L M Smedstad

Diakonhjemmet Hospital (Norway), Kristiania (historical), Oslo County, Norway

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Publications (18)39.88 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: The objective was (1) to examine the prevalence of rheumatoid arthritis (RA) by a county patient register, (2) to cross-validate the register findings by a postal population survey, and (3) to estimate prevalences of disease subsets according to age, sex, and levels of physical disability. The study was performed within a county setting in the city of Oslo with 356,486 inhabitants between 20 and 79 years of age. Prevalence estimates were calculated from a county patient register comprising 1333 patients with RA and a population survey of 10,000 inhabitants. The overall prevalence of RA between 20 and 79 years was 0.437 (95% CI 0.413, 0.461) after adjusting for the incompleteness of the register by a factor of 1.17. Prevalences exceeding 1.0% was only found among females over 60 years. The prevalence of RA with MHAQ scores ≥1.5 and ≥2.0 (range 1–4) was 0.225 (95% CI 0.209, 0.243) and 0.099 (0.088, 0.111) respectively. We conclude that RA is less frequent in the city of Oslo than stated in most of the literature. The prevalence of RA with physical disability levels assumed to be associated with increased mortality is less than half of the overall prevalence of 0.4–0.5%.
    07/2009; 26(6):412-418.
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    ABSTRACT: To examine the agreement between and compare the sensitivity to change of the Arthritis Impact Measurement Scale (AIMS2) and AIMS2 Short Form (AIMS2-SF) in a large sample of rheumatoid arthritis (RA) patients examined within the framework of a longitudinal observational study. Data were collected from patients in a community based RA register by a postal survey in April 1994 (1,030 respondents) and again in 1996 (1,153 respondents), comprising AIMS2, Modified Health Assessment Questionnaire (MHAQ), Medical Outcome Survey SF-36, and other commonly used health status measures. The degree of agreement was examined by plotting differences between AIMS2 and AIMS2-SF against the mean of the 2 scores for the 5 main components. The upper and lower limits of agreement (mean diff. +/- 1.96 SD) were calculated and plotted. The intraclass correlation coefficients were computed by repeated measurement ANOVA. Validity was assessed on the basis of external indicators of health status, and responsiveness on the basis of standardized response means. The AIMS2 and AIMS2-SF showed substantial to near-perfect agreement. Best agreement was seen for the physical and affect components. Better agreement for the symptom component was obtained when replacing item 42 with item 38. Internal consistency was high in all components. The 2 forms correlated similarly with scores from other instruments within the same domains, showing similar construct validity. There was no difference in responsiveness between the 2 forms when using changes in patient assessed global disease activity as external indicator of change in health status, and responsiveness for the physical and symptom dimension was similar to other instruments (SF-36, MHAQ). The AIMS2-SF is amenable for use in large surveys with a modification of one item in the symptom scale.
    The Journal of Rheumatology 01/2001; 27(12):2810-6. · 3.26 Impact Factor
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    ABSTRACT: : To examine the course of RA over 5 yr and identify predictors of psychological, physical and radiographic outcome. Out of 238 patients with rheumatoid arthritis of no more than 4 (mean 2.2) yr duration, 182 (76%) completed a clinical examination with follow-up at 1, 2, and 5 yr. The course of the disease was assessed by measures of psychological and physical health status, disease process and radiographic damage. : Over 5 yr we observed at a group level a stable disease course for measures of disease process, psychological and physical health status. Radiographic damage progressed. Health status and radiographic damage after 5 yr were predicted by the baseline measures for the respective outcome. Physical function was also predicted by age and by psychological status when the physical dimension of the Arthritis Impact Measurement Scales was chosen as outcome variable. Erythrocyte sedimentation rate and presence of rheumatoid factor predicted radiographic progression. : The 5 yr course of RA was characterized by preserved health status measures and clinically preserved disease process measures, whereas joint damage progressed steadily. Outcomes after 5 yr can be predicted partly by certain measures at baseline.
