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  • 1.
    Berglund, Erik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Anderzén, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Andersén, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Carlsson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Gustavsson, Catharina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, SE-17177 Stockholm, Sweden.
    Multidisciplinary Intervention and Acceptance and Commitment Therapy for Return-to-Work and Increased Employability among Patients with Mental Illness and/or Chronic Pain: A Randomized Controlled Trial2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 11, article id 2424Article in journal (Refereed)
    Abstract [en]

    Background: People on long-term sick leave often have a long-lasting process back to work, where the individuals may be in multiple and recurrent states; i.e., receiving different social security benefits or working, and over time they may shift between these states. The purpose of this study was to evaluate the effects of two vocational rehabilitation programs, compared to a control, on return-to-work (RTW) or increased employability in patients on long-term sick leave due to mental illness and/or chronic pain. Methods: In this randomized controlled study, 427 women and men were allocated to either (1) multidisciplinary team management, i.e., multidisciplinary assessments and individual rehabilitation management, (2) acceptance and commitment therapy (ACT), or (3) control. A positive outcome was defined as RTW or increased employability. The outcome was considered negative if the (part-time) wage was reduced or ceased, or if there was an indication of decreased employability. The outcome was measured one year after entry in the project and analyzed using binary and multinomial logistic regressions. Results: Participants in the multidisciplinary team group reported having RTW odds ratio (OR) 3.31 (95% CI 1.39-7.87) compared to the control group in adjusted models. Participants in the ACT group reported having increased employability OR 3.22 (95% CI 1.13-9.15) compared to the control group in adjusted models. Conclusions: This study of vocational rehabilitation in mainly female patients on long-term sick leave due to mental illness and/or chronic pain suggests that multidisciplinary team assessments and individually adapted rehabilitation interventions increased RTW and employability. Solely receiving the ACT intervention also increased employability.

  • 2. Bränström, R
    et al.
    Arrelöv, B
    Gustavsson, Catharina
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
    Kjeldgård, L
    Ljungquist, T
    Nilsson, G H
    Alexanderson, K
    Sickness certification at oncology clinics: perceived problems, support, need for education and reasons for certifying unnecessarily long sickness absences2014In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 23, no 1, p. 89-97Article in journal (Refereed)
    Abstract [en]

    Physicians' work with sickness certifications is an understudied field. The aims of this study were to gain knowledge of experiences concerning the sickness certification process among physicians working at oncology clinics. In 2008, all physicians working in Sweden (n = 36 898) were sent a questionnaire concerning sick-listing practices. All respondents working at an oncology clinic (n = 428) were included in the current study. Most of the physicians had sickness certification consultations at least weekly (91.3%). More than one fifth (22.3%) reported that they worked at a clinic with a workplace policy regarding the handling of sickness certification and 61.1% reported receiving at least some support in such cases from their immediate manager. Issuing unnecessary long sickness certificates were related to experiencing delicate interactions with patients and to lack of time. To a moderate degree, further competence was requested regarding: different types of compensation in the social insurance system, responsibilities of the Social Insurance Agency and employers, and sickness insurance rules. The large majority of physicians working in oncology reported regularly having consultations involving sickness certification. Overall, they reported few problems, low level of need for more competence regarding sickness certification, and low frequency of issuing sickness absences for longer periods than necessary.

  • 3. Bränström, Richard
    et al.
    Arrelöv, Britt
    Gustavsson, Catharina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Kjeldgård, Linnea
    Ljungquist, Therese
    Nilsson, Gunnar H
    Alexanderson, Kristina
    Reasons for and factors associated with issuing sickness certificates for longer periods than necessary: results from a nationwide survey of physicians.2013In: BMC public health, ISSN 1471-2458, Vol. 13, p. 478-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Physicians' work with sickness certifications is an understudied field. Physicians' experience of sickness certifying for longer periods than necessary has been previous reported. However, the extent and frequency of such sickness certification is largely unknown. The aims of this study were: a) to explore the frequency of sickness certifying for longer periods than necessary among physicians working in different clinical settings; b) to examine main reasons for issuing sickness certificates for longer periods than necessary; and c) to examine factors associated with unnecessary issued sickness certificates.

