| 1. |
- Agnew, Louise, et al.
(författare)
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Factors associated with work ability in patients with chronic whiplash-associated disorder grade II-III : a cross-sectional analysis
- 2015
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Ingår i: Journal of Rehabilitation Medicine. - : FOUNDATION REHABILITATION INFORMATION. - 1650-1977 .- 1651-2081. ; 47:6, s. 546-551
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the factors related to self-perceived work ability in patients with chronic whiplash-associated disorder grades II-III.Design: Cross-sectional analysis.Patients: A total of 166 working age patients with chronic whiplash-associated disorder.Methods: A comprehensive survey collected data on work ability (using the Work Ability Index); demographic, psychosocial, personal, work- and condition-related factors. Forward, stepwise regression modelling was used to assess the factors related to work ability.Results: The proportion of patients in each work ability category were as follows: poor (12.7%); moderate (39.8%); good (38.5%); excellent (9%). Seven factors explained 65% (adjusted R-2 = 0.65, p < 0.01) of the variance in work ability. In descending order of strength of association, these factors are: greater neck disability due to pain; reduced self-rated health status and health-related quality of life; increased frequency of concentration problems; poor workplace satisfaction; lower self-efficacy for performing daily tasks; and greater work-related stress.Conclusion: Condition-specific and psychosocial factors are associated with self-perceived work ability of individuals with chronic whiplash-associated disorder.
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| 2. |
- Boersma, Katja, 1973-, et al.
(författare)
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Lowering fear-avoidance and enhancing function through exposure in vivo : a multiple baseline study across six patients with back pain
- 2004
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Ingår i: Pain. - : Elsevier. - 0304-3959 .- 1872-6623. ; 108:1-2, s. 8-16
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Tidskriftsartikel (refereegranskat)abstract
- This study investigated the effects of an exposure in vivo treatment for chronic pain patients with high levels of fear and avoidance. The fear-avoidance model offers an enticing explanation of why some back pain patients develop persistent disability, stressing the role of catastrophic interpretations; largely fueled by beliefs and expectations that activity will cause injury and will worsen the pain problem. Recently, an exposure in vivo treatment was developed that aims to enhance function by directly addressing these fears and expectations. The purpose of this study was to describe the short-term, consequent effect of an exposure in vivo treatment. The study employed a multiple baseline design with six patients who were selected based on their high levels of fear and avoidance. The results demonstrated clear decreases in rated fear and avoidance beliefs while function increased substantially. These improvements were observed even though rated pain intensity actually decreased somewhat. Thus, the results replicate and extend the findings of previous studies to a new setting, with other therapists and a new research design. These results, together with the initial studies, provide a basis for pursuing and further developing the exposure technique and to test it in group designs with larger samples.
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| 3. |
- Elvén, Maria, 1973-, et al.
(författare)
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Assessing clinical reasoning in physical therapy : discriminative validity of the Reasoning 4 Change instrument
- 2022
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Ingår i: Physiotherapy. - : Elsevier BV. - 0031-9406 .- 1873-1465. ; 117, s. 8-15
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To evaluate discriminative validity of the Reasoning 4 Change (R4C) instrument by investigating differences in clinical reasoning skills between first semester, final semester physical therapy students and physical therapy experts.Design:Cross-sectional designSetting: University and physical therapy practiceParticipantsStudents from the first (n = 87) and final semester (n = 47) of an entry-level physical therapy program and experts in physical therapy with a behavioral medicine approach (n = 14).Methods: The students and experts answered the web-based R4C instrument on one occasion. The R4C instrument includes four domains designed to assess physical therapists’ clinical reasoning skills with a focus on supporting clients’ behavior change and has demonstrated acceptable content validity, convergent validity and reliability. Data was analyzed with one-way analysis of variance and Games-Howell post hoc test.Results: Differences in all domains and subscale scores were found between the three groups. Pairwise comparisons demonstrated that experts scored higher (better clinical reasoning skills) than first semester students in all domains and subscales; and higher scores than final semester students, except for two subscales. Final semester students scored higher than first semester students, except for one subscale.Conclusions: The findings highlight differences in clinical reasoning skills focusing on clients’ behavior change among physical therapy students with different degrees of training and education in clinical reasoning and physical therapists with extensive experience and expertise. The results provide evidence for the discriminative validity of the R4C instrument which support the use of the R4C instrument in education, research and clinical practice.
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| 4. |
- Linton, Steven J., et al.
(författare)
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A randomized controlled trial of exposure in vivo for patients with spinal pain reporting fear of work-related activities
- 2008
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Ingår i: European Journal of Pain. - : Elsevier. - 1090-3801 .- 1532-2149. ; 12:6, s. 722-730
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Pain-related fear is related to disability in persistent pain conditions. Exposure treatment has been reported to be of great benefit in replicated single case experiments.AIM: To evaluate the effects of exposure in vivo on fear and function in patients with persistent pain and work disability.METHOD: We recruited 46 patients suffering from long-term back pain and reduced function, who also were deemed fearful according to standardized measures. Participants were randomized into either an exposure plus usual treatment or waiting list control plus usual treatment group. After the waiting period the control group crossed over and received the exposure treatment.RESULTS: Between group comparisons showed a significantly better result for the exposure group on function, but not for fear or pain and effect sizes were modest (function=.6; fear=.4; pain=.1). When the control group crossed over to treatment significant treatment effects were noted for fear and function. For all patients treated, the pre to post-treatment effect sizes were large (function=.7; fear=1.1; pain=.9). There were 12 dropouts (8 in exposure and 4 in the control) during the first treatment phase and an additional 4 when the control group crossed over to exposure.CONCLUSIONS: Compared to a group receiving usual treatment and waiting for exposure, the exposure in vivo group demonstrated a significantly larger improvement on function. Overall exposure had moderate effects on function, fear and pain intensity. We conclude that exposure may be important in treatment, but is not recommended as a "stand alone" adjunct to usual treatment.
