| 1. |
- Strömbäck, Maria, 1965-
(författare)
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Skapa rum. Ung femininitet, kroppslighet och psykisk ohälsa : genusmedveten hälsofrämjande intervention.
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Mental health problems among young people, girls and young women in particular, are a serious public health problem. Gendered patterns of mental illness are seen in conjunction with stress-related problems such as anxiety, depression, and psychosomatic complaints. Intervention models tailored to the health care situation are therefore in need of development and evaluation. The overall aim of this thesis is to develop knowledge and understanding for young women’s mental health, stress-related, and bodily problems from a psychosomatic and gender theory perspective, and to evaluate a gender sensitive physiotherapeutic intervention model consisting of a stress management course for young women with stress-related problems.The thesis consists of four studies. The overall research design combines qualitative and quantitative methods in which questionnaires and interviews were used to explore participant experiences and symptoms linked to perceived stress before and after the intervention. Data consisted of a cumulative sample of 65 young women, 16 to 25 years of age, who attended the youth-friendly health center because of stress-related problems. In paper I, multiple symptom areas of mental health and somatic problems, self-image and aspects of body perception were measured before the course. Participants were 47 of the young women. The results were compared with published normative and clinical reference groups. In paper II, the young women’s experiences of living stressful femininity were analysed with a qualitative content analysis using gender theoretical and phenomenological perspectives as an interpretative frame. The study was based on interviews with 25 of the women. In paper III, follow-up interviews were done with 32 of the women after completion of the course. Data was using qualitative content analysis to illuminate experiences of participating in the course. In paper IV, the course was evaluated by measuring changes in multiple symptom areas using the Adult Self Report (ASR), Social Analysis of Social Behaviour (SASB), and Body Perception Questionnaire (BPQ). Participants were 54 of the women who completed measurements finishing the course.Young women present complex symptomatology of stress-related problems. The total burden of symptoms plus the narrated experiences highlight how renegotiations of gender constructions and handling of normative and stressful femininity constrain access to bodily resources. After the stress management course, their measured and narrated experiences show positive changes and release of mental health and stress problems, including a more positive self-image and sense of enhanced confidence in their bodies. Experiences of the course as a safe and explorative space for gendered collective understanding and embodied empowerment indicate the need to develop gender-sensitive interventions. The thesis contributes to youth and gender theoretical perspectives with integration of psychosomatic and psychiatric physiotherapy. A broader awareness of how gender constructions and sociocultural aspects are significant in the understanding of psychosomatic expressions of mental ill health and young femininity is valuable in development of theory and interventions in physiotherapy, as well as into other fields.
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| 2. |
- Peterson, Gunnel, 1959-
(författare)
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Neck muscle function in individuals with persistent pain and disability after whiplash injury
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Neck pain and disability are common after whiplash injury. One year after the accident up to 50 % still have symptoms called whiplash associated disorders (WAD). Despite decades of research the cause of persistent pain and disability are largely unknown and effective treatment and diagnostic tools are lacking. Altered neck muscle function may cause pain and disability, and real-time non-invasive methods that investigate both superficial and deep neck muscle function need to be evaluated.Aim: The general aim of the work presented in this thesis was to investigate mechanical neck muscle function and evaluate effects of three different exercise interventions related to neck muscle function in individuals with persistent pain and disability after whiplash injury.Method: The thesis comprised two studies, reported in four papers. Study A was a prospective randomized controlled trail with 216 participants. The effects of three exercise interventions; neck-specific exercises, neck-specific exercises with behavioral approach and prescription of physical activity were evaluated. Neck muscle endurance, perceived pain following testing, kinesiophobia and satisfaction with treatment were compared between the three groups (paper I). Study B was an experimental case-control study with participants consecutively recruited from the randomized controlled trial. Deformation and deformation rates in the neck muscles were investigated with real-time ultrasound imaging during ten repetitive arm elevations (paper II-IV). To investigate ventral neck muscles, 26 individuals with WAD were compared with 26 healthy controls (paper II). The dorsal neck muscles were investigated in paper III, including 40 individuals with WAD and 40 controls. In total 46 individuals, 23 with WAD and 23 healthy controls were included in paper IV to develop ventral neck muscle interaction models.Results: Paper I: Participants in the two neck-specific exercise groups (with and without behavioral approach) showed increased dorsal neck muscle endurance (p = 0.003), decreased pain intensity following testing (p = 0.04) and were more satisfied with treatment (p < 0.001) than participants in the prescribed physical activity group. Kinesiophobia did not significantly differ between groups (p > 0.12).Paper II: Deformation and deformation rate showed linear positive relationship between ventral muscle pairs in healthy controls, especially between superficial and deep neck muscles. This relationship was weaker or absent in the WAD group.Paper III: The WAD group had higher deformation rates in the deepest dorsal neck muscles during the first and tenth (only women) arm elevations compared to the control group (p < 0.04). Women in the WAD group showed a weaker linear relationship between the two deepest dorsal neck muscles compared to women in the control group.Paper IV: The results revealed two different ventral neck muscle models in individuals with WAD and healthy controls (R2Y = 0.72, Q2Y = 0.59). The models were capable to detect different neck muscle interplay in people with WAD.Conclusion: Neck-specific exercise intervention with or without a behavioral approach appears to improve neck muscle endurance in individuals with persistent WAD. Decreased pain after the neck muscle endurance test also suggests improved tolerance of load in these two groups. Altered mechanical neck muscle function was revealed in individuals with WAD indicating decreased muscular support for maintain a stable cervical spine during repetitive arm elevations. The results show great promise for improved diagnosis of neck muscle function in WAD.
