Emma Haglund

Background: Chronic widespread pain (CWP) affects around 10% of adults and is more prevalent in women. The impact of CWP on daily life varies, as do coping strategies. Objective: To describe women's different ways of coping with CWP. Methods: A descriptive, qualitative phenomenographic study. Semi‐structured interviews were performed with 19 women (aged 45–67) from a population‐based cohort who did not report CWP in 1995 but reported CWP at the 2016 follow‐up assessment. Analysis followed phenomenographic procedures, deriving categories of description and an outcome space. Results: Four categories described different ways of coping: (i) Taking control by using self‐initiated adjustments, listening to bodily signals, boundary‐setting, and planned recovery; (ii) Continuing as usual by preserving routines and roles while accepting or downplaying pain; (iii) Relying on guidance by using professional advice, structured routines, and tailored programmes; and (iv) Resting by prioritising rest and reducing demands when pain and fatigue dominated. The outcome space showed that these categories were analytically distinct but not mutually exclusive, as women described different ways of coping in different situations depending on bodily signals, resources, and everyday demands. Conclusions: Women described different ways of coping with CWP in relation to symptoms, everyday demands, and available resources. Recognising this variation may help healthcare professionals provide person‐centred support tailored to current needs, resources, and everyday demands.

Background: Axial spondyloarthritis (axSpA) is a chronic inflammatory disease primarily affecting the axial skeleton causing pain, inflammation, and stiffness. Individuals with axSpA are at greater risk of developing cardiovascular disease, which can be counteracted by physical activity. High‐intensity interval training (HIIT) has been shown to improve cardiovascular health, but the effect on disease activity and the level of inflammation in axSpA has been less studied. In the herein presented pilot study, the aim was to investigate if serum levels of inflammatory cytokines, myokines, and protein markers for bone metabolism are acutely affected by one bout of HIIT in individuals with axSpA and healthy controls (HC). Methods: Ten participants with axSpA (medication: 6 NSAIDs, 3 biologics, 1 no‐treatment) and 11 age‐ and sex‐matched HC performed a single HIIT bout on a cycle ergometer: 4 × 4 min intervals with 3 min active rest in between. Blood samples were taken before and 1 h after the HIIT bout. Serum proteins (IL‐6, IL‐17, IL‐18, TNF‐α, CXCL‐10, VEGF‐A, BDNF, DKK‐1, osteoprotegerin, osteocalcin, osteopontin, BMP‐7, CRP) were analyzed with a Luminex system or ELISA. A two‐way ANOVA was used for comparisons. Results: A main effect from baseline to 1 h post HIIT showed that both groups had a significant increase in serum levels of IL‐6. VEGF‐A was significantly lower in the axSpA group but was not affected by the HIIT bout. BMP‐7 increased in both groups after the HIIT. For the other proteins analyzed, there were no significant differences in serum concentrations between individuals with axSpA and HC, or within the two groups before and after one bout of HIIT. Conclusions: One acute bout of HIIT significantly increases the serum concentrations of IL‐6 and BMP‐7 after 1 h in both individuals with axSpA and HC, whereas serum levels of other proteins investigated are not changed.

Background: Adolescent depression is a growing public health concern. Health promotion for this group requires an understanding of what health means in the context of depression. Given that parents play a central role in adolescents’ everyday lives, their perspectives on health for adolescents are important. The aim of this study was to describe parents’ perceptions of what health means for adolescents with depression. Methods: This qualitative study employed a phenomenographic approach. In-depth interviews were conducted with 28 parents of adolescents with depression. The analysis resulted in four categories, each comprising two sub-categories, reflecting variations in how health was perceived. Results: Parents described health for adolescents with depression in terms of taking initiative in everyday life and creating a daily structure through routines (navigating daily life with depression); experiencing belonging in supportive relationships and understanding one’s own value (building trust in self and others); having a positive outlook while facing struggles and finding pleasure in daily activities (experiencing joy despite depression); and balancing body and mind and maintaining healthy habits (supporting well-being despite depression). Conclusions: The findings provide new insights into how parents understand health for adolescents with depression. These perceptions may inform the development of supportive and health-promoting strategies tailored to adolescents’ and their families’ everyday challenges.

