Bård Natvig

• Tyrdal, Mari Kristine; Perrier, Flavie; Røe, Cecilie; Natvig, Bård; Wahl, Astrid Klopstad & Veierød, Marit Bragelien [Show all 7 contributors for this article] (2026). Treatment trajectories among patients with musculoskeletal disorders in Norway–a register-based cohort study over 2 years. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 44(1), p. 1–15. doi: 10.1080/02813432.2026.2633751. Full text in Research Archive Show summary

  Objective Explore treatment trajectories over a two-year follow-up among patients with musculoskeletal disorders (MSDs) in Norway and investigate the associations with education and country of origin. Design Register-based cohort study. Settings Data were obtained from three national registers, the Norwegian Control and Payment of Health Reimbursements Database (KUHR), the Norwegian Patient Registry (NPR) and Statistics Norway (SSB). Subjects Patients diagnosed with MSDs in 2015 in primary healthcare according to the International Classification of Primary Care, second edition (ICPC-2). Main outcome measures Treatment trajectory classes of healthcare use over a 2-years follow-up were generated using group-based multi-trajectory modelling, for all patients registered with MSDs and three common diagnoses: spine pain, osteoarthritis and fibromyalgia. Results From the analysis, four treatment trajectory classes of healthcare use were identified for MSD patients overall; low (75%), stable (10%), descending (9%) and high use (5%). The pattern was almost similar for the three diagnostic groups. High use was primarily caused by consistent high use of physiotherapy. For MSD patients overall, low education increased the probability of being in the low and stable use classes, while high education increased the probability of being in the descending use class. Patients with Norway as country of origin, were less likely to be in the class with low use and more likely to be in the class with descending use. Conclusion Using nationwide register data and group-based multi-trajectory modelling show that about 75% of all patients with MSD, consulting primary healthcare in Norway, were classified as low users of healthcare services and 5% were classified as high users. Overall, both education and country of origin were associated with the treatment trajectory classes. However, high use was not associated with neither education nor country of origin.

• Shakeel, Nilam; Jenum, Anne Karen; Waage, Christin; Mdala, Ibrahimu; Werner, Erik Lønnmark & Natvig, Bård [Show all 7 contributors for this article] (2025). Symptom burden in middle-aged women, the role of immigrant status. BMC Public Health. 25. doi: 10.1186/s12889-025-25093-x. Full text in Research Archive Show summary

  Background Subjective health complaints (SHCs) are symptoms from various organs that do not have an obvious explanation. Immigrants in Western countries are often exposed to multiple stressors that may trigger SHCs. Increased symptom load may reflect subjective health and functioning in the present and in the future. We, therefore, aimed to identify symptom load and distribution of subjective health complaints among middle-aged women by immigrant status. Methods This is a cross-sectional study which uses 11-year follow-up data from the STORK Groruddalen Cohort Study of 823 healthy pregnant women enrolled in primary antenatal care in a multi-ethnic city district in Oslo from 2008 to 2010. 11 years later, 379 women (53% of the eligible) provided questionnaire data on subjective health complaints drawn from the Subjective Health Complaints Inventory (SHCI) and regarding demographics and health issues collected through interviews. Participants were divided into three immigrant status groups: born in Norway by Norwegian parents (reference), born in Norway with one or two foreign born parents, and born abroad. The primary outcomes were the total score and the scores for each of the five domains in the SHCI: musculoskeletal pain, pseudo-neurology and gastrointestinal problems, allergy and flu. In addition, we studied the distribution of the 29 health complaints from the SHCI. Results Musculoskeletal symptoms were most severe and prevalent in all three immigrant-status groups. Compared to women born in Norway with Norwegian parents (reference), women born abroad had significantly higher total scores (median: 11.0 (IQR: 14.82–21.45) vs. 7.6 (9.38–12.78) (p = 0.002)). For musculoskeletal pain, the crude median scores were 4.3 (0.92–4.36) for women born abroad and 2.1 (3.81–5.72) for women born in Norway with Norwegian parents (p < 0.001). The following health complaints, headache, migraine, dizziness, pain in feet on exertion, bloating, constipation, chest pain, breathing difficulties and asthma, were more prevalent in women born abroad than in the reference group, before and after adjusting for age and education. Conclusion SHCs were more frequent and severe among women born abroad compared to the reference group. This knowledge is essential to identify women at risk and target appropriate interventions. Trial registration The study (STORK G 2) was prospectively registered at ClinicalTrials.gov (registration number: NCT03870724), registration date: 08.03.2019.

• Tyrdal, Mari Kristine; Perrier, Flavie; Røe, Cecilie; Natvig, Bård; Wahl, Astrid Klopstad & Veierød, Marit Bragelien [Show all 7 contributors for this article] (2024). Musculoskeletal disorders in Norway: trends in health care utilization and patient pathways: a nationwide register study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 42(4), p. 582–592. doi: 10.1080/02813432.2024.2368848. Full text in Research Archive Show summary

  Objective Describe trends in health care utilization, demographic characteristics and patient pathways among patients with musculoskeletal disorders (MSD) in Norway. Design Register-based cohort study. Settings Data were obtained from two Norwegian National registries; the Norwegian Control and Payment of Health Reimbursements Database (KUHR) and the Norwegian Patient Registry (NPR). Subjects Patients with MSD according to ICPC-2 and ICD-10 during 2014–2017. Main outcome measures Patient pathways from the first contact and the following two years, described in a Sankey Diagram for all MSD patients and three common diagnoses: spine pain, osteoarthritis (OA) and fibromyalgia (FM). Result About 26% of the Norwegian population consulted PHC annually while 7% were treated in SHC. Mean age was 47 and 53 years in PHC and SHC, respectively. The proportion of women increased by age. Spine pain was the most common diagnosis; 33% and 22% in PHC and SHC, respectively. Over 90% visited a GP first, 50% of them were treated by PT and/or in SHC during follow-up. Patients visiting the PT first were less likely to be treated in SHC. OA patients were most likely to be treated by more than one health care professional (>70%). Conclusion One third of the Norwegian population consulted health care services due to MSD annually between 2014–2017. GP was the most consulted health care professional. Among MSD patients with long-term use of health care services, 50% were treated by a PT and/or in SHC in addition to a GP.

• Wigers, Sigrid Hørven; Veierød, Marit Bragelien; Mengshoel, Anne Marit; Forseth, Karin Maria Øien; Dahli, Mina Piiksi & Juel, Niels Gunnar [Show all 7 contributors for this article] (2024). Healthcare experiences of fibromyalgia patients and their associations with satisfaction and pain relief. A patient survey. Scandinavian Journal of Pain. ISSN 1877-8860. 24(1). doi: 10.1515/sjpain-2023-0141. Full text in Research Archive Show summary

  Objectives The etiology of fibromyalgia (FM) is disputed, and there is no established cure. Quantitative data on how this may affect patients’ healthcare experiences are scarce. The present study aims to investigate FM patients’ pain-related healthcare experiences and explore factors associated with high satisfaction and pain relief. Methods An anonymous, online, and patient-administered survey was developed and distributed to members of the Norwegian Fibromyalgia Association. It addressed their pain-related healthcare experiences from both primary and specialist care. Odds ratios for healthcare satisfaction and pain relief were estimated by binary logistic regression. Directed acyclic graphs guided the multivariable analyses. Results The patients (n = 1,626, mean age: 51 years) were primarily women (95%) with a 21.8-year mean pain duration and 12.7 years in pain before diagnosis. One-third did not understand why they had pain, and 56.6% did not know how to get better. More than half had not received satisfactory information on their pain cause from a physician, and guidance on how to improve was reported below medium. Patients regretted a lack of medical specialized competence on muscle pain and reported many unmet needs, including regular follow-up and pain assessment. Physician-mediated pain relief was low, and guideline adherence was deficient. Only 14.8% were satisfied with non-physician health providers evaluating and treating their pain, and 21.5% were satisfied (46.9% dissatisfied) with their global pain-related healthcare. Patients’ knowledge of their condition, physicians’ pain competence and provision of information and guidance, agreement in explanations and advice, and the absence of unmet needs significantly increased the odds of both healthcare satisfaction and pain relief. Conclusions Our survey describes deficiencies in FM patients’ pain-related healthcare and suggests areas for improvement to increase healthcare satisfaction and pain relief. (REC# 2019/845, 09.05.19).

• Østerås, Nina; Aas, Eline; Moseng, Tuva; Bodegom-Vos, Leti van; Dziedzic, Krysia & Natvig, Bård [Show all 11 contributors for this article] (2023). Longer-term quality of care, effectiveness, and cost-effectiveness of implementing a model of care for osteoarthritis: A cluster-randomized controlled trial. Osteoarthritis and Cartilage. ISSN 1063-4584. 32(1), p. 108–119. doi: 10.1016/j.joca.2023.10.003. Full text in Research Archive Show summary

  Objective To assess the quality of care, effectiveness, and cost-effectiveness over 12 months after implementing a structured model of care for hip and knee osteoarthritis (OA) in primary healthcare as compared to usual care. Design In this pragmatic cluster-randomized, controlled trial with a stepped-wedge cohort design, we recruited 40 general practitioners (GPs), 37 physiotherapists (PTs), and 393 patients with symptomatic hip or knee OA from six municipalities (clusters) in Norway. The model included the delivery of a 3-hour patient education and 8–12 weeks individually tailored exercise programs, and interactive workshops for GPs and PTs. At 12 months, the patient-reported quality of care was assessed by the OsteoArthritis Quality Indicator questionnaire (16 items, pass rate 0–100%, 100%=best). Costs were obtained from patient-reported and national register data. Cost-effectiveness at the healthcare perspective was evaluated using incremental net monetary benefit (INMB). Results Of 393 patients, 109 were recruited during the control periods (control group) and 284 were recruited during interventions periods (intervention group). At 12 months the intervention group reported statistically significant higher quality of care compared to the control group (59% vs. 40%; mean difference: 17.6 (95% confidence interval [CI] 11.1, 24.0)). Cost-effectiveness analyses showed that the model of care resulted in quality-adjusted life-years gained and cost-savings compared to usual care with mean INMB €2020 (95% CI 611, 3492) over 12 months. Conclusions This study showed that implementing the model of care for OA in primary healthcare, improved quality of care and showed cost-effectiveness over 12 months compared to usual care.

• Moen, Unni; Knapstad, Mari Kalland; Wilhelmsen, Kjersti Thulin; Goplen, Frederik Kragerud; Nordahl, Stein Helge Glad & Berge, Jan Erik [Show all 9 contributors for this article] (2023). Musculoskeletal pain patterns and association between dizziness symptoms and pain in patients with long term dizziness – a cross-sectional study. BMC Musculoskeletal Disorders. 24(1). doi: 10.1186/s12891-023-06279-z. Full text in Research Archive Show summary

  Background The impact of long-term dizziness is considerable both on the personal level and in society and may lead to self-imposed restrictions in daily activities and social relations due to fear of triggering the symptoms. Musculoskeletal complaints seem to be common in persons with dizziness, but studies addressing these complaints as a widespread occurrence, are scarce. This study aimed to examine the occurrence of widespread pain in patients with long-term dizziness and investigate the associations between pain and dizziness symptoms. Further, to explore whether diagnostic belonging is related to the occurrence of pain. Methods This cross-sectional study was conducted in an otorhinolaryngology clinic and included 150 patients with persistent dizziness. The patients were categorized into three groups: episodic vestibular syndromes, chronic vestibular syndromes, and non-vestibular group. The patients completed questionnaires on dizziness symptoms, catastrophic thinking, and musculoskeletal pain when entering the study. Descriptive statistics were used to describe the population, and associations between pain and dizziness were investigated by linear regression. Results Pain was reported by 94.5% of the patients. A significantly higher prevalence of pain was reported in all the ten pain sites examined compared to the general population. Number of pain sites and pain intensity were associated with the dizziness severity. Number of pain sites was also associated with dizziness-related handicap, but not with catastrophic thinking. There was no association between pain intensity and dizziness-related handicap or catastrophic thinking. Pain was equally distributed in the diagnostic groups. Conclusion Patients with long-term dizziness have a considerably higher prevalence of pain and number of pain sites than the general population. Pain co-exists with dizziness and is associated with dizziness severity. These findings may indicate that pain should be systematically assessed and treated in patients with persisting dizziness.