    Rheumatology 08/2000; 39(7):732-41. · 4.21 Impact Factor
  • K B Hagen, L M Smedstad, T Uhlig, T K Kvien
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    ABSTRACT: To compare the responsiveness of 2 disease-specific questionnaires, the Modified Health Assessment Questionnaire (MHAQ) and the Arthritis Impact Measurement Scale (AIMS2) with corresponding dimensions (physical function, mental health, pain, and fatigue) in a generic health status measure [the MOS Short Form-36)] in patients with rheumatoid arthritis (RA). Within the framework of an observational study, a prospective cohort of 595 patients with RA from a community based patient register responded to a questionnaire at baseline and after 2 years' followup. Changes in patient global disease activity assessed on a categorical verbal rating scale (range 1-5) were used as external indicator of improvement or deterioration. Responsiveness was evaluated with standardized response means (SRM), calculated as mean change score divided by the standard deviation of the mean change score. Changes in patient global disease activity were classified as much better (n = 33), slightly better (n = 108), no change (n = 291), slightly worse (n = 108), and much worse (n = 20). There were no significant differences in responsiveness between SF-36 and the disease-specific measures within the same dimensions of health. The SRM of the tools within the dimension of pain (AIMS2 and SF-36) were moderate (0.5-0.8) to large (> 0.8) consistently in both directions (improvement and deterioration). The physical function subscales detected the same pattern, but the magnitude of the gradients was smaller. The fatigue and mental health subscales did not show any clear and consistent pattern of change. In patients with RA, there was no difference in responsiveness of subscales from SF-36 and disease-specific instruments when using changes in patient assessed global disease activity as an external indicator of change in health status. The dimension of pain was most sensitive to changes in patient assessed global disease activity followed by physical function, fatigue, and mental health.
    The Journal of Rheumatology 07/1999; 26(7):1474-80. · 3.26 Impact Factor
  • T K Kvien, S Kaasa, L M Smedstad
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    ABSTRACT: The performance of the SF-36 was compared with disease-specific health status instruments (Arthritis Impact Measurements Scales [AIMS2], Modified Health Assessment Questionnaire [MHAQ] and visual analogue scales) in 1030 patients with rheumatoid arthritis (mean age 62.3 years, 79% females, mean disease duration 12.9 years, 48% rheumatoid factor positive). The scales performed similarly in known group comparisons (age cohorts, disease severity, disease activity, comorbidity). The SF-36 physical functioning scale correlated -0.69 and -0.73 with the MHAQ and AIMS2 physical scales, respectively. A strong negative correlation was found with the walking and bending subscale of AIMS2 (r = -0.80), a substantial negative correlation with mobility (r = -0.65), and moderate correlations with the scales for hand/finger and arm function (r = -0.52 and r = -0.53). Frequency distributions of scores revealed more skewed distributions of the AIMS2 physical scale and the MHAQ scale than the physical functioning scale of the SF36, whereas the pain and mental health scales were distributed similarly. In conclusion, the SF-36 performs well in patients with rheumatoid arthritis. The physical functioning scale of the SF-36 does not seem to capture all aspects of physical health in rheumatoid arthritis patients, but may be more sensitive than disease-specific measures to low levels of physical disability.
    Journal of Clinical Epidemiology 12/1998; 51(11):1077-86. · 5.33 Impact Factor
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    ABSTRACT: To examine the incidence of rheumatoid arthritis (RA) in the community of Oslo, Norway; and to link the incidence to measures of disease severity. A register for RA in the county of Oslo was validated to be 85% complete for patients between 20 and 79 years of age. The incidence of RA was calculated from this register for patients with disease onset 1988-1993 (n=550). Data on health related quality of life [Modified Health Assessment Questionnaire (MHAQ), Arthritis Impact Measurement Scale 2 (AIMS2), pain, fatigue] were obtained from a postal survey (response rate 73%). The overall annual incidence of RA over a 6 year period was 25.7/100,000 (females 36.7, males 13.8). The incidence increased with age, from 7.8 in the age group 20-29 to 61.0 between 70 and 79 years. After 5 year followup a clinically important effect on physical function (MHAQ > 1.5) was seen in 38% of the patients, on social functioning (AIMS2 social > 4) in 50%, on mental distress (AIMS2 affect > 4) in 27%, on pain (VAS > 40 mm) in 35%, and on fatigue (VAS > 40 mm) in 41%. The incidence of RA was 25.7/100,000 in the population of Oslo. After 5 years, 40-50% had clinically important changes in health status. The annual disease incidence with clinically important effect on physical function after 5 years was 10/100,000 individuals at risk.
