J and WAP four-disulfide core domain protein 2 and increased levels of Golgi membrane protein 1, Uteroglobin and Protein S100-A6 at the end of the workweek. At year two, after preventive interventions, there were no significant differences at the end of the workweek. In welders, Annexin A1 and Protein S100-A6 were increased at the end of the workweek. The analysis of 71 inflammatory biomarkers showed no significant differences between the beginning and the end of workweek year 1 in AM operators. We identified several proteins of interest in the AM operators that could serve as possible markers for exposure in future studies with a larger cohort for validation.

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  • 13.
    Bajramaj, Ermira
    et al.
    Malmo Univ, Sweden.
    Haggman-Henrikson, Birgitta
    Malmo Univ, Sweden; Umea Univ, Sweden.
    Dawson, Andreas
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Public Dental Health Care, Center for Oral Rehabilitation Norrköping. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Ghafouri, Bijar
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    The Effect of Microdialysis Catheter Insertion on Glutamate and Serotonin Levels in Masseter Muscle in Patients with Myofascial Temporomandibular Disorders and Healthy Controls2019In: Diagnostics (Basel), ISSN 2075-4418, Vol. 9, no 1, article id 14Article in journal (Refereed)
    Abstract [en]

    Myofascial temporomandibular disorders (TMD) are the most common cause of chronic pain in the orofacial region. Microdialysis has been used to study metabolic changes in the human masseter muscle. The insertion of the microdialysis probe causes acute tissue trauma that could affect the metabolic milieu and thereby influence the results when comparing healthy subjects to those with TMD. This study aimed to investigate the levels of serotonin and glutamate during the acute tissue trauma period in healthy subjects and in patients with TMD. Microdialysis was carried out in 15 patients with TMD and 15 controls, and samples were collected every 20 min during a period of 140 min. No significant alterations of serotonin or glutamate were observed over the 2 h period for the healthy subjects. For the TMD group, a significant decrease in serotonin was observed over time (p amp;lt; 0.001), followed by a significant increase between 120 and 140 min (p amp;lt; 0.001). For glutamate, a significant reduction was observed at 40 min compared to baseline. The results showed that there was a spontaneous increase of serotonin 2 h after the insertion of the catheter in patients with TMD. In conclusion, the results showed that there are differences in the masseter muscle levels of serotonin and glutamate during acute nociception in patients with myofascial TMD compared to healthy subjects.

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  • 14. Order onlineBuy this publication >>
    Bendelin, Nina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Internet-Delivered Acceptance and Commitment Therapy for Chronic Pain: Feasibility, patients’ experiences and implementation process2023Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Chronic pain represents a major burden for individuals and society. Internet-delivered psychological interventions are evidence-based treatments that enable patients to access qualified care at a time and place convenient for them. Internet-delivered Acceptance and commitment therapy (IACT) has shown promising treatment effects for chronic pain patients on pain-related outcomes such as disability, pain intensity, and interference, and on psychological outcomes such as catastrophizing, fear-avoidance and acceptance. Interdisciplinary pain rehabilitation programs (IPRP) are multimodal interventions given by synchronized teams of health care professionals from different disciplines. With moderate treatment effects on many outcomes, IPRP is the best evidence treatment for chronic pain to date.   

    IACT may add to IPRP’s effectiveness by providing individual psychological treatment via the internet. However, IACT has not yet been implemented in routine care in a larger scale. In this thesis, the aim was to study if IACT may be acceptable for chronic pain patients and if it is feasible and effective as an addition to IPRP. Three methodological approaches were used: qualitative analysis, implementation science and a controlled trial of effectiveness in a clinical context.   

    Study I showed that an internet-delivered aftercare intervention enabled chronic pain patients to change their perception of their body and pain and their attitude about their future and self. Furthermore, self-motivating goals and acceptance strategies appeared to influence autonomy. The results gave promise to the feasibility of IACT as aftercare following IPRP. Study II showed that chronic pain patients’ experiences of IACT vary, with respect to being in treatment and the consequences of treatment. Specifically, e-therapist feedback and deadlines for homework may have an impact on autonomy and change. Patients’ expectations, motivations, and restraints could explain treatment engagement and experiences. In Study III, IACT added during IPRP enhanced the treatment effects on pain acceptance and affective distress. Furthermore, IACT added as aftercare strengthened the long-term effect of IPRP on psychological flexibility and self-efficacy. However, unsatisfactory completion rates complicated the interpretation of the findings. Study IV showed that implementing IACT in an IPRP setting may be facilitated by contextual alinement and modifications based on patients’ needs. Thorough testing of the application and matching the intervention’s aim with the host’s needs are important not to challenge the process. An implementation framework may ease planning and evaluation of implementation processes.   

    In conclusion, IACT could be feasible as an addition to IPRP. IACT can help chronic pain patients self-manage their pain and improve pain acceptance and self-efficacy. However, chronic pain patients’ varying experiences may need to be considered to improve treatment engagement and help patients benefit from treatment. In addition, implementation of IACT in IPRP settings is likely to depend on both flexibility to changing host needs and continuity of known pivotal components in IACT.   

    List of papers
    1. Internet-delivered aftercare following multimodal rehabilitation program for chronic pain: a qualitative feasibility study
    Open this publication in new window or tab >>Internet-delivered aftercare following multimodal rehabilitation program for chronic pain: a qualitative feasibility study
    2018 (English)In: Journal of Pain Research, E-ISSN 1178-7090, Vol. 11, p. 1715-1728Article in journal (Refereed) Published
    Abstract [en]

    Purpose: Methods for delivering aftercare to help chronic pain patients to continue practice self-management skills after rehabilitation are needed. Internet-delivered cognitive behavioral therapy (ICBT) has the potential to partly fill this gap given its accessibility and emphasis on self-care. Methods for engaging and motivating patients to persist throughout the full length of treatment are needed. The aim of this study was to describe how chronic pain patients work in an ICBT program, through their descriptions of what is important when they initiate behavior change in aftercare and their descriptions of what is important for ongoing practice of self-management skills in aftercare. Patients and methods: Following a multimodal rehabilitation program, 29 chronic pain patients participated in a 20-week-long Internet-delivered aftercare program (ACP) based on acceptance-based cognitive behavioral therapy. Latent content analysis was made on 138 chapters of diary-like texts written by participants in aftercare. Results: Attitudes regarding pain and body changed during ACP, as did attitudes toward self and the future for some participants. How participants practiced self-management skills was influenced by how they expressed motivation behind treatment goals. Whether they practiced acceptance strategies influenced their continuous self-management practice. Defusion techniques seemed to be helpful in the process of goal setting. Mindfulness strategies seemed to be helpful when setbacks occurred. Conclusion: Self-motivating goals are described as important both to initiate and in the ongoing practice of self-management skills. Experiencing a helpful effect of acceptance strategies seems to encourage participants to handle obstacles in new ways and to persist throughout treatment. Research on whether tailored therapist guidance might be helpful in stating self-motivating goals and contribute to ongoing practice of self-management skills is needed.

    Place, publisher, year, edition, pages
    DOVE MEDICAL PRESS LTD, 2018
    Keywords
    Internet-delivered cognitive-behavioral therapy; chronic pain; acceptance and commitment therapy; qualitative analysis; self-management
    National Category
    Physiotherapy
    Identifiers
    urn:nbn:se:liu:diva-151536 (URN)10.2147/JPR.S157939 (DOI)000443450600002 ()30233229 (PubMedID)
    Note

    Funding Agencies|County Council of Ostergotland (forsknings-ALF); AFA insurance

    Available from: 2018-09-24 Created: 2018-09-24 Last updated: 2024-01-17
    2. Patients experiences of internet-based Acceptance and commitment therapy for chronic pain: a qualitative study
    Open this publication in new window or tab >>Patients experiences of internet-based Acceptance and commitment therapy for chronic pain: a qualitative study
    Show others...
    2020 (English)In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, BMC MUSCULOSKELETAL DISORDERS, Vol. 21, no 1, article id 212Article in journal (Refereed) Published
    Abstract [en]

    Background: Chronic pain is a globally widespread condition with complex clusters of symptoms within a heterogeneous patient group. Internet-delivered Acceptance and Commitment Therapy (IACT) has shown promising results in the treatment of chronic pain. How IACT is experienced by patients is less well known. Qualitative studies of patients experiences are needed to further understand factors behind both engagement and negative effects. The aim of this study was to explore how IACT was experienced by chronic pain patients who had participated in a controlled trial. Methods: Through an open and exploratory approach this study aimed to investigate how IACT was experienced when delivered as a guided self-help program to persons with chronic pain. Eleven participants were interviewed over telephone after completing IACT. Results: Qualitative analysis based on grounded theory resulted in 2 core categories and 8 subcategories. In treatment: Physical and cognitive restraints, Time and deadline, Therapist contact, and Self-confrontation. After treatment: Attitude to pain, Image of pain, Control or Command, and Acting with pain. Individual differences as well as specific conditions of the treatment may explain variations in how the treatment was approached, experienced and what consequences it led to. Therapist guidance and deadlines for homework play complex roles in relation to autonomy and change. Conclusions: Adjusting treatment content and format based on participants characteristics, such as expectations, motivation and restraints, might positively affect engagement, autonomy and change. Further research on attrition and negative effects of treatment might clarify what enables chronic pain patients to benefit from IACT.

