Published in 2017

International patient and physician consensus on a psoriatic arthritis core outcome set for clinical trials

Orbai, A-M., de Wit, M., Mease, P., Shea, J. A., Gossec, L., Leung, Y. Y., Tillett, W., Elmamoun, M., Callis Duffin, K., Campbell, W., Christensen, R., Coates, L., Dures, E., Eder, L., FitzGerald, O., Gladman, D., Goel, N., Grieb, S. D., Hewlett, S., Hoejgaard, P., Kalyoncu, U., Lindsay, C., McHugh, N., Shea, B., Steinkoenig, I., Strand, V. & Ogdie, A. apr. 2017 I : Annals of the Rheumatic Diseases. 76, 4, s. 673-680 8 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

OBJECTIVE: To identify a core set of domains (outcomes) to be measured in psoriatic arthritis (PsA) clinical trials that represent both patients' and physicians' priorities.

METHODS: We conducted (1) a systematic literature review (SLR) of domains assessed in PsA; (2) international focus groups to identify domains important to people with PsA; (3) two international surveys with patients and physicians to prioritise domains; (4) an international face-to-face meeting with patients and physicians using the nominal group technique method to agree on the most important domains; and (5) presentation and votes at the Outcome Measures in Rheumatology (OMERACT) conference in May 2016. All phases were performed in collaboration with patient research partners.

RESULTS: We identified 39 unique domains through the SLR (24 domains) and international focus groups (34 domains). 50 patients and 75 physicians rated domain importance. During the March 2016 consensus meeting, 12 patients and 12 physicians agreed on 10 candidate domains. Then, 49 patients and 71 physicians rated these domains' importance. Five were important to >70% of both groups: musculoskeletal disease activity, skin disease activity, structural damage, pain and physical function. Fatigue and participation were important to >70% of patients. Patient global and systemic inflammation were important to >70% of physicians. The updated PsA core domain set endorsed by 90% of OMERACT 2016 participants includes musculoskeletal disease activity, skin disease activity, pain, patient global, physical function, health-related quality of life, fatigue and systemic inflammation.

CONCLUSIONS: The updated PsA core domain set incorporates patients' and physicians' priorities and evolving PsA research. Next steps include identifying outcome measures that adequately assess these domains.

Originalsprog Engelsk
Tidsskrift Annals of the Rheumatic Diseases
Vol/bind 76
Tidsskriftsnummer 4
Sider (fra-til) 673-680
Antal sider 8
ISSN 0003-4967
DOI
Status Udgivet - apr. 2017

Interventions for treating persistent pain in survivors of torture

Baird, E., Williams, A. C. D. C. & Amris, K. 18 aug. 2017 I : Cochrane Database of Systematic Reviews. 8, s. CD012051

Publikation: Bidrag til tidsskriftReviewForskningpeer review

BACKGROUND: Persistent (chronic) pain is a frequent complaint in survivors of torture, particularly but not exclusively pain in the musculoskeletal system. Torture survivors may have no access to health care; where they do, they may not be recognised when they present, and the care available often falls short of their needs. There is a tendency in state and non-governmental organisations' services to focus on mental health, with poor understanding of persistent pain, while survivors may have many other legal, welfare, and social problems that take precedence over health care.

OBJECTIVES: To assess the efficacy of interventions for treating persistent pain and associated problems in survivors of torture.

SEARCH METHODS: We searched for randomised controlled trials (RCTs) published in any language in CENTRAL, MEDLINE, Embase, Web of Science, CINAHL, LILACS, and PsycINFO, from database inception to 1 February 2017. We also searched trials registers and grey literature databases.

SELECTION CRITERIA: RCTs of interventions of any type (medical, physical, psychological) compared with any alternative intervention or no intervention, and with a pain outcome. Studies needed to have at least 10 participants in each arm for inclusion.

DATA COLLECTION AND ANALYSIS: We identified 3578 titles in total after deduplication; we selected 24 full papers to assess for eligibility. We requested data from two completed trials without published results.We used standard methodological procedures expected by Cochrane. We assessed risk of bias and extracted data. We calculated standardised mean difference (SMD) and effect sizes with 95% confidence intervals (CI). We assessed the evidence using GRADE and created a 'Summary of findings' table.

