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Ahlstrand, Inger
Publications (10 of 14) Show all publications
Lindmark, U., Bülow, P. H., Mårtensson, J., Rönning, H., Ahlstrand, I., Broström, A., . . . Sandgren, A. (2019). The use of the concept of transition in different disciplines within health and social welfare: An integrative literature review. Nursing Open, 6(3), 664-675
Open this publication in new window or tab >>The use of the concept of transition in different disciplines within health and social welfare: An integrative literature review
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2019 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 6, no 3, p. 664-675Article, review/survey (Refereed) Published
Abstract [en]

Aims

To continuing the quest of the concept of transition in nursing research and to explore how the concept of transition is used in occupational therapy, oral health and social work as well as in interdisciplinary studies in health and welfare, between 2003–2013.

Design

An integrative literature review.

Methods

PubMed, CINAHL, PsycINFO, DOSS, SocIndex, Social Science Citation Index and AMED databases from 2003–2013 were used. Identification of 350 articles including the concept of transition in relation to disciplines included. Assessment of articles are in accordance to Meleis' typologies of transition by experts in each discipline. Chosen key factors were entered into Statistical Package for the Social Sciences (SPSS).

Results

Meleis' four typologies were found in all studied disciplines, except development in oral health. The health‐illness type was the most commonly explored, whereas in social work and in occupation therapy, situational transitions dominated.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
literature review, nursing theory, occupational therapy, oral health, social welfare, social work, theory–practice gap, transition
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-43307 (URN)10.1002/nop2.249 (DOI)000476917700002 ()31367388 (PubMedID)2-s2.0-85069778425 (Scopus ID)GOA HHJ 2019 (Local ID)GOA HHJ 2019 (Archive number)GOA HHJ 2019 (OAI)
Available from: 2019-03-07 Created: 2019-03-07 Last updated: 2019-09-13Bibliographically approved
Ahlstrand, I., Wagman, P., Hakansson, C. & Bjork, M. (2018). Occupational balance and its relation to performance of valued life activities in persons with rheumatoid arthritis in working age. Paper presented at Congress of the European-League-Against-Rheumatism (EULAR), Amsterdam, Netherlands, June 13-16, 2018. Annals of the Rheumatic Diseases, 77(Suppl. 2), 186-186
Open this publication in new window or tab >>Occupational balance and its relation to performance of valued life activities in persons with rheumatoid arthritis in working age
2018 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, no Suppl. 2, p. 186-186Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Background Experience of balance in everyday activities where work is an essential part is important to health and well-being, as has also been observed in previous studies in people with rheumatoid arthritis (RA). The Valued life activity scale (VLA-swe) is a questionnaire in which patient’s first report if the separate activities are valued or not to perform and secondly difficulties to perform these activities. Occupational Balance Questionnaire (OBQ) focuses on satisfaction with the amount and variation of occupations.

Objectives The objectives were to 1) describe the relationship between performance of valued activities and experienced occupational balance, and to 2) identify aspects associated with low occupational balance in persons with RA.

Methods 368 persons (age 18–65 years, 77% women) with RA responded to a questionnaire measuring occupational balance (OBQ) and performance of valued life activities (VLA-swe). Other aspects of interest were activity limitations measured by Health Assessment Questionnaire (HAQ), pain (measured by VAS), continuous stress (stressed continuously for more than a month during the last 12 months), children at home, education, and living situation. The relation between OBQ and performance in VLA across genders and Workers/Non-workers were analysed using non-parametric correlation analyses. To identify the impact of different aspects on the likelihood that participants would report lower occupational balance, OBQ was analysed using workers/nonworkers, stress, gender, age, pain and difficulties performing valued activities as independent variables in logistic regressions models. The study was approved by the Regional Ethics Committee (Dnr2011/452–31).

Results The OBQ was significantly related to difficulties to perform valued activities reported by VLA (r=-0.41, p<0.001). Having more difficulties performing valued activities was the strongest predictor of lower occupation balance and increased the risk of reporting lower occupation balance with nearly five times (OR=4.54, p 0.001). Continuous stress increased the risk of having lower occupation balance more than three times (OR=3.27, p<0.0001) than those who not reported being stressed. The other variables show no significant impact on the likelihood that the participants would report lower occupational balance.

