Published in 2022

Municipal Support of Diabetes Management in Daycare, Kindergarten and School: A Qualitative Study of Differences, Challenges and Potentials

Johansen, L. B., Nannsen, A. Ø., Iken, M. S., Madsen, M., Kristensen, K., Pilgaard, K. A., Schou, A. J., Hangaard, S., Mouritsen, A. K., Andersen, A. & Grabowski, D., 17 aug. 2022, I: Healthcare (Basel, Switzerland). 10, 8

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Diabetes care during institutional hours is a major challenge affecting the whole family. The aim of this study was to highlight challenges and potentials regarding municipal support in relation to diabetes care of children in school, kindergarten, and daycare. The dataset consists of 80 semi-structured online interviews with 121 municipal employees from 74 (of 98) municipalities in Denmark. Data were analysed using qualitative content analysis. The analysis produced four main themes: (1) Institutional staff initially feel insecure about diabetes care responsibilities, (2) There is a high degree of parental involvement and responsibilities during institutional hours, (3) The roles of health employees vary, and (4) Fluctuating allocation of special needs assistants (SNAs) creates challenges. The findings of this nationwide qualitative study show that, even though Denmark guarantees, by law, the child's right to support in diabetes self-care in school and childcare institutions, diabetes management in Denmark still needs to be improved, with a view to ensuring equal support for all children with diabetes.

Originalsprog Engelsk
Tidsskrift Healthcare (Basel, Switzerland)
Vol/bind 10
Udgave nummer 8
ISSN 2227-9032
DOI
Status Udgivet - 17 aug. 2022

Network meta-analysis comparing the efficacy of biologic treatments for achieving complete resolution of nail psoriasis

Reich, K., Conrad, C., Kristensen, L. E., Smith, S. D., Puig, L., Rich, P., Sapin, C., Holzkaemper, T., Koppelhus, U. & Schuster, C., maj 2022, I: The Journal of dermatological treatment. 33, 3, s. 1652-1660 9 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: Nail psoriasis (NP) is common and of high importance in patients with psoriasis. Complete resolution of NP at week 24‒26 is an unambiguous nail outcome accessible for indirect treatment comparison of biologics.

OBJECTIVE: To evaluate the comparative efficacy of approved biologics in achieving complete resolution of NP at week 24‒26.

METHODS: A network meta-analysis (NMA) was conducted to indirectly compare the efficacy of six biologics in achieving complete resolution of NP at week 24‒26 in patients with moderate-to-severe psoriasis and concomitant NP. Complete resolution of NP was defined as a score of zero on the Nail Psoriasis Severity Index (NAPSI), modified NAPSI (mNAPSI) or Physician's Global Assessment of Fingernails (PGA-F).

RESULTS: The probability of achieving complete resolution of NP was highest for ixekizumab (46.5%; 95% credibility interval [CrI] 35.1‒58.0; Surface Under the Cumulative RAnking curve [SUCRA] 97%), followed by brodalumab (37.0%; 17.0‒61.0; 79%), adalimumab (28.3%; 24.4‒32.4; 62%), guselkumab (27.7%; 21.1‒35.1; 58%), ustekinumab (20.8%; 10.2‒35.2; 37%), and infliximab (0.8%; 0.0‒8.9; 17%).

CONCLUSION: In patients with moderate-to-severe psoriasis and concomitant NP, ixekizumab has the greatest likelihood among approved biologics of achieving complete resolution of NP at week 24‒26. Findings should be interpreted carefully because of inherent study limitations.

Originalsprog Engelsk
Tidsskrift The Journal of dermatological treatment
Vol/bind 33
Udgave nummer 3
Sider (fra-til) 1652-1660
Antal sider 9
ISSN 0954-6634
DOI
Status Udgivet - maj 2022

Celiac disease (CD), a gluten-induced autoimmune disease, is associated with low bone mineral density (BMD) among children. Unfortunately, it is often diagnosed in adulthood, which may lead to an increased risk of fragile bones. The aim of this systematic review was to report on BMD status among young adults newly diagnosed with CD, and to examine the effect of a gluten-free diet (GFD), nutritional supplements, such as vitamin D, or antiresorptive medications on BMD recovery. Databases searched were Medline, Embase, and Cochrane Library up to July 2nd, 2020. Both observational studies and clinical trials were considered, if patients were newly diagnosed and between 20 and 35 years of age and reported on BMD. We critically appraised the identified studies using ROBINS-I and summarized the findings narratively. Out of 3991 references, we identified 3 eligible studies: one cross-sectional study and two longitudinal studies. In total, 188 patients were included, and the study population consisted primarily of women with an age range between 29 and 37 years old. Compared to healthy controls, our target population had lower BMD. Moreover, a strict GFD may increase BMD during a follow-up period of up to 5 years. Newly diagnosed CD patients aged 20-35 years are at risk of lower BMD. Therefore, it may be crucial to assess BMD at time of diagnosis in young women. Whether the results can be extrapolated to young men is unknown. While strict GFD may improve BMD over time, there is a lack of robust evidence to demonstrate that nutritional supplements or antiresorptive agents are beneficial in the prevention of fragile bones in this age group.

Originalsprog Engelsk
Tidsskrift Calcified Tissue International
Vol/bind 110
Udgave nummer 6
Sider (fra-til) 641-648
Antal sider 8
ISSN 0171-967X
DOI
Status Udgivet - jun. 2022

Bibliografisk note

© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

One-year treatment outcomes of secukinumab versus tumor necrosis factor inhibitors in Spondyloarthritis

Glintborg, B., Lindstrom, U., De Giuseppe, D., Provan, S. A., Gudbjornsson, B., Hetland, M. L., Michelsen, B., Wallman, J., Aaltonen, K., Hokkanen, A-M., Nordström, D., Jørgensen, T. S., Hansen, R. L., Jon Geirsson, A., Grøn, K., Krogh, N. S., Askling, J., Kristensen, L. E., Jacobsson, L. & DANBIO (Denmark), ARTIS/SRQ (Sweden), ICEBIO (Iceland), ROB-FIN (Finland), NOR-DMARD (Norway) registries, 2022, (E-pub ahead of print) I: Arthritis Care & Research.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

OBJECTIVE: To describe baseline characteristics and to compare treatment effectiveness of secukinumab versus tumor necrosis factor inhibitors (TNFi), in patients with spondyloarthritis (SpA) using adalimumab as the main comparator.