• Irgens, Pernille Marie Stähr; Myhrvold, Birgitte Lawaetz; Kongsted, Alice; Natvig, Bård; Vøllestad, Nina Køpke & Robinson, Hilde Stendal (2022). Exploring visual pain trajectories in neck pain patients, using clinical course, SMS-based patterns, and patient characteristics: a cohort study. Chiropractic & Manual Therapies. 30(1), p. 37–37. doi: 10.1186/s12998-022-00443-3. Full text in Research Archive Show summary

  Background The dynamic nature of neck pain has so far been identified through longitudinal studies with frequent measures, a method which is time-consuming and impractical. Pictures illustrating different courses of pain may be an alternative solution, usable in both clinical work and research, but it is unknown how well they capture the clinical course. The aim of this study was to explore and describe self-reported visual trajectories in terms of details of patients’ prospectively reported clinical course, their SMS-based pattern classification of neck pain, and patient’s characteristics. Methods Prospective cohort study including 888 neck pain patients from chiropractic practice, responding to weekly SMS-questions about pain intensity for 1 year from 2015 to 2017. Patients were classified into one of three clinical course patterns using definitions based on previously published descriptors. At 1-year follow-up, patients selected a visual trajectory that best represented their retrospective 1-year course of pain: single episode, episodic, mild ongoing, fluctuating and severe ongoing. Results The visual trajectories generally resembled the 1-year clinical course characteristics on group level, but there were large individual variations. Patients selecting Episodic and Mild ongoing visual trajectories were similar on most parameters. The visual trajectories generally resembled more the clinical course of the last quarter. Discussion The visual trajectories reflected the descriptors of the clinical course of pain captured by weekly SMS measures on a group level and formed groups of patients that differed on symptoms and characteristics. However, there were large variations in symptoms and characteristics within, as well as overlap between, each visual trajectory. In particular, patients with mild pain seemed predisposed to recall bias. Although the visual trajectories and SMS-based classifications appear related, visual trajectories likely capture more elements of the pain experience than just the course of pain. Therefore, they cannot be seen as a proxy for SMS-tracking of pain over 1 year.

• Tyrdal, Mari Kristine; Veierød, Marit Bragelien; Røe, Cecilie; Natvig, Bård; Wahl, Astrid Klopstad & Robinson, Hilde Stendal (2022). Neck and back pain: Differences between patients treated in primary and specialist health care. Journal of Rehabilitation Medicine. ISSN 1650-1977. 54, p. jrm00300–jrm00300. doi: 10.2340/jrm.v54.363. Full text in Research Archive Show summary

  Objective: To describe and compare patients with neck and back pain treated by physiotherapists in primary healthcare (PHC) and in departments for physical medicine and rehabilitation in specialist healthcare (SHC) in Norway. Design: Cross-sectional study using data from the FYSIOPRIM database in PHC and the Norwegian Neck and Back Registry in SHC. Neck and back pain patients in the period 2014–18 aged ≥ 18 years were included. Demographics, lifestyle and clinical factors were investigated. Results: A total of 8,125 patients were included: 584 in PHC and 7,541 in SHC. Mean age was 47.1 and 45.5 years, respectively, with more females in PHC (72% vs 56%). Low levels of education and physical activity, high workload and receiving social benefits were associated with treatment in SHC. Treatment in SHC was most common from 3 to 12 months’ pain duration. Higher pain intensity and lower health-related quality of life were found in patients treated in SHC, no differences were found for psychological distress. Conclusion: This is the first study comparing register data in patients with neck and back pain treated in PHC and SHC. Differences were found in pain and health-related quality of life, but levels of psychological distress were similar between patients treated in PHC and those treated in SHC. LAY ABSTRACT Patients with neck or back pain have high levels of healthcare utilization, both in primary and specialist healthcare. The aim of this study was to investigate patients referred and treated by physiotherapists in primary healthcare and by specialists in specialist healthcare in Norway, to evaluate differences in the demographics, lifestyle and clinical factors of patients treated in each healthcare setting. Included patients had been diagnosed with neck or back pain from 2014 to 2018, and were aged ≥18 years. Patients in specialist care had more pain and lower health-related quality of life, but similar levels of psychological distress to those treated in primary healthcare. Furthermore, patients treated in specialist healthcare had lower socioeconomic status (education, workload, social benefits) compared with those treated in primary healthcare.

• Kjeldsberg, Mona; Tschudi-Madsen, Hedda; Bruusgaard, Dag & Natvig, Bård (2022). Factors related to self-rated health: a survey among patients and their general practitioners. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 40(2), p. 320–328. doi: 10.1080/02813432.2021.2022341. Full text in Research Archive Show summary

  Objective To explore associations between general practice patients’ SRH and symptoms, diagnoses, chronic conditions, unexplained conditions, and life stressors. Design A cross-sectional study. Data were collected from GP and patient questionnaires. Setting General practices in Southeast Norway. Subjects 47 general practitioners (GPs) who included 866 consecutive patients. Main outcome measures SRH was measured with a single question from the COOP-WONCA overall health chart and dichotomized into good/poor SRH. Binary logistic regression models were used in the analyses. Results Poor SRH was reported by 48% of the patients in the past week. A higher prevalence of poor SRH was found for women, middle-aged, recipients of social security grants, patients diagnosed with asthenia, lower back pain, and depression/anxiety, and for patients with reported life stressors and unexplained conditions. We found an almost linear association between the number of symptoms and the likelihood of reporting poor SRH. The probability of reporting poor SRH increased along with an increasing number of symptoms for common diagnoses. In a multivariate analysis, the only number of symptoms, being in receipt of social security grants and being retired was associated with poor SRH. Conclusion The likelihood of reporting poor SRH increased with an increasing number of symptoms, partly independent of the diagnosis given by GPs. This result coincides with our previous findings of a strong association between the number of symptoms, function, and health. The symptom burden thus appears to be an important factor for SRH among patients in general practice.

• Ekeberg, Ole Marius; Pedersen, Stein Jarle; Natvig, Bård; Brox, Jens Ivar; Biringer, Eva Aaker & Reme, Silje Endresen [Show all 10 contributors for this article] (2022). Making should erpa in simple in general practice: Implementing an evidence-based guideline for shoulder pain, protocol for a hybrid design stepped-wedge cluster randomised study (EASIER study). BMJ Open. 12(1). doi: 10.1136/bmjopen-2021-051656. Full text in Research Archive
• Øverås, Cecilie Krage; Johansson, Melker S; Campos, Tarcisio F. de; Ferreira, Manuela L.; Natvig, Bård & Mork, Paul Jarle [Show all 7 contributors for this article] (2021). Distribution and prevalence of musculoskeletal pain co-occurring with persistent low back pain: a systematic review. BMC Musculoskeletal Disorders. doi: 10.1186/s12891-020-03893-z. Full text in Research Archive Show summary

  Background Co-occurring musculoskeletal pain is common among people with persistent low back pain (LBP) and associated with more negative consequences than LBP alone. The distribution and prevalence of musculoskeletal pain co-occurring with persistent LBP has not been systematically described, which hence was the aim of this review. Methods Literature searches were performed in MEDLINE, Embase, CINAHL and Scopus. We considered observational studies from clinical settings or based on cohorts of the general or working populations involving adults 18 years or older with persistent LBP (≥4 wks) and co-occurring musculoskeletal pain for eligibility. Study selection, data extraction and risk of bias assessment were carried out by independent reviewers. Results are presented according to study population, distribution and location(s) of co-occurring pain. Results Nineteen studies out of 5744 unique records met the inclusion criteria. Studies were from high-income countries in Europe, USA and Japan. A total of 34,492 people with persistent LBP were included in our evidence synthesis. Methods for assessing and categorizing co-occurring pain varied considerably between studies, but based on the available data from observational studies, we identified three main categories of co-occurring pain – these were axial pain (18 to 58%), extremity pain (6 to 50%), and multi-site musculoskeletal pain (10 to 89%). Persistent LBP with co-occurring pain was reported more often by females than males, and co-occurring pain was reported more often in patients with more disability. Conclusions People with persistent LBP often report co-occurring neck pain, extremity pain or multi-site pain. Assessment of co-occurring pain alongside persistent LBP vary considerable between studies and there is a need for harmonisation of measurement methods to advance our understanding of how pain in different body regions occur alongside persistent LBP.

• Mengshoel, Anne Marit; Brandsar, Nina Linnea; Natvig, Bård & Fors, Egil Andreas (2021). Concordance between clinician- and 2016 criteria-based diagnoses of fibromyalgia. Scandinavian Journal of Pain. ISSN 1877-8860. 22(1), p. 59–66. doi: 10.1515/sjpain-2021-0087. Full text in Research Archive Show summary

  Objectives The Fibromyalgia Survey Diagnostic Criteria-2016 (FSD-2016 criteria) were recently recommended for both clinical and research purposes. The present study aims to examine whether there is concordance between clinician-based and FSD-2016 criteria-based diagnoses of FM, and secondly, to examine how the illness severity and physical function relate to the criteria-based diagnosis among patients referred to a rheumatism hospital. Methods Participants with a clinician-based diagnosis of FM were included consecutively when referred to a patient education programme for patients with FM. Illness severity was assessed with the Fibromyalgia Survey Questionnaire (FSQ). Based on the FSQ, the fulfilment of the FSD-2016 criteria was evaluated. Physical function was assessed using the Fibromyalgia Impact Questionnaire (FIQ) function scale and self-reported employment status. Results The sample included 130 patients (84% women) from 20 to 66 years of age. Eighty-nine per cent met the FSD-2016 criteria, and 44% of the patients were fully or partially employed. Great variability in illness severity was seen irrespective of employment status. There was an association between illness severity and physical function (r=0.4, p<0.001). For 95% of the patients, the FSQ illness severity scores classify as severe or very severe, and even for those not fulfilling the diagnostic criteria the scores were moderate and severe. Conclusions There was relatively high agreement between clinician- and criteria-based diagnoses. The illness severity overlapped irrespective of different employment status and fulfilment of FSD-2016 criteria.

• Stenehjem, Jo Steinson; Røise, Olav; Nordseth, Trond; Clausen, Thomas; Natvig, Bård & Skurtveit, Svetlana Ondrasova [Show all 10 contributors for this article] (2021). Injury Prevention and long-term Outcomes following Trauma - The IPOT project: a protocol for prospective nationwide registry-based studies in Norway. BMJ Open. 11(5). doi: 10.1136/bmjopen-2020-046954. Full text in Research Archive Show summary

  Introduction Traumatic injuries constitute a major cause of mortality and morbidity. Still, the public health burden of trauma in Norway has not been characterised using nationwide registry data. More knowledge is warranted on trauma risk factors and the long-term outcomes following trauma. The Injury Prevention and long-term Outcomes following Trauma project will establish a comprehensive research database. The Norwegian National Trauma Registry (NTR) will be merged with several data sources to pursue the following three main research topics: (1) the public health burden of trauma to society (eg, excess mortality and disability-adjusted life-years (DALYs)), (2) trauma aetiology (eg, socioeconomic factors, comorbidity and drug use) and (3) trauma survivorship (eg, survival, drug use, use of welfare benefits, work ability, education and income). Methods and analysis The NTR (n≈27 000 trauma patients, 2015–2018) will be coupled with the data from Statistics Norway, the Norwegian Patient Registry, the Cause of Death Registry, the Registry of Primary Health Care and the Norwegian Prescription Database. To quantify the public health burden, DALYs will be calculated from the NTR. To address trauma aetiology, we will conduct nested case–control studies with 10 trauma-free controls (drawn from the National Population Register) matched to each trauma case on birth year, sex and index date. Conditional logistic regression models will be used to estimate trauma risk according to relevant exposures. To address trauma survivorship, we will use cohort and matched cohort designs and time-to-event analyses to examine various post-trauma outcomes.

