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Tseli, E., Vixner, L., Lo Martire, R., Grooten, W. J., Gerdle, B. & Äng, B. (2020). Prognostic factors for improved physical and emotional functioning one year after interdisciplinary rehabilitation in patients with chronic pain: Results from a national quality registry in Sweden. Journal of Rehabilitation Medicine
Open this publication in new window or tab >>Prognostic factors for improved physical and emotional functioning one year after interdisciplinary rehabilitation in patients with chronic pain: Results from a national quality registry in Sweden
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2020 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE: To investigate prognostic factors for physical and emotional functioning following interdisciplinary multimodal pain rehabilitation, by targeting patients' baseline characteristics and health measures.

METHODS: A prospective cohort of 2,876 patients from 38 specialist clinics across Sweden, who were completing interdisciplinary multimodal pain rehabilitation programmes, was followed through the Swedish Quality Registry for Pain Rehabilitation, from initial assessment to 12-month follow-up. Using logistic regression, baseline data were regressed to predict improvement in Physical functioning and Emotional functioning, fused by principal component analyses using the 36-item Short Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS).

RESULTS: Employment status emerged as having the largest effect sizes in both Physical functioning and Emotional functioning; Working: odds ratio (OR) 2.05 (95% confidence interval (95% CI) 1.64-2.56) and OR 1.59 (95% CI 1.27-1.98), respectively. Strong beliefs in restored health, better initial emotional health, lower levels of pain and pain interference, and younger age all predicted Physical functioning. European origin, higher levels of general activity, and sense of life control all predicted Emotional functioning. Worse initial physical and emotional health predicted the corresponding dependent outcomes.

CONCLUSION: Employment was consistently found to be an important prognostic factor, suggesting the significance of avoiding delay in interdisciplinary multimodal pain rehabilitation. A positive treatment expectancy was of importance. In general, multidimensional measures indicated that better initial status was more favourable; however, inconsistency implies a complex prognostic picture.

Keywords
health-related quality of life, multidisciplinary pain clinic, prognosis, registry, treatment outcome, chronic pain
National Category
Clinical Medicine
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-32012 (URN)10.2340/16501977-2648 (DOI)31995224 (PubMedID)
Available from: 2020-02-24 Created: 2020-02-24 Last updated: 2020-02-24Bibliographically approved
Bartholdsson, Å. & Vixner, L. (2019). När kvinnor lyfter: Flickors och kvinnors föreställningar om, och erfarenheter av att utöva styrkeidrott. Falun: Högskolan Dalarna
Open this publication in new window or tab >>När kvinnor lyfter: Flickors och kvinnors föreställningar om, och erfarenheter av att utöva styrkeidrott
2019 (Swedish)Report (Other academic)
Place, publisher, year, edition, pages
Falun: Högskolan Dalarna, 2019
National Category
Sport and Fitness Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-31120 (URN)
Note

Avrapportering av projekt till Centrum för idrottsforskning 2019

Available from: 2019-11-20 Created: 2019-11-20 Last updated: 2019-11-20
Tseli, E., Vixner, L., Lo Martire, R., Grooten, W., Gerdle, B. & Äng, B. (2019). Prognostic Factors for 12-month Outcome After Interdisciplinary Treatment in Patients with Chronic Pain: a Prospective Multicenter Cohort Study. In: : . Paper presented at Pain in Europe XI, 11th congress of the European Pain Federation EFIC, Valencia, September 4, 2019 - September 7, 2019.
Open this publication in new window or tab >>Prognostic Factors for 12-month Outcome After Interdisciplinary Treatment in Patients with Chronic Pain: a Prospective Multicenter Cohort Study
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2019 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Clinical Medicine
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-32020 (URN)
Conference
Pain in Europe XI, 11th congress of the European Pain Federation EFIC, Valencia, September 4, 2019 - September 7, 2019
Available from: 2020-02-25 Created: 2020-02-25 Last updated: 2020-02-25Bibliographically approved
Lo Martire, R., Äng, B., Gerdle, B. & Vixner, L. (2019). Psychometric properties of Short Form-36 Health Survey, EuroQol 5-dimensions, and Hospital Anxiety and Depression Scale in patients with chronic pain. Pain, 161(1), 83-95
Open this publication in new window or tab >>Psychometric properties of Short Form-36 Health Survey, EuroQol 5-dimensions, and Hospital Anxiety and Depression Scale in patients with chronic pain
2019 (English)In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 161, no 1, p. 83-95Article in journal (Refereed) Published
Abstract [en]