METHODS: Observational, prospective cohort study. Patients with SpA (clinical ankylosing spondylitis/non-radiographic axial SpA/undifferentiated SpA) starting secukinumab or a TNFi during 2015-2018 were identified from five Nordic clinical rheumatology registries. Comorbidities and extra-articular manifestations (psoriasis/uveitis/inflammatory bowel disease) were captured from national registries (data available in 94% of patients) and included in multivariable analyses. We assessed 1-year treatment retention (crude survival curves, adjusted hazard ratios (HR) for treatment discontinuation) and 6-months' response-rates (ASDAS<2.1/BASDAI<40mm, crude/LUNDEX-adjusted, adjusted logistic-regression analyses with odds-ratio(OR)), stratified by line of biological treatment (1st /2nd /3rd +).

RESULTS: In total, 10,853 treatment courses (842 secukinumab/10,011 TNFi whereof 1,977 adalimumab) were included. The proportion treated with secukinumab during 1st /2nd /3rd + was 1%/6%/22%). Extra-articular manifestations varied across treatments, while other baseline characteristics were largely similar. Secukinumab had a one-year retention comparable to adalimumab as 1st or 2nd , but poorer as 3rd + line of therapy (secukinumab 56% (51%-61%) versus adalimumab 70% (64%-75%)), adjusted HR 1.43 (1.12-1.81). Across treatment lines, secukinumab had poorer estimates for 6-months response rates than adalimumab, statistically significantly so only for 3rd + line (adjusted analyses: ASDAS<2.1 OR=0.56 (0.35-0.90), BASDAI<40mm OR=0.62 (0.41-0.95)). Treatment outcomes varied across the five TNFi.

CONCLUSION: Secukinumab was mainly used in biologically experienced SpA patients. Secukinumab and adalimumab performed similar in patients who had failed a first biological, although with increasing prior biological exposure, adalimumab was superior.

Originalsprog Engelsk
Tidsskrift Arthritis Care & Research
ISSN 2151-464X
DOI
Status E-pub ahead of print - 2022

Bibliografisk note

COPECARE

One-year treatment outcomes of secukinumab versus tumor necrosis factor inhibitors in Spondyloarthritis: Results From Five Nordic Biologic Registries Including More Than 10,000 Treatment Courses

Glintborg, B., Lindstrom, U., De Giuseppe, D., Provan, S. A., Gudbjornsson, B., Hetland, M. L., Michelsen, B., Wallman, J., Aaltonen, K., Hokkanen, A-M., Nordström, D., Jørgensen, T. S., Hansen, R. L., Jon Geirsson, A., Grøn, K., Krogh, N. S., Askling, J., Kristensen, L. E., Jacobsson, L. & DANBIO (Denmark), ARTIS/SRQ (Sweden), ICEBIO (Iceland), ROB-FIN (Finland), NOR-DMARD (Norway) registries, maj 2022, I: Arthritis Care & Research. 74, 5, s. 748-758 11 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

OBJECTIVE: To describe baseline characteristics and to compare treatment effectiveness of secukinumab versus tumor necrosis factor inhibitors (TNFi) in patients with spondyloarthritis (SpA) using adalimumab as the main comparator.

METHODS: This was an observational, prospective cohort study. Patients with SpA (clinical ankylosing spondylitis, nonradiographic axial SpA, or undifferentiated SpA) starting secukinumab or a TNFi during 2015-2018 were identified from 5 Nordic clinical rheumatology registries. Data on comorbidities and extraarticular manifestations (psoriasis, uveitis, and inflammatory bowel disease) were captured from national registries (data available in 94% of patients) and included in multivariable analyses. We assessed 1-year treatment retention (crude survival curves, adjusted hazard ratios [HR
adj ] for treatment discontinuation) and 6-month response rates (Ankylosing Spondylitis Disease Activity Score [ASDAS] score <2.1, Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] <40 mm, crude/LUNDEX-adjusted, adjusted logistic regression analyses with odds ratios [ORs]) stratified by line of biologic treatment (first, second, and third plus).

RESULTS: In total, 10,853 treatment courses (842 secukinumab and 10,011 TNFi, of which 1,977 were adalimumab) were included. The proportions of patients treated with secukinumab during the first, second, and third-plus lines of treatment were 1%, 6%, and 22%, respectively). Extraarticular manifestations varied across treatments, while other baseline characteristics were largely similar. Secukinumab had a 1-year retention comparable to adalimumab as a first or second line of treatment but poorer as a third-plus line of therapy (secukinumab 56% [95% confidence interval (95% CI) 51-61%] versus adalimumab 70% [95% CI 64-75%]; HR
adj 1.43 [95% CI 1.12-1.81]). Across treatment lines, secukinumab had poorer estimates for 6-month response rates than adalimumab, statistically significantly only for the third-plus line (adjusted analyses: ASDAS score <2.1 OR 0.56 [95% CI 0.35-0.90]; BASDAI <40 mm OR 0.62 [95% CI 0.41-0.95]). Treatment outcomes varied across the 5 TNFi.

CONCLUSION: Secukinumab was mainly used in biologics-experienced patients with SpA. Secukinumab and adalimumab performed similarly in patients who had failed a first biologic, although with increasing prior biologic exposure, adalimumab was superior.