Background: Physical exercise is part of the recommended treatment for individuals with axial spondyloarthritis (axSpA). High-intensity interval training (HIIT) is an effective way to improve cardiovascular health without risk of increased disease activity. Nevertheless, there is a lack of knowledge regarding facilitating factors for digitally-based HIIT among individuals with axSpA. Objective: This study aimed to explore facilitators influencing participation in a twelve-week digitally-based HIIT intervention among individuals with axSpA. Methods: Individuals with axSpA (9 females/7 males) were recruited from the intervention group of a randomized controlled trial. The intervention included three high-intensity training sessions, two of which would be interval training, weekly for twelve weeks with digitally-based coaching by a physiotherapist. Individual semi-structured interviews were conducted with the participants after completing the intervention. At baseline, the median (min-max) age was 47 (28–65), disease activity (BASDAI) was 2.6 (0.2–5.5) and aerobic capacity was 31 ml O2/kg/min (24–54). A qualitative content analysis was used to bring out manifest content from the interviews. The analysis revealed three categories and eight sub-categories. Results: The participants described that HIIT was facilitated by intervention design, encouragement, and feelings of well-being. The intervention design facilitated HIIT to be feasible to perform, adaptable to everyday life, and by use of digital tools. The importance of inner drive, need for individual coaching, and support of social networks were highlighted as keys for encouragement. Feelings of well-being facilitated HIIT through perceived health effects and improved self-efficacy. Conclusion: A self-managed digitally-based HIIT intervention coached by a physiotherapist but performed outside the healthcare settings could be used as an additional non-pharmacological treatment for individuals with axSpA. Trial registration: Not applicable.

Knee pain increases the risk of developing chronic widespread pain (CWP) and knee osteoarthritis (KOA). The prevalence of CWP and KOA has increased, and there is a need for early prevention. Therefore, the aim was to examine the associations of health-related quality of life (HRQoL) and lifestyle habits with chronic pain at a two-year follow-up in individuals with knee pain. A two-year longitudinal cohort study including 251 individuals aged 30-60 years reporting knee pain at baseline. HRQoL was measured via the Short-Form General Health Survey (SF-36), and lifestyle habits included questions on overweight, physical activity, diet, alcohol and tobacco use. Pain was assessed with a pain mannequin. Differences in health status and lifestyle habits over time in groups with unchanged no chronic pain (NCP), transitioned to less and more pain, and unchanged CWP were analysed using Wilcoxon's, McNemar's and Friedman's tests. Multinominal regression analysis was performed to study associations with reporting chronic pain at follow-up. Reporting better HRQoL across various SF-36 concepts and normal weight at baseline was associated with reporting NCP after two years. A few changes were made regarding HRQoL and lifestyle habits over the course of two years, but an increase in general health was associated with transitioning to less pain. During primary care visits for knee pain with a combination of overweight or lower HRQoL, individuals should receive comprehensive attention to prevent the development of CWP. Future studies should investigate the associations further.

Objectives: The STarT Back screening Tool (SBT) captures patients with low back pain (LBP) at risk of worse prognosis. However, the SBT does not include assessment of multisite and chronic widespread pain (MS-CWP). The aim was to study the differences in prognostic factors in patients with LBP classified according to SBT or SBT in combination with MS-CWP, and the 1-year outcome regarding visits to physiotherapist and sickness absence, in relation to risk scorings. Methods: In this 1-year prospective study, adults (18–67 years) seeking care for LBP in primary care were classified into three prognostic risk groups (low, medium, high), using SBT only and using a combined screening tool (SBT and MS-CWP). Differences in prognostic factors at baseline, and outcome in terms of number of physiotherapist visits and sickness absence the year after inclusion were compared for risk groups derived by the two methods. Results: Eighty-four patients (61% women) were included in the study. According to SBT alone, 19 were classified as low risk, 48 as medium risk, and 17 as high risk. When using the combined screening tool, additionally seven patients from the medium risk group were classified as high risk. Patients classified as high risk by SBT only or by the combined screening tool showed similar statistically significant worse mental health, health status, kinesiophobia, physical function, and sleep, as compared to the low-risk group. There were no differences in visits to physiotherapist and sickness absence between the risk groups for neither of the tools. Conclusion: The combined screening tool resulted in more patients being classified as high risk than with SBT alone. The three risk groups identified either by SBT alone or by the combined screening tool differed significantly on all investigated prognostic factors, suggesting that including MS-CWP to the SBT captures more patients at risk.

The aim of this study was to investigate how physical fitness performance, which is related to the strength and power of the lower extremities and core, as well as lateral agility, changes across 20 weeks of in-season training in youth female and male padel players. This study was conducted using a prospective cohort design on 16 Swedish high school padel players aged between 15 and 18 years old. The players were assessed at baseline with five tests of their physical fitness and followed prospectively, with the registration of their training load for 20 weeks, and then assessed at a follow-up, approximately five months later. The players increased their performance in all tests (p ≤ 0.02). The mean improvement in their Isometric squat test performance was 20% for peak force, 18% for relative strength value and 69% for average rate of force development. Their improvement in the squat jump test performance was 9%, whereas the improvement in their countermovement jump test was 6%. For the 30 second sit-up test, an improvement of 14% was observed. Improvements were also noted for the 30 second side hop test performance on both the right (9%) and left leg (11%). The effect size ranged from 0.31 to 1, respectively, for the tests, representing a small to large effect. The data from this study suggest that an improvement in physical fitness performance can be obtained during 20 weeks of padel training.