Conclusions The results showed support for the relationship between occupation balance and performance of valued life activities and highlights to identify what’s important for the individual and to assume that in the rehabilitation. The results also show the importance of ability to manage stress, in order to enable for retaining ability to work and achieve high occupational balance.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
Occupational Therapy Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:hj:diva-42362 (URN)10.1136/annrheumdis-2018-eular.7185 (DOI)000444351000440 ()
Conference
Congress of the European-League-Against-Rheumatism (EULAR), Amsterdam, Netherlands, June 13-16, 2018
Available from: 2018-12-19 Created: 2018-12-19 Last updated: 2018-12-19Bibliographically approved
Bergström, M., Ahlstrand, I., Thyberg, I., Falkmer, T., Börsbo, B. & Björk, M. (2017). ‘Like the worst toothache you’ve had’ – How people with rheumatoid arthritis describe and manage pain. Scandinavian Journal of Occupational Therapy, 24(6), 468-476
Open this publication in new window or tab >>‘Like the worst toothache you’ve had’ – How people with rheumatoid arthritis describe and manage pain
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2017 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 24, no 6, p. 468-476Article in journal (Refereed) Published
Abstract [en]

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease often associated with disability. Despite new treatments, pain and activity limitations are still present.

Objectives: To describe how persons with RA experience and manage pain in their daily life.

Methods: Seven semi-structured focus groups (FGs) were conducted and analyzed using content analysis.

Results: The analysis revealed four categories: 1) Pain expresses itself in different ways referred to pain as overwhelming, aching or as a feeling of stiffness. 2) Mitigating pain referred to the use of heat, cold, medications and activities as distractions from the pain. 3) Adapting to pain referred to strategies employed as coping mechanisms for the pain, e.g. planning and adjustment of daily activities, and use of assistive devices. 4) Pain in a social context referred to the participants’ social environment as being both supportive and uncomprehending, the latter causing patients to hide their pain.

Conclusions: Pain in RA is experienced in different ways. This emphasizes the multi-professional team to address this spectrum of experiences and to find pain management directed to the individual experience that also include the person’s social environment.

Place, publisher, year, edition, pages
Taylor & Francis, 2017
Keywords
Activities; adapting to pain; mitigating pain; social environment
National Category
Occupational Therapy
Identifiers
urn:nbn:se:hj:diva-34645 (URN)10.1080/11038128.2016.1272632 (DOI)000407390500009 ()28052711 (PubMedID)2-s2.0-85008391464 (Scopus ID)HHJADULTIS, HHJCHILDIS (Local ID)HHJADULTIS, HHJCHILDIS (Archive number)HHJADULTIS, HHJCHILDIS (OAI)
Available from: 2017-01-10 Created: 2017-01-10 Last updated: 2017-10-25Bibliographically approved
Ahlstrand, I., Vaz, S., Falkmer, T., Thyberg, I. & Björk, M. (2017). Self-efficacy and pain acceptance as mediators of the relationship between pain and performance of valued life activities in women and men with rheumatoid arthritis. Clinical Rehabilitation, 31(6), 824-834
Open this publication in new window or tab >>Self-efficacy and pain acceptance as mediators of the relationship between pain and performance of valued life activities in women and men with rheumatoid arthritis
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2017 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 31, no 6, p. 824-834Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To study whether personal factors (self-efficacy and pain acceptance) mediate the relationship between pain and performance of valued life activities in persons with rheumatoid arthritis.

METHODS: Persons with rheumatoid arthritis for at least four years (n = 737; 73% women) answered a questionnaire measuring self-efficacy, pain acceptance, performance of valued life activities, and self-rated pain. Relationships among these constructs were explored using univariate and multivariate analyses. Structural equation modelling was then used to examine the mediational role of personal factors on the relationship between pain and performance of valued life activities.

RESULTS: A direct negative association between pain and performance of valued life activities was identified (Beta = .34, P < .001). This suggests that people with rheumatoid arthritis who had higher levels of pain has increased difficulties in performing valued life activities. Self-efficacy and activity engagement component of pain acceptance mediated the relationship between pain and performance of valued life activities, however the pain willingness component of pain acceptance did not influence participation in valued life activities.

CONCLUSION: These findings highlight the importance of considering personal factors, such as pain acceptance and self-efficacy, in facilitating participation in valued life activities.