    METHODS: In 2008, all physicians living and working in Sweden (a total of 36,898) were sent an invitation to participate in a questionnaire study concerning their sick-listing practices. A total of 22,349 (60.6%) returned the questionnaire. In the current study, physicians reporting handling sickness certification consultations at least weekly were included in the analyses, a total of 12,348.

    RESULTS: The proportion of physicians reporting issuing sickness certificates for longer periods than actually necessary varied greatly between different types of clinics, with the highest frequency among those working at: occupational medicine, orthopedic, primary health care, and psychiatry clinics; and lowest among those working in: eye, dermatology, ear/nose/throat, oncology, surgery, and infection clinics. Logistic analyses showed that sickness certifying for longer periods than necessary due to limitations in the health care system was particularly common among physicians working at occupational medicine, orthopedic, and primary health care clinics. Sickness certifying for longer periods than necessary due to patient-related factors was much more common among physicians working at psychiatric clinics. In addition to differences between clinics, frequency of sickness certificates issued for longer periods than necessary varied by age, physicians' experiences of different situations, and perceived problems.

    CONCLUSIONS: This study showed that physicians issued sickness certificates for longer periods than actually necessary quite frequently at some types of clinics. Differences between clinics were to a large extent associated with frequency of problems, lack of time, delicate interactions with patients, and need for more competence.

  • 4.
    Carlsson, Lars
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden.
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Anderzén, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Gustavsson, Catharina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden.
    Motivation for return to work and actual return to work among people on long-term sick leave due to pain syndrome or mental health conditionsManuscript (preprint) (Other academic)
  • 5.
    Fridberg, Helena
    et al.
    Dalarna Univ, Sch Educ Hlth & Social Studies, S-79188 Falun, Sweden.
    Gustavsson, Catharina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Dalarna Univ, Sch Educ Hlth & Social Studies, S-79188 Falun, Sweden.
    Self-efficacy in Activities of daily living and symptom management in people with dizziness: a focus group study2019In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 41, no 6, p. 705-713Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Self-efficacy is associated with health status, health behaviour and health behaviour change in various chronic health conditions.

    PURPOSE: To describe self-efficacy in relation to Activities of daily living and symptom management in people with dizziness.

    MATERIAL AND METHODS: Thirteen women and three men, aged 45-82 years, with persistent dizziness (duration 4 months to 30 years) were recruited from an outpatient physiotherapy unit. A qualitative study was conducted using four focus groups and one individual interview and was then analysed with qualitative content analysis.

    RESULTS: The participants conveyed, in-depth information concerning two predefined main categories. Self-efficacy in Activities of daily living was related to challenging body positions and motions, environments, social activities, work tasks, and complex cognitive behaviours. Self-efficacy in symptom management was related to distress and aggravated symptoms, unfamiliar environment, and unknown people.

    CONCLUSIONS: People with dizziness describe how self-efficacy for specific activities varies according to the perceived difficulty of the task, the context of the activity, and day-to-day variations in general wellbeing. The results underscore the importance of targeting self-efficacy in the rehabilitation of people with dizziness. Our findings can guide the rehabilitation process by providing a deeper understanding of self-efficacy judgements in relation to Activities of daily living and symptom management in people with dizziness. Implication for rehabilitation This study adds important in-depth knowledge to the rehabilitation area on self-efficacy beliefs in relation to Activities of daily living and symptom management in people with dizziness. Self-efficacy for specific activities varies according to the perceived difficulty of the task, the context in which the activity takes place and day-to-day variations in perceived general well-being. The results can be used as a topic list to guide rehabilitation efforts in exploring and intervening aspects of people's everyday activities that are affected by low self-efficacy judgements. Activities perceived to be crucial to everyday life and important for well-being should be targeted in rehabilitation to increase self-efficacy and thereby activity performance and participation in people with dizziness.

  • 6.
    Gustavsson, Catharina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Self-management of Persistent Neck Pain: A Multi-component Group Intervention in Primary Health Care2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to evaluate effects of a multi-component pain and stress self-management group intervention (PASS) and to explore plausible predictors associated with short-term and long-term treatment effects among patients with persistent tension-type neck pain in primary health care (PHC).