• Kjeldsberg, Mona; Tschudi-Madsen, Hedda; Mdala, Ibrahimu; Bruusgaard, Dag & Natvig, Bård (2021). Patients in general practice share a common pattern of symptoms that is partly independent of the diagnosis. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 39(2), p. 184–193. doi: 10.1080/02813432.2021.1913886. Full text in Research Archive
• Moseng, Tuva; Dagfinrud, Hanne Solveig; Bodegom-Vos, Leti van; Dziedzic, Krysia; Hagen, Kåre Birger & Natvig, Bård [Show all 9 contributors for this article] (2020). Low adherence to exercise may have influenced the proportion of OMERACT-OARSI responders in an integrated osteoarthritis care model: secondary analyses from a cluster-randomised stepped-wedge trial. BMC Musculoskeletal Disorders. 21. doi: 10.1186/s12891-020-03235-z. Full text in Research Archive Show summary

  Background: To address the well-documented gap between hip and knee osteoarthritis (OA) treatment recommendations and current clinical practice, a structured model for integrated OA care was developed and evaluated in a stepped-wedge cluster-randomised controlled trial. The current study used secondary outcomes to evaluate clinically important response to treatment through the Outcome Measures in Rheumatology Clinical Trials clinical responder criteria (OMERACT-OARSI responder criteria) after 3 and 6 months between patients receiving the structured OA care model vs. usual care. Secondly, the study aimed to investigate if the proportion of responders in the intervention group was influenced by adherence to the exercise program inherent in the model. Methods: The study was conducted in primary healthcare in six Norwegian municipalities. General practitioners and physiotherapists received training in OA treatment recommendations and use of the structured model. The intervention group attended a physiotherapist-led OA education program and performed individually tailored exercises for 8–12 weeks. The control group received usual care. Patient-reported pain, function and global assessment of disease activity during the last week were evaluated using 11-point numeric rating scales (NRS 0–10). These scores were used to calculate the proportion of OMERACT-OARSI responders. Two-level mixed logistic regression models were fitted to investigate differences in responders between the intervention and control group. Results: Two hundred eighty-four intervention and 109 control group participants with hip and knee OA recruited from primary care in six Norwegian municipalities. In total 47% of the intervention and 35% of the control group participants were responders at 3 or 6 months combined; showing an uncertain between-group difference (ORadjusted 1.38 (95% CI 0.41, 4.67). In the intervention group, 184 participants completed the exercise programme (exercised ≥2 times/week for ≥8 weeks) and 55% of these were classified as responders. In contrast, 28% of the 86 non-completers were classified as responders. Conclusions: The difference in proportion of OMERACT-OARSI responders at 3 and 6 months between the intervention and control group was uncertain. In the intervention group, a larger proportion of responders were seen among the exercise completers compared to the non-completers.

• Irgens, Pernille Marie; Kongsted, Alice; Myhrvold, Birgitte Lawaetz; Waagan, Knut; Engebretsen, Kaia Beck & Natvig, Bård [Show all 8 contributors for this article] (2020). Neck pain patterns and subgrouping based on weekly SMS-derived trajectories. BMC Musculoskeletal Disorders. 21, p. 1–14. doi: 10.1186/s12891-020-03660-0. Full text in Research Archive Show summary

  Background Neck and low back pain represent dynamic conditions that change over time, often with an initial improvement after the onset of a new episode, followed by flare-ups or variations in intensity. Pain trajectories were previously defined based on longitudinal studies of temporal patterns and pain intensity of individuals with low back pain. In this study, we aimed to 1) investigate if the defined patterns and subgroups for low back pain were applicable to neck pain patients in chiropractic practice, 2) explore the robustness of the defined patterns, and 3) investigate if patients within the various patterns differ concerning characteristics and clinical findings. Methods Prospective cohort study including 1208 neck pain patients from chiropractic practice. Patients responded to weekly SMS-questions about pain intensity and frequency over 43 weeks. We categorized individual responses into four main patterns based on number of days with pain and variations in pain intensity, and subdivided each into four subgroups based on pain intensity, resulting in 16 trajectory subgroups. We compared baseline characteristics and clinical findings between patterns and between Persistent fluctuating and Episodic subgroups. Results All but two patients could be classified into one of the 16 subgroups, with 94% in the Persistent fluctuating or Episodic patterns. In the largest subgroup, “Mild Persistent fluctuating” (25%), mean (SD) pain intensity was 3.4 (0.6) and mean days with pain 130. Patients grouped as “Moderate Episodic” (24%) reported a mean pain intensity of 2.7 (0.6) and 39 days with pain. Eight of the 16 subgroups each contained less than 1% of the cohort. Patients in the Persistent fluctuating pattern scored higher than the other patterns in terms of reduced function and psychosocial factors. Conclusions The same subgroups seem to fit neck and low back pain patients, with pain that typically persists and varies in intensity or is episodic. Patients in a Persistent fluctuating pattern are more bothered by their pain than those in other patterns. The low back pain definitions can be used on patients with neck pain, but with the majority of patients classified into 8 subgroups, there seems to be a redundancy in the original model.

• Monsbakken, Liv; Bukholm, Ida Rashida Khan & Natvig, Bård (2020). Pasientskader hos fastleger meldt til Norsk pasientskadeerstatning 2011–17. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 140(4). doi: 10.4045/tidsskr.19.0191. Full text in Research Archive
• Myhrvold, Birgitte Lawaetz; Irgens, Pernille Marie; Robinson, Hilde Stendal; Engebretsen, Kaia Beck; Natvig, Bård & Kongsted, Alice [Show all 7 contributors for this article] (2020). Visual trajectory pattern as prognostic factors for neck pain. European Journal of Pain. ISSN 1090-3801. 24(9), p. 1752–1764. doi: 10.1002/ejp.1622. Full text in Research Archive Show summary

  Background A novel approach capturing both temporal variation and pain intensity of neck pain is by visual trajectory patterns. Recently, both previous and expected visual trajectory patterns were identified as stronger predictors of outcome than traditional measures of pain history and psychological distress. Our aim was to examine patient characteristics within the various previous and expected patterns, relationship between the two patterns and predictive value of a variable combining the previous and expected patterns. Methods Patients with neck pain (n = 932) consulting chiropractors were included. Baseline measures included pain intensity, disability, psychological variables and symptom history and expectations. Participants reported global perceived effect after 12 weeks. Analyses included descriptive statistics and logistic regression. Results Pain intensity, disability, psychological and worse outcome expectations increased from a single pain episode to severe ongoing pain of previous and expected patterns. Having a severe pain history was associated with poor prognosis, particularly if combined with negative expectations. The variable combining previous and expected patterns had a discriminative ability similar to that of other predictors AUC = 0.64 (95% CI = 0.60–0–67) versus AUC = 0.66 (95% CI = 0.62–0.70). The model with highest discriminative ability was achieved when adding the combined patterns to other predictors AUC = 0.70 (95% CI = 0.66–0.73). Conclusion The study indicates that pain expectations are formed by pain history. The patients’ expectations were similar to or more optimistic compared with their pain history. The prognostic ability of the model including a simplified combination of previous and expected patterns, together with a few other predictors, suggests that the trajectory patterns might have potential for clinical use. Significance The dynamic nature of neck pain can be captured by visual illustrations of trajectory patterns. We report, that trajectory patterns of pain history and future expectations to some extent are related. The patterns also reflect a difference in severity assessed by higher degree of symptoms and distress. Moreover, the visual trajectory patterns predict outcome at 12‐weeks. Since the patterns are easily applicable, they might have potential as a clinical tool.

• Costa, Natália R.; Ferreira, Manuela L; Setchell, Jenny; Makovey, Joanna; Dekroo, Tanya & Downie, Aron [Show all 28 contributors for this article] (2019). A Definition of “Flare” in Low Back Pain: A Multiphase Process Involving Perspectives of Individuals With Low Back Pain and Expert Consensus. Journal of Pain. ISSN 1526-5900. 20(11), p. 1267–1275. doi: 10.1016/j.jpain.2019.03.009. Full text in Research Archive
• Weldingh, Eirik; Johnsen, Marianne Bakke; Hagen, Kåre Birger; Østerås, Nina; Risberg, May Arna & Natvig, Bård [Show all 11 contributors for this article] (2019). The Maternal and Paternal Effects on Clinically and Surgically Defined Osteoarthritis. Arthritis & Rheumatology. ISSN 2326-5191. 71(11), p. 1844–1848. doi: 10.1002/art.41023. Full text in Research Archive Show summary

  Objective: It is currently unknown whether osteoarthritis (OA) is inherited mainly from the mother, father, or both. This study was undertaken to explore the effect of maternal and paternal factors on hip, knee, and hand OA in offspring. Methods: Participants from the Musculoskeletal Pain in Ullensaker Study (MUST) (69% female; mean ± SD age 64 ± 9 years) and a Norwegian OA twin study (Nor‐Twin) (56% female; 49 ± 11 years) reported whether their mother and/or father had OA. Using a recurrence risk estimation approach, we calculated whether maternal and paternal OA increased the risk of 1) surgically defined hip and knee OA (i.e., total joint replacement) and 2) clinically defined hip, knee, and hand OA (i.e., the American College of Rheumatology criteria) using logistic regression. Relative risks (RRs) with 95% confidence intervals (95% CIs) were calculated. Results: Maternal OA consistently increased the risk of offspring OA across different OA locations and severities. Having a mother with OA increased the risk of any OA in daughters (RR 1.13 [95% CI 1.02–1.25] in the MUST cohort; RR 1.44 [95% CI 1.05–1.97] in the Nor‐Twin cohort) but not (or with less certainty) in sons (RR 1.16 [95% CI 0.95–1.43] in the MUST cohort; RR 1.31 [95% CI 0.71–2.41] in the Nor‐Twin cohort). Having a father with OA was less likely to increase the risk of any OA in daughters (RR 1.00 [95% CI 0.85–1.16] in the MUST cohort; RR 1.52 [95% CI 0.94–2.46] in the Nor‐Twin cohort) and sons (RR 1.08 [95% CI 0.83–1.41] in the MUST cohort; RR 0.93 [95% CI 0.35–2.48] in the Nor‐Twin cohort). Conclusion: OA in the mother increased the risk of surgically and clinically defined hip, knee, and hand OA in offspring, particularly in daughters. Our findings imply that heredity of OA may be linked to maternal genes and/or maternal‐specific factors such as the fetal environment.