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| 5. |
- Overmeer, Thomas, 1960-, et al.
(författare)
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Do evidence-based guidelines have an impact in primary care? : A cross-sectional study of Swedish physicians and physiotherapists
- 2005
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Ingår i: Spine. - : Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 30:1, s. 146-151
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. A cross-sectional study of physicians and physiotherapists in primary care. Objectives. To survey how familiar clinicians were with evidence-based guidelines for back pain and their opinion about their clinical usefulness and to compare self-reported practice behavior with the guidelines. Summary of Background Data. Guidelines, based on empirical evidence, are meant to ensure that patients get the most effective treatment. These evidence-based guidelines should steer clinical praxis, but clinicians may not read, let alone heed, them. Methods. Using a questionnaire, the authors surveyed all physicians and physiotherapists in primary health care in Örebro County, Sweden (N = 235). Results. Forty-two percent of the physicians and 37% of the physiotherapists were unfamiliar with the content of the guidelines, and 40% of the physicians and 25% of the physiotherapists were unfamiliar with the concept of 'red flags.' Less than half of the clinicians, 47%, were familiar both with the content of the guidelines and the concept of red flags. Their opinion about the guidelines showed that 54% of the physicians and 56% of the physiotherapists agreed that the guidelines were useful in clinical praxis. Concerning the self-reported practice behavior, the majority indicated that they followed the key points in the guidelines. Conclusions. A relatively large proportion of clinicians were unfamiliar with the content of evidence-based guidelines and/or with the concept of red flags. The process of implementing research into clinical practice is in need of an overhaul, and the impact of guidelines on clinical practice may be questioned.
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| 6. |
- Overmeer, Thomas, et al.
(författare)
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Do physical therapists change their beliefs, attitudes,knowledge, skills and behaviour after a biopsychosocially orientated university course?
- 2009
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Ingår i: Journal of Evaluation In Clinical Practice. - Oxford : Blackwell. - 1356-1294 .- 1365-2753. ; 15:4, s. 724-732
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Tidskriftsartikel (refereegranskat)abstract
- Aim The aim of this study is to examine the effects of an 8-day university-based training course, aimed at identifying and addressing psychosocial prognostic factors during physiotherapy treatment, in shifting therapists towards a more biopsychosocial orientation as measured by changes in beliefs/attitudes, knowledge, skills and behaviour.MethodWe combined a randomized controlled trail with a pre-post design. Forty-two physiotherapists applied for a university-accredited training course designed to enhance knowledge and management of psychosocial factors in their practice with patients suffering from musculoskeletal pain. The course participants were randomized either to receiving the course or to a waiting list for training. Attitudes and beliefs towards, and knowledge of psychosocial factors, patient vignettes and a video of an imaginary patient were tested before and after training. The patients of the course participants were asked to fill out a questionnaire with background questions at treatment start. The patients also received a questionnaire about the physical therapists' behaviour and patient satisfaction 6 weeks after treatment start.ResultsThe results show that physical therapists' attitudes and believes became more biopsychosocially and less biomedically orientated, they were less convinced that pain justifies disability and limitation of activities, and their knowledge and skills on psychosocial risk factors increased after a university-accredited training course. Yet despite these changes their patients perceived their practice behaviour before and after the course as similar and were equally satisfied with their treatment and treatment result.ConclusionA course, which enhanced biopsychosocial attitudes and beliefs, as well as increased such knowledge and skills did not change the way patients perceived their physical therapists. A future question is whether it improves patient outcome.
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| 7. |
- Overmeer, Thomas, 1960-, et al.
(författare)
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Do physical therapists recognise established risk factors? : Swedish physical therapists' evaluation in comparison to guidelines
- 2004
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Ingår i: Physiotherapy. - Amsterdam : Elsevier. - 0031-9406 .- 1873-1465. ; 90:1, s. 35-41
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose The Swedish Council on Technology Assessment in Health Care has widely distributed the most recent Swedish evidence-based review on neck and back pain. In this review psychosocial factors were acknowledged as important risk factors for developing chronic pain. We surveyed physical therapists’ evaluation of risk factors for the development of chronic pain. The results were compared to the review of the Swedish Council on Technology Assessment in Health Care.Methods A postal questionnaire was sent to all 117 physical therapists working in primary care in Örebro County, Sweden.Results The survey was responded to by 102 physical therapists (87%). Over 50% of them indicated as important more than twice as many risk factors than are supported by the evidence-based review.More than 50% of the physical therapists pointed out all eight evidence-based factors described in the evidence-based review but they also indicated a median of 10 additional factors with little or no support in the literature. More than 80% of the physical therapists responded according to the recommendations of the evidence-based review concerning sick leave and instructions to patients regarding activities and pain relief. Forty-four physical therapists (43%) indicated that they could predict which patients would develop chronic pain in the future.Conclusions Physical therapists represented by this sample were well aware of the importance of psychosocial risk factors, but because of the large number of additional factors indicated it seems physical therapists lack specificity about which factors are important.
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