| 1. |
- Calner, Tommy, et al.
(författare)
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Effects of a self-guided, web-based activity programme for patients with persistent musculoskeletal pain in primary healthcare : A randomized controlled trial
- 2017
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Ingår i: European Journal of Pain. - : John Wiley & Sons. - 1090-3801 .- 1532-2149. ; 21:6, s. 1110-1120
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUNDWeb-based interventions for pain management are increasingly used with possible benefits, but never used in addition to multimodal rehabilitation (MMR). MMR is recommended treatment for persistent pain in Sweden. The aim was to evaluate the effects of a self-guided, web-based programme added to MMR for work ability, pain, disability and health-related quality of life.METHODSWe included 99 participants with persistent musculoskeletal pain in a randomized study with two intervention arms: (1) MMR and web-based intervention, and (2) MMR. Data was collected at baseline, 4 and 12 months. Outcome measures were work ability, working percentage, average pain intensity, pain-related disability, and health-related quality of life.RESULTSThere were no significant effects of adding the web-based intervention to MMR regarding any of the outcome variables.CONCLUSIONSThis trial provides no support for adding a self-guided, web-based activity programme to MMR for patients with persistent musculoskeletal pain.SIGNIFICANCEThe comprehensive self-guided, web-based programme for activity, Web-BCPA, added to multimodal treatment in primary health care had no effect on work ability, pain, disability or health-related quality of life. Future web-based interventions should be tailored to patients' individual needs and expectations
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| 2. |
- Calner, Tommy, et al.
(författare)
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Physiotherapy in combination with personalized counseling and a web-based programme for persistent pain : an early stage evaluation
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- ObjectiveWe evaluated first a self-managed web-based programme for activity compared to waiting list for persons with persistent musculoskeletal pain suited for primary health care. Thereafter, we evaluated the effects and process of a novel multimodal treatment intervention combining the web programme with counselling and physiotherapy. DesignA weekly comparison of measures of outcome data between those using the self-managed web-based programme to those on a waiting list. After that a Single Subject Experimental Design (SSED) evaluation of the multimodal intervention, structured interviews and log data. SettingClinical setting in primary health care. SubjectsTen participants with persistent musculoskeletal pain. InterventionFirst, only a self-managed web-based programme for activity. Thereafter a multimodal intervention combining the web programme with counselling and physiotherapy. Main measuresEffect measures were work ability, pain intensity, disability and self-efficacy. Process evaluation by interviews of the participants and log data of usage of the modalities. ResultsThere were no conclusive effects of the self-managed web-based programme as compared to waiting list. The SSED analyses of the multi-modal showed promising short-term results regarding disability and pain intensity, but no conclusive results for work ability or self-efficacy. The multimodal intervention process seemed successfully implemented, and the importance of physiotherapy and to some extent counselling was emphasized by the participants. Conclusion For persons with persistent musculoskeletal pain, the newly designed multimodal intervention in primary care seemed feasible and showed some promising short-terms effects, while the implementation of a self-managed web-based programme as a single intervention seemed without effect.
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| 3. |
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| 4. |
- Nordin, Catharina, et al.
(författare)
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Being in an exchange process : experiences of patient participation in multimodal pain rehabilitation
- 2013
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 45:6, s. 580-586
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore primary healthcare patients' experiences of patients participation in multimodal pain rehabilitation.Patients and methods: A total of 17 patients who had completed multimodal rehabilitation for persistent pain were interviewed. The interviews were analysed using qualitative content analysis.Results: One theme, Being in an exchange process, and 4 categories emerged. The theme depicted patient participation as a continuous exchange of emotions, thoughts and knowledge. The category Fruitful encounters represented the basic prerequisites for patient participation through dialogue and platforms to meet. Patients' emotional and cognitive resources and restrictions, as well as knowledge gaps, were conditions influencing patient participation in the category Inequality in co-operation. Mutual trust and respect were crucial conditions in patient's personal relationships with the health professionals, forming the category Confidence-inspiring alliance. In the category Competent health professionals, the health professionals' expertise, empathy and personal qualities, were emphasized to favour patient participation.Conclusion: Patient participation can be understood as complex and individualized. A confidence-inspiring alliance enables a trusting relationship to be formed between patients and health professionals. Patients emphasized that health professionals need to play an active role in building common ground in the interaction. Understanding each patient's needs in the participation process may favour patient participation.
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| 5. |
- Nordin, Catharina, et al.
