oru.sePublications
Change search
Link to record
Permanent link

Direct link
BETA
Welin, Elisabet, professorORCID iD iconorcid.org/0000-0002-4258-5348
Alternative names
Publications (10 of 39) Show all publications
Georg, C., Welin, E., Jirwe, M., Karlgren, K. & Ulfvarson, J. (2019). Psychometric properties of the virtual patient version of the Lasater Clinical Judgment Rubric. Nurse Education in Practice, 38, 14-20
Open this publication in new window or tab >>Psychometric properties of the virtual patient version of the Lasater Clinical Judgment Rubric
Show others...
2019 (English)In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 38, p. 14-20Article in journal (Refereed) Published
Abstract [en]

A number of studies attest to the effectiveness of virtual patients in fostering and assessing students' development of clinical reasoning. An objective assessment of students' clinical reasoning is, however, challenging. This study focused on determining the psychometric properties of the virtual patient version of the Lasater Clinical Judgment Rubric, a rubric that is aimed at assessing nursing students' clinical reasoning processes when encountering virtual patients. A nonexperimental design was used in which data from 125 students' reflections on solving two different virtual patient scenarios were included in the analysis. First, a deductive content analysis was conducted using the categories of the rubric as a lens. After that, each student's performance was quantified according to the different levels of the rubric. Exploratory factor analysis and test of normality and reliability, including the Kaiser-Meyer-Olkin test, Bartlett's test, the Shapiro-Wilk test, and Cronbach's alpha were used in the analysis. The result suggested three factors: "Understanding the patient", "Care planning" and "Reflecting" that explained 81.8% of the variance. Cronbach's alpha was 0.931. The result showed the rubric to be a valid assessment instrument for assessing nursing students' clinical reasoning when encountering virtual patients.

Place, publisher, year, edition, pages
Churchill Livingstone, 2019
Keywords
Clinical reasoning, Nursing education, Rubric, Virtual patients
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-75630 (URN)10.1016/j.nepr.2019.05.016 (DOI)000481564200003 ()31174134 (PubMedID)2-s2.0-85067042329 (Scopus ID)
Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2019-11-15Bibliographically approved
Parodis, I., Lopez Benavides, A. H., Zickert, A., Pettersson, S., Möller, S., Welin Henriksson, E., . . . Gunnarsson, I. (2019). The impact of belimumab and rituximab on health-related quality of life in patients with systemic lupus erythematosus. Arthritis care & research, 71(6), 811-821
Open this publication in new window or tab >>The impact of belimumab and rituximab on health-related quality of life in patients with systemic lupus erythematosus
Show others...
2019 (English)In: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 71, no 6, p. 811-821Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Accumulating evidence supports an impaired health-related quality of life (HRQoL) in patients with systemic lupus erythematosus (SLE). We investigated the effects of two biologic treatments on SLE patients' HRQoL.

METHODS: SLE patients from the Karolinska University Hospital treated with belimumab (n=34) or rituximab (n=35) were included; Swedish population-based age- and sex-matched norms served as controls. Data were collected prospectively at treatment initiation and at months 3, 6, 12 and 24; these included the SF-36, FACIT-Fatigue, EQ-5D, and Stanford HAQ-DI.

RESULTS: Substantial decrements from Swedish norms were observed across all SF-36 domains at baseline. Belimumab-treated patients reported gradual improvements in the SF-36 physical component summary (significant from month 12; P=0.023) and FACIT-Fatigue (significant by month 24; P=0.001), no changes in EQ-5D scores, and improvements in HAQ-DI by month 6 (P=0.014). Rituximab-treated patients showed rapid improvements in the SF-36 mental component summary and FACIT-Fatigue by month 3 (P=0.031 and P=0.007, respectively), as well as improvements in EQ-5D at month 6 (P=0.016) and HAQ-DI at month 3 (P=0.033). Based on baseline evaluations, patients receiving antimalarial agents (n=33) performed better in the SF-36 social functioning (P=0.022) and mental health (P=0.023) domains compared to patients who were not (n=36).