    The Journal of Rheumatology 06/1998; 25(6):1078-84. · 3.26 Impact Factor
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    L M Smedstad, P Vaglum, T Moum, T K Kvien
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    ABSTRACT: In this longitudinal study (12 and 24 months follow-up) of 216 patients with early rheumatoid arthritis (RA) (< or = 4 yr duration), we assessed the strength and stability of the relationship between psychological distress and traditional clinical variables examined the ability of these clinical variables to predict changes in mental distress, and explored the directionality between mental distress and the other clinical variables. Study variables were symptoms of anxiety and depression measured by the Arthritis Impact Measurement Scales, tender joint counts, erythrocyte sedimentation rate (ESR), and self-reported pain and disability. Psychological distress showed high levels of stability over time. Pain and disability were the two variables most strongly and consistently related to mental distress. High levels of disability predicted an increase in depression during the next year; otherwise, changes in psychological distress were not predicted by disease-related variables. Attempts at causal modelling of the temporal relationship between mental distress, pain and disability failed to yield consistent results.
    British journal of rheumatology 12/1997; 36(12):1304-11.
  • A Finset, L M Smedstad, B Ogar
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    ABSTRACT: The physician-patient relationship may be important in helping cancer patients to cope with their disease, but little research has focused on the role of the physician in the process of coping with cancer. The objective of this study was to investigate the patients' experience of the informational and emotional aspects of physician-patient interactions, and the relevance of these two aspects of such interactions for the coping process. In three focus group sessions, patients were interviewed about their relationships with their physicians. Statements about physician-patient interactions were subjected to quantitative and qualitative analysis. How physicians helped the patients to cope with their illness was seldom spontaneously mentioned in any of the three focus group sessions. The patients frequently described specific encounters with doctors, often with an emotional content. When asked, they indicated that these encounters had been important in their adaptation to their illness. The findings indicate that coping strategies tend to remain an implicit topic in physician-patient interactions. Some patients consider emotional components of physician behavior to be significant for their coping. Physicians should consider more explicitly therapeutic strategies to enhance patient coping behaviors.
    Journal of Cancer Education 02/1997; 12(3):174-8. · 0.88 Impact Factor
  • L M Smedstad, T K Kvien, T Moum, P Vaglum
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    ABSTRACT: Considering the key position of patients' global assessment in clinical practice and research, we wanted to examine the relationships between patients' global assessment and biological, functional, and mental variables, and to explore the relative contribution of these variables on patients' assessment of arthritis impact. Patients with RA of < or = 4 yrs duration were examined at baseline (n = 238) and after 12 and 24 months (n = 216). Study variables were tender joints, ESR, CRP, hand X-ray abnormalities and self-reported global arthritis impact, pain, disability, and symptoms of depression. 2-yr mean scores were computed for all variables. Strong correlations were found between patients' global assessment and pain (r = .73), depression (r = .68), disability (r = .64), and tender joints (r = .51), while ESR, CRP, and X-ray abnormalities correlated weakly with the global assessment. Using a multivariate approach, however, the relative effects of disability and tender joints were no longer statistically significant, whereas pain and depression still had significant impact on patients' global assessments.
    Scandinavian Journal of Rheumatology 01/1997; 26(4):259-65. · 2.22 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: The objective was (1) to examine the prevalence of rheumatoid arthritis (RA) by a county patient register, (2) to cross-validate the register findings by a postal population survey, and (3) to estimate prevalences of disease subsets according to age, sex, and levels of physical disability. The study was performed within a county setting in the city of Oslo with 356,486 inhabitants between 20 and 79 years of age. Prevalence estimates were calculated from a county patient register comprising 1333 patients with RA and a population survey of 10,000 inhabitants. The overall prevalence of RA between 20 and 79 years was 0.437 (95% CI 0.413, 0.461) after adjusting for the incompleteness of the register by a factor of 1.17. Prevalences exceeding 1.0% was only found among females over 60 years. The prevalence of RA with MHAQ scores > or = 1.5 and > or = 2.0 (range 1-4) was 0.225 (95% CI 0.209, 0.243) and 0.099 (0.088, 0.111) respectively. We conclude that RA is less frequent in the city of Oslo than stated in most of the literature. The prevalence of RA with physical disability levels assumed to be associated with increased mortality is less than half of the overall prevalence of 0.4-0.5%.