    Study I was a pilot study in order to explore feasibility of the study design and methods. It included 37 participants randomly assigned to the intervention (n=18) or treatment-as-usual (n=19). Study II-III was a pragmatic randomized controlled trial that compared effects of the PASS and individually administered physiotherapy (IAPT) on patients with persistent tension-type neck pain in PHC. Study II evaluated short-term effects over a 20-week follow-up. Study III evaluated long-term effects on maintenance over a follow-up period of 2 years. Studies included 156 participants randomly assigned to PASS (n=77) or IAPT (n=79). Study IV explored predictive factors for favorable outcome in disability regarding participants assigned to PASS.

    The results showed that PASS had better effects than IAPT regarding coping with pain, in terms of patients’ ability to control pain, self-efficacy regarding activities interfered with by pain, disability and catastrophizing, over the 20-week follow-up, and treatment effects were largely maintained over a 2-year follow-up. Post-treatment scores in disability, self-efficacy and pain intensity were associated with long-term outcome in pain-related disability 2 years post-treatment following PASS. Pre-treatment characteristics explained only a minor proportion of variance in disability, and were assumed weakly associated with treatment success and long-term outcome.

    Key components for enhancement of long-term efficacy in pain self-management coping efforts were adequately targeted by PASS. It is suggested important to strengthen self-efficacy beliefs in regard to pain coping, to reduce disability and enhance pain self-management in the treatment of persistent neck pain, and to induce long-term maintenance of treatment gains on disability following a pain self-management intervention.

    List of papers
    1. Applied relaxation in the treatment of long-lasting neck pain: a randomized controlled pilot study.
    Open this publication in new window or tab >>Applied relaxation in the treatment of long-lasting neck pain: a randomized controlled pilot study.
    2006 (English)In: J Rehabil Med, ISSN 1650-1977, Vol. 38, no 2, p. 100-7Article in journal (Other scientific) Published
    Keywords
    Adaptation; Psychological, Adolescent, Adult, Aged, Chronic Disease, Comparative Study, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neck Pain/psychology/rehabilitation/*therapy, Patient Participation, Physical Therapy Modalities, Pilot Projects, Questionnaires, Relaxation Techniques, Research Support; Non-U.S. Gov't, Self Concept, Stress; Psychological/therapy, Treatment Outcome
    Identifiers
    urn:nbn:se:uu:diva-81992 (URN)16546766 (PubMedID)
    Available from: 2006-09-06 Created: 2006-09-06 Last updated: 2011-01-13
    2. Self-management of persistent neck pain: a randomized controlled trial of a multi-component group intervention in primary health care
    Open this publication in new window or tab >>Self-management of persistent neck pain: a randomized controlled trial of a multi-component group intervention in primary health care
    2010 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 14, no 6, p. 630.e1-630.e11Article in journal (Refereed) Published
    Abstract [en]

    Studies regarding self-management of persistent neck pain are infrequent. Objective: to compare treatment effects of (a) a multi-component pain and stress self-management group intervention (PASS) and (b) individually administered physical therapy (IAPT) for patients with persistent musculoskeletal tension-type neck pain. Methods: Persons seeking physical therapy treatment due to persistent tension-type neck pain at nine primary health care centers in Sweden were randomly assigned to either PASS or IAPT. Before treatment (baseline) and at 10- and 20-weeks the participants completed a self-assessment questionnaire comprising: the Self-Efficacy Scale, the Neck Disability Index, the Coping Strategies Questionnaire, the Hospital Anxiety and Depression Scale, the Fear-Avoidance Beliefs Questionnaire and questions regarding neck pain, analgesics and utilization of health care. Intention-to-treat analyses were performed using repeated measures analysis of variance between baseline, 10-week and 20-week follow-up. Results: One hundred and fifty six participants were included (PASS n=77, IAPT n=79). On average participants receiving PASS attended seven treatment sessions and participants receiving IAPT 11 sessions over the 20-week follow-up period. Repeated measures ANCOVA showed significant time x group interaction effects for ability to control pain (p<0.001), self-efficacy regarding pain-interfering activities (p=0.005), disability due to neck pain (p=0.001) and levels of catastrophic thinking (p<0.001) in favour of PASS. Conclusion: PASS had a better effect than IAPT in the treatment of persistent musculoskeletal tension-type neck pain regarding coping with pain, in terms of patients' self-reported pain control, self-efficacy, disability and catastrophizing, over the 20-week follow-up.