CONCLUSION: Our findings corroborated considerable HRQoL impairments in SLE patients. Patients' perceptions of HRQoL showed discrepant patterns over time in the two treatment groups, and could provide additional information along with the clinical evaluation of biologic therapy in SLE. Survey on the effects of antimalarial agents on SLE patients' HRQoL in larger cohorts is merited.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
Biologic agents, fatigue, health-related quality of life, systemic lupus erythematosus
National Category
Medical and Health Sciences Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:oru:diva-70525 (URN)10.1002/acr.23718 (DOI)000474808500012 ()30055091 (PubMedID)2-s2.0-85064576980 (Scopus ID)
Available from: 2019-03-24 Created: 2019-03-24 Last updated: 2019-11-12Bibliographically approved
Georg, C., Karlgren, K., Ulfvarson, J., Jirwe, M. & Welin, E. (2018). A Rubric to Assess Students' Clinical Reasoning When Encountering Virtual Patients. Journal of Nursing Education, 57(7), 408-415
Open this publication in new window or tab >>A Rubric to Assess Students' Clinical Reasoning When Encountering Virtual Patients
Show others...
2018 (English)In: Journal of Nursing Education, ISSN 0148-4834, E-ISSN 1938-2421, Vol. 57, no 7, p. 408-415Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Training with virtual patients has been proposed as a suitable learning activity to improve clinical reasoning skills for nursing students. However, published instruments with the capacity to assess students' reasoning process in the encounter with virtual patients are lacking.

METHOD: Deductive and abductive analyses were used to adapt the Lasater Clinical Judgment Rubric (LCJR) to assess nursing students' clinical reasoning skills in the encounter with virtual patients. The new rubric's ability to capture nursing students' clinical reasoning processes was tested using deductive analysis and statistical analysis.

RESULTS: A grading rubric for virtual patients, the vpLCJR, was developed. Cronbach's alpha showed .892, indicating good internal consistency.

CONCLUSION: The rubric vpLCJR, which deconstructs aspects of clinical reasoning for both students and faculty members, can be used to clarify expectations, assess students' clinical reasoning process, and provide feedback for learning when nursing students encounter virtual patients. [J Nurs Educ. 2018;57(7):408-415.].

Place, publisher, year, edition, pages
Slack Incorporated, 2018
National Category
Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:oru:diva-70526 (URN)10.3928/01484834-20180618-05 (DOI)000437235300005 ()29958310 (PubMedID)2-s2.0-85050144057 (Scopus ID)
Available from: 2019-03-24 Created: 2019-03-24 Last updated: 2019-06-18Bibliographically approved
Waldheim, E., Ajeganova, S., Bergman, S., Frostegård, J. & Welin, E. (2018). Variation in pain related to systemic lupus erythematosus (SLE): a 7-year follow-up study. Clinical Rheumatology, 37(7), 1825-1834
Open this publication in new window or tab >>Variation in pain related to systemic lupus erythematosus (SLE): a 7-year follow-up study
Show others...
2018 (English)In: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 37, no 7, p. 1825-1834Article in journal (Refereed) Published
Abstract [en]

We have previously shown that most patients with systemic lupus erythematosus (SLE) reported low degree of SLE-related pain. However, 24% of the patients reported high degree of SLE-related pain, more fatigue, anxiety and depression, and worse health-related quality of life (HRQoL). To explore SLE-related pain, the presence of long-standing widespread pain, and patient-reported outcomes (PROs) after 7 years. Sixty-four out of 84 patients participated in a 7-year follow-up of the original survey and completed the same questionnaires answered at inclusion: pain (VAS 100 mm), fatigue (MAF), HRQoL (SF-36), anxiety and depression (HADS), and, if appropriate, a pain-drawing. Differences between inclusion and follow-up (change) were calculated. The patients with a low degree of SLE-related pain at inclusion reported no changes at follow-up in pain and PROs except for worsening in physical function in SF-36, median change (IQR) 0 (- 10 to 5), p = 0.024. Half of the patients with high degree of pain at inclusion reported decreased pain at follow-up, median change (IQR) 45 (35 to 65), p = 0.021; fatigue, 8 (8 to 17), p = 0.018; anxiety, 4 (1 to 4), p = 0.035; and depression, 4 (2 to 5), p = 0.018 and improvements in most dimensions of SF-36. The remaining half of the patients reported no changes regarding pain and PROs except for a worsening in vitality in SF-36, 20 (15 to 35), p = 0.0018. All patients with remaining high level of pain indicated long-standing widespread pain. After 7 years, a subgroup of patients with SLE reported remaining high level of SLE-related pain and a high symptom burden, including long-standing widespread pain. Such patients require more observant attention to receive appropriate treatment.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Anxiety, Depression, Fatigue, Health-related quality of life, Pain, SLE
National Category
Medical and Health Sciences Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:oru:diva-70527 (URN)10.1007/s10067-018-4079-1 (DOI)000435599200011 ()29654486 (PubMedID)2-s2.0-85045244134 (Scopus ID)
Funder
Swedish Rheumatism AssociationStockholm County CouncilThe Karolinska Institutet's Research FoundationLinköpings universitet
Note