MAIN RESULTS: Three small published studies (88 participants) met the inclusion criteria, but one had been retracted from publication because of ethical problems concerned with confidentiality and financial irregularities. Since these did not affect the data, the study was retained in this review. Despite the search including any intervention, only two types were represented in the eligible studies: two trials used cognitive behavioural therapy (CBT) with biofeedback versus waiting list on unspecified persistent pain (58 participants completed treatment), and one examined the effect of complex manual therapy versus self-treatment on low back pain (30 participants completed treatment). Excluded studies were largely either not RCTs or did not report pain as an outcome.There was no difference for the outcome of pain relief at the end of treatment between CBT and waiting list (two trials, 58 participants; SMD -0.05, 95% CI -1.23 to 1.12) (very low quality evidence); one of these reported a three-month follow-up with no difference between intervention and comparison (28 participants; SMD -0.03, 95% CI -0.28 to 0.23) (very low quality evidence). The manual therapy trial also reported no difference between complex manual therapy and self-treatment (30 participants; SMD -0.48, 95% CI -9.95 to 0.35) (very low quality evidence). Two studies reported dropouts, one with partial information on reasons; none of the studies reported adverse effects.There was no information from any study on the outcomes of use of analgesics or quality of life.Reduction in disability showed no difference at the end of treatment between CBT and waiting list (two trials, 57 participants; SMD -0.39, 95% CI -1.17 to 0.39) (very low quality evidence); one of these reported a three-month follow-up with no difference between intervention and comparison (28 participants; SMD 0, 95% CI -0.74 to 0.74) (very low quality evidence). The manual therapy trial reported superiority of complex manual therapy over self-treatment for reducing disability (30 participants; SMD -1.10, 95% CI - 1.88 to -0.33) (very low quality evidence).Reduction in distress showed no difference at the end of treatment between CBT and waiting list (two trials, 58 participants; SMD 0.07, 95% CI -0.46 to 0.60) (very low quality evidence); one of these reported a three-month follow-up with no difference between intervention and comparison (28 participants; SMD -0.24, 95% CI -0.50 to 0.99) (very low quality evidence). The manual therapy trial reported superiority of complex manual therapy over self-treatment for reducing distress (30 participants; SMD -1.26, 95% CI - 2.06 to -0.47) (very low quality evidence).The risk of bias was considered high given the small number of trials, small size of trials, and the likelihood that each was underpowered for the comparisons it reported. We primarily downgraded the quality of the evidence due to small numbers in trials, lack of intention-to-treat analyses, high unaccounted dropout, lack of detail on study methods, and CIs around effect sizes that included no effect, benefit, and harm.

AUTHORS' CONCLUSIONS: There is insufficient evidence to support or refute the use of any intervention for persistent pain in survivors of torture.

Originalsprog Engelsk
Tidsskrift Cochrane Database of Systematic Reviews
Vol/bind 8
Sider (fra-til) CD012051
ISSN 1361-6137
DOI
Status Udgivet - 18 aug. 2017

Interventions to improve access to cataract surgical services and their impact on equity in low- and middle-income countries

Ramke, J., Petkovic, J., Welch, V., Blignault, I., Gilbert, C., Blanchet, K., Christensen, R., Zwi, A. B. & Tugwell, P. 9 nov. 2017 I : Cochrane Database of Systematic Reviews. 11, s. CD011307

Publikation: Bidrag til tidsskriftReviewForskningpeer review

BACKGROUND: Cataract is the leading cause of blindness in low- and middle-income countries (LMICs), and the prevalence is inequitably distributed between and within countries. Interventions have been undertaken to improve cataract surgical services, however, the effectiveness of these interventions on promoting equity is not known.

OBJECTIVES: To assess the effects on equity of interventions to improve access to cataract services for populations with cataract blindness (and visual impairment) in LMICs.

SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2017, Issue 3), MEDLINE Ovid (1946 to 12 April 2017), Embase Ovid (1980 to 12 April 2017), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to 12 April 2017), the ISRCTN registry (www.isrctn.com/editAdvancedSearch); searched 12 April 2017, ClinicalTrials.gov (www.clinicaltrials.gov); searched 12 April 2017 and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 12 April 2017. We did not use any date or language restrictions in the electronic searches for trials.

SELECTION CRITERIA: We included studies that reported on strategies to improve access to cataract services in LMICs using the following study designs: randomised and quasi-randomised controlled trials (RCTs), controlled before-and-after studies, and interrupted time series studies. Included studies were conducted in LMICs, and were targeted at disadvantaged populations, or disaggregated outcome data by 'PROGRESS-Plus' factors (Place of residence; Race/ethnicity/ culture/ language; Occupation; Gender/sex; Religion; Education; Socio-economic status; Social capital/networks. The 'Plus' component includes disability, sexual orientation and age).

DATA COLLECTION AND ANALYSIS: Two authors (JR and JP) independently selected studies, extracted data and assessed them for risk of bias. Meta-analysis was not possible, so included studies were synthesised in table and text.

MAIN RESULTS: From a total of 2865 studies identified in the search, two met our eligibility criteria, both of which were cluster-RCTs conducted in rural China. The way in which the trials were conducted means that the risk of bias is unclear. In both studies, villages were randomised to be either an intervention or control group. Adults identified with vision-impairing cataract, following village-based vision and eye health assessment, either received an intervention to increase uptake of cataract surgery (if their village was an intervention group), or to receive 'standard care' (if their village was a control group).One study (n = 434), randomly allocated 26 villages or townships to the intervention, which involved watching an informational video and receiving counselling about cataract and cataract surgery, while the control group were advised that they had decreased vision due to cataract and it could be treated, without being shown the video or receiving counselling. There was low-certainty evidence that providing information and counselling had no effect on uptake of referral to the hospital (OR 1.03, 95% CI 0.63 to 1.67, 1 RCT, 434 participants) and little or no effect on the uptake of surgery (OR 1.11, 95% CI 0.67 to 1.84, 1 RCT, 434 participants). We assessed the level of evidence to be of low-certainty for both outcomes, due to indirectness of evidence and imprecision of results.The other study (n = 355, 24 towns randomised) included three intervention arms: free surgery; free surgery plus reimbursement of transport costs; and free surgery plus free transport to and from the hospital. These were compared to the control group, which was reminded to use the "low-cost" (˜USD 38) surgical service. There was low-certainty evidence that surgical fee waiver with/without transport provision or reimbursement increased uptake of surgery (RR 1.94, 95% CI 1.14 to 3.31, 1 RCT, 355 participants). We assessed the level of evidence to be of low-certainty due to indirectness of evidence and imprecision of results.Neither of the studies reported our primary outcome of change in prevalence of cataract blindness, or other outcomes such as cataract surgical coverage, surgical outcome, or adverse effects. Neither study disaggregated outcomes by social subgroups to enable further assessment of equity effects. We sought data from both studies and obtained data from one; the information video and counselling intervention did not have a differential effect across the PROGRESS-Plus categories with available data (place of residence, gender, education level, socioeconomic status and social capital).