    Keywords
    Coping, Neck pain, Randomized controlled trial, Self-assessment questionnaire, Self-management
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-134517 (URN)10.1016/j.ejpain.2009.10.004 (DOI)000280062700010 ()19939717 (PubMedID)
    Available from: 2010-11-29 Created: 2010-11-29 Last updated: 2017-12-12Bibliographically approved
    3. Self-management of persistent neck pain: 2-year follow-up of a randomized controlled trial of a multi-component group intervention in primary health care
    Open this publication in new window or tab >>Self-management of persistent neck pain: 2-year follow-up of a randomized controlled trial of a multi-component group intervention in primary health care
    2011 (English)In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 36, no 25, p. 2105-2115Article in journal (Refereed) Published
    Abstract [en]

    Study design

    A 2-year follow-up of a randomized controlled trial.

    Objective

    To compare long-term effects of a) a multi-component pain and stress self-management group intervention (PASS) and b) individually administered physical therapy (IAPT) on patients with persistent tension-type neck pain in a primary health care (PHC) setting.

    Summary of Background Data

    In a previously reported short-term follow-up, PASS had better effects on pain control, pain-related self-efficacy, disability and catastrophizing than IAPT. Long-term effects of self-management interventions for persistent neck pain, e.g. maintenance of improvement and adherence to coping skills are sparsely investigated.

    Methods

    Persons with persistent tension-type neck pain seeking physical therapy treatment at nine PHC centers in Sweden were randomly assigned to either PASS or IAPT. Before intervention, at 10 and 20 weeks and at 1 and 2 years after the intervention, the participants completed a self-assessment questionnaire comprising: the Self-Efficacy Scale, the Neck Disability Index, the Coping Strategies Questionnaire, the Hospital Anxiety and Depression Scale and questions regarding neck pain and analgesics. Analyses were performed using linear mixed models for repeated measures.

    Results

    The study included 156 participants (PASS n=77, IAPT n=79). Between baseline, 10-week, 20-week, 1-year and 2-year follow-up, significant time by group interaction effects were found in favor of PASS regarding the primary outcomes ability to control pain (p<0.001) and self-efficacy for performing activities in spite of pain (p=0.002), and the secondary outcome catastrophic thinking (p<0.001) but not in neck pain related disability.

    Conclusions

    The initial treatment effects of a self-management group intervention were largely maintained over a 2 year follow-up period and with a tendency to have superior long-term effects as compared to individually administered physical therapy, in the treatment of persistent tension-type neck pain with regard to coping with pain, in terms of pain control, self-efficacy and catastrophizing.

    Keywords
    coping, neck pain, randomized controlled trial, self-assessment questionnaire, self-management
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-134519 (URN)10.1097/BRS.0b013e3182028b04 (DOI)000297270000010 ()21358487 (PubMedID)
    Available from: 2010-11-29 Created: 2010-11-29 Last updated: 2017-12-12Bibliographically approved
    4. Predictive factors for disability outcome at 20 weeks and 2 years following a pain self-management group intervention in patients with persistent neck pain in primary health care
    Open this publication in new window or tab >>Predictive factors for disability outcome at 20 weeks and 2 years following a pain self-management group intervention in patients with persistent neck pain in primary health care
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Study design. An explorative, longitudinal, prospective study, with measurement at baseline, 20 weeks and 2 years.

    Objective. To explore plausible predictors associated with short-term (20 weeks) and long-term (2 years) treatment success in terms of pain-related disability for patients with persistent tension-type neck pain following a multi-component pain and stress self-management group intervention (PASS).

    Summary of Background Data. In previously reported short-term and long-term follow-up, PASS had better effect on pain control, pain-related self-efficacy, disability and catastrophizing than a control treatment; individually administered physical therapy (IAPT). Identification of patients who are likely to benefit from particular interventions is required.

    Methods. Data collected from 77 participants assigned to PASS in a randomized controlled trial were explored in order to identify plausible predictors of favorable outcome regarding pain-related disability as measured by the Neck Disability Index (NDI), by use of Pearson correlation analysis, factor analysis (FA) and partial least squares (PLS) and ordinary least squares (OLS) regression analyses. Data from self-assessment questionnaires completed by the participants before intervention, post-treatment (20 weeks) and at 2 years after the intervention, were used. The questionnaire comprised: the Self-Efficacy Scale (SES), the NDI, the Coping Strategies Questionnaire(CSQ), the Hospital Anxiety and Depression Scale (HADS) and questions regarding neck pain and analgesics.

