Nina Brodin

Coaching patients with early rheumatoid arthritis to healthy physical activity: a multicenter, randomized, controlled study.

OBJECTIVE To investigate the effect of a 1-year coaching program for healthy physical activity on perceived health status, body function, and activity limitation in patients with early rheumatoid arthritis. METHODS A total of 228 patients (169 women, 59 men, mean age 55 years, mean time since diagnosis 21 months) were randomized to 2 groups after assessments with the EuroQol visual analog scale (VAS), Grippit, Timed-Stands Test, Escola Paulista de Medicina Range of Motion scale, walking in a figure-of-8, a visual analog scale for pain, the Health Assessment Questionnaire disability index, a self-reported physical activity questionnaire, and the Disease Activity Score in 28 joints. All patients were regularly seen by rheumatologists and underwent rehabilitation as prescribed. Those in the intervention group were further individually coached by a physical therapist to reach or maintain healthy physical activity (> or =30 minutes, moderately intensive activity, most days of the week). RESULTS The retention rates after 1 year were 82% in the intervention group and 85% in the control group. The percentages of individuals in the intervention and control groups fulfilling the requirements for healthy physical activity were similar before (47% versus 51%; P > 0.05) and after (54% versus 44%; P > 0.05) the intervention. Analyses of outcome variables indicated improvements in the intervention group over the control group in the EuroQol VAS (P = 0.025) and muscle strength (Timed-Stands Test; P = 0.000) (Grippit; P = 0.003), but not in any other variables assessed. CONCLUSION A 1-year coaching program for healthy physical activity resulted in improved perceived health status and muscle strength, but the mechanisms remain unclear, as self-reported physical activity at healthy level did not change.

2016 update of the EULAR recommendations for the management of early arthritis

Objectives Since the 2007 recommendations for the management of early arthritis have been presented, considerable research has been published in the field of early arthritis, mandating an update of the 2007 European League Against Rheumatism (EULAR) recommendations for management of early arthritis. Methods In accordance with the 2014 EULAR Standardised Operating Procedures, the expert committee pursued an approach that was based on evidence in the literature and on expert opinion. The committee involved 20 rheumatologists, 2 patients and 1 healthcare professional representing 12 European countries. The group defined the focus of the expert committee and target population, formulated a definition of ‘management’ and selected the research questions. A systematic literature research (SLR) was performed by two fellows with the help of a skilled librarian. A set of draft recommendations was proposed on the basis of the research questions and the results of the SLR. For each recommendation, the categories of evidence were identified, the strength of recommendations was derived and the level of agreement was determined through a voting process. Results The updated recommendations comprise 3 overarching principles and 12 recommendations for managing early arthritis. The selected statements involve the recognition of arthritis, referral, diagnosis, prognostication, treatment (information, education, pharmacological and non-pharmacological interventions), monitoring and strategy. Eighteen items were identified as relevant for future research. Conclusions These recommendations provide rheumatologists, general practitioners, healthcare professionals, patients and other stakeholders with an updated EULAR consensus on the entire management of early arthritis.

Physical Activity Coaching of Patients with Rheumatoid Arthritis in Everyday Practice: A Long-term Follow-up

OBJECTIVES To investigate the long-term effects on perceived general health, disease activity, pain, activity limitation and cognitive behavioural factors of a one-year coaching programme performed in ordinary physical therapy practice to promote the adoption of health-enhancing physical activity in patients with early rheumatoid arthritis (RA). METHODS A total of 228 patients with early RA, from 10 rheumatology clinics in Sweden, were randomly assigned to an intervention group (IG; n = 94) or a control group (CG; n = 134). The IG was coached by physical therapists during the first year to adopt health-enhancing levels of physical activity (30 minutes/day, moderately intensive, ≥ 4 days/week). No coaching was given during the subsequent year between post-intervention and follow-up. Follow-up assessment consisted of a postal questionnaire on physical activity and of visual analogue scales for ratings of general health perception and pain. The Health Assessment Questionnaire Disability Index (HAQ) and the Disease Activity Score in 28 joints (DAS 28) were collected at regular medical check-ups. RESULTS Sixty-five (69%) participants in the IG and 92 (69%) in the CG completed the entire study period by filling in the follow-up questionnaire on physical activity two years after baseline. The intervention seemed to lack any significant influence on long-term outcome. However, different patterns of change in physical activity behaviour were observed in the two groups. CONCLUSIONS No long-term improvement in perceived general health or other outcomes were found in the follow-up. This may partly be because the intervention lacked several important behavioural elements for physical activity maintenance.