Originalsprog Engelsk
Tidsskrift Arthritis Care & Research
Vol/bind 74
Udgave nummer 5
Sider (fra-til) 748-758
Antal sider 11
ISSN 2151-464X
DOI
Status Udgivet - maj 2022

Bibliografisk note

COPECARE

Oophorectomy and rate of dementia: a prospective cohort study

Uldbjerg, C. S., Wilson, L. F., Koch, T., Christensen, J., Dehlendorff, C., Priskorn, L., Abildgaard, J., Simonsen, M. K., Lim, Y-H., Jørgensen, J. T., Andersen, Z. J., Juul, A., Hickey, M. & Bräuner, E. V., 1 maj 2022, I: Menopause (New York, N.Y.). 29, 5, s. 514-522 9 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

OBJECTIVE: Globally, dementia disproportionally affects women, which is not fully explained by higher female longevity. Oophorectomy at any age leads to the permanent loss of ovarian sex steroids, potentially increasing the risk of dementia. We aimed to investigate the association between oophorectomy and dementia and whether this was conditional on age at oophorectomy, hysterectomy or use of hormone therapy (HT).

METHODS: A prospective study of 24,851 female nurses from the Danish Nurse Cohort. Nurses were followed from age 60 years or entry into the cohort, whichever came last, until date of dementia, death, emigration or end of follow-up (December 31, 2018), whichever came first. Poisson regression models with log-transformed person-years as offset were used to estimate the associations.

RESULTS: During 334,420 person-years of follow-up, 1,238 (5.0%) nurses developed dementia and 1,969 (7.9%)/1,016 (4.1%) contributed person-time after bilateral-/unilateral oophorectomy. In adjusted analyses, an 18% higher rate of dementia was observed following bilateral oophorectomy (aRR 1.18: 95% CI, 0.89-1.56) and 13% lower rate (aRR 0.87: 95% CI, 0.59-1.23) following unilateral oophorectomy compared to nurses who retained their ovaries. Similar effects were detected after stratification according to age at oophorectomy. No statistically significant modifying effects of hysterectomy or HT were detected (Pinteraction≥0.60).

CONCLUSIONS: Bilateral, but not unilateral, oophorectomy was associated with an increased rate of incident dementia. We were unable to establish whether this association was conditional on hysterectomy or HT use. Although an increase in dementia after bilateral oophorectomy is biologically plausible, limited statistical power hampers the precision of the estimates.

Originalsprog Engelsk
Tidsskrift Menopause (New York, N.Y.)
Vol/bind 29
Udgave nummer 5
Sider (fra-til) 514-522
Antal sider 9
ISSN 1072-3714
DOI
Status Udgivet - 1 maj 2022

Bibliografisk note

Copyright © 2022 by The North American Menopause Society.

OBJECTIVE: Evaluating the effect of self-management interventions targeting people with inflammatory arthritis (IA) is a challenge because self-management interventions are complex and consensus on important outcomes is lacking. The aim is to identify, and map applied outcome domains and outcome measurement instruments from previous trials measuring the effect of self-management interventions targeting people with IA.

METHOD: We performed an informative systematic literature review following guidance from the 'Outcome Measures in Rheumatology' (OMERACT) and 'Core Outcome Measures in Effectiveness Trials' (COMET) initiatives. Trials describing their experimental intervention as "self-management" applied in people diagnosed with any IA were included. Information on outcome domains and the corresponding measurement instruments were extracted, sorted, and categorized in domains and sub-domains.

RESULTS: From a total of 2,502 records, we included 38 trials published between 1988 and 2021. We identified 12 different outcome domains, covering 39 subdomains, collected with 119 different measurement instruments. The most frequently applied outcome domains were self-efficacy, pain, physical functioning/disability, anxiety and depression, quality of life, fatigue, global assessment/disease activity and coping. The applied measurement instruments varied within each outcome domain and were predominantly patient-reported outcomes.

CONCLUSION: The outcome domains and measurement instruments used in self-management trials were widely diverse and differ from the current general OMERACT Core Outcome Sets (COS) for IA conditions. Further steps towards the establishment of a COS to be reported in all self-management intervention trials will enhance the relevance and the subsequent impact on the body of evidence from these trials.

Originalsprog Engelsk
Artikelnummer 151995
Tidsskrift Seminars in Arthritis and Rheumatism
Vol/bind 54
Sider (fra-til) 151995
ISSN 0049-0172
DOI
Status Udgivet - jun. 2022

Bibliografisk note

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

Participation and engagement in family activities among girls and young women with Rett syndrome living at home with their parents - a cross-sectional study

Kruse Gyldhof, D., Stahlhut, M. & Waehrens, E. E., jul. 2022, I: Disability and Rehabilitation. 44, 14, s. 3650-3660 11 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

PURPOSE: To describe the extent of participation and engagement in family activities and explore variables potentially impacting on these factors in family activities among girls and young women with Rett syndrome (RTT) under the age of 21.

MATERIALS AND METHODS: The Child Participation in Family Activities (Child-PFA) questionnaire was sent to parents in the target group (n = 42). Additionally, age, number of siblings at home, ambulation level, clinical severity and level of hand function were recorded to explore possible impact. Data were analyzed using descriptive statistics, Fishers exact test and cross-tables.

RESULTS: 23 families participated. Highest degrees of participation and engagement were seen in social and stationary family activities. Indoor activities were frequent and showed high levels of participation and engagement, Outdoor activities were infrequent and showed low levels of participation despite a high degree of engagement. Routine activities were frequent but showed moderate to low participation and engagement. A negative association was found between participation in watching a movie and number of siblings living at home, and positive associations between engagement and age in three family activities.