    Results. Multivariate PLS regression analysis showed that baseline scores in NDI, SES and pain intensity explained only 31% of the variance in disability (NDI) immediately post-treatment (20-week follow-up). PLS regression analysis showed that post-treatment scores in NDI, SES and pain intensity explained 68% of the variance in disability (NDI) at 2 years. Univariate OLS linear regression analyses indicated that each variable contributed significantly to the latter PLS regression model (NDI p<0.001, SES p<0.001, pain intensity p<0.001).

    Conclusions. Treatment gains, as measured by immediate post-treatment scores at 20-week follow-up, in disability, self-efficacy and pain intensity were associated with long-term outcome in pain-related disability two years post-treatment, in patients with persistent neck pain participating in a self-management group intervention in PHC. Pre-treatment characteristics explained only a small proportion of variance in disability post-treatment. Thus, the intervention appears to be feasible for the majority of persons seeking PHC due to persistent tension-type neck pain.

    Keywords
    coping, neck pain, predictors, randomized controlled trial, self-assessment questionnaire, self-management
    Identifiers
    urn:nbn:se:uu:diva-134520 (URN)
    Available from: 2010-11-29 Created: 2010-11-29 Last updated: 2011-01-13
  • 7.
    Gustavsson, Catharina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Bergstrom, Jakob
    Denison, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    von Koch, Lena
    Predictive factors for disability outcome at twenty weeks AND two years following a pain self-management group intervention in patients with persistent neck pain in primary health care2013In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, no 2, p. 170-176Article in journal (Refereed)
    Abstract [en]

    Objective: To explore possible predictors associated with short-term (post-treatment) and long-term (2 years) treatment success in terms of pain-related disability for patients with persistent neck pain following a pain and stress self-management intervention (PASS). Methods: Data from 77 participants assigned to PASS in a randomized controlled trial were explored to identify possible predictors of favourable outcome regarding pain-related disability as measured by the Neck Disability Index (NDI), by use of Pearson correlation analysis, partial least squares (PLS) and ordinary least squares (OLS) regression analyses. Data from self-assessment questionnaires completed by the participants before, post-treatment (i.e. 20 weeks after inclusion) and 2 years after inclusion in the study, were used. Results: Multivariate PLS regression analysis showed that baseline scores in NDI, the Self-Efficacy Scale. (SES) and pain intensity explained 31% of the variance in disability (NDI) post-treatment. Multivariate PLS regression analysis showed that post-treatment scores in NDI, SES and pain intensity explained 68% of the variance in disability (NDI) at 2 years. Conclusion: Treatment gains, as measured by post-treatment scores at 20-week follow-up, in disability, self-efficacy and pain intensity were associated with long-term outcome in pain-related disability at 2 years, in patients with persistent neck pain participating in a self-management group intervention in primary health care.

  • 8.
    Gustavsson, Catharina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Denison, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    von Koch, Lena
    Karolinska Institutet, Department of Neurobiology, Care Science and Society.
    Self-management of persistent neck pain: 2-year follow-up of a randomized controlled trial of a multi-component group intervention in primary health care2011In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 36, no 25, p. 2105-2115Article in journal (Refereed)
    Abstract [en]

    Study design

    A 2-year follow-up of a randomized controlled trial.

    Objective

    To compare long-term effects of a) a multi-component pain and stress self-management group intervention (PASS) and b) individually administered physical therapy (IAPT) on patients with persistent tension-type neck pain in a primary health care (PHC) setting.

    Summary of Background Data

    In a previously reported short-term follow-up, PASS had better effects on pain control, pain-related self-efficacy, disability and catastrophizing than IAPT. Long-term effects of self-management interventions for persistent neck pain, e.g. maintenance of improvement and adherence to coping skills are sparsely investigated.

    Methods

    Persons with persistent tension-type neck pain seeking physical therapy treatment at nine PHC centers in Sweden were randomly assigned to either PASS or IAPT. Before intervention, at 10 and 20 weeks and at 1 and 2 years after the intervention, the participants completed a self-assessment questionnaire comprising: the Self-Efficacy Scale, the Neck Disability Index, the Coping Strategies Questionnaire, the Hospital Anxiety and Depression Scale and questions regarding neck pain and analgesics. Analyses were performed using linear mixed models for repeated measures.