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| 3. |
- Zetterberg, Lena, 1961-
(författare)
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Multidimensional Aspects of Dystonia : Description and Physiotherapy Management
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: The overall aim of this research was to increase the knowledge about dystonia by identifying factors that influence self-reported quality of life and health in this disorder and to determine what factors predict disability. A further aim was to develop an objective outcome measure for quantifying the movement dysfunction in cervical dystonia (CD) and evaluate effects of physiotherapy.Methods: A descriptive correlative design was adopted for study I (n=351), with a questionnaire covering physical activity, satisfaction with treatment, physiotherapy or not, and quality of life and health measured with the Craniocervical Dystonia Questionnaire (CDQ-24) and the Cervical Dystonia Impact Profile, respectively.In study II a CD group (n=6) was compared with a control group (n=6). Head movements were measured with a motion capture system, and a Movement Energy Index (MEI) was calculated. In study III an experimental single-case design (n=6) was used, with continuous assessments during pre-treatment, intervention and follow-up. Quality of life, measured with CDQ-24, was the primary outcome measure.A prospective correlative design was applied in study IV (n=179), where data from questionnaires were collected on inclusion and 2 months later. Independent variables were: duration of dystonia, severity of dystonia, pain intensity, catastrophizing, self-efficacy, fatigue, kinesiophobia, depression, anxiety and physical activity; and the dependent variables were the Neck Disability Index and the Functional Disability Questionnaire.Results: Study I indicated that physical activity and satisfaction with treatment were associated with quality of life and health in dystonia. In study II the groups differed significantly concerning MEI in all movement directions. Mean MEI was significantly higher in patients than in controls. Positive treatment outcomes were reported by all patients in study III, mainly with reduced pain and reduced CD severity during the treatment period. Five of the six patients reported increased quality of life at the 6-month follow-up. Perceived self-efficacy, fatigue, pain intensity and anxiety contributed significantly to disability prediction in study IV.Conclusion: These investigations have increased the knowledge of dystonia from a multidimensional perspective and the results could be valuable in developing new treatment strategies.