    Scandinavian Journal of Rheumatology 01/1997; 26(6):412-8. · 2.22 Impact Factor
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    ABSTRACT: Self-reported diagnoses of rheumatic conditions are frequently used in epidemiological and clinical research. Our objectives were to examine the validity of patient self-reported rheumatoid arthritis (RA); and to assess the predictive value of symptoms, health status measures, and demographic variables with respect to the actual diagnosis. A postal survey was performed in Oslo of 10,000 randomly selected individuals between 20 and 79 years of age. Respondents reported musculoskeletal pain, stiffness, rheumatic diagnoses, disability, and mental distress. The patients reporting RA (either according to patient or doctor) were selected for further examination. Of 5886 respondents (3670 with musculoskeletal pain or stiffness) 158 patients (2.7%) reported having RA diagnosed by doctor (n = 107) and/or according to their own opinion (n = 142). RA was confirmed by clinical examination in 35 of these 158 individuals (22%, CI 16,29). Patients with perceived and actual RA differed regarding self-reported presence of swollen joints and disability score. Multivariate analyses failed to identify a set of useful predictors for the correct diagnosis. Patient self-reported diagnosis of RA is unreliable for research or clinical purposes.
    The Journal of Rheumatology 12/1996; 23(11):1866-71. · 3.26 Impact Factor
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    ABSTRACT: In this cross-sectional study of 706 European patients with rheumatoid arthritis (RA) of < or = 4 yr duration, we examined possible correlates of functional disability assessed by the Health Assessment Questionnaire. First, we examined a subsample of 237 Norwegian patients. The Ritchie index, sex, age, erythrocyte sedimentation rate (ESR) and disease duration correlated significantly with disability, whereas serum rheumatoid factor, hand X-ray changes and educational level did not. Subsequently, we cross-validated these findings in a similar sample of 469 French, Dutch and Northern Irish patients. The results supported the Ritchie index, sex, ESR and disease duration as significant correlates of disability, whereas rheumatoid factor, age and education were not significantly correlated with disability. The correlation between X-ray changes and disability could not be cross-validated. The main findings of this study are that female sex correlates significantly with disability even early in the course of RA, whereas the rheumatoid factor does not.
    British journal of rheumatology 09/1996; 35(8):746-51.
  • L M Smedstad, T Moum, P Vaglum, T K Kvien
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    ABSTRACT: The objective of our study was to estimate the impact of early rheumatoid arthritis (RA) on psychological distress by comparing patients with RA and matched controls. A sample of 238 patients (age 20-70 years, mean age 52 yrs) with RA of 0 to 4 years duration (mean 2.2 yrs), was compared to 116 control persons matched to the patients with respect to sex, age, and geographic area. Data were collected through self-report questionnaires. Patients with RA rated their mental health significantly lower than the controls. Symptoms of anxiety and depression were significantly higher among arthritic patients. Twenty% of the patients had scores indicating possible psychiatric caseness compared to 6% of the controls. However, controlling for pain, disability, and fatigue, there was no significant difference in psychological distress between the patients and the controls. RA appears to have a strong impact on mental distress even early in the disease. The present study demonstrates that pain, disability, and fatigue are strongly related to the increased levels of psychological distress in RA.
    Scandinavian Journal of Rheumatology 02/1996; 25(6):377-82. · 2.22 Impact Factor
  • L M Smedstad, T K Kvien, T Moum, P Vaglum
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    ABSTRACT: To explore how life events, psychosocial factors, and demographic variables are related to one-year changes in disability in early rheumatoid arthritis (RA). A sample of 238 patients with RA of 48 mo duration or less was examined at baseline and after 12 mo (n = 227; 95%). Data on life events and psychosocial variables were collected by structured interviews, and functional disability was measured by the Health Assessment Questionnaire (HAQ). Analyses of variance and forward stepwise linear regression analyses were used as statistical procedures. Mean functional disability measured by the HAQ was relatively low at baseline and remained stable during one year. Positive life events experienced during the past year were significantly related to improved physical ability, whereas female sex was significantly related to reduction in ability. Neither age, income, education, number of network members, symptoms of mental distress, nor negative life events in the past year significantly predicted one-year changes in functional limitations. The experience of positive life events during the past year was significantly related to a reduction in disability in this prospective study of 238 patients with early RA. This finding adds to our knowledge regarding the relationship between psychosocial factors and disease progression in RA.