Recent research has highlighted a need for the psychometric evaluation of instruments targeting core domains of the pain experience in chronic pain populations. In this study, the measurement properties of SF-36, EQ-5D, and HADS were analyzed within the item response-theory framework based on data from 35,908 patients. To assess the structural validity of these instruments, the empirical representations of several conceptually substantiated latent structures were compared in a cross-validation procedure. The most structurally sound representations were selected from each questionnaire and their internal consistency reliability computed as a summary of their precision. Lastly, questionnaire scores were correlated to each other to evaluate their convergent and discriminant validity. Our results supported that SF-36 is an acceptable measure of two independent constructs of physical and mental health. In contrast, although the approach to summarize the HRQoL construct of EQ-5D as a unidimensional score was valid, its low reliability rendered practical model implementation of doubtful utility. Finally, rather than being separated into two subscales of anxiety and depression, HADS was a valid and reliable measure of overall emotional distress. In support of convergent and discriminant validity, correlations between questionnaires showed that theoretically similar traits were highly associated whereas unrelated traits were not. Our models can be applied to score SF-36 and HADS in chronic pain patients, but we recommend against using the EQ-5D model due to its low reliability. These results are useful for researchers and clinicians involved in chronic pain populations, as questionnaires' properties determine their discriminating ability in patient status assessment.

National Category
Clinical Medicine
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-31009 (URN)10.1097/j.pain.0000000000001700 (DOI)31568237 (PubMedID)2-s2.0-85077108477 (Scopus ID)
Available from: 2019-10-21 Created: 2019-10-21 Last updated: 2020-02-24
Järnbert-Pettersson, H. & Vixner, L. (2018). Labour pain - poorly analysed and reported: a systematic review. BMC Pregnancy and Childbirth, 18(1), Article ID 483.
Open this publication in new window or tab >>Labour pain - poorly analysed and reported: a systematic review
2018 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, no 1, article id 483Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Modelling and analysing repeated measures data, such as women's experiences of pain during labour, is a complex topic. Traditional end-point analyses such as t-tests, ANOVA, or repeated measures [rANOVA] have known disadvantages. Modern and more sophisticated statistical methods such as mixed effect models provide flexibility and are more likely to draw correct conclusions from data. The aim of this study is to study how labour pain is analysed in repeated measures design studies, and to increase awareness of when and why modern statistical methods are suitable with the aim of encouraging their use in preference of traditional methods.

METHODS: Six databases were searched with the English language as a restriction. Study eligibility criteria included: Original studies published between 1999 and 2016, studying pregnant women in labour with the aim to compare at least two methods for labour pain management, with at least two measurements of labour pain separated by time, and where labour pain was analysed. After deduplication, all records (n = 2800) were screened by one of the authors who excluded ineligible publication types, leaving 737 records remaining for full-text screening. A sample of 309 studies was then randomly selected and screened by both authors.

RESULTS: Among the 133 (of 309) studies that fulfilled the study eligibility criteria, 7% used mixed effect models, 20% rANOVA, and 73% used end-point analysis to draw conclusions regarding treatment effects for labour pain between groups. The most commonly used end-point analyses to compare groups regarding labour pain were t-tests (57, 43%) and ANOVA (41, 31%). We present a checklist for clinicians to clarify when mixed effect models should be considered as the preferred choice for analysis, in particular when labour pain is measured.

CONCLUSIONS: Studies that aim to compare methods for labour pain management often use inappropriate statistical methods, and inaccurately report how the statistical analyses were carried out. The statistical methods used in analyses are often based on assumptions that are not fulfilled or described. We recommend that authors, reviewers, and editors pay greater attention to the analysis when designing and publishing studies evaluating methods for pain relief during labour.

