Objectives Consideration of health literacy (HL) in shared decision-making (SDM) is key to improving rehabilitation outcomes and addressing social health inequities. Therefore, the aim of this study was to investigate the relationship between HL skills and patient-perceived involvement in SDM within goal setting in rheumatology rehabilitation. Methods A multicentre online survey was sent to patients attending goal setting in rehabilitation. SDM was measured with the patient-reported questionnaire CollaboRATE (CollaboRATE is a brief patient‑reported measure of shared decision making; the top score reflects optimal SDM) and HL skills with the Health Literacy Questionnaire (HLQ, 9 scales). Associations between HLQ scores and CollaboRATE (suboptimal vs optimal [top score]) were investigated by polynomial logistic regression analyses adjusted for possible covariates. Results A total of 408/514 (79%) patients responded to the survey; 401 (78%) completed both questionnaires (mean age 58.5 years [SD: 12.4], disease duration 11.4 years [SD: 11.2], 85% women). A linear relationship between HLQ and CollaboRATE was demonstrated in 2/9 HLQ scales, while 5/9 HLQ scales showed a U/J-shaped pattern (P < .039). Higher HLQ scores were associated with the greatest probability of reporting optimal SDM, followed by lower scores. In contrast, moderate scores were more frequently associated with suboptimal SDM. Two HLQ scales showed no association with SDM. More men than women reported suboptimal SDM (64% vs 48%, P = .02). Conclusions This study found a complex relationship between HL skills and patients’ experience of involvement in SDM, and these findings highlight the need for tailored support from healthcare providers to facilitate meaningful SDM, particularly for those facing challenges related to HL including individuals with moderate HL skills.

Objectives Patients with rheumatoid arthritis (RA) can reduce their increased risk for cardiovascular diseases and improve symptoms and quality of life with healthy lifestyle habits. This study aimed to explore patients’ experiences of managing their lifestyle habits following a diagnosis of RA. Methods In this qualitative study, 20 patients with RA, 14 women, and 6 men, were included. Individual semistructured interviews were conducted, and a qualitative content analysis resulted in 7 subcategories and 3 categories. Results Patients’ experiences of managing lifestyle habits following a diagnosis of RA included perceived barriers, strategies, and benefits associated with adopting a healthy lifestyle. Barriers were described in relation to pain, impaired function, and feelings of being overwhelmed by a new diagnosis. Strategies were shaped by newly acquired knowledge and positive experiences that served as sources of motivation. The benefits of healthy lifestyle habits were linked to enhanced physical and psychological well-being and improved RA management. Conclusions This study shows that patients following an RA diagnosis experience not only barriers to adopting a healthy lifestyle, but also strategies and benefits that support healthy lifestyle changes.

PURPOSE:To explore how employers support their employees with inflammatory arthritis (IA) to maintain their job, prevent sick leave and job loss. The study aimed to inform the development of a novel vocational rehabilitation offer, WORK-ON. MATERIALS AND METHODS:A qualitative study using semi-structured individual interviews was performed with employer representatives. The analysis followed Kirsti Malterud's systematic text condensation. RESULTS:Thirteen interviews were performed from November 2020 to February 2021. Three main themes derived: Support to enable continuous participation in work. All participants facilitated adaptations at the workplace, but found it complicated and time consuming. They demonstrated awareness of the employees' need to balance work and family in everyday life.A trusting relationship between employer and employee. The participants encouraged employees to be open about their condition and asked for mutual respect and a trusting relationship to be able to facilitate support when needed.Need for medical and legislative expertise. The participants engaged with municipal job centres and trade unions, although the cooperation could be challenging. CONCLUSION:The employers supported their employees, emphasising a trusting relationship. They considered prevention of sick leave and job loss to be complicated and asked for medical and legal expertise.