    Place, publisher, year, edition, pages
    BioMed Central, 2020
    Keywords
    ICBT; ACT; Person-based approach; Motivation; Change; Engagement; Attrition; Constructivist grounded theory
    National Category
    Physiotherapy
    Identifiers
    urn:nbn:se:liu:diva-165330 (URN)10.1186/s12891-020-03198-1 (DOI)000525521300001 ()32252707 (PubMedID)2-s2.0-85083071771 (Scopus ID)
    Note

    Funding Agencies|County Council of Ostergotland

    Available from: 2020-04-27 Created: 2020-04-27 Last updated: 2024-01-17Bibliographically approved
    3. Internet-Delivered Acceptance and Commitment Therapy Added to Multimodal Pain Rehabilitation: A Cluster Randomized Controlled Trial
    Open this publication in new window or tab >>Internet-Delivered Acceptance and Commitment Therapy Added to Multimodal Pain Rehabilitation: A Cluster Randomized Controlled Trial
    Show others...
    2021 (English)In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 10, no 24, article id 5872Article in journal (Refereed) Published
    Abstract [en]

    Internet-delivered interventions hold the possibility to make pain rehabilitation more accessible and adaptable by providing qualified individualized psychological care to chronic pain patients in their homes. Acceptance and commitment therapy (ACT) has shown promising results on psychological functioning and pain acceptance. Internet-delivered ACT (IACT) added to multimodal pain rehabilitation program (MMRP) in primary care has, so far, not shown better results than MMRP alone. The aim of this cluster randomized controlled study was to investigate the effects of adding IACT during and after MMRP in specialist care on psychological outcomes. In total, 122 patients who enrolled in a specialist pain clinic were cluster randomized groupwise to either MMRP (n = 12 groups) or to MMRP with added IACT (n = 12 groups). The IACT addition included 6 weeks of treatment during MMRP and 11 weeks of aftercare following MMRP. Online and paper-and-pencil self-report measures of pain acceptance, psychological inflexibility, self-efficacy, and psychosocial consequences of pain, were collected at four occasions: prior to and post MMRP, post aftercare intervention and at 1 year follow-up. Dropout was extensive with 25% dropping out at post treatment, an additional 35% at post aftercare, and 29% at 1 year follow-up. Medium treatment between-group effects were found on pain acceptance in favor of the group who received IACT added to MMRP, at post treatment and at post aftercare. Large effects were seen on psychological inflexibility and self-efficacy at post aftercare. A medium effect size was seen on affective distress at post aftercare. Moreover, a medium effect on self-efficacy was found at 1 year follow-up. The results indicate that IACT added during MMRP may enhance the treatment effects on pain-related psychological outcomes. Results also suggest that IACT as aftercare may strengthen the long-term effect of MMRP. However, adding a second pain treatment, IACT, to an already extensive pain treatment, MMRP, could be perceived as too comprehensive and might hence influence completion negatively. Further research on adverse events and negative effects could be helpful to improve adherence. Next step of implementation trials could focus on adding IACT before MMRP to improve psychological functioning and after MMRP to prolong its effect.

    Place, publisher, year, edition, pages
    MDPI, 2021
    Keywords
    chronic pain; internet-delivered acceptance and commitment therapy (IACT); multimodal pain rehabilitation program (MMRP); aftercare; implementation; internet-delivered cognitive behavioral therapy (ICBT); booster intervention; combined treatment
    National Category
    Physiotherapy
    Identifiers
    urn:nbn:se:liu:diva-182224 (URN)10.3390/jcm10245872 (DOI)000737821800001 ()34945167 (PubMedID)
    Note

    Funding Agencies|REHSAM; Swedish Social Insurance Agency; Ministry of Health and Social Affairs; Swedish Association of Local Authorities and Regions; Vardal Foundation [99368-2009/RS10]; Lions Ostergotland Sweden [2020-01334]; City Council of OEstergoetland, Sweden [LIO-938308, SC-2019-00155-39]

    Available from: 2022-01-12 Created: 2022-01-12 Last updated: 2023-04-11
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  • 15.
    Bendelin, Nina
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Björkdahl, Pär
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Risell, Mimmi
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Zetterqvist Nelson, Karin
    Linköping University, Department of Thematic Studies, Department of Child Studies. Linköping University, Faculty of Arts and Sciences.
    Gerdle, Björn
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden.
    Buhrman, Monica
    Uppsala Univ, Sweden.
    Patients experiences of internet-based Acceptance and commitment therapy for chronic pain: a qualitative study2020In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, BMC MUSCULOSKELETAL DISORDERS, Vol. 21, no 1, article id 212Article in journal (Refereed)
    Abstract [en]

    Background: Chronic pain is a globally widespread condition with complex clusters of symptoms within a heterogeneous patient group. Internet-delivered Acceptance and Commitment Therapy (IACT) has shown promising results in the treatment of chronic pain. How IACT is experienced by patients is less well known. Qualitative studies of patients experiences are needed to further understand factors behind both engagement and negative effects. The aim of this study was to explore how IACT was experienced by chronic pain patients who had participated in a controlled trial. Methods: Through an open and exploratory approach this study aimed to investigate how IACT was experienced when delivered as a guided self-help program to persons with chronic pain. Eleven participants were interviewed over telephone after completing IACT. Results: Qualitative analysis based on grounded theory resulted in 2 core categories and 8 subcategories. In treatment: Physical and cognitive restraints, Time and deadline, Therapist contact, and Self-confrontation. After treatment: Attitude to pain, Image of pain, Control or Command, and Acting with pain. Individual differences as well as specific conditions of the treatment may explain variations in how the treatment was approached, experienced and what consequences it led to. Therapist guidance and deadlines for homework play complex roles in relation to autonomy and change. Conclusions: Adjusting treatment content and format based on participants characteristics, such as expectations, motivation and restraints, might positively affect engagement, autonomy and change. Further research on attrition and negative effects of treatment might clarify what enables chronic pain patients to benefit from IACT.

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  • 16.
    Bendelin, Nina
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Karolinska Inst, Sweden.
    Hurdles and potentials when implementing internet-delivered Acceptance and commitment therapy for chronic pain: a retrospective appraisal using the Quality implementation framework2023In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 24, no 1, article id 20220139Article in journal (Refereed)
    Abstract [en]

    Objectives: Internet-delivered psychological interventions can be regarded as evidence-based practices and have been implemented in psychiatric and somatic care at primary and specialist levels. However, challenges as low adherence and poor routinization, have arisen during attempts to implement internet-delivered interventions in chronic pain settings. Internet-delivered Acceptance and Commitment Therapy (IACT) has been found to be helpful for chronic pain patients and might aid in developing pain rehabilitation services. However, the integration of IACT into standard health care has not yet been described from an implementation science perspective. The aim of this hybrid 1 effectiveness-implementation study was to evaluate the process of implementing IACT in a pain rehabilitation setting, to guide future implementation initiatives.Methods: In this retrospective study we described actions taken during an implementation initiative, in which IACT was delivered as part of an interdisciplinary pain rehabilitation program (IPRP) at a specialist level clinic. All documents relevant to the study were reviewed and coded using the Quality Improvement Framework (QIF), focusing on adoption, appropriateness and sustainability.Results: The QIF-analysis of implementation actions resulted in two categories: facilitators and challenges for implementation. Sustainability may be facilitated by sensitivity to the changing needs of a clinical setting and challenged by unfitting capacity building. Appropriateness might be challenged by an insufficient needs assessment and facilitated by aligning routines for communication with the clinics existing infrastructure. Adoption may be facilitated by staff key champions and an ability to adapt to occurring hurdles. Possible influential factors, hypotheses and key process challenges are presented in a logic model to guide future initiatives.Conclusions: Sustainable implementation may depend on both the continuity of facilitating implementation actions and flexibility to the changing needs and interests of patients, caregivers and organization. We conclude that the use of theories, models and frameworks (TMF) as well as a logic model may ease design, planning and evaluation of an implementation process. Lastly, we suggest that IACT may be appropriate for IPRP when given before or after IPRP, focusing on psychiatric comorbidities.

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  • 17.
    Bendelin, Nina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden.
    Internet-delivered aftercare following multimodal rehabilitation program for chronic pain: a qualitative feasibility study2018In: Journal of Pain Research, E-ISSN 1178-7090, Vol. 11, p. 1715-1728Article in journal (Refereed)
    Abstract [en]

    Purpose: Methods for delivering aftercare to help chronic pain patients to continue practice self-management skills after rehabilitation are needed. Internet-delivered cognitive behavioral therapy (ICBT) has the potential to partly fill this gap given its accessibility and emphasis on self-care. Methods for engaging and motivating patients to persist throughout the full length of treatment are needed. The aim of this study was to describe how chronic pain patients work in an ICBT program, through their descriptions of what is important when they initiate behavior change in aftercare and their descriptions of what is important for ongoing practice of self-management skills in aftercare. Patients and methods: Following a multimodal rehabilitation program, 29 chronic pain patients participated in a 20-week-long Internet-delivered aftercare program (ACP) based on acceptance-based cognitive behavioral therapy. Latent content analysis was made on 138 chapters of diary-like texts written by participants in aftercare. Results: Attitudes regarding pain and body changed during ACP, as did attitudes toward self and the future for some participants. How participants practiced self-management skills was influenced by how they expressed motivation behind treatment goals. Whether they practiced acceptance strategies influenced their continuous self-management practice. Defusion techniques seemed to be helpful in the process of goal setting. Mindfulness strategies seemed to be helpful when setbacks occurred. Conclusion: Self-motivating goals are described as important both to initiate and in the ongoing practice of self-management skills. Experiencing a helpful effect of acceptance strategies seems to encourage participants to handle obstacles in new ways and to persist throughout treatment. Research on whether tailored therapist guidance might be helpful in stating self-motivating goals and contribute to ongoing practice of self-management skills is needed.

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  • 18.
    Bendelin, Nina
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Blom, Marie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Södermark, Martin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Internet-Delivered Acceptance and Commitment Therapy Added to Multimodal Pain Rehabilitation: A Cluster Randomized Controlled Trial2021In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 10, no 24, article id 5872Article in journal (Refereed)
    Abstract [en]

    Internet-delivered interventions hold the possibility to make pain rehabilitation more accessible and adaptable by providing qualified individualized psychological care to chronic pain patients in their homes. Acceptance and commitment therapy (ACT) has shown promising results on psychological functioning and pain acceptance. Internet-delivered ACT (IACT) added to multimodal pain rehabilitation program (MMRP) in primary care has, so far, not shown better results than MMRP alone. The aim of this cluster randomized controlled study was to investigate the effects of adding IACT during and after MMRP in specialist care on psychological outcomes. In total, 122 patients who enrolled in a specialist pain clinic were cluster randomized groupwise to either MMRP (n = 12 groups) or to MMRP with added IACT (n = 12 groups). The IACT addition included 6 weeks of treatment during MMRP and 11 weeks of aftercare following MMRP. Online and paper-and-pencil self-report measures of pain acceptance, psychological inflexibility, self-efficacy, and psychosocial consequences of pain, were collected at four occasions: prior to and post MMRP, post aftercare intervention and at 1 year follow-up. Dropout was extensive with 25% dropping out at post treatment, an additional 35% at post aftercare, and 29% at 1 year follow-up. Medium treatment between-group effects were found on pain acceptance in favor of the group who received IACT added to MMRP, at post treatment and at post aftercare. Large effects were seen on psychological inflexibility and self-efficacy at post aftercare. A medium effect size was seen on affective distress at post aftercare. Moreover, a medium effect on self-efficacy was found at 1 year follow-up. The results indicate that IACT added during MMRP may enhance the treatment effects on pain-related psychological outcomes. Results also suggest that IACT as aftercare may strengthen the long-term effect of MMRP. However, adding a second pain treatment, IACT, to an already extensive pain treatment, MMRP, could be perceived as too comprehensive and might hence influence completion negatively. Further research on adverse events and negative effects could be helpful to improve adherence. Next step of implementation trials could focus on adding IACT before MMRP to improve psychological functioning and after MMRP to prolong its effect.

