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- 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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| 3. |
- Fjellman-Wiklund, Anncristine, et al.
(författare)
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Retrospective experiences of individuals two decades after anterior cruciate ligament injury : a process of re-orientation towards acceptance
- 2022
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Ingår i: Disability and Rehabilitation. - : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 44:21, s. 6267-6276
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Individual perspectives of long-term consequences decades after anterior cruciate ligament (ACL) injury are unexplored. We addressed experiences and the impact on life of former athletes >20 years post-ACL injury.Methods: Individual interviews, analysed using Grounded Theory, were conducted with 18 persons injured mainly during soccer 20–29 years ago.Results: A theoretical model was developed with the core category Re-orientation towards acceptance, overarching three categories illustrating the long-term process post-injury. Initially the persons felt like disaster had struck; their main recall was strong pain followed by reduced physical ability and fear of movement and re-injury. In the aftermaths of injury, no participant reached the pre-injury level of physical activity. Over the years, they struggled with difficult decisions, such as whether to partake or refrain from different physical activities, often ending-up being less physically active and thereby gaining body weight. Fear of pain and re-injury was however perceived mainly as psychological rather than resulting from physical limitations. Despite negative consequences and adjustments over the years, participants still found their present life situation manageable or even satisfying.Conclusion: ACL injury rehabilitation should support coping strategies e.g., also related to fear of re-injury and desirable physical activity levels, also with increasing age.IMPLICATIONS FOR REHABILITATIONMore than 20 years after the ACL injury, the individuals despite re-orientation towards acceptance and a settlement with their life situation, still had fear of both pain and re-injury of the knee, with concerns about physical activity and gaining of body weight. Patients with ACL injury may need better individual guidance and health advice on how to remain physically active, to find suitable exercises and to maintain a healthy body weight. Education related to pain, treatment choices, physical activity, injury mechanisms in participatory discussions with the patient about the ACL injury may be beneficial early in the rehabilitation process to avoid catastrophizing and avoidance behaviour. ACL injury rehabilitation needs to address coping strategies incorporating the psychological aspects of suffering an ACL injury, including fear of movement/secondary injury, in order to support return-to-sport and/or re-orientation over time.
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| 4. |
- Fjellman-Wiklund, Anncristine, et al.
(författare)
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Take charge : Patients' experiences during participation in a rehabilitation programme for burnout
- 2010
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 42:5, s. 475-481
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to explore the experiences of patients with burnout during a rehabilitation programme.Patients and methods: Eighteen patients with burnout were interviewed at the end of a one-year rehabilitation programme. The programme consisted of 2 groups, one with a focus on cognitively-oriented behavioural rehabilitation and Qigong and 1 with a focus on Qigong alone. The interviews were analysed using the grounded theory method.Results: One core category, Take Charge, and 6 categories emerged. The core category represents a beneficial recovery process that helped the patients to take control of their lives. The common starting point for the process is presented in the 3 categories of Good encounters, Affirmation and Group cohesiveness. The categories were basic conditions for continuing development during rehabilitation. In the categories Get to know myself, How can I be the one I want to be? and Choice of track, the more group-specific tools are included, through which the patients adopted a new way of behaving.Conclusion: Patients in both groups experienced group participation as being beneficial for recovery and regaining control of their lives, although in somewhat different way. An experience of affirmation and support from health professionals and group participants is of importance for behavioural change
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| 5. |
- Halvarsson, Sara, et al.