Funding Agencies:

King Gustav V 80 Year's Foundation

Swedish Society of Nursing

Available from: 2019-03-24 Created: 2019-03-24 Last updated: 2019-06-18Bibliographically approved
Pettersson, S., Svenungsson, E., Gustafsson, J., Möller, S., Gunnarsson, I. & Welin Henriksson, E. (2017). A comparison of patients' and physicians' assessments of disease activity using the Swedish version of the Systemic Lupus Activity Questionnaire. Scandinavian Journal of Rheumatology, 46(6), 474-483
Open this publication in new window or tab >>A comparison of patients' and physicians' assessments of disease activity using the Swedish version of the Systemic Lupus Activity Questionnaire
Show others...
2017 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 46, no 6, p. 474-483Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: We compared patients' assessments of systemic lupus erythematosus (SLE) disease activity by a Swedish version of the Systemic Lupus Activity Questionnaire (SLAQ) with physicians' assessments by the Systemic Lupus Activity Measure (SLAM) and Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K). We also explored the performance of the SLAQ in patients with short (< 1 year) versus long (≥ 1 year) disease duration.

METHOD: Patients filled out the SLAQ before physicians' assessments. Correlations between SLAQ total, subscales (Symptom score, Flares, Patients global) and SLAM and SLEDAI-2K, as well as between the corresponding items in SLAQ and SLAM, were evaluated using Spearman's ρ. Comparisons between patients with different disease durations were performed with Mann-Whitney U or chi-squared tests.

RESULTS: We included 203 patients (79% women), with a median age of 45 years [interquartile range (IQR) 33-57 years] and disease duration of 5 years (IQR 0-14 years). Correlations between physicians' SLAM without laboratory items (SLAM-nolab) and patients' assessments were: SLAQ total, ρ = 0.685, Symptom score, ρ = 0.651, Flares, ρ = 0.547, and Patients global, ρ = 0.600. Of the symptom items, fatigue (ρ = 0.640), seizures (ρ = 0.635), and headache (ρ = 0.604) correlated most closely. Neurology/stroke syndrome, skin, and lymphadenopathy correlated less well (ρ < 0.24). Patients' and physicians' assessments were notably more discordant for patients with short disease durations.

CONCLUSION: We confirm that the SLAQ can be used to monitor disease activity. However, the discrepancy between patients' and physicians' assessments was greater for patients with short versus long disease duration. We encourage further use of the SLAQ, but would like to develop a shorter version which would be valuable in modern, partly web-based, clinical care.

Place, publisher, year, edition, pages
Taylor & Francis, 2017
National Category
Medical and Health Sciences Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:oru:diva-70528 (URN)10.1080/03009742.2016.1276959 (DOI)000415723100008 ()28293972 (PubMedID)2-s2.0-85015160822 (Scopus ID)
Funder
Swedish Rheumatism AssociationStockholm County CouncilThe Karolinska Institutet's Research Foundation
Note

Funding Agencies:

King Gustaf V's 80th Birthday Fund

Swedish Society of Nursing

Available from: 2019-03-24 Created: 2019-03-24 Last updated: 2019-04-08Bibliographically approved
Andersson, S. F., Bergman, S., Henriksson, E. W. & Bremander, A. (2017). Arthritis management in primary care: A study of physiotherapists' current practice, educational needs and adherence to national guidelines. Musculoskeletal Care, 15(4), 333-340
Open this publication in new window or tab >>Arthritis management in primary care: A study of physiotherapists' current practice, educational needs and adherence to national guidelines
2017 (English)In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 15, no 4, p. 333-340Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: With an increasing number of patients with osteoarthritis (OA) and rheumatoid arthritis (RA) in primary care, our aim was to investigate arthritis-related practice in physiotherapy and to study adherence to evidence-based care.

METHODS: Seventy physiotherapists (PTs) working in primary care were emailed a questionnaire to investigate current practice and the number of roles assumed by PTs, the degree of confidence, educational needs and adherence to national guidelines in managing patients with OA or RA. Interventions supported by national guidelines were compared with reports of treatment modalities in the questionnaire.

