Mats Arne

Physical activity and quality of life in subjects with chronic disease: Chronic obstructive pulmonary disease compared with rheumatoid arthritis and diabetes mellitus

Objective. Chronic diseases interfere with the life situation of the affected person in different ways. The aim was to compare the burden of disease in three chronic diseases – chronic obstructive pulmonary disease (COPD), rheumatoid arthritis (RA), diabetes mellitus (DM) – and in healthy subjects, with a particular interest in physical activity, quality of life, and psychological health. Design. Cross-sectional, observational study. Setting and subjects. Postal survey questionnaire to a stratified, random population of 68 460 subjects aged 18–84 years in Sweden. The subjects included were 40–84 years old (n = 43 589) and data were analysed for COPD (n = 526), RA (n = 1120), DM (n = 2149) and healthy subjects (n = 6960). Result: Some 84% of subjects with COPD, 74% (RA), 72% (DM), and 60% in healthy subjects (p < 0.001, COPD versus RA, DM, and healthy subjects) had a physical activity level considered too low to maintain good health according to guidelines. Quality of life (EuroQol five-dimension questionnaire, EQ-5D) was lower in COPD and RA than in DM. Anxiety/depression was more common in subjects with COPD (53%) than in those with RA (48%) and DM (35%) (p < 0.001, COPD versus RA and DM), whereas mobility problems were more common in RA (55%) than COPD (48%) and DM (36%) (p < 0.001, RA versus COPD and DM). All differences between groups remained significant after adjusting for age, sex, and socioeconomic background factors. Conclusion. Subjects with chronic diseases had a low level of physical activity, most evident in subjects with COPD. COPD and RA had a higher negative impact on quality of life than DM. Our results indicate that increased attention regarding physical inactivity in subjects with chronic diseases is needed to minimize the burden of disease.

How often is diagnosis of COPD confirmed with spirometry

BACKGROUND Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality worldwide. Diagnosis is customarily confirmed with spirometry, but there are few studies on documented spirometry use in everyday clinical practice. METHODS In a cross-sectional survey and study of the medical records of primary and secondary care COPD patients aged 18-75 in a Swedish region, patients with COPD were randomly selected from the registers of 56 primary care centres and 14 hospital outpatient clinics. Spirometry data at diagnosis +/-6 months were analyzed. RESULTS From 1114 patients with COPD, 533 with a new diagnosis of COPD during the four-year study period were identified. In 59% (n=316), spirometry data in connection with diagnosis were found in the medical records. Spirometry data with post-bronchodilator forced expiratory volume in 1s (FEV(1))/ vital capacity (VC) ratios were available in 45% (n=241). FEV1/VC ratio <0.70 were found in 160 patients, which corresponds to 30% of the patients with a new diagnosis. Lower age, female gender, current smoking, higher body mass index (BMI) and shorter forced exhalation time were related to COPD diagnosis despite an FEV(1)/VC ratio of >/=0.70. The most common problem in the quality assessment was an insufficient exhalation time. CONCLUSIONS Only a third of Swedish patients with COPD had their diagnosis confirmed with spirometry. Our data indicate that female gender, current smoking, higher BMI and short exhalation time increase the risk of being diagnosed with COPD without fulfilling the spirometric criteria for the disease.

Estimated prevalences of respiratory symptoms, asthma and chronic obstructive pulmonary disease related to detection rate in primary health care

OBJECTIVE To assess the prevalence of respiratory symptoms, asthma and chronic obstructive pulmonary disease (COPD), and to relate it to an estimated detection rate in primary health care. DESIGN A two-staged study with a cross-sectional survey and a clinical validation. SETTING The adult population of Värmland, a county in Sweden. SUBJECTS 4814 persons completed the survey and 206 the confirmative validation study. MAIN OUTCOME MEASURES Prevalence of respiratory symptoms, of asthma and COPD. RESULTS More than 40% reported respiratory symptoms. Wheeze was reported by 8.0%, shortness of breath by 11.4% and sputum production by 14.1%. Smoking was more common among women than among men. The prevalence of asthma was 8.2% and COPD 2.1%. Of persons with asthma, 33% were estimated to be undiagnosed, 67% used medication and nearly 60% attended primary health care services. CONCLUSION Respiratory symptoms as well as asthma were common in this study and equivalent to earlier findings. The difference between the epidemiologically estimated prevalence of asthma and the lower detection rate in primary health care can be explained by at least three factors: persons who did not seek any care, were underdiagnosed or attended other health care providers.

Nurse-led multidisciplinary programme for patients with COPD in primary health care: a controlled trial.