Keywords
CONSORT, Labour pain, Longitudinal study, Mixed effect models, Mixed models, Repeated measure ANOVA, Repeated-measures data, STROBE, Statistical analysis
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29093 (URN)10.1186/s12884-018-2089-2 (DOI)000452751500002 ()30526516 (PubMedID)2-s2.0-85058080455 (Scopus ID)
Note

Open Access APC beslut 22/2018

Available from: 2018-12-14 Created: 2018-12-14 Last updated: 2019-01-08Bibliographically approved
Waldenström, U., Cnattingius, S., Vixner, L. & Norman, M. (2017). Advanced maternal age increases the risk of very preterm birth, irrespective of parity: a population-based register study. British Journal of Obstetrics and Gynecology, 124(8), 1235-1244
Open this publication in new window or tab >>Advanced maternal age increases the risk of very preterm birth, irrespective of parity: a population-based register study
2017 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 124, no 8, p. 1235-1244Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate whether advanced maternal age is associated with preterm birth, irrespective of parity.

DESIGN: Population-based registry study.

SETTING: Swedish Medical Birth Register.

POPULATION: First, second, and third live singleton births to women aged 20 years or older in Sweden, from 1990 to 2011 (n = 2 009 068).

METHODS: Logistic regression analysis was used in each parity group to estimate risks of very and moderately preterm births to women at 20-24, 25-29, 30-34, 35-39, and 40 years or older, using 25-29 years as the reference group. Odds ratios (ORs) were adjusted for year of birth, education, country of birth, smoking, body mass index, and history of preterm birth. Age-related risks of spontaneous and medically indicated preterm births were also investigated.

MAIN OUTCOME MEASURES: Very preterm (22-31 weeks of gestation) and moderately preterm (32-36 weeks) births.

RESULTS: Risks of very preterm birth increased with maternal age, irrespective of parity: adjusted ORs in first, second, and third births ranged from 1.18 to 1.28 at 30-34 years, from 1.59 to 1.70 at 35-39 years, and from 1.97 to 2.40 at ≥40 years. In moderately preterm births, age-related associations were weaker, but were statistically significant from 35-39 years in all parity groups. Advanced maternal age increased the risks of both spontaneous and medically indicated preterm births.

CONCLUSIONS: Advanced maternal age is associated with an increased risk of preterm birth, irrespective of parity, especially very preterm birth. Women aged 35 years and older, expecting their first, second, or third births, should be regarded as a risk group for very preterm birth.

Keywords
Maternal age; parity; preterm birth
National Category
Clinical Medicine
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-23280 (URN)10.1111/1471-0528.14368 (DOI)000403938600025 ()27770495 (PubMedID)2-s2.0-85020931829 (Scopus ID)
Available from: 2016-10-25 Created: 2016-10-25 Last updated: 2017-07-31Bibliographically approved
Vixner, L. (2017). Associations between maternal characteristics and women’s responses to acupuncture during labour: a secondary analysis from a randomised controlled trial. Acupuncture in Medicine, 35(3), 180-188
Open this publication in new window or tab >>Associations between maternal characteristics and women’s responses to acupuncture during labour: a secondary analysis from a randomised controlled trial
2017 (English)In: Acupuncture in Medicine, ISSN 0964-5284, E-ISSN 1759-9873, Vol. 35, no 3, p. 180-188Article in journal (Refereed) Published
Abstract [en]

Background Patient characteristics are modulators of pain experience after acupuncture treatment for chronic pain. Whether this also applies to labour pain is unknown.

Aim To examine for associations between maternal characteristics and response to acupuncture in terms of labour pain intensity in close proximity to the treatment (within 60 min) and over a longer time period (up to 240 min), and whether or not epidural analgesia is used, before and after adjustment for obstetric status upon admission to the labour ward.

Methods Cohort study (n=253) using data collected for a randomised controlled trial. Associations were examined using linear mixed models and logistic regression analyses. Tests of interactions were also applied to investigate whether maternal characteristics were influenced by treatment group allocation.

Results In close proximity to the treatment, advanced age and cervical dilation were associated with lower pain scores (mean difference (MD) −13.2, 95% CI −23.4 to −2.9; and MD −5.0, 95% CI −9.6 to −0.5, respectively). For the longer time period, labour pain was negatively associated with age (MD −11.8, 95% CI −19.6 to −3.9) and positively associated with dysmenorrhoea (MD 5.5, 95% CI 1.6 to 9.5). Previous acupuncture experience and advanced cervical dilatation were associated with higher and lower use of epidural analgesia (OR 2.7, 95% CI 1.3 to 5.9; and OR 0.3, 95% CI 0.1 to 0.5, respectively). No interactions with treatment allocation were found.