RESULTS: Sixty-four (91%) PTs responded, and they reported a higher degree of confidence in assessment, treatment and education of patients with OA than for those with RA (p < 0.001). The total number of roles assumed by the PTs was higher in the management of OA than for RA (p < 0.001). PTs who assumed a greater number of roles also reported a stronger degree of confidence in assessing OA (p = 0.036). Those who assumed fewer roles also reported less confidence in RA treatment (p = 0.045). Recommendations in the guidelines were followed by the majority of PTs for eight of 11 treatment modalities in OA and for six of six in RA.

CONCLUSIONS: PTs reported a lower degree of confidence and the assumption of fewer roles in managing patients with RA compared with OA. There was good adherence to the national guidelines for almost all the treatment modalities listed. Even so, the results indicate a need for education, especially in chronic inflammatory arthritis care.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
Evidence-based practice, osteoarthritis, physiotherapy, rheumatoid arthritis
National Category
Medical and Health Sciences Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:oru:diva-70529 (URN)10.1002/msc.1176 (DOI)000417760300005 ()28009092 (PubMedID)2-s2.0-85007341847 (Scopus ID)
Available from: 2019-03-24 Created: 2019-03-24 Last updated: 2019-04-08Bibliographically approved
Tingström, J., Hjelmstedt, A., Welin Henriksson, E., Ambrosi, A., Sonesson, S.-E. & Wahren-Herlenius, M. (2016). Anti-Ro/SSA autoantibody-positive women's experience of information given on the risk of congenital heart block.. Lupus, 25(5), 536-542
Open this publication in new window or tab >>Anti-Ro/SSA autoantibody-positive women's experience of information given on the risk of congenital heart block.
Show others...
2016 (English)In: Lupus, ISSN 0961-2033, E-ISSN 1477-0962, Vol. 25, no 5, p. 536-542Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Congenital heart block (CHB) may develop in fetuses of women with anti-Ro/SSA autoantibodies, and carries substantial morbidity and mortality. The aim was to evaluate how information on CHB is imparted and identify areas of improvement.

METHODS: A questionnaire was distributed to anti-Ro/SSA antibody-positive women who had either participated in a surveillance programme but whose expected child did not develop CHB (n = 100, denoted Doppler-Assessed Pregnancies (DAP) group) or given birth to a child with CHB (n = 88, denoted CHB-Affected Pregnancies (CAP) group).

RESULTS: The response rate was 83% (157/188). Most women received the information on CHB when they were already pregnant (DAP group 60%, CAP group 83%). However, a majority of them would have wanted the information before pregnancy (DAP group 52%, CAP group 56%), and most stated that it would not have influenced their decision to have a child (DAP group 77%, CAP group 58%). The ability to both understand the information and to perceive the information as sufficient were significantly higher when someone trained in paediatric cardiology gave the information.

CONCLUSIONS: Our findings indicate that information on CHB should be given to women before pregnancy. The data further highlight the importance of having specific knowledge for giving relevant and understandable, yet sufficient information.

Place, publisher, year, edition, pages
Sage Publications, 2016
Keywords
Congenital heart block, Doppler echocardiography, Ro/SSA autoantibodies, Sjögren's syndrome, pregnancy, systemic lupus erythematosus
National Category
Medical and Health Sciences Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:oru:diva-70530 (URN)10.1177/0961203315620760 (DOI)000372150400012 ()26670329 (PubMedID)2-s2.0-84962522765 (Scopus ID)
Funder
Swedish Research CouncilRagnar Söderbergs stiftelseGöran Gustafsson Foundation for Research in Natural Sciences and MedicineSwedish Heart Lung FoundationThe Karolinska Institutet's Research FoundationSwedish Rheumatism Association
Note

Funding Agencies:

King Gustaf the Vth 80-year foundation

Freemasons Foundation Stockholm

Available from: 2019-03-24 Created: 2019-03-24 Last updated: 2019-04-08Bibliographically approved
Pettersson, S., Lundberg, I. E., Liang, M. H., Pouchot, J. & Welin Henriksson, E. (2015). Determination of the minimal clinically important difference for seven measures of fatigue in Swedish patients with systemic lupus erythematosus. Scandinavian Journal of Rheumatology, 44(3), 206-210
Open this publication in new window or tab >>Determination of the minimal clinically important difference for seven measures of fatigue in Swedish patients with systemic lupus erythematosus
Show others...
2015 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 44, no 3, p. 206-210Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To estimate the minimal clinically important difference (MCID) in seven self-administered measures assessing fatigue in Swedish patients with systemic lupus erythematosus (SLE).

