Doctoral Theses / Doktorsavhandlingar Institutionen för neurovetenskap och fysiologihttps://hdl.handle.net/2077/5442024-03-29T10:34:16Z2024-03-29T10:34:16ZPhysiotherapist as primary assessor of knee osteoarthritis in primary care - Evaluation of patients’ self-assessment, preferences, quality of life, and health economyHo-Henriksson, Chan-Meihttps://hdl.handle.net/2077/796972024-03-27T21:02:41Z2024-03-27T00:00:00ZPhysiotherapist as primary assessor of knee osteoarthritis in primary care - Evaluation of patients’ self-assessment, preferences, quality of life, and health economy
Ho-Henriksson, Chan-Mei
Aim: The purposes with this thesis was to evaluate the feasibility of 30-second chair stand test as a self-test, and to investigate the effects of direct access to physiotherapist on costs and health in people with knee osteoarthritis, as well to investigate experiences of care among these individuals when physiotherapists serve as the primary assessor.
Methods: This thesis consists of four papers: Paper I investigated intra- and inter-rater reliability and the diagnostic ability of 30-second chair stand test to function as a self-test for people with knee osteoarthritis (n=114); Papers II-III investigated differences in health outcomes (Paper II) and the cost-effectiveness (Paper III) of a randomised controlled pragmatic trial using a physiotherapist assessment compared with physician’s assessment in people with knee osteoarthritis in primary care (n=69); and Paper IV used a qualitative interview study to explore the expectations and experiences of a care pathway initiated with a physiotherapist assessment in people with knee osteoarthritis (n=15).
Results: The 30-second chair stand test seem feasible as a self-test with excellent intra-rater reliability and moderate to good inter-rater reliability when comparing self-test results with a physiotherapist assessment. The differences between physiotherapists and physicians as primary assessors on health outcomes were not significant, and both healthcare pathways resulted in significant improvements in health-related quality of life. Direct access to a physiotherapist could lead to cost savings with a marginal quality adjusted life-year (QALY) loss. People seeking care for knee osteoarthritis reported that they expected to be “taken seriously” and receive a proper examination so that they can get the help they need to get back to their normal physical activities. The informants viewed physiotherapist and exercise-based treatment as a natural first option. The knowledge gained from the physiotherapist and the supported osteoarthritis self-management programme were seen as important factors in learning how to self-manage knee osteoarthritis and informants were hopeful that they could return to their normal physical activity level.
Conclusion: The results of this thesis imply that a 30-second chair stand as a self-test is a reliable instrument that can be useful in digital healthcare and self-assessment and that direct access to a physiotherapist could lead to cost savings without significant differences in health outcomes for individuals suffering from knee osteoarthritis. However, larger studies are needed. Informants who were assessed by a physiotherapist first felt they were understood and gained the knowledge they needed to self-manage their knee osteoarthritis. They reported feeling hopeful that they could return to their normal physical activities.
2024-03-27T00:00:00Zlnduction Therapies in Multiple Sclerosis - Clinical and immunological follow-upSandgren, Sofiahttps://hdl.handle.net/2077/797032024-03-21T21:08:41Z2024-03-21T00:00:00Zlnduction Therapies in Multiple Sclerosis - Clinical and immunological follow-up
Sandgren, Sofia
Multiple sclerosis (MS) is a chronic disease that damages the central nervous system. Its pathophysiology is complex, and consists of inflammation and degeneration from the disease onset. The treatment of MS has continuously been developed with improved efficacy. The classical escalation treatment strategy with chronic immunosuppression and thus, by extension, accumulated risk of side effects is challenged by immune reconstitution or induction therapies (IRT). IRT is given once or intermittently as short courses that causes transient immunosuppression followed by a "reboot" of the immune system and thus loss of previous autoimmunity. In this way, long-term disease control can be achieved even in treatment-free intervals, with reduced safety risks over time. Currently, there are 3 therapies that are considered as IRTs for treatment of relapsing-remitting MS (RRMS): autologous hematopoietic stem cell transplantation (AHSCT), alemtuzumab (ALZ) and cladribine therapy. The aim of this thesis was to study the long-term efficacy and safety of ALZ, and to compare its efficacy and safety with AHSCT. In addition, we evaluated a wide range of different methods and biomarkers to investigate the long-term effect of ALZ on inflammation and degeneration in RRMS. In study I, ALZ achieved a progression-free survival of 69%, cumulative no evidence of disease activity with three components (NEDA-3) of 33%, and reduced neurofilament light levels in RRMS, over a five-year follow-up. In study II, it appeared that ALZ's ability to mitigate neurodegeneration was essentially limited to RRMS without inflammatory disease activity. In them, we show signs of remyelination using quantitative measures of white matter volume and myelin content in the brain. In study III, AHSCT was associated with a greater probability than ALZ of exhibiting NEDA-3 during follow-up. Early adverse events (<100 days) were more common with AHSCT but late adverse events were more common with ALZ. In study IV, 40% of patients developed an ALZ-induced autoimmune thyroid disease (AITD), of these, 62% exhibited thyroid autoimmune antibodies (auto-Abs). Thyroid auto-Abs often proceeded AITD development and can be used to monitor the risk of thyroid disease after ALZ treatment. In conclusion, we confirm ALZ as a highly effective treatment in suppressing inflammatory disease activity in RRMS, and that this effect is maintained long-term, even during drug-free intervals. Slowed neurodegeneration appeared to be limited to RRMS patients without inflammatory disease activity, who even showed signs of remyelination. AHSCT was superior to ALZ in achieving remission of RRMS, and AITD was confirmed as the most common long-term side effect after ALZ. Finally, the surveillance of ALZ-induced AITD may be improved by monitoring thyroid auto-Abs.