Place, publisher, year, edition, pages
Sage Publications, 2017
Keywords
Disability; ICF; mediation; pain; personal factors; rheumatoid arthritis; structural equation modelling; valued life activities scale
National Category
Rheumatology and Autoimmunity Occupational Therapy
Identifiers
urn:nbn:se:hj:diva-34123 (URN)10.1177/0269215516646166 (DOI)000401719500013 ()27146888 (PubMedID)2-s2.0-85019634376 (Scopus ID)HHJADULTIS, HHJCHILDIS (Local ID)HHJADULTIS, HHJCHILDIS (Archive number)HHJADULTIS, HHJCHILDIS (OAI)
Available from: 2016-11-30 Created: 2016-11-30 Last updated: 2017-06-08Bibliographically approved
Ahlstrand, I., Thyberg, I., Falkmer, T., Dahlström, Ö. & Björk, M. (2015). Pain and activity limitations in women and men with contemporary treated early RA compared to 10 years ago: the Swedish TIRA project. Scandinavian Journal of Rheumatology, 44(4), 259-264
Open this publication in new window or tab >>Pain and activity limitations in women and men with contemporary treated early RA compared to 10 years ago: the Swedish TIRA project
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2015 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 44, no 4, p. 259-264Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To study differences regarding pain and activity limitations during the 3 years following diagnosis in women and men with contemporary treated early RA compared with their counterparts who were diagnosed 10 years earlier.

METHOD: This study was based on patients recruited to the Early Intervention in RA (TIRA) project. In the first cohort (TIRA-1) 320 patients were included in time for diagnosis during 1996-1998 and 463 patients were included in the second cohort (TIRA-2) during 2006-2009. Disease activity, pain intensity (Visual Analogue Scale, VAS), bodily pain (BP) in the 36-item Short Form Health Survey (SF-36), activity limitations (Health Assessment Questionnaire, HAQ), and medication were reported at inclusion and at follow-up after 1, 2, and 3 years.

RESULTS: Disease activity, pain, and activity limitations were pronounced at inclusion across both genders and in both cohorts, with some improvement observed during the first year after diagnosis. Disease activity did not differ between cohorts at inclusion but was significantly lower at the follow-ups in the TIRA-2 cohort, in which the patients were prescribed traditional disease-modifying anti-rheumatic drugs (DMARDs) and biological agents more frequently. In TIRA-2, patients reported significantly lower pain and activity limitations at all follow-ups, with men reporting lower pain than women. Women reported significantly higher activity limitations at all time points in TIRA-2.

CONCLUSIONS: Pain and activity limitations were still pronounced in the contemporary treated early RA cohort compared with their counterparts diagnosed 10 years earlier and both of these factors need to be addressed in clinical settings.

National Category
Health Sciences
Identifiers
urn:nbn:se:hj:diva-26391 (URN)10.3109/03009742.2014.997285 (DOI)000359960100001 ()25786818 (PubMedID)2-s2.0-84937796766 (Scopus ID)
Available from: 2015-04-29 Created: 2015-04-29 Last updated: 2017-12-04Bibliographically approved
Ahlstrand, I., Björk, M., Thyberg, I. & Falkmer, T. (2015). Pain and difficulties performing valued life activities in women and men with rheumatoid arthritis. Clinical Rheumatology, 34(8), 1353-1362
Open this publication in new window or tab >>Pain and difficulties performing valued life activities in women and men with rheumatoid arthritis
2015 (English)In: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 34, no 8, p. 1353-1362Article in journal (Refereed) Published
Abstract [en]

This study aimed to examine the difficulties with performing valued life activities in relation to pain intensity in women and men with rheumatoid arthritis (RA). In total, 737 persons with RA (73 % women) from three rheumatology units in Sweden responded to a questionnaire measuring performance of 33 valued life activities and self-rated pain. The relationships between performance of valued life activities (VLAs) and pain (measured by visual analogue scale (VAS)) were analysed based on gender. Multiple linear regression analyses were conducted with the total VLA score as dependent variable. Women reported more pain and difficulties in performing valued life activities than men. Across genders, 85 % reported at least one valued life activity affected by RA. Significantly more women than men encountered difficulties in performing some activities such as cooking, gardening and meeting new people. Women reported higher pain intensity (35 mm) than men (31 mm). Almost all 33 difficulty ratings for valued life activities were higher among persons with high pain (>40 mm) than persons with lower pain. Difficulty ratings for valued life activities correlated positively with pain in persons with lower pain, but not among those with high pain. The results highlight the importance of addressing pain, especially among women with RA, as they reported pain to impact on their valued life activities. Interestingly, this was evident also in women with lower levels of pain.

