| 1. |
- Chruzander, Charlotte, et al.
(författare)
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Longitudinal changes in sickness absence and disability pension, and associations between disability pension and disease-specific and contextual factors and functioning, in people with multiple sclerosis.
- 2016
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Ingår i: Journal of the Neurological Sciences. - : Elsevier BV. - 0022-510X .- 1878-5883. ; 367, s. 319-325
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Even though it is well known that disability due to MS is highly associated with employment status, the long-term longitudinal perspective on sickness absence and disability pension over the MS trajectory is lacking. In addition, further knowledge of risk factors for future disability pension is needed.OBJECTIVES: To explore long-term longitudinal changes in the prevalence of sickness absence and disability pension in people with MS (PwMS), as well as to explore associations between disease-specific factors, contextual factors and functioning, and the outcome of future full-time disability pension.METHODS: A prospective, population-based survival cohort study, with a nine year follow-up, including 114 PwMS was conducted by combining face-to-face collected data and register-based data.RESULTS: The prevalence of full-time disability pension increased from 20% to 50%, however 24% of the PwMS had no disability pension at all at end of follow-up. Sex, age, disease severity and impaired manual dexterity were associated with future full-time disability pension.CONCLUSIONS: The large increase in prevalence of PwMS on full-time disability pension during the MS trajectory, calls for the development and implementation of evidence-based interventions, aiming at keeping PwMS in the work force. Modifiable factors, such as manual dexterity should be targeted in such interventions.
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| 2. |
- Ytterberg, Charlotte, et al.
(författare)
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A qualitative study of cognitive behavioural therapy in multiple sclerosis : experiences of psychotherapists
- 2017
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2631. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To investigate how psychotherapists experience using individual, face-to-face cognitive behavioural therapy (CBT) aimed at alleviating depressive symptoms in persons with multiple sclerosis (MS).METHOD: Semi-structured interviews with three psychotherapists were conducted after CBT with 12 participants with MS, and analysed using qualitative content analysis.RESULTS: Two main themes emerged: Trusting their expertise as psychotherapists whilst lacking MS-specific knowledge, and The process of exploring the participants' readiness for CBT with modifications of content and delivery. The psychotherapists perceived it difficult to know whether a symptom was attributable to depression or to MS, and for some participants the CBT needed to be adapted to a more concrete content.CONCLUSIONS: Psychotherapists may need more MS-specific knowledge and an insight into the individual's functioning. The content of CBT in terms of concrete home assignments and behavioural activation needs to be individualised.
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| 3. |
- Chruzander, Charlotte
(författare)
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A 10-year follow-up of people with multiple sclerosis-aspects of disability and health, use of and satisfaction with care, and feasibility of cognitive behavioural therapy
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Multiple sclerosis (MS) is a neuroinflammatory and neurodegenerative disease in the central nervous system which affects a number of life areas of the afflicted individual. Detailed knowledge is required on functioning and health in people with MS (PwMS) from a broad and longitudinal perspective. There is also an urgent need to increase knowledge about effective methods for alleviating depressive symptoms in PwMS. Aims: The overall aim in this thesis was to explore the occurrence of disability, health related quality of life (HRQL), use of care and patient satisfaction with care, and to explore the importance of different variables to predict the occurrence of disability, HRQL and use of care in PwMS in a long-term longitudinal perspective. In addition, the aim was to evaluate the feasibility of face-to -face cognitive behavioural therapy (CBT) for alleviating depressive symptoms in PwMS. Material and Methods: Study I, II and III were based on a 10-year follow-up of a population-based sample of PwMS in Stockholm County (n=166). A total of 123 PwMS agreed to participate in the 10-year follow-up. Information on disease-specific variables, contextual factors, various aspects of disability, HRQL and patient satisfaction with care were collected by home visits at baseline and at the 10-year follow-up. Information regarding time and cause of death was collected from the National Board of Health and Welfare. Information regarding use of care was collected from the Stockholm County Council. Recruitment of patients to study IV (n=15) was conducted at the Department of Neurology, Karolinska University Hospital. Inclusion criteria were a definite and informed MS-diagnosis and sub-threshold to moderate depressive symptoms. The intervention included 15-20 individual sessions with a licensed psychotherapist. Main outcome was feasibility of methods and measurements used and depressive symptoms. Follow-ups were conducted three weeks and three months after completed intervention. Results: There was no change in occurrence of PwMS with cognitive impairment, depressive symptoms or restrictions in social/lifestyle activities from baseline to the 10-year follow-up. There was an increase in occurrence of PwMS with limitation in manual dexterity, walking ability and activities of daily living over time. Overall, HRQL was quite stable over time. The use of care over time was extensive, including primary care, hospital outpatient and inpatient care. Higher disease severity was an important variable in predicting disability. Low coping capacity, depressive symptoms and cognitive impairment were important variables in predicting HRQL. Low coping capacity, manual dexterity and progress in disease severity were important variables in predicting the use of care. Satisfaction with care was quite stable over time. Overall, the methods and measurements used in the pilot feasibility study of face- to-face CBT were found to be feasible. Conclusion: Awareness of the psychological aspects of the disease needs to increase among care professionals. There is a potential to decrease the impact of modifiable factors on HRQL in PwMS as well as meeting the need for environmental facilitators aiming at reducing disability. By establishing the PwMS as full partners to their care providers in care decisions and implement strategies to coordinate care between care providers there is a potential to increase efficacy/outcome of care. Face- to-face CBT is feasible for use in PwMS.
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