CONCLUSION: Therapists working with this target group may benefit from focusing on engagement in routine activities and modification of family activities.IMPLICATIONS FOR REHABILITATIONTherapists may benefit from focusing on engagement in routine activities in the goal setting process and intervention as they occur on a daily basis, giving the opportunity for development of new skills.Therapists may benefit from focusing on assistive devices or other compensatory strategies for outdoor activities and activities that require a certain amount of hand function.Therapists may benefit from modifying the family's activities so that they require more social and mental participation and focus on experiencing different types of sensory input e.g., sound, tactile, visual or vestibular input rather than taking part in the activity by using their hands.

Originalsprog Engelsk
Tidsskrift Disability and Rehabilitation
Vol/bind 44
Udgave nummer 14
Sider (fra-til) 3650-3660
Antal sider 11
ISSN 1464-5165
DOI
Status Udgivet - jul. 2022

Performance of the 2016 diagnostic criteria for fibromyalgia in a tertiary care pain rehabilitation setting: a diagnostic accuracy study

Jensen, H. I., Blichfeldt-Eckhardt, M. R., Vaegter, H. B., Toft, P., Amris, K. & Kvorning, N., 27 jan. 2022, I: Scandinavian Journal of Pain. 22, 1, s. 67-76 10 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

OBJECTIVES: With the International Classification of Diseases 11th revision (classifying fibromyalgia as a primary pain disorder) soon to be implemented, the importance of pain physicians being able to identify patients with fibromyalgia is emphasized. The diagnostic criteria proposed in 2016 are based on self-reported pain distribution and symptom severity. The study aimed to evaluate the diagnostic accuracy of the 2016 diagnostic criteria for fibromyalgia applied in a population of patients with high impact chronic pain referred for pain rehabilitation.

METHODS: The study was performed as a diagnostic accuracy study at two Danish interdisciplinary pain rehabilitation centers, including 215 participants. All participants were evaluated clinically to identify patients with fibromyalgia. The diagnosis was based on expert opinion, but the minimum requirements were: (1) pain in all four body quadrants and axially for at least three months and (2) minimum 8 of 18 positive tender points. Participants filled in the fibromyalgia survey questionnaire, the patient version of the 2016 diagnostic criteria. Sensitivity, specificity, likelihood ratios, and positive and negative post-test probabilities were calculated using a clinical diagnosis of fibromyalgia as the reference standard.

RESULTS: Based on clinical diagnosis 45% of the participants were diagnosed with fibromyalgia; of these, only 19% had been diagnosed previously. The 2016 diagnostic criteria demonstrated a sensitivity of 88.5%, a specificity of 81.5%, a positive likelihood ratio of 4.79, a negative likelihood ratio of 0.14, a positive post-test probability of 79.4%, and a negative post-test probability of 10.2%.

CONCLUSIONS: Fibromyalgia was severely under-diagnosed among patients with high impact chronic pain referred to tertiary care in two pain rehabilitation centers in Denmark. The 2016 diagnostic criteria showed sufficient discriminatory properties suggesting that the fibromyalgia survey questionnaire can be used as a screening tool assisting the identification of fibromyalgia in this patient population.

Originalsprog Engelsk
Tidsskrift Scandinavian Journal of Pain
Vol/bind 22
Udgave nummer 1
Sider (fra-til) 67-76
Antal sider 10
ISSN 1877-8860
DOI
Status Udgivet - 27 jan. 2022

Bibliografisk note

© 2021 Walter de Gruyter GmbH, Berlin/Boston.

Physical Activity and Subsequent Change in Body Weight, Composition and Shape: Effect Modification by Familial Overweight

Specht, I. O., Heitmann, B. L. & Larsen, S. C., 2022, I: Frontiers in Endocrinology. 13, s. 787827 787827.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Background: Physical activity (PA) has been shown to attenuate the genetic risk of obesity as measured using polygenic risk scores. However, familial obesity history might be an easier predictor. We examined associations between PA and subsequent changes in BMI, body fat percentage (BF%) and waist circumference (WC) among participants with and without adiposity and a familial overweight.

Methods: In total, 1971 participants from the Danish MONICA cohort were included. Mean differences for 6-year changes in BMI, BF% and WC across PA levels were estimated. Association between walking and biking and subsequent change in adiposity were analysed. Effect modification by familial obesity was assessed by adding product terms to the models.

Results: We observed weak associations between leisure PA level and changes in WC [participants with low PA: 3.4 cm (95%CI: 2.8;4.0), participants with high PA: 2.4 cm (95%CI: 1.8;3.0)], with no evidence of effect modification by familial obesity. We found effect modification in analyses on walking and biking in relation to changes in BMI (P-interaction<0.01) and BF% (P-interaction=0.04), suggesting lower gain with more hours of activity among participants with adiposity and familial overweight.

Conclusions: The results were modest but suggested that PA, especially walking and biking, may prevent future adiposity.

Originalsprog Engelsk
Artikelnummer 787827
Tidsskrift Frontiers in Endocrinology
Vol/bind 13
Sider (fra-til) 787827
ISSN 1664-2392
DOI
Status Udgivet - 2022

Bibliografisk note

Copyright © 2022 Specht, Heitmann and Larsen.

Physical activity, physical capacity and sedentary behavior among asthma patients