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| 4. |
- Klompstra, Leonie, 1982-
(författare)
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Physical activity in patients with heart failure : motivations, self-efficacy and the potential of exergaming
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Adherence to recommendations for physical activity is low in patients with heart failure (HF). It is essential to explore to what extent and why patients with HF are physically active. Self-efficacy and motivation for physical activity are important in becoming more physically active, but the role of self-efficacy in the relationship between motivation and physical activity in patients with HF is unknown. Alternative approaches to motivate and increase self-efficacy to exercise are needed. One of these alternatives might be using exergames (games to improve physical exercise). Therefore, it is important to obtain more knowledge on the potential of exergaming to increase physical activity.The overall aim was to describe the physical activity in patients with HF, with special focus on motivations and self-efficacy in physical activity, and to describe the potential of exergaming to improve exercise capacity.Methods: Study I (n = 154) and II (n = 101) in this thesis had a cross-sectional survey design. Study III (n = 32) was a 12-week pilot intervention study, including an exergame platform at home, with a pretest-posttest design. Study IV (n = 14) described the experiences of exergaming in patients who participated in the intervention group of a randomized controlled study in which they had access to an exergame platform at home.Results: In total, 34% of the patients with HF had a low level of physical activity, 46% had a moderate level, 23% reported a high level. Higher education, higher selfefficacy, and higher motivation were significantly associated with a higher amount of physical activity. Barriers to exercise were reported to be difficult to overcome and psychological motivations were the most important motivations to be physically active. Women had significantly higher total motivation to be physically active. Self-efficacy mediated the relationship between exercise motivation and physical activity; motivation leads to a higher self-efficacy towards physical activity.More than half of the patients significantly increased their exercise capacity after 12 weeks of using an exergame platform at home. Lower NYHA-class and shorter time since diagnosis were factors significantly related to the increase in exercise capacity. The mean time spent exergaming was 28 minutes per day. Having grandchildren and being male were related to more time spent exergaming.The analysis of the qualitative data resulted in three categories describing patients’ experience of exergaming: (i) making exergaming work, (ii) added value of exergaming, (iii) no appeal of exergaming.Conclusion: One-third of the patients with HF had a low level of physical activity in their daily life. Level of education, exercise self-efficacy, and motivation were important factors to take into account when advising patients with HF about physical activity. In addition to a high level of motivation to be physically active, it is important that patients with HF have a high degree of exercise self-efficacy.Exergaming has the potential to increase exercise capacity in patients with HF. The results also showed that this technology might be suitable for some patients while others may prefer other kinds of physical activity.
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| 5. |
- Wickford, Jenny, 1979
(författare)
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Physiotherapists in Afghanistan. Exploring, encouraging and experiencing professional development in the Afghan development context
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The aim of the thesis is to analyze the matter of supporting professional development of physiotherapists in Afghanistan, and the issues involved in expatriate physiotherapists working with professional development cross-culturally and in development contexts. The thesis is based on two field studies, aspects of which are reported on in four papers. The first field study aimed at analyzing and describing the physiotherapy component of a disability programme. The aim of the second field study was to explore the process of a development project, in order to gain understanding of how such work can be done in a better way. Participant observation was used for the data production of both studies. The adult learning theories of transformative learning and situated learning were used as a theoretical framework in the thesis. Paper I describes the situation, needs and challenges for developing physiotherapy in Afghanistan. The therapists worked in isolation with little opportunity for further education or professional development. Their approach was mainly medical, where the work was dictated by the patients’ expectations and doctors’ recommendations. They used primarily passive methods of treatment, and their work was affected by cultural, religious and situational factors and they demonstrated a basic capacity of clinical reasoning. Paper II explores factors that impacted learning and professional development of the Afghan physiotherapists in the development project. Examples of these factors were: a pattern approach to treatment, linear thinking, and socially oriented decision-making that affected how new things learned were put into practice; concrete representations and an instrumental view of knowledge characterized learning approaches; language barriers, different interpretations of meaning and cultural codes challenged communication; and a prescriptive, encouraging approach of the expatriate physiotherapy development worker affected teaching and learning. Paper III explores professional ethics for Afghan physiotherapists and identifies two ethical tensions for the professional practice of Afghan physiotherapists: between individualistic and communitarian ethical perspectives, and between normative ethics and local morals. Paper IV is a critical reflection over the expatriate development worker’s development process through, and impact on, the development project. The perspective of the development worker is transformed from an idealistic helper to an enterprising learner as a consequence of active participation in and a self-critical reflection of the process. Conclusion: Working with and researching professional development cross-culturally and in development contexts is complex and requires consideration of many different factors. Cultural competency is essential, where to understand others one needs to first understand oneself, and oneself in relation to others. This requires support when in the field. Physiotherapy theory and practice must be adapted to the local context. Actions taken towards promoting learning and professional development must be firmly rooted in the Afghan context, and investigated, planned and implemented together with Afghan physiotherapists. The professional development of Afghan supervisors and teachers should be a priority. To encourage reflection of both Afghan and expatriate physiotherapists a communicative learning approach could be taken, where ethical challenges and disorienting dilemmas can form the basis of a reflective discourse and lead to increased understanding.
