Long-term patient-reported back and shoulder function after delayed breast reconstruction with a latissimus dorsi flap: case-control cohort study.

BACKGROUND: Sacrifice of the latissimus dorsi (LD) muscle might entail donor site morbidity when used in delayed breast reconstruction. Previous studies are small, have short follow-up, and demonstrate diverging results. The aims of this study were to evaluate long-term patient-reported effects on shoulder and back function following LD flap harvest, and to investigate predictors for a worse outcome. METHOD: This is a retrospective observational case-control cohort study. Cases were all patients who had undergone an LD flap reconstruction during the years 2007-2017. Controls were patients reconstructed with a deep inferior epigastric perforator (DIEP) flap during the same time period. Participants completed two validated questionnaires; the BREAST-Q reconstruction LD domains and the Western Ontario Shoulder Osteoarthritis Index (WOOS). RESULTS: A total of 135 cases (75 per cent) and 118 controls (60 per cent) responded to the questionnaires. The mean follow-up time was 7 years. Patients reconstructed with a LD flap were significantly less satisfied with their back and shoulder function when compared to the DIEP controls, as measured with BREAST-Q and WOOS. Predictors for a poor patient-reported back and shoulder function included axillary surgery and axillary radiotherapy, especially when combined, as well as higher age at reconstruction. CONCLUSION: Patients who have undergone LD flap for delayed breast reconstruction had a lower satisfaction with back and shoulder function, when compared to patients who had undergone a DIEP reconstruction. Delayed LD reconstruction should be used with care, especially in patients who have undergone axillary surgery and axillary radiotherapy.

Do beta-blockers reduce negative intrusive thoughts and anxiety in cancer survivors? - An emulated trial.

BACKGROUND: High rates of negative intrusive thoughts have been reported among cancer patients. Prevalent users of beta-blocker therapy have reported lower levels of cancer related intrusive thoughts than non-user. The aim of this study is to investigate if initiation of beta-blocker therapy reduces the prevalence and severity of intrusive thoughts (co-primary endpoints) and the prevalence of anxiety, depressed mood, and low quality of life (secondary endpoints) in cancer survivors. METHODS: Data on patient-reported outcomes from three cohort studies of Swedish patients diagnosed with colon, prostate or rectal cancer were combined with data on beta-blocker prescriptions retrieved from the Swedish Prescribed Drug Register. Two randomized controlled trials were emulated. Trial 1 had follow-up 1 year after diagnosis, trial 2 had follow-up 2 years after diagnosis, baseline in both trials was 12 months before follow-up. Those who initiated beta-blocker therapy between baseline and follow-up was assigned Active group, those who did not was assigned Control group. All endpoints were analysed using Bayesian ordered logistic regression. RESULTS: Trial 1 consisted of Active group, n = 59, and Control group, n = 3936. Trial 2 consisted of Active group, n = 87, and Control group, n = 3132. The majority of participants were men, 83% in trial 1 and 94% in trial 2. The prevalence and severity of intrusive thoughts were lower in the Active group in trial 1, but no significant differences between groups were found in either trial. The prevalence of depressed mood, worse quality of life and periods of anxiety were higher in the Active group in both trials with significant differences for quality of life in trial 1 and anxiety in trial 2. CONCLUSIONS: The emulated trials demonstrated no evidence of a protective effect of beta-blocker therapy against intrusive thoughts. The Active group had reduced quality of life and elevated anxiety compared to the Control group. TRIAL REGISTRATION: The three cohort studies were registered at isrctn.com/clinicaltrials.gov (ISRCTN06393679, NCT02530593 and NCT01477229).

Monitoring handgrip strength to motivate lifestyle choices for patients with diabetes type 2 - a pragmatic randomised controlled trial.

