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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.
    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.
    Healthcare and patient factors affecting sick leave: From a primary health care perspective2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: For indeterminate reasons, there have been major variations in sick leave in Sweden, and many physicians have perceived sick leave assignments as burdensome.

    Aim: To gain more knowledge and understanding, from a perspective of primary health care, about factors in health care and patients that affect sick leave. Thereby help patients in the best way, facilitate the work of physicians and other health professionals involved in the rehabilitation process, and use the health care resources optimally.

    Methods: This thesis is based on a randomised controlled trial (RCT) in a primary health care centre with participants on short-term sick leave, due to pain and/or mental illness, who received a multidisciplinary assessment. Qualitative focus-group discussions with physicians in primary health care centres. A cohort of women on very long-term sick leave due to pain and/or mental illness, who lost sickness benefits due to a new time limit on sickness insurance, were randomised to multidisciplinary assessment and multimodal intervention (TEAM), or to Acceptance and Commitment Therapy (ACT). In an extended cohort, including some men on very long-term sick leave due to pain and/or mental illness, the importance of the motivation for return to work (RTW) was investigated.

    Results. Very early multidisciplinary assessment increased days on sick leave in the first three month period. Physicians at primary health care centres perceived sick leave assignments as burdensome, but clearer rules and cooperation with other professionals have made sick leave assignments less burdensome. TEAM intervention resulted in an increase in working hours per week as well as an increase in work-related engagements, compared to control in the RCT. Motivation for RTW was associated with RTW or increased employability in the rehabilitation of patients

    Conclusions: Continued studies are needed to find those who are at risk of long-term sick leave, the time when rehabilitation efforts should be started, and the content of rehabilitation. Collaboration in teams facilitates sick leave assignments for physicians at primary care health centres. Motivation for RTW might be a factor of importance for the effect of rehabilitation and needs to be studied further.

    List of papers
    1. Early multidisciplinary assessment was associated with longer periods of sick leave: A randomized controlled trial in a primary health care centre
    Open this publication in new window or tab >>Early multidisciplinary assessment was associated with longer periods of sick leave: A randomized controlled trial in a primary health care centre
    2013 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 31, no 3, p. 141-146Article in journal (Refereed) Published
    Abstract [en]

    Objective

    To study the effects on sick leave from an early multidisciplinary assessment at a primary health care centre. Design. Randomized controlled trial.

    Setting

    Patients who saw GPs at a primary health care centre in mid-Sweden and asked for a sickness certificate for psychiatric or musculoskeletal diagnoses were invited to participate. Patients included were sick-listed for less than four weeks; 33 patients were randomized either to an assessment within a week by a physiotherapist, a psychotherapist, and an occupational therapist or to "standard care". The therapists used methods and tools they normally use in their clinical work.

    Main outcome measure

    Proportion of patients still sick-listed three months after randomization, total and net days on sick leave, and proportion who were on part-time sick leave.

    Results

    At follow-up after three months, in contrast to the pre-trial hypothesis, there was a trend toward a higher proportion of patients still sick-listed in the intervention group (7/18) as compared with the control group (3/15). The intervention group also had significantly longer sick-listing periods (mean 58 days) than the control group (mean 36 days) (p = 0.038). The proportion of patients who were part time sick-listed was significantly higher in the intervention group (10/18) than in the control group (2/15) (p = 0.027).

    Conclusions

    In this study an early multidisciplinary assessment was associated with longer periods on sick leave and more individuals on part-time sick leave.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-205930 (URN)10.3109/02813432.2013.811943 (DOI)000323243900005 ()23909930 (PubMedID)
    Available from: 2013-08-26 Created: 2013-08-26 Last updated: 2017-08-17Bibliographically approved
    2. General practitioners' perceptions of working with the certification of sickness absences following changes in the Swedish social security system: a qualitative focus-group study
    Open this publication in new window or tab >>General practitioners' perceptions of working with the certification of sickness absences following changes in the Swedish social security system: a qualitative focus-group study
    2015 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 16, article id 21Article in journal (Refereed) Published
    Abstract [en]

    Background: Many physicians in Sweden, as well as in other countries, find the matter of certification of sickness absence (COSA) particularly burdensome. The issuing of COSAs has also been perceived as a work-environment problem among physicians. Among general practitioners (GPs) are the highest proportion of physicians in Sweden who experience difficulties with COSA. Swedish authorities have created several initiatives, by changing the social security system, to improve the rehabilitation of people who are ill and decrease the number of days of sick leave used. The aim of this study was to describe how GPs in Sweden perceive their work with COSA after these changes. Methods: A descriptive design with a qualitative, inductive focus-group discussion (FGD) approach was used. Results: Four categories emerged from the analysis of FGDs with GPs in Sweden: 1) Physicians' difficulties in their professional role; 2) Collaboration with other professionals facilitates the COSA; 3) Physicians' approach in relation to the patient; 4) An easier COSA process. Conclusions: Swedish GPs still perceived COSA to be a burdensome task. However, system changes in recent years have facilitated work related to COSA. Cooperation with other professionals on COSA was perceived positively.