AUTHORS' CONCLUSIONS: Current evidence on the effect on equity of interventions to improve access to cataract services in LMICs is limited. We identified only two studies, both conducted in rural China. Assessment of equity effects will be improved if future studies disaggregate outcomes by relevant social subgroups. To assist with assessing generalisability of findings to other settings, robust data on contextual factors are also needed.

Originalsprog Engelsk
Tidsskrift Cochrane Database of Systematic Reviews
Vol/bind 11
Sider (fra-til) CD011307
ISSN 1361-6137
DOI
Status Udgivet - 9 nov. 2017

Intra-rater and inter-rater reliability of the standardized ultrasound protocol for assessing subacromial structures

Hougs Kjær, B., Ellegaard, K., Wieland, I., Warming, S. & Juul-Kristensen, B. maj 2017 I : Physiotherapy Theory and Practice. 33, 5, s. 398-409 12 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: US-examinations related to shoulder impingement (SI) often vary due to methodological differences, examiner positions, transducers, and recording parameters. Reliable US protocols for examination of different structures related to shoulder impingement are therefore needed.

OBJECTIVES: To investigate the intra- and inter-rater reliability of the existing ultrasound (US) examinations of the subacromial space, the subacromial-subdeltoid bursa, and the supraspinatus tendon.

METHOD: In a three-phased design, two physiotherapists using a standardized US protocol examined the thickness of the supraspinatus tendon (SUPRA) and subacromial subdeltoid (SASD) bursa in two imaging positions, and the acromial humeral distance (AHD) in one position. Additionally, agreement on dynamic impingement (DI) examination was performed. The intra- and inter-rater reliability was carried out on the same day.

PARTICIPANTS: Forty-six sports active participants with a mean age of 37 years (range 18-57) participated. Twenty-two had SI and pain within previous week and 24 did not have SI or pain within previous week.

RESULTS: Intra- and inter-rater reliability ICC (2,3) models were all above 0.80 (range 0.82-0.99) with no systematic bias (Bland Altman plots). For the DI examination, the overall agreement was 98% and 93%, with Kappa of 0.96 and 0.82, for intra- and inter-rater reliability, respectively.

CONCLUSION: The reliability of the current standardized protocol for US examination of SI was excellent and considered feasible for clinical practice.

Originalsprog Engelsk
Tidsskrift Physiotherapy Theory and Practice
Vol/bind 33
Tidsskriftsnummer 5
Sider (fra-til) 398-409
Antal sider 12
ISSN 0959-3985
DOI
Status Udgivet - maj 2017

Introducing Standing Weight-bearing MRI in the Di-agnostics of Low Back Pain and Degenerative Spinal Disorders

Hansen, B. B. okt. 2017 I : Danish Medical Bulletin (Online). 64, 10

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

This PhD thesis is based on three scientific papers. In 2011 the Parker Institute the department of rheumatology introduced standing weight-bearing MRI (G-Scan, ESAOTE, Genova, Italy) in the diagnostic of low back pain patients. Unfortunately, we experienced a substantial risk of fainting (orthostatic syncope) during standing pMRI. In paper 1 we present in an observational study that the risk of fainting (19%) during standing pMRI could almost be eliminated by the use of an external pneumatic compression device (2%). The lumbar lordosis in the standing position is a significant contributor to positional changes in the morphology in the lumbar spine. In paper 2, we present in an observational study that changes in lumbar lordosis angle (ΔLA) between the conventional supine and standing position were independent of pain and the degenerative disc score. Before a full introduction of standing pMRI in clinical practice, it is important to know if the interpretation of positional changes in common degenerative findings has a sufficient reproducibility. In paper 3, we present in a reliability study that the pMRI evaluation has a fair to substantial reliability, although positional changes in the lumbar spine's morphology from the supine to the standing seems a less reliable outcome. There are currently no international evidence-based recommendations for the use of standing pMRI, and we have limited knowledge about how to interpret these positional changes in the lumbar spine into a clinical context. Therefore, further research is warranted to test the precision (sensitivity and specificity) in prospective longitudinal studies or RCTs. However, from a clinical perspective it seems logical to scan patients with low back pain in the position worsening their symptoms - typically the upright position. Therefore, standing pMRI may provide a higher diagnostic specificity and additional benefit to low back pain patients in the future.

Originalsprog Engelsk
Tidsskrift Danish Medical Bulletin (Online)
Vol/bind 64
Tidsskriftsnummer 10
ISSN 1603-9629
Status Udgivet - okt. 2017

Investigating the causal effect of smoking on hay fever and asthma: a Mendelian randomization meta-analysis in the CARTA consortium