METHODS: Measurement of HGS with Jamar dynamometers was added to annual check-ups for patients with T2DM by diabetes nurses in primary care with feedback about normal values for age and sex in the intervention group. The control group had standard check-ups. Change in self-reported PA level was measured with questionnaires. RESULTS: Seven clinics and 334 patients participated. The intervention led to similar effects on PA in both groups. Patients with T2DM had comparable HGS to the general public. Regression analyses showed statistically significantly higher HGS in the intervention group than in the control group at follow-up and no improvement in PA, HbA1c, or waist circumference. Increased HGS was found for older people, men, and people with normal-to-high inclusion HGS, while patients with low inclusion HGS reduced their strength levels. CONCLUSIONS: Measuring HGS and giving feedback to patients with T2DM can lead to increased HGS but does not seem to affect general PA level, HbA1c, or waist circumference. People over 65 years, men, and people with normal-to-high HGS were influenced positively by the intervention. Patients with low HGS may need personalised support to increase physical activity and improve function.ClinicalTrials registration: NCT03693521.

General self-efficacy and social support in men and women with pain - irregular sex patterns of cross-sectional and longitudinal associations in a general population sample.

BACKGROUND: The study of sex and gender patterns in psychosocial resources is a growing field of interest in pain research with importance for pain rehabilitation and prevention. The aims of this study were first, to estimate cross-sectional differences in psychosocial resources (general self-efficacy and social support) across men and women in a population with frequent musculoskeletal pain (pain in the back or neck/shoulder nearly every day or now and again during the week for the last 12 months) and to compare these differences with a population with no frequent pain. Second, to examine if psychosocial resources at baseline were associated with pain at follow-up among men and women in the frequent pain population. METHODS: This study was based on survey data from the Swedish Health Assets Project, including The General Self-Efficacy Scale and social support questions. Participants (n = 4010, 55% women) were divided into no frequent pain (n = 2855) and frequent pain (n = 1155). General self-efficacy and social support were analyzed (cross-sectional and longitudinal data) with linear and logistic regressions. RESULTS: Men, with and without frequent pain, had higher general self-efficacy than the corresponding groups in women. Women, with and without frequent pain, had stronger emotional social support than the corresponding groups in men. Men with no frequent pain had weaker instrumental social support than women with no frequent pain (OR = 0.64 (95% CI 0.47-0.87)), men with frequent pain did not (OR = 1.32 (95% CI 0.86-2.01)). In the frequent pain population, the interaction between sex and strong (compared to weak) emotional social support was statistically significant (p = 0.040) for no frequent pain at follow-up, with women having OR = 1.81 and men OR = 0.62. Among women, strong emotional social support was associated with no frequent pain at follow-up. Among men, strong emotional social support was associated with frequent pain at follow-up. CONCLUSION: Some of the associations between general self-efficacy, social support and musculosceletal pain showed unexpected sex patterns. Gendered expectations might have relevance for some of the results.

Factor structure and internal consistency of a Swedish version of the Pain Catastrophizing Scale.

BACKGROUND: Pain catastrophizing is highly relevant to assess in the context of long-standing pain. The Pain Catastrophizing Scale (PCS) is a well-established questionnaire used to measure catastrophizing in individuals with long-standing pain. So far, no Swedish translation has been evaluated in regard to validity and reliability. The aims of this study were to translate the PCS questionnaire from English to Swedish, and to investigate its construct validity (face, content, and structural validity) and reliability (internal consistency). METHODS: We translated the original English version of the PCS to Swedish and collected item responses from 194 persons suffering from primarily long-standing musculoskeletal pain. We used confirmatory factor analysis to evaluate structural validity, and tested the model fit of a one-factor model, an oblique two-factor model, and an oblique three-factor model. We evaluated the measure's reliability in regard to internal consistency calculated with Cronbach's alpha. RESULTS: A three-factor model comprising a four-item rumination factor, a three-item magnification factor, and a six-item helplessness factor provided the best fit to the data. Internal consistency was adequate and Cronbach's α was 0.92 for the entire scale, 0.84 for the rumination subscale; 0.69 for the magnification subscale, and 0.89 for the helplessness subscale. CONCLUSIONS: The results indicated adequacy of a three-factor solution and the questionnaire's internal consistency, and provide initial support for the structural validity and internal consistency of a Swedish version of the PCS. Future studies should replicate the study in larger samples and extend the current evaluation in regard to validity and reliability.

