Ursula Hass

Comparison between women and men with recent onset rheumatoid arthritis of disease activity and functional ability over two years (the TIRA project)

Objective: To describe the course of recent onset rheumatoid arthritis (RA) and to compare consequences of the disease in men and women. Methods: 284 patients with recent onset RA were followed up prospectively for two years from the time of diagnosis. Measures of disease activity (for example, 28 joint disease activity score (DAS28), C reactive protein, morning stiffness, physician’s global assessment) and function outcome (for example, range of movement, hand function, walking time) were determined. The patients’ self reported assessment of functional capacity (Health Assessment Questionnaire (HAQ)) and grading of wellbeing and pain (visual analogue scale) were registered. Changes over time and differences between men and women were evaluated. Results: Improvements were seen for all variables within the first three months. Disease activity then remained unchanged. Function variables followed the same pattern during the first year, but then tended to worsen. HAQ scores were similar at baseline, but significantly worse in women than in men at the one and two year follow ups. Conclusions: Disease activity was well managed and had improved substantially after two years, whereas function seemed slowly to deteriorate. Although disease variables were similar for men and women, functional ability (HAQ) had a less favourable course in women.

Recent-onset rheumatoid arthritis: a 1-year observational study of correlations between health-related quality of life and clinical/laboratory data.

OBJECTIVE To analyse correlations within and between clinical/laboratory assessments and health-related quality of life variables for recent-onset rheumatoid arthritis at the time of diagnosis and 12 months later. METHODS A total of 297 patients with recent-onset (< or =12 months) rheumatoid arthritis were included at diagnosis and followed up for 12 months. Clinical/laboratory assessment was performed by erythrocyte sedimentation rate, C-reactive protein, 28-joint count of tender/swollen joints, physicians global assessment, grip force, grip ability, functional impairment and walking speed. The self-reported health-related quality of life included symptoms (pain, morning stiffness), patients estimated general health, Health Assessment Questionnaire and SF-36. RESULTS All tested variables improved within 6 months of diagnosis and then remained stable but still affected at the 12-month follow-up. Multivariate correlations between clinical/laboratory variables and health-related quality of life were weak. At inclusion, clinical/laboratory assessments explained 18% of health-related quality of life at the same time-point and predicted 7% of the variation in health-related quality of life after 12 months. CONCLUSION The time-course followed similar patterns for most variables, but only a small part of the variation in health-related quality of life was explained or predicted by the clinical/laboratory variables. This implies that health-related quality of life adds important information to clinical/laboratory assessments in clinical practice and should be considered in goal setting together with clinical/laboratory assessment in order to optimize healthcare and outcome.

Assistive technology selection: a study of participation of users with rheumatoid arthritis

A new program based on improved user participation for the selection of assistive devices was implemented and its effectiveness and efficiency assessed. The intervention was compared with traditional routines. The study population comprised persons with rheumatoid arthritis who lived in two communities in Sweden. The selection process yielded increased user participation, user satisfaction, an increased number of prescriptions, and consequently also higher costs. The outcome measures showed more vague improvements. No improvement in functional ability was found regarding pain and difficulty with daily activities in the two study groups, but an increased use of assistive devices was found among women below 64 years in the intervention group (p = 0.001). Women below 64 years in the intervention group rated an improved health-related quality of life regarding both the total score (p = 0.017) and the underlying dimensions of physical function (p = 0.012). Even though the intervention yielded positive results on process-variables as increased user participation and an increased number of prescribed assistive devices, only women below 64 years showed an increased use of assistive devices in daily activities and an improved health related quality of life.

Assessment of Rehabilitation Technologies in Stroke: Outcomes and Costs

Initial functional ability (Barthel Index, mean 57) was found to be an important predictor of functional ability 1 year after stroke (mean 80) and for costs during the period. On average the total cost for a stroke patient was about SEK 200,000; the main expense, accommodation, averaged about SEK 140,000, while assistive devices amounted to SEK 2,600. Those who use assistive devices, although having achieved a high functional ability, perceive and rate their life situation (Nottingham Health Profile) considerably more impaired than those without assistive devices.

Assessment of computer-aided assistive technology: analysis of outcomes and costs

The objectives of this study were to identify and quantify outcomes related to implementation of computer-aided assistive technologies (CAAT) for individuals with communication disabilities and to ...

Designing a Decision Support System for Existing Clinical Organizational Structures: Considerations From a Rheumatology Clinic

The aim of this study was to identify the social and organizational requirements for a decision support system (DSS) to be implemented in a clinical rheumatology setting, utilizing data-mining techniques. Field observations and focus group interviews were used for data collection. The decision-making was found to be situated, patient-focused, and long-term in nature. At the same time, the main part of peer-to-peer communication was informal. Patient records were involved in almost every decision. The conclusion is that the main challenges, when introducing a DSS at a rheumatology unit, are adapting the system to informal communication structures and integrating it with patient records. Considering incentive structures, understanding workflow and incorporating awareness are relevant issues when addressing these issues in future studies.

The cost of the Swedish handicap service system. Implications for technology assessment.

The total cost of the Swedish handicap system is estimated at US

Transfer of health care technology in university-industry research collaboration environment

10.7 billion for 1989. The cost is distributed across different authorities with separate legal and financial responsibility. The concept of technology must be extended to include consideration of both the resources spent and benefits gained in the public sector and the magnitude and distribution of transfer payments from social insurance to fulfill its function in handicap policy decision making.

Outcome assessment of computer aided assistive devices in Sweden

The traditional innovation research has focused on the diffusion process and adoption of new technologies. This paper deals with health care technology in the early innovation stages preceding targeted development and marketing. A model of early research processes in the biomedical field and determinants of technology transfer will be presented. The study material is eleven projects in the Competence Center Noninvasive Medical Measurements (NIMED), Linkoping University, which is a collaboration center where academic researchers cooperate with industry and clinical departments. Data collection was made through semi-structured interviews. A qualitative approach has been adopted for data analysis. Research initiatives of the investigated projects do in most cases originate in the academic knowledge base and earlier connections in industry and health care play an important role in the formation of cooperation constellation. A number of internal factors are perceived as positive to project advancement, such as stable economy, proximity to clinical departments, and positive feedback from collaboration partners. Significant negative factors are all related to changes in cooperation structure. Clusters of related projects seem to be beneficial to research work and is an evident external factor which has to be added in a new model of technology transfer.

Competence Centre NIMED and it's graduate education collaboration between university and industry

An assessment of computer aided assistive technology was performed with three types of outcome measures. Ratings of goal fulfilment showed good ability to handle the equipment, increased functional ability (write, read and speak), and improvements in activities and role performance. The outcomes regarding health related quality of life and utility provide a more complex picture, with both improvements and deteriorations.