Skaaby, T., Taylor, A. E., Jacobsen, R. K., Paternoster, L., Thuesen, B. H., Ahluwalia, T. V. S., Larsen, S. C., Zhou, A., Wong, A., Gabrielsen, M. E., Bjørngaard, J. H., Flexeder, C., Männistö, S., Hardy, R., Kuh, D., Barry, S. J., Tang Møllehave, L., Cerqueira, C., Friedrich, N., Bonten, T. N., Noordam, R., Mook-Kanamori, D. O., Taube, C., Jessen, L. E., McConnachie, A., Sattar, N., Upton, M. N., McSharry, C., Bønnelykke, K., Bisgaard, H., Schulz, H., Strauch, K., Meitinger, T., Peters, A., Grallert, H., Nohr, E. A., Kivimaki, M., Kumari, M., Völker, U., Nauck, M., Völzke, H., Power, C., Hyppönen, E., Hansen, T., Jørgensen, T., Pedersen, O., Salomaa, V., Grarup, N., Langhammer, A., Romundstad, P. R., Skorpen, F., Kaprio, J., R Munafò, M. & Linneberg, A. 22 maj 2017 I : Scientific Reports. 7, 1, s. 2224 7 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Observational studies on smoking and risk of hay fever and asthma have shown inconsistent results. However, observational studies may be biased by confounding and reverse causation. Mendelian randomization uses genetic variants as markers of exposures to examine causal effects. We examined the causal effect of smoking on hay fever and asthma by using the smoking-associated single nucleotide polymorphism (SNP) rs16969968/rs1051730. We included 231,020 participants from 22 population-based studies. Observational analyses showed that current vs never smokers had lower risk of hay fever (odds ratio (OR) = 0·68, 95% confidence interval (CI): 0·61, 0·76; P < 0·001) and allergic sensitization (OR = 0·74, 95% CI: 0·64, 0·86; P < 0·001), but similar asthma risk (OR = 1·00, 95% CI: 0·91, 1·09; P = 0·967). Mendelian randomization analyses in current smokers showed a slightly lower risk of hay fever (OR = 0·958, 95% CI: 0·920, 0·998; P = 0·041), a lower risk of allergic sensitization (OR = 0·92, 95% CI: 0·84, 1·02; P = 0·117), but higher risk of asthma (OR = 1·06, 95% CI: 1·01, 1·11; P = 0·020) per smoking-increasing allele. Our results suggest that smoking may be causally related to a higher risk of asthma and a slightly lower risk of hay fever. However, the adverse events associated with smoking limit its clinical significance.

Originalsprog Engelsk
Tidsskrift Scientific Reports
Vol/bind 7
Tidsskriftsnummer 1
Sider (fra-til) 2224
Antal sider 7
ISSN 2045-2322
DOI
Status Udgivet - 22 maj 2017

INTRODUCTION: Physical activity is a cornerstone in type 2 diabetes (T2D) rehabilitation. Effective long-term and low-cost strategies to keep these patients' physically active are needed. However, maintaining physical activity behaviour is difficult once formalised interventions end. Structured exercise training supported by mobile technology and remote feedback is potentially an effective strategy. The objective of the trial is to investigate whether mobile health support using the InterWalk application for smartphones is effective in increasing physical activity levels in persons with T2D over time compared with standard care. We investigate whether Interval Walking Training using the InterWalk application is superior to Danish municipality-based rehabilitation in increasing moderate-and-vigorous physical activity levels in patients with T2D across 52 weeks. Secondary, we hypothesise that a motivational programme added from end of intervention to 52 weeks further increases level of physical activity in everyday life in patients with T2D.

METHODS AND ANALYSIS: The trial is a parallel-group, open-labelled, randomised controlled trial with long-term follow-up at 52 week including patients with T2D. The primary outcome is change in moderate-and-vigorous physical activity. The key secondary outcome includes motivation for physical activity behaviour change. Other secondary outcomes are VO2-peak, strength in the lower extremities. Exclusion criterion is medical contraindication to exercise. We include up to 246 patients and randomly allocate them into a control (standard group) or an experimental group (8-12 weeks of IWT supported by the smartphone-based InterWalk application) in a 1:2 fashion. After intervention, the experimental group is randomly allocated into two follow-up conditions with unsupervised IWT with or without motivational support until 52-week follow-up. The intention-to-treat principle is applied.

ETHICS AND DISSEMINATION: The local regional Research Ethics Committee in Denmark (H-1-2014-074) and the Danish Data Protection Agency (j.nr. 2014-54-0897) have approved the trial. Positive, negative or inconclusive results will be disseminated in scientific journals and conferences.

TRIAL REGISTRATION NUMBER: NCT02341690.

Originalsprog Engelsk
Tidsskrift B M J Open
Vol/bind 7
Tidsskriftsnummer 4
Sider (fra-til) e014036
Antal sider 11
ISSN 2044-6055
DOI
Status Udgivet - 7 apr. 2017

Background: A formula low-energy diet (LED) reduces weight effectively in obese patients with knee osteoarthritis, but the role of LED in long-term weight-loss maintenance is unclear.Objective: We aimed to determine the effect of intermittent LED compared with daily meal replacements on weight-loss maintenance and number of knee replacements over 3 y.Design: The design was a randomized trial with participants aged >50 y who had knee osteoarthritis and a body mass index [BMI (in kg/m(2))] ≥30. Participants were recruited from the osteoarthritis outpatient clinic at Copenhagen University Hospital in Frederiksberg, Denmark; they had previously completed a 68-wk lifestyle intervention trial and achieved an average weight loss of 10.5 kg (10% of initial body weight). Participants were randomly assigned to either the intermittent treatment (IN) group with LED for 5 wk every 4 mo for 3 y or to daily meal replacements of 1-2 meals for 3 y [regular (RE) group]. Attention by dietitians and the amount of formula products were similar. Primary outcomes were changes in body weight and proportion of participants receiving knee replacements. Outcomes were analyzed on the intention-to-treat-population with the use of baseline-carried-forward imputation for missing data.Results: A total of 153 participants (means ± SDs: BMI: 33.3 ± 4.6; age: 63.8 ± 6.3 y; 83% women) were recruited between June and December 2009 and randomly assigned to the IN (n = 76) or RE (n = 77) group. A total of 53 and 56 participants, respectively, completed the trial. Weight increased by 0.68 and 1.75 kg in the IN and RE groups, respectively (mean difference: -1.06 kg; 95% CI: -2.75, 0.63 kg; P = 0.22). Alloplasty rates were low and did not differ (IN group: 8 of 76 participants; RE group: 12 of 77 participants; P = 0.35).Conclusions: After a mean 10% weight-loss and 1-y maintenance, additional use of daily meal replacements or intermittent LED resulted in weight-loss maintenance for 3 y. These results challenge the commonly held assumption that weight regain in the long term is inevitable. This trial was registered at clinicaltrials.gov as NCT00938808.