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  • 19.
    Bergström, Maria
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences.
    Ahlstrand, Inger
    Jönköping University, Sweden.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Jonköping University, Sweden; Curtin University, Australia.
    Börsbo, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Björk, Mathilda
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Like the worst toothache you've had - How people with rheumatoid arthritis describe and manage pain2017In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 24, no 6, p. 468-476Article in journal (Refereed)
    Abstract [en]

    Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease often associated with disability. Despite new treatments, pain and activity limitations are still present. Objectives: To describe how persons with RA experience and manage pain in their daily life. Methods: Seven semi-structured focus groups (FGs) were conducted and analyzed using content analysis. Results: The analysis revealed four categories: 1) Pain expresses itself in different ways referred to pain as overwhelming, aching or as a feeling of stiffness. 2) Mitigating pain referred to the use of heat, cold, medications and activities as distractions from the pain. 3) Adapting to pain referred to strategies employed as coping mechanisms for the pain, e.g. planning and adjustment of daily activities, and use of assistive devices. 4) Pain in a social context referred to the participants social environment as being both supportive and uncomprehending, the latter causing patients to hide their pain. Conclusions: Pain in RA is experienced in different ways. This emphasizes the multi-professional team to address this spectrum of experiences and to find pain management directed to the individual experience that also include the persons social environment.

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  • 20.
    Bergström, Maria
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Thyberg, Ingrid
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Rheumatology.
    Björk, Mathilda
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    The role of support from significant others in the association between disease-related factors and sickness absence in early rheumatoid arthritis: a longitudinal study2021In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 50, no 6, p. 427-434Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to analyse how support from significant others affects the associations between disease-related variables and sickness absence during the first 2 years after rheumatoid arthritis (RA) diagnosis. Method: Data from 274 people with RA (73% women) of working age (18-63 years) were retrieved from the Swedish early RA cohort TIRA-2. These data concerned disease-related variables (disease activity, activity limitations, pain intensity, and grip force), sickness absence, and perceived support from significant others. Associations of disease-related variables with sickness absence and how these associations were moderated by support from significant others were analysed using zero-inflated negative binomial regression. Results: During the 2 years after diagnosis, higher disease activity was significantly associated with increased odds of sickness absence, a connection strengthened by perceived support from family during the first year. More perceived support was also directly and significantly associated with increased odds of sickness absence during the first year. Conclusions: Support from significant others is related to sickness absence in RA, specifically during the first year after diagnosis. Although patients report high levels of support from significant others, this does not necessarily lead to more positive work outcomes. Therefore, it is important to consider other aspects of support that might influence work outcomes, e.g. type and quality of support. Future research should investigate these forms of support, and when significant others should be encouraged to support in the rehabilitation process to increase the chances of people with RA having a well-functioning and sustainable work life.

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  • 21.
    Bergström, Maria
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Larsson Ranada, Åsa
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Sverker, Annette M.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health. Linköping University, Department of Culture and Society, Division of Social Work. Region Östergötland, Primary Care Center, Operations management PVC.
    Thyberg, Ingrid
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Rheumatology.
    Björk, Mathilda
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    A dyadic exploration of support in everyday life of persons with RA and their significant others2023In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 30, no 5, p. 616-627Article in journal (Refereed)
    Abstract [en]

    Background Support from significant others is important for participation in everyday life for persons with rheumatoid arthritis (RA). Meanwhile, significant others also experience limitations. Aims To explore how support is expressed by persons with RA and significant others, and how support relates to participation in everyday life of persons with RA. Material and methods Sixteen persons with RA and their significant others participated in individual semi-structured interviews. The material was analyzed using dyadic analysis. Results Persons with RA and significant others reported that RA and support had become natural parts of everyday life, especially emotional support. The reciprocal dynamics of support were also expressed as imperative. Also, support from people outside of the dyads and well-functioning communication facilitated everyday life. Conclusions Significant others and the support they give are prominent factors and facilitators in everyday life of persons with RA. Concurrently, the support persons with RA provide is important, along with support from outside of the dyads. Significance The results indicate that the interaction between persons with RA and the social environment is central to gain insight into how support should be provided for optimal participation in everyday life. Significant others can preferably be more involved in the rehabilitation process.

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  • 22.
    Bernfort, Lars
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    People in states worse than dead according to the EQ-5D UK value set: would they rather be dead?2018In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 27, no 7, p. 1827-1833Article in journal (Refereed)
    Abstract [en]

    Quality-adjusted life years (QALYs) measure health by combining length and quality of life. QALYs constitute the effect side of incremental cost-effectiveness ratios, describing the results of health economic evaluations. The objectives of this study were to (1) investigate the prevalence of states worse than dead (SWD) when using the EuroQol-5D UK value set, and (2) to study to what extent SWDs are reasonable with a starting point in experience-based valuations of health states. Data from a Swedish cross-sectional population survey were used. The survey was directed to 10,000 persons 65 years and older and its primary aim was to investigate the prevalence and consequences of chronic pain. The survey included questions reflecting life situation and well-being. Some of these were used in order to characterise people in SWD. SWD were found in 1.8% of the 6611 respondents. The prevalence of SWD increased with advancing age and was more common among women than men. The control questions used indicated that most of the persons being in SWD according to the EQ-5D UK value set most probably would not judge themselves to be in a SWD. Though negative QALY-weights are not very common, they constitute a non-negligible part of health states in a Swedish population 65 years and older. Prevalence of SWD is higher among women than men and increases with age. From responses to other questions on well-being and life situation, there is reason to doubt the reasonableness of experience-based negative QALY-weights in many cases.

  • 23.
    Bernfort, Lars
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Allergy Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Rahmqvist, Mikael
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Chronic pain in an elderly population in Sweden: Impact on costs and quality of life2015Report (Other academic)
    Abstract [en]

    Chronic pain among elderly people has long been a well-known problem, in terms of both societal costs and the quality of life of affected individuals. To estimate the magnitude of the problems associated with chronic pain in an elderly population, data on both costs and quality of life were gathered. A postal questionnaire was sent out to a stratified sample of 10 000 inhabitants 65 years and older in Linköping and Norrköping. The survey included questions on demographics, habits, and life situation, and different kinds of questions and instruments related to well-being (e.g., quality-of-life and pain-specific questions). In the questionnaire respondents were asked whether they were receiving any help—informal care—from a relative. If they answered yes, they were asked for permission to contact the informal caregiver and to provide contact details. The amount of informal care provided by relatives to persons with chronic pain was investigated by use of a questionnaire directed to the caregiving relatives, containing questions about time spent providing informal care.

    Data on costs were collected from registers of consumption of health care, drugs, and municipal services.

    The results of the study showed a very clear association between existence and severity of chronic pain and societal costs. The study population was subdivided into three groups with respect to having chronic pain or not, and a pain intensity during the last week of 0–4 (mild), 5–7 (moderate), or 8–10 (severe) on a scale of 0–10. Taking all costs (health care, drugs, municipal services, and informal care) into account, persons in the severe chronic pain group consumed on average 72% more resources than persons in the moderate chronic pain group and 143% more than those in the no or mild chronic pain group. Differences were most pronounced concerning municipal services and informal care costs.

    Even more alarming are the results on the quality of life of persons in the different groups. On the EQ-5D index, the average value for persons in the no or mild chronic pain group was 0.82. For those in the moderate chronic pain group the average value was 0.64, and for those in the severe chronic pain group the average value was only 0.38. EQ-VAS resulted in less pronounced but still clearly significant differences.

    It is concluded that this study, reaching a rather large part of the target population, shows that existence and severity of chronic pain among people 65 years and older affects costs to society and the quality of life of affected individuals in a massive way.

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  • 24.
    Bernfort, Lars
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Allergy Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Rahmqvist, Mikael
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Severity of chronic pain in an elderly population in Sweden-impact on costs and quality of life2015In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 156, no 3, p. 521-527Article in journal (Refereed)
    Abstract [en]

    Chronic pain is associated with large societal costs, but few studies have investigated the total costs of chronic pain with respect to elderly subjects. The elderly usually require informal care, care performed by municipalities, and care for chronic diseases, all factors that can result in extensive financial burdens on elderly patients, their families, and the social services provided by the state. This study aims to quantify the societal cost of chronic pain in people of age 65 years and older and to assess the impact of chronic pain on quality of life. This study collected data from 3 registers concerning health care, drugs, and municipal services and from 2 surveys. A postal questionnaire was used to collect data from a stratified sample of the population 65 years and older in southeastern Sweden. The questionnaire addressed pain intensity and quality of life variables (EQ-5D). A second postal questionnaire was used to collect data from relatives of the elderly patients suffering from chronic pain. A total of 66.5% valid responses of the 10,000 subjects was achieved; 76.9% were categorized as having no or mild chronic pain, 18.9% as having moderate chronic pain, and 4.2% as having severe chronic pain. Consumed resources increased with the severity of chronic pain. Clear differences in EQ-5D were found with respect to the severity of pain. This study found an association between resource use and severity of chronic pain in elderly subjects: the more severe the chronic pain, the more extensive (and expensive) the use of resources.

