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Lööf, H. & Johansson, U.-B. (2018). “A body in transformation”: - An Empirical phenomenological study about fear-avoidance beliefs towards physical activity among persons experiencing moderate to severe rheumatic pain. Journal of Clinical Nursing, 1-9
Open this publication in new window or tab >>“A body in transformation”: - An Empirical phenomenological study about fear-avoidance beliefs towards physical activity among persons experiencing moderate to severe rheumatic pain
2018 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, p. 1-9Article in journal (Refereed) Published
Abstract [en]

Aims. To gain a better understanding of fear-avoidance beliefs towards physical activity and body awareness in people experiencing moderate to severe rheumatic pain.  Background. Rheumatoid arthritis and psoriatic arthritis are long-term conditions with pain as the prominent symptom. Health-promoting physical activity is recommended, and can have an analgesic effect. High self-rated pain has previously been reported to be associated with increased fear-avoidance behaviour in relation to physical activity. Body awareness, which includes attentional focus and awareness of internal body sensations, could be valuable in the nursing care of long-term diseases.   Design. Empirical phenomenological.  Methods. An empirical phenomenological psychological method was applied. Interviews were undertaken in 2016 with 11 informants (eight females and three males, age range 44–71 years) who were diagnosed with rheumatoid arthritis (n = 7) or psoriatic arthritis (n = 4), with a disease duration ranging from 3–35 years. The mean visual analogue scale score in the study sample was 60 mm.   Results. Three typologies were identified: “My relatively fragile physical status”, “I am an active creator” and “Part of something bigger than myself.” Conclusions. The current findings indicated that pain anticipation and fear-avoidance beliefs towards physical activity sometimes affected the behaviour of individuals with long-term rheumatic pain syndromes. People experiencing moderate to high rheumatic pain tended to focus on their fragile physical and emotional state. By adopting a more favourable attitude towards the self, the body could be restored to a state of calm and balance.  Relevance to clinical practice. The current findings are relevant for healthcare professionals engaged in health-promotion clinical practice.

Keywords
Fear-avoidance beliefs, Body awareness, Pain, Rheumatic diseases, Nursing
National Category
Medical and Health Sciences
Research subject
Care Sciences
Identifiers
urn:nbn:se:mdh:diva-40184 (URN)10.1111/jocn.14606 (DOI)
Available from: 2018-07-04 Created: 2018-07-04 Last updated: 2018-08-30Bibliographically approved
Lööf, H. & Johansson, U.-B. (2018). Long-term rheumatic pain, body awareness and fear-avoidance beliefs. In: Nordic Conference in Nursing Research 2018, June 13-15th, Oslo.: . Paper presented at Nordic Conference in Nursing Research. Stockholm
Open this publication in new window or tab >>Long-term rheumatic pain, body awareness and fear-avoidance beliefs
2018 (English)In: Nordic Conference in Nursing Research 2018, June 13-15th, Oslo., Stockholm, 2018Conference paper, Oral presentation with published abstract (Refereed)
Place, publisher, year, edition, pages
Stockholm: , 2018
Keywords
Pain, Body awareness, Fear-avoidance, Health-promoting, Phenomenology
National Category
Medical and Health Sciences
Research subject
Care Sciences
Identifiers
urn:nbn:se:mdh:diva-40189 (URN)
Conference
Nordic Conference in Nursing Research
Available from: 2018-07-05 Created: 2018-07-05 Last updated: 2018-08-14Bibliographically approved
Rossen, J., Lööf, H., Yngve, A., Hagströmer, M., Brismar, K. & Johansson, U.-B. (2017). Using pedometers for self-management of physical activity: Participants' experiences from Sophia Step Study: A physical activity promotion intervention in pre- and type 2 diabetes. In: : . Paper presented at International Society of Behavioural Nutrition and Physical Activity 16th Annual meeting (ISBNPA), Victoria, Canada, 7-10 juni, 2017.
Open this publication in new window or tab >>Using pedometers for self-management of physical activity: Participants' experiences from Sophia Step Study: A physical activity promotion intervention in pre- and type 2 diabetes
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2017 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:mdh:diva-36462 (URN)
Conference
International Society of Behavioural Nutrition and Physical Activity 16th Annual meeting (ISBNPA), Victoria, Canada, 7-10 juni, 2017
Available from: 2017-08-21 Created: 2017-09-19Bibliographically approved
Lööf, H. (2016). A journey through Cross-cultural adaptation, Psychometrics and Phenomenological design in research projects. In: : . Paper presented at Second Nordic Conference in Nursing research, 15-17 June 2016, Stockholm..
Open this publication in new window or tab >>A journey through Cross-cultural adaptation, Psychometrics and Phenomenological design in research projects
2016 (English)Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Focus of the first study in my doctoral thesis (dissertation Karolinska Institutet, May 2015) was a body awareness questionnaire. I used a method for cross-cultural adaptation of self-reporting measures. I initially translated a version of a body awareness questionnaire (into Swedish), and I also pretested the translated version. By using think-aloud interviews I measured the content validity. I also performed a psychometric evaluation of the Swedish translated version, trough confirmatory factor analysis (measure the construct validity).

Focus of the second study was pain and fatigue in persons with rheumatoid arthritis, and focus of the third study was fear-avoidance beliefs about physical activity in persons with rheumatoid arthritis. Studies two and three were crosssectional survey studies. In study two I used univariate analysis of variance and backwards stepwise multiple regression and in study three I used univariate analysis of variance and backwards stepwise logistic regression. Focus of the forth study was body awareness in persons with rheumatoid arthritis.

A phenomenological study design, using the Empirical Phenomenological Psychological (EPP) method was used. The purpose of choosing narrative interviews was that they can provide valuable information about the phenomenon (body awareness) from the patient’s perspective. The life world perspective includes the world in which we live and to which we ascribe meaning, which means that our experience is always subjective and relative. According to the method the researcher does not attempt to validate a hypothesis (nor does the researcher seek to prove theoretical constructions).

National Category
Nursing
Identifiers
urn:nbn:se:mdh:diva-36376 (URN)
Conference
Second Nordic Conference in Nursing research, 15-17 June 2016, Stockholm.
Available from: 2016-09-06 Created: 2017-09-07Bibliographically approved
Rossen, J., Johansson, U.-B., Lööf, H., Hagströmer, M. & Yngve, A. (2016). Exploration of study participants experiences following Sophia Step Study: A two-year physical activity intervention. In: : . Paper presented at The 9th Nordic Diabetes PhD and Postdoc Research Conference, Bergen, Norge, 9-10 maj 2016.
Open this publication in new window or tab >>Exploration of study participants experiences following Sophia Step Study: A two-year physical activity intervention
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2016 (English)Conference paper, Oral presentation only (Other academic)
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:mdh:diva-36459 (URN)
Conference
The 9th Nordic Diabetes PhD and Postdoc Research Conference, Bergen, Norge, 9-10 maj 2016
Available from: 2016-06-15 Created: 2017-09-19Bibliographically approved
Lööf, H., Johansson, U.-B., Welin Henriksson, E., Lindblad, S. & Bullington, J. (2015). Body awareness in persons diagnosed with rheumatoid arthritis. Paper presented at EULAR Congress 2015, Rome, Italy, June 10-13, 2015. Annals of the Rheumatic Diseases, 74(Suppl 2), 1327
Open this publication in new window or tab >>Body awareness in persons diagnosed with rheumatoid arthritis
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2015 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 74, no Suppl 2, p. 1327-Article in journal, Meeting abstract (Refereed) Published
National Category
Nursing
Identifiers
urn:nbn:se:mdh:diva-36381 (URN)10.1136/annrheumdis-2015-eular.1015 (DOI)
Conference
EULAR Congress 2015, Rome, Italy, June 10-13, 2015
Available from: 2015-06-25 Created: 2017-09-07Bibliographically approved
Lööf, H., Demmelmaier, I., Welin Henriksson, E., Lindblad, S., Nordgren, B., Opava, C. & Johansson, U.-B. (2015). Fear-avoidance beliefs about physical activity in adults with rheumatoid arthritis. Scandinavian Journal of Rheumatology, 44(2), 93-99
Open this publication in new window or tab >>Fear-avoidance beliefs about physical activity in adults with rheumatoid arthritis
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2015 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 44, no 2, p. 93-99Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of this study was to describe fear-avoidance beliefs about physical activity and explore how these beliefs correlate with sociodemographic, disease-specific, and psychosocial factors in adults with rheumatoid arthritis (RA). Method: This cross-sectional study is part of the Physical Activity in Rheumatoid Arthritis (PARA) 2010 study. The study participants (n = 2351) were identified through the Swedish Rheumatology Quality (SRQ) registries from six rheumatology clinics in Sweden. Univariate and backwards stepwise logistic regressions were performed. Results: Stepwise logistic regressions showed that male gender [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.26-1.91] and having a below average income (OR 1.35, 95% CI 1.12-1.63) were associated with an increased risk of high scores on the modified Fear Avoidance-Belief Questionnaire (mFABQ). The two disease-specific factors most indicative of high mFABQ scores were high level of pain (OR 1.99, 95% CI 1.40-2.84) and poor health (OR 1.59, 95% CI 1.10-2.29). With regard to psychosocial factors, low health-related quality of life (HRQoL; OR 0.44, 95% CI 0.35-0.55) and a low score on the Exercise Self-Efficacy Scale (ESES; OR 0.66, 95% CI 0.52-0.82) were significantly associated with a high mFABQ score. The model fit was 0.27 (Nagelkerke's R(2)). Conclusions: High fear-avoidance beliefs about physical activity in patients with RA were found to be associated with being male and having a below average income, a high level of pain, poor health, a low HRQoL, and low ESES score. Additional research is warranted for adults with RA to capture the multiple potential correlates to fear-avoidance beliefs about physical activity.

National Category
Nursing
Identifiers
urn:nbn:se:mdh:diva-36378 (URN)10.3109/03009742.2014.932432 (DOI)25222440 (PubMedID)
Available from: 2017-09-07 Created: 2017-09-07 Last updated: 2017-12-05Bibliographically approved
Lööf, H. (2015). Kroppsmedvetande vid reumatoid artrit - den problematiska och den hanterliga kroppen: ett skifte av uppmärksamhetsfokus. Ä : en tidning för Riksföreningen sjuksköterskan inom äldrevård : geriatriker, dietister inom geriatrik samt alla professioner runt den äldre patienten (4), 38-39
Open this publication in new window or tab >>Kroppsmedvetande vid reumatoid artrit - den problematiska och den hanterliga kroppen: ett skifte av uppmärksamhetsfokus
2015 (Swedish)In: Ä : en tidning för Riksföreningen sjuksköterskan inom äldrevård : geriatriker, dietister inom geriatrik samt alla professioner runt den äldre patienten, ISSN 2001-1164, no 4, p. 38-39Article in journal (Other (popular science, discussion, etc.)) Published
National Category
Nursing
Identifiers
urn:nbn:se:mdh:diva-36372 (URN)
Available from: 2016-01-15 Created: 2017-09-07Bibliographically approved
Lööf, H. (2015). Pain, fatigue and fear-avoidance beliefs in relation to physical activity and body awareness in persons diagnosed with rheumatoid arthritis. (Doctoral dissertation). Stockholm: Karolinska Institutet
Open this publication in new window or tab >>Pain, fatigue and fear-avoidance beliefs in relation to physical activity and body awareness in persons diagnosed with rheumatoid arthritis
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Pain and fatigue are highly common and a major concern for persons diagnosed with rheumatoid arthritis (RA). Having physical limitations, which have a significant effect on daily life, is also described as a major problem for persons with RA. Research findings show that a minority of persons with RA perform maintained health-enhancing physical activity (HEPA), and that psychosocial factors seem to be the most salient and consistent factors to explain variations in HEPA. Furthermore, fear of physical activity and exercise has been described as major barriers for persons with chronic pain. The ability to notice bodily inner sensations and stimuli (body awareness, BA) is described in the literature as having either a positive or a negative impact on a person’s health and well-being. However, the concept of BA is complex and therefore greater insight into this phenomenon is needed.

Aim: The overall aim of this thesis was to investigate pain, fatigue and fear-avoidance beliefs in relation to physical activity and their correlates in persons with RA. A further overall aim was to develop a psychometric measurement of BA. A final overall aim was to deepen our understanding of BA in persons with RA.

Methods: Study I was a psychometric evaluation of a Swedish version of the Body Awareness Questionnaire (BAQ) in a student population and in adults with RA. Studies II - III were a cross-sectional survey studies in adults with RA. Study IV was a phenomenological study using the empirical phenomenological psychological (EPP) method in adults with RA.

Results: In study I, the value of Cronbach's alpha coefficients for the total score in the Swedish version of the BAQ was satisfactory. According to confirmatory factor analysis (CFA), neither a one-factor model nor a four-factor model tested in this study fulfilled the pre-specified criteria. In study II, pain was significantly associated with health-related quality of life (HRQoL) and disease activity. Fatigue was significantly associated with disease activity, BA and positive affect. The adjusted R2 was 28.6% for fatigue and 50.0% for pain. Study III showed that, for socio-demographic factors, being male and having a below average income were associated with an increased risk of high fear-avoidance beliefs about physical activity (mFABQ high). Moreover, the two disease-specific factors, which are most indicative of mFABQ high, were high level of pain and poor health. Concerning psychosocial factors, low HRQoL and low exercise self- efficacy were significantly associated with mFABQ high. The model fit was 0.27 (Nagelkerkés R2). In study IV, some general characteristics were found, which had to do with the disease giving rise to a higher degree of negatively toned BA. BA was a reactive process of searching or controlling for disease-related symptoms, or a reactive process that was triggered by emotions. In addition, BA was an active process in the sense of taking an inventory of abilities. All the participants had the ability to shift focus from BA to the outside world.

Conclusions: This thesis showed that pain, fatigue and fear-avoidance beliefs about physical activity in persons with RA have several potential correlates, including socio-demographic, disease-specific and psychosocial factors for the variables investigated. The Swedish version of the BAQ is simple to administer and should be used as a tool to measure self-reported attentiveness to normal body processes. Cronbach’s alpha coefficient for the total score was satisfactory; nevertheless, since neither of the models fulfilled the pre-specified criteria further testing of the Swedish version of the BAQ is required. BA was found to be both positively and negatively toned in persons with RA, though RA resulted in a higher degree of negatively toned BA. Thus, the ability to shift attention, from BA to activities in the outside world, could sometimes be beneficial for the person’s general health and well-being. Having the opportunity to participate in meaningful and purposeful daily real-world activities keeps the mind busy (and distracted) and can decrease the negative BA.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2015. p. 82
Keywords
Rheumatoid arthritis, Body awareness, Pain, Fatigue, Fear-avoidance beliefs about physical activity, Physical activity, Coping strategies, Cross-cultural adaptation, Concurrent think-aloud interviews, Narrative interviews, Phenomenological, Cross-sectional, Psychometrics
National Category
Nursing
Identifiers
urn:nbn:se:mdh:diva-36375 (URN)978-91-7549-867-6 (ISBN)
Public defence
2015-05-29, Erfors- & Weitnersalen, Sophiahemmet Högskola, Vallhallavägen 91, 09:30
Opponent
Supervisors
Available from: 2015-05-07 Created: 2017-09-07 Last updated: 2017-09-19Bibliographically approved
Lööf, H. (2015). Rädsla-undvikande-föreställningar i relation till kroppsmedvetande och fysisk aktivitet hos personer med reumatoid artrit. Best Practice, 7(24), 20-21
Open this publication in new window or tab >>Rädsla-undvikande-föreställningar i relation till kroppsmedvetande och fysisk aktivitet hos personer med reumatoid artrit
2015 (Swedish)In: Best Practice, ISSN 1329-1874, Vol. 7, no 24, p. 20-21Article in journal (Other academic) Published
National Category
Nursing
Identifiers
urn:nbn:se:mdh:diva-36374 (URN)
Available from: 2015-09-07 Created: 2017-09-07Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-7018-2706

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