Concurrent and lagged effects of psychosocial job stressors on symptoms of burnout.

PURPOSE: Burnout is a mental condition described as being a result of long-term stressors commonly related to psychosocial factors at work. The aim of the present study was to investigate longitudinal relationships between job demands, decision authority, effort and reward, and symptoms of burnout, as well as the joint effects of job demands and decision authority, and of effort and reward. METHODS: The data came from a four-wave longitudinal cohort study of Swedish health care workers. Longitudinal associations were analysed using mixed effects regression models with random intercept. RESULTS: The concurrent analysis showed that demand and decision authority, as well as effort and reward, were associated with symptoms of burnout over time. Evidence of the lagged effects of workplace factors on burnout symptoms was limited to reward. No clear effect modification was found. CONCLUSION: An increase in unfavourable working conditions implied increasing scores on the burnout measure over time. The concurrent effects of job demands, decision authority, effort and reward on symptoms of burnout were seen. The evidence of lagged effects was limited to the low-reward condition. Regularly monitoring these work environment conditions at workplaces can help identify risk situations for burnout and thus be useful in the prevention of work-related mental illness. Lastly, a new approach to defining the risk groups was proposed, which is consistent across different populations and time points.

Longitudinal associations between cardiorespiratory fitness and stress-related exhaustion, depression, anxiety and sleep disturbances.

BACKGROUND: In the last few years, so-called "common mental disorders", including adjustment disorder and stress-related exhaustion, have outrivalled musculoskeletal disorders as being the leading cause of long-term sick leave in Sweden. Cardiorespiratory fitness level defined as "the maximal amount of physiological work that an individual can do as measured by oxygen consumption" has in many studies shown to reduce the risk of several life-style related diseases and moreover to improve mood, well-being and physical performance. The aim of the present study was to investigate, longitudinal associations between cardiorespiratory fitness and self-reported physical activity levels and the severity of symptoms connected to stress-related exhaustion, depression, anxiety, and sleep disturbances among women clinically diagnosed with stress-related exhaustion disorder (ED). METHODS: The study was that of a longitudinal cohort study consisting of women (n = 88) diagnosed with stress-related ED in a specialist clinic in Gothenburg, Sweden. Cardiorespiratory fitness was measured with the Åstrand indirect test of maximal oxygen uptake (VO2max) and subjective measures of physical activity levels were rated on 4-graded physical activity scale. To measure and follow symptoms of ED over time the SMBQ-questionnaire (Shirom Melamed Burnout Questionnaire) was used. The Hospital Anxiety and Depression Scale (HADS) was used to measure depression and anxiety. A proxy variable for capturing overall disturbed sleep used to measure sleep. Longitudinal associations for continuous outcome variables and the dichotomous variable sleep were analysed using mixed- effects regression models with random intercepts. Regression coefficients along with the 95% confidence interval (CI) are presented as measures of association. Both exposures and the outcome were measured simultaneously over six waves (T1-T6). RESULTS: The results showed statistically significant associations between level of fitness and reduced symptoms of stress-related exhaustion over time. Best improvements over time were seen in patients having a medium cardiorespiratory fitness level. No associations could be found between cardiorespiratory fitness level over time and anxiety, depression or sleep disturbances. CONCLUSION: Having medium cardiorespiratory fitness was positivity associated with a more sustained reduction in symptoms of ED overtime compared to those having low or high cardiorespiratory fitness levels. The clinical implication following this result is that an individual recommendation based on a medium level of physical activity in line with the recommendations from ACSM (American College of Sports Medicine) is preferable compared to recommendations including more vigorous physical activity in order to restore and sustainably reduce symptoms of exhaustion disorder over time.