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| 6. |
- Essner, Ann, 1971-
(författare)
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On assessment methods related to pain in dogs with osteoarthritis
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There is a need of valid and reliable assessment methods that are clinically applicable in canine rehabilitation practice. The aim of this thesis was to psychometrically evaluate measurement properties in assessment methods related to pain in naturally occurring canine osteoarthritis. Assessment methods developed for heart rate variability analysis, i.e. Polar heart rate monitor, and owner-reported perceptions of pain severity and pain interference with functionality, i.e. Canine Brief Pain Inventory, were tested.Methods: Four observational studies were conducted. Study I was a cross-sectional study consisting of two groups of consecutively recruited dogs. The Canine Brief Pain Inventory was administered to owners of dogs with naturally occurring osteoarthritis (n=61) and clinically sound dogs (n=21). Study II was a descriptive and correlative cross-sectional study based on the same sample of dogs with osteoarthritis (n=71), assessing chronic pain behavior and associations between explanatory variables and chronic pain behavior. Study III and IV were correlative studies, assessing Polar heart rate monitor measuring interbeat intervals and time- and frequency-based heart rate variability parameters, compared to simultaneously recorded electrocardiogram in dogs (n=11).Results: High internal consistencies and ability to discriminate sound dogs from osteoarthritis dogs were found. The hypothesis of the presented two-factor structure of the Canine Brief Pain Inventory was rejected. Owners reported higher proportions of chronic pain behavior in items targeting physical activities, e.g. getting up, moving after rest and moving after major exercise. A minor proportion of dogs with osteoarthritis showed no owner-perceived behavioural signs of chronic pain. Owner observations were not associated with ongoing antiinflammatory medications. In Study III and IV, 595 errors (12.3%) were identified in Polar data. The number of errors were unequally distributed among the dogs. Interbeat intervals and heart rate variability parameters from electrocardiogram and Polar were strongly associated. Standard error of measurements were high among some heart rate variability parameters in Polar and electrocardiogram.In conclusion, this thesis contributes to our knowledge about assessment methods related to diverse components of pain in dogs with osteoarthritis, allowing improved pain management in clinical practice.
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| 7. |
- Gustavsson, Catharina, 1961-
(författare)
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Self-management of Persistent Neck Pain : A Multi-component Group Intervention in Primary Health Care
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- 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.
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| 8. |
- Bäcklund, Catharina, 1971-
(författare)
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Promoting physical activity among overweight and obese children : Effects of a family-based lifestyle intervention on physical activity and metabolic markers
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Overweight and obesity in childhood is associated with physical, psychological and social consequences. Physical inactivity is regarded as one of the main factors that have contributed to the increase in childhood obesity through out the world. Overweight and obesity as well as physical activity level are shown to track from childhood to adolescence and adulthood, thereby influencing not only the current health status but also long-term health. The general purpose of this thesis was to evaluate the effect of a 2-year family-based lifestyle intervention on physical activity and metabolic health among children with overweight and obesity. Methods Children with overweight or obesity living in northern Sweden were recruited to the study. In total 105 children, mean age 10.5 years (SD±1.09), were randomized into either an intervention or a control group. The intervention group was offered as a 2-year family-based lifestyle intervention; the 1st year consisted of 14 group sessions and during the 2nd year the intervention was web-based. The control group did not participate in any intervention sessions, but performed all measurements. Physical activity was measured in all children using SenseWear Pro2 Armband (SWA) during 4 consecutive days before, in the middle and after the intervention, data regarding anthropometrics and blood values were collected in the same periods. Twenty-two of the children wore SWA during 14 days before the intervention in order to validate energy expenditure (EE) estimated by SWA against EE measured with double labelled water. Results The SWA, together with software version 5.1, proved to be a valid device to accurately estimate EE at group level of overweight and obese children. There were no statistically significant differences between the groups neither before nor after the intervention regarding physical activity and screen-time. All children significantly decreased their time being active ≥3 METs during the study period. After the study period, significantly fewer in the control group achieved the national physical activity recommendation, and they had significantly increased their screen-time. However, these changes were not seen within the intervention group. The intervention group had a significantly lower apolipoprotein B/A1 compared to the control group at 1-year measurement; no other significant differences were found regarding metabolic markers. No statistical difference was found between the groups regarding body mass index after the 2-year study period. Conclusion Even though a comprehensive program, the 2-year family-based lifestyle intervention had limited effects on physical activity and metabolic health in overweight and obese children. SWA is a device that can be used in future studies to measure energy expenditure among free-living overweight or obese children.
