A striving for independence: a qualitative study of women living with vertebral fracture

<p>Abstract</p> <p>Background</p> <p>Quantitative studies using generic and disease-specific health-related quality of life (HRQOL) questionnaires have shown that osteoporosis-related vertebral fractures have a significant negative effect on HRQOL, but there are only few studies that address what it means to live with vertebral fracture from a deeper experiential perspective. How HRQOL and daily life are affected several years after vertebral fracture and how women cope with this are more unclear. This study aimed to describe how HRQOL and daily life had been affected in women with vertebral fracture several years after diagnosis.</p> <p>Methods</p> <p>The study design was qualitative. Semi-structured interviews were conducted with ten Swedish women during 2008. Data were analysed using qualitative inductive content analysis.</p> <p>Results</p> <p>The findings of this study revealed three themes related to the influence on HRQOL and daily life: <it>A threatened independence</it>, i.e. back pain, anxiety, negative impact on self-image and consequences in daily life; <it>Strategies for maintaining independence</it>, i.e. coping, self-care and support; and <it>The importance of maintaining independence</it>, i.e. the ability to perform everyday activities, social interaction and having something meaningful to do. The women were striving for independence or maintaining their independence by trying to manage different types of symptoms and consequences in different ways.</p> <p>Conclusion</p> <p>HRQOL and daily life were strongly affected in a negative way by the impact of the vertebral fracture. Information from this study may provide new knowledge and understanding of the women's experiences of living with vertebral fracture from an insider's point of view in order to obtain a deeper understanding of the women's everyday life. However, further evaluation is still needed in larger study groups.</p

Journal of Human Hypertension advance online publication

Globally, hypertension is poorly controlled and its treatment consists mainly of preventive behavior, adherence to treatment and risk-factor management. The aim of this study was to explore patients&apos; experiences of an interactive mobile phone-based system designed to support the self-management of hypertension. Forty-nine patients were interviewed about their experiences of using the self-management system for 8 weeks regarding: (i) daily answers on self-report questions concerning lifestyle, well-being, symptoms, medication intake and side effects; (ii) results of home blood-pressure measurements; (iii) reminders and motivational messages; and (iv) access to a web-based platform for visualization of the self-reports. The audio-recorded interviews were analyzed using qualitative thematic analysis. The patients considered the self-management system relevant for the follow-up of hypertension and found it easy to use, but some provided insight into issues for improvement. They felt that using the system offered benefits, for example, increasing their participation during follow-up consultations; they further perceived that it helped them gain understanding of the interplay between blood pressure and daily life, which resulted in increased motivation to follow treatment. Increased awareness of the importance of adhering to prescribed treatment may be a way to minimize the cardiovascular risks of hypertension

Mastery and Autonomy in Medication With a Mobile Self-Report System – A Project in Action

Abstract. The overall aim of this research program is to design and examine if a mobile phone-based self-report system can be used to a) mediate knowledge about hypertension b) improve adherence to antihypertensive treatment and c) increase patient participation and autonomy

Health-related quality of life after vertebral or hip fracture: a seven-year follow-up study

<p>Abstract</p> <p>Background</p> <p>The negative impact of vertebral and hip low-energy fractures on health-related quality-of-life (HRQOL) has been demonstrated previously, but few prospective long-term follow-up studies have been conducted. This study aims to (i) investigate the changes and long-term impact of vertebral or hip fracture and between fracture groups on HRQOL in postmenopausal women prospectively between two and seven years after the inclusion fracture, (ii) compare HRQOL results between fracture and reference groups and (iii) study the relationship between HRQOL and physical performance, spinal deformity index and bone mineral density at seven-year follow-up.</p> <p>Methods</p> <p>Ninety-one women examined two years after a low-energy vertebral or hip fracture were invited to a new examination seven years after the diagnosis. HRQOL was examined using the SF-36 questionnaire and was compared with an age and sex-matched reference group. Physical function was assessed using tests and questionnaires. Bone mineral density was measured. Radiographs of the spine were evaluated using the visual semiquantitative technique. A longitudinal and cross-sectional design was used in this study. Statistical analyses included descriptive statistics, Student's <it>t</it>-tests, ANCOVA, and partial correlation.</p> <p>Results</p> <p>Sixty-seven women participated. In the 42 women (mean age 75.8, SD 4.7) with vertebral fracture as inclusion fracture, bodily pain had deteriorated between two and seven years and might be explained by new fracture. Remaining pronounced reduction of HRQOL was seen in all domains except general health and mental health at seven-year follow-up in women with vertebral fractures compared to the reference group (p < 0.05). All 25 women (mean age 75.0, SD 4.7) with hip fracture as inclusion fracture had no significant changes in HRQOL between two and seven years and did not differ from the reference group regarding HRQOL after seven years. The vertebral group had significantly lower values for bodily pain, vitality, role-emotional function and mental health compared to the hip group. HRQOL showed a positive relationship between physical activity, static balance and handgrip strength.</p> <p>Conclusion</p> <p>The long-term reduction of HRQOL in women with vertebral fracture emerged clearly in this study. The relationships between HRQOL and physical performance in women with vertebral and hip fracture raise questions for more research.</p