Keywords
Disability; Gender; HAQ; Participation restrictions; VAS; VLA
National Category
Health Sciences
Identifiers
urn:nbn:se:hj:diva-26392 (URN)10.1007/s10067-015-2874-5 (DOI)000359267100006 ()25618175 (PubMedID)2-s2.0-84922341299 (Scopus ID)
Available from: 2015-04-29 Created: 2015-04-29 Last updated: 2017-12-04Bibliographically approved
Ahlstrand, I. (2015). Pain and its relation to participation in valued activities in rheumatoid arthritis. (Doctoral dissertation). Jönköping: Jönköping University, School of Health and Welfare
Open this publication in new window or tab >>Pain and its relation to participation in valued activities in rheumatoid arthritis
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

There has been a dramatic change over the past two decades for persons with rheumatoid arthritis (RA) not only due to early diagnosis, structured treatment, and aggressive medication but also due to an increased demand of participation in work life and society. Despite these treatment changes, RA continues to impact these individuals’ participation in valued daily activities. Participation in valued daily activities provides wellbeing and the opportunity for engagement and participation. By persons with RA pain has been highlighted as one of the most restrictive symptoms. This thesis uses the International Classification of Functioning, Disability, and Health (ICF) as a conceptual framework to describe disability and how participation is related to pain.

Aims: The overall aim of this thesis was to explore and describe the relationship between pain and participation in valued activities, in RA. Paper I compared pain and activity limitations in women and men with contemporary treated early RA with persons who were diagnosed ten years earlier. Paper II described experiences of pain and pain’s relationship with daily activities. Paper III examined difficulties performing valued life activities in relation to pain intensity. Paper IV described personal factors, including self-efficacy and pain acceptance, and studied whether personal factors are mediators of the relationbetween pain and performance of valued life activities.

Methods: Different methodological approaches were used to provide a comprehensive understanding of pain and participation in valued activities in persons with RA. A prospective longitudinal cohort study was used to compare women and men treated with contemporary treated RA (n=276) with their counterparts ten years earlier (n=373) (Paper I). This study was followed by a focus group study where 33 persons with RA participated in seven focus groups (Paper II). Subsequently, Papers III and IV were conducted based on data from The Swedish Rheumatology Quality Registry (SRQ) and data from a postal questionnaire that gathered data on demographics, pain, personal factors, and participation in valued life activities (n=737). In addition, these studies used descriptive and analytical statistics with multiple regression and structural equation modelling (SEM).

Results: Pain and activity limitations were still pronounced in women and men with RA despite recent treatment advances (Paper I). The relationship between participation and pain was dynamic and is related to fatigue, stress, and mood, factors that generated difficulties finding a suitable level of activity, resulting in difficulties balancing daily activities (Paper II). Both women and men reported restrictions in participation in valued life activities. Pain was identified as having an important relationship to difficulties performing valued life activities (Paper III). Personal factors were found important as mediators for pain in relation to participation (Paper IV).

Conclusions: This thesis found a continued need for multidisciplinary interventions despite current treatments. Pain was identified as related to participation restrictions and had an important relationship to difficulties performing valued life activities. Pain and participation in valued activities needs to be comprehensively analysed and treated in the context of the person’s perspective and needs and demands of persons with RA. The subjective experience of participation, the engagement, must be highlighted. Personal factors mediated the relationship between pain and participation and this finding supports the value of self-management interventions to enable participation in valued activities

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare, 2015. p. 100
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 61
National Category
Health Sciences
Identifiers
urn:nbn:se:hj:diva-27646 (URN)978-91-85835-60-7 (ISBN)
Public defence
2015-09-18, Forum Humanum, Hälsohögskolan, Jönköping, 13:00
Opponent
Supervisors
Available from: 2015-08-03 Created: 2015-08-03 Last updated: 2015-12-22Bibliographically approved
Ahlstrand, I., Thyberg, I., Falkmer, T., Dahlström, Ö. & Björk, M. (2014). Less pain and activity limitations in today's early RA patients compared with patients diagnosed 10 years earlier (the swedish TIRA-project). In: EULAR 2014: Scientific Abstracts: . Paper presented at EULAR conference, Paris June 2014 (pp. 141-142).
Open this publication in new window or tab >>Less pain and activity limitations in today's early RA patients compared with patients diagnosed 10 years earlier (the swedish TIRA-project)
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2014 (English)In: EULAR 2014: Scientific Abstracts, 2014, p. 141-142Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Background: Over the last decades the RA-treatment strategies have changed considerably. Routines for early RA diagnosis and instituted disease modifying anti rheumatic drugs (DMARDs) have been established. In the early 2000s biologic agents also became available for treatment purposes. Despite these altered and improved strategies RA patients continue to report pain and activity limitations; women more so than men.

Objectives: To study differences regarding pain and activity limitations during the first three years after diagnosis of RA in today's patients compared with patients diagnosed 10 years earlier from a gender perspective.