• Holmedal, Øystein; Olaussen, Morten; Mdala, Ibrahimu; Natvig, Bård & Lindbæk, Morten (2019). Predictors for outcome in acute lateral epicondylitis. BMC Musculoskeletal Disorders. 20(1). doi: 10.1186/s12891-019-2758-y. Full text in Research Archive Show summary

  Background Lateral epicondylitis or tennis elbow is a frequent condition with long-lasting symptoms. In order to identify predictors for treatment success and pain in lateral epicondylitis, we used data from a randomized controlled trial. This trial investigated the efficacy of physiotherapy alone or combined with corticosteroid injection for acute lateral epicondylitis in general practice. Methods The outcomes treatment success and pain score on VAS were assessed at 6, 12, 26 and 52 weeks. We ran a univariate binary logistic regression with generalized estimating equations (GEE) and subsequently an adjusted multilevel logistic regression to analyze the association between potential prognostic indicators and the outcome success/ no success. To assess the changes in pain score we used a two-level multilevel linear regression (MLR) followed by an adjusted MLR model with random effects. Results The most consistent predictor for reduced treatment success at all time points was a high Pain Free Function Index score signifying more pain on everyday activities. Being on paid sick-leave and having a recurring complaint increased short term treatment success but gave decreased long-term treatment success. The patients reporting symptoms after engaging in probable overuse in an unusual activity, tended towards increased treatment success at all time-points, but significant only at 12 weeks. The most consistent predictor of increased pain at all time points was a higher overall complaints score at baseline. Conclusions: Our results suggest that in treating acute lateral epicondylitis, a consideration of baseline pain, a registration of the patient’s overall complaint on a VAS scale and an assessment of the patient’s perceived performance in everyday activities with the Pain Free Function Index can be useful in identifying patients that will have a more protracted and serious condition. Trial registration ClinicalTrials.gov Identifier: NCT00826462 . Date of registration January 22, 2009. The Trial was prospectively registrated.

• Østerås, Nina; Moseng, Tuva; Bodegom-Vos, Leti van; Dziedzic, Krysia; Mdala, Ibrahimu & Natvig, Bård [Show all 12 contributors for this article] (2019). Implementing a structured model for osteoarthritis care in primary healthcare: A stepped-wedge cluster-randomised trial. PLoS Medicine. ISSN 1549-1277. 16(10). doi: 10.1371/journal.pmed.1002949. Full text in Research Archive Show summary

  Background To improve quality of care for patients with hip and knee osteoarthritis (OA), a structured model for integrated OA care was developed based on international recommendations. The objective of this study was to assess the effectiveness of this model in primary care. Methods and findings We conducted a cluster-randomised controlled trial with stepped-wedge cohort design in 6 Norwegian municipalities (clusters) between January 2015 and October 2017. The randomised order was concealed to the clusters until the time of crossover from the control to the intervention phase. The intervention was implementation of the SAMBA model, facilitated by interactive workshops for general practitioners and physiotherapists with an update on OA treatment recommendations. Patients in the intervention group attended a physiotherapist-led OA education and individually tailored exercise programme for 8–12 weeks. The primary outcome was patient-reported quality of care (OsteoArthritis Quality Indicator questionnaire; 0–100, 100 = optimal quality) at 6 months. Secondary outcomes included patient-reported referrals to physiotherapy, magnetic resonance imaging (MRI), and orthopaedic surgeon consultation; patients’ satisfaction with care; physical activity level; and proportion of patients who were overweight or obese (body mass index ≥ 25 kg/m2). In all, 40 of 80 general practitioners (mean age [SD] 50 [12] years, 42% females) and 37 of 64 physiotherapists (mean age [SD] 42 [8] years, 65% females) participated. They identified 531 patients, of which 393 patients (mean age [SD] 64 [10] years, 71% females) with symptomatic hip or knee OA were included. Among these, 109 patients were recruited during the control periods (control group), and 284 patients were recruited during interventions periods (intervention group). The patients in the intervention group reported significantly higher quality of care (score of 60 versus 41, mean difference 18.9; 95% CI 12.7, 25.1; p < 0.001) and higher satisfaction with OA care (odds ratio [OR] 12.1; 95% CI 6.44, 22.72; p < 0.001) compared to patients in the control group. The increase in quality of care was close to, but below, the pre-specified minimal important change. In the intervention group, a higher proportion was referred to physiotherapy (OR 2.5; 95% CI 1.08, 5.73; p = 0.03), a higher proportion fulfilled physical activity recommendations (OR 9.3; 95% CI 2.87, 30.37; p < 0.001), and a lower proportion was referred to an orthopaedic surgeon (OR 0.3; 95% CI 0.08, 0.80; p = 0.02), as compared to the control group. There were no significant group differences regarding referral to MRI (OR 0.6; 95% CI 0.13, 2.38; p = 0.42) and proportion of patients who were overweight or obese (OR 1.3; 95% CI 0.70, 2.51; p = 0.34). Study limitations include the imbalance in patient group size, which may have been due to an increased attention to OA patients among the health professionals during the intervention phase, and a potential recruitment bias as the patient participants were identified by their health professionals. Conclusions In this study, a structured model in primary care resulted in higher quality of OA care as compared to usual care. Future studies should explore ways to implement the structured model for integrated OA care on a larger scale.

• Østerås, Nina; Tveter, Anne Therese; Garratt, Andrew; Svinøy, Odd-Einar; Kjeken, Ingvild & Natvig, Bård [Show all 8 contributors for this article] (2018). Measurement properties for the revised patient-reported OsteoArthritis Quality Indicator questionnaire. Osteoarthritis and Cartilage. ISSN 1063-4584. 26(10), p. 1300–1310. doi: 10.1016/j.joca.2018.06.007. Full text in Research Archive
• Aarseth, Guri; Natvig, Bård; Engebretsen, Eivind & Lie, Anne Helene Kveim (2018). Acting by persuasion— values and rhetoric in medical certificates of work incapacity: A qualitative document analysis. Medical Humanities. ISSN 1468-215X. 0, p. 1–7. doi: 10.1136/medhum-2018-011496. Full text in Research Archive
• Ruud, Sven Eirik; Hjortdahl, Per & Natvig, Bård (2017). Reasons for attending a general emergency outpatient clinic versus a regular general practitioner - a survey among immigrant and native walk-in patients in Oslo, Norway. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 35(1), p. 35–45. doi: 10.1080/02813432.2017.1288817. Full text in Research Archive Show summary

  Objective: To explore reasons for attending a general emergency outpatient clinic versus a regular general practitioner (RGP). Design: Cross-sectional study using a multilingual anonymous questionnaire. Setting: Native and immigrant walk-in patients attending a general emergency outpatient clinic in Oslo (Monday–Friday, 08:00–23:00) during 2 weeks in September 2009. Subjects: We included 1022 walk-in patients: 565 native Norwegians (55%) and 457 immigrants (45%). Main outcome measures: Patients’ reasons for attending an emergency outpatient clinic versus their RGP. Results: Among patients reporting an RGP affiliation, 49% tried to contact their RGP before this emergency encounter: 44% of native Norwegian and 58% of immigrant respondents. Immigrants from Africa [odds ratio (OR) = 2.55 (95% confidence interval [CI]: 1.46–4.46)] and Asia [OR = 2.32 (95% CI: 1.42–3.78)] were more likely to contact their RGP before attending the general emergency outpatient clinic compared with native Norwegians. The most frequent reason for attending the emergency clinic was difficulty making an immediate appointment with their RGP. A frequent reason for not contacting an RGP was lack of access: 21% of the native Norwegians versus 4% of the immigrants claimed their RGP was in another district/municipality, and 31% of the immigrants reported a lack of affiliation with the RGP scheme. Conclusions and implications: Access to primary care provided by an RGP affects patients’ use of emergency health care services. To facilitate continuity of health care, policymakers should emphasize initiatives to improve access to primary health care services.

• Øverås, Cecilie Krage; Johansson, Melker S; Campos, Tarcisio F. de; Ferreira, Manuela L; Natvig, Bård & Mork, Paul Jarle [Show all 7 contributors for this article] (2017). Prevalence and pattern of co-occurring musculoskeletal pain and its association with back-related disability among people with persistent low back pain: protocol for a systematic review and meta-analysis. Systematic Reviews. doi: 10.1186/s13643-017-0656-7. Full text in Research Archive
• Magnusson, Karin; Mathiessen, Alexander; Hammer, Hilde Berner; Kvien, Tore Kristian; Christensen, Barbara Therese Slatkovsky & Natvig, Bård [Show all 9 contributors for this article] (2017). Smoking and alcohol use are associated with structural and inflammatory hand osteoarthritis features. Scandinavian Journal of Rheumatology. ISSN 0300-9742. 46(5), p. 388–395. doi: 10.1080/03009742.2016.1257736. Full text in Research Archive
• Aarseth, Guri; Natvig, Bård; Engebretsen, Eivind & Lie, Anne Helene Kveim (2017). ‘Working is out of the question’: a qualitative text analysis of medical certificates of disability. BMC Family Practice. 18(55). doi: 10.1186/s12875-017-0627-z. Full text in Research Archive Show summary

  Background Medical certificates influence the distribution of economic benefits in welfare states; however, the qualitative aspects of these texts remain largely unexplored. The present study is the first systematic investigation done of these texts. Our aim was to investigate how GPs select and mediate information about their patients’ health and how they support their conclusions about illness, functioning and fitness for work in medical certificates. Methods We performed a textual analysis of thirty-three medical certificates produced by general practitioners (GP) in Norway at the request of the Norwegian Labour and Welfare Administration (NAV).The certificates were subjected to critical reading using the combined analytic methods of narratology and linguistics. Results Some of the medical information was unclear, ambiguous, and possibly misleading. Evaluations of functioning related to illness were scarce or absent, regardless of diagnosis, and, hence, the basis of working incapacity was unclear. Voices in the text frequently conflated, obscuring the source of speaker. In some documents, the expert’s subtle use of language implied doubts about the claimant’s credibility, but explicit advocacy also occurred. GPs show little insight into their patients’ working lives, but rather than express uncertainty and incompetence, they may resort to making too absolute and too general statements about patients’ working capacity, and fail to report thorough assessments. Conclusions A number of the texts in our material may not function as sufficient or reliable sources for making decisions regarding social benefits. Certificates as these may be deficient for several reasons, and textual incompetence may be one of them. Physicians in Norway receive no systematic training in professional writing. High-quality medical certificates, we believe, might be economical in the long term: it might increase the efficiency with which NAV processes cases and save costs by eliminating the need for unnecessary and expensive specialist reports. Moreover, correct and coherent medical certificates can strengthen legal protection for claimants. Eventually, reducing advocacy in these documents may contribute to a fairer evaluation of whether claimants are eligible for disability benefits or not. Therefore, we believe that professional writing skills should be validated as an important part of medical practice and should be integrated in medical schools and in further education as a discipline in its own right, preferably involving humanities professors.

• Overaas, Cecile K; Johansson, Melker S; Campos, Tarcisio F de; Ferreira, Manuela L; Natvig, Bård & Mork, Paul Jarle [Show all 7 contributors for this article] (2017). Prevalence and pattern of co-occuring musculoskeletal pain and its association with back-related disability among people with persistent low back pain: protocol for a systematic review and meta-analysis. Systematic Reviews. 6(1). doi: 10.1186/s13643-017-0656-7. Full text in Research Archive Show summary

  Background Individuals with persistent low back pain commonly have a broad range of other health concerns including co-occurring musculoskeletal pain, which significantly affect their quality of life, symptom severity, and treatment outcomes. The purpose of this review is to get a better understanding of prevalence and patterns of co-occurring musculoskeletal pain complaints in those with persistent low back pain and its potential association with age, sex, and back-related disability as it might affect prognosis and management. Methods This systematic review protocol has been designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. We will perform a comprehensive search, with no date limit, in the following bibliographic databases: MEDLINE and Embase (via Ovid), CINAHL, and Scopus for citation tracking, based on the following domains: back pain, co-occurring musculoskeletal pain, combined with a focus group that emphasizes study design. Appropriate papers will be screened against the eligibility criteria by three reviewers independently, data extracted by two independent author pairs and disagreement resolved by consensus meetings or other reviewers if required. Assessment of methodological quality and risk of bias will be conducted using a modified version of the Risk of Bias Tool for Prevalence Studies developed by Hoy and colleagues. The overall risk of bias will be determined for each included study based on the raters’ consensus of the responses to the items in this tool. In case of sufficiently homogenous studies, meta-analysis will be performed. Discussion Given the lack of standard terms used to define co-occurring musculoskeletal pain, the search strategy will include the broader term “back pain,” different terms for the “other co-occurring pain,” and specific study designs combined with several exclusion terms. The results of this proposed review will identify the prevalence and patterns of co-occurring musculoskeletal pain among those with persistent low back pain, which is likely to inform clinical management, research, and policy in management of musculoskeletal disorders.