    The Journal of Rheumatology 01/1996; 22(12):2218-25. · 3.26 Impact Factor
  • L. M. Smedstad, T. Mourn, P. Vaglum, T. K. Kvien
    Scandinavian Journal of Rheumatology - SCAND J RHEUMATOL. 01/1996; 25(6):377-382.
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    ABSTRACT: To compare a disease specific measure of functional status, the Health Assessment Questionnaire (HAQ) with a generic measure of functional status, the Groningen Activity Restriction Scale (GARS) in a cross cultural and longitudinal setting. Besides the comparison of psychometric properties, sex differences were also studied. In a sample of 634 patients with rheumatoid arthritis (RA) (290 from The Netherlands, 116 from France, 228 from Norway), the psychometric properties (Cronbach's alpha and rho) of the GARS and the HAQ were compared among countries. The sensitivity for change between T1 and T2 was tested by means of the standardized response mean for a one year followup; furthermore, the relative efficiency of both instruments was computed. A t test was used to trace sex differences. The psychometric properties of both the HAQ and the GARS were very good. Both form unidimensional scales of hierarchically ordered items; alpha and rho are > 0.91 for both instruments. For patients who improved between T1 and T2, measured by the Ritchie Articular Index, the standardized response mean of the HAQ and the GARS were moderate, whereas for patients who worsened, the standardized response means were small. The results based on the relative efficiency were ambiguous. Furthermore, the mean score for women on the HAQ was 0.25 higher in contrast to scores for men. The GARS did not yield different scores for women and men. The internal consistency of the GARS and the HAQ are comparable. The HAQ has yielded different results for women and men. Therefore, when the HAQ is used, sex differences should be taken into account. With respect to sensitivity to change, the GARS and the HAQ obtained much better results for patients who improved in contrast to patients who worsened. The GARS was found to be more sensitive to change for patients who improved.
    The Journal of Rheumatology 10/1995; 22(10):1834-43. · 3.26 Impact Factor
  • L M Smedstad, P Vaglum, T K Kvien, T Moum
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    ABSTRACT: Self-reported pain is one of the core endpoint measures in RA. The objective of this cross sectional study of 238 patients with rheumatoid arthritis (RA) was to examine the relationship between self-reported pain intensity, sociodemographic variables, anxiety, and depressive symptoms. A weighted sum score of pain intensity was constructed by combining a visual analog pain scale with items from the Arthritis Impact Measurement Scales (AIMS) and the Nottingham Health Profile. Symptoms of anxiety and depression were measured by subscales of Multiple regression analyses showed no significant effects of age, sex, income, or level of education on self-reported pain intensity, whereas there was a significant association between the pain index and anxiety and depressive symptoms. The correlation between the pain index and anxiety, and the pain index and depression, was 0.46 for both. Controlling for sociodemographic variables, the Ritchie index, erythrocyte sedimentation rate, and C-reactive protein, the standardized regression coefficients were 0.33 and 0.31 of the pain index on the AIMS anxiety and depression subscale, respectively. Furthermore, the results indicate that the effect of inflammation on mental distress is mediated by pain. Self-reported pain in RA is not significantly influenced by sex, age, level of education, or income. Even when controlling for disease activity, there was a considerable correlation between self-reported pain and mental distress. Furthermore, our study lends support to the hypothesis that mental distress is mainly secondary to pain rather than vice versa.
    The Journal of Rheumatology 04/1995; 22(3):514-20. · 3.26 Impact Factor

Publication Stats

528 Citations
14 Downloads
598 Views
39.88 Total Impact Points

Institutions

  • 1996–2009
    • Diakonhjemmet Hospital (Norway)
      Kristiania (historical), Oslo County, Norway
  • 1995–1999
    • University of Oslo
      • Department of Behavioural Sciences in Medicine
      Kristiania (historical), Oslo County, Norway