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| 9. |
- Stenberg, Gunilla, 1968-
(författare)
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Genusperspektiv på rehabilitering för patienter med rygg- och nackbesvär i primärvård
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction Gender as a social and cultural construction has an impact on physiotherapist and patient beliefs, understanding, and behaviour and could affect physiotherapy encounters. Gender studies in early rehabilitation are scarce. The aim of this thesis was to study gender during different parts of the rehabilitation process for primary health care patients with neck and back pain. Method The analyses are based on data from three different samples. One sample is composed of physiotherapists and two samples consist of patients consulting primary health care providers because of neck and back pain. All data were gathered from primary health care provided in Västerbotten County. Baseline data on 73 physiotherapists and 586 of their patients with neck and back pain were collected by questionnaire during three consecutive days in 2006. Patient data included affected pain site and treatment procedures used by the physiotherapist (Study I). Differences in treatment procedures used by female and male physiotherapists and differences in use for female or male patients were analysed using Chi square-test, Fisher’s exact tests, Mann-Whitney U tests and logistic regressions with cluster analysis. Thematised interviews with 12 patients were made before the patient’s first appointment with a physiotherapist or doctor and repeated after three months. Data were analysed according to grounded theory (Study II) and qualitative content analysis (Study III). A comprehensive questionnaire was answered at the first appointment when patients sought a physiotherapist in primary health care. The questionnaires included questions about pain intensity, self-rated health, function, psychological stress reactions, domestic work, work environment, self-efficacy and kinesiophobia. Response patterns were linked to the International Classification of Functioning Disability and Health (ICF) and analysed using principal component analysis (PCA) and partial least squares projections to latent structures (PLS). Result Patients were given the same treatment procedures irrespective of gender. The treatment procedures most often used were training of joint motion (48%), training of muscle functions and strength training (31%), massage (31%), physical treatment (28%), information about health/ill health (24%), and acupuncture (18%). Female and male physiotherapists used the same treatment procedures with a few exceptions. Female physiotherapists used treatment for mental functions and acupuncture more often than male physiotherapists. The women gave their patients a unique mixture of treatment procedures more frequently (43%) compared to their male colleagues (25%). Male physiotherapists used more training of joint motion. "To be confirmed" emerged as the core category when analysing interviews that considered expectations or experiences. Five categories were extracted: "To be taken seriously", "To get an explanation", "To be individually assessed and treated", "To be invited to participate", and "To be taken care of in a trustworthy environment". These were factors leading to confirmation. Two ideal types were identified: "confident" and "ambiguous". The "confident" did not doubt their right to health care and blamed their work for causing the pain. They related to a positive identity of strong or hard working. The "ambiguous" were afraid of being regarded as old, whining women and not being taken seriously. They were ashamed of having neck or back pain and blamed themselves; they thought they were not fit enough. The ideal types were not completely defined by gender, but more men were among the "confident" ideal type and more women were among the "ambiguous" type. Patients reacted differently to feelings of being confirmed or not, and this depended on whether they were the "confident" or "ambiguous" ideal type. The "confident" were satisfied and reacted with reorientation when they felt confirmed, even if they were not totally cured. When not confirmed, the "confident" reacted with anger, frustration, and feelings of shame or remained proud and blamed the health care personnel for being incompetent. The "ambiguous" also were satisfied and felt reoriented when they were confirmed. They then moved from being an "ambiguous" type to a more "confident" type. When the "ambiguous" were not confirmed in healthcare, they became dissatisfied and unhappy. They doubted the assessment, felt forlorn, and felt increased shame. Not being confirmed was experienced more negatively by women than by men irrespective of ideal type. Interesting information was found about how patients view their body in relation to pain during analysis of expectations and experiences in study II interviews. This led to Study III. In study III, "Fear of hurting the fragile body" emerged as an interview theme. Five categories supported or undermined beliefs about pain and physical activity: "The mechanical body", "Messages about activity", "Earlier experiences of pain and activity", "To be a good citizen", and "Support to be active". Patients thought their pain was due to tissue damage and viewed their bodies in a mechanical way. Clear messages from health care personnel about activity led to less fear of physical activity. Vague and contradictory messages led to more fear. Gender-stereotyped messages were given to patients. "The take it carefully" was such a message, and was more often to women when women were thought to be weak and in need of training. Another message was "Pain goes with heavy work". This message was more often given to men when men were thought to be strong and not in need