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  • 25.
    Bernfort, Lars
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Allergy Center.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Chronic pain in a population 65 years and older: correlation with age of health care costs and quality of life2015Conference paper (Refereed)
  • 26.
    Biazus, Tais Boeira
    et al.
    Univ Sao Paulo, Brazil.
    Beraldi, Gabriel Henrique
    Univ Sao Paulo, Brazil.
    Tokeshi, Lucas
    Univ Sao Paulo, Brazil.
    Rotenberg, Luisa de Siqueira
    Univ Sao Paulo, Brazil.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Univ Ioannina, Greece.
    Carvalho, Andre F.
    Deakin Univ, Australia.
    Solmi, Marco
    Univ Ottawa, Canada; Charite, Germany.
    Lafer, Beny
    Univ Sao Paulo, Brazil.
    All-cause and cause-specific mortality among people with bipolar disorder: a large-scale systematic review and meta-analysis2023In: Molecular Psychiatry, ISSN 1359-4184, E-ISSN 1476-5578, Vol. 28, no 6, p. 2508-2524Article, review/survey (Refereed)
    Abstract [en]

    ObjectiveBipolar disorder (BD) is associated with premature mortality. All-cause and specific mortality risks in this population remain unclear, and more studies are still needed to further understand this issue and guide individual and public strategies to prevent mortality in bipolar disorder Thus, a systematic review and meta-analysis of studies assessing mortality risk in people with BD versus the general population was conducted. The primary outcome was all-cause mortality, whilst secondary outcomes were mortality due to suicide, natural, unnatural, and specific-causes mortality.ResultsFifty-seven studies were included (BD; n = 678,353). All-cause mortality was increased in people with BD (RR = 2.02, 95% CI: 1.89-2.16, k = 39). Specific-cause mortality was highest for suicide (RR = 11.69, 95% CI: 9.22-14.81, k = 25). Risk of death due to unnatural causes (RR = 7.29, 95% CI: 6.41-8.28, k = 17) and natural causes (RR = 1.90, 95% CI: 1.75-2.06, k = 17) were also increased. Among specific natural causes analyzed, infectious causes had the higher RR (RR = 4,38, 95%CI: 1.5-12.69, k = 3), but the analysis was limited by the inclusion of few studies. Mortality risk due to respiratory (RR = 3.18, 95% CI: 2.55-3.96, k = 6), cardiovascular (RR = 1.76, 95% CI: 1.53-2.01, k = 27), and cerebrovascular (RR = 1.57, 95% CI: 1.34-1.84, k = 13) causes were increased as well. No difference was identified in mortality by cancer (RR = 0.99, 95% CI: 0.88-1.11, k = 16). Subgroup analyses and meta-regression did not affect the findings.ConclusionResults presented in this meta-analysis show that risk of premature death in BD is not only due to suicide and unnatural causes, but somatic comorbidities are also implicated. Not only the prevention of suicide, but also the promotion of physical health and the prevention of physical conditions in individuals with BD may mitigate the premature mortality in this population. Notwithstanding this is to our knowledge the largest synthesis of evidence on BD-related mortality, further well-designed studies are still warranted to inform this field.

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  • 27.
    Bileviciute-Ljungar, Indre
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Danderyd University Hospital, Karolinska Institutet, Sweden.
    Maroti, Daniel
    Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet; and ME/CFS-rehabilitation, Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden.
    Bejerot, Susanne
    Department of Medical Sciences, Örebro University, Örebro, Sweden.
    Patients with chronic fatigue syndrome do not score higher on the autism-spectrum quotient than healthy controls: Comparison with autism spectrum disorder2018In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 59, no 4, p. 428-432Article in journal (Refereed)
    Abstract [en]

    Clinically, there is an overlap of several symptoms of chronic fatigue syndrome (CFS) and autism spectrum disorder (ASD), including fatigue; brain "fog"; cognitive impairments; increased sensitivity to sound, light, and odour; increased pain and tenderness; and impaired emotional contact. Adults with CFS (n = 59) or ASD (n = 50) and healthy controls (HC; n = 53) were assessed with the Autism-Spectrum Quotient (AQ) in a cross-sectional study. Non-parametric analysis was used to compare AQ scores among the groups. Univariate analysis of variance (ANCOVA) was used to identify if age, sex, or diagnostic group influenced the differences in scores. Patients with ASD scored significantly higher on the AQ than the CFS group and the HC group. No differences in AQ scores were found between the CFS and HC groups. AQ results were influenced by the diagnostic group but not by age or sex, according to ANCOVA. Despite clinical observations of symptom overlap between ASD and CFS, adult patients with CFS report few autistic traits in the self-report instrument, the AQ. The choice of instrument to assess autistic traits may influence the results.

  • 28.
    Biurrun Manresa, Jose A.
    et al.
    Aalborg University, Denmark.
    Sörensen, Jan
    Linköping University, Department of Medical and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Linköping University, Faculty of Medicine and Health Sciences.
    Andersen, Ole K.
    Aalborg University, Denmark.
    Arendt-Nielsen, Lars
    Aalborg University, Denmark.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Dynamic Changes in Nociception and Pain Perception After Spinal Cord Stimulation in Chronic Neuropathic Pain Patients2015In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 31, no 12, p. 1046-1053Article in journal (Refereed)
    Abstract [en]

    Objectives: Patients with an implanted spinal cord stimulation (SCS) system for pain management present an opportunity to study dynamic changes in the pain system in a situation where patients are not stimulated (ie, experiencing severe pain) compared with a situation in which patients have just been stimulated (ie, pain free or greatly reduced pain). The aims of this study were (1) to determine if there are differences in nociceptive withdrawal reflex thresholds (NWR-T) and electrical pain thresholds (EP-T) before and after SCS; and (2) to establish if these differences are related to psychological factors associated with chronic pain. Methods: Seventeen volunteers with chronic neuropathic pain participated in the experiment. Electrical stimuli were applied to assess the NWR-T and the EP-T. In addition, psychological factors (ie, pain characteristics, depression, anxiety, and disability indexes) were also recorded. The NWR-T and EP-T were assessed with the SCS system off (at least 8 h before the experiment), and then reassessed 1 hour after the SCS system was turned on. Results: Ongoing pain intensity ratings decreased (P=0.018), whereas the NWR-T increased (P=0.028) after the SCS was turned on, whereas no significant difference was found for EP-T (P=0.324). Psychological factors were significant predictors for EP-T but not for NWR-T. Discussion: The results of this study suggest that pain relief after SCS is partially mediated by a decrease in the excitability of dorsal horn neurons in the spinal cord.

  • 29.
    Bjersing, Jan L.
    et al.
    University of Gothenburg, Sweden; Sahlgrens University Hospital, Sweden.
    Larsson, Anette
    University of Gothenburg, Sweden.
    Palstam, Annie
    University of Gothenburg, Sweden.
    Ernberg, Malin
    Karolinska Institute, Sweden.
    Bileviciute-Ljungar, Indre
    Karolinska Institute, Sweden.
    Löfgren, Monika
    Karolinska Institute, Sweden.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Kosek, Eva
    Karolinska Institute, Sweden; Stockholm Spine Centre, Sweden.
    Mannerkorpi, Kaisa
    University of Gothenburg, Sweden; Sahlgrenska University Hospital, Sweden.
    Benefits of resistance exercise in lean women with fibromyalgia: involvement of IGF-1 and leptin2017In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 18, article id 106Article in journal (Refereed)
    Abstract [en]

    Background: Chronic pain and fatigue improves by exercise in fibromyalgia (FM) but underlying mechanisms are not known. Obesity is increased among FM patients and associates with higher levels of pain. Symptom improvement after aerobic exercise is affected by body mass index (BMI) in FM. Metabolic factors such as insulin-like growth factor 1 (IGF1) and leptin may be involved. In this study, the aim was to evaluate the role of metabolic factors in lean, overweight and obese women during resistance exercise, in relation to symptom severity and muscle strength in women with FM. Methods: Forty-three women participated in supervised progressive resistance exercise, twice weekly for 15-weeks. Serum free and total IGF-1, IGF-binding protein 3 (IGFBP3), adiponectin, leptin and resistin were determined at baseline and after 15-weeks. Level of current pain was rated on a visual analogue scale (0-100 mm). Level of fatigue was rated by multidimensional fatigue inventory (MFI-20) subscale general fatigue (MFIGF). Knee extension force, elbow flexion force and handgrip force were assessed by dynamometers. Results: Free IGF-1 (p = 0.047), IGFBP3 (p = 0.025) and leptin (p = 0.008) were significantly decreased in lean women (n = 18), but not in the overweight (n = 17) and the obese (n = 8). Lean women with FM benefited from resistance exercise with improvements in current pain (p= 0.039, n = 18), general fatigue (MFIGF, p = 0.022, n = 18) and improved elbow-flexion force (p = 0.017, n = 18). In overweight and obese women with FM there was no significant improvement in pain or fatigue but an improvement in elbow flexion (p = 0.049; p = 0.012) after 15 weeks of resistance exercise. Conclusion: The clearest clinical response to resistance exercise was found in lean patients with FM. In these individuals, individualized resistance exercise was followed by changes in IGF-1 and leptin, reduced pain, fatigue and improved muscular strength. In overweight and obese women FM markers of metabolic signaling and clinical symptoms were unchanged, but strength was improved in the upper limb. Resistance exercise combined with dietary interventions might benefit patients with FM and overweight.