Predicting participation in the population-based Swedish cardiopulmonary bio-image study (SCAPIS) using register data.

AIMS: To illustrate the importance of access to register data on determinants and predictors of study participation to assess validity of population-based studies. In the present investigation, we use data on sociodemographic conditions and disease history among individuals invited to the Swedish cardiopulmonary bio-image study (SCAPIS) in order to establish a model that predicts study participation. METHODS: The pilot study of SCAPIS was conducted within the city of Gothenburg, Sweden, in 2012, with 2243 invited individuals (50% participation rate). An anonymous data set for the total target population ( n = 24,502) was made available by register authorities (Statistics Sweden and the National Board of Health and Welfare) and included indicators of invitation to and participation in SCAPIS along with register data on residential area, sociodemographic variables, and disease history. Propensity scores for participation were estimated using logistic regression. RESULTS: Residential area, country of birth, civil status, education, occupational status, and disposable income were all associated with participation in multivariable models. Adding data on disease history only increased overall classification ability marginally. The associations with disease history were diverse with some disease groups negatively associated with participation whereas some others tended to increase participation. CONCLUSIONS: The present investigation stresses the importance of a careful consideration of selection effects in population-based studies. Access to detailed register data also for non-participants can in the statistical analysis be used to control for selection bias and enhance generalizability, thereby making the results more relevant for policy decisions.

Opportunities for recovery at work and excellent work ability - a cross-sectional population study among young workers.

BACKGROUND: Better opportunities for recovery at work are thought to be associated with work ability in a young workforce but evidence is scarce to lacking. The aim of this study was to examine cross-sectional associations between opportunities for recovery at work and excellent work ability among young workers and specifically for young workers with high work demands. METHODS: A study group of 1295 women and 1056 men aged 18-29 years was selected from three biennial years of a population cohort. The subsample reporting high work demands consisted of 439 women and 349 men. The study group had completed a work environment questionnaire in a survey conducted by Statistics Sweden. Associations between opportunities for recovery at work and excellent work ability were assessed by multiple logistic regression models stratified for gender. RESULTS: Having varied work was associated with excellent work ability in all young men (p < 0.0006; prevalence ratio [PR] 1.3) and also specifically in men with high work demands (p = 0.019; PR 1.3). For the latter group the possibility of deciding when to perform a work task was also associated with excellent work ability (p = 0.049; PR 1.3). Among young women with high work demands, the possibility of deciding one's working hours was associated with excellent work ability (p = 0.046; PR 1.2). CONCLUSIONS: For young men, having varied work can contribute to excellent work ability. In addition, for men with high work demands, the possibility of deciding when to perform a work task may be favourable for excellent work ability. For young women with high work demands, the possibility of deciding one's working hours can contribute to excellent work ability. Employers could use these opportunities for recovery in promoting work ability among young workers.

Experiences of work ability in young workers: an exploratory interview study.

PURPOSE: The aim of this study was to explore the experiences of and influences on work ability in young workers related to their work and life situation. METHODS: In a qualitative study of a strategic sample of 12 young female and 12 young male workers, aged 25-30 years, in work or recently left work, recruited from the 5-year follow-up of a Swedish cohort, semi-structured interviews were performed to explore the experiences of work ability in these young workers. Systematic text condensation inspired by phenomenology was used in the analysis. RESULTS: Work ability was experienced as complex, consisting of four themes, each with three subthemes. To be alert and have energy, to possess sufficient education, skills and working life experience and experience meaningfulness and engagement in work, were perceived to be fundamental for work ability and were seen as the worker's own responsibility. Moreover, work ability can be improved or reduced by the psychosocial work climate, the work organization and the private life. Optimal work ability was experienced when all themes integrated in a positive way. CONCLUSIONS: Work ability was experienced as the worker's own responsibility that could be influenced by work circumstances and private life. To promote good work ability among young workers, work ability has to be understood in its specific context. Whether the understanding of work ability found in this study is explicit for the group of young adults needs to be explored in a more general population in further research.