of training. Earlier experiences of pain and activity could have been positive or negative. If positive, the experiences led to less fear of engaging in physical activity. A wish to be a good citizen, such as being a good parent, led to patients being more engaged in child care and playing more than they thought was good for their pain. Women, more than men, expressed avoidance of sick leave because they did not want to be a burden to society or to their work colleagues. Patients were anxious about how to do the "correct" exercises to avoid further injury. Practical support and a follow up to adjust the training program were important to reduce the fear of engaging in physical activity and to maintain motivation. One hundred and eighteen patients (84 women and 34 men) completed the questionnaire. PCA of all questions identified five significant components. The model explained 37% of the variance. The predictive power was 17%. PC1 explained 17% of the variance and the predictive power was 0.13%. PC1 was mainly explained by questions classified in ICF as Activity and Participation. These included questions about physical function and self-efficacy (classified as Content of Thought). Questions about support (classified as Environmental Factors) and stress reactions (classified as Body Function (Emotional Functions)) mainly explained PC2. PC3 was mainly explained by reported pain and symptoms from muscles (classified as Body Functions) and domestic work and leisure time activities (classified as Activity and Participation). There were differences in t-scores between women and men in PC2 (p=0.045) and PC3 (p=0.003). Variables that discriminated between women and men were questions about stress reactions and support at work in PC2, and questions about pain intensity and domestic work in PC3. Conclusion As a physiotherapist working with neck and back pain rehabilitation patients, it is important to be aware of both one’s own and the patient’s preconceptions about women and men. It is also important to be aware of the impact of gender on the professional role when choosing treatment procedures in order to ensure that choices will be based on evidence of effectiveness and not from stereotypes. Awareness of the patient’s individual needs and subsequent adaptation of treatments is also important. Some patients display a negative self-assessment and shame. They need more support to be able to reorient. Unless these patients are confirmed, they are at risk of prolonged disability. Gender stereotypes can hinder rehabilitation of neck and back pain if women are seen as weak and in need of protection and men are seen as strong and not in need of preventive muscle training. When assessing neck and back pain patients with questionnaires, gender has less significance than when asking questions about physical function and self-efficacy. Questions about emotions of stress reactions, support at work, and pain intensity contribute to gender differences for women. Questions on the level of domestic work contribute to gender differences for men.
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| 10. |
- Lönnberg, Lena, 1964-
(författare)
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Lifestyle counselling in primary health care for patients with high cardiovascular risk : Aspects of a 1-year structured lifestyle programme promoting healthier lifestyle habits to reduce future risk of cardiovascular disease
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- While the effects of lifestyle habits on hypertension or type 2 diabetes mellitus (T2DM) are well established, few lifestyle programmes in primary care directed towards patients with high cardiovascular risk have been evaluated.Aims To describe and elaborate on how participation in a 1-year lifestyle programme supported changes in lifestyle habits and altered the risk of cardiovascular disease (CVD) as well as explore patients’ and community health nurses’ (CHNs’) experiences of lifestyle change and counselling.Methods The 1-year lifestyle programme consisted of five appointments with a CHN for patients diagnosed with hypertension, T2DM or impaired glucose tolerance (n = 448). Focuse was on lifestyle habits that were related to patients’ diagnosis. Different behaviour change techniques were used to support lifestyle changes. Blood sampling and anthropometrical measurements were obtained at baseline and 1-year follow-up. The design of Studies I and II was observational and based on data that were consecutively collected between 2009 and 2014, whereas Studies III and IV had a qualitative design. Qualitative content analyses were performed based on data from individual interviews with patients (n = 16) and a focus group interview of CHNs (n = 3).Results Study I: Favourable changes in physical activity, dietary habits and smoking were detected after participation in the programme. Study II: Significant improvements were demonstrated for all cardiovascular risk factors and the estimated 10-year CVD risk after participation in the programme. Study III: Patients’ experiences of lifestyle changes indicated that increased knowledge of lifestyle habits, gaining trust in oneself and support from others were important elements in the adoption of lifestyle changes. Study IV: The informants expressed that counselling should be based on a partnership, include goal setting and repeated measurements, and incorporate long-term support after the completion of the lifestyle programme.Conclusion This thesis adds to the knowledge on how lifestyle counselling can be designed and implemented in primary care. The findings show that patients with a new diagnosis of hypertension or T2DM are at high risk for future CVD and a structured lifestyle programme can contribute to improved lifestyle habits and a reduced 10-year CVD risk.
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