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  • 30.
    Björk, Mathilda
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Alexandersson, Helene
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Esbensen, Bente Appel
    Rigshosp, Denmark; Univ Copenhagen, Denmark.
    Bostrom, Carina
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Friden, Cecilia
    Karolinska Inst, Sweden.
    Hjalmarsson, Sara
    Swedish Rheumatism Assoc, Sweden.
    Hornberg, Kristina
    Umea Univ, Sweden.
    Kjeken, Ingvild
    Diakonhjemmet Hosp, Norway.
    Regardt, Malin
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Sundelin, Gunnevi
    Umea Univ, Sweden.
    Sverker, Annette M.
    Linköping University, Department of Culture and Society, Division of Social Work. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Primary Care Center, Operations management PVC.
    Welin, Elisabet
    Orebro Univ, Sweden.
    Brodin, Nina
    Karolinska Inst, Sweden; Danderyd Hosp Corp, Sweden.
    Inflammatory Arthritis and the Effect of Physical Activity on Quality of Life and Self-Reported Function: A Systematic Review and Meta-Analysis2022In: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 74, no 1, p. 31-43Article, review/survey (Refereed)
    Abstract [en]

    Objective Although physical activity is an evidence-based intervention that reduces disease-related symptoms and comorbidity in rheumatoid arthritis (RA), the effect of physical activity on self-reported function and quality of life (QoL) has not yet been analyzed. The present study synthesizes the evidence for the effectiveness of physical activity on QoL and self-reported function in adults with RA, spondyloarthritis (SpA), and psoriatic arthritis (PsA). Methods The databases PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify relevant randomized controlled trials (RCTs). Screening, risk of bias assessment (using the RoB 2.0 tool), and data extraction were independently performed by 2 or more of the authors. Meta-analyses were conducted with a random-effects model. Results Systematic review included 55 RCTs, and meta-analysis included 37 RCTs. Of the 55 studies included, 76%, 20%, and 4% were designed to investigate RA, SpA, and PsA, respectively. In the RA studies, effects of physical activity on QoL and function were found compared to the group of inactive controls; no effects were found compared to the group of active controls. In the SpA studies, the effects of physical activity on QoL were in favor of the control group. Effects of physical activity on function were found compared to the group of inactive controls and sustained in fatigue and pain when compared to the group of active controls. In the PsA studies, no effects on QoL were found, but effects on function were noted when compared to the group of inactive controls. The effect size was below 0.30 in the majority of the comparisons. Conclusion Physical activity may improve QoL and self-reported function in individuals with RA, SpA, and PsA. However, larger trials are needed, especially in SpA and PsA.

  • 31.
    Björk, Mathilda
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Liedberg, Gunilla
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Svanholm, Frida
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Solmi, Marco
    Univ Padua, Italy.
    Thompson, Trevor
    Univ Greenwich, England.
    Chaimani, Anna
    Univ Paris, France.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Interventions to facilitate return to work in adults with chronic non-malignant pain: a protocol for a systematic review and network meta-analysis2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 11, article id e040962Article, review/survey (Refereed)
    Abstract [en]

    Introduction Work absenteeism due to chronic non-malignant pain (CNMP) is a major societal and individual cause of concern that requires effective treatments. Objective We present a protocol for a systematic review and network meta-analysis (NMA) aiming to compare available interventions for return to work (RTW) in adults with CNMP. Methods and analysis PubMed, Embase, PsycINFO, Web of Knowledge and Cochrane Central Register of Controlled Trials databases will be searched till 31 August 2020 for randomised controlled trials (RCTs) examining interventions for RTW outcomes among patients with CNMP. Two independent investigators will search the databases, perform data extraction and assess the methodological quality of the selected RCTs. The primary outcome will be RTW, if possible, full-time or part-time after work absence due to chronic pain from baseline to the last available follow-up. Secondary outcomes will include self-reported workability or work capacity, or self-reported physical functioning and quality of life as measured by any validated scale. Pairwise meta-analysis and NMA will be conducted for each outcome using a random-effects model. For the primary outcomes, we will also obtain the ranking of all competing interventions within each NMA using surface under the cumulative ranking curve. The assumption of coherence (ie, that direct and indirect evidence are in statistical agreement) will be examined using both a local and a global approach. We will also conduct subgroup and meta-regression analyses, whenever feasible, to investigate the unexplained variation in effect size. The comparison-adjusted funnel plot will be used to evaluate small-study effects. The overall quality of evidence will be rated with the Confidence in Network Meta-Analysis tool. Data analysis will be conducted using Stata V.16.0. Ethics and dissemination This systematic review does not require ethical approval since it will not disseminate any private patient data. The results of this study will be disseminated through peer-reviewed publication. PROSPERO registration number CRD42020171429.

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  • 32.
    Black, Melissa H.
    et al.
    Curtin Univ, Australia; GPO Box U1987, Australia.
    Mahdi, Soheil
    Karolinska Inst, Sweden; Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Milbourn, Benjamin
    Curtin Univ, Australia.
    Scott, Melissa
    Curtin Univ, Australia.
    Gerber, Alan
    SUNY Stony Brook, NY 11794 USA.
    Esposito, Christopher
    SUNY Stony Brook, NY 11794 USA.
    Falkmer, Marita
    Curtin Univ, Australia; Jonkoping Univ, Sweden.
    Lerner, Matthew D.
    SUNY Stony Brook, NY 11794 USA.
    Halladay, Alycia
    Autism Sci Fdn, NY USA; Rutgers State Univ, NJ USA.
    Strom, Eva
    Swedish Publ Employment Serv, Sweden.
    DAngelo, Axel
    Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Falkmer, Torbjörn
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin Univ, Australia; Curtin Univ, Australia.
    Bolte, Sven
    Curtin Univ, Australia; Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden; Stockholm Hlth Care Serv, Sweden.
    Girdler, Sonya
    Curtin Univ, Australia.
    Multi-informant International Perspectives on the Facilitators and Barriers to Employment for Autistic Adults2020In: Autism Research, ISSN 1939-3792, E-ISSN 1939-3806, Vol. 13, no 7, p. 1195-1214Article in journal (Refereed)
    Abstract [en]

    Employment rates for autistic individuals are poor, even compared to those from other disability groups. Internationally, there remains limited understanding of the factors influencing employment across the stages of preparing for, gaining, and maintaining employment. This is the third in a series of studies conducted as part of an International Society for Autism Research (INSAR) policy brief intended to improve employment outcomes for autistic individuals. A multi-informant international survey with five key stakeholder groups, including autistic individuals, their families, employers, service providers, and researchers, was undertaken in Australia, Sweden, and the United States to understand the facilitators and barriers to employment for autistic adults. A total of 687 individuals participated, including autistic individuals (n = 246), family members (n = 233), employers (n = 35), clinicians/service providers (n = 123), and researchers (n = 50). Perceptions of the facilitators and barriers to employment differed significantly across both key stakeholder groups and countries, however, ensuring a good job match and focusing on strengths were identified by all groups as important for success. Key barriers to employment included stigma, a lack of understanding of autism spectrum disorder (ASD) and communication difficulties. Results suggest that a holistic approach to employment for autistic individuals is required, aimed at facilitating communication between key stakeholders, addressing attitudes and understanding of ASD in the workplace, using strength-based approaches and providing early work experience. Lay Summary Autistic individuals experience significant difficulty getting and keeping a job. This article presents a survey study involving autistic individuals, their families, employers, service providers and researchers in Australia, Sweden, and the United States to understand their perspectives on the factors that support or act as barriers to employment. While perspectives varied across key stakeholders, strategies such as using a holistic approach, targeting workplace attitudes and understanding, focusing on strengths, and providing early work experience are important for success. (c) 2020 International Society for Autism Research, Wiley Periodicals, Inc.

  • 33.
    Black, Melissa H.
    et al.
    Curtin Univ, Australia.
    Mandi, Soheil
    Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Milbourn, Benjamin
    Curtin Univ, Australia.
    Thompson, Craig
    Curtin Univ, Australia.
    DAngelo, Axel
    Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Strom, Eva
    Swedish Publ Employment Serv, Sweden.
    Falkmer, Marita
    Curtin Univ, Australia; Jonkoping Univ, Sweden.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin Univ, Australia.
    Lerner, Matthew
    SUNY Stony Brook, NY 11794 USA.
    Halladay, Alycia
    Autism Sci Fdn, NY USA.
    Gerber, Alan
    SUNY Stony Brook, NY 11794 USA.
    Esposito, Christopher
    SUNY Stony Brook, NY 11794 USA.
    Girdler, Sonya
    Curtin Univ, Australia; Curtin Univ, Australia.
    Bolte, Sven
    Curtin Univ, Australia; Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden; Stockholm Hlth Care Serv, Sweden.
    Perspectives of key stakeholders on employment of autistic adults across the united states, australia, and sweden2019In: Autism Research, ISSN 1939-3792, E-ISSN 1939-3806, Vol. 12, no 11, p. 1648-1662Article in journal (Refereed)
    Abstract [en]

    Despite efforts to improve employment outcomes for autistic individuals, internationally their employment rates remain low. There is a need to better understand the factors influencing successful employment for autistic adults in the labor market from the perspectives of multiple key stakeholders. This study represents the second in a series of papers conducted as part of an International Society for Autism Research policy brief aimed at improving employment outcomes for autistic individuals. A community consultation methodology using focus groups, forums, and interviews was applied with autistic individuals (n = 19), family members (n = 18), service providers (n = 21), employers (n = 11), researchers (n = 5), and advocacy group representatives (n = 5) in Australia, Sweden, and the United States, aiming to identify the factors perceived to determine gaining and maintaining employment for autistic individuals. Directed content analysis, guided by the International Classification of Functioning, Disability and Health (ICF), was conducted to investigate the key factors influencing employment outcomes for autistic individuals. Meaningful verbal concepts, or units of text with common themes, were also derived from the qualitative data and then linked and compared to the ICF Autism Spectrum Disorder (ASD) Core-sets. Across countries, activity and participation and environmental factor categories of the ICF were the most associated with employment outcomes. Results suggest that removal of environmental barriers and enhancing environmental facilitators may assist to remediate ASD-related difficulties in the workplace. Autism Res 2019, (c) 2019 International Society for Autism Research, Wiley Periodicals, Inc. Lay Summary This study sought to understand the perspectives of autistic individuals and key stakeholders on factors influencing if autistic adults get and keep jobs. Across Australia, Sweden, and the United States, focus groups and interviews were conducted to understand international perspectives on what helps and hinders getting and keeping a job for autistic individuals. The environment, including supports, relationships, attitudes, and services, were perceived to be the most important for workplace success. Intervention targeting barriers and facilitators in the workplace environment may support autistic adults to be successful in the labor market.