AIM To investigate the effects of a nurse-led multidisciplinary programme (NMP) of pulmonary rehabilitation in primary health care with regard to functional capacity, quality of life (QoL), and exacerbations among patients with chronic obstructive pulmonary disease (COPD). METHOD A 1-year longitudinal study with a quasi-experimental design was undertaken in patients with COPD, 49 in the intervention group and 54 in the control group. Functional capacity was assessed using the 6-minute walking test, and quality of life (QoL) was assessed using the Clinical COPD Questionnaire. Exacerbations were calculated by examination of patient records. RESULTS No significant differences were found between the groups in functional capacity and QoL after 1 year. The exacerbations decreased in the intervention group (n = -0.2) and increased in the control group (n = 0.3) during the year after NMP. The mean difference of change in exacerbation frequency between the groups was statistically significant after one year (p=0.009). CONCLUSIONS The NMP in primary care produced a significant reduction in exacerbation frequency, but functional capacity and QoL were unchanged. More and larger studies are needed to evaluate potential benefits in functional capacity and QoL.

Factors associated with good self-rated health and quality of life in subjects with self-reported COPD

Background Recent guidelines for chronic obstructive pulmonary disease (COPD) state that COPD is both preventable and treatable. To gain a more positive outlook on the disease it is interesting to investigate factors associated with good, self-rated health and quality of life in subjects with self-reported COPD in the population. Methods In a cross-sectional study design, postal survey questionnaires were sent to a stratified, random population in Sweden in 2004 and 2008. The prevalence of subjects (40–84 years) who reported having COPD was 2.1% in 2004 and 2.7% in 2008. Data were analyzed for 1475 subjects. Regression models were used to analyze the associations between health measures (general health status, the General Health Questionnaire, the EuroQol five-dimension questionnaire) and influencing factors. Results The most important factor associated with good, self-rated health and quality of life was level of physical activity. Odds ratios for general health varied from 2.4 to 7.7 depending on degree of physical activity, where subjects with the highest physical activity level reported the best health and also highest quality of life. Social support and absence of economic problems almost doubled the odds ratios for better health and quality of life. Conclusions In this population-based public health survey, better self-rated health status and quality of life in subjects with self-reported COPD was associated with higher levels of physical activity, social support, and absence of economic problems. The findings indicated that of possible factors that could be influenced, promoting physical activity and strengthening social support are important in maintaining or improving the health and quality of life in subjects with COPD. Severity of the disease as a possible confounding effect should be investigated in future population studies.

Hospital-based pulmonary rehabilitation in patients with COPD in Sweden : A national survey

Pulmonary rehabilitation (PR) is an evidence-based, multidisciplinary and cost-effective intervention that leads to improved health in patients with chronic obstructive pulmonary disease, COPD. However, the availability of PR programs varies between and within different countries. The aim of this study was to investigate the availability and content of hospital-based PR programs in patients with COPD in Sweden. A cross-sectional descriptive design was applied using a web-based questionnaire which was sent out to all hospitals in Sweden. The questionnaire consisted of 32 questions that concerned availability and content of PR in patients with COPD during 2011. Seventy out of 71 hospitals responded the electronic survey. Forty-six (66%) hospitals offered PR for patients with COPD. Around 75% of the hospitals in southern and middle parts of Sweden and 33% of the hospitals in the northern part offered PR. Thirty-four percent of the patients declined participation. A total number of 1355 patients participated in PR which represents 0.2% of the COPD population in Sweden. All hospitals had exercise training as major component and 76% offered an educational program. Not even half a percent of the patients with COPD in Sweden took part in a hospital-based PR program during 2011. There was a considerable geographic discrepancy in availability over the country. To enable a greater part of the increasing number of patients with COPD to take part in this evidence-based treatment, there is a need of evaluating other settings of PR programs; in primary care, at home and/or over the internet.

Keep moving to retain the healthy self: the meaning of physical exercise in individuals with Parkinson’s disease

Abstract Purpose: The aim of this study was to explore and generate an understanding of the meaning of physical exercise in the lives of individuals with Parkinson’s disease (PD) participating in an exercise program. Method: A qualitative design, using Grounded Theory methodology, was used. Eleven individuals diagnosed with PD were interviewed. Results: The core category “Keep moving to retain the healthy self” identified the continuing process of maintaining functions and activities in the individuals’ lives, in which exercise was a major contribution. Two categories, “Having explicit life goals” and “Having confidence in one’s own ability”, were important prerequisites for adherence to physical exercise. Four categories – “Taking rational position”, “Exercising to slow progression”, “Exercising to achieve well-being” and “Using exercise as coping strategy” – were generated as important for starting and maintaining exercise habits. Conclusions: Insights into the process of exercising in view of living with PD were generated, which have implications for strategies in promoting physical exercise in older individuals with PD. Implications for Rehabilitation Physical exercise can contribute to the process of retaining the healthy self in older individuals with PD. Having explicit life goals and having confidence in one’s own ability may facilitate exercise adherence. Health personnel need to be perceptive for patients’ life stories in order to understand the goals of the individual and how to support the individual in his achievement of them.