    Keywords
    General practitioners, Primary health care, Focus group discussions, Sick leave, Certification of sickness absence, Social security system
    National Category
    Other Medical Sciences
    Identifiers
    urn:nbn:se:uu:diva-248186 (URN)10.1186/s12875-015-0238-5 (DOI)000350069200001 ()
    Available from: 2015-04-12 Created: 2015-03-30 Last updated: 2017-12-04Bibliographically approved
    3. Effectiveness of two vocational rehabilitation programmes in women with long-term sick leave due to pain syndrome or mental illness: 1-year follow-up of a randomized controlled trial
    Open this publication in new window or tab >>Effectiveness of two vocational rehabilitation programmes in women with long-term sick leave due to pain syndrome or mental illness: 1-year follow-up of a randomized controlled trial
    2017 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, no 2, p. 170-177Article in journal (Refereed) Published
    Abstract [en]

    Objective: Mental illness and chronic pain are common reasons for long-term sick leave, typically more so for women. This study investigated the effects on return to work of 2 vocational rehabilitation programmes. Methods: In this randomized controlled study, 308 women were allocated to treatment with acceptance and commitment therapy, to multidisciplinary assessment and individualized rehabilitation interventions, or to a control group. Return-to-work at 12 months was assessed as: (i) returning to health insurance; (ii) number of reimbursed health insurance days during follow-up; (iii) self-reported change in working hours; (iv) a composite measure of self-reported change in work-related engagement. Results: The mean age of the Swedish study population was 48.5 years (standard deviation (SD) 6.3 years) and the mean time on sick leave 7.5 years (SD 3.2 years). There were no significant differences in reimbursed days or returning to the health insurance at 12 months. The multidisciplinary assessment and individualized rehabilitation interventions group, compared with control, reported a significant increase in working hours per week, as well as a significant increase in work-related engagement. Conclusion: Multidisciplinary assessments and individual rehabilitation interventions may improve the chance of return-to-work in women with long-term sick leave due to pain condition or mental illness.

    Keywords
    return to work, vocational rehabilitation, multidisciplinary rehabilitation, acceptance and commitment therapy, chronic pain
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:uu:diva-317212 (URN)10.2340/16501977-2188 (DOI)000396799000010 ()28101560 (PubMedID)
    Funder
    Swedish Social Insurance Agency
    Available from: 2017-03-11 Created: 2017-03-11 Last updated: 2018-09-06Bibliographically approved
    4. Motivation for return to work and actual return to work among people on long-term sick leave due to pain syndrome or mental health conditions
    Open this publication in new window or tab >>Motivation for return to work and actual return to work among people on long-term sick leave due to pain syndrome or mental health conditions
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Keywords
    Sick leave, motivation, return to work, sickness insurance, insurance medicine, public employment service, self-determination theory
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Research subject
    Family Medicine
    Identifiers
    urn:nbn:se:uu:diva-327288 (URN)
    Available from: 2017-08-08 Created: 2017-08-08 Last updated: 2017-08-17Bibliographically approved
  • 3.
    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. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Anderzén, I
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Motivationfor return to work and actual return to work among people on long-term sickleave due to pain syndrome or mental health conditions2018In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed)
    Abstract [en]

    ABSTRACTPurpose:The purpose of this study was to investigate associations between motivation for return towork and actual return to work, or increased employability among people on long-term sick leave.Materials and methods:Data by responses to questionnaires was collected from 227 people on long-term sick leave (mean¼7.9years) due to pain syndrome or mild to moderate mental health conditionswho had participated in a vocational rehabilitation intervention. The participants’motivation for return towork was measured at baseline. At 12-month follow-up, change in the type of reimbursement betweenbaseline and at present was assessed and used to categorise outcomes as:“decreased work and employ-ability”,“unchanged”,“increased employability”,and“increased work”. Associations between baselinemotivation and return to work outcome were analysed using logistic and multinomial regression models.Results:Motivation for return to work at baseline was associated with return to work or increasedemployability at 12-month follow-up in the logistic regression model adjusting for potential confounders(OR 2.44, 95% CI 1.25–4.78).Conclusions:The results suggest that motivation for return to work at baseline was associated withactual chances of return to work or increased employability in people on long-term sick leave due topain syndrome or mild to moderate mental health conditions.

  • 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.
    Lytsy, Per
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden.
    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. Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden.
    Anderzén, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Effectiveness of two vocational rehabilitation programmes in women with long-term sick leave due to pain syndrome or mental illness: 1-year follow-up of a randomized controlled trial2017In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, no 2, p. 170-177Article in journal (Refereed)
    Abstract [en]

    Objective: Mental illness and chronic pain are common reasons for long-term sick leave, typically more so for women. This study investigated the effects on return to work of 2 vocational rehabilitation programmes. Methods: In this randomized controlled study, 308 women were allocated to treatment with acceptance and commitment therapy, to multidisciplinary assessment and individualized rehabilitation interventions, or to a control group. Return-to-work at 12 months was assessed as: (i) returning to health insurance; (ii) number of reimbursed health insurance days during follow-up; (iii) self-reported change in working hours; (iv) a composite measure of self-reported change in work-related engagement. Results: The mean age of the Swedish study population was 48.5 years (standard deviation (SD) 6.3 years) and the mean time on sick leave 7.5 years (SD 3.2 years). There were no significant differences in reimbursed days or returning to the health insurance at 12 months. The multidisciplinary assessment and individualized rehabilitation interventions group, compared with control, reported a significant increase in working hours per week, as well as a significant increase in work-related engagement. Conclusion: Multidisciplinary assessments and individual rehabilitation interventions may improve the chance of return-to-work in women with long-term sick leave due to pain condition or mental illness.

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