IntroductionMilitary service places high physical demands on conscripts, requiring adequate aerobic capacity, strength, power, and body composition. This study examined longitudinal changes in body composition and physical performance among Swedish conscripts during military training.MethodsA total of 218 Swedish conscripts completed 12 weeks of Basic Military Training (BMT) followed by 32 weeks of Specialized Military Training (SMT). Physical assessments were conducted at baseline, after BMT, and after SMT. Outcomes included aerobic capacity (V̇O₂peak), muscular strength and power, multitest performance, and body composition measured using bioelectrical impedance analysis.ResultsBMT elicited marked improvements in endurance, with V̇O₂peak increasing by 6.4%. By the end of service, V̇O₂peak had increased by 9.8% overall. Multitest performance improved by 35% across the full training period, with most gains occurring during BMT. Lower-body power showed modest unilateral improvements. Body composition changes included increased skeletal muscle mass and reduced body fat.DiscussionMilitary training substantially improved aerobic fitness and overall physical performance, particularly during the initial BMT phase. However, improvements in muscle mass and power were limited. These findings highlight the need for training strategies that better optimize physical readiness and reduce fatigue-related risk during modern military operations.

PurposeThe complex Interdisciplinary Nurse-coordinated SELf-MAnagement (INSELMA) intervention for patients with IA who experience substantial disease impact, was tested in a feasibility study. This study explored healthcare professionals' (HPs) experiences of delivering the intervention.Materials and methodsA qualitative longitudinal evaluation study was conducted based on four focus group interviews. Twelve HPs participated from two outpatient rheumatology hospitals in Denmark. Data was analyzed using qualitative content analysis.ResultsFive themes emerged (1) Change in work tasks required training, (2) New professional roles challenged professional identities, (3) Meaningful and increased coherence in pathways, (4) Enabling support for patients with complex health issues, and (5) Appreciated interdisciplinary collaboration.ConclusionThe HPs found the new roles and tasks challenging, but perceived the INSELMA intervention as meaningful for the patients, enhanced coherence, strengthened the relation with the patient and ensured continuous follow-up on goals.

Knee pain is often an early sign of knee osteoarthritis (KOA). Physical activities (PA) constitute the recommended regime to those affected. However, knee-loading PA at work is linked to an increased risk for KOA. The primary aim of this study was to investigate associations between knee pain and accelerometer-measured knee-loading PA, at work and leisure respectively. The secondary aim was to investigate knee-related problems in relation to self-reported physical effort at work. This cross-sectional study included 107 working participants (aged 30–67) with knee pain. Knee pain was evaluated using the Knee Injury and Osteoarthritis Outcome Scale (KOOS), subscale Pain. Knee-loading PA (including daily steps, time in upright position, stair walking), and sitting/lying were measured by accelerometer for one week. Each knee-loading PA was analysed separately for the measurement periods: (1) total period, (2) time at work, and (3) leisure on workdays. Knee-related problems were evaluated by the KOOS subscales Symptoms, Activities of Daily Living, Function in Sport and Recreation, and Quality of Life. Analyses were made with linear regression, and stratified by high or low self-reported physical effort at work. Participants with more knee pain walked on average fewer steps per day, and spent less time in an upright position during leisure on workdays, unstandardized coefficient (β) = 0.001, p = 0.044, β = 0.075, p = 0.001 respectively, i.e. spent less time in knee-loading PA. The associations were stronger for those reporting high physical effort at work, β = 0.116, p = 0.016. Participants with high physical effort at work rated their (knee-related) quality of life worse. There were no associations between knee pain and knee-loading PA during work hours. Participants with more knee pain were less physically active during leisure, with stronger associations among those with higher physical effort at work. Those reporting high physical effort at work had worse (knee-related) quality of life compared to participants reporting low effort at work. This highlights the importance of taking knee-loading PA at work and leisure into account when recommending exercise regimes to individuals with knee pain. ClinicalTrials.Gov (NCT04928170), Date of registration: 2017-12-20.

To explore healthcare professionals' (HPs’) experiences of work-related challenges among people with inflammatory arthritis (IA). A qualitative, interview study using a hermeneutic approach was planned. HPs with different professional backgrounds working with people with rheumatic diseases were recruited. An interview guide was developed according to relevant literature. The analysis followed Graneheim and Lundman’s qualitative content analysis. Twenty-one HPs representing two municipalities, three hospitals, a university college and one patient organisation participated in individual semi-structured interviews. The analysis derived three themes: (1) Work identity and living with IA. The disease causes emotional and economic effects regarding fulfilling roles in everyday life, including work; (2) Opportunities and challenges when supporting patients. Promoting and inhibiting factors that affect retention in the labour market include organisational factors at work, opportunities for involving the patient’s relatives and working interprofessionally and cross-sectorally; and (3) Cooperation with employers. People with IA use different strategies and opportunities for compensatory schemes to maintain work. Cooperation with employers is an important part of vocational rehabilitation. HPs experience that people with IA find it difficult to manage their everyday life, including work. HPs want to support people with IA to maintain their jobs but find it difficult if the patient has not informed the employer about the disease. This study clarifies the need for vocational rehabilitation to support people with IA to stay in work, from time of diagnosis through hospitalisation, municipal rehabilitation and job clarification.

Objectives Inflammatory arthritis significantly impacts daily life, requiring interdisciplinary support despite optimal pharmacological treatment. We developed a 6-month interdisciplinary nurse-coordinated self-management intervention (INSELMA) based on the British Medical Research Council’s framework for complex interventions. The intervention includes a biopsychosocial assessment, goal setting, and continuous support from the coordinating nurse, with referrals to other healthcare professionals and municipal offers. This study aimed to evaluate the feasibility of the INSELMA intervention. Methods We conducted a multicentre single-arm pre-test-post-test study. Patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) were recruited via the Danish nationwide Rheumatology registry, DANBIO. Patient-reported outcomes were collected at baseline and end of the intervention. Feasibility was assessed by evaluating recruitment, retention, attendance rates, fidelity, goal setting, activities, resources and data collection methods. Results A total of 386 patients were screened, 18 were included (8 with RA, 6 with PsA and 4 with AxSpA) and 17 completed the 6-month intervention. The interdisciplinary team allocated an average of 8 hours per participant, with nurses contributing 5.4 hours. Seventy-four per cent of the participants were referred to physiotherapists, 24% to occupational therapists and none to social workers. Patient-reported outcome measures at baseline and 6 months indicated reduced anxiety, depression and pain and improved mental well-being, coping with fatigue, overall disease impact and quality of life. Conclusions The INSELMA intervention is considered feasible and potentially effective in supporting patients with inflammatory arthritis by reducing disease impact and improving quality of life. Further testing in a larger randomised controlled trial is warranted.

Objectives The objective of this study was to systematically review and assess the quality of the evidence regarding (1) the need for non-pharmacological support of adult patients with mixed connective tissue disease (MCTD) and (2) the elements of non-pharmacological interventions delivered to patients with MCTD. Methods A systematic literature search was conducted in August 2024 across 4 databases: Embase, CINAHL, CENTRAL, and Medline, using diverse terminologies for MCTD. The quality of the selected studies was assessed with the Critical Appraisal Skills Programme tools for qualitative and case-control studies, and results were summarised narratively. The study protocol was preregistered with PROSPERO (ID: CRD42024591268). Results The search yielded 7091 unique records, with 4 articles meeting the inclusion criteria after screening. Three studies with varying quality assessments (1 low and 2 high) identified patient support needs across 3 domains: educational, mental health, and pregnancy-related needs. A fourth study, found to be of low quality, assessed a non-pharmacological intervention, specifically a tandem-psychotherapy approach. Conclusions This review with a narrative synthesis highlights a significant gap in high-quality evidence regarding non-pharmacological support for patients with MCTD. It underscores the urgent need for further research to better understand and address the non-pharmacological needs of this population, facilitating the development of effective interventions for managing the complexity of MCTD.