METHOD: The participants (n = 51, women 98%, age 52.8 ± 12.1 years, disease duration 18.7 ± 13.6 years) met in groups of six to nine persons. After completing seven fatigue questionnaires [the Fatigue Severity Scale (FSS); the Multidimensional Assessment of Fatigue (MAF) scale; the 20-item Multidimensional Fatigue Inventory (MFI); the Chalder Fatigue Scale (CFS); the Short Form-36 Vitality subscale (VT); the Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F) scale; and the Numeric Rating Scale (NRS)], each respondent had a minimum of five face-to-face discussions, followed by an individual comparative assessment of their own level of fatigue (seven-grade scale). This method resulted in 260 contrasting assessments; MCIDs were first calculated using the paired differences and then established by a regression approach. Patients were asked to comment on their experience with the questionnaires and whether they captured their fatigue adequately.

RESULTS: The paired approach (using 'little more fatigue' as an anchor for MCID during the face-to-face comparative assessments) provided estimates of 4.6-17.0; the regression approach provided estimates of 4.3-10.8. Estimates using the regression approach were consistently lower than those using the paired model. The MCID estimates were least favourable and fewer respondents supported the use of the NRS compared to the other self-reported questionnaires.

CONCLUSIONS: All seven instruments detect MCIDs for fatigue in Swedish patients with SLE. However, the single-question measure was not supported by the MCID estimates or by comments from the respondents.

Place, publisher, year, edition, pages
Taylor & Francis, 2015
National Category
Medical and Health Sciences Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:oru:diva-70535 (URN)10.3109/03009742.2014.988173 (DOI)000354392800005 ()25656604 (PubMedID)2-s2.0-84929321040 (Scopus ID)
Funder
Swedish Rheumatism AssociationSwedish Heart Lung FoundationSwedish Society for Medical Research (SSMF)The Karolinska Institutet's Research FoundationStockholm County Council
Note

Funding Agencies:

King Gustaf V 80th Birthday Fund

Åke Wiberg Foundation 

Alex and Eva Wallströms Foundation 

Foundation in memory of Clas Groschinsky

Available from: 2019-03-24 Created: 2019-03-24 Last updated: 2019-04-08Bibliographically approved
Lööf, H., Demmelmaier, I., Henriksson, E. W., Lindblad, S., Nordgren, B., Opava, C. H. & Johansson, U.-B. (2015). Fear-avoidance beliefs about physical activity in adults with rheumatoid arthritis. Scandinavian Journal of Rheumatology, 44(2), 93-89
Open this publication in new window or tab >>Fear-avoidance beliefs about physical activity in adults with rheumatoid arthritis
Show others...
2015 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 44, no 2, p. 93-89Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The aim of this study was to describe fear-avoidance beliefs about physical activity and explore how these beliefs correlate with sociodemographic, disease-specific, and psychosocial factors in adults with rheumatoid arthritis (RA).

METHOD: This cross-sectional study is part of the Physical Activity in Rheumatoid Arthritis (PARA) 2010 study. The study participants (n = 2351) were identified through the Swedish Rheumatology Quality (SRQ) registries from six rheumatology clinics in Sweden. Univariate and backwards stepwise logistic regressions were performed.

RESULTS: Stepwise logistic regressions showed that male gender [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.26-1.91] and having a below average income (OR 1.35, 95% CI 1.12-1.63) were associated with an increased risk of high scores on the modified Fear Avoidance-Belief Questionnaire (mFABQ). The two disease-specific factors most indicative of high mFABQ scores were high level of pain (OR 1.99, 95% CI 1.40-2.84) and poor health (OR 1.59, 95% CI 1.10-2.29). With regard to psychosocial factors, low health-related quality of life (HRQoL; OR 0.44, 95% CI 0.35-0.55) and a low score on the Exercise Self-Efficacy Scale (ESES; OR 0.66, 95% CI 0.52-0.82) were significantly associated with a high mFABQ score. The model fit was 0.27 (Nagelkerke's R(2)).