Hansen, N. B., Henriksen, M., Dall, C. H., Vest, S., Larsen, L., Suppli Ulrik, C. & Backer, V., 2022, I: European Clinical Respiratory Journal. 9, 1, s. 2101599 2101599.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: Although exercise and daily physical activity (PA) have long been known to benefit patients with chronic disorders, knowledge is limited regarding asthma. OBJECTIVE: In a Danish setting, our aim was to measure physical activity, sedentary behavior, and physical capacity among patients with asthma. We hypothesized that people with severe asthma would be less active and more sedentary than their mild-moderate counterparts. METHODS: Adults with asthma were recruited through respiratory outpatient clinics and subsequently examined twice, 4 weeks apart. At each visit, participants underwent a series of lung function tests, questionnaires, and maximum oxygen uptake testing (VO
2max). Between the visits, participants wore an accelerometer continuously for 4 weeks, measuring sedentary time and daily steps. Sixty patients, 27 with mild-moderate asthma (GINA 1–3) and 33 with severe asthma (GINA 4–5), completed both visits and had valid accelerometer measurements. RESULTS: No significant differences between the two groups were found in sedentary time, number of steps or VO
2max.   VO
2max was significantly correlated with FeNO (r = −0.30, p < 0.05), Short Form-12 Mental Health (r = 0.37, p < 0.05), Asthma Control Questionnaire (r = −0.35, p < 0.05), and Mini Asthma Quality of Life Questionnaire (r = 0.36, p < 0.05). CONCLUSION: No differences were observed between patients with mild-moderate and severe asthma regarding sedentary behavior, daily steps or level of cardiopulmonary fitness. Furthermore, patients with the highest VO
2max had the higher quality of life scores. Abbreviations: VO
2max: Maximal Oxygen Uptake; CPET: Cardiopulmonary Exercise Testing; BMI: Body Mass Index; FEV1: Forced Expired Volume in the First Second; FVC: Forced Vital Capacity; PEF: Peak Expiratory Flow; EIB: Exercise-Induced Bronchoconstriction; COPD: Chronic Obstructive Pulmonary Disease; ACQ: Asthma Control Questionnaire; Mini-AQLQ: Mini Asthma Quality of Life Questionnaire; SF-12: Short Form 12 Health Survey; SNOT-22: Sino-Nasal Outcome Test 22; GINA: The Global Initiative for Asthma; CRP: C-reactive Protein; Hgb:Hemoglobin count; EOS: Eosinophil count; EVH: Eucapnic Voluntary Hyperventilation; FeNO: Fractional Exhaled Nitric Oxide; PA: Physical Activity ERS: European Respiratory Society; ATS: American Thoracic Society; CRS: Chronic Rhinosinusitis; AHR: Airway Hyperresponsiveness.

Originalsprog Engelsk
Artikelnummer 2101599
Tidsskrift European Clinical Respiratory Journal
Vol/bind 9
Udgave nummer 1
Sider (fra-til) 2101599
ISSN 2001-8525
DOI
Status Udgivet - 2022

Bibliografisk note

© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Physicians' vs patients' global assessments of disease activity in rheumatology and musculoskeletal trials: A meta-research project with focus on reasons for discrepancies

Lynæs, C., Lynæs, M., Simon, L. S., Tugwell, P., D'Agostino, M-A., Strand, V., Juhl, C. B., Nielsen, S. M., De Witt, M., Beaton, D., Maxwell, L. J., Meara, A. S., Christensen, R. & on-behalf-of-the-OMERACT-Technical-Advisory-Group-(TAG), okt. 2022, I: Seminars in Arthritis and Rheumatism. 56, s. 152074 152074.

Publikation: Bidrag til tidsskriftReviewpeer review

BACKGROUND: In most rheumatic and musculoskeletal diseases (RMDs), global assessments of disease activity by physicians and patients are 'anchor outcomes' in therapeutic trials evaluating whether a treatment is effective.

OBJECTIVES: To compare physicians' vs patients' global assessments of disease activity in RMD trials and explore reasons for discrepancies between them.

METHODS: Eligible trials were sampled from systematic reviews of treatments for RMDs by using the Cochrane database of systematic reviews (i.e., reviews from the Cochrane Musculoskeletal Group, [CMSG]). Randomized controlled trials (RCTs) of interventions for RMDs were eligible if they reported quantitative analyses of both physicians´ and patients´ global assessments at the same time point for the comparison of the same experimental intervention against the same comparator (i.e., placebo, no treatment, or other treatment). We accepted data from trial comparisons for each type of outcome, regardless of the type of intervention and type of RMD within the CMSG. Using mixed-effects meta-regression models, we assigned the dependent variable as the ratio of odds ratios (ROR) of global change with the experimental intervention, versus the control comparator. An ROR>1 would indicate that physicians rated the experimental intervention more favorable than their patients did.

RESULTS: We were able to estimate the ROR (data from both physicians' and patients' global assessments) across 70 trials (116 randomized comparisons) in 7 diseases (ankylosing spondylitis, fibromyalgia, psoriatic arthritis, osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, and gout). The combined ROR across all effectiveness comparisons were rated significantly in favor of the intervention by physicians: ROR=1.15 CI 95% (1.07 to 1.23). This combined ROR was based on a substantial heterogeneity across comparisons (I2=89.1%). Across all the stratified analyses, the type of the RMD was an informative reason for discrepancies, with a statistically significant ROR in rheumatoid arthritis ROR=1.33, CI 95% (1.13 to 1.56), unlike the ROR in all other conditions (ROR=1.04, CI 95% (0.95-1.14).

CONCLUSION: In comparative effectiveness research on rheumatology, physicians' global assessments of disease activity, surprisingly, are more in favor of the experimental interventions than are those of the patients.

Originalsprog Engelsk
Artikelnummer 152074
Tidsskrift Seminars in Arthritis and Rheumatism
Vol/bind 56
Sider (fra-til) 152074
ISSN 0049-0172
DOI
Status Udgivet - okt. 2022

Bibliografisk note

Copyright © 2022 Elsevier Inc. All rights reserved.

Physiotherapists' prognosis of 1-year outcome after lumbar spinal fusion - A prospective cohort study

Tegner, H., Garval, M., Rolving, N., Esbensen, B. A., Bech-Azeddine, R. & Henriksen, M., 21 feb. 2022, (E-pub ahead of print) I: Physiotherapy Theory and Practice. s. 1-12 12 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: Physiotherapists (PTs) have an essential role in the facilitation of patients' mobilization after lumbar spinal fusion (LSF). The aim of this study is to investigate whether PTs can predict one-year post-surgery outcome based on their first meeting with the patient immediately after LSF.