Conclusions This study did not identify any maternal characteristics associated with women's responses to acupuncture during labour.

Trial registration number NCT01197950; Post-results.

Keywords
acupuncture, obstetrics, pain management
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-23535 (URN)10.1136/acupmed-2016-011164 (DOI)000407905400003 ()27986648 (PubMedID)
Note

Open Access APC beslut 21/2016

Available from: 2016-12-05 Created: 2016-12-05 Last updated: 2017-09-07Bibliographically approved
Vixner, L. (2015). Acupuncture for labour pain. (Doctoral dissertation). Stockholm: Karolinska Institutet
Open this publication in new window or tab >>Acupuncture for labour pain
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Acupuncture involves puncturing the skin with thin sterile needles at defined acupuncture points. Previous studies are inconclusive regarding the effect of acupuncture on labour pain, but some studies have found a reduction in the use of pharmacological pain relief when acupuncture is administered. The appropriate dose of acupuncture treatment required to elicit a potential effect on labour pain has not been fully explored. The dose is determined by many different factors, including the number of needles used and the intensity of the stimulation. In Sweden, manual stimulation of the needles is common practice when acupuncture is used for labour pain, but electrical stimulation of the needles, which gives a higher dose, could possibly be more effective. The overall aim of this thesis was to evaluate the effectiveness of acupuncture with manual stimulation (MA) of the needles as well as acupuncture with a combination of manual and electrical stimulation (EA) in reducing labour pain, compared with standard care without any form of acupuncture (SC).

Methods: The study was designed as a three-armed randomised controlled trial in which 303 nulliparous women with normal pregnancies were randomised to MA, EA, or SC. The primary outcome was labour pain, assessed using the Visual Analogue Scale (VAS). Secondary outcomes were relaxation during labour, use of obstetric pain relief, and associations between maternal characteristics and labour pain and use of epidural analgesia respectively. Also, labour and infant outcomes, recollection of labour pain, and maternal experiences, such as birth experience and experience of the midwife, were investigated two months after the birth. The sample size calculation was based on the potential to discover a difference of 15 mm on the VAS. Data were collected during labour before the interventions, the day after birth, and two months later. Besides using the VAS, information was collected by means of study specific protocol, questionnaires and medical records.

Results: The mean VAS scores were 66.4 in the MA group, 68.5 in the EA group, and 69.0 in the SC group (mean differences: MA vs. SC 2.6 95% CI -1.7 to 6.9, and EA vs. SC 0.6 95% CI -3.6 to 4.8). Other methods of pain relief were used less frequently in the EA group, including epidural analgesia, MA 61.4%, EA 46%, and SC 69.9%. (EA vs. SC OR 0.4 95% CI 0.2 to 0.7). No statistically significant differences were found in the recollection of labour pain between the three groups two months after birth (mean VAS score: MA 69.3, EA 68.7 and SC 70.1). A few maternal characteristics were associated with labour pain (age, dysmenorrhea, and cervix dilatation), but none of the investigated characteristics predicted the outcome of the acupuncture treatment in MA or EA. Women in the EA group experienced acupuncture as being effective for labour pain to a higher extent than women who received MA, MA 44.4%, EA 67.1% (EA vs. MA OR 2.4 95% CI 1.2 to 4.8). Women in the EA group also spent less time in labour (mean 500 min) than those who received MA (mean 619 min) and SC (mean 615 min) (EA vs. MA HR 1.4 95% CI 1.0 to1.9, EA vs. SC HR 1.4, 95% CI 1.1 to 2.0), and had less blood loss than women receiving SC, (EA vs. SC OR 0.1 95% CI 0.3 to 0.7). The women’s assessment of the midwife as being supportive during labour (MA 77.2%, EA 83.5%, SC 80%), overall satisfaction with midwife care (MA 100%, EA 97.5%, SC 98.7%), and having an overall positive childbirth experience (MA 64.6%, EA 61.0%, SC 54.3%) did not differ statistically. No serious side effects of the acupuncture treatment were reported.