CONCLUSIONS: High fear-avoidance beliefs about physical activity in patients with RA were found to be associated with being male and having a below average income, a high level of pain, poor health, a low HRQoL, and low ESES score. Additional research is warranted for adults with RA to capture the multiple potential correlates to fear-avoidance beliefs about physical activity.

Place, publisher, year, edition, pages
Taylor & Francis, 2015
National Category
Medical and Health Sciences Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:oru:diva-70537 (URN)10.3109/03009742.2014.932432 (DOI)000351182100002 ()25222440 (PubMedID)2-s2.0-84924347632 (Scopus ID)
Funder
Swedish Research CouncilSwedish Rheumatism Association
Note

Funding Agencies:

Sophiahemmet University

Sophiahemmet Foundation in Stockholm

Combine Sweden

National Postgraduate School of Health Care Sciences

Strategic Research Program in Health Care Sciences at Karolinska Institutet

Available from: 2019-03-24 Created: 2019-03-24 Last updated: 2019-04-08Bibliographically approved
Pettersson, S., Boström, C., Eriksson, K., Svenungsson, E., Gunnarsson, I. & Welin Henriksson, E. (2015). Lifestyle habits and fatigue among people with systemic lupus erythematosus and matched population controls. Lupus, 24(9), 955-965
Open this publication in new window or tab >>Lifestyle habits and fatigue among people with systemic lupus erythematosus and matched population controls
Show others...
2015 (English)In: Lupus, ISSN 0961-2033, E-ISSN 1477-0962, Vol. 24, no 9, p. 955-965Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The objective of this paper is to identify clusters of fatigue in patients with systemic lupus erythematosus (SLE) and matched controls, and to analyze these clusters with respect to lifestyle habits, health-related quality of life (HRQoL), anxiety and depression.

METHODS: Patients with SLE (n = 305) and age- and gender-matched population controls (n = 311) were included. Three measurements of fatigue (Fatigue Severity Scale (FSS), Vitality (VT, from SF-36) and Multidimensional Assessment of Fatigue scale (MAF) and hierarchic cluster analysis were used to define clusters with different degrees of fatigue. Lifestyle habits were investigated through questionnaires. HRQoL was assessed with the SF-36 and anxiety/depression with the Hospital Anxiety and Depression Scale.

RESULTS: Three clusters, denominated "High," "Intermediate" and "Low" fatigue clusters, were identified. The "High" contained 80% patients, and 20% controls (median; VT 25, FSS 5.8, MAF 37.4). These had the most symptoms of depression (51%) and anxiety (34%), lowest HRQoL (p < 0.001) and they exercised least frequently. The "Intermediate" (48% patients and 52% controls) (median; VT 55, FSS 4.1, MAF 23.5) had similarities with the "Low" regarding sleep/rest whereas social status and smoking were closer to the "High." The"Low" contained 22% patients and 78% controls (median; VT 80, FSS 2.3, MAF 10.9). They had the highest perceived HRQoL (p < 0.001), least symptoms of anxiety (10%), no depression, smoked least (13%) and reported the highest percentage (24%) of exercising ≥ 3 times/week.

CONCLUSION: Fatigue is common, but not a general feature of SLE. It is associated with depression, anxiety, low HRQoL and less physical exercise. Patients with SLE and population controls with a healthy lifestyle reported lower levels of fatigue. Whether lifestyle changes can reduce fatigue, which is a major problem for a majority of SLE patients, needs to be further explored.

Place, publisher, year, edition, pages
Sage Publications, 2015
Keywords
Lupus erythematosus, cluster analysis, exercise, fatigue, health-related quality of life, lifestyle habits, systemic
National Category
Medical and Health Sciences Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:oru:diva-70534 (URN)10.1177/0961203315572716 (DOI)000358262600009 ()25697772 (PubMedID)2-s2.0-84937904371 (Scopus ID)
Funder
Swedish Rheumatism AssociationSwedish Heart Lung FoundationSwedish Research CouncilSwedish Society for Medical Research (SSMF)The Karolinska Institutet's Research FoundationStockholm County Council
Note

Funding Agencies:

King Gustaf V 80th Birthday Fund

Åke Wiberg Foundation

Alex and Eva Wallströms Foundation 

Foundation in Memory of Clas Groschinsky

Available from: 2019-03-24 Created: 2019-03-24 Last updated: 2019-04-08Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4258-5348

Search in DiVA

Show all publications