METHOD: A prospective cohort study with one-year follow-up was conducted. In the first days after surgery, the PTs from hospital wards were asked to predict the patients' overall LSF outcome one year after surgery. One year after surgery, the patients received a questionnaire including the Oswestry Disability Index (ODI), visual analogue scales (VAS) for leg and back pain, quality of life survey (EQ-5D-3 L), global perceived effect (GPA), and satisfaction with surgery outcome (SSO). Univariate and logistic regression were used to calculate the associations between the prognosis and predictive values.

RESULTS: The study included 170 patients. The analyses showed a significant association between the PTs' prognosis and the primary outcome ODI (p < .01), VAS leg and back, EQ-5D-3 L, and GPE one-year post-surgery (p ≤ .04). However, the predictive value of the PTs' prognosis was low (R2 ≤ 0.09). There was no significant association between the PTs' prognosis and the patients' SSO (p = .17; R2 = 0.01).

CONCLUSION: There were significant associations between the PTs' prognosis and disability, pain, health-related quality of life and global perceived effect one-year post-surgery, although the associations had low predictive values. There was no significant association between the PTs' prognosis and patients' SSO after one year. The PTs' prognosis should not be used as a single component in further rehabilitation planning.

Originalsprog Engelsk
Tidsskrift Physiotherapy Theory and Practice
Sider (fra-til) 1-12
Antal sider 12
ISSN 0959-3985
DOI
Status E-pub ahead of print - 21 feb. 2022

Plain Radiographic Instruments for Structural Damage in Peripheral Joints in Psoriatic Arthritis: A Report From the GRAPPA-OMERACT Working Group

Antony, A., Holland, R., Mathew, A. J., D'Agostino, M-A., Maksymowych, W. P., Mease, P. J., Goel, N., Ogdie, A., Coates, L. C., Strand, V., Christensen, R., Gladman, D. D., Orbai, A-M., Leung, Y. Y. & Tillett, W., jun. 2022, I: Journal of Rheumatology. 49, 6 Suppl 1, s. 20-25 6 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)-Outcome Measures in Rheumatology (OMERACT) Psoriatic Arthritis (PsA) Core Set working group is focused on the development of a core set of instruments used to assess the domains described in the 2016 PsA Core Domain Set. At the 2021 annual meeting, the group presented an update on the domain of structural damage. In this report, we discuss the steps taken to assess the domain match and feasibility of plain radiographic instruments in the assessment of structural damage in PsA.

Originalsprog Engelsk
Tidsskrift Journal of Rheumatology
Vol/bind 49
Udgave nummer 6 Suppl 1
Sider (fra-til) 20-25
Antal sider 6
ISSN 0315-162X
DOI
Status Udgivet - jun. 2022

Bibliografisk note

Copyright © 2022 by The Journal of Rheumatology.

Positive predictive values of hematological procedure codes in the Danish National Patient Registry - a population-based validation study

Lauritsen, T. B., Nørgaard, J. M., Christensen, M. E., Dalton, S. O. & Østgård, L. S. G., 31 maj 2022, (E-pub ahead of print) I: Pharmacoepidemiology and Drug Safety.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: The Danish National Patient Registry holds data on hematological procedure codes including date and type of treatment from all hematological departments in Denmark. The validity of the hematological procedure codes remains to be clarified before they are used in epidemiological research.

PATIENTS AND METHODS: Using the Danish Myelodysplastic Syndromes Database, we identified 897 patients diagnosed with myelodysplastic syndromes or chronic myelomonocytic leukemia treated at five Danish Hospitals between 1 January 2012 and 30 April 2019. From the Danish National Patient Registry, we ascertained information about hematological procedure codes and date of procedure registered on each patient and generated random samples. Using medical record review as the reference standard, we validated procedure codes in the Danish National Patient Registry and calculated positive predictive values (PPVs) with 95% confidence intervals (CIs) for each procedure code.

RESULTS: A total of 523 medical records (99% of the total sample) were available for review. PPVs for specific procedure codes ranged from 71% to 100%. The overall PPV was 91% (95% CI: 88%-92%), reflecting PPVs of 95% (95% CI: 92%-97%) for low-dose-chemotherapy, 90% (95% CI: 81%-96%) for high-dose chemotherapy, 99% (95% CI: 93%-100%) for allogeneic stem cell transplantation, 75% (95% CI: 62%-85%) for immuno-modulating agents, 80% (95% CI: 74%-85%) for growth-factors, and 99% (95% CI: 99%-100%) for bone marrow examination. The accuracy of coding was consistent across geographic regions and year of registration/coding.

CONCLUSIONS: Hematological procedure codes reported to the Danish National Patient Registry had high PPVs and are suitable for epidemiological research. This article is protected by copyright. All rights reserved.

Originalsprog Engelsk
Tidsskrift Pharmacoepidemiology and Drug Safety
ISSN 1053-8569
DOI
Status E-pub ahead of print - 31 maj 2022

Bibliografisk note

This article is protected by copyright. All rights reserved.

Probing cellular health at the muscle level-Multi-frequency bioimpedance in Parkinson's disease