(författare)
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Effects of the Web Behavior Change Program for Activity and Multimodal Pain Rehabilitation : Randomized Controlled Trial
- 2016
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 18:10, s. 24-41
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Web-based interventions with a focus on behavior change have been used for pain management, but studies of Web-based interventions integrated in clinical practice are lacking. To emphasize the development of cognitive skills and behavior, and to increase activity and self-care in rehabilitation, the Web Behavior Change Program for Activity (Web-BCPA) was developed and added to multimodal pain rehabilitation (MMR).OBJECTIVE:The objective of our study was to evaluate the effects of MMR in combination with the Web-BCPA compared with MMR among persons with persistent musculoskeletal pain in primary health care on pain intensity, self-efficacy, and copying, as part of a larger collection of data. Web-BCPA adherence and feasibility, as well as treatment satisfaction, were also investigated.METHODS:A total of 109 participants, mean age 43 (SD 11) years, with persistent pain in the back, neck, shoulder, and/or generalized pain were recruited to a randomized controlled trial with two intervention arms: (1) MMR+WEB (n=60) and (2) MMR (n=49). Participants in the MMR+WEB group self-guided through the eight modules of the Web-BCPA: pain, activity, behavior, stress and thoughts, sleep and negative thoughts, communication and self-esteem, solutions, and maintenance and progress. Data were collected with a questionnaire at baseline and at 4 and 12 months. Outcome measures were pain intensity (Visual Analog Scale), self-efficacy to control pain and to control other symptoms (Arthritis Self-Efficacy Scale), general self-efficacy (General Self-Efficacy Scale), and coping (two-item Coping Strategies Questionnaire; CSQ). Web-BCPA adherence was measured as minutes spent in the program. Satisfaction and Web-BCPA feasibility were assessed by a set of items.RESULTS:Of 109 participants, 99 received the allocated intervention (MMR+WEB: n=55; MMR: n=44); 88 of 99 (82%) completed the baseline and follow-up questionnaires. Intention-to-treat analyses were performed with a sample size of 99. The MMR+WEB intervention was effective over time (time*group) compared to MMR for the two-item CSQ catastrophizing subscale (P=.003), with an effect size of 0.61 (Cohen d) at 12 months. There were no significant between-group differences over time (time*group) regarding pain intensity, self-efficacy (pain, other symptoms, and general), or regarding six subscales of the two-item CSQ. Improvements over time (time) for the whole study group were found regarding mean (P<.001) and maximum (P=.002) pain intensity. The mean time spent in the Web-based program was 304 minutes (range 0-1142). Participants rated the items of Web-BCPA feasibility between 68/100 and 90/100. Participants in the MMR+WEB group were more satisfied with their MMR at 4 months (P<.001) and at 12 months (P=.003).CONCLUSIONS:Adding a self-guided Web-based intervention with a focus on behavioral change for activity to MMR can reduce catastrophizing and increase satisfaction with MMR. Patients in MMR may need more supportive coaching to increase adherence in the Web-BCPA to find it valuable.
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| 6. |
- Nordin, Catharina, et al.
(författare)
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In search of recognition - Patients' experiences of patient participation prior to multimodal pain rehabilitation
- 2014
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Ingår i: European Journal of Physiotherapy. - : Taylor & Francis Group. - 2167-9169 .- 2167-9177. ; 16:1, s. 49-57
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to explore primary healthcare patients' experiences of patient participation prior to multimodal pain rehabilitation. Data was collected from interviews with 17 patients, aged 23-59 years, after completing multimodal rehabilitation. Data was analysed using qualitative content analysis. The theme, In search of recognition, depicted patient participation prior to the multimodal pain rehabilitation as a lack of recognition in the healthcare system. A demand for medical help and the healthcare professionals' preferential right to interpret the patients' condition formed the category Need for medical affirmation. In the category Emotional and cognitive alienation, patients emphasized distress when being unconfirmed. This entailed an emotional and cognitive distance between the patients and the healthcare professionals. Situational factors, together with patients' emotional and cognitive prerequisites and patients' strategies to be included in dialogue represented the category Need to communicate, which influenced the opportunities to participate. For healthcare professionals, it is important to understand that patients in multimodal pain rehabilitation may have experiences of a clinician-centred behaviour in the past. Patients may have been unconfirmed and their point of view disregarded. For the future, greater effort for dialogue and patients' involvement in decision-making and rehabilitation planning is needed. © 2014 Informa Healthcare.
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| 7. |
- Nordin, Catharina, et al.
(författare)
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It's about me : patients’ Experiences of Patient Participation in the Web Behavior Change Program for Activity in Combination With Multimodal Pain Rehabilitation
- 2017
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications. - 1438-8871. ; 19:1, s. 62-72
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPatients’ participation in their health care is recognized as a key component in high-quality health care. Persons with persistent pain are recommended treatments with a cognitive approach from a biopsychosocial explanation of pain, in which a patient’s active participation in their rehabilitation is in focus. Web-based interventions for pain management have the potential to increase patient participation by enabling persons to play a more active role in rehabilitation. However, little is known about patients’ experiences of patient participation in Web-based interventions in clinical practice.ObjectiveThe objective of our study was to explore patients’ experiences of patient participation in a Web Behavior Change Program for Activity (Web-BCPA) in combination with multimodal rehabilitation (MMR) among patients with persistent pain in primary health care.MethodsQualitative interviews were conducted with 15 women and 4 men, with a mean age of 45 years. Data were analyzed with qualitative content analysis.ResultsOne theme, “It’s about me,” and 4 categories, “Take part in a flexible framework of own priority,” “Acquire knowledge and insights,” “Ways toward change,” and “Personal and environmental conditions influencing participation,” were developed. Patient participation was depicted as being confirmed in an individualized and structured rehabilitation framework of one’s own choice. Being confirmed was fundamental to patient participation in the interaction with the Web-BCPA and with the health care professionals in MMR. To acquire knowledge and insights about pain and their life situation, through self-reflection in the solitary work in the Web-BCPA and through feedback from the health care professionals in MMR, was experienced as patient participation by the participants. Patient participation was described as structured ways to reach their goals of behavior change, which included analyzing resources and restrictions, problem solving, and evaluation. The individual’s emotional and cognitive resources and restrictions, as well as health care professionals and significant others’ attitudes and behavior influenced patient participation in the rehabilitation. To some extent there were experiences of restrained patient participation through the great content of the Web-BCPA.ConclusionsPatient participation was satisfactory in the Web-BCPA in combination with MMR. The combined treatment was experienced to increase patient participation in the rehabilitation. Being confirmed through self-identification and finding the content of the Web-BCPA trustworthy was emphasized. Patient participation was experienced as a learning process leading to new knowledge and insights. Higher user control regarding the timing of the Web-BCPA and therapist guidance of the content may further increase patient participation in the combined treatment.
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