• Magnusson, Karin; Hagen, Kåre Birger & Natvig, Bård (2016). Individual and joint effects of risk factors for onset widespread pain and obesity – a population-based prospective cohort study. European Journal of Pain. ISSN 1090-3801. 20(7), p. 1102–1110. doi: 10.1002/ejp.834. Full text in Research Archive
• Ruud, Sven Eirik; Hjortdahl, Per & Natvig, Bård (2016). Is it a matter of urgency? A survey of assessments by walk-in patients and doctors of the urgency level of their encounters at a general emergency outpatient clinic in Oslo, Norway. BMC Emergency Medicine. 16(22). doi: 10.1186/s12873-016-0086-1. Full text in Research Archive Show summary

  Background Emergency room (ER) use is increasing in several countries. Variability in the proportion of non-urgent ER visits was found to range from 5 to 90 % (median 32 %). Non-urgent emergency visits are considered an inappropriate and inefficient use of the health-care system because they may lead to higher expenses, crowding, treatment delays, and loss of continuity of health care provided by a general practitioner. Urgency levels of doctor–walk-in patient encounters were assessed based on their region of origin in a diverse Norwegian population. Methods An anonymous, multilingual questionnaire was distributed to all walk-in patients at a general emergency outpatient clinic in Oslo during two weeks in September 2009. We analysed demographic data, patient–doctor assessments of the level of urgency, and the results of the consultation. We used descriptive statistics to obtain frequencies with 95 % confidence interval (CI) for assessed levels of urgency and outcomes. Concordance between the patients’ and doctors’ assessments was analysed using a Kendall tau-b test. We used binary logistic regression modelling to quantify associations of explanatory variables and outcomes according to urgency level assessments. Results The analysis included 1821 walk-in patients. Twenty-four per cent of the patients considered their emergency consultation to be non-urgent, while the doctors considered 64 % of encounters to be non-urgent. The concordance between the assessments by the patient and by their doctor was positive but low, with a Kendall tau-b coefficient of 0.202 (p < 0.001). Adjusted logistic regression analysis showed that patients from Eastern Europe (odds ratio (OR) = 3.04; 95 % CI 1.60–5.78), Asia and Turkey (OR = 4.08; 95 % CI 2.43–6.84), and Africa (OR = 8.47; 95 % CI 3.87–18.5) reported significantly higher urgency levels compared with Norwegians. The doctors reported no significant difference in assessment of urgency based on the patient’s region of origin, except for Africans (OR = 0.64; 95 % CI 0.43–0.96). Conclusion This study reveals discrepancies between assessments by walk-in patients and doctors of the urgency level of their encounters at a general emergency clinic. The patients’ self-assessed perception of the urgency level was related to their region of origin.

• Haugen, Anne Julsrud; Grøvle, Lars; Brox, Jens Ivar; Natvig, Bård & Grotle, Margreth (2016). Pain-related fear and functional recovery in sciatica: results from a 2-year observational study. Journal of Pain Research. 9, p. 925–931. doi: 10.2147/JPR.S115003. Full text in Research Archive
• Aarseth, Guri; Natvig, Bård; Engebretsen, Eivind; Maagerø, Eva & Lie, Anne Helene Kveim (2016). Writing the patient down and out: the construal of the patient in medical certificates of disability. Sociology of Health and Illness. ISSN 0141-9889. 38(8), p. 1379–1395. doi: 10.1111/1467-9566.12481. Full text in Research Archive Show summary

  We analysed a set of medical certificates to investigate how GPs portray patients who seek disability benefits in Norway, focusing on patient centredness, agency and involvement. We performed a qualitative linguistic analysis of 33 medical certificates collected throughout Norway that were strategically selected based on the patients’ sex, age and diagnosis. We found that patients were represented as passive carriers of symptoms, in whom agency was low, failed, conditional or non-existing, or as passive objects of the actions of impersonalised others. Conversely, symptoms were foregrounded as independent and powerful actors. The patient's experience of illness was sometimes reported, but the perspective of the GP tended to be doctor oriented, rather than patient centred. The policy of the social services, which emphasises patient involvement, patient centredness and work, rather than social benefits, was almost completely absent from these medical certificates. If medical certificates are to be a valid basis for decisions within the social services, we suggest that doctor paternalism in these documents must give way to considering the patient as an involved and co-responsible individual in the processes of disability assessment.

• Ruud, Sven Eirik; Aandstad, Ruth Aga; Natvig, Bård & Hjortdahl, Per (2015). Use of emergency care services by immigrants—a survey of walk-in patients who attended the Oslo Accident and Emergency Outpatient Clinic. BMC Emergency Medicine. 15:25. doi: 10.1186/s12873-015-0055-0. Full text in Research Archive Show summary

  Background The Oslo Accident and Emergency Outpatient Clinic (OAEOC) experienced a 5–6 % annual increase in patient visits between 2005 and 2011, which was significantly higher than the 2–3 % annual increase among registered Oslo residents. This study explored immigrant walk-in patients’ use of both the general emergency and trauma clinics of the OAEOC and their concomitant use of regular general practitioners (RGPs) in Oslo. Methods A cross-sectional survey of walk-in patients attending the OAEOC during 2 weeks in September 2009. We analysed demographic data, patients’ self-reported affiliation with the RGP scheme, self-reported number of OAEOC and RGP consultations during the preceding 12 months. The first approach used Poisson regression models to study visit frequency. The second approach compared the proportions of first- and second-generation immigrants and those from the four most frequently represented countries (Sweden, Pakistan, Somalia and Poland) among the patient population, with their respective proportions within the general Oslo population. Results The analysis included 3864 patients: 1821 attended the Department of Emergency General Practice (“general emergency clinic”); 2043 attended the Section for Orthopaedic Emergency (“trauma clinic”). Both first- and second-generation immigrants reported a significantly higher OAEOC visit frequency compared with Norwegians. Norwegians, representing 73 % of the city population accounted for 65 % of OAEOC visits. In contrast, first- and second-generation immigrants made up 27 % of the city population but accounted for 35 % of OAEOC visits. This proportional increase in use was primarily observed in the general emergency clinic (42 % of visits). Their proportional use of the trauma clinic (29 %) was similar to their proportion in the city. Among first-generation immigrants only 71 % were affiliated with the RGP system, in contrast to 96 % of Norwegians. Similar finding were obtained when immigrants were grouped by nationality. Compared to Norwegians, immigrants from Sweden, Pakistan and Somalia reported using the OAEOC significantly more often. Immigrants from Sweden, Poland and Somalia were over-represented at both clinics. The least frequent RGP affiliation was among immigrants from Sweden (32 %) and Poland (65 %). Conclusions In Norway, immigrant subgroups use emergency health care services in different ways. Understanding these patterns of health-seeking behaviour may be important when designing emergency health services.

• Lacey, R. J.; Strauss, V. Y.; Rathod, T.; Belcher, J.; Croft, P. R. & Natvig, Bård [Show all 8 contributors for this article] (2015). Clustering of pain and its associations with health in people aged 50 years and older: Cross-sectional results from the North Staffordshire Osteoarthritis Project. BMJ Open. 5(11). doi: 10.1136/bmjopen-2015-008389. Full text in Research Archive
• Østerås, Nina; Bodegom-Vos, Leti van; Dziedzic, Krysia; Moseng, Tuva; Aas, Eline & Andreassen, Øyvor [Show all 12 contributors for this article] (2015). Implementing international osteoarthritis treatment guidelines in primary Health care: study protocol for the SAMBA stepped wedge cluster randomized controlled trial. Implementation Science. 10(1). doi: 10.1186/s13012-015-0353-7. Full text in Research Archive Show summary

  Background Previous research indicates that people with osteoarthritis (OA) are not receiving the recommended and optimal treatment. Based on international treatment recommendations for hip and knee OA and previous research, the SAMBA model for integrated OA care in Norwegian primary health care has been developed. The model includes physiotherapist (PT) led patient OA education sessions and an exercise programme lasting 8–12 weeks. This study aims to assess the effectiveness, feasibility, and costs of a tailored strategy to implement the SAMBA model. Methods/design A cluster randomized controlled trial with stepped wedge design including an effect, process, and cost evaluation will be conducted in six municipalities (clusters) in Norway. The municipalities will be randomized for time of crossover from current usual care to the implementation of the SAMBA model by a tailored strategy. The tailored strategy includes interactive workshops for general practitioners (GPs) and PTs in primary care covering the SAMBA model for integrated OA care, educational material, educational outreach visits, feedback, and reminder material. Outcomes will be measured at the patient, GP, and PT levels using self-report, semi-structured interviews, and register based data. The primary outcome measure is patient-reported quality of care (OsteoArthritis Quality Indicator questionnaire) at 6-month follow-up. Secondary outcomes include referrals to PT, imaging, and referrals to the orthopaedic surgeon as well as participants’ treatment satisfaction, symptoms, physical activity level, body weight, and self-reported and measured lower limb function. The actual exposure to the tailor made implementation strategy and user experiences will be measured in a process evaluation. In the economic evaluation, the difference in costs of usual OA care and the SAMBA model for integrated OA care will be compared with the difference in health outcomes and reported by the incremental cost-effectiveness ratio (ICER). Discussion The results from the present study will add to the current knowledge on tailored strategies, which aims to improve the uptake of evidence-based OA care recommendations and improve the quality of OA care in primary health care. The new knowledge can be used in national and international initiatives designed to improve the quality of OA care.