  • 34.
    Black, Melissa H.
    et al.
    Curtin Univ, Australia.
    Milbourn, Benjamin
    Curtin Univ, Australia.
    Chen, Nigel T. M.
    Curtin Univ, Australia.
    McGarry, Sarah
    Curtin Univ, Australia.
    Wali, Fatema
    Curtin Univ, Australia.
    Ho, Armilda S. V
    Curtin Univ, Australia.
    Lee, Mika
    Curtin Univ, Australia.
    Boelte, Sven
    Curtin Univ, Australia; Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden; Stockholm Hlth Care Serv, Sweden.
    Falkmer, Torbjörn
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin Univ, Australia.
    Girdler, Sonya
    Curtin Univ, Australia.
    The use of wearable technology to measure and support abilities, disabilities and functional skills in autistic youth: a scoping review2020In: Scandinavian Journal of Child and Adolescent Psychiatry and Psychology, E-ISSN 2245-8875, Vol. 8, p. 48-69Article, review/survey (Refereed)
    Abstract [en]

    Background: Wearable technology (WT) to measure and support social and non-social functioning in Autism Spectrum Disorder (ASD) has been a growing interest of researchers over the past decade. There is however limited understanding of the WTs currently available for autistic individuals, and how they measure functioning in this population. Objective: This scoping review explored the use of WTs for measuring and supporting abilities, disabilities and functional skills in autistic youth. Method: Four electronic databases were searched to identify literature investigating the use of WT in autistic youth, resulting in a total of 33 studies being reviewed. Descriptive and content analysis was conducted, with studies subsequently mapped to the ASD International Classification of Functioning, Disability and Health Core-sets and the ICF Child and Youth Version (ICF-CY). Results: Studies were predominately pilot studies for novel devices. WTs measured a range of physiological and behavioural functions to objectively measure stereotypical motor movements, social function, communication, and emotion regulation in autistic youth in the context of a range of environments and activities. Conclusions: While this review raises promising prospects for the use of WTs for autistic youth, the current evidence is limited and requires further investigation.

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  • 35.
    Black, Melissa H.
    et al.
    Curtin Univ, Australia.
    Scott, Melissa
    Curtin Univ, Australia.
    Baker-Young, Elliot
    Curtin Univ, Australia.
    Thompson, Craig
    Curtin Univ, Australia.
    McGarry, Sarah
    Curtin Univ, Australia.
    Hayden-Evans, Maya
    Curtin Univ, Australia.
    Snyman, Zelma
    Curtin Univ, Australia.
    Zimmermann, Frank
    Curtin Univ, Australia; Klinikum Aschaffenburg Hosp Child & Adolescent Ps, Germany.
    Kacic, Viktor
    Curtin Univ, Australia; Klinikum Aschaffenburg Hosp Child & Adolescent Ps, Germany.
    Falkmer, Torbjörn
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin Univ, Australia; Lund Univ, Sweden.
    Romanos, Marcel
    Univ Hosp Wurzburg, Germany.
    Boelte, Sven
    Curtin Univ, Australia; Karolinska Inst, Sweden; Reg Stockholm, Sweden; Reg Stockholm, Sweden.
    Girdler, Sonya
    Curtin Univ, Australia; Karolinska Inst, Sweden; Reg Stockholm, Sweden; Univ Western Australia, Australia.
    Milbourn, Benjamin
    Curtin Univ, Australia.
    Preventing suicide in post-secondary students: a scoping review of suicide prevention programs2023In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 32, p. 735-771Article, review/survey (Refereed)
    Abstract [en]

    Suicide among students enrolled in post-secondary education, including university or college, is a major public health concern. Previous research has examined the effectiveness of suicide prevention programs for this population. However, the effective elements of these interventions remain unknown. This study reviewed the literature on suicide prevention programs for post-secondary students, exploring and identifying those elements likely contributing to their effectiveness. A scoping review process was undertaken exploring suicide prevention programs for post-secondary students. Methodological quality of the articles was assessed, and content analysis was used to explore the programs and their effective elements. Twenty seven articles were included in this review, covering a variety of approaches. Gatekeeper training programs were the most common type of suicide prevention program. Programs for post-secondary students may be effective in improving student rates of engagement with mental health services and were associated with greater knowledge, and help-seeking attitudes and behaviors, and gatekeeper-related outcomes. While evidence was found supporting the effectiveness of some interventions such as gatekeeper programs to influence suicide-related knowledge, attitudes and behaviour, further and more rigorous research surrounding suicide prevention programs for post-secondary students is required, with a particular emphasis on student outcomes.

  • 36.
    Black, Melissa H.
    et al.
    Curtin Univ, Australia.
    Vaz, Sharmila
    Curtin Univ, Australia.
    Parsons, Richard
    Curtin Univ, Australia.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin Univ, Australia.
    Tang, Julia S. Y.
    Curtin Univ, Australia.
    Morris, Susan
    Curtin Univ, Australia.
    Lee, Hoe
    Curtin Univ, Australia.
    Falkmer, Marita
    Curtin Univ, Australia; Jonkoping Univ, Sweden.
    Disembedding performance and eye gaze behavior of adolescents with Autism Spectrum Disorder2019In: Research in Autism Spectrum Disorders, ISSN 1750-9467, E-ISSN 1878-0237, Vol. 66, article id UNSP 101417Article in journal (Refereed)
    Abstract [en]

    Background: Atypical visual perception in individuals with Autism Spectrum Disorders (ASD) may contribute to superiority in disembedding tasks. Gaze behavior has provided some insights in to mechanisms underlying this purported superiority in children, however evidence is limited and requires additional investigation. Method: The performance and gaze behavior of 27 adolescents with ASD and 27 matched typically developing (TD) peers were examined during the Figure Ground Subtest of the Test of Visual Perception Skills-third edition (TVPS-3). Results: Compared to their TD counterparts, adolescents with ASD were no different in accuracy, however, had a longer response time. Differences in gaze behavior were also observed, characterized by adolescents with ASD spending less time viewing the incorrect and target figures, and spending a greater proportion of time viewing irrelevant areas of the stimuli compared to TD adolescents. Conclusions: Results suggest that while altered visual perception was observed, this did not contribute to superiority in disembedding tasks in adolescents with ASD. Future research is required to elucidate conditions under which altered visual perception may contribute to behavioral superiority.

  • 37.
    Blane, Alison
    et al.
    Curtin Univ, Australia.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin Univ, Australia; Jonkoping Univ, Sweden; La Trobe Univ, Australia.
    Lee, Hoe C.
    Curtin Univ, Australia.
    Dukic Willstrand, Tania
    Swedish Natl Rd and Transport Res Inst VTI, Sweden.
    Investigating cognitive ability and self-reported driving performance of post-stroke adults in a driving simulator2018In: Topics in Stroke Rehabilitation, ISSN 1074-9357, E-ISSN 1945-5119, Vol. 25, no 1, p. 44-53Article in journal (Refereed)
    Abstract [en]

    Background: Safe driving is a complex activity that requires calibration. This means the driver can accurately assess the level of task demand required for task completion and can accurately evaluate their driving capability. There is much debate on the calibration ability of post-stroke drivers. Objectives: The aim of this study was to assess the cognition, self-rated performance, and estimation of task demand in a driving simulator with post-stroke drivers and controls. Methods: A between-groups study design was employed, which included a post-stroke driver group and a group of similarly aged older control drivers. Both groups were observed driving in two simulator-based driving scenarios and asked to complete the NASA Task Load Index (TLX) to assess their perceived task demand and self-rate their driving performance. Participants also completed a battery of psychometric tasks to assess attention and executive function, which was used to determine whether post-stroke cognitive impairment impacted on calibration. Results: There was no difference in the amount of perceived task demand required to complete the driving task. Despite impairments in cognition, the post-stroke drivers were not more likely to over-estimate their driving abilities than controls. On average, the post-stroke drivers self-rated themselves more poorly than the controls and this rating was related to cognitive ability. Conclusion: This study suggests that post-stroke drivers may be aware of their deficits and adjust their driving behavior. Furthermore, using self-performance measures alongside a driving simulator and cognitive assessments may provide complementary fitness-to-drive assessments, as well as rehabilitation tools during post-stroke recovery.

  • 38.
    Blane, Alison
    et al.
    Curtin University, Australia.
    Lee, Hoe C.
    Curtin University, Australia.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin University, Australia; Jonköping University, Sweden; La Trobe University, Australia.
    Dukic Willstrand, Tania
    Swedish National Rd and Transport Research Institute VTI, Sweden.
    Assessing Cognitive Ability and Simulator-Based Driving Performance in Poststroke Adults2017In: Behavioural Neurology, ISSN 0953-4180, E-ISSN 1875-8584, article id 1378308Article in journal (Refereed)
    Abstract [en]

    Driving is an important activity of daily living, which is increasingly relied upon as the population ages. It has been well-established that cognitive processes decline following a stroke and these processes may influence driving performance. There is much debate on the use of off-road neurological assessments and driving simulators as tools to predict driving performance; however, the majority of research uses unlicensed poststroke drivers, making the comparability of poststroke adults to that of a control group difficult. It stands to reason that in order to determine whether simulators and cognitive assessments can accurately assess driving performance, the baseline should be set by licenced drivers. Therefore, the aim of this study was to assess differences in cognitive ability and driving simulator performance in licensed community-dwelling poststroke drivers and controls. Two groups of licensed drivers (37 poststroke and 43 controls) were assessed using several cognitive tasks and using a driving simulator. The poststroke adults exhibited poorer cognitive ability; however, there were no differences in simulator performance between groups except that the poststroke drivers demonstrated less variability in driver headway. The application of these results as a prescreening toolbox for poststroke drivers is discussed.

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  • 39.
    Blane, Alison
    et al.
    Curtin Univ, Australia.
    Lee, Hoe
    Curtin Univ, Australia.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin Univ, Australia; Jonkoping Univ, Sweden; La Trobe Univ, Australia.
    Willstrand, Tania Dukic
    Jonkoping Univ, Sweden; Swedish Natl Rd and Transport Res Inst VTI, Sweden.
    Cognitive ability as a predictor of task demand and self-rated driving performance in post-stroke drivers - Implications for self-regulation2018In: Journal of Transport and Health, ISSN 2214-1405, E-ISSN 2214-1405, Vol. 9, p. 169-179Article in journal (Refereed)
    Abstract [en]

    Driving is a highly complex task requiring multiple cognitive processes that can be adversely affected post-stroke. It is unclear how much ability post-stroke adults have to self-evaluate their driving performance. Furthermore, the impact of cognitive decline on this evaluation has not been previously investigated. The aim of this study was to investigate the perceived level of task demand involved in driving tasks, and to examine differences between perceived and observed driving performance in post-stroke drivers in comparison to a control group. A further aim of the research was to investigate the influence of cognition on self-rated driving performance. A total of 78 participants (35 post-stroke and 43 controls) were assessed using a series of cognitive tasks and were observed whilst driving. Participants were asked to rate their own driving performance and the task demand involved while driving using the NASA Task Load Index. Between group analyses were conducted to determine differences in the level of self-rated performance and task demand. Further analyses were conducted to investigate whether cognition accounted for differences in task demand or self-rated performance. Overall, the results suggested that the post-stroke drivers exhibited deficits in cognition, but they did not report increased levels of task demand when driving. Post-stroke adults also rated themselves more conservatively than the controls for on-road performance, which was associated with their reduced propensity for risk. The study suggests that cognitive deficits may influence post-stroke drivers to amend their driving behaviour, in order to bring the task demand within a manageable level. Understanding the mechanisms involved in self-rated performance and estimations of task demand can help promote accurate self-regulation practices in post-stroke drivers. Furthermore, measuring calibration may assist practitioners with assessing fitness-to-drive, as well as with tailoring driving rehabilitation.