Originalsprog Engelsk
Tidsskrift The American journal of clinical nutrition
ISSN 0002-9165
DOI
Status Udgivet - 26 jul. 2017

Managing occupations in everyday life for people with advanced cancer living at home

Peoples, H., Brandt, Å., Wæhrens, E. E. & la Cour, K. jan. 2017 I : Scandinavian Journal of Occupational Therapy. 24, 1, s. 57-64 8 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: People with advanced cancer are able to live for extended periods of time. Advanced cancer can cause functional limitations influencing the ability to manage occupations. Although studies have shown that people with advanced cancer experience occupational difficulties, there is only limited research that specifically explores how these occupational difficulties are managed.

OBJECTIVE: To describe and explore how people with advanced cancer manage occupations when living at home.

MATERIAL AND METHODS: A sub-sample of 73 participants from a larger occupational therapy project took part in the study. The participants were consecutively recruited from a Danish university hospital. Qualitative interviews were performed at the homes of the participants. Content analysis was applied to the data.

RESULTS: Managing occupations were manifested in two main categories; (1) Conditions influencing occupations in everyday life and (2) Self-developed strategies to manage occupations.

SIGNIFICANCE: The findings suggest that people with advanced cancer should be supported to a greater extent in finding ways to manage familiar as well as new and more personally meaningful occupations to enhance quality of life.

Originalsprog Engelsk
Tidsskrift Scandinavian Journal of Occupational Therapy
Vol/bind 24
Tidsskriftsnummer 1
Sider (fra-til) 57-64
Antal sider 8
ISSN 1103-8128
DOI
Status Udgivet - jan. 2017

Marine Oil Supplements for Arthritis Pain: A Systematic Review and Meta-Analysis of Randomized Trials

Senftleber, N., Nielsen, S. M., Andersen, J. R., Bliddal, H., Tarp, S., Lauritzen, L., Furst, D. E., Suarez-Almazor, M. E., Lyddiatt, A. & Christensen, R. 6 jan. 2017 I : Nutrients. 9, 1

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Arthritis patients often take fish oil supplements to alleviate symptoms, but limited evidence exists regarding their efficacy. The objective was to evaluate whether marine oil supplements reduce pain and/or improve other clinical outcomes in patients with arthritis. Six databases were searched systematically (24 February 2015). We included randomized trials of oral supplements of all marine oils compared with a control in arthritis patients. The internal validity was assessed using the Cochrane Risk of Bias tool and heterogeneity was explored using restricted maximum of likelihood (REML)-based meta-regression analysis. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rate the overall quality of the evidence. Forty-two trials were included; 30 trials reported complete data on pain. The standardized mean difference (SMD) suggested a favorable effect (-0.24; 95% confidence interval, CI, -0.42 to -0.07; heterogeneity, I² = 63%. A significant effect was found in patients with rheumatoid arthritis (22 trials; -0.21; 95% CI, -0.42 to -0.004) and other or mixed diagnoses (3 trials; -0.63; 95% CI, -1.20 to -0.06), but not in osteoarthritis patients (5 trials; -0.17; 95% CI, -0.57-0.24). The evidence for using marine oil to alleviate pain in arthritis patients was overall of low quality, but of moderate quality in rheumatoid arthritis patients.

Originalsprog Engelsk
Tidsskrift Nutrients
Vol/bind 9
Tidsskriftsnummer 1
ISSN 2072-6643
DOI
Status Udgivet - 6 jan. 2017

Mindre fastholdelse ved indtagelse af KOL-medicin hos patienter fra etniske minoriteter i København

Hu, A. Y., Cantarero-Arevalo, L., Frølich, A. & Jacobsen, R. 2017 I : Best Practice. Oktober 2017, s. 38-40 3 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelFormidling

Originalsprog Dansk
Tidsskrift Best Practice
Vol/bind Oktober 2017
Sider (fra-til) 38-40
Antal sider 3
ISSN 1473-9240
Status Udgivet - 2017

Neonatal Vitamin D Levels in Relation to Risk of Overweight at 7 Years in the Danish D-Tect Case-Cohort Study

Jensen, C. B., Lundqvist, M., Sørensen, T. I. A. & Heitmann, B. L. 10 jun. 2017 I : Obesity Facts. 10, 3, s. 273-283 11 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: Vitamin D level in pregnancy may be associated with risk of overweight in the offspring later in life.

METHODS: In a case-cohort study based on Danish biobanks and registers we examined the association between 25-hydroxy-vitamin D (25(OH)D) level at birth and overweight at 7 years. Cases of overweight (n = 871) were randomly selected among 7-year-old children from the Copenhagen School Health Records Register (CSHRR) with a BMI above the 90th percentile. The cohort (n = 1,311) was a random sample selected among all Danish children born during the same period. Neonatal 25(OH)D was measured in dried blood spots.