Seasonal variations in fatigue in persons with rheumatoid arthritis: a longitudinal study.

BACKGROUND: Fatigue is a prominent symptom in persons with rheumatoid arthritis (RA). Although this symptom has been described to vary in duration and frequency little is known about fluctuations in fatigue over time and season. The aim of this study was to describe monthly and seasonal variations in fatigue, in persons with RA of working age. METHODS: Sixty-five participants diagnosed with RA and aged 20-65 years were recruited from a rheumatology clinic in Sweden. The participants provided self-assessments of their fatigue at seven time points during the four seasons using a 0-100 mm visual analogue scale (VAS) and the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ). Multiple regression analysis using mixed models was used to analyze changes in fatigue over time. RESULTS: The mean ± SD of fatigue rated on the VAS was 51 ± 13, indicating substantial fatigue. Analysis of monthly variation showed statistically significant variation in fatigue ratings concerning VAS fatigue score (p < 0.01) as well as the BRAF-MDQ total score and Living, Cognition (p < 0.001), and Physical (p < 0.05) sub-scores, but not the BRAF-MDQ Emotional sub-score. The greatest variations were seen from January to September, with higher fatigue ratings in January. The changes in VAS fatigue scores over time were considered to be of clinical importance. Analysis of seasonal variation revealed a statistically significant seasonal variation in fatigue levels, with higher fatigue values during the winter as measured by VAS fatigue score (p < 0.01) as well as BRAF-MDQ total score (p < 0.01) and Physical and Living sub-scores (both p < 0.01). The greatest variation was seen between winter and autumn for VAS fatigue and between winter and summer for BRAF-MDQ total score and Physical and Living sub-scores. There were no statistical differences in fatigue levels, monthly or seasonal, between sexes or age groups. CONCLUSIONS: The majority of rating scales used in this study showed fluctuations in fatigue, general and physical fatigue being significantly greater during the winter. As fatigue is a substantial symptom in many persons with RA, this information is important for rheumatology professionals when dealing with persons with RA in routine care.

Affective stress responses during leisure time: Validity evaluation of a modified version of the Stress-Energy Questionnaire.

BACKGROUND: Psychosocial stress at work is one of the most important factors behind increasing sick-leave rates. In addition to work stressors, it is important to account for non-work-related stressors when assessing stress responses. In this study, a modified version of the Stress-Energy Questionnaire (SEQ), the SEQ during leisure time (SEQ-LT) was introduced for assessing the affective stress response during leisure time. The aim of this study was to investigate the internal construct validity of the SEQ-LT. A second aim was to define the cut-off points for the scales, which could indicate high and low levels of leisure-time stress and energy, respectively. METHODS: Internal construct validity of the SEQ-LT was evaluated using a Rasch analysis. We examined the unidimensionality and other psychometric properties of the scale by the fit to the Rasch model. A criterion-based approach was used for classification into high and low stress/energy levels. RESULTS: The psychometric properties of the stress and energy scales of the SEQ-LT were satisfactory, having accommodated for local dependency. The cut-off point for low stress was proposed to be in the interval between 2.45 and 3.02 on the Rasch metric score; while for high stress, it was between 3.65 and 3.90. The suggested cut-off points for the low and high energy levels were values between 1.73-1.97 and 2.66-3.08, respectively. CONCLUSIONS: The stress and energy scale of the SEQ-LT satisfied the measurement criteria defined by the Rasch analysis and it provided a useful tool for non-work-related assessment of stress responses. We provide guidelines on how to interpret the scale values.

Leisure time computer use and overweight development in young adults--a prospective study.