Objectives The aim was to study the development of radiographic knee osteoarthritis (RKOA) in individuals with knee pain over 2 years, and the associations between radiographic changes and baseline variables. Design Longitudinal cohort study. Participants and setting This study is part of the Halland Osteoarthritis cohort. The included 178 individuals, aged 30–67, had knee pain, without cruciate ligament injury or radiographic findings and 67% were women. The presence of RKOA was defined as Ahlbäck score of ≥1 in ≥1 knee. (Ahlbäck grade 1: joint space narrowing in the tibiofemoral joint Results In all, 13.8% (n=24) developed RKOA in 2 years whereof all had clinical KOA at baseline, as defined by NICE. Deterioration to RKOA was significantly associated with higher BMI, OR 1.119 (95% CI 1.024 to 1.223; p=0.013), and VFA, 1.008 (95% CI 1.000 to 1.016; p=0.049), worse knee pain intensity, 1.238 (95% CI 1.028 to 1.490; p=0.024), worse scores for KOOS Pain, 0.964 (95% CI 0.937 to 0.992; p=0.013) and KOOS Symptoms, 0.967 (95% CI 0.939 to 0.996; p=0.027), KOOS Activities of daily living 0.965 (95% CI 0.935 to 0.996; p=0.026) and KOOS Quality of Life 0.973 (95% CI 0.947 to 0.999; p=0.044), at baseline. Conclusions One out of seven individuals with clinical KOA developed RKOA in only 2 years. Baseline variables associated with RKOA after 2 years may possibly be detected early by using the NICE guideline, assessment of obesity and self-reported data of symptoms to support first-line treatment: education, exercise and weight control. Trial registration number ClinicalTrials.gov (NCT04928170)

Background: Low health literacy is associated with worse pain and poorer self-management. This study (1) examined the level of health literacy and associations with lifestyle habits, health status, chronic pain, and radiographic knee osteoarthritis; and (2) explored experiences illuminating health literacy among individuals with knee pain. Methods: A convergent parallel mixed-methods design was used, including 221 individuals. Health literacy was assessed by HLS-EU-Q16 and eHEALS. The questionnaire included questions on lifestyle habits, health status, and pain distribution. Radiographic knee osteoarthritis was assessed with x-rays. Associations were analysed using logistic regression analyses. Individual semi-structured interviews were conducted (n = 19) and analysed with qualitative content analysis. Results: The result showed that 71% reported sufficient health literacy. Higher education, healthy lifestyle habits, better general health, and absence of widespread pain were associated with sufficient health literacy. Experiences regarding health literacy influencing the decision-making process toward a decision on action comprised: (1) searching for information actively or passively; (2) processing of the information included being informed, critical, and interpretive; and (3) taking a stand on the information based on trustfulness and motivation. Conclusion: Seven out of 10 reported sufficient health literacy. Despite this, unhealthy lifestyles were common, suggesting that having sufficient HL is not enough for a behavioural change and the decision-making process, including different phases such as searching, processing, and taking a stand on health information is important to consider. More research on health literacy is needed to gain knowledge of how best to develop health promotion in individuals with knee pain.

Knee pain is an early sign of knee osteoarthritis (KOA) and a risk factor for chronic widespread pain (CWP). Early prevention is vital, and more research is needed to understand health-promoting activities for individuals with knee pain from a patient perspective. This study aimed to explore how individuals with knee pain experienced health-promoting activities. Explorative qualitative design with inductive approach was applied to explore the experiences of 22 individuals (13 women, 9 men; median age: 52). Semi-structured interviews were conducted and analysed using latent qualitative content analysis. The results revealed health-promoting activities in individuals with knee pain and were interpreted in the overall theme, striving for balance in everyday life. Two categories explored the content in health-promoting activities: (1) Caring for the body—being physically active, having a healthy diet, and utilising support; and (2) Managing life stressors—allowing for recovery, promoting vitality, and safeguarding healthy relationships. In conclusion, individuals with knee pain described various health-promoting activities. They strived for balance in everyday life by caring for the body and managing life stressors. We suggest that a broader approach to everyday life can be helpful in treatment plans and health promotion to manage and prevent KOA and CWP, while striving for a healthy lifestyle.