Celicanin, M., Harrison, A. P., Olsen, J. K., Korbo, L., Løkkegård, A., Petersen, C. B., Danneskiold-Samsøe, B., Siebner, H. R., Ilic, T. & Bartels, E. M., okt. 2022, I: Physiological Reports. 10, 19, s. e15465 e15465.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Bioimpedance (mfBIA) non-invasively assesses cellular muscle health. Our aim was to explore whether mfBIA captures abnormal cellular muscle health in patients with Parkinson's Disease (PD) and how such changes are modulated with the use of Parkinson's medication. In patients with PD (n = 20) mfBIA measurements were made of biceps brachii, triceps, and extensor carpi radialis longus muscles of the more affected arm whilst at rest, using a mobile mfBIA device (IMPEDIMED, Australia). mfBIA and assessment of motor symptoms were performed in a pragmatic off-medication state, as well as one and 3 h after oral intake of 200 mg levodopa. Age and sex-matched healthy subjects (HC; n = 20) served as controls. PD and HC mfBIA parameters were compared by applying an unpaired two-tailed adjusted t-test and ANOVA with Tukey's correction for multiple comparisons (p ≤ 0.05). The PD group consisted of 13 men (71 ± 17 years) and 7 women (65 ± 7 years). Independent of medication, internal (Ri ) and external resistance (Re ) were found to be significantly higher, and membrane capacitance (Mc) significantly lower, in m.biceps brachii in PD subjects compared to HC. Center frequency (fc) was significantly higher in m.biceps brachii of PD subjects in the "medication-off" state. There was no difference between PD and HC in mfBIA parameters in the measured extensor muscles. The upper limb flexor muscle shows a difference in mfBIA parameters in PD compared to HC. mfBIA may be useful in the diagnosis and assessment of PD patients and is objective, non-invasive, reliable, and easy to use.

Originalsprog Engelsk
Artikelnummer e15465
Tidsskrift Physiological Reports
Vol/bind 10
Udgave nummer 19
Sider (fra-til) e15465
ISSN 2051-817X
DOI
Status Udgivet - okt. 2022

Bibliografisk note

© 2022 The Authors. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.

Rebozo and External Cephalic Version in breech presentation (RECEIVE): A randomised controlled study

de Wolff, M. G., Ladekarl, M., Sparholt, L. & Lykke, J. A., sep. 2022, I: BJOG : an international journal of obstetrics and gynaecology. 129, 10, s. 1666-1675 10 s., 17111.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

OBJECTIVE: To investigate if a hospital-initiated home-based rebozo intervention performed by the pregnant woman and her partner before external cephalic version (ECV) would increase the rate of cephalic presentations at birth.

DESIGN: A multicentre randomised controlled trial.

SETTING: Three university hospitals in Copenhagen, Denmark.

POPULATION: Pregnant women with a breech or transverse presentation at 35 weeks or more of gestation eligible for ECV.

METHODS: We compared rebozo before ECV with ECV alone. The randomisation was computer-generated in blocks and stratified by parity. The woman and her partner were instructed in the technique by a project midwife and performed the technique at home three times daily for 3-5 days before the scheduled ECV. Analyses were by intention-to-treat.

MAIN OUTCOME MEASURE: The number of cephalic presentations at the time of birth. Odds ratios (OR) and 95% confidence intervals (CI) were calculated.

RESULTS: A total of 372 women were randomly assigned (1:1) to either rebozo intervention (n = 187) or control (n = 185). At birth, 95 (51%) in the intervention group versus 112 (62%) in the control group had a fetus in cephalic presentation (OR 0.61; 95% CI 0.40-0.95). No adverse events were observed in relation to the intervention.

CONCLUSIONS: In breech or transverse presentation, home-based rebozo exercise before ECV lowered the overall rate of cephalic presentation at birth.

TWEETABLE ABSTRACT: Home-based rebozo for breech presentation before external version reduces the rate of cephalic presentation at birth.

Originalsprog Engelsk
Artikelnummer 17111
Tidsskrift BJOG : an international journal of obstetrics and gynaecology
Vol/bind 129
Udgave nummer 10
Sider (fra-til) 1666-1675
Antal sider 10
ISSN 1470-0328
DOI
Status Udgivet - sep. 2022

Bibliografisk note

This article is protected by copyright. All rights reserved.

Rebozo and External Cephalic Version in breech presentation (RECEIVE): a randomized controlled study

de Wolff, M. G., Ladekarl, M., Sparholt, L. & Lykke, J. A., 3 feb. 2022, (E-pub ahead of print) I: BJOG : an international journal of obstetrics and gynaecology. s. 1-27 27 s., 17111.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

OBJECTIVE: To investigate if a hospital-initiated home-based rebozo intervention performed by the pregnant woman and her partner before external cephalic version (ECV) would increase the rate of cephalic presentations at birth.

DESIGN: A multicentre randomised controlled trial.

SETTING: Three university hospitals in Copenhagen, Denmark.

POPULATION: Pregnant women with a breech or transverse presentation at 35 weeks or more of gestation eligible for ECV.

METHODS: We compared rebozo before ECV with ECV alone. The randomisation was computer-generated in blocks and stratified by parity. The woman and her partner were instructed in the technique by a project midwife and performed the technique at home three times daily for 3-5 days before the scheduled ECV. Analyses were by intention-to-treat.

MAIN OUTCOME MEASURE: The number of cephalic presentations at the time of birth. Odds ratios (OR) and 95% confidence intervals (CI) were calculated.

RESULTS: A total of 372 women were randomly assigned (1:1) to either rebozo intervention (n = 187) or control (n = 185). At birth, 95 (51%) in the intervention group versus 112 (62%) in the control group had a fetus in cephalic presentation (OR 0.61; 95% CI 0.40-0.95). No adverse events were observed in relation to the intervention.

CONCLUSIONS: In breech or transverse presentation, home-based rebozo exercise before ECV lowered the overall rate of cephalic presentation at birth.

Originalsprog Engelsk
Artikelnummer 17111
Tidsskrift BJOG : an international journal of obstetrics and gynaecology
Sider (fra-til) 1-27
Antal sider 27
ISSN 1470-0328
DOI
Status E-pub ahead of print - 3 feb. 2022

Bibliografisk note

This article is protected by copyright. All rights reserved.

Risk of flare after tapering or withdrawal of biologic/targeted synthetic disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis or axial spondyloarthritis: a systematic review and meta-analysis

Uhrenholt, L., Christensen, R., Dinesen, W. K. H., Liboriussen, C. H., Andersen, S. S., Dreyer, L., Schlemmer, A., Hauge, E-M., Skrubbeltrang, C., Taylor, P. C. & Kristensen, S., 3 aug. 2022, I: Rheumatology (Oxford, England). 61, 8, s. 3107-3122 16 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

OBJECTIVE: To evaluate flare risk when tapering or withdrawing biologic or targeted synthetic DMARDs (bDMARDs or tsDMARDs) compared with continuation in patients with inflammatory arthritis in sustained remission or with low disease activity.