BACKGROUND: The prevalence of overweight among Swedish young adults has nearly doubled since the 1980s. The weight increase has been paralleled by the increased use of computers at work, at school, and at leisure time. The aim was to examine leisure time computer use for gaming, and for emailing/chatting, in relation to overweight development in young adults. METHODS: A prospective cohort study with Swedish young adults (20-24 years at baseline) who responded to a questionnaire at baseline (n = 6735), and after 1 year (n = 3928) and 5 years (n = 2593). Exposure variables were average daily time spent on leisure time computer gaming and emailing/chatting. Logistic regression was performed for cross-sectional analyses with overweight (BMI ≥ 25) and obesity (BMI ≥ 30) as the outcomes, and for prospective analyses with new cases of overweight at the 1- and 5-year follow-ups. Change in BMI from baseline to 5 year-follow-up was analyzed with linear regression. RESULTS: There were cross-sectional and prospective associations between computer gaming and overweight (BMI ≥ 25) in women, after adjusting for age, occupation, physical activity, sleep, social support, and total computer use. For the men, only cross-sectional associations could be seen. Spending more than 2 h daily for emailing and chatting was related cross-sectionally to overweight in the women. No clear prospective associations were found for emailing/chatting and overweight development in either sex. CONCLUSIONS: We have identified a new risk group for overweight development: young adult female computer gamers. Leisure time computer gaming was a prospective risk factor for overweight in women even after adjusting for demographic and lifestyle factors, but not in men. There were no clear prospective associations between computer use for emailing/chatting and overweight in either sex.

Internal construct validity of the stress-energy questionnaire in a working population, a cohort study.

BACKGROUND: Psychosocial stress at work has been recognised as one of the most important factors behind the increase in sick leave due to stress-related mental disorders. It is therefore important to be able to measure perceived work stress in a way that is both valid and reliable. It has been suggested that the Stress-Energy Questionnaire (SEQ) could be a useful tool for measuring mood (stress and energy) at work and it has been used in many Scandinavian studies. The aim of the study is to examine the internal construct validity of the SEQ in a working population and to address measurement issues, such as the ordering of response categories and potential differences in how women and men use the scale - what is termed differential item functioning (DIF). METHODS: The data used in the present study is baseline data from a longitudinal cohort study aimed at evaluating psychosocial working conditions, stress, health and well-being among employees in two human service organisations in Western Sweden. A modern psychometric approach for scale validations, the Rasch model, was used. RESULTS: Stress items showed a satisfactory fit to the model. Problems related to unidimensionality and local dependence were found when the six stress items were fitted to the model, but these could be resolved by using two testlets. As regards the energy scale, although the final analysis showed an acceptable fit to the model some scale problems were identified. The item dull had disordered thresholds and DIF for gender was detected for the item passive. The items were not well targeted to the persons, with skewness towards high energy. This might explain the scale problems that were detected but these problems need to be investigated in a group where the level of energy is spread across the trait, measured by the SEQ. CONCLUSION: The stress scale of the SEQ has good psychometric properties and provides a useful tool for assessing work-related stress, on both group and individual levels. However, the limitations of the energy scale make it suitable for group evaluations only. The energy scale needs to be evaluated further in different settings and populations.

Comorbidities, intensity, frequency and duration of pain, daily functioning and health care seeking in local, regional, and widespread pain - a descriptive population-based survey (SwePain).