RESULTS: 25(OH)D3 exhibited the expected seasonal variation. Median level of 25(OH)D3 was 20.6 (11.9-33.3) nmol/l in the overweight group and 23.4 (13.5-34.3) nmol/l in the cohort. We found no association between neonatal 25(OH)D3 level and risk of overweight at age 7 years, neither in the crude model (OR (CI) 1.00 (0.99; 1.00)) nor in a model adjusted for maternal ethnicity, educational level, civil status, parity, season and year of birth, and offspring ponderal index (OR (CI) 1.00 (0.99; 1.01)).

CONCLUSION: Risk of overweight at 7 years of age was not associated with vitamin D level at birth.

Originalsprog Engelsk
Tidsskrift Obesity Facts
Vol/bind 10
Tidsskriftsnummer 3
Sider (fra-til) 273-283
Antal sider 11
ISSN 1662-4025
DOI
Status Udgivet - 10 jun. 2017

Background: Whether antenatal and neonatal vitamin D status have clinical relevance in fracture prevention has not been examined extensively, although observational studies indicate that fetal life may be a sensitive period in relation to bone growth and mineralization during childhood.Objective: We examined whether 25-hydroxyvitamin D3 [25(OH)D3] concentrations in stored neonatal dried blood spot (DBS) samples are associated with pediatric fracture risk. We hypothesized that in particular, low neonatal vitamin D status may be a risk factor for fracture incidence among children.Design: In a register-based case-cohort study design, the case group was composed of 1039 individuals who were randomly selected from a total of 82,154 individuals who were born during 1989-1999 and admitted to a Danish hospital with a fracture of the forearm, wrist, scaphoid bone, clavicle, or ankle at age 6-13 y. The subcohort was composed of 1600 individuals randomly selected from all Danish children born during 1989-1999. The neonatal 25(OH)D3 concentrations in DBS samples were assessed by using highly sensitive chromatography-tandem mass spectrometry.Results: The mean ± SD 25(OH)D3 concentration for all subjects was 27.7 ± 18.9 nmol/L [median (IQR): 23.5 nmol/L (13.3, 37.3 nmol/L)] and showed significant monthly variation (P < 0.0001) with the highest values in July and August. Individuals in the middle quintile of neonatal 25(OH)D3 had lower odds of sustaining a fracture than did those in the lowest quintile (adjusted OR: 0.75; 95% CI: 0.58, 0.96), but a global test did not show any significant overall association (adjusted P = 0.13).Conclusions: This study suggested that neonatal vitamin D status does not influence subsequent fracture risk in childhood. This is in accordance with studies that report no association between antenatal maternal vitamin D status and childhood fractures. Further studies are needed to examine fracture risk in relation to prenatal vitamin D status in a randomized controlled setting.

Originalsprog Engelsk
Tidsskrift The American journal of clinical nutrition
ISSN 0002-9165
DOI
Status Udgivet - 17 maj 2017

New perspectives on the development of muscle contractures following central motor lesions

Pingel, J., Bartels, E. M. & Nielsen, J. B. 15 feb. 2017 I : Journal of Physiology. 595, 4, s. 1027-1038 12 s.

Publikation: Bidrag til tidsskriftReviewForskningpeer review

Muscle contractures are common in patients with central motor lesions, but the mechanisms responsible for the development of contractures are still unclear. Increased or decreased neural activation, protracted placement of a joint with the muscle in a short position and muscle atrophy have been suggested to be involved, but none of these mechanisms are sufficient to explain the development of muscle contractures alone. Here we propose that changes in tissue homeostasis in the neuromuscular–tendon–connective tissue complex is at the heart of the development of contractures, and that an integrated physiological understanding of the interaction between neural, mechanical and metabolic factors, as well as genetic and epigenetic factors, is necessary in order to unravel the mechanisms that result in muscle contractures. We hope thereby to contribute to a reconsideration of how and why muscle contractures develop in a way which will open a window towards new insight in this area in the future. (Figure presented.).

Originalsprog Engelsk
Tidsskrift Journal of Physiology
Vol/bind 595
Tidsskriftsnummer 4
Sider (fra-til) 1027-1038
Antal sider 12
ISSN 0022-3751
DOI
Status Udgivet - 15 feb. 2017

Oral Lactobacillus Counts Predict Weight Gain Susceptibility: A 6-Year Follow-Up Study

Rosing, J. A., Walker, K. C., Jensen, B. A. H. & Heitmann, B. L. 2017 I : Obesity Facts. 10, 5, s. 473-482 10 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: Recent studies have shown an association between weight change and the makeup of the intestinal microbiota in humans. Specifically, Lactobacillus, a part of the entire gastrointestinal tract's microbiota, has been shown to contribute to weight regulation.

AIM: We examined the association between the level of oral Lactobacillus and the subsequent 6-year weight change in a healthy population of 322 Danish adults aged 35-65 years at baseline.

DESIGN: Prospective observational study.

RESULTS: In unadjusted analysis the level of oral Lactobacillus was inversely associated with subsequent 6-year change in BMI. A statistically significant interaction between the baseline level of oral Lactobacillus and the consumption of complex carbohydrates was found, e.g. high oral Lactobacillus count predicted weight loss for those with a low intake of complex carbohydrates, while a medium intake of complex carbohydrates predicted diminished weight gain. A closer examination of these relations showed that BMI change and Lactobacillus level was unrelated for those with high complex carbohydrate consumption.