METHODS: Articles were identified in the Cochrane Library, PubMed, Embase and Web of Science. Eligible trials were randomized controlled trials comparing tapering and/or withdrawal of bDMARDs and/or tsDMARDs with the standard dose in inflammatory arthritis. Random effects meta-analysis was performed with risk ratio (RR) or Peto's odds ratio (POR) for sparse events and 95% CI.

RESULTS: The meta-analysis comprised 22 trials: 11 assessed tapering and 7 addressed withdrawal (4 assessed both). Only trials with an RA or axial SpA (axSpA) population were identified. An increased flare risk was demonstrated when b-/tsDMARD tapering was compared with continuation [RR 1.45 (95% CI 1.19, 1.77), I2 = 42.5%] and potentially increased for persistent flare [POR 1.56 (95% CI 0.97, 2.52), I2 = 0%]. Comparing TNF inhibitor (TNFi) withdrawal with continuation, a highly increased flare risk [RR 2.28 (95% CI 1.78, 2.93), I2 = 78%] and increased odds of persistent flare [POR 3.41 (95% CI 1.91, 6.09), I2 = 49%] were observed. No clear difference in flare risk between RA or axSpA was observed.

CONCLUSION: A high risk for flare and persistent flare was demonstrated for TNFi withdrawal, whereas an increased risk for flare but not for persistent flare was observed for b-/tsDMARD tapering. Thus tapering seems to be the more favourable approach.

REGISTRATION: PROSPERO (CRD42019136905).

Originalsprog Engelsk
Tidsskrift Rheumatology (Oxford, England)
Vol/bind 61
Udgave nummer 8
Sider (fra-til) 3107-3122
Antal sider 16
ISSN 1462-0324
DOI
Status Udgivet - 3 aug. 2022

Bibliografisk note

© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Similar Effects of Exercise Therapy, Nonsteroidal Anti-inflammatory Drugs, and Opioids for Knee Osteoarthritis Pain: A Systematic Review with Network Meta-analysis

Thorlund, J. B., Simic, M., Pihl, K., Berthelsen, D. B., Day, R., Koes, B. & Juhl, C. B., apr. 2022, I: Journal of Orthopaedic and Sports Physical Therapy. 52, 4, s. 207-216 10 s.

Publikation: Bidrag til tidsskriftReviewpeer review

OBJECTIVE: To compare the effectiveness of opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and exercise therapy for knee osteoarthritis pain.

DESIGN: Systematic review with network meta-analysis.

LITERATURE SEARCH: We searched the databases MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from inception to April 15, 2021. Web of Science was used for citation tracking.

STUDY SELECTION CRITERIA: Randomized controlled trials comparing exercise therapy, NSAIDs, and opioids in any combination for knee osteoarthritis pain.

DATA SYNTHESIS: Network meta-analysis comparing exercise therapy, NSAIDs, opioids, and placebo/control for knee osteoarthritis pain. Additional trials from previous reviews were included to create the external placebo/control anchor.

RESULTS: We included 13 trials (1398 patients) with direct comparisons, supplemented with data from 101 additional trials. The treatment effect of NSAIDs for knee osteoarthritis pain was similar to that of opioids (standardized mean difference [SMD], 0.02; 95% confidence interval [CI], -0.14 to 0.18; Grading of Recommendations, Assessment, Development and Evaluations [GRADE]: low certainty). Exercise therapy had a larger effect than NSAIDs (SMD, 0.54; 95% CI, 0.19 to 0.89; GRADE: very low certainty). No estimate could be made for exercise vs opioids due to the lack of studies. Exercise therapy ranked as the "best" intervention in the network meta-analysis, followed by NSAIDs, opioids, and placebo/control intervention (GRADE: low certainty).

CONCLUSION: Exercise therapy ranked as the best treatment for knee osteoarthritis pain, followed by NSAIDs and opioids. The difference between treatments was small and likely not clinically relevant, and the overall confidence in the ranking was low. The results highlight the limited evidence for comparative effectiveness between exercise therapy, NSAIDs, and opioids for knee osteoarthritis pain. J Orthop Sports Phys Ther 2022;52(4):207-216. doi:10.2519/jospt.2022.10490.

Originalsprog Engelsk
Tidsskrift Journal of Orthopaedic and Sports Physical Therapy
Vol/bind 52
Udgave nummer 4
Sider (fra-til) 207-216
Antal sider 10
ISSN 0190-6011
DOI
Status Udgivet - apr. 2022

Bibliografisk note

Funding Information:
1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. 2Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark. 3Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. 4Department of Rehabilitation, Municipality of Guldborgsund, Nykøbing Falster, Denmark. 5Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark. 6Department of Clinical Pharmacology & Toxicology, St Vincent’s Hospital Sydney, Sydney, Australia. 7Faculty of Medicine, St Vincent’s Clinical School, University of New South Wales, Sydney, Australia. 8Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands. 9Department of Occupational Therapy and Physiotherapy, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark. This study was registered with PROSPERO (International Prospective Register of Systematic Reviews; registration number CRD42018106484). No funding was received for conducting this study. Jonas Bloch Thorlund reports a grant from Pfizer outside the submitted work. Milena Simic is supported by the Sydney University Research Accelerator (SOAR) fellowship. Richard Day has received support for his participation as “Community Expert” from Reckitt Benckiser ending in 2018. The other authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. Address correspondence to Dr Jonas Bloch Thorlund, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark. E-mail: jthorlund@health.sdu.dk U Copyright ©2022 JOSPT ®, Inc

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