| 1. |
- Axelsson, Sarianne Wiklund
(författare)
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Prerequisites for sustainable life style changes among older persons with obesity and for ICT support
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The experiences from persons in the third age of lifestyle changes due to obesity are rarely described in research. Interventions regarding lifestyle changes and obesity show weak evidence for long-term effects. Information and communication technology (ICT) may add an important potential in interventions, but readiness among older persons and the actual needs for support must be explored. Therefore the overall aim for the thesis was to explore the prerequisites for sustainable lifestyle changes among older persons with obesity; and how this could be supported by ICT.Both qualitative and quantitative approaches were used. In paper I, 10 participants were individually interviewed about their experiences of lifestyle changes and in a multistage focus group study (paper IV), 6 participants expressed the support needed for sustainable lifestyle changes in relation to obesity. Qualitative content analysis was used. In a randomly selected population survey, 154 participants responded to an enquiry about general and health related ICT usage (paper II). They also rated scenarios for expected psychosocial impact on web based e-health services and mobile health applications (paper III).An integration of the results identified four main findings: The first finding, A never-ending process of vigilance and vulnerability, showed constant attempts of weight loss and pre-occupation on not to fail in an un-supportive environment. The second finding; Need for psychosocial support marked that the process of lifestyle changes was influenced by factors as sensibility to moods, social support and others’ attitudes. It was therefore essential for the persons to achieve emotional balance. The third finding, ICT as a possible support for adaptability, presented that older Swedes expected a positive psychosocial impact by ICT, especially in a future perspective. ICT was most valued in the domain of adaptability. The degree of usage of health related ICT, however, was low, although persons with overweight had more experience of this usage. Finally, the fourth finding; Reconstructions from weight to health expresses the needs of reconstructing focus towards health, rather than being pre-occupied with weight loss. Physical activity that was associated to joy and to have a functioning body, a body that would serve them as before, were motives to lose weight.In conclusion, this thesis illustrates that a lifestyle change due to obesity in third age is lined with vigilance not to fail and requires a great deal of endurance and effort. The potential of ICT to support lifestyle changes is likely to be substantiated by the positive expectations on ICT from a psychosocial impact perspective, especially in views of the future. Findings indicate a need for moving focus from weight towards health and to see opportunities, and that psychosocial support and enjoyable physical activity are important prerequisites for sustainable change.
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| 2. |
- Holm, Sara
(författare)
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Children and Adolescents with Pain in Primary care : Biopsychosocial determinants and behavioral medicine treatment in a physical therapy framework
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Pain during childhood and adolescents is prevalent and longstanding pain can have severe consequences for children, their families and in the long run for the society. Persisting pain influences many aspects of life and pain-related disability is often associated with impairment, decreased health-related quality of life, school functioning, participation in social life, emotional well-being, and with increased healthcare utilization. The overall aim was to explore, with cross-sectional design, pain conditions, to identify biopsychosocial determinants and their association with pain-related disability, and to study the feasibility of applying a behavioral medicine treatment for adolescents experiencing musculoskeletal pain using randomized controlled design and multimethod approach. Samples of children and adolescents and their parents seeking primary care physical therapy for a pain condition, and a sample of treating physical therapists were included.The results showed that some children had profiles of biopsychosocial determinants that could increase the risk for long-term pain-related disability. Many had long pain duration and multiple pain locations. Girls reported higher levels of catastrophizing compared to boys, who in turn used more behavioral distraction generally regarded as a positive coping strategy.Behavioral medicine treatment, based on a biopsychosocial approach, targeting adolescents with pain was shown to be feasible for use in primary care, with promising outcomes. Tailoring of the treatment was suboptimal but the effect of behavioral medicine treatment in pain-related disability exceeded the effect of the control treatment. The satisfaction with treatment content and results were high for both the control- and experimental condition, significantly higher for the experimental condition as rated by participants. Learning and delivering the behavioral medicine intervention was perceived challenging but rewarding by the treating physical therapists. The biopsychosocial approach in tailoring the treatment, and dialogs with parents were identified as key aspects in the behavioral medicine treatment program.In conclusion, in children seeking primary care for pain, the factors associated with pain-related disability were complex and interrelated. The findings highlight the importance for primary care health care providers to apply a biