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Papers by Bente Danneskiold-samsøe

Research paper thumbnail of Occupational performance amongst asylum seekers in Denmark

Introduction: Increased health problems are reported among asylum seekers, often related to tortu... more Introduction: Increased health problems are reported among asylum seekers, often related to torture, but there is no knowledge regarding occupational performance and whether there are any changes in asylum seekers occupational performance during time spent in a centre. Objectives: Our aim was to assess if newly arrived asylum seekers had impaired occupational performance and if this was associated with previous exposure to torture and/or self-reported psychological symptoms and pain measures. We also wanted to evaluate changes in occupational performance and general health over time. Methods: At baseline 43 newly arrived asylum seekers, age 20-43, were consecutively enrolled in the study. All participants were assessed using AMPS and the questionnaires WHO-5, Major Depression Inventory, Pain Detect Questionnaire and a questionnaire about exposure to torture and trauma. Ten months later, 17 participants were accessible for re-assessment, based on the same instruments as above. The pa...

Research paper thumbnail of Intra-Articular Analgesia and Steroid Reduce Pain Sensitivity in Knee OA Patients: An Interventional Cohort Study

Pain Research and Treatment, 2014

Objectives. To assess the effects of intra-articular therapy on pain sensitivity in the knee and ... more Objectives. To assess the effects of intra-articular therapy on pain sensitivity in the knee and surrounding tissues in knee OA patients. Methods. Twenty-five knee OA patients with symptomatic knee OA were included in this interventional cohort study. Pressure pain thresholds (PPT) were recorded before, immediately after, and two weeks after ultrasound guided intra-articular injection of lidocaine combined with glucocorticosteroid. Computer-controlled and manual pressure algometers were used to assess PPT on the knee, vastus lateralis, tibialis anterior, and the extensor carpi radialis longus muscles (control site). Results. Significantly increased PPTs were found following intra-articular injection, at both the knee ( < 0.0001) and the surrounding muscles ( < 0.042). The treatment effects were sustained for two weeks, and at some points the effect was even greater at two weeks ( < 0.026). Albeit not statistically significant, a similar trend was observed at the control site. Conclusions. Intra-articular anesthesia, combined with glucocorticosteroid, reduced pain sensitivity in both the knee and surrounding muscles for at least two weeks.

Research paper thumbnail of Activity of daily living performance amongst Danish asylum seekers: a cross-sectional study

Torture : quarterly journal on rehabilitation of torture victims and prevention of torture, 2014

The aim of this study was to evaluate the extent of Activities of Daily Living (ADL) ability impa... more The aim of this study was to evaluate the extent of Activities of Daily Living (ADL) ability impairment in newly arrived Danish asylum seekers. It was hypothesized that exposure to trauma and torture would negatively influence ADL performance and that measures of ADL ability would be lower in individuals exposed to torture as compared to the non-tortured. Forty-three newly arrived asylum seekers aged 20-50 years, from Iran, Afghanistan and Syria, were consecutively included in the study. ADL ability was assessed with the observation-based test Assessment of Motor and Process Skills (AMPS). Interviews were based on questionnaires about torture exposure, WHO-5 Wellbeing Index, Major Depression Inventory and Pain Detect Questionnaire. All participants were interviewed and tested using a linguistic interpreter. Thirty three (77%) participants reported exposure to torture. The tortured did not differ significantly from the nontortured on measures of ADL ability (two-sample t-tests: Motor...

Research paper thumbnail of Producing medico-legal evidence: documentation of torture versus the Saudi Arabian state of denial

Torture : quarterly journal on rehabilitation of torture victims and prevention of torture, 2007

Five British men were detained and allegedly tortured in Saudi Arabia in 2000 and 2001. Two were ... more Five British men were detained and allegedly tortured in Saudi Arabia in 2000 and 2001. Two were sentenced to death and three were sentenced to 12 to 18 years of imprisonment. They received clemency in 2003 and were deported to England. After their homecoming, the men have unsuccessfully attempted to sue Saudi Arabian officials who had been responsible for their false accusations and human rights abuses. Saudi Arabia denies any form of torture and ill treatment of the five men, who maintain their allegations against the authorities responsible in Saudi Arabia. This article provides medical documentation of torture of the five British men by comparing: 1. Alleged torture methods, 2. Histories of immediate effects of torture, 3. Objective medical observations using clinical examinations as well as ultrasound scans of the victims' feet. The article concludes that there is a high degree of consistency between the claims of torture and observations, despite Saudi Arabian denial.

Research paper thumbnail of Vascular response to ischemia in the feet of falanga torture victims and normal controls--color and spectral Doppler findings

Torture : quarterly journal on rehabilitation of torture victims and prevention of torture, 2009

To investigate whether signs of chronic compartment syndrome could be found in plantar muscles of... more To investigate whether signs of chronic compartment syndrome could be found in plantar muscles of falanga torture victims with painful feet and impaired gait. The hypothesis was that the muscular vascular response to two minutes ischemia would be decreased in torture victims compared to controls. On color Doppler this would be seen as less color after ischemia and on spectral Doppler as elevated resistive index (RI). Ten male torture victims from the Middle East and nine age, sex and ethnically matched controls underwent Doppler examination of the abductor hallucis and flexor digitorum brevis muscles before and after two minutes ischemia induced with a pressure cuff over the malleoli. The color Doppler findings were quantified with the color fraction (CF) before and after ischemia. On spectral Doppler the resistive index was measured once before and three consecutive times after ischemia. Both torture victims and controls responded to ischemia with an increased CF. There was no diff...

Research paper thumbnail of Spiritual Healing in the Treatment of Rheumatoid Arthritis: An Exploratory Single Centre, Parallel-Group, Double-Blind, Three-Arm, Randomised, Sham-Controlled Trial

Evidence-Based Complementary and Alternative Medicine, 2014

Our objective was to investigate the efficacy of "energy/spiritual healing" in rheumatoid arthrit... more Our objective was to investigate the efficacy of "energy/spiritual healing" in rheumatoid arthritis (RA). Eligible patients were women with RA on stable medication. The design was a randomised, blinded, sham-controlled trial; the third group included an external unblinded control of the natural course of RA. Participants in both groups received 8 sessions with "perceived healing" over 21 weeks with 8 weeks of follow-up. Active healing (AH) treatment comprised healing with no physical contact, and sham healing (SH) included exactly the same healing with a sham healer. During intervention, participants wore hearing protectors and were blindfolded. No healing (NH) only had their outcomes assessed. Coprimary outcomes were disease activity score (DAS) for 28 joints and Doppler ultrasound. All 96 patients randomised were handled as the intention-to-treat population, using a baselinecarried forward approach to replace the missing data. Eighty-two (85%) participants completed the 29-week trial. At end point (week 29), mean difference in DAS28 between AH versus SH was statistically but not clinically significant in favour of AH (0.62 DAS28 points; 95% CI: 0.13 to 1.11; = 0.014), while no differences between groups occurred in Doppler ultrasound. There are no clear physiological or psychological explanations for the findings in this tightly controlled study. The trial data indicates a need for independent replication.

Research paper thumbnail of Interdisciplinary rehabilitation of patients with chronic widespread pain: Primary endpoint of the randomized, nonblinded, parallel-group IMPROvE trial

Pain, 2014

This study examined the functional and psychological outcomes of a 2-week, group-based multicompo... more This study examined the functional and psychological outcomes of a 2-week, group-based multicomponent treatment course that targeted patients with chronic widespread pain. Patients (192 included in the intention-to-treat population), all fulfilling the 1990 American College of Rheumatology classification criteria for fibromyalgia, were consecutively recruited from a tertiary care setting and randomized (1:1) to either the treatment course or a waiting list control group. Co-primary outcomes were the Assessment of Motor and Process Skills (AMPS) and SF-36 Mental Composite Score (MCS) evaluated at 6-month followup. Primary endpoints were partly achieved with a statistically significant improvement in AMPS activities of daily living motor (group mean difference: 0.20 [95% confidence interval (CI): 0.09 to 0.31] logits; P = .0003) and AMPS activities of daily living process (0.20 [95% CI: 0.12 to 0.27] logits, P < .0001) ability measures, whereas no difference in the SF-36 MCS (1.14 [95% CI: À1.52 to 3.81], P = .40) was observed. Individual patient responses varied, and the proportion of patients achieving a clinically meaningful change of at least 0.3 logits on the AMPS seemed influenced by the reporting of a pending social welfare application at the time of enrollment. We conclude that even in fibromyalgia patients presenting with a substantial disability established over many years, the 2-week multicomponent treatment course resulted in observable improvement of functional ability in a subgroup of patients at 6-month followup. This improvement, however, was not reflected in secondary patient reported outcomes, including scores of self-reported functional ability on standardized questionnaires. We suggest including observation-based assessments in future clinical trials focusing on functional outcomes in patients with fibromyalgia.

Research paper thumbnail of Can the painDETECT Questionnaire score and MRI help predict treatment outcome in rheumatoid arthritis: protocol for the Frederiksberg hospital's Rheumatoid Arthritis, pain assessment and Medical Evaluation (FRAME-cohort) study

Research paper thumbnail of Satisfaction with daily occupations amongst asylum seekers in Denmark

Scandinavian Journal of Occupational Therapy, 2015

The aim of this study was to describe asylum seekers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;... more The aim of this study was to describe asylum seekers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; satisfaction with daily occupations and activity level while in a Danish asylum centre, and whether this changed over time. Another aim was to describe whether exposure to torture, self-rated health measures, and ADL ability were related to their satisfaction with daily occupations and activity level. A total of 43 asylum seekers at baseline and 17 at follow-up were included. The questionnaires Satisfaction with Daily Occupations, Major Depression Inventory, WHO-5 Wellbeing, Pain Detect, a questionnaire covering torture, and basic social information were used as well as Assessment of Motor and Process Skills. The results showed a low level of satisfaction with daily occupations at both baseline and follow-up. There was no statistically significant change in satisfaction or activity level between baseline and the follow-up. Associations between AMPS process skills - education, worst pain and activity level - were present at baseline, as was a relationship between AMPS process skills and satisfaction. At follow-up, associations between WHO-5 and satisfaction and activity level and between MDI scores and activity level were found. Asylum seekers experience a low level of satisfaction with daily occupations, both at arrival and after 10 months in an asylum centre. There is a need for further research and development of occupation-focused rehabilitation methods for the asylum seeker population.

Research paper thumbnail of A microdialysis study of topically applied diclofenac to healthy humans: Passive versus iontophoretic delivery

Results in Pharma Sciences, 2011

Topical application of NSAIDs is an alternative route to systemic administration when a local ant... more Topical application of NSAIDs is an alternative route to systemic administration when a local antiinflammatory effect of the underlying tissue is a treatment option. The aim of the present microdialysis study was to assess and compare plasma and tissue levels of diclofenac when topically applied with or without iontophoresis in healthy adults. Fourteen healthy adults (26 7 9.4 years) were randomized to diclofenac applied by iontophoresis, or by a gel, in a crossover design. Diclofenac concentrations were measured in plasma and in microdialysis perfusates from the underlying tissues. Iontophoretic application resulted in the highest plasma concentration of 3.4 7 0.5 ng/ml (SEM given) compared to 0.4 ng/ml (at the detection limit) with gel, whereas no differences were observed between tissue concentrations for the two application methods, both being very low, below or around the detection limit. Iontophoresis caused skin reactions in 25% of the participants. Iontophoresis of diclofenac as compared to traditional topical application was not superior in order to increase the NSAID concentration locally and appears to have a higher frequency of skin reactions.

Research paper thumbnail of Validity and Agreement between the 28-Joint Disease Activity Score Based on C-Reactive Protein and Erythrocyte Sedimentation Rate in Patients with Rheumatoid Arthritis

Arthritis, 2015

Objective. To validate the agreement between the 28-joint disease activity score based on erythro... more Objective. To validate the agreement between the 28-joint disease activity score based on erythrocyte sedimentation rate (DAS28-ESR) and the 28-joint disease activity score based on C-reactive protein (DAS28-CRP) in a group of Danish patients with rheumatoid arthritis (RA). Methods. Data from 109 Danish RA patients initiating biologic treatment were analysed at baseline and following one year of treatment. Participants were retrospectively enrolled from a previous cohort study and were considered eligible for this project if CRP and ESR were measured at baseline and at the follow-up visit. To assess the extent of agreement between the two DAS28 definitions, the "European League Against Rheumatism" (EULAR) response criteria based on each definition were calculated with cross-classification. Weighted Kappa (κ) coefficients were calculated, and Bland-Altman plots were used to illustrate degree of agreement between DAS28 definitions. Results. The 75 eligible patients were clas...

Research paper thumbnail of Influence of recent exercise and skin temperature on ultrasound Doppler measurements in patients with rheumatoid arthritis--an intervention study

Rheumatology, 2009

Use of ultrasound Doppler (USD) in diagnosing and treatment monitoring of patients with RA has in... more Use of ultrasound Doppler (USD) in diagnosing and treatment monitoring of patients with RA has increased considerably. Hyperaemia is an integral part of the inflammatory response, and the amount of USD activity in an inflamed synovium may therefore be used to quantify the inflammatory activity. It is unclear, however, whether the hyperaemia alone reflects the disease activity or may be influenced by other factors. Twenty-nine patients with RA underwent USD examination of the wrist before and immediately after three interventions. The interventions were carried out on three separate days. The interventions were (i) isometric exercise of the muscles of the hand and forearm, (ii) heating and (iii) cooling of the hand. The amount of Doppler in the wrist joint was quantified by measuring the percentage of colour in the synovium-the colour fraction (CF). The CF values estimated before and after each intervention were compared to see if any intervention affected the amount of Doppler in the synovium. The CF decreased significantly after cooling of the hand (P = 0.018 and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001). Despite being highly significant, the numerical decrease in CF was only modest, 0.78-1.33 percentage points. The other interventions did not affect the CF significantly, with P-values of 0.65 and 0.59 in the heating intervention and 0.49 in the exercise intervention. Cooling of the hand should, if possible, be avoided before a USD examination of the wrist in patients with RA, because the amount of Doppler activity might be affected by low skin temperatures.

Research paper thumbnail of Ultrasound colour Doppler measurements in a single joint as measure of disease activity in patients with rheumatoid arthritis--assessment of concurrent validity

Rheumatology, 2008

Colour Doppler ultrasound (CDU) displays blood flow in the tissues and is able to detect hyperaem... more Colour Doppler ultrasound (CDU) displays blood flow in the tissues and is able to detect hyperaemia. Because hyperaemia is part of the inflammatory response, the amount of CDU activity in the inflamed synovium may be used to quantify the inflammatory activity in RA. It has never been investigated if the amount of CDU activity in a single joint can be used to quantify disease activity in RA. A total of 109 patients with RA and affection of the wrist joint underwent a standardized CDU examination assessing three positions in their most affected wrist at start up in biological treatment. On the same day the following measures of disease activity were collected: assessment of the number of tender and swollen joints, CRP, ESR and 28-joint disease activity score (DAS28). The amount of CDU activity was quantified by measuring the percentage of colour in the synovium--the colour fraction (CF). Correlation between CF and other measures of disease activity was calculated. There was a significant correlation between CF and DAS28 (r = 0.29; P &lt; 0.001), swollen joint count (r = 0.35; P &lt; 0.001), CRP (r = 0.5; P &lt; 0.001) and ESR (r = 0.5; P &lt; 0.001). No other significant correlations were found. A standardized ultrasound examination of a single affected wrist joint in patients with RA may be used as a measure of disease activity. More studies are needed to identify the number of joints needed to examine by CDU to obtain the best validity of Doppler measurements.

Research paper thumbnail of Contribution of the local and referred pain from active myofascial trigger points in fibromyalgia syndrome

PAIN, 2009

The generalized hypersensitivity associated with fibromyalgia syndrome (FMS) may in part be drive... more The generalized hypersensitivity associated with fibromyalgia syndrome (FMS) may in part be driven by peripheral nociceptive sources. The aim of the study was to investigate whether local and referred pain from active myofascial trigger points (MTrPs) contributes to fibromyalgia pain. FMS patients and healthy controls (n=22 each, age- and gender-matched) were recruited. The surface area over the upper trapezius muscle on each side was divided into 13 sub-areas (points) of 1cm in diameter for each point. Pressure pain threshold (PPT) and the local and referred pain pattern induced by manual palpation at 13 points bilaterally in the upper trapezius were recorded. Results showed that PPT levels at all measured points were significantly lower in FMS than controls. Multiple active MTrPs (7.4+/-2.2) were identified bilaterally in the muscle in FMS patients, but no active MTrPs were found in controls. The mid-fiber region of the muscle had the lowest PPT level with the largest number of active MTrPs in FMS and with the largest number of latent MTrPs in controls. The local and referred pain pattern induced from active MTrPs bilaterally in the upper trapezius muscle were similar to the ongoing pain pattern in the neck and shoulder region in FMS. In conclusion, active MTrPs bilaterally in the upper trapezius muscle contribute to the neck and shoulder pain in FMS. Active MTrPs may serve as one of the sources of noxious input leading to the sensitization of spinal and supraspinal pain pathways in FMS.

Research paper thumbnail of Observation-based assessment of functional ability in patients with chronic widespread pain: A cross-sectional study

PAIN, 2011

Knowledge about functional ability, including activities of daily living (ADL), in patients with ... more Knowledge about functional ability, including activities of daily living (ADL), in patients with chronic widespread pain (CWP) and fibromyalgia (FMS) is largely based on self-report. The purpose of this study was to assess functional ability by using standardised, observation-based assessment of ADL performance and to examine the relationship between self-reported and observation-based measures of disability. A total of 257 women with CWP, 199 (77%) fulfilling the American College of Rheumatology tender point criteria for FMS, were evaluated with the Assessment of Motor and Process Skills (AMPS), an observation-based assessment providing linear measures of ADL motor and ADL process skill ability (unit: logits). A cutoff for effortless and independent ADL task performance is set at 2.0 for the motor scale and 1.0 for the process scale. A total of 248 (96.5%) had ability measures below the 2.00 ADL motor cutoff and 107 (41.6%) below the 1.00 ADL process cutoff, indicating increased effort and/or inefficiency during task performance as well as a potential need of assistance for community living. Mean ADL motor ability measure was 1.07 and was significantly lower in patients diagnosed with FMS than plain CWP (1.02 vs 1.27 logits, P = .001). Mean ADL process ability measure was 1.09 logits and was without difference between FMS and plain CWP (1.07 vs 1.16 logits, P = .064). Only weak to moderate correlations between self-reported functional ability and observation-based AMPS ability measures were observed. The results of the study support the notion of considerable performance difficulties in women with CWP. The everyday life problems are substantial and place the individual at risk of need of support for community living.

Research paper thumbnail of Poorer elbow proprioception in patients with lateral epicondylitis than in healthy controls: A cross-sectional study

Journal of Shoulder and Elbow Surgery, 2008

Research paper thumbnail of Correlation Between Tender Points and the Fibromyalgia Impact Questionnaire

Journal Of Musculoskeletal Pain, 2000

... Henrik Røgind Bente Danneskiold-Samsøe Henning Bliddal ABSTRACT. Objectives: To investigate a... more ... Henrik Røgind Bente Danneskiold-Samsøe Henning Bliddal ABSTRACT. Objectives: To investigate a possible correlation be-tween the number of tender points [TePs] and the myalgic score versus the Activities of Daily Living [ADL] items and the pain visual analog scale [VAS] ...

Research paper thumbnail of Idiopathic Low Back Pain: Classification and Differential Diagnosis

Journal Of Musculoskeletal Pain, 2005

... The lateral recesscomprisesthelateralpartofthecanaland is found between the articular process... more ... The lateral recesscomprisesthelateralpartofthecanaland is found between the articular process posteri-orly and the vertebral body anteriorly. ... 16. Helewa A, Goldsmith C, Smythe HA: Inflamma-tory myopathy–Do we have adequate measures of the treatment response? ...

Research paper thumbnail of A Longitudinal Study of Changes in Asylum Seekers Ability Regarding Activities of Daily Living During Their Stay in the Asylum Center

Journal of Immigrant and Minority Health, 2014

The aim of this study was to evaluate the extent of Activities of Daily Living (ADL) ability impa... more The aim of this study was to evaluate the extent of Activities of Daily Living (ADL) ability impairment in newly arrived Danish asylum seekers. It was hypothesized that exposure to trauma and torture would negatively influence ADL performance and that measures of ADL ability would be lower in individuals exposed to torture as compared to the non-tortured. Subjects: Forty-three newly arrived asylum seekers aged 20-50 years, from Iran, Afghanistan and Syria, were consecutively included in the study. Method: ADL ability was assessed with the observation-based test Assessment of Motor and Process Skills (AMPS). Interviews were based on questionnaires about torture exposure, WHO-5 Wellbeing Index, Major Depression Inventory and Pain Detect Questionnaire. All participants were interviewed and tested using a linguistic interpreter. Results: Thirty three (77%) participants

Research paper thumbnail of Diagnostic accuracy of heel pad palpation – A phantom study

Journal of Forensic and Legal Medicine, 2008

Falanga torture involves repetitive blunt trauma to the soles of the feet and typically leaves fe... more Falanga torture involves repetitive blunt trauma to the soles of the feet and typically leaves few detectable changes. Reduced elasticity in the heel pads has been reported as characteristic sequelae and palpatory testing of heel pad elasticity is therefore part of medicolegal assessment of alleged torture victims. The goal was to test the accuracy of two experienced investigators in determining whether a heel pad model was soft, medium or hard. The skin-to-bone distance in the models varied within the human range. Two blinded investigators independently palpated nine different heel pad models with three different elasticities combined with three different skin-to-bone distances in five consecutive trials and categorized the models as soft, medium or hard. Two experienced investigators were able to identify three known elasticities correctly in approximately two thirds of the cases. The skin-to-bone distance affected the accuracy. The use of clinical examination in documenting alleged exposure to torture warrants a high diagnostic accuracy of the applied tests. The study implies that palpatory testing of the human heel pad may not meet this demand. It is therefore recommended that a device able to perform an accurate measurement of the viscous-elastic properties of the heel pad be developed.

Research paper thumbnail of Occupational performance amongst asylum seekers in Denmark

Introduction: Increased health problems are reported among asylum seekers, often related to tortu... more Introduction: Increased health problems are reported among asylum seekers, often related to torture, but there is no knowledge regarding occupational performance and whether there are any changes in asylum seekers occupational performance during time spent in a centre. Objectives: Our aim was to assess if newly arrived asylum seekers had impaired occupational performance and if this was associated with previous exposure to torture and/or self-reported psychological symptoms and pain measures. We also wanted to evaluate changes in occupational performance and general health over time. Methods: At baseline 43 newly arrived asylum seekers, age 20-43, were consecutively enrolled in the study. All participants were assessed using AMPS and the questionnaires WHO-5, Major Depression Inventory, Pain Detect Questionnaire and a questionnaire about exposure to torture and trauma. Ten months later, 17 participants were accessible for re-assessment, based on the same instruments as above. The pa...

Research paper thumbnail of Intra-Articular Analgesia and Steroid Reduce Pain Sensitivity in Knee OA Patients: An Interventional Cohort Study

Pain Research and Treatment, 2014

Objectives. To assess the effects of intra-articular therapy on pain sensitivity in the knee and ... more Objectives. To assess the effects of intra-articular therapy on pain sensitivity in the knee and surrounding tissues in knee OA patients. Methods. Twenty-five knee OA patients with symptomatic knee OA were included in this interventional cohort study. Pressure pain thresholds (PPT) were recorded before, immediately after, and two weeks after ultrasound guided intra-articular injection of lidocaine combined with glucocorticosteroid. Computer-controlled and manual pressure algometers were used to assess PPT on the knee, vastus lateralis, tibialis anterior, and the extensor carpi radialis longus muscles (control site). Results. Significantly increased PPTs were found following intra-articular injection, at both the knee ( < 0.0001) and the surrounding muscles ( < 0.042). The treatment effects were sustained for two weeks, and at some points the effect was even greater at two weeks ( < 0.026). Albeit not statistically significant, a similar trend was observed at the control site. Conclusions. Intra-articular anesthesia, combined with glucocorticosteroid, reduced pain sensitivity in both the knee and surrounding muscles for at least two weeks.

Research paper thumbnail of Activity of daily living performance amongst Danish asylum seekers: a cross-sectional study

Torture : quarterly journal on rehabilitation of torture victims and prevention of torture, 2014

The aim of this study was to evaluate the extent of Activities of Daily Living (ADL) ability impa... more The aim of this study was to evaluate the extent of Activities of Daily Living (ADL) ability impairment in newly arrived Danish asylum seekers. It was hypothesized that exposure to trauma and torture would negatively influence ADL performance and that measures of ADL ability would be lower in individuals exposed to torture as compared to the non-tortured. Forty-three newly arrived asylum seekers aged 20-50 years, from Iran, Afghanistan and Syria, were consecutively included in the study. ADL ability was assessed with the observation-based test Assessment of Motor and Process Skills (AMPS). Interviews were based on questionnaires about torture exposure, WHO-5 Wellbeing Index, Major Depression Inventory and Pain Detect Questionnaire. All participants were interviewed and tested using a linguistic interpreter. Thirty three (77%) participants reported exposure to torture. The tortured did not differ significantly from the nontortured on measures of ADL ability (two-sample t-tests: Motor...

Research paper thumbnail of Producing medico-legal evidence: documentation of torture versus the Saudi Arabian state of denial

Torture : quarterly journal on rehabilitation of torture victims and prevention of torture, 2007

Five British men were detained and allegedly tortured in Saudi Arabia in 2000 and 2001. Two were ... more Five British men were detained and allegedly tortured in Saudi Arabia in 2000 and 2001. Two were sentenced to death and three were sentenced to 12 to 18 years of imprisonment. They received clemency in 2003 and were deported to England. After their homecoming, the men have unsuccessfully attempted to sue Saudi Arabian officials who had been responsible for their false accusations and human rights abuses. Saudi Arabia denies any form of torture and ill treatment of the five men, who maintain their allegations against the authorities responsible in Saudi Arabia. This article provides medical documentation of torture of the five British men by comparing: 1. Alleged torture methods, 2. Histories of immediate effects of torture, 3. Objective medical observations using clinical examinations as well as ultrasound scans of the victims' feet. The article concludes that there is a high degree of consistency between the claims of torture and observations, despite Saudi Arabian denial.

Research paper thumbnail of Vascular response to ischemia in the feet of falanga torture victims and normal controls--color and spectral Doppler findings

Torture : quarterly journal on rehabilitation of torture victims and prevention of torture, 2009

To investigate whether signs of chronic compartment syndrome could be found in plantar muscles of... more To investigate whether signs of chronic compartment syndrome could be found in plantar muscles of falanga torture victims with painful feet and impaired gait. The hypothesis was that the muscular vascular response to two minutes ischemia would be decreased in torture victims compared to controls. On color Doppler this would be seen as less color after ischemia and on spectral Doppler as elevated resistive index (RI). Ten male torture victims from the Middle East and nine age, sex and ethnically matched controls underwent Doppler examination of the abductor hallucis and flexor digitorum brevis muscles before and after two minutes ischemia induced with a pressure cuff over the malleoli. The color Doppler findings were quantified with the color fraction (CF) before and after ischemia. On spectral Doppler the resistive index was measured once before and three consecutive times after ischemia. Both torture victims and controls responded to ischemia with an increased CF. There was no diff...

Research paper thumbnail of Spiritual Healing in the Treatment of Rheumatoid Arthritis: An Exploratory Single Centre, Parallel-Group, Double-Blind, Three-Arm, Randomised, Sham-Controlled Trial

Evidence-Based Complementary and Alternative Medicine, 2014

Our objective was to investigate the efficacy of "energy/spiritual healing" in rheumatoid arthrit... more Our objective was to investigate the efficacy of "energy/spiritual healing" in rheumatoid arthritis (RA). Eligible patients were women with RA on stable medication. The design was a randomised, blinded, sham-controlled trial; the third group included an external unblinded control of the natural course of RA. Participants in both groups received 8 sessions with "perceived healing" over 21 weeks with 8 weeks of follow-up. Active healing (AH) treatment comprised healing with no physical contact, and sham healing (SH) included exactly the same healing with a sham healer. During intervention, participants wore hearing protectors and were blindfolded. No healing (NH) only had their outcomes assessed. Coprimary outcomes were disease activity score (DAS) for 28 joints and Doppler ultrasound. All 96 patients randomised were handled as the intention-to-treat population, using a baselinecarried forward approach to replace the missing data. Eighty-two (85%) participants completed the 29-week trial. At end point (week 29), mean difference in DAS28 between AH versus SH was statistically but not clinically significant in favour of AH (0.62 DAS28 points; 95% CI: 0.13 to 1.11; = 0.014), while no differences between groups occurred in Doppler ultrasound. There are no clear physiological or psychological explanations for the findings in this tightly controlled study. The trial data indicates a need for independent replication.

Research paper thumbnail of Interdisciplinary rehabilitation of patients with chronic widespread pain: Primary endpoint of the randomized, nonblinded, parallel-group IMPROvE trial

Pain, 2014

This study examined the functional and psychological outcomes of a 2-week, group-based multicompo... more This study examined the functional and psychological outcomes of a 2-week, group-based multicomponent treatment course that targeted patients with chronic widespread pain. Patients (192 included in the intention-to-treat population), all fulfilling the 1990 American College of Rheumatology classification criteria for fibromyalgia, were consecutively recruited from a tertiary care setting and randomized (1:1) to either the treatment course or a waiting list control group. Co-primary outcomes were the Assessment of Motor and Process Skills (AMPS) and SF-36 Mental Composite Score (MCS) evaluated at 6-month followup. Primary endpoints were partly achieved with a statistically significant improvement in AMPS activities of daily living motor (group mean difference: 0.20 [95% confidence interval (CI): 0.09 to 0.31] logits; P = .0003) and AMPS activities of daily living process (0.20 [95% CI: 0.12 to 0.27] logits, P < .0001) ability measures, whereas no difference in the SF-36 MCS (1.14 [95% CI: À1.52 to 3.81], P = .40) was observed. Individual patient responses varied, and the proportion of patients achieving a clinically meaningful change of at least 0.3 logits on the AMPS seemed influenced by the reporting of a pending social welfare application at the time of enrollment. We conclude that even in fibromyalgia patients presenting with a substantial disability established over many years, the 2-week multicomponent treatment course resulted in observable improvement of functional ability in a subgroup of patients at 6-month followup. This improvement, however, was not reflected in secondary patient reported outcomes, including scores of self-reported functional ability on standardized questionnaires. We suggest including observation-based assessments in future clinical trials focusing on functional outcomes in patients with fibromyalgia.

Research paper thumbnail of Can the painDETECT Questionnaire score and MRI help predict treatment outcome in rheumatoid arthritis: protocol for the Frederiksberg hospital's Rheumatoid Arthritis, pain assessment and Medical Evaluation (FRAME-cohort) study

Research paper thumbnail of Satisfaction with daily occupations amongst asylum seekers in Denmark

Scandinavian Journal of Occupational Therapy, 2015

The aim of this study was to describe asylum seekers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;... more The aim of this study was to describe asylum seekers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; satisfaction with daily occupations and activity level while in a Danish asylum centre, and whether this changed over time. Another aim was to describe whether exposure to torture, self-rated health measures, and ADL ability were related to their satisfaction with daily occupations and activity level. A total of 43 asylum seekers at baseline and 17 at follow-up were included. The questionnaires Satisfaction with Daily Occupations, Major Depression Inventory, WHO-5 Wellbeing, Pain Detect, a questionnaire covering torture, and basic social information were used as well as Assessment of Motor and Process Skills. The results showed a low level of satisfaction with daily occupations at both baseline and follow-up. There was no statistically significant change in satisfaction or activity level between baseline and the follow-up. Associations between AMPS process skills - education, worst pain and activity level - were present at baseline, as was a relationship between AMPS process skills and satisfaction. At follow-up, associations between WHO-5 and satisfaction and activity level and between MDI scores and activity level were found. Asylum seekers experience a low level of satisfaction with daily occupations, both at arrival and after 10 months in an asylum centre. There is a need for further research and development of occupation-focused rehabilitation methods for the asylum seeker population.

Research paper thumbnail of A microdialysis study of topically applied diclofenac to healthy humans: Passive versus iontophoretic delivery

Results in Pharma Sciences, 2011

Topical application of NSAIDs is an alternative route to systemic administration when a local ant... more Topical application of NSAIDs is an alternative route to systemic administration when a local antiinflammatory effect of the underlying tissue is a treatment option. The aim of the present microdialysis study was to assess and compare plasma and tissue levels of diclofenac when topically applied with or without iontophoresis in healthy adults. Fourteen healthy adults (26 7 9.4 years) were randomized to diclofenac applied by iontophoresis, or by a gel, in a crossover design. Diclofenac concentrations were measured in plasma and in microdialysis perfusates from the underlying tissues. Iontophoretic application resulted in the highest plasma concentration of 3.4 7 0.5 ng/ml (SEM given) compared to 0.4 ng/ml (at the detection limit) with gel, whereas no differences were observed between tissue concentrations for the two application methods, both being very low, below or around the detection limit. Iontophoresis caused skin reactions in 25% of the participants. Iontophoresis of diclofenac as compared to traditional topical application was not superior in order to increase the NSAID concentration locally and appears to have a higher frequency of skin reactions.

Research paper thumbnail of Validity and Agreement between the 28-Joint Disease Activity Score Based on C-Reactive Protein and Erythrocyte Sedimentation Rate in Patients with Rheumatoid Arthritis

Arthritis, 2015

Objective. To validate the agreement between the 28-joint disease activity score based on erythro... more Objective. To validate the agreement between the 28-joint disease activity score based on erythrocyte sedimentation rate (DAS28-ESR) and the 28-joint disease activity score based on C-reactive protein (DAS28-CRP) in a group of Danish patients with rheumatoid arthritis (RA). Methods. Data from 109 Danish RA patients initiating biologic treatment were analysed at baseline and following one year of treatment. Participants were retrospectively enrolled from a previous cohort study and were considered eligible for this project if CRP and ESR were measured at baseline and at the follow-up visit. To assess the extent of agreement between the two DAS28 definitions, the "European League Against Rheumatism" (EULAR) response criteria based on each definition were calculated with cross-classification. Weighted Kappa (κ) coefficients were calculated, and Bland-Altman plots were used to illustrate degree of agreement between DAS28 definitions. Results. The 75 eligible patients were clas...

Research paper thumbnail of Influence of recent exercise and skin temperature on ultrasound Doppler measurements in patients with rheumatoid arthritis--an intervention study

Rheumatology, 2009

Use of ultrasound Doppler (USD) in diagnosing and treatment monitoring of patients with RA has in... more Use of ultrasound Doppler (USD) in diagnosing and treatment monitoring of patients with RA has increased considerably. Hyperaemia is an integral part of the inflammatory response, and the amount of USD activity in an inflamed synovium may therefore be used to quantify the inflammatory activity. It is unclear, however, whether the hyperaemia alone reflects the disease activity or may be influenced by other factors. Twenty-nine patients with RA underwent USD examination of the wrist before and immediately after three interventions. The interventions were carried out on three separate days. The interventions were (i) isometric exercise of the muscles of the hand and forearm, (ii) heating and (iii) cooling of the hand. The amount of Doppler in the wrist joint was quantified by measuring the percentage of colour in the synovium-the colour fraction (CF). The CF values estimated before and after each intervention were compared to see if any intervention affected the amount of Doppler in the synovium. The CF decreased significantly after cooling of the hand (P = 0.018 and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001). Despite being highly significant, the numerical decrease in CF was only modest, 0.78-1.33 percentage points. The other interventions did not affect the CF significantly, with P-values of 0.65 and 0.59 in the heating intervention and 0.49 in the exercise intervention. Cooling of the hand should, if possible, be avoided before a USD examination of the wrist in patients with RA, because the amount of Doppler activity might be affected by low skin temperatures.

Research paper thumbnail of Ultrasound colour Doppler measurements in a single joint as measure of disease activity in patients with rheumatoid arthritis--assessment of concurrent validity

Rheumatology, 2008

Colour Doppler ultrasound (CDU) displays blood flow in the tissues and is able to detect hyperaem... more Colour Doppler ultrasound (CDU) displays blood flow in the tissues and is able to detect hyperaemia. Because hyperaemia is part of the inflammatory response, the amount of CDU activity in the inflamed synovium may be used to quantify the inflammatory activity in RA. It has never been investigated if the amount of CDU activity in a single joint can be used to quantify disease activity in RA. A total of 109 patients with RA and affection of the wrist joint underwent a standardized CDU examination assessing three positions in their most affected wrist at start up in biological treatment. On the same day the following measures of disease activity were collected: assessment of the number of tender and swollen joints, CRP, ESR and 28-joint disease activity score (DAS28). The amount of CDU activity was quantified by measuring the percentage of colour in the synovium--the colour fraction (CF). Correlation between CF and other measures of disease activity was calculated. There was a significant correlation between CF and DAS28 (r = 0.29; P &lt; 0.001), swollen joint count (r = 0.35; P &lt; 0.001), CRP (r = 0.5; P &lt; 0.001) and ESR (r = 0.5; P &lt; 0.001). No other significant correlations were found. A standardized ultrasound examination of a single affected wrist joint in patients with RA may be used as a measure of disease activity. More studies are needed to identify the number of joints needed to examine by CDU to obtain the best validity of Doppler measurements.

Research paper thumbnail of Contribution of the local and referred pain from active myofascial trigger points in fibromyalgia syndrome

PAIN, 2009

The generalized hypersensitivity associated with fibromyalgia syndrome (FMS) may in part be drive... more The generalized hypersensitivity associated with fibromyalgia syndrome (FMS) may in part be driven by peripheral nociceptive sources. The aim of the study was to investigate whether local and referred pain from active myofascial trigger points (MTrPs) contributes to fibromyalgia pain. FMS patients and healthy controls (n=22 each, age- and gender-matched) were recruited. The surface area over the upper trapezius muscle on each side was divided into 13 sub-areas (points) of 1cm in diameter for each point. Pressure pain threshold (PPT) and the local and referred pain pattern induced by manual palpation at 13 points bilaterally in the upper trapezius were recorded. Results showed that PPT levels at all measured points were significantly lower in FMS than controls. Multiple active MTrPs (7.4+/-2.2) were identified bilaterally in the muscle in FMS patients, but no active MTrPs were found in controls. The mid-fiber region of the muscle had the lowest PPT level with the largest number of active MTrPs in FMS and with the largest number of latent MTrPs in controls. The local and referred pain pattern induced from active MTrPs bilaterally in the upper trapezius muscle were similar to the ongoing pain pattern in the neck and shoulder region in FMS. In conclusion, active MTrPs bilaterally in the upper trapezius muscle contribute to the neck and shoulder pain in FMS. Active MTrPs may serve as one of the sources of noxious input leading to the sensitization of spinal and supraspinal pain pathways in FMS.