    Results

    The study included 156 participants (PASS n=77, IAPT n=79). Between baseline, 10-week, 20-week, 1-year and 2-year follow-up, significant time by group interaction effects were found in favor of PASS regarding the primary outcomes ability to control pain (p<0.001) and self-efficacy for performing activities in spite of pain (p=0.002), and the secondary outcome catastrophic thinking (p<0.001) but not in neck pain related disability.

    Conclusions

    The initial treatment effects of a self-management group intervention were largely maintained over a 2 year follow-up period and with a tendency to have superior long-term effects as compared to individually administered physical therapy, in the treatment of persistent tension-type neck pain with regard to coping with pain, in terms of pain control, self-efficacy and catastrophizing.

  • 9.
    Gustavsson, Catharina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Karolinska Inst, Div Insurance Med, Dept Clin Neurosci, SE-17177 Stockholm, Sweden.
    Hinas, Elin
    Karolinska Inst, Div Insurance Med, Dept Clin Neurosci, SE-17177 Stockholm, Sweden.
    Ljungquist, Therese
    Karolinska Inst, Div Insurance Med, Dept Clin Neurosci, SE-17177 Stockholm, Sweden.
    Alexanderson, Kristina
    Karolinska Inst, Div Insurance Med, Dept Clin Neurosci, SE-17177 Stockholm, Sweden.
    General practitioners' use of sickness certification guidelines in Sweden at introduction and four years later: a survey study2018In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 30, no 6, p. 429-436Article in journal (Refereed)
    Abstract [en]

    Objective: National sickness certification guidelines were introduced in Sweden in 2007, comprising both overarching and diagnoses-specific recommendations. This study aimed to investigate how general practitioners (GP) used and perceived the usefulness of these guidelines in the sickness certification process close after introduction and 4 years later. Design: Two nationwide cross-sectional surveys in 2008 and 2012. Setting: Swedish healthcare. Participants: Physicians working in primary healthcare and having sickness certification consultations at least a few times per year (n = 4214 in 2008, and n = 4067 in 2012). Main Outcome Measures: Frequency of use and perceived usefulness of the sickness certification guidelines. Results: Most GPs used the guidelines at least a few times per year (in 2008 74.6%; in 2012 85.2%). In 2008, 44.1% reported a need to develop competence in using the guidelines, compared with 23.3% in 2012. Of those using the guidelines, 36.7% in 2008 and 44.6% in 2012 reported it problematic to write sickness certificates in accordance with the guidelines. Most GPs (89.2% in 2008 and 88.8% in 2012) valued the guidelines beneficial to ensure quality in sickness certification consultations. A larger proportion in 2012 compared with 2008 reported that the guidelines facilitated contacts with patients (61.2%, respectively, 55.6%), as well as with other stakeholders. Conclusions: The guidelines were perceived as useful and beneficial to ensure high quality in sickness certification consultations, and facilitated contacts with patients as well as other stakeholders. In 2012, still one-fourth reported a need to develop more competence in using the sickness certification guidelines.

  • 10.
    Gustavsson, Catharina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Hinas, Elin
    Ljungquist, Therese
    Alexanderson, Kristina
    Obstetricians/Gynecologists' Problems in Sickness Certification Consultations: Two Nationwide Surveys.2016In: Obstetrics and Gynecology International, ISSN 1687-9589, E-ISSN 1687-9597, Vol. 2016, article id 9421316Article in journal (Refereed)
    Abstract [en]

    Although O/Gs perceived sickness certification as problematic, there was less perceived severity of problems in 2012 compared to 2008, possibly because interventions regarding sickness certification have been introduced in Sweden recent years. Still, more organizational support, for example, time and supervision, are needed to enhance O/Gs' sickness certification practices.

  • 11.
    Gustavsson, Catharina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Kjeldgård, Linnea
    Bränström, Richard
    Lindholm, Christina
    Ljungquist, Therese
    Nilsson, Gunnar H
    Alexanderson, Kristina
    Problems experienced by gynecologists/obstetricians in sickness certification consultations.2013In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, no 9, p. 1007-16Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To explore frequencies and experiences with problems in sickness certification consultations among gynecologists and obstetricians in two different years.

    DESIGN: Cross-sectional surveys on two occasions; in 2004 and 2008.