CONCLUSION: A high level of oral Lactobacillus seems related to weight loss among those with medium and low intakes of complex carbohydrates. Absence, or a low level of oral Lactobacillus, may potentially be a novel marker to identify those at increased risk of weight gain.

Originalsprog Engelsk
Tidsskrift Obesity Facts
Vol/bind 10
Tidsskriftsnummer 5
Sider (fra-til) 473-482
Antal sider 10
ISSN 1662-4025
DOI
Status Udgivet - 2017

Osteoarthritis year in review 2016: imaging

Boesen, M., Ellegaard, K., Henriksen, M., Gudbergsen, H., Hansen, P., Bliddal, H., Bartels, E. M. & Riis, R. G. feb. 2017 I : Osteoarthritis and Cartilage. 25, 2, s. 216-226 11 s.

Publikation: Bidrag til tidsskriftReviewForskningpeer review

PURPOSE: The current narrative review covers original research related to imaging in osteoarthritis (OA) in humans published in English between April 1st 2015 and March 31st 2016, in peer reviewed journals available in Medline via PubMed (http://www.ncbi.nlm.nih.gov/pubmed/).

METHODS: Relevant studies in humans, subjectively decided by the authors, contributing significantly to the OA imaging field, were selected from an extensive Medline search using the terms "Osteoarthritis" in combination with "MRI", "Imaging", "Radiography", "X-rays", "Ultrasound", "Computed tomography", "Nuclear medicine", "PET-CT", "PET-MRI", "Scintigraphy", "SPECT". Publications were sorted according to relevance for the OA imaging research community with an emphasis on high impact special interest journals using the software for systematic reviews www.covidence.org.

RESULTS: An overview of newly published studies compared to studies reported previous years is presented, followed by a review of selected imaging studies of primarily knee, hip and hand OA focussing on (1) results for detection of OA and OA-related pathology (2) studies dealing with treatments and (3) studies focussing on prognosis of disease progression or joint replacement. A record high number of 1420 articles were published, among others, of new technologies and tools for improved morphological and pathophysiological understanding of OA-related changes in joints. Also, imaging data were presented of monitoring treatment effect and prognosis of OA progression, primarily using established radiographic, magnetic resonance imaging (MRI), and ultrasound (US) methods.

CONCLUSION: Imaging continues to play an important role in OA research, where several exciting new technologies and computer aided analysis methods are emerging to complement the conventional imaging approaches.

Originalsprog Engelsk
Tidsskrift Osteoarthritis and Cartilage
Vol/bind 25
Tidsskriftsnummer 2
Sider (fra-til) 216-226
Antal sider 11
ISSN 1063-4584
DOI
Status Udgivet - feb. 2017

Osteoarthritis: Time to put steroid injections behind us?

Bliddal, H. & Henriksen, M. jul. 2017 I : Nature reviews. Rheumatology. 13, 9, s. 519-520 2 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Originalsprog Engelsk
Tidsskrift Nature reviews. Rheumatology
Vol/bind 13
Tidsskriftsnummer 9
Sider (fra-til) 519-520
Antal sider 2
DOI
Status Udgivet - jul. 2017

BACKGROUND: Central pain mechanisms may be prominent in subsets of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and other spondyloarthritis (SpA). The painDETECT questionnaire (PDQ) identifies neuropathic pain features, which may act as a proxy for centrally mediated pain. The objectives were to quantify and characterize pain phenotypes (non-neuropathic vs. neuropathic features) among Danish arthritis patients using the PDQ, and to assess the association with on-going inflammation.

METHODS: The PDQ was included onto the DANBIO touch screens at 22 departments of Rheumatology in Denmark for six months. Clinical data and patient reported outcomes were obtained from DANBIO. A PDQ-score >18 indicated neuropathic pain features, 13-18 unclear pain mechanism and <13 non-neuropathic pain.

RESULTS: Pain data (visual analogue scale, VAS) was available for 15,978 patients. 7,054 patients completed the PDQ (RA: 3,826, PsA: 1,180, SpA: 1,093). 52% of all patients and 63% of PDQ-completers had VAS pain score ≥ 30 mm. The distribution of the PDQ classification-groups (<13/ 13-18/ >18) were; RA: 56%/24%/20%. PsA: 45%/ 27%/ 28%. SpA: 55% / 24%/ 21%. More patients with PsA had PDQ score >18 compared to RA and SpA (p<0.001). For PDQ > 18 significantly higher scores were found for all patient reported outcomes and disease activity scores. No clinical difference in CRP or swollen joint count was found. Logistic regression showed increased odds for having VAS pain ≥39 mm (the median) for a PDQ-score >18 compared to <13 (OR = 10.4; 95%CI 8.6-12.5).

CONCLUSIONS: More than 50% of the Danish arthritis patients reported clinically significant pain. More than 20% of the PDQ-completers had indication of neuropathic pain features, which was related to a high pain-level. PDQ-score was associated with DAS28-CRP and VAS pain but not with indicators of peripheral inflammation (CRP and SJC). Thus, pain classification by PDQ may assist in mechanism-based pain treatment.