(författare)
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From authority to coach : parents' experiences of streching as a home programme for childrern with cerebral palsy
- 2010
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Ingår i: Advances in Physiotherapy. - : Informa UK Limited. - 1403-8196 .- 1651-1948. ; 12:4, s. 208-216
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Tidskriftsartikel (refereegranskat)abstract
- Stretching is a common treatment for children with cerebral palsy, carried out by parents together with their children in the home. The aim of the present study was to explore parents’ experiences of carrying out stretching as a home programme. In order to capture the informants’ own perceptions and experiences, a qualitative method, the Grounded Theory, was chosen. Fifteen semi-structured interviews with parents, using open-ended questions, were analysed. One core category, “From authority to coach”, and two categories, “Prerequisites for parenting during stretching” and “Child and parent interaction”, emerged. The parents described a gradual development of their own role in the home stretching programme, from that of an authority, when the child was young, to that of a coach when the child grew older. With this gradual development came an increased level of participation from the child, enabling stretching to be carried out regularly. According to the parents, stretching could not be carried out without the child's active participation. Along with the process, the parents perceived increasing stress through added pressure and demands. Mobility, time, coping strategies for stress and support from professionals, in particular physiotherapists, were important prerequisites for parents to help their child best with stretching exercises. Read More: http://informahealthcare.com/doi/abs/10.3109/14038196.2010.528023
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| 6. |
- Johansson, Lena, et al.
(författare)
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Ventilated patients' experiences of body awareness at an intensive care unit
- 2005
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Ingår i: Advances in Physiotherapy. - : Taylor & Francis. - 1403-8196 .- 1651-1948. ; 7, s. 154-161
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Tidskriftsartikel (refereegranskat)abstract
- Treatment with mechanical ventilation (MV) in an intensive care unit (ICU) can cause extensive problems for patients.There is, however, a dearth of research investigation into how ICU treatment affects a person’s body image. The aim of thisstudy was to enhance the knowledge and understanding of body awareness and body image in persons treated with MV in anICU. In order to capture the informants’ own perceptions and experiences, a qualitative method of Grounded Theory waschosen. Seven thematic in-depth interviews were carried out with former ICU patients. To increase credibility, triangulationof researchers and reference group checking was used. The analysis resulted in the core category Limited possibilitiesto act, which relates to the informants’ experiences of not being able to act as they normally would. The core category wasderived from the experiences of feeling like another person, the perceptions of not being in contact with their body andreality and the feeling of being restrained. This study adds a perspective of body awareness to the interpretations of ICUpatients’ experiences. It emphasizes the experience and movement aspects of the body and that physiotherapists have animportant role in the rehabilitation of ICU patients.
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| 7. |
- Stenberg, Gunilla, Med dr, 1968-, et al.
(författare)
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Gender matters in physiotherapy
- 2022
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Ingår i: Physiotherapy Theory and Practice. - : Taylor & Francis. - 0959-3985 .- 1532-5040. ; 38:13, s. 2316-2329
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Tidskriftsartikel (refereegranskat)abstract
- The World Health Organization states that gender has implications for health across the course of a person's life in terms of norms, roles and relations. It also has implications in rehabilitation. In this article, we argue the need of gender perspectives in the field of physiotherapy; gender matters and makes a difference in health and rehabilitation. We highlight a number of central areas where gender may be significant and give concrete examples of social gender aspects in physiotherapy practice and in diverse patient groups. We also discuss why it can be important to consider gender from an organizational perspective and how sociocultural norms and ideals relating to body, exercise and health are gendered. Further we present useful gender theories and conceptual frameworks. Finally, we outline future directions in terms of gender-sensitive intervention, physiotherapy education and a gendered application of the ICF model. We want to challenge physiotherapists and physiotherapy students to broaden knowledge and awareness of how gender may impact on physiotherapy, and how gender theory can serve as an analytical lens for a useful perspective on the development of clinical practice, education and research within physiotherapy.
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| 8. |
- Stenberg, Gunilla, et al.