Understanding how to determine the intensity of physical activity–An interview study among individuals with rheumatoid arthritis

Purpose. The study sought to describe variation in understandings of how to determine the intensity of physical activity among individuals with rheumatoid arthritis (RA). Method. Nineteen individuals aged 21–82 years with RA participated in semi-structured interviews, which were recorded, transcribed verbatim and analysed using a phenomenographic approach. Results. Four qualitatively different ways of understanding how to determine the intensity of physical activity were identified: a) focus on alterations of bodily features; b) focus on will-power and awareness; c) focus on type and performance of activity; and d) focus on consequences of the disease. Conclusions. The results suggest that there might be a discrepancy between health professionals and patients with RA regarding the understanding of physical activity intensity. This highlights the importance for health professionals to recognise what individuals focus most attention on when communicating ‘intensity’. If necessary, health professionals should endeavour to reach a common understanding of evidence-based ways of determining physical activity intensity with each patient in order to prescribe accurately, and assess, physical activity.

Effects of aerobic and muscle strengthening exercise in adults with rheumatoid arthritis: a narrative review summarising a chapter in Physical activity in the prevention and treatment of disease (FYSS 2016)

Background Besides pharmacological treatment, regular exercise is one of the cornerstones of care in rheumatoid arthritis (RA). In many of the earlier studies of exercise in RA, the intensity of the exercise did not reach the current recommendations or is not described in satisfactory detail. This narrative review is based on randomised controlled trials with a detailed description of the exercise type, frequency, duration and intensity. Results There is moderate-quality evidence that short-term land-based aerobic exercise of moderate to high intensity augments oxygen uptake but does not improve muscle strength. Short-term water-based aerobic exercise of moderate to high intensity augments oxygen uptake; short term land-based aerobic and muscle strengthening exercise of moderate to high intensity augments oxygen uptake and muscle strength. Long-term land-based aerobic and muscle strengthening exercise of moderate to high intensity reduces activity limitations and improves both oxygen uptake and muscle strength. Conclusions Clinicians should recommend that patients with RA participate in various types of exercise.

Clinical applicability of two tests of aerobic fitness in patients with rheumatoid arthritis

The aim of this study was to describe the clinical applicability of two different methods of aerobic fitness testing in patients with rheumatoid arthritis (RA). Five hundred and fifty-six patients with RA (median age 56 years, range 19–90, disease duration ≤6.5 years, 75% women) were included from 17 rheumatology units. Each patient was scheduled to perform a submaximal test of aerobic fitness, either on a bicycle or on a treadmill; the assignment to method was mainly determined by access to equipment at each participating unit. Eighty-eight patients (16%) were never tested, mainly because of use of beta-blockers or impairments, 45 patients (8%) terminated their tests prematurely and 423 patients (76%) completed their assigned test. Their estimated aerobic fitness was mainly classified as “low” (30%), “fair” (40%) or “average” (23%). The determinants of completing either of the tests were female gender (OR=2.06, 95% CI 1.22–3.47), age <65 years (OR=6.50, 95% CI 4.00–10.55) and no (OR=4.67, 95% CI 2.10–10.40) or mild disability (OR=6.24, 95% CI 2.43–16.06). It thus appears as if a majority of patients with RA are able to perform aerobic fitness testing despite the expected limitations related to impairments.

Predicting general health perception and exercise habits in ankylosing spondylitis

The aims of this study were to describe changes over time in work, civil status, exercise habits, medication, self-reported disease activity, activity limitation, general health perception and body functions, and to predict self-reported general health perception and exercise habits, in 50 patients with ankylosing spondylitis (AS) according to the modified New York criteria. Logistic regressions were used to identify predictors. Exercise frequency decreased and general health perception improved significantly over time, while all other variables remained stable. Predictors for good general health perception were low activity limitation, good general health perception, full-time work and living alone. Predictors of exercise ≥2/week were long symptom duration, previous exercise habits, high disease activity and living alone. We believe our study has contributed to the prediction of exercise habits and good general health perception in AS by suggesting ways of establishing what variables might be important to consider. The ability to identify those individuals who are likely to maintain good health and healthy exercise habits leaves room for physiotherapists to direct resources to those who need more support.