Originalsprog Engelsk
Tidsskrift P L o S One
Vol/bind 12
Tidsskriftsnummer 7
Sider (fra-til) e0180014
ISSN 1932-6203
DOI
Status Udgivet - 2017

Patient reported outcomes in patients undergoing arthroscopic partial meniscectomy for traumatic or degenerative meniscal tears: comparative prospective cohort study

Thorlund, J. B., Englund, M., Christensen, R., Nissen, N., Pihl, K., Jørgensen, U., Schjerning, J. & Lohmander, L. S. 2 feb. 2017 I : B M J (Online). 356, s. j356

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

OBJECTIVES: To compare patient reported outcomes from before surgery to 52 weeks after surgery between individuals undergoing arthroscopic partial meniscectomy for traumatic meniscal tears and those for degenerative meniscal tears.

DESIGN: Comparative prospective cohort study.

SETTING: Four public orthopaedic departments in the Region of Southern Denmark. Participants were recruited between 1 February 2013 and 31 January 2014, and at one of the original four hospitals from 1 February 2014 to 31 January 2015.

PARTICIPANTS: Individuals selected from Knee Arthroscopy Cohort Southern Denmark, aged 18-55, and undergoing arthroscopic partial meniscectomy for a traumatic or degenerative meniscal tear (defined by a combination of age and symptom onset).

INTERVENTIONS: Both participant groups underwent arthroscopic partial meniscectomy for a meniscal tear, with operating surgeons recording relevant information on knee pathology. Patient reported outcomes were recorded via online questionnaires.

MAIN OUTCOME MEASURES: Primary outcome was the average between-group difference in change on four of five subscales of the knee injury and osteoarthritis outcome score (KOOS). The four subscales covered pain, symptoms, sport and recreational function, and quality of life (KOOS4). A 95% confidence interval excluding differences greater than 10 KOOS points between groups was interpreted as absence of a clinically meaningful difference. Analyses adjusted for age, sex, and body mass index.

RESULTS: 397 eligible adults (42% women) with a traumatic or degenerative meniscal tear (n=141, mean age 38.7 years (standard deviation 10.9); n=256, 46.6 years (6.4); respectively) were included in the main analysis. At 52 weeks after arthroscopic partial meniscectomy, 55 (14%) patients were lost to follow-up. Statistically, participants with degenerative meniscal tears had a significantly larger improvement in KOOS4 scores than those with traumatic tears (adjusted between-group difference -5.1 (95% confidence interval -8.9 to -1.3); P=0.008). In the analysis including KOOS4 score at all time points, a significant time-by-group interaction was observed in both the unadjusted (P=0.025) and adjusted analysis (P=0.024), indicating better self-reported outcomes in participants with degenerative tears. However, the difference between groups was at no time point considered clinically meaningful.

CONCLUSIONS: These results question the current tenet that patients with traumatic meniscal tears experience greater improvements in patient reported outcomes after arthroscopic partial meniscectomy than patients with degenerative tears.Trial registration ClinicalTrials.gov identifier NCT01871272.

Originalsprog Engelsk
Tidsskrift B M J (Online)
Vol/bind 356
Sider (fra-til) j356
ISSN 1756-1833
Status Udgivet - 2 feb. 2017

Physical activity, obesity and mortality: does pattern of physical activity have stronger epidemiological associations?

Bauman, A. E., Grunseit, A. C., Rangul, V. & Heitmann, B. L. 5 okt. 2017 I : BMC Public Health. 17, 1, s. 788

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: Most studies of physical activity (PA) epidemiology use behaviour measured at a single time-point. We examined whether 'PA patterns' (consistently low, consistently high or inconsistent PA levels over time) showed different epidemiological relationships for anthropometric and mortality outcomes, compared to single time-point measure of PA.

METHODS: Data were the Danish MONICA (MONItoring Trends and Determinants in CArdiovascular Disease) study over three waves 1982-3 (time 1), 1987-8 (time 2) and 1993-4 (time 3). Associations between leisure time single time-point PA levels at time 1 and time 3, and sport and active travel at times 1 and 2 with BMI, waist, hip circumference and mortality (death from coronary heart disease (CHD) and cardiovascular disease (CVD)) were compared to 'PA patterns' spanning multiple time points. PA pattern classified participants' PA as either 1) inactive or low PA at both time points; 2) moderate level PA at time 1 and high activity at time 3; or 3) a 'mixed PA pattern' indicating a varying levels of activity over time. Similarly, sport and active travel were also classified as indicating stable low, stable high and mixed patterns.

RESULTS: The moderately and highly active groups for PA at times 1 and 3 had up to 1.7 cm lower increase in waist circumference compared with the inactive/low active group. Across 'PA patterns', 'active maintainers' had a 2.0 cm lower waist circumference than 'inactive/low maintainers'. Waist circumference was inversely related to sport but not active travel. CHD risk did not vary by activity levels at time 1, but was reduced significantly by 43% for high PA at time 3 (vs 'inactive' group) and among 'active maintainers' (vs 'inactive/low maintainers') by 62%. 'Sport pattern' showed stronger reductions in mortality for cardiovascular disease and CHD deaths among sport maintainers, than the single time point measures.

CONCLUSIONS: PA patterns demonstrated a stronger association with a number of anthropometric and mortality outcomes than the single time-point measures. Operationalising PA as a sustained behavioural pattern may address some of the known under-estimation of risk for poor health in PA self-report measurements and better reflect exposure for epidemiological analysis of risk of health outcomes.

Originalsprog Engelsk
Tidsskrift BMC Public Health
Vol/bind 17
Tidsskriftsnummer 1
Sider (fra-til) 788
ISSN 1471-2458
DOI
Status Udgivet - 5 okt. 2017

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