    SETTING: Gynecological, obstetric and maternal health care.

    SAMPLE: Physicians working in gynecology, obstetrics or maternal health care in two Swedish counties from two samples: in 2004 (n = 315), and in 2008 (n = 327).

    METHODS: Data regarding sickness certification consultations were obtained from comprehensive questionnaires that had been mailed to the physicians in two Swedish counties in 2004 and in 2008, respectively.

    OUTCOME MEASURES: Frequencies and types of problems in sickness certification consultations, organizational support, and need to acquire more competence.

    RESULTS: The majority experienced that patients requested to be on sick leave for a reason other than work incapacity due to disease or injury, at least a few times per year (85% in 2004 and 88% in 2008). The most problematic situation to handle was when the physician and the patient had different opinions about the need for sick leave (2004: 66% and 2008: 58%). The physicians expressed a need for more competence about the options and responsibilities of employers, social insurance officers and physicians in sickness certification cases.

    CONCLUSIONS: Most gynecologists/obstetricians find sickness certification consultations problematic and especially when encountering patients requesting to be on sick leave for reasons other than disease. The physicians expressed a need for more competence in insurance medicine, especially about their own and other stakeholders' options and responsibilities.

  • 12.
    Gustavsson, Catharina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Sch Hlth Care & Social Welf, Dept Physiotherapy, Vasteras, Sweden;Hgsk Dalarna, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Nordlander, Jessica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Söderlund, Anne
    Sch Hlth Care & Social Welf, Dept Physiotherapy, Vasteras, Sweden.
    Activity and life-role targeting rehabilitation for persistent pain: feasibility of an intervention in primary healthcare2018In: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, Vol. 20, no 3, p. 141-151Article in journal (Refereed)
    Abstract [en]

    Background: The activity and life-role targeting rehabilitation programme (ALAR) promotes patient's active involvement in pain rehabilitation.

    Purpose: to explore the feasibility of ALAR applied in a primary healthcare context.

    Materials and methods: An intervention was conducted at primary healthcare centres. Patients experiencing persistent pain were randomly assigned to ALAR + MMR or Multimodal pain rehabilitation (MMR). Data were collected by patient questionnaires before and after intervention (9 weeks and 1 year), medical record examination and therapist telephone interviews.

    Results: Seventy percent of ALAR +MMR participants completed the programme (n = 24). Complete data were obtained for half of the participants (ALAR +MMR n = 15, MMR n = 17). More ALAR +MMR than MMR participants perceived that they had been participating in planning their rehabilitation. The addition of ALAR to MMR induced higher costs short term, but had favourable health-economic effects in the long term.

    Conclusions: The methods for delivering ALAR in primary healthcare by specially trained physio and occupational therapists were feasible. Therapists' acceptability and perceived usability of the ALAR programme was high. More ALAR + MMR than MMR participants withdrew without completing treatment. Measures to increase patients' acceptability of the ALAR programme are warranted. Flexibility in number of treatment sessions and addressing patients' self-efficacy for undertaking rehabilitation is suggested, thus emphasising a more individualised rehabilitation plan.

  • 13.
    Gustavsson, Catharina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Dalarna Univ, Sch Educ Hlth & Social Studies, SE-79188 Falun, Sweden;Malardalen Univ, Sch Hlth Care & Social Welf, Box 883, SE-72123 Vasteras, Sweden.
    Nordqvist, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Malardalen Univ, Sch Hlth Care & Social Welf, Box 883, SE-72123 Vasteras, Sweden.
    Bröms, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Jerdén, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Dalarna Univ, Sch Educ Hlth & Social Studies, SE-79188 Falun, Sweden.
    Kallings, Lena V
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Swedish Sch Sport & Hlth Sci GIH, Dept Sport & Hlth Sci, Box 5626, SE-11486 Stockholm, Sweden.
    Wallin, Lars
    Dalarna Univ, Sch Educ Hlth & Social Studies, SE-79188 Falun, Sweden;Karolinska Inst, Div Nursing, Dept Neurobiol Care Sci & Soc, SE-17770 Stockholm, Sweden;Univ Gothenburg, Sahlgrenska Acad, Inst Hlth Care Sci, Box 457, S-40530 Gothenburg, Sweden.
    What is required to facilitate implementation of Swedish physical activity on prescription?: - interview study with primary healthcare staff and management2018In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, article id 196Article in journal (Refereed)
    Abstract [en]