BACKGROUND: The clinical knowledge of factors related to the spread of pain on the body has increased and understanding these factors is essential for effective pain treatment. This population-based study examines local (LP), regional (RP), and widespread pain (WSP) on the body regarding comorbidities, pain aspects, and impact of pain and elucidates how the spread of pain varies over time. MATERIAL AND METHODS: A postal questionnaire that addressed pain aspects (intensity, frequency, duration and anatomical spreading on a body manikin), comorbidities and implications of pain (i.e., work situation, physical activity, consumption of health care and experience of hospitality and treatment of health care) was sent to 9000 adults living in southeastern Sweden. Of these, 4774 (53 %) completed and returned the questionnaire. After 9 weeks, a follow-up questionnaire was sent to the 2983 participants who reported pain in the first questionnaire (i.e. 62 % of 4774 subjects). Of these, 1940 completed and returned the questionnaire (i.e. 65 % of 2983 subjects). The follow-up questionnaire included the same items as the first questionnaire. RESULTS: This study found differences in intensity, frequency and duration of pain, comorbidities, aspects of daily functioning and health care seeking in three pain categories based on spreading of pain: LP, RP and WSP. Compared to the participants with RP and LP, the participants with WSP had lower education and worse overall health, including more frequent heart disease and hypertension. In addition, participants with WSP had more intense, frequent, and long-standing pain, required more medical consultations, and experienced more impact on work. The participants with RP constituted an intermediate group regarding frequency and intensity of pain, and impact on work. The participants with LP were the least affected group regarding these factors. A substantial transition to RP had occurred by the 9-week follow-up. CONCLUSIONS: This study shows an association between increased spread of pain and prevalence of heart disease, hypertension, more severe pain characteristics (i.e., intensity, frequency and duration), problems with common daily activities and increased health care seeking. The WSP group was the most affected group and the LP group was the least affected group. Regarding these factors, RP was an obvious intermediate group. The transitions between the pain categories warrant research that broadly investigates factors that increase and decrease pain.

Salivary cortisol in two professions: daily cortisol profiles in school teachers and firefighters.

BACKGROUND: It's indicated negative-perceived stress could induce worse health status and change of cortisol secretion. OBJECTIVES: To assess salivary cortisol levels in two occupations with a high psychosocial workload, but different features, teachers and firefighters. METHODS: The study population consisted of 142 school teachers and 136 firefighters. Four saliva samples were collected from pedagogical participants during their busiest workday. The cortisol measures used were: morning values, evening values, slope of decline, ratio (evening value divided by morning value), and area under the curve (AUC). RESULTS: The salivary cortisol measurements in both genders were almost equal regarding morning values, slope, and AUC increase. Evening values were lower and the relative reactivity was higher (lower ratio) for female teachers, compared to male teachers. There was a tendency of a lower total daytime output of cortisol (AUC ground) among female teachers. Firefighters had lower levels of cortisol, lower total daytime output, and higher relative reactivity (lower ratio), but lower absolute reactivity, regarding both slope and AUC increase. CONCLUSION: Overall, male teachers might be the group most affected by stress in this study, even if some of their cortisol values were almost equal to the female teachers' values. Male teachers also seemed to be more affected by stress, according to salivary cortisol, compared to male firefighters, even if there were some inconsistencies.

Timed Up & Go as a measure for longitudinal change in mobility after stroke - Postural Stroke Study in Gothenburg (POSTGOT).

BACKGROUND: A frequently used clinical test to assess mobility after stroke is the Timed Up & Go. Knowledge regarding whether or not the Timed Up & Go is able to detect change over time in patients with stroke, whether improvements in mobility exist after the first three months and whether or not longitudinal change in mobility after stroke depend on the patients' age, is limited or unclear. The objectives were to investigate the distribution-based responsiveness of the Timed Up & Go (TUG) during the first three months after a first event of stroke, to measure the longitudinal change in TUG time during the first year after stroke and to establish whether recovery in TUG time differs between different age groups. METHODS: Ninety-one patients with first-ever stroke were assessed using the Timed Up & Go at the 1st week and at 3, 6 and 12 months after stroke. The non-parametric sign-test, the parametric t-test and a mixed model approach to linear regression for repeated measurements (Proc mixed) were used for the statistical analyses. RESULTS: The median TUG time was reduced from 17 to 12 seconds (p < 0.001) between the 1st week and 3 months. No further improvement was seen between 3 and 12 months after stroke. In a mixed model approach to linear regression, there was a significant age difference. Patients at age 80 and above tended to deteriorate in terms of TUG time between 3 and 12 months after stroke, while patients < 80 years did not (p = 0.011 for the interaction between age group and time). CONCLUSION: The Timed Up & Go demonstrates ability to detect change in mobility over time in patients with stroke. A significant improvement in TUG time from the 1st week to 3 months after stroke was found, as expected, but thereafter no statistically significant change was detected. After 3 months, patients ≥80 years tended to deteriorate in terms of TUG time, while the younger patients did not.