2024-03-21T00:00:00ZPolycystic ovary syndrome in women with severe obesity - effects of a 12-month weight loss interventionKataoka, Josefinhttps://hdl.handle.net/2077/796962024-03-19T21:01:47Z2024-03-19T00:00:00ZPolycystic ovary syndrome in women with severe obesity - effects of a 12-month weight loss intervention
Kataoka, Josefin
Background: Polycystic ovary syndrome (PCOS) affects one out of eight women and is associated
with reproductive, metabolic, and psychiatric features. There is a strong association with obesity but
studies on PCOS in women with severe and morbid obesity are lacking.
Aim: To estimate the prevalence of PCOS in women with severe obesity (body mass index [BMI] ³
35 kg/m2), and to compare hormonal and metabolic features, anxiety and depression, health-related
quality of life (HRQoL), energy intake, physical activity, and eating behavior by PCOS diagnosis and
evaluate the effects of a 12-month weight loss intervention.
Methods: Participants with severe obesity were recruited from the obesity unit at Sahlgrenska
University Hospital where they had been referred for weight loss treatment. Participants were divided
into groups by PCOS-status, diagnosed with the National Institutes of Health-criteria, and assessed
with clinical examination and questionnaires at baseline and after a 12-month weight-loss
intervention.
Results: PCOS was present in 25.6% (n=63/246). Participants with PCOS had higher androgen
levels, lower low-density lipo-protein cholesterol (LDL-C) and lower total cholesterol compared to
women without PCOS. Groups did not differ in the prevalence of metabolic syndrome, symptoms of
anxiety and depression, HRQoL, energy intake, or physical activity at baseline. Those with PCOS had
higher cognitive restraint eating behavior at baseline. Anti-müllerian hormone (AMH) was higher in
those with PCOS, but due to low sensitivity and specificity it was not possible to use AMH as a
discriminator between women with and without PCOS. Over the course of the 12-month weight loss
intervention, 70% (n=174) of participants dropped out leaving 72 women for follow up (PCOS n=16,
non-PCOS n=56). Both groups lost weight (PCOS -12.5 ± 9.3 kg p <0.001; non-PCOS -14.0 ± 12.5
kg p <0.001), with no difference between groups. In women without PCOS, weight loss was
associated with lower androgens, insulin and blood lipids, less symptoms of anxiety and depression
and higher mental HRQoL. Further, those without PCOS reported reduced energy intake, and
changed eating behavior. From baseline to follow-up, in comparison between the two groups, women
without PCOS reported larger increase in cognitive restraint than those with PCOS and larger
reduction in carbohydrates and sugars compared to women with PCOS, whereas women with PCOS
reported larger reduction in fat intake.
Conclusion: In this unique cohort of women with severe obesity, PCOS was present in one out of
four. AMH could not be used as a single surrogate marker of the syndrome. Before obesity treatment,
women with PCOS had more conscious control regarding eating. Importantly, using a structured
weight loss intervention, those with PCOS lost weight to the same extent as women without PCOS.
Comparing groups regarding change from baseline, there were no major discernible differences
except that women without PCOS changed more in eating behavior with more cognitive restraint
towards a behavior more favorable for further weight loss.
2024-03-19T00:00:00ZHealth conditions, functioning and social outcomes in adults with cerebral palsyJonsson, Ulricahttps://hdl.handle.net/2077/793352024-02-27T12:37:18Z2024-02-21T00:00:00ZHealth conditions, functioning and social outcomes in adults with cerebral palsy
Jonsson, Ulrica
Background: A majority of individuals with cerebral palsy (CP) are adults,
and yet healthcare and research are focused on children. In comparison to the
consequences in childhood, little is known about the long-term consequences
of CP.
Aims: To explore the health, functioning, and social outcomes in a populationbased
cohort of middle-aged adults with CP in western Sweden.
Methods: The total cohort of individuals with CP born between 1959-1978 in
the CP Register of western Sweden formed the basis for this thesis. Childhood
data from the CP Register was used to compare survivors from the total cohort
with the total cohort. Register data on the survivors’ social outcomes and of
sex and age matched controls in the general population were gathered from
Statistics Sweden and compared. All survivors still residing in the region were
invited to a follow-up assessment of impairments and health conditions. The
presence of impairments at the follow-up assessment in adulthood were
compared to childhood data from the CP Register.
Results: The survivors differed from children with CP in the distribution of
CP subtypes and had less severe associated impairments. Among the survivors,
there was a decline in walking ability from childhood to adulthood and an
increase in individuals with intellectual disability and epilepsy. In adulthood,
pain and gastrointestinal, respiratory, and psychiatric disorders were common,
and social outcomes, such as education, living arrangements, employment, and
income differed greatly from the general population.
Conclusions: CP has serious long-term consequences for health and social
outcomes. From childhood to adulthood, the presence and severity of CPrelated
impairments may change, and other health conditions may develop. In
order to improve health and functioning and provide equal opportunities for
adults with CP so that they can fully participate in society, it is recommended
that specialized services and follow-up be extended into adulthood.
2024-02-21T00:00:00Z