Disabilities of importance for patients to improve – using a patient preference tool in rheumatoid arthritis

Abstract Purpose: To investigate, using the McMaster Toronto Arthritis patient preference disability questionnaire (MACTAR), disabilities most important to improve in Swedish patients with rheumatoid arthritis (RA) and to compare these with the pre-defined activities in the International Classification of Functioning (ICF) comprehensive core set for RA and the Stanford Health Assessment Questionnaire (HAQ). Also to categorize patient preference selected disabilities using the ICF, to correlate the MACTAR score to RA core set measures and to evaluate the MACTAR’s test–retest reliability. Methods: 45 patients with RA (median (md) age 59 years, diagnosis duration md 10 years) were included. Assessments included disease activity score (DAS28), timed-stands test (TST), shoulder function assessment (SFA), visual analogue scale for pain (VAS), HAQ, patients’ global assessment of well-being (PGA) and the MACTAR. Results: 58 disabilities were identified of which 17 were identified by at least 5 patients. 47% of them were represented in the Comprehensive ICF RA core set and 53% in the HAQ. 16/17 were categorized in the ICF activities and participation component. Correlations between the MACTAR and other measures were: DAS28 (rs −0.65), TST (rs −0.19), SFA (rs 0.38), VAS (rs −0.61), HAQ (rs −0.51) and PGA (rs −0.61). Weighted κ was 0.59. Conclusions: Half of the disabilities patients with RA identified by use of the MACTAR are not evaluated in the Comprehensive ICF core set for RA or the HAQ. MACTAR has moderate test–retest reliability. MACTAR can be considered to be used in addition to traditional RA outcomes and may potentially improve clinical assessment of patients with RA. Implications for Rehabilitation RA has an impact on personal life areas. The MACTAR helps identify individual disease-related disabilities of importance to improve. The MACTAR provides an opportunity for individualized goal-setting in rehabilitation and can thus promote adherence in rehabilitation. MACTAR may potentially improve clinical assessment for patients with RA.

Characterizing the concept of activity pacing as a non-pharmacological intervention in rheumatology care: Results of an international Delphi survey

Objective: To develop a consensual list of the most important aspects of activity pacing (AP) as an intervention within the context of non-pharmacological rheumatology care. Method: An international, multidisciplinary expert panel comprising 60 clinicians and/or healthcare providers experienced in AP across 12 different countries participated in a Delphi survey. Over four Delphi rounds, the panel identified and ranked the most important goals of AP, behaviours of AP (the actions people take to meet the goal of AP), strategies to change behaviour in AP, and contextual factors that should be acknowledged when instructing AP. Additionally, topics for future research on AP were formulated and prioritized. Results: The Delphi panel prioritized 9 goals, 11 behaviours, 9 strategies to change behaviour, and 10 contextual factors of AP. These items were integrated into a consensual list containing the most important aspects of AP interventions in non-pharmacological rheumatology care. Nine topics for future research on AP with the highest ranking were included in a research agenda highlighting that future research should focus on the effectiveness of AP interventions and on appropriate outcome measures to assess its effectiveness, as selected by 64% and 82% of the panellists, respectively. Conclusions: The diversity and number of items included in the consensual list developed in the current study reflect the heterogeneity of the concept of AP. This study is an important first step in achieving more transparency and homogeneity in the concept of AP in both rheumatology daily clinical practice and research.

Validity and sensitivity to change of the Patient Specific Functional Scale used during rehabilitation following proximal humeral fracture

Abstract Purpose: To describe content validity, concurrent validity, sensitivity to change, internal consistency and the outcome distribution of the Patient Specific Functional Scale (PSFS) in patients with proximal humeral fracture. Method: Fifty-three patients with proximal humeral fracture treated conservatively or surgically with plate and screw or intramedullary nail were recruited 6 weeks (±1 week) post-trauma or post-surgery. The following assessments were used: the PSFS, patient global score, shoulder function assessment, grip strength and Western Ontario Osteoarthritis of the shoulder Index (WOOS), before start of (n = 53) and after (n = 22) 2–3 months of group rehabilitation. Results: In total, 96% of the activities stated in the PSFS was classified in the International Classification of Functioning, Disability and Health activity component and 62% were found in the WOOS. Correlations between measures were low. The PSFS was highly sensitive to change to a period of group rehabilitation. All questions of the PSFS contributed to the total score. Both floor and ceiling effects could be noted. Conclusion: The PSFS shows satisfying measurement properties and may be a useful complement in the evaluation of individual changes during a period of rehabilitation after proximal humeral fracture. Implications for Rehabilitation The PSFS assesses on activity level in patients with proximal humeral fracture. The PSFS is sensitive to change for group rehabilitation after humeral fracture. The PSFS can be useful for goal-setting, motivating and individually tailoring rehabilitation activities. The PSFS should be used in addition to specific measures of body functions and general health.