Measurement Error, Minimal Detectable Change, and Minimal Clinically Important Difference of the Short Form-36 Health Survey, Hospital Anxiety and Depression Scale, and Pain Numeric Rating Scale in Patients With Chronic Pain.

In both pain research and clinical practice, patient-reported outcome measures are used to assess dimensions of health. Interpreting these instruments requires understanding their measurement error and what magnitude of change has subjective importance for patients. This study estimated the standard error of measurement, 1-year minimal detectable change, and 1-year minimal clinically important difference (MCID) for the Short Form-36 Health Survey physical component summary and mental component summary, the Hospital Anxiety and Depression Scale subscales for anxiety symptoms and depression symptoms, and the numeric rating scale for past-week average pain intensity. MCIDs for these instruments have not previously been estimated in a large sample of chronic pain patients participating in interdisciplinary pain rehabilitation. Data were drawn from the Swedish Quality Registry for Pain Rehabilitation (n = 8,854 patients). MCID was estimated as average change and change difference based on 3 different anchors. MCID estimates were 2.62 to 4.69 for Short Form-36 Health Survey physical component summary, 4.46 to 6.79 for Short Form-36 Health Survey mental component summary, .895 to 1.48 for numeric rating scale, 1.17 to 2.13 for anxiety symptoms in the Hospital Anxiety and Depression Scale, and 1.48 to 2.54 for depression symptoms in the Hospital Anxiety and Depression Scale. The common assumption of an identical standard error of measurement for pre- and post-treatment measurements was not always applicable. When estimating MCID, researchers should select an estimation method and anchor aligned with the study's context and objectives. PERSPECTIVE: This article presents estimates of MCID and minimal detectable change for several commonly used patient-reported outcome measures among patients with chronic pain. These estimates can help clinicians and researchers to determine when a measured health improvement is subjectively important to the patient and greater than measurement error.

MediYoga compared to physiotherapy treatment as usual for patients with stress-related symptoms in primary care rehabilitation: A randomized controlled trial.

OBJECTIVE: The purpose of this study was to compare the effect of MediYoga as a group treatment to conventional treatment provided by a physiotherapist for people with perceived stress-related symptoms. DESIGN: Randomized controlled trial. SETTINGS: Primary care rehabilitation, Gothenburg Sweden. SUBJECTS: Fifty-five patients with stress-related symptoms were invited to participate. Nine patients declined, and a total of 46 patients aged 26-70 years (mean 47), 44 women and two men were randomized, 23 to the MediYoga group and 23 to the physiotherapy treatment as usual group. INTERVENTIONS: The MediYoga group performed MediYoga for one hour a week during an 8-week period. The control group received physiotherapy treatment as usual. MAIN MEASURES: Data were mainly collected by self-reported questionnaires. For primary outcome the Swedish version of the Perceived Stress Scale (PSS) was used. Secondary outcomes were the Hospital Anxiety and Depression Scale (HADS), EuroQol-5D (EQ-5D) and EuroQol-Visual Analog Scale (EQ-VAS). Thoracic excursion was the only physical measurement. Mixed effect model was used for analyse. RESULTS: For the primary outcome PSS, there was a close to statistically significant group effect over time advantaging MediYoga over physiotherapy (P = 0.06). For secondary outcomes, the group effect over time was statistically significant in HADS anxiety (P = 0.01) and EQ-VAS (P = 0.03). There was a group trend over time advantaging MediYoga in HADS depression (P = 0.08). CONCLUSION: Despite a large dropout in both groups, MediYoga can be recommended as a treatment option for people suffering from stress-related symptoms. TRIAL REGISTRATION: Registered in: ClinicalTrials.gov NCT02907138.