Health-Related Quality of Life in Postmenopausal Women with Osteoporotic Fractures

Background: The global burden of osteoporosis includes considerable numbers of fractures, morbidity, mortality and expenses, due mainly to vertebral, hip and forearm fractures. Underdiagnosis and undertreatment are common. Several studies have shown decreased health-related quality of life (HRQOL) after osteoporotic fracture, but there is a lack of data from long-term follow-up studies, particularly regarding vertebral fractures, which are often overlooked despite patients reporting symptoms. Aim: The overall aim of this thesis was to evaluate the usefulness of a recent low-energy fracture as index event in a case-finding strategy for osteoporosis and to describe and analyse long-term HRQOL in postmenopausal women with osteoporotic fracture. The specific aims were to describe bone mineral density and risk factors in women 55-75 years of age with a recent low-energy fracture (I), estimate the impact of osteoporotic fractures on HRQOL in women three months and two years after a forearm, proximal humerus, vertebral or hip fracture (II), investigate the changes and long-term impact of vertebral or hip fracture on HRQOL in women prospectively between two and seven years after the inclusion fracture (III), and describe how HRQOL and daily life had been affected in women with vertebral fracture several years after diagnosis (IV). Design and methods: Data were collected from southern Sweden between 1998 and 2008. A total of 303 women were included in Study I, and this group served as the basis for Studies II (n=303), III (n=67), and IV (n=10). A cross-sectional observational, case-control design (I), and a prospective longitudinal observational design (II-III) were used. In Study IV a qualitative inductive approach with interviews was used and data were analysed using a qualitative conventional content analysis. Results: The type of recent fracture and number of previous fractures are important information for finding the most osteoporotic women in terms of severity (I). Hip and vertebral fractures in particular have a significantly larger impact on HRQOL evaluated using the SF-36 than do humerus and forearm fractures, both during the three months after fracture and two years later, compared between the different fracture groups and the reference population (II). Women who had a vertebral fracture as inclusion fracture had remaining pronounced reduction of HRQOL at seven years. At the mean age of 75.5 years (±4.6 SD), the prevalence of vertebral fracture suggests more negative long-term impact on HRQOL, more severe osteoporosis and a poorer prognosis than a hip fracture does, and this effect may have been underestimated in the past (III). Study IV demonstrates that the women’s HRQOL and daily life have been strongly affected by the long-term impact of the vertebral fracture several years after diagnosis. The women strive to maintain their independence by trying to manage different types of symptoms and consequences in different ways. Conclusions and implications: Type and number of fractures should be taken into account in the case-finding strategy for osteoporosis in postmenopausal women between 55 and 75 years of age. The long-term reduction of HRQOL in postmenopausal women (age span 55-75 yr) with vertebral fracture emerged clearly, compared to women with other types of osteoporotic fractures and references in this thesis. The results ought to be taken into consideration when developing guidelines for more effective fracture prevention and treatment, including non-pharmacological intervention for women with osteoporotic fractures, with highest priority placed on vertebral fractures and multiple fractures, to increase or maintain HRQOL

Actors and intentions in the development process of a mobile phone platform for self-management of hypertension

Aim: The aim of this study was to enhance the knowledge regarding actors and intentions in the development process of a mobile phone platform for self-management of hypertension. Methods: Our research approach was a 14-month longitudinal “real-time ethnography” method of description and analysis. Data were collected through focus groups with patients and providers, patient interviews, and design meetings with researchers and experts. The analysis was informed by the concepts of actors and inscriptions in actor-network theory (ANT). Results: Our study showed that laypersons, scientific actors, as well as technology itself, might influence development processes of support for self-management of hypertension. The intentions were inscribed into the technology design as well as the models of learning and treatment. Conclusions: The study highlighted important aspects of how actors and intentions feature in the development of the mobile phone platform to support self-management of hypertension. The study indicated the multifacetedness of the participating actors, including the prominent role of technology. The concrete results of such processes included questions in the self-report system, learning and treatment models

Linköping University Medical Dissertations No. 1155 Health-Related Quality of Life in Postmenopausal Women with Osteoporotic Fractures

Published article has been reprinted with the permission of the copyrigh

http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-51527 BMC Musculoskeletal Disorders

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Interventions in hypothetical elder abuse situations suggested by Swedish formal carers.

In Sweden, public attention has not focused on elder abuse. No common view of interventions or organizational repsonsibilities has been developed. The aim of this study was to describe interventions suggested by Swedish formal carers in three hypothetical, typical cases of elder abuse. From one municipality in Sweden, 71 formal carers (district nurses, home service assistants, and general practitioners0 responded to a questionnaire concerning three cases: "The Spouse Abuse Case," "The Dependent Adult Child Case," and "The Caregiving Relative Case." Cluster analysis of the interventions was performed to explore patterns and reduce the number of variables. The findings showed that the respondents suggested few interventions, mainly vieweing the problem as a social one, more specifically, as one for health care and voluntary organizations, or they suggested all types of interventions. The respondents' professions were significantly related to their suggested interventions, i.e., there was a proportional predominance of district nurses suggesting more interventions of all types. Each professional group and organization seemed to develop their own view of elder abuse. The suggested interventions were related to their professional discipline, the specific type of situation, and the two cultures of health and social care