Research paper thumbnail of Observation-based assessment of functional ability in patients with chronic widespread pain: A cross-sectional study

PAIN, 2011

Knowledge about functional ability, including activities of daily living (ADL), in patients with ... more Knowledge about functional ability, including activities of daily living (ADL), in patients with chronic widespread pain (CWP) and fibromyalgia (FMS) is largely based on self-report. The purpose of this study was to assess functional ability by using standardised, observation-based assessment of ADL performance and to examine the relationship between self-reported and observation-based measures of disability. A total of 257 women with CWP, 199 (77%) fulfilling the American College of Rheumatology tender point criteria for FMS, were evaluated with the Assessment of Motor and Process Skills (AMPS), an observation-based assessment providing linear measures of ADL motor and ADL process skill ability (unit: logits). A cutoff for effortless and independent ADL task performance is set at 2.0 for the motor scale and 1.0 for the process scale. A total of 248 (96.5%) had ability measures below the 2.00 ADL motor cutoff and 107 (41.6%) below the 1.00 ADL process cutoff, indicating increased effort and/or inefficiency during task performance as well as a potential need of assistance for community living. Mean ADL motor ability measure was 1.07 and was significantly lower in patients diagnosed with FMS than plain CWP (1.02 vs 1.27 logits, P = .001). Mean ADL process ability measure was 1.09 logits and was without difference between FMS and plain CWP (1.07 vs 1.16 logits, P = .064). Only weak to moderate correlations between self-reported functional ability and observation-based AMPS ability measures were observed. The results of the study support the notion of considerable performance difficulties in women with CWP. The everyday life problems are substantial and place the individual at risk of need of support for community living.

Research paper thumbnail of Poorer elbow proprioception in patients with lateral epicondylitis than in healthy controls: A cross-sectional study

Journal of Shoulder and Elbow Surgery, 2008

Research paper thumbnail of Correlation Between Tender Points and the Fibromyalgia Impact Questionnaire

Journal Of Musculoskeletal Pain, 2000

... Henrik Røgind Bente Danneskiold-Samsøe Henning Bliddal ABSTRACT. Objectives: To investigate a... more ... Henrik Røgind Bente Danneskiold-Samsøe Henning Bliddal ABSTRACT. Objectives: To investigate a possible correlation be-tween the number of tender points [TePs] and the myalgic score versus the Activities of Daily Living [ADL] items and the pain visual analog scale [VAS] ...

Research paper thumbnail of Idiopathic Low Back Pain: Classification and Differential Diagnosis

Journal Of Musculoskeletal Pain, 2005

... The lateral recesscomprisesthelateralpartofthecanaland is found between the articular process... more ... The lateral recesscomprisesthelateralpartofthecanaland is found between the articular process posteri-orly and the vertebral body anteriorly. ... 16. Helewa A, Goldsmith C, Smythe HA: Inflamma-tory myopathy–Do we have adequate measures of the treatment response? ...

Research paper thumbnail of A Longitudinal Study of Changes in Asylum Seekers Ability Regarding Activities of Daily Living During Their Stay in the Asylum Center

Journal of Immigrant and Minority Health, 2014

The aim of this study was to evaluate the extent of Activities of Daily Living (ADL) ability impa... more The aim of this study was to evaluate the extent of Activities of Daily Living (ADL) ability impairment in newly arrived Danish asylum seekers. It was hypothesized that exposure to trauma and torture would negatively influence ADL performance and that measures of ADL ability would be lower in individuals exposed to torture as compared to the non-tortured. Subjects: Forty-three newly arrived asylum seekers aged 20-50 years, from Iran, Afghanistan and Syria, were consecutively included in the study. Method: ADL ability was assessed with the observation-based test Assessment of Motor and Process Skills (AMPS). Interviews were based on questionnaires about torture exposure, WHO-5 Wellbeing Index, Major Depression Inventory and Pain Detect Questionnaire. All participants were interviewed and tested using a linguistic interpreter. Results: Thirty three (77%) participants

Research paper thumbnail of Diagnostic accuracy of heel pad palpation – A phantom study

Journal of Forensic and Legal Medicine, 2008

Falanga torture involves repetitive blunt trauma to the soles of the feet and typically leaves fe... more Falanga torture involves repetitive blunt trauma to the soles of the feet and typically leaves few detectable changes. Reduced elasticity in the heel pads has been reported as characteristic sequelae and palpatory testing of heel pad elasticity is therefore part of medicolegal assessment of alleged torture victims. The goal was to test the accuracy of two experienced investigators in determining whether a heel pad model was soft, medium or hard. The skin-to-bone distance in the models varied within the human range. Two blinded investigators independently palpated nine different heel pad models with three different elasticities combined with three different skin-to-bone distances in five consecutive trials and categorized the models as soft, medium or hard. Two experienced investigators were able to identify three known elasticities correctly in approximately two thirds of the cases. The skin-to-bone distance affected the accuracy. The use of clinical examination in documenting alleged exposure to torture warrants a high diagnostic accuracy of the applied tests. The study implies that palpatory testing of the human heel pad may not meet this demand. It is therefore recommended that a device able to perform an accurate measurement of the viscous-elastic properties of the heel pad be developed.