Methods: This study was based on patients recruited to the project “early interventions in RA” (TIRA). In the first cohort (TIRA-1) 320 patients were included during 1996-1998. In the second cohort (TIRA-2) 463 patients were included during 2006-2008. Disease activity score 28 joint count (DAS-28) and medication were registered. Pain intensity (VAS), bodily pain (BP) in Short Form36 (SF-36) and activity limitation (Health Assessment Questionnaire, HAQ) were reported at inclusion and at follow-ups after one, two and three years.

Results: Disease activity did not differ between cohorts at inclusion, but was significant lower at the follow ups in the TIRA-2 cohort compared with the TIRA-1 cohort. Patients in TIRA2 were prescribed traditional DMARD:s and biologic agents more frequent than in TIRA-1. The TIRA-2 patients reported significantly higher pain intensity and activity limitations at inclusion but lower pain intensity and activity limitations at all follow-ups than TIRA-1 patients. There were no significant differences between cohorts regarding bodily pain at inclusion, but thereafter the TIRA-2 patients showed significant lower bodily pain than the TIRA-1 patients. Men reported lower activity limitation than women in TIRA-1; otherwise there were no gender differences in TIRA-1. In TIRA-2, there were no significant gender differences regarding pain at inclusion. However, men reported lower pain than women at all follow-ups. Women, in turn, reported significantly higher activity limitations at all time points in TIRA-2. Pain and activity limitations were significantly reduced from inclusion to the one year follow-up but remained stable thereafter.

Conclusions: Both women and men in today's early RA patient cohort report lower pain and less activity limitations at the follow ups after diagnosis of RA compared to 10 years earlier. However, both activity limitations and bodily pain are still pronounced.

National Category
Health Sciences
Identifiers
urn:nbn:se:hj:diva-26402 (URN)10.1136/annrheumdis-2014-eular.3298 (DOI)
Conference
EULAR conference, Paris June 2014
Available from: 2015-04-30 Created: 2015-04-30 Last updated: 2015-12-22Bibliographically approved
Ahlstrand, I., Björk, M. & Thyberg, I. (2013). Low levels of pain impact on valued life activities in women and men with Rheumatoid Arthritis. In: : . Paper presented at EULAR 2013 Congress, Madrid.
Open this publication in new window or tab >>Low levels of pain impact on valued life activities in women and men with Rheumatoid Arthritis
2013 (English)Conference paper, Poster (with or without abstract) (Refereed)
Keywords
Gender, Pain, Rheumatoid arthritis, Valued life activities
National Category
Occupational Therapy
Identifiers
urn:nbn:se:hj:diva-22696 (URN)
Conference
EULAR 2013 Congress, Madrid
Available from: 2013-12-13 Created: 2013-12-13 Last updated: 2013-12-13Bibliographically approved
Ahlstrand, I., Björk, M., Thyberg, I., Börsbo, B. & Falkmer, T. (2012). Pain and Daily Activities in Rheumatoid Arthritis. Disability and Rehabilitation, 34(15), 1245-1253
Open this publication in new window or tab >>Pain and Daily Activities in Rheumatoid Arthritis
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2012 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, no 15, p. 1245-1253Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to describe experiences of pain and its relationship to daily activities in people with rheumatoid arthritis (RA). Method. Seven semi-structured focus group discussions were conducted with 33 men and women of different ages with RA. Data were analysed with content analysis. Results. Pain affected everyday life and may be a barrier to perform valued activities. Regarding the impact of pain on participation and independence, personal factors and the social environment were found to be important. It could be a struggle to find the right activity balance, since it was easy to be overactive, triggering subsequent elevation of pain levels. However, the participants also described activities as a mediator of pain and a distraction from it.Conclusion. The relationship between pain and daily activities in RA was complex. Pain as an impairment was expressed to be related to activity limitations and participation restrictions, as well as to contextual factors. These findings highlight the clinical importance of paying attention to the complexity of pain and its relation to daily activities and participation.

Place, publisher, year, edition, pages
Informa Healthcare, 2012
Keywords
client perspective, content analysis, ICF, pain, participation, Rheumatoid arthritis
National Category
Health Sciences
Identifiers
urn:nbn:se:hj:diva-17115 (URN)10.3109/09638288.2011.638034 (DOI)HHJADULTIS (Local ID)HHJADULTIS (Archive number)HHJADULTIS (OAI)
Available from: 2012-01-13 Created: 2012-01-13 Last updated: 2017-12-08Bibliographically approved
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