    Background: The method, Swedish Physical Activity on Prescription (SPAP), has been launched in Swedish healthcare to promote physical activity for prevention and treatment of lifestyle related health disorders. Despite scientific support for the method, and education campaigns, it is used to a limited extent by health professionals. The aim of the study was to describe the views of health professionals on perceived facilitators, barriers and requirements for successful implementation of SPAP in primary healthcare. Methods: Eighteen semi-structured interviews with stakeholders in SPAP, i.e. ten people working in local or central management and eight primary healthcare professionals in two regional healthcare organisations, were analysed using qualitative content analysis. Results: We identified an overarching theme regarding requirements for successful implementation of SPAP: Need for knowledge and organisational support, comprising four main categories: Need for increased knowledge and affirmative attitude among health professionals; Need for clear and supportive management; Need for central supporting structures; Need for local supporting structures. Knowledge of the SPAP method content and core components was limited. Confidence in the method varied among health professionals. There was a discrepancy between the central organisation policy documents declaring that disease preventive methods were prioritised and a mandatory assignment, while the health professionals asked for increased interest, support and resources from management, primarily time and supporting structures. There were somewhat conflicting views between primary healthcare professionals and managers concerning perceived barriers and requirements. In contrast to some of the management's beliefs, all primary healthcare professionals undisputedly acknowledged the importance of promoting physical activity, but they lacked time, written routines and in some cases competence for SPAP counselling. Conclusion: The study provides knowledge regarding requirements to facilitate the implementation of SPAP in healthcare. There was limited knowledge among health professionals regarding core components of SPAP and how to practise the method, which speaks for in-depth training in the SPAP method. The findings highlight the importance of forming policies and guidelines and establishing organisational supporting structures, and ensuring that these are well known and approved in all parts of the healthcare organisation.

  • 14.
    Gustavsson, Catharina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden..
    von Koch, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Karolinska Inst, Dept Neurobiol Care Sci & Soc, S-10401 Stockholm, Sweden.;Karolinska Univ Hosp, Dept Neurol, Stockholm, Sweden..
    A 9-year follow-up of a self-management group intervention for persistent neck pain in primary health care: a randomized controlled trial2017In: Journal of Pain Research, ISSN 1178-7090, E-ISSN 1178-7090, Vol. 10, p. 53-64Article in journal (Refereed)
    Abstract [en]

    Background and objective: In previous short-term and 2-year follow-ups, a pain and stress self-management group intervention (PASS) had better effect on pain-related disability, self-efficacy, catastrophizing, and perceived pain control than individually administered physiotherapy (IAPT) for patients with persistent tension-type neck pain. Studies that have evaluated long-term effects of self-management approaches toward persistent neck pain are sparse. The objective of this study was to compare pain-related disability, self-efficacy for activities of daily living (ADL), catastrophizing, pain, pain control, use of analgesics, and health care utilization in people with persistent tension-type neck pain 9 years after they received the PASS or IAPT. Materials and methods: Of 156 people (PASS, n = 77; IAPT, n = 79) originally included in a randomized controlled trial, 129 people (PASS, n = 63; IAPT, n = 66) were eligible and were approached for the 9-year follow-up. They were sent a self-assessment questionnaire, comprising the Neck Disability Index, the Self-Efficacy Scale, the Coping Strategies Questionnaire, and questions regarding pain, analgesics, and health care utilization. Mixed linear models for repeated measures analysis or generalized estimating equations were used to evaluate the differences between groups and within groups over time (baseline, previous follow-ups, and 9-year follow-up) and the interaction effect of "time by group". Results: Ninety-four participants (73%) responded (PASS, n = 48; IAPT, n = 46). At 9 years, PASS participants reported less pain-related disability, pain at worst, and analgesics usage, and a trend toward better self-efficacy compared to IAPT participants. There was a difference between groups in terms of change over time for disability, self-efficacy for ADL, catastrophizing, perceived pain control, and health care visits in favor of PASS. Analyses of simple main effects at 9 years showed that the PASS group had less disability (p = 0.006) and a trend toward better self-efficacy (p = 0.059) than the IAPT group. Conclusion: The favorable effects on pain-related disability of PASS were sustained 9 years after the intervention.

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