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A Behavioral Medicine Perspective on Pain Disability in a Work Context: Prevention, Assessment, and Tailored Physiotherapy
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Physiotherapy.
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Description
Abstract [en]

Chronic pain (>3 months) is associated with work limitations and sick leave. This thesis aimed to evaluate assessments and interventions targeting work disability for individuals at risk of or with chronic pain. Specific aims for studies I and II were to compare the preventive effects of a brief psychosocial program with an active educational control. Study III aimed to evaluate the construct validity and internal consistency of the Work Ability Index (WAI). Study IV aimed to systematically replicate a behavioral medicine physiotherapy intervention within a return-to-work context and evaluate its effects on an individual level.  

Methods: Studies I and II were based on a cluster-randomized controlled trial, including 191 employees with reported pain and/or stress-related ill-health and 53 supervisors. Study I reported on the primary outcome of sick leave and secondary health-related outcomes on employees at 6-months follow-up; study II reported on the supervisors’ communication behavior and perceived stress. Study III was a cross-sectional study including 118 patients with chronic pain referred to specialized care. Study IV was a single case experimental design study including five participants with chronic pain on long-term sick leave. 

Results: In studies I and II, no effects of the brief psychosocial program were found on outcomes on employees or supervisors. In study III, the construct validity and internal consistency of the WAI were supported. In study IV, the physiotherapy protocol was successfully replicated, and the results indicated an effect on task-specific self-efficacy for target activities at work, but not on experience of target activities or work ability.

Conclusion: The results highlight the importance of selecting participants for preventive workplace interventions based on their assessed risk profiles for long-term pain disability, and that targeting mainly the supervisors might be insufficient. The WAI appears to be a valid measurement of work ability for patients with chronic pain in specialized care. Accordingly, behavioral medicine physiotherapy can be successfully adapted to work disability needs for patients with chronic pain. Large-scale trials are needed to evaluate its effects on return-to-work. A behavioral medicine perspective on pain disability in a work context motivates a focus on target activities at work, which can be seen to mediate the incorporation of behavioral knowledge in assessments and interventions for individuals with pain.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2022. , p. 83
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1859
Keywords [en]
Chronic pain, Pain Disability, Work Ability, Prevention, Measurement Properties, Rehabilitation, Physiotherapy
National Category
Medical and Health Sciences
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-481863ISBN: 978-91-513-1573-7 (print)OAI: oai:DiVA.org:uu-481863DiVA, id: diva2:1688004
Public defence
2022-10-07, A1:111a, BMC, Husargatan 3, 752 37 Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2022-09-13 Created: 2022-08-17 Last updated: 2022-09-13
List of papers
1. Preventing Pain and Stress-related Ill-health in Employees: A 6-months follow-up of a Psychosocial program in a Cluster Randomized Controlled Trial
Open this publication in new window or tab >>Preventing Pain and Stress-related Ill-health in Employees: A 6-months follow-up of a Psychosocial program in a Cluster Randomized Controlled Trial
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2022 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688Article in journal (Refereed) Epub ahead of print
Abstract [en]

Purpose

Pain and stress-related ill-health are major causes of long-term disability and sick leave. This study evaluated the effects of a brief psychosocial program, which previously has been tested for an at-risk population of employees.

Methods

The Effective Communication within the Organization (ECO) program, where supervisors and employees were trained in communication and problem solving, was compared to an active control consisting of psychoeducative lectures (PE) about pain and stress in a cluster randomized controlled trial. First-line supervisors were randomized to ECO or PE, and a total of 191 mainly female employees with self-reported pain and/or stress-related ill-health were included. The hybrid format programs consisted of 2–3 group sessions. Sick leave data was collected from social insurance registers, before and 6-months after the program. Secondary outcomes (work ability, work limitations, pain-disability risk, exhaustion symptoms, perceived stress, perceived health, quality of life, perceived communication and support from supervisors) were assessed at baseline, post intervention, and at 6-months follow-up.

Results

No effects were observed on primary or secondary outcome variables. Pain symptoms were common (89%), however a lower proportion (30%) were identified as at risk for long-term pain disability, which might explain the lack of evident effects. The Covid-19 pandemic affected participation rates and delivery of intervention.

Conclusion

In this study, preventive effects of the ECO program were not supported. Altogether, the findings point at the importance of selecting participants for prevention based on screening of psychosocial risk. Further research on workplace communication and support, and impact on employee health is warranted.

Place, publisher, year, edition, pages
Springer, 2022
Keywords
Chronic Pain, Stress symptoms, Prevention, Randomized Controlled Trial, Communication, Problem Solving
National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-481844 (URN)10.1007/s10926-022-10074-3 (DOI)000875807400001 ()36308628 (PubMedID)
Available from: 2022-08-16 Created: 2022-08-16 Last updated: 2022-11-15Bibliographically approved
2. Enhancing Supportive Communication in Supervisors to prevent Work Disability associated with Pain and Stress – A Test of Effects
Open this publication in new window or tab >>Enhancing Supportive Communication in Supervisors to prevent Work Disability associated with Pain and Stress – A Test of Effects
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(English)In: Article in journal (Refereed) Submitted
National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-481858 (URN)
Available from: 2022-08-17 Created: 2022-08-17 Last updated: 2022-08-17
3. Psychometric Assessment of the Swedish version of the Work Ability Index in Patients with Chronic Pain in Specialized Care
Open this publication in new window or tab >>Psychometric Assessment of the Swedish version of the Work Ability Index in Patients with Chronic Pain in Specialized Care
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(English)In: Article in journal (Refereed) Submitted
National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-481861 (URN)
Available from: 2022-08-17 Created: 2022-08-17 Last updated: 2022-08-17
4. Behavioral Medicine Physiotherapy in the Context of Return to Work for Chronic Pain: A Single-Case Experimental Design Study
Open this publication in new window or tab >>Behavioral Medicine Physiotherapy in the Context of Return to Work for Chronic Pain: A Single-Case Experimental Design Study
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2022 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 3, article id 1509Article in journal (Refereed) Published
Abstract [en]

Effective interventions are needed for return-to-work (RTW) for individuals with chronic pain on long-term sick leave. In this study, a behavioral medicine physiotherapy protocol was systematically replicated and added to workplace components. The intervention was evaluated for fidelity and effects on target activities and work ability. A single-case experimental design was used with five participants. Daily and weekly ratings of personalized target activities at work as well as work ability were carried out throughout the study period of 26-28 weeks. Effects of the behavioral medicine physiotherapy intervention were evaluated for each individual using visual analysis of displayed graphs and quantitative non-overlap methods. Goal achievement for target activities was reviewed. Three participants completed the intervention. The results indicated an effect from the behavioral medicine physiotherapy intervention on task-specific self-efficacy for target activities, but no consistent effect on experience of target activities or work ability. All three participants had increased function in target activities in line with pre-defined goals. Fidelity to the intervention manual was good. Behavioral medicine physiotherapy can be successfully adapted to work disability and was here replicated in an RTW context for individuals with chronic pain. The intervention protocol should be further evaluated in large-scale studies.

Place, publisher, year, edition, pages
MDPI AG, 2022
Keywords
behavioral medicine, chronic pain, return to work, rehabilitation, exercise
National Category
Physiotherapy Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-469056 (URN)10.3390/ijerph19031509 (DOI)000759520400001 ()35162528 (PubMedID)
Available from: 2022-03-07 Created: 2022-03-07 Last updated: 2022-08-17Bibliographically approved

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