Availability of pulmonary rehabilitation in primary care for patients with COPD : a cross-sectional study in Sweden

Background Pulmonary rehabilitation (PR) is an important, evidence-based component for the management of individuals with chronic obstructive pulmonary disease (COPD). In daily practice, the majority of COPD patients are treated in primary care. However, information about the availability of PR in primary care in Sweden is lacking. The aim was to investigate the availability of rehabilitation resources in primary care settings for patients with COPD in Sweden. Methods A cross-sectional descriptive design was applied, using web-based questionnaires sent to all primary care centres in four regions, comprising more than half of the 9.6 million inhabitants of Sweden. The main questionnaire included questions about the content and availability of rehabilitation resources for COPD patients. PR was defined as exercise training and one or more of the following activities: education, nutritional intervention, energy conservation techniques or psychosocial support. Results A total of 381 (55.9%) of the 682 primary care centres answered the main questionnaire. In addition to physicians and nurses, availability of healthcare professionals for rehabilitation in primary care settings was physiotherapists 92.0%, occupational therapists 91.9%, dieticians 83.9% and social workers or psychologists 98.4%. At 23.7% of all centres, PR was not available to COPD patients – neither in primary care nor at hospitals. Conclusion Despite high availability of professionals for rehabilitation in primary care settings, about one-quarter of managers at primary care centres stated that their COPD patients had no access to PR. This indicates a need to structure resources for rehabilitation and to present and communicate the available resources within the healthcare system.

Adherence to guidelines in patients with chronic heart failure in primary health care

Abstract Objective: To describe adherence to international guidelines for chronic heart failure (CHF) management concerning diagnostics, pharmacological treatment and self-care behaviour in primary health care. Design: A cross-sectional descriptive study of patients with CHF, using data obtained from medical records and a postal questionnaire. Setting: Three primary health care centres in Sweden. Subjects: Patients with a CHF diagnosis registered in their medical record. Main outcome measures: Adherence to recommended diagnostic tests and pharmacological treatment by the European Society of Cardiology guidelines and self-care behaviour, using the European Heart Failure Self-care Behaviour Scale (EHFScBS-9). Results. The 155 participating patients had a mean age of 79 (SD9) years and 89 (57%) were male. An ECG was performed in all participants, 135 (87%) had their NT-proBNP measured, and 127 (82%) had transthoracic echocardiography performed. An inhibitor of the renin angiotensin system (RAS) was prescribed in 120 (78%) patients, however only 45 (29%) in target dose. More men than women were prescribed RAS-inhibition. Beta blockers (BBs) were prescribed in 117 (76%) patients, with 28 (18%) at target dose. Mineralocorticoidreceptor antagonists were prescribed in 54 (35%) patients and daily diuretics in 96 (62%). The recommended combination of RAS-inhibitors and BBs was prescribed to 92 (59%), but only 14 (9%) at target dose. The mean score on the EHFScBS-9 was 29 (SD 6) with the lowest adherence to daily weighing and consulting behaviour. Conclusion: Adherence to guidelines has improved since prior studies but is still suboptimal particularly with regards to medication dosage. There is also room for improvement in patient education and self-care behaviour.

Spirometry in primary care; results after education of operators using quality indicators in a real-life study

A correct performed spirometry is of importance for diagnosis and indicators can be used to assess some aspects of performance quality. The aim was to investigate differences in quality indicators after education and introduction of quality criteria among spirometry operators in primary care. Subjects and methods: All operators performing at least five spirometry sessions per year during the two periods 2009-2011 and 2014 in one region in Sweden were included in the study. Operators received two days of education and quality criteria according to ATS/ERS 2005 were introduced. Data were collected from a central database and comprised back-extrapolated volume (BEV) 1 and FVC (the highest value minus the second highest value) of ≤150 mL. Results: Results from 18 operators are presented as the mean percentage of all tests per operator meeting the criteria, from the first period (2009-2011; 2 903 spirometry sessions) to the second (2014; 1 249 sessions): Start of test; BEV from 86.2% to 87.8% (+1.6%, not significant (NS)), end of test; FET 65.6% to 74.0% (+8.4%, p=0.020). Repeatability of FEV 1 88.9% to 92.9% (+4.0%, p=0.017), and repeatability of FVC 78.6% to 82.1% (+3.5%, NS). Conclusions: Fulfilment of quality criteria increased significantly for the indicators FET and repeatability of FEV 1 between the periods. Education in spirometry and introduction of quality criteria as intervention could have effect on indicators. To further increase quality of spirometry, an intervention with individual operator feed-back is planned to be performed.