• Magnusson, Karin; Hagen, Kåre Birger; Østerås, Nina; Nordsletten, Lars; Natvig, Bård & Haugen, Ida Kristin (2015). Diabetes is associated with increased hand pain in erosive hand osteoarthritis: Data from a population-based study. Arthritis care & research. ISSN 2151-464X. 67(2), p. 187–195. doi: 10.1002/acr.22460. Full text in Research Archive
• Knutsen, Kirsten Irene Valebjørg; Madar, Ahmed Ali; Brekke, Mette; Meyer, Haakon E; Natvig, Bård & Mdala, Ibrahimu [Show all 7 contributors for this article] (2014). Effect of vitamin D on musculoskeletal pain and headache: A randomized, double-blind, placebo-controlled trial among adult ethnic minorities in Norway. Pain. ISSN 0304-3959. 155(12), p. 2591–2598. doi: 10.1016/j.pain.2014.09.024. Full text in Research Archive
• Tschudi-Madsen, Hedda; Kjeldsberg, Mona; Natvig, Bård; Ihlebæk, Camilla; Straand, Jørund & Bruusgaard, Dag (2014). Medically unexplained conditions considered by patients in general practice. Family Practice. ISSN 0263-2136. 31(2), p. 156–163. doi: 10.1093/fampra/cmt081. Full text in Research Archive
• Engebretsen, Kaia Beck; Grotle, Margreth & Natvig, Bård (2014). Patterns of shoulder pain during a 14-year follow-up: results from a longitudinal population study in Norway. Shoulder & Elbow. ISSN 1758-5732. doi: 10.1177/1758573214552007. Full text in Research Archive
• Juel, Niels Gunnar & Natvig, Bård (2014). Shoulder diagnoses in secondary care, a one year cohort. BMC Musculoskeletal Disorders. 15(1). doi: 10.1186/1471-2474-15-89. Full text in Research Archive
• Grøvle, Lars; Haugen, Anne Julsrud; Hasvik, Eivind; Natvig, Bård; Brox, Jens Ivar & Grotle, Margreth (2014). Patients' ratings of global perceived change during 2 years were strongly influenced by the current health status. Journal of Clinical Epidemiology. ISSN 0895-4356. 67(5), p. 508–515. doi: 10.1016/j.jclinepi.2013.12.001. Full text in Research Archive Show summary

  Objectives: To investigate the longitudinal validity of patients' ratings of global perceived change (GPC) and to assess the implications of using the GPC as the anchor to determine the minimal important change (MIC). Study Design and Setting: Secondary analysis of data from a multicenter study including 380 patients with disc-related sciatica with follow-ups at 3, 6, 12, and 24 months. The GPC scale ranged from much worse to completely gone. Five patient-reported outcome measures were used. An MIC was defined as the mean change score in the actual outcome measure for patients reporting being better. The influence of patients' current state and baseline scores on the GPC was analyzed by multivariate linear regression. Differences in the magnitude of the MIC between the 3- and 24-month recall periods were analyzed by hierarchical linear models. Results: Across all recall periods and outcome measures, the GPC was strongly influenced by the patient's state at the time of asking. In four of five outcome measures, the magnitude of the MIC increased when recall increased from 3 to 24 months. Conclusion: Caution is needed when using the GPC to determine the MIC of patient-reported outcome measures in patients with chronic conditions.

• Magnusson, Karin; Østerås, Nina; Mowinckel, Petter; Natvig, Bård & Hagen, Kåre Birger (2014). No strong temporal relationship between obesity and multisite pain - results from a population-based 20-year follow-up study. European Journal of Pain. ISSN 1090-3801. 18(1), p. 120–127. doi: 10.1002/j.1532-2149.2013.00338.x. Full text in Research Archive
• Magnusson, Karin; Østerås, Nina; Haugen, Ida Kristin; Mowinckel, Petter; Nordsletten, Lars & Natvig, Bård [Show all 7 contributors for this article] (2014). No strong relationship between body mass index and clinical hand osteoarthritis: results from a population-based case-control study. Scandinavian Journal of Rheumatology. ISSN 0300-9742. 43(5), p. 409–415. doi: 10.3109/03009742.2014.900700. Full text in Research Archive
• Magnusson, Karin; Haugen, Ida Kristin; Østerås, Nina; Nordsletten, Lars; Natvig, Bård & Hagen, Kåre Birger (2014). The validity of self-reported body mass index in a population-based osteoarthritis study. BMC Musculoskeletal Disorders. 15(1), p. 442–446. doi: 10.1186/1471-2474-15-442. Full text in Research Archive Show summary

  Background Obesity is a well-known risk factor for osteoarthritis (OA). The majority of obesity research in OA is performed using self-reported BMI-data, however, its validity in persons with OA is unknown. The aim of this study was to compare the validity of self-reported body mass index (BMI) in persons with and without clinical osteoarthritis (OA) in a population-based survey. Methods Height and weight were self-reported, and thereafter measured in 600 persons with and without clinical OA according to the American College of Rheumatology-criteria (knees, hips and/or hands). We compared the differences between measured and self-reported heights, weights and BMIs (kg/m2) for the two groups and explored whether demographic/clinical factors were associated with inaccurate reporting in the OA patients using multivariate linear regression analyses. Results Mean (SD) age was 64 (8.7) years and 412 (69%) were women. Participants with clinical OA (n = 449) underreported their BMI to a greater extent than participants without clinical OA (n = 151) [mean (SD) difference 1.34 (1.68) kg/m2 and 0.78 (1.40) kg/m2 (p = 0.000), respectively]. There was a strong dose-dependent association between higher measured BMI and greater underreporting of BMI in multivariate analyses (BMI 25–29.99 kg/m2: B = 0.40, 95% CI, 0.06, 0.77), BMI ≥ 30 kg/m2: B = 1.30, 95% CI, 0.86, 1.75) in the clinical OA patients. A higher age as well as the time interval from self-reported to measured BMI-data were associated with inaccurate reporting. Conclusions Researchers using self-reported height and weight data should be aware of limited agreement with actual height and weight in overweight and obese individuals with clinical OA.

• Hartvigsen, Jan; Natvig, Bård & Ferreira, Manuela (2013). Is it all about a pain in the back? Baillière's Best Practice & Research : Clinical Rheumatology. ISSN 1521-6942. 27(5), p. 613–623. doi: 10.1016/j.berh.2013.09.008. Full text in Research Archive
• Tschudi-Madsen, Hedda; Kjeldsberg, Mona; Natvig, Bård; Ihlebæk, Camilla; Dalen, Ingvild & Straand, Jørund [Show all 7 contributors for this article] (2013). Multiple symptoms and medically unexplained symptoms - Closely related concepts in general practitioners' evaluations. A linked doctor-patient study. Journal of Psychosomatic Research. ISSN 0022-3999. 74(3), p. 186–190. doi: 10.1016/j.jpsychores.2013.01.003. Full text in Research Archive
• Grøvle, Lars; Haugen, Anne Julsrud; Natvig, Bård; Brox, Jens Ivar & Grotle, Margreth (2013). The prognosis of self-reported paresthesia and weakness in disc-related sciatica. European spine journal. ISSN 0940-6719. 22(11), p. 2488–2495. doi: 10.1007/s00586-013-2871-9. Full text in Research Archive
• Grøvle, Lars; Haugen, Anne Julsrud; Keller, Anne; Natvig, Bård; Brox, Jens Ivar & Grotle, Margreth (2013). Prognostic factors for return to work in patients with severe sciatica. The spine journal. ISSN 1529-9430. 13(12), p. 1849–1857. doi: 10.1016/j.spinee.2013.07.433. Full text in Research Archive
• Kjeldsberg, Mona; Tschudi-Madsen, Hedda; Dalen, Ingvild; Straand, Jørund; Bruusgaard, Dag & Natvig, Bård (2013). Symptom reporting in a general population in Norway: Results from the Ullensaker study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 31(1), p. 36–42. doi: 10.3109/02813432.2012.751697. Full text in Research Archive
• Østerås, Nina; Risberg, May Arna; Kvien, Tore Kristian; Engebretsen, Lars; Nordsletten, Lars & Bruusgaard, Dag [Show all 22 contributors for this article] (2013). Hand, hip and knee osteoarthritis in a Norwegian population-based study - The MUST protocol. BMC Musculoskeletal Disorders. doi: 10.1186/1471-2474-14-201. Full text in Research Archive Show summary

  Abstract Background Knowledge about the prevalence and consequences of osteoarthritis (OA) in the Norwegian population is limited. This study has been designed to gain a greater understanding of musculoskeletal pain in the general population with a focus on clinically and radiologically confirmed OA, as well as risk factors, consequences, and management of OA. Methods/Design The Musculoskeletal pain in Ullensaker STudy (MUST) has been designed as an observational study comprising a population-based postal survey and a comprehensive clinical examination of a sub-sample with self-reported OA (MUST OA cohort). All inhabitants in Ullensaker municipality, Norway, aged 40 to 79 years receive the initial population-based postal survey questionnaire with questions about life style, general health, musculoskeletal pain, self-reported OA, comorbidities, health care utilisation, medication use, and functional ability. Participants who self-report OA in their hip, knee and/or hand joints are asked to attend a comprehensive clinical examination at Diakonhjemmet Hospital, Oslo, including a comprehensive medical examination, performance-based functional tests, different imaging modalities, cardiovascular assessment, blood and urine samples, and a number of patient-reported questionnaires including five OA disease specific instruments. Data will be merged with six national data registries. A subsample of those who receive the questionnaire has previously participated in postal surveys conducted in 1990, 1994, and 2004 with data on musculoskeletal pain and functional ability in addition to demographic characteristics and a number of health related factors. This subsample constitutes a population based cohort with 20 years follow-up. Discussion This protocol describes the design of an observational population-based study that will involve the collection of data from a postal survey on musculoskeletal pain, and a comprehensive clinical examination on those with self-reported hand, hip and/or knee OA. These data, in addition to data from national registries, will provide unique insights into clinically and radiologically confirmed OA with respect to risk factors, consequences, and management. Keywords: Osteoarthritis; Hand; Hip; Knee; Observational study; Study protocol

• Østerås, Nina; Garratt, Andrew; Grotle, Margreth; Natvig, Bård; Kjeken, Ingvild & Kvien, Tore Kristian [Show all 7 contributors for this article] (2013). Patient-Reported Quality of Care for Osteoarthritis: Development and Testing of the OsteoArthritis Quality Indicator Questionnaire. Arthritis care & research. ISSN 2151-464X. 65(7), p. 1043–1051. doi: 10.1002/acr.21976. Full text in Research Archive Show summary

  Objective To develop and test a new instrument for patient self-reported quality of osteoarthritis (OA) care, and to provide quality indicator (QI) pass rates in a Norwegian OA cohort. Methods The OsteoArthritis Quality Indicator (OA-QI) questionnaire was developed using published QIs, expert panels, and patient interviews. Self-reported data were collected from 359 persons in a Norwegian OA cohort, and test–retest reliability and validity were assessed. Separate QI pass rates and summary QI pass rates were calculated. Results The 17-item questionnaire includes QIs related to patient education and information, regular provider assessments, referrals, and pharmacologic treatment. The patient self-reported questionnaire was completed with minimal respondent burden. Support for content validity was confirmed by 2 patient research partners and 2 expert panels. All 10 predefined hypotheses relating to construct validity were confirmed. Test–retest kappa coefficients ranged from 0.20–0.80 and the percentage of exact agreement ranged from 62–90%. The mean pass rate for individual QIs was 31% (range 5–49%). The median summary QI pass rate was 27% (interquartile range 12–50%), with lower summary pass rates for nonpharmacologic compared to pharmacologic treatments. Conclusion To our knowledge, this is the first instrument developed to measure patient-reported QI pass rates for OA care. This study indicates that the OA-QI questionnaire is acceptable to persons with OA, and its short format makes it suitable for population surveys. The low patient self-reported QI pass rates in this study suggest a potential for quality improvement in OA care.

• Grøvle, Lars; Haugen, Anne Julsrud; Keller, Anne; Natvig, Bård; Brox, Jens Ivar & Grotle, Margreth (2012). Poor agreement found between self-report and a public registry on duration of sickness absence. Journal of Clinical Epidemiology. ISSN 0895-4356. 65(2), p. 212–218. doi: 10.1016/j.jclinepi.2011.05.009. Full text in Research Archive
• Bruusgaard, Dag; Tschudi-Madsen, Hedda; Ihlebæk, Camilla; Kamaleri, Yusman & Natvig, Bård (2012). Symptom load and functional status: results from the Ullensaker population study. BMC Public Health. 12(1085). doi: 10.1186/1471-2458-12-1085. Full text in Research Archive Show summary

  Background There is evidence to support that the number of self-reported symptoms is a strong predictor of health outcomes. In studies examining the link between symptoms and functional status, focus has traditionally been on individual symptoms or specific groups of symptoms. We aim to identify associations between the number of self-reported symptoms and functional status. Methods A questionnaire was sent to people in seven age groups (N = 3227) in Ullensaker municipality in Southern Norway. The Standardised Nordic Questionnaire and the Subjective Health Complaints Inventory were used to record 10 musculoskeletal symptoms and 13 non-musculoskeletal symptoms, respectively. Four COOP-WONCA charts were used to measure functional status. Results We found a strong linear association between the number of self-reported symptoms and functional status. The number of symptoms explained 39.2% of the variance in functional status after adjusting for the effects of age and sex. Including individual symptoms instead of only the number of symptoms made little difference to the effect of musculoskeletal pain but affected the influence of non-muscular symptoms. Including even minor problems captured substantially more of the variance in functional status than including only serious problems. Conclusions The strong association between the number of symptoms and functional status, irrespective of type of symptom, might indicate that the symptoms share some common characteristics. The simple act of counting symptoms may provide an approach to study the relationships between health and function in population studies and might be valuable in research on medically unexplained conditions.