Conclusion: Acupuncture, regardless of type of stimulation, did not differ from standard care without acupuncture in terms of reducing women’s experience of pain during labour, or their memory of pain and childbirth overall two months after the birth. However, other forms of obstetric pain relief were less frequent in women receiving a combination of manual and electrical stimulation, suggesting that this method could facilitate coping with labour pain.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2015
Keywords
acupuncture, labour pain, randomised controlled trial
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-17488 (URN)978-91-7549-823-2 (ISBN)
Public defence
2015-04-24, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2015-05-25 Created: 2015-05-21 Last updated: 2015-11-26Bibliographically approved
Vixner, L. (2015). Acupuncture for Labour Pain. In: : . Paper presented at The Society for Acupuncture Research Conference 2015. Boston, MA, November 12-14, 2015..
Open this publication in new window or tab >>Acupuncture for Labour Pain
2015 (English)Conference paper, Oral presentation with published abstract (Other academic)
National Category
Clinical Medicine
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-20557 (URN)
Conference
The Society for Acupuncture Research Conference 2015. Boston, MA, November 12-14, 2015.
Available from: 2015-12-29 Created: 2015-12-29 Last updated: 2015-12-29Bibliographically approved
Vixner, L., Mårtensson, L. B. & Schytt, E. (2015). Acupuncture with manual and electrical stimulation for labour pain: a two month follow up of recollection of pain and birth experience.. BMC Complementary and Alternative Medicine, 15, Article ID 180.
Open this publication in new window or tab >>Acupuncture with manual and electrical stimulation for labour pain: a two month follow up of recollection of pain and birth experience.
2015 (English)In: BMC Complementary and Alternative Medicine, ISSN 1472-6882, E-ISSN 1472-6882, Vol. 15, article id 180Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In a previous randomised controlled trial we showed that acupuncture with a combination of manual- and electrical stimulation (EA) did not affect the level of pain, as compared with acupuncture with manual stimulation (MA) and standard care (SC), but reduced the need for other forms of pain relief, including epidural analgesia. To dismiss an under-treatment of pain in the trial, we did a long-term follow up on the recollection of labour pain and the birth experience comparing acupuncture with manual stimulation, acupuncture with combined electrical and manual stimulation with standard care. Our hypothesis was that despite the lower frequency of use of other pain relief, women who had received EA would make similar retrospective assessments of labour pain and the birth experience 2 months after birth as women who received standard care (SC) or acupuncture with manual stimulation (MA).

METHODS: Secondary analyses of data collected for a randomised controlled trial conducted at two delivery wards in Sweden. A total of 303 nulliparous women with normal pregnancies were randomised to: 40 min of MA or EA, or SC without acupuncture. Questionnaires were administered the day after partus and 2 months later.

RESULTS: Two months postpartum, the mean recalled pain on the visual analogue scale (SC: 70.1, MA: 69.3 and EA: 68.7) did not differ between the groups (SC vs MA: adjusted mean difference 0.8, 95 % confidence interval [CI] -6.3 to 7.9 and SC vs EA: mean difference 1.3 CI 95 % -5.5 to 8.1). Positive birth experience (SC: 54.3 %, MA: 64.6 % and EA: 61.0 %) did not differ between the groups (SC vs MA: adjusted Odds Ratio [OR] 1.8, CI 95 % 0.9 to 3.7 and SC vs EA: OR 1.4 CI 95 % 0.7 to 2.6).

CONCLUSIONS: Despite the lower use of other pain relief, women who received acupuncture with the combination of manual and electrical stimulation during labour made the same retrospective assessments of labour pain and birth experience 2 months postpartum as those who received acupuncture with manual stimulation or standard care.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT01197950.

Keywords
Lessing, Ben, Outsider, Other, post-colonial theory, psychoanalytical theory
National Category
Health Sciences
Research subject
Hälsa och välfärd, Akupunktur som smärtlindring vid förlossning - En randomiserad kontrollerad studie
Identifiers
urn:nbn:se:du-18737 (URN)10.1186/s12906-015-0708-2 (DOI)000357254700001 ()26066641 (PubMedID)
Available from: 2015-07-21 Created: 2015-07-21 Last updated: 2017-12-04Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-6923-7140

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