(författare)
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Patterns of reported problems in women and men with back and neck pain : similarities and differences
- 2014
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 46:7, s. 668-675
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine similarities and differences in problem areas reported by women and men who seek physiotherapy for back or neck pain. Methods: Principal component analysis (PCA) was used to analyse questionnaire data including demographics, pain, domestic work, stress, health status, physical disability, psychosocial and physical workload, kinesiophobia and self-efficacy. Most of the questions were recruited from a number of scales, e.g. EuroQol (EQ-5D), Neck Disability Index (NDI), Oswestry Disability Questionnaire (ODQ), Tampa Scale for Kinesiophobia, and Functional-Efficacy-Scale. Results: A total of 118 patients (84 women, 34 men) completed the questionnaire. Men and women scored similarly on physical disability, functional self-efficacy and kinesiophobia, but women scored higher on stress reactions and pain intensity. PCA showed that questions about physical disability and functional self-efficacy comprised the first component and explained most of the variance in this patient group. Questions about stress and social support at work constituted the second component. Questions about domestic workload and pain comprised the third component. Gender differences were found in the second and third components. Conclusion: In general, women and men answered questions similarly, but there were differences: more women reported stress, pain and low support at work and more men reported a lower domestic workload.
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| 9. |
- Stenberg, Gunilla, 1968-, et al.
(författare)
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Similarities and differences : patterns of reported problems and ICF classification in women and men with back or neck pain seeking physiotherapy treatment
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Objective: The primary aim of this study was to examine similarities and differences in problem areas reported by women and men who seek physiotherapy treatment for back or neck pain. A second aim was to evaluate the appropriateness of ICF classification in relation to gender.Methods: Principal component analysis (PCA) and partial least squares of latent structures (PLS) were used to analyse questionnaire data including background data, questions about pain, domestic work, stress, EQ-5D, Neck Disability Index (NDI), Oswestry Disability Questionnaire (ODQ), psychosocial and physical workload, Tampa Scale and Functional Self-Efficacy Scale.Results: One hundred and eighteen patients (84 women and 34 men) completed the questionnaire. Men and women scored similarly on the NDI, ODQ, Functional Self Efficacy, and Tampa Scale, but women rated higher on stress reactions. PCA showed that questions from the NDI, ODQ and Functional Self-Efficacy Scale explained most of the variance in this patient group. Questions about stress and social support at work constituted the second component. Questions about domestic workload and pain comprised the third component. Gender differences were found in the two last components.Conclusion: Further investigation of the impact of gender on neck and back pain in different cultures is important.
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| 10. |
- Stenberg, Gunilla, 1968-, et al.
(författare)
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'I am afraid to make the damage worse' : fear of engaging in physical activity among patients with neck or back pain : a gender perspective
- 2014
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley-Blackwell. - 0283-9318 .- 1471-6712. ; 28:1, s. 146-154
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Tidskriftsartikel (refereegranskat)abstract
- Rationale: Neck and back pain are major public health problems in Western societies and cause considerable disability and health service use. Swedish women report more severe neck and back pain compared with Swedish men. Most studies on the aetiology of gender differences in pain deal with biological mechanisms, and less with the role of psychological and sociocultural factors. 'Pain beliefsis a sociocultural factor and can be expressed in different ways among women and men. It is important to know what pain beliefs are held by neck and back pain patients, especially when medical guidelines recommend that back pain patients stay physically active.Aim: Exploring pain beliefs in relation to physical activity among neck and back pain patients consulting primary health care.Method: Twelve patients (seven women, five men) consulting primary health care for an initial episode of neck or back pain were interviewed before their first appointment with a physiotherapist or general practitioner and 3 months later. The interviews covered patient experiences of neck or back pain, consequences, strategies and treatment experiences. The interviews were analysed with qualitative content analysis from a gender perspective.Result: One theme 'Fear of hurting the fragile body' was expressed by all neck or back pain patients. Five categories were identified 'The mechanical body', 'Messages about activity', 'Earlier experiences of pain and activity', 'To be a good citizen' and 'Support to be active' supported or undermined beliefs about pain and physical activity. Gender expressions occurred in the categories 'Messages about activity', 'To be a good citizen' and 'Support to be active'.Conclusions: Neck or back pain patients in the study saw the body as fragile and were afraid of hurting it. Notions of gender had an impact on the given advice about activity and on how patients perceived the message about staying active.
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