• Haugen, Anne Julsrud; Brox, Jens Ivar; Grøvle, Lars; Keller, Anne; Natvig, Bård & Soldal, Dag [Show all 7 contributors for this article] (2012). Prognostic factors for non-success in patients with sciatica and disc herniation. BMC Musculoskeletal Disorders. 13. doi: 10.1186/1471-2474-13-183. Full text in Research Archive Show summary

  Background Few studies have investigated prognostic factors for patients with sciatica, especially for patients treated without surgery. The aim of this study was to identify factors associated with non-success after 1 and 2 years of follow-up and to test the prognostic value of surgical treatment for sciatica. Methods The study was a prospective multicentre observational study including 466 patients with sciatica and lumbar disc herniation. Potential prognostic factors were sociodemographic characteristics, back pain history, kinesiophobia, emotional distress, pain, comorbidity and clinical examination findings. Study participation did not alter treatment considerations for the patients in the clinics. Patients reported on the questionnaires if surgery of the disc herniation had been performed. Uni- and multivariate logistic regression analyses were used to evaluate factors associated with non-success, defined as Maine–Seattle Back Questionnaire score of ≥5 (0–12) (primary outcome) and Sciatica Bothersomeness Index ≥7 (0–24) (secondary outcome). Results Rates of non-success were at 1 and 2 years 44% and 39% for the main outcome and 47% and 42% for the secondary outcome. Approximately 1/3 of the patients were treated surgically. For the main outcome variable, in the final multivariate model non-success at 1 year was significantly associated with being male (OR 1.70 [95% CI; 1.06 − 2.73]), smoker (2.06 [1.31 − 3.25]), more back pain (1.0 [1.01 − 1.02]), more comorbid subjective health complaints (1.09 [1.03 − 1.15]), reduced tendon reflex (1.62 [1.03 − 2.56]), and not treated surgically (2.97 [1.75 − 5.04]). Further, factors significantly associated with non-success at 2 years were duration of back problems >; 1 year (1.92 [1.11 − 3.32]), duration of sciatica >; 3 months (2.30 [1.40 − 3.80]), more comorbid subjective health complaints (1.10 [1.03 − 1.17]) and kinesiophobia (1.04 [1.00 − 1.08]). For the secondary outcome variable, in the final multivariate model, more comorbid subjective health complaints, more back pain, muscular weakness at clinical examination, and not treated surgically, were independent prognostic factors for non-success at both 1 and 2 years. Conclusions The results indicate that the prognosis for sciatica referred to secondary care is not that good and only slightly better after surgery and that comorbidity should be assessed in patients with sciatica. This calls for a broader assessment of patients with sciatica than the traditional clinical assessment in which mainly the physical symptoms and signs are investigated.

• Haugen, Anne Julsrud; Grøvle, Lars; Brox, Jens Ivar; Natvig, Bård; Keller, Anne & Soldal, Dag [Show all 7 contributors for this article] (2011). Estimates of success in patients with sciatica due to lumbar disc herniation depend upon outcome measure. European spine journal. ISSN 0940-6719. 20(10), p. 1669–1675. doi: 10.1007/s00586-011-1809-3. Full text in Research Archive
• Tschudi-Madsen, Hedda; Kjeldsberg, Mona; Natvig, Bård; Ihlebæk, Camilla Martha; Dalen, Ingvild & Kamaleri, Yusman [Show all 8 contributors for this article] (2011). A strong association between non-musculoskeletal symptoms and musculoskeletal pain symptoms: Results from a population study. BMC Musculoskeletal Disorders. 12. doi: 10.1186/1471-2474-12-285. Full text in Research Archive Show summary

  Background There is a lack of knowledge about the pattern of symptom reporting in the general population as most research focuses on specific diseases or symptoms. The number of musculoskeletal pain sites is a strong predictor for disability pensioning and, hence, is considered to be an important dimension in symptom reporting. The simple method of counting symptoms might also be applicable to non-musculoskeletal symptoms, rendering further dimensions in describing individual and public health. In a general population, we aimed to explore the association between self-reported non-musculoskeletal symptoms and the number of pain sites. Methods With a cross-sectional design, the Standardised Nordic Questionnaire and the Subjective Health Complaints Inventory were used to record pain at ten different body sites and 13 non-musculoskeletal symptoms, respectively, among seven age groups in Ullensaker, Norway (n = 3,227). Results Results showed a strong, almost linear relationship between the number of non-musculoskeletal symptoms and the number of pain sites (r = 0.55). The number and type of non-musculoskeletal symptoms had an almost equal explanatory power in the number of pain sites reported (27.1% vs. 28.2%). Conclusion The linear association between the number of non-musculoskeletal and musculoskeletal symptoms might indicate that the symptoms share common characteristics and even common underlying causal factors. The total burden of symptoms as determined by the number of symptoms reported might be an interesting generic indicator of health and well-being, as well as present and future functioning. Research on symptom reporting might also be an alternative pathway to describe and, possibly, understand the medically unexplained multisymptom conditions.

• Grøvle, Lars; Haugen, Anne Julsrud; Ihlebæk, Camilla Martha; Keller, Anne; Natvig, Bård & Brox, Jens Ivar [Show all 7 contributors for this article] (2011). Comorbid subjective health complaints in patients with sciatica: A prospective study including comparison with the general population. Journal of Psychosomatic Research. ISSN 0022-3999. 70(6), p. 548–556. doi: 10.1016/j.jpsychores.2010.11.008. Full text in Research Archive
• Grøvle, Lars; Haugen, Anne Julsrud; Keller, Anne; Natvig, Bård; Brox, Jens Ivar & Grotle, Margreth (2010). The bothersomeness of sciatica: patients' self-report of paresthesia, weakness and leg pain. European spine journal. ISSN 0940-6719. 19(2), p. 263–269. doi: 10.1007/s00586-009-1042-5. Full text in Research Archive
• Natvig, Bård; Ihlebæk, Camilla Martha; Kamaleri, Yusman & Bruusgaard, Dag (2010). Number of pain sites - a simple measure of population risk? In Croft, Peter; Blyth, Fiona M. & Windt, Danielle van der (Ed.), Chronic Pain Epidemiology - From Aetiology to Public Health. Oxford University Press. ISSN 9780199235766. p. 71–82. Full text in Research Archive
• Ihlebæk, Camilla Martha; Brage, Søren Karl; Natvig, Bård & Bruusgaard, Dag (2010). Forekomst av muskel- og skjelettlidelser i Norge. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 130(23), p. 2365–2368. doi: 10.4045/tidsskr.09.0802. Full text in Research Archive
• Natvig, Bård; Ihlebæk, Camilla Martha; Grotle, Margreth; Brage, Søren Karl & Bruusgaard, Dag (2010). Neck pain is often a part of widespread pain and is associated with reduced functioning. Spine. ISSN 0362-2436. 35(23), p. E1285–E1289. doi: 10.1097/BRS.0b013e3181e38e73. Full text in Research Archive
• Brage, Søren Karl; Ihlebæk, Camilla Martha; Natvig, Bård & Bruusgaard, Dag (2010). Muskel- og skjelettlidelser som årsak til sykefravær og uføreytelser. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 130(23), p. 2369–2370. doi: 10.4045/tidsskr.10.0236. Full text in Research Archive

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• Juel, Niels Gunnar; Pedersen, Stein Jarle; Ekeberg, Ole Marius; Natvig, Bård & Skonnord, Trygve (2024). START-øvelser ved muskel- og skjelettplager i allmennpraksis. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 144(4), p. 1–4. doi: 10.4045/tidsskr.24.0008. Full text in Research Archive
• Østerås, Nina; Moseng, Tuva; Bodegom-Vos, L van; Dziedzic, K; Natvig, Bård & Røtterud, Jan Harald Myhreng [Show all 9 contributors for this article] (2024). POS1080 IMPLEMENTING OA TREATMENT RECOMMENDATIONS IN PRIMARY CARE POSTPONED JOINT REPLACEMENT IN HIP AND KNEE JOINTS - 8 YEAR FOLLOW-UP OF A CLUSTER RANDOMIZED CONTROLLED TRIAL. Annals of the Rheumatic Diseases. ISSN 0003-4967. doi: 10.1136/annrheumdis-2024-eular.1530. Full text in Research Archive
• Nytrøen, Gunhild; Solberg, Lene Bergendal; Skjeie, Holgeir; Natvig, Bård; Rosseland, Leiv Arne & Skonnord, Trygve (2024). Reduced Opioid Use and Improved Quality of Life After Accidental Injuries; a Randomised Controlled Trial ─ A Study Protocol ─. Full text in Research Archive
• Nytrøen, Gunhild; Solberg, Lene Bergendal; Skjeie, Holgeir; Natvig, Bård; Rosseland, Leiv Arne & Skonnord, Trygve (2023). A Pain And Coordination plan for reduced opioid use and improved quality of life after accidental injuries; an RCT protocol. Full text in Research Archive
• Moen, Unni; Knapstad, Mari Kalland; Wilhelmsen, Kjersti Thulin; Goplen, Fredrik; Nordahl, Stein Helge Glad & Berge, Jan Erik [Show all 9 contributors for this article] (2023). Er det sammenheng mellom langvarig svimmelhet og muskelskjelettsmerter? Full text in Research Archive
• Nytrøen, Gunhild; Solberg, Lene Bergendal; Skjeie, Holgeir; Natvig, Bård; Rosseland, Leiv Arne & Skonnord, Trygve (2023). A Pain and Coordination Plan for Reduced Opioid Use After Accidental Injuries. A Randomised Controlled Trial Protocol. Full text in Research Archive
• Nytrøen, Gunhild; Solberg, Lene Bergendal; Skjeie, Holgeir; Natvig, Bård; Rosseland, Leiv Arne & Skonnord, Trygve (2023). Kan en Smerte- Og Samhandlingsplan (SOS-plan) ved utskrivning etter alvorlig skade gi redusert opioidbruk og økt livskvalitet? Full text in Research Archive
• Uleberg, Oddvar; Stenehjem, Jo S.; Nordseth, Trond; Clausen, Thomas; Natvig, Bård & Skurtveit, Svetlana Ondrasova [Show all 12 contributors for this article] (2022). The injury prevention and outcomes following trauma (IPOT) project: is a nationwide registry-based study in Norway feasible? Full text in Research Archive
• Stenehjem, Jo S.; Røise, Olav; Nordseth, Trond; Clausen, Thomas; Natvig, Bård & Skurtveit, Svetlana Ondrasova [Show all 12 contributors for this article] (2021). Injury Prevention and long-term Outcomes following Trauma - the IPOT project: a protocol for prospective nationwide registry-based studies in Norway. Full text in Research Archive
• Rosseland, Leiv Arne; Stenehjem, Jo S.; Nordseth, Trond; Clausen, Thomas; Natvig, Bård & Skurtveit, Svetlana Ondrasova [Show all 12 contributors for this article] (2021). The Injury Prevention and Outcomes following Trauma project: a prospective nationwide registry-based study in Norway. Full text in Research Archive
• Juel, Niels Gunnar; Pedersen, Stein Jarle; Engebretsen, Kaia Beck; Brurberg, Kjetil Gundro; Ekeberg, Ole Marius & Reme, Silje Endresen [Show all 8 contributors for this article] (2019). Atraumatiske skuldersmerter i prim?rhelsetjenesten. 139(7). doi: 10.4045/tidsskr.19.0116. Full text in Research Archive
• Winge, Odd; Natvig, Bård & Thorsen, Olav (2019). Helseopplysningsgruppa takker for seg. Referansegruppe for helseopplysning 1986-2019. Utposten. ISSN 0800-5680. p. 44–46. Full text in Research Archive
• Juel, Niels Gunnar; Brox, Jens Ivar; Ekeberg, Ole Marius; Brurberg, Kjetil Gundro; Engebretsen, Kaia Beck & Reme, Silje Endresen [Show all 8 contributors for this article] (2018). Norwegian guidelines for shoulder pain in primary care. Full text in Research Archive
• Pedersen, Stein Jarle; Juel, Niels Gunnar; Brox, Jens Ivar; Engebretsen, Kaia Beck; Ekeberg, Ole Marius & Reme, Silje Endresen [Show all 7 contributors for this article] (2018). Shoulder pain in primary care. Presentation of a simple net-based educational program for the general practitioner. Full text in Research Archive
• Østerås, Nina; Hagen, Kåre Birger; Moseng, Tuva; Andreassen, Øyvor; Hansen, Jorun Nygren & Natvig, Bård [Show all 8 contributors for this article] (2018). Samhandling for bedre artrosebehandling (SAMBA) - forskning i primærhelsetjenesten. Full text in Research Archive
• Moseng, Tuva; Dagfinrud, Hanne; Andreassen, Øyvor; Dziedzic, Krysia; Hagen, Kåre Birger & Hansen, Jorun Nygren [Show all 13 contributors for this article] (2018). Implementing international osteoarthritis guidelines in primary care: results on symptom-related outcomes in secondary analyses from a randomised controlled study. Full text in Research Archive
• Ekeberg, Ole Marius; Pedersen, Stein Jarle; Juel, Niels Gunnar; Brox, Jens Ivar; Biringer, Eva Aaker & Natvig, Bård (2018). Shoulder pain in primary care. Cost-effectiveness. Full text in Research Archive
• Ruud, Sven Eirik; Hjortdahl, Per & Natvig, Bård (2017). Reasons for attending a general emergency outpatient clinic versus a regular general practitioner – a survey among immigrant and native walk-in patients in Oslo, Norway. Full text in Research Archive
• Ruud, Sven Eirik; Hjortdahl, Per & Natvig, Bård (2016). Immigrants' self-reported affilliation with the regular general practitioner scheme: Survey of an emergency outpatient clinic population in Oslo, Norway. Full text in Research Archive Show summary

  Background: Continuity of health care provided by a regular general practitioner (RGP) is associated with prevention of illness and death, and reduced emergency department attendances and emergency hospital admissions. Undocumented immigrants, rejected asylum seekers, and short- term labour immigrants fall outside the RGP system, but they have the right to receive emergency health care. The objective of this study was to explore the self-reported affiliation with the RGP scheme in a diverse population of immigrants attending an accident and emergency outpatient clinic. Methods: A multilingual anonymous survey was administered to all walk-in patients at Oslo Accident and Emergency Outpatient Clinic (OAEOC) during two weeks in September 2009. We analysed demographic data, the patients’ country of origin and self-reported affiliation with the RGP scheme. We used descriptive statistics to obtain frequencies and Pearson’s chi-square to test categorical variables. Results: The analysis included 3,864 walk-in patients of which first- and second-generation immigrants comprised 1,364 (35%). Among first-generation immigrants only 689 (71%) reported an affiliation with the RGP system in contrast to 2,326 (96%) of Norwegians (p <0.001), and second- generation immigrant registrations, 336 (96%). The least frequent RGP affiliation was among immigrants, including both first- and second generation, from Sweden (32%, p < 0.001), Poland (65%, p < 0.001), Irak (84%, p <0.001) and Somalia (91%, p < 0.001). Conclusions: Subgroups of immigrants report lower affiliation with the RGP scheme than Norwegians. Disparity in access to a RGP involves inequity in continuity of primary health care. Message: This study reveals lower self-reported affiliation with the RGP scheme compared to Norwegians among first-generation immigrants and certain immigrant subgroups grouped by nationality.

• Ruud, Sven Eirik; Hjortdahl, Per & Natvig, Bård (2016). Immigrants' self-reported affilliation with the regular general practitioner scheme: Survey of an emergency outpatient clinic population in Oslo, Norway. Full text in Research Archive Show summary

  Background: Continuity of health care provided by a regular general practitioner (RGP) is associated with prevention of illness and death, and reduced emergency department attendances and emergency hospital admissions. Undocumented immigrants, rejected asylum seekers, and short- term labour immigrants fall outside the RGP system, but they have the right to receive emergency health care. The objective of this study was to explore the self-reported affiliation with the RGP scheme in a diverse population of immigrants attending an accident and emergency outpatient clinic. Methods: A multilingual anonymous survey was administered to all walk-in patients at Oslo Accident and Emergency Outpatient Clinic (OAEOC) during two weeks in September 2009. We analysed demographic data, the patients’ country of origin and self-reported affiliation with the RGP scheme. We used descriptive statistics to obtain frequencies and Pearson’s chi-square to test categorical variables. Results: The analysis included 3,864 walk-in patients of which first- and second-generation immigrants comprised 1,364 (35%). Among first-generation immigrants only 689 (71%) reported an affiliation with the RGP system in contrast to 2,326 (96%) of Norwegians (p <0.001), and second- generation immigrant registrations, 336 (96%). The least frequent RGP affiliation was among immigrants, including both first- and second generation, from Sweden (32%, p < 0.001), Poland (65%, p < 0.001), Irak (84%, p <0.001) and Somalia (91%, p < 0.001). Conclusions: Subgroups of immigrants report lower affiliation with the RGP scheme than Norwegians. Disparity in access to a RGP involves inequity in continuity of primary health care. Message: This study reveals lower self-reported affiliation with the RGP scheme compared to Norwegians among first-generation immigrants and certain immigrant subgroups grouped by nationality.

• Natvig, Bård (2016). En enkel inndeling av personer over 50 år med smerter. Best Practice Smerte. p. 12–13. Full text in Research Archive
• Ruud, Sven Eirik; Hjortdahl, Per & Natvig, Bård (2015). Is it a matter of urgency? - A descriptive survey of patients’ and general practitioners’ assessments of how acutely they estimate the need for help at an emergency primary health care clinic in Oslo. Full text in Research Archive
• Ruud, Sven Eirik; Aga, Ruth; Hjortdahl, Per & Natvig, Bård (2015). Use of emergency care services by immigrants—a survey of walk-in patients who attended the Oslo Accident and Emergency Outpatient Clinic. Full text in Research Archive
• Knutsen, Kirsten Irene Valebjørg; Madar, Ahmed Ali; Brekke, Mette; Meyer, Haakon E; Natvig, Bård & Mdala, Ibrahimu [Show all 7 contributors for this article] (2015). Effect of vitamin D on musculoskeletal pain and headache: a randomized, double-blind, placebo-controlled trial among adult ethnic minorities in Norway. Full text in Research Archive
• Eeg, Ingvild Karsen; Rollefstad, Silvia Christin Hellerud; Haugen, Ida Kristin; Olsen, Inge C.; Østerås, Nina & Christensen, Barbara Therese Slatkovsky [Show all 11 contributors for this article] (2014). Risk of cardiovascular disease in patients with osteoarthritis: results from the MUST Heart Study. Full text in Research Archive
• Aarseth, Guri; Natvig, Bård; Engebretsen, Eivind & Lie, Anne Helene Kveim (2014). Legeerklæring ved arbeidsuførhet - skjema til besvær. 134(1), p. 58–61. doi: 10.4045/tidsskr.13.1107. Full text in Research Archive
• Østerås, Nina; Hagen, Kåre Birger & Natvig, Bård (2013). No sweat – no gain? Persons with lower limb osteoarthritis report lower intensity and duration of physical activity compared to their healthy peers – data from the MUST cohort. Annals of the Rheumatic Diseases. ISSN 0003-4967. p. 689–689. Full text in Research Archive
• Østerås, Nina; Hagen, Kåre Birger & Natvig, Bård (2013). No sweat – no gain? Persons with lower limb osteoarthritis report lower intensity and duration of physical activity compared to their healthy peers – data from the MUST cohort. Full text in Research Archive
• Aarseth, Guri; Lie, Anne Helene Kveim & Natvig, Bård (2012). Hvordan står det til med legeerklæringene? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 132, p. 2148–2149. Full text in Research Archive
• Østerås, Nina; Hagen, Kåre Birger; Garratt, Andrew; Natvig, Bård; Kjeken, Ingvild & Kvien, Tore Kristian [Show all 7 contributors for this article] (2012). QUALITY OF OSTEOARTHRITIS CARE: TEST-RETEST RELIABILITY AND FEASIBILITY OF THE OSTEOARTHRITIS QUALITY INDICATOR QUESTIONNAIRE. Osteoarthritis and Cartilage. ISSN 1063-4584. 20, p. S185–S186. Full text in Research Archive
• Grøvle, L; Brox, JI; Haugen, AJ; Keller, A; Natvig, Bård & Grotle, Margreth (2012). Prognostic factors for return to work in patients with sciatica. Annals of the Rheumatic Diseases. ISSN 0003-4967. p. 78–78. Full text in Research Archive
• Magnusson, Karin; Østerås, Nina; Mowinckel, Petter; Natvig, Bård & Hagen, Kåre Birger (2012). No prospective association found between obesity and chronic, widespread musculoskeletal pain in a population based 20-year prospective follow-up study. Annals of the Rheumatic Diseases. ISSN 0003-4967. 71, p. 731–731. Full text in Research Archive
• Kjeldsberg, Mona; Tschudi-Madsen, Hedda; Dalen, Ingvild; Natvig, Bård; Straand, Jørund & Bruusgaard, Dag (2011). Symptom reporting in the population I: Most adults experience many symptoms each month. Full text in Research Archive
• Østerås, Nina; Grotle, Margreth; Garratt, Andrew; Natvig, Bård; Kjeken, Ingvild & Kvien, Tore Kristian [Show all 7 contributors for this article] (2011). Suboptimal osteoarthritis care in a Norwegian population based osteoarthritis cohort. Full text in Research Archive
• Tschudi-Madsen, Hedda; Kjeldsberg, Mona; Dalen, Ingvild; Natvig, Bård; Ihlebæk, Camilla Martha & Kamaleri, Yusman [Show all 8 contributors for this article] (2011). Symptom reporting in the population II: Musculoskeletal and other symptoms closely related. Full text in Research Archive
• Kjeldsberg, Mona; Tschudi-Madsen, Hedda; Natvig, Bård; Straand, Jørund & Bruusgaard, Dag (2010). Telling i stedet for diagnostisering? Selvrapporterte symptomer i en voksen befolkning. Full text in Research Archive
• Lærum, Even; Brage, Søren; Ihlebæk, Camilla; Johnsen, Kjetil; Natvig, Bård & Aas, Eline (2013). Et muskel – og skjelettregnskap – forekomst og kostnader knyttet til skader, sykdommer og plager I muskel – og skjelettsystemet. Muskel og Skjelett Tiåret (MST), FORMI. ISSN 9788230323113. Full text in Research Archive

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