  • 40.
    Blom, Kerstin
    et al.
    Karolinska Institute, Sweden.
    Tarkian Tillgren, Hanna
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Wiklund, Tobias
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Danlycke, Ewa
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Forssen, Mattias
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Söderström, Alexandra
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Johansson, Robert
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Jernelov, Susanna
    Karolinska Institute, Sweden.
    Lindefors, Nils
    Karolinska Institute, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Kaldo, Viktor
    Karolinska Institute, Sweden.
    Internet-vs. group-delivered cognitive behavior therapy for insomnia: A randomized controlled non-inferiority trial2015In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 70, p. 47-55Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to compare guided Internet-delivered to group-delivered cognitive behavioral therapy (CBT) for insomnia. We conducted an 8-week randomized controlled non-inferiority trial with 6-months follow-up. Participants were forty-eight adults with insomnia, recruited via media. Interventions were guided Internet-delivered CBT (ICBT) and group-delivered CBT (GCBT) for insomnia. Primary outcome measure was the Insomnia Severity Index (ISI), secondary outcome measures were sleep diary data, depressive symptoms, response- and remission rates. Both treatment groups showed significant improvements and large effect sizes for ISI (Within Cohens d: ICBT post = 1.8, 6-months follow-up = 2.1; GCBT post = 2.1, 6-months follow-up = 2.2). Confidence interval of the difference between groups posttreatment and at FU6 indicated non-inferiority of ICBT compared to GCBT. At post-treatment, two thirds of patients in both groups were considered responders (ISI-reduction greater than 7p). Using diagnostic criteria, 63% (ICBT) and 75% (GCBT) were in remission. Sleep diary data showed moderate to large effect sizes. We conclude that both guided Internet-CBT and group-CBT in this study were efficacious with regard to insomnia severity, sleep parameters and depressive symptoms. The results are in line with previous research, and strengthen the evidence for guided Internet-CBT for insomnia. Trial registration: The study protocol was approved by, and registered with, the regional ethics review board in Linkoping, Sweden, registration number 2010/385-31.

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  • 41.
    Boersma, Katja
    et al.
    Orebro Univ, Sweden.
    Södermark, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology.
    Flink, Ida K.
    Orebro Univ, Sweden.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Linton, Steven J.
    Orebro Univ, Sweden.
    Efficacy of a transdiagnostic emotion-focused exposure treatment for chronic pain patients with comorbid anxiety and depression: a randomized controlled trial2019In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 160, no 8, p. 1708-1718Article in journal (Refereed)
    Abstract [en]

    The comorbidity between chronic pain and emotional problems has proven difficult to address with current treatment options. This study addresses the efficacy of a transdiagnostic emotion-focused exposure treatment ("hybrid") for chronic pain patients with comorbid emotional problems. Adults (n = 115) with chronic musculoskeletal pain and functional and emotional problems were included in a 2-centre, parallel randomized controlled, open-label trial comparing this treatment to an active control condition receiving a guided Internet-delivered pain management treatment based on CBT principles (iCBT). The hybrid treatment (n = 58, 10-16 sessions) integrates exposure in vivo for chronic pain based on the fear-avoidance model with an emotion-regulation approach informed by procedures in Dialectical Behavior Therapy. The iCBT (n = 57; 8 treatment modules) addresses topics such as pain education, coping strategies, relaxation, problem solving, stress, and sleep management using standard CBT techniques. Patient-reported outcomes were assessed before and after treatment as well as at a 9-month primary end point. Across conditions, 78% participants completed post-treatment and 81% follow-up assessment. Intent-to-treat analyses showed that the hybrid had a significantly better post-treatment outcome on pain catastrophizing (d = 0.39) and pain interference (d = 0.63) and significantly better follow-up outcomes on depression (d = 0.43) and pain interference (d = 0.51). There were no differences on anxiety and pain intensity. Observed proportions of clinically significant improvement favoured the hybrid on all but one comparison, but no statistically significant differences were observed. We conclude that the hybrid emotion-focused treatment may be considered an acceptable, credible, and efficacious treatment option for chronic pain patients with comorbid emotional problems.

  • 42.
    Boonen, Annelies
    et al.
    Division of Rheumatology, Maastricht University Medical Centre+ Internal Medicine, Maastricht, The Netherlands; Universiteit Maastricht Care and Public Health Research Institute, Maastricht, The Netherlands.
    Putrik, Polina
    Division of Rheumatology, Maastricht University Medical Centre+ Internal Medicine, Maastricht, The Netherlands; Universiteit Maastricht Care and Public Health Research Institute, Maastricht, The Netherlands.
    Marques, Mary Lucy
    Rheumatologist, Leiden University Medical Center, Leiden, The Netherlands; Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.
    Alunno, Alessia
    Rheumatology Unit, University of Perugia Department of Medicine, Perugia, Italy.
    Abasolo, Lydia
    Department of Rheumatology, Instituto de Investigation Sanitaria San Carlos, Hospital Clinico Universitario San Carlos, Madrid, Spain.
    Beaton, Dorcas
    Mobility Program Clinical Research Unit, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada.
    Betteridge, Neil
    Neil Betteridge Associates, London, UK.
    Björk, Mathilda
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Boers, Maarten
    Department of Epidemiology and Data Science; Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Amsterdam, The Netherlands.
    Boteva, Boryana
    Patients with Arthritis and Rheumatism (PARE) working group, European League Against Rheumatism, Zurich, Switzerland.
    Fautrel, Bruno
    PEPITES teams, Pierre Louis Institute for Epidemiology and Public Health, Inserm UMR 1136, Paris, France; Rheumatology Dept, Pitié Salpetriere Hospital, Sorbonne University; Assistance Publique- Hôpitaux de Paris, Paris, Fance.
    Guillemin, Francis
    APEMAC, Université de Lorraine, Nancy, France; CIC Epidémiologie Clinique, CHRU Nancy, Inserm, Université de Lorraine, Nancy, France.
    Mateus, Elsa F
    Portuguese League Against Rheumatic Diseases (LPCDR) and Comprehensive Health Research Centre (CHRC), Lisbon, Portugal; People with Arthritis and Rheumatism (PARE), European League Against Rheumatism, Zurich, Switzerland.
    Nikiphorou, Elena
    Centre for Rheumatic Diseases, King’s College of London, London, UK; Rheumatology Department, King’s College Hospital, London, UK.
    Péntek, Márta
    Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary.
    Pimentel Santos, Fernando
    Rheumatology Department, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal; NOVA Medical School, Lisboa, Portugal.
    Severens, Johannes L
    Erasmus School of Health Policy & Management and iMTA, Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
    Verstappen, Suzanne M M
    Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK.
    Walker-Bone, Karen
    MRC Versus Arthritis Centre for Musculoskeletal Health and Work, MRC Life course Epidemiology Unit, Southampton General Hospital, Southampton, UK.
    Wallman, Johan Karlsson
    Department of Clinical sciences, Lund University, Lund, Sweden; Department of Rheumatology, Skåne University Hospital, Lund, Sweden.
    Ter Wee, Marieke M
    Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Rheumatology and immunology, AI&I, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Westhovens, René
    Dept of Rheumatology, KU Leuven University Hospitals Leuven, Leuven, Belgium; Skeletal Biology and Engineering Research Centre, KU Leuven Department of Development and Regeneration, Leuven, Belgium.
    Ramiro, Sofia
    Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands.
    EULAR Points to Consider (PtC) for designing, analysing and reporting of studies with work participation as an outcome domain in patients with inflammatory arthritis2021In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 80, no 9, p. 1116-1123, article id annrheumdis-2020-219523Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Clinical studies with work participation (WP) as an outcome domain pose particular methodological challenges that hamper interpretation, comparison between studies and meta-analyses.

    OBJECTIVES: To develop Points to Consider (PtC) for design, analysis and reporting of studies of patients with inflammatory arthritis that include WP as a primary or secondary outcome domain.

    METHODS: The EULAR Standardised Operating Procedures were followed. A multidisciplinary taskforce with 22 experts including patients with rheumatic diseases, from 10 EULAR countries and Canada, identified methodologic areas of concern. Two systematic literature reviews (SLR) appraised the methodology across these areas. In parallel, two surveys among professional societies and experts outside the taskforce sought for additional methodological areas or existing conducting/reporting recommendations. The taskforce formulated the PtC after presentation of the SLRs and survey results, and discussion. Consensus was obtained through informal voting, with levels of agreement obtained anonymously.

    RESULTS: Two overarching principles and nine PtC were formulated. The taskforce recommends to align the work-related study objective to the design, duration, and outcome domains/measurement instruments of the study (PtC: 1-3); to identify contextual factors upfront and account for them in analyses (PtC: 4); to account for interdependence of different work outcome domains and for changes in work status over time (PtC: 5-7); to present results as means as well as proportions of patients reaching predefined meaningful categories (PtC: 8) and to explicitly report volumes of productivity loss when costs are an outcome (PtC:9).

    CONCLUSION: Adherence to these EULAR PtC will improve the methodological quality of studies evaluating WP.

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  • 43.
    Borgestig, Maria
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Folke Bernadotte Regional Habilitation Centre and Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden.
    Sandqvist, Jan
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy.
    Ahlsten, Gunnar
    Folke Bernadotte Regional Habilitation Centre and Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden.
    Falkmer, Torbjorn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. School of Occupational Therapy & Social Work, Curtin University, Perth, WA, Australia; School of Occupational Therapy, La Trobe University, Melbourne, Victoria, Australia.
    Hemmingsson, Helena
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy.
    Gaze-based assistive technology in daily activities in children with severe physical impairments: an intervention study2017In: Developmental Neurorehabilitation, ISSN 1751-8423, E-ISSN 1751-8431, Vol. 20, no 3, p. 129-141Article in journal (Refereed)
    Abstract [en]

    Objective: To establish the impact of a gaze-based assistive technology (AT) intervention on activity repertoire, autonomous use, and goal attainment in children with severe physical impairments, and to examine parents’ satisfaction with the gaze-based AT and with services related to the gaze-based AT intervention.

    Methods: Non-experimental multiple case study with before, after, and follow-up design. Ten children with severe physical impairments without speaking ability (aged 1–15 years) participated in gaze-based AT intervention for 9–10 months, during which period the gaze-based AT was implemented in daily activities.

    Results: Repertoire of computer activities increased for seven children. All children had sustained usage of gaze-based AT in daily activities at follow-up, all had attained goals, and parents’ satisfaction with the AT and with services was high.

    Discussion: The gaze-based AT intervention was effective in guiding parents and teachers to continue supporting the children to perform activities with the AT after the intervention program.

  • 44.
    Borgestig, Maria
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Folke Bernadotte Regional Habilitation Centre and Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden.
    Sandqvist, Jan
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy.
    Parsons, Richard
    School of Occupational Therapy & Social Work, Curtin University, Perth, WA, Australia.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. School of Occupational Therapy & Social Work, Curtin University, Perth, WA, Australia / School of Occupational Therapy, La Trobe University, Melbourne, Victoria, Australia.
    Hemmingsson, Helena
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences.
    Eye gaze performance for children with severe physical impairments using gaze-based assistive technology: a longitudinal study2016In: Assistive technology, ISSN 1040-0435, E-ISSN 1949-3614, Vol. 28, no 2, p. 93-102Article in journal (Refereed)
    Abstract [en]

    Gaze-based assistive technology (gaze-based AT) has the potential to provide children affected by severe physical impairments with opportunities for communication and activities. This study aimed to examine changes in eye gaze performance over time (time on task and accuracy) in children with severe physical impairments, without speaking ability, using gaze-based AT. A longitudinal study with an AB design was conducted on ten children (aged 1–15 years) with severe physical impairments, who were beginners to gaze-based AT at baseline. Thereafter, all children used the gaze-based AT in daily activities over the course of the study. Compass computer software was used to measure time on task and accuracy with eye selection of targets on screen, and tests were performed with the children at baseline, after 5 months, 9–11 months, and after 15–20 months. Findings showed that the children improved in time on task after 5 months and became more accurate in selecting targets after 15–20 months. This study indicates that these children with severe physical impairments, who were unable to speak, could improve in eye gaze performance. However, the children needed time to practice on a long-term basis to acquire skills needed to develop fast and accurate eye gaze performance.

  • 45.
    Briseniou, Evangelia
    et al.
    Univ Thessaly, Greece.
    Skenteris, Nikolaos
    Univ Thessaly, Greece.
    Hatzoglou, Chryssi
    Univ Thessaly, Greece.
    Tsitsas, George
    Harokopio Univ, Greece.
    Diamantopoulos, Epaminondas
    Univ Ioannina, Greece.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Univ Ioannina, Greece.
    Gouva, Mary
    Univ Ioannina, Greece.
    The effects of psychopathology and shame on social representations of health and lifestyle behaviours via free association: a graph analysis approach2021In: BMC Psychology, E-ISSN 2050-7283, Vol. 9, no 1, article id 168Article in journal (Refereed)
    Abstract [en]

    Background There is a knowledge gap in whether psychopathology aspects can shape and mark the social representations about health and lifestyle. In this work, we investigated the association of psychopathology and shame with the centrality of the words describing eight common social representations of health and lifestyle. Methods A convenience sample of 288 adults participated with an average age of 44.7, and 62.6% were women. The participants were asked to express three consecutive words associated with eight different health and lifestyle experiences by utilizing the free association method. The participants also were completed the Symptom Checklist-90-Revised (SCL-90-R), the Experiences of Shame Scale (ESS), and the Other as Shamer Scale (OAS). Canonical correlation analysis was applied to investigate the relationship between the set of the eight-word centralities and the psycho-demographic variables consisting of the subjects age and gender, the SCL 90 subscales, the OAS, and the ESS. Based on these findings, a structural equation explorative model was formed to test the unidimensionality of the five centralities construct. Results tau he psychological characteristics of interpersonal sensitivity, depression, external shame, and hostility were found to affect the word selection process on the social representations concerning nightlife, health, diet, lifestyle, and alcohol consumption. Participants with increased levels of depression tend to choose more centrally positioned words when the stimulus word was diet and more decentralized responses when the stimulus word was health. At the same time, higher external shame corresponded to more decentralized words for the categories of health and lifestyle. Conclusions Our results indicate that there is a potential interaction between the psychological state and how a social representation of health and lifestyle is constructed through selected words. Graph theory emerged as an additional tool to use to study these relations.

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  • 46.
    Brodin, Nina
    et al.
    Karolinska Inst, Sweden; Danderyd Hosp, Sweden.
    Sundstrom, Bjorn
    Uppsala Univ, Sweden; Umea Univ, Sweden.
    Björk, Mathilda
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Swardh, Emma
    Karolinska Inst, Sweden.
    "It's Like Listening to the Radio with a Little Interference": A Qualitative Study Describing Pain Management among Patients with Psoriatic Arthritis2023In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 12, no 23, article id 7348Article in journal (Refereed)
    Abstract [en]

    Pain is one of the most important areas to focus on in the assessment and treatment of psoriatic arthritis (PsA), and treatment should be individualized and based on the needs of the patient. Therefore, our aim was to explore and describe the management of pain among patients with PsA. We conducted semi-structured interviews with 11 participants with PsA (3 men and 8 women) and used qualitative content analysis to analyze the text. The results showed a main overarching theme of meaning and three subthemes. They were 'Taking charge of life despite the constant murmur of pain' through 'Sorting out vulnerability', 'Reaching acceptance and engagement', and 'Directing focus to change'. Nine categories further described the components of pain management: 'face uncertainty for the future, 'consider restrictions', 'illuminate the invisible', 'increase awareness', 'find a permissive environment and social support', 'enhance inner endurance', 'reformulate emotions and thoughts', 'use distracting activities', and 'adjust activities'. The action components of pain management interpreted from a theoretical perspective highlight the importance for the patients of attaining the satisfaction of three basic psychological needs, i.e., competence, autonomy, and relatedness. Health professionals therefore need to increase the skills required for needs-supportive behaviors as well as facilitating spouse and peer support in the management of pain in PsA.

  • 47.
    Bruce, C. R.
    et al.
    La Trobe University, Australia.
    Unsworth, C. A.
    La Trobe University, Australia; CQUniversity, Australia; Jonköping University, Sweden; Curtin University, Australia.
    Dillon, M. P.
    La Trobe University, Australia.
    Tay, R.
    RMIT University, Australia.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin University, Australia.
    Bird, P.
    Gosforth Clin, Australia.
    Carey, L. M.
    La Trobe University, Australia; Florey Institute Neurosci and Mental Health Neurorehabil and, Australia.
    Hazard perception skills of young drivers with Attention Deficit Hyperactivity Disorder (ADHD) can be improved with computer based driver training: An exploratory randomised controlled trial2017In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 109, p. 70-77Article in journal (Refereed)
    Abstract [en]

    Background: Young drivers with Attention Deficit Hyperactivity Disorder (ADHD) are at higher risk of road traffic injuries than their peers. Increased risk correlates with poor hazard perception skill. Few studies have investigated hazard perception training using computer technology with this group of drivers. Objectives: *Determine the presence and magnitude of the between-group.and within- subject change in hazard perception skills in young drivers with ADHD who receive Drive Smart training. *Determine whether training facilitated change in hazard perception is maintained over time. Methods: This was a feasibility study, randomised control trial conducted in Australia. The design included a delayed treatment for the control group. Twenty-five drivers with a diagnosis of ADHD were randomised to the Immediate Intervention or Delayed Intervention group.The Immediate Intervention group received a training session using a computer application entitled Drive Smart. The Delayed Intervention group watched a documentary video initially (control condition), followed by the Drive Smart computer training session. The participants hazard perception skill was measured using the Hazard Perception Test (HPT). Findings: After adjusting for baseline scores, there was a significant betweengroup difference in post-intervention HPT change scores in favour of the Immediate Intervention group. The magnitude of the effect was large. There was no significant within-group delayed intervention effect. A significant maintenance effect was found at 6 week follow-up for the Immediate Intervention group. Conclusions: The hazard perception skills of participants improved following training with large effect size and some maintenance of gain. A multimodal approach to training is indicated to facilitate maintenance. A full-scale trial is feasible.

  • 48.
    Bäckryd, Emmanuel
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Alkohol, misär Och delirium tremens I Emile Zolas roman »Krogen«2021In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 23/24Article in journal (Other (popular science, discussion, etc.))
  • 49.
    Bäckryd, Emmanuel
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Att bli och förbli en bra läkare: handbok för egna reflektioner och kollegiala samtal2021Book (Other academic)
  • 50.
    Bäckryd, Emmanuel
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Att navigera mellan opioidrädsla och opiocentrism i dagens vård: Undvik stereotyp förskrivning med hjälp av grundlig smärtanalys och individualiserad analys av risk och nytta [Navigating between opiophobia and opiocentrism in today's healthcare]2022In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 119, article id 21198Article in journal (Refereed)
    Abstract [sv]

    Opioids are an essential category of medicines, and opiophobia should therefore be shunned. However, it is also important to avoid opiocentrism, i.e., the phenomenon of giving an unduly central place to opioids in the practice of pain medicine. To find a way between these two extremes, it is essential to do a thorough pain assessment and a risk analysis. In this paper, the question of how to best prescribe opioids is related to a "Pain Analysis 3×3" framework in which 3 areas, each consisting of 3 points, are discussed: 1) Is the pain acute, chronic, or cancer-related? 2) Is the pain nociceptive, neuropathic, or nociplastic? 3) Have biological, psychological and social/contextual aspects been taken into consideration (the bio-psycho-social model of pain)? Chronic nociplastic pain conditions such as e.g. fibromyalgia, irritable bowel syndrome or "unspecific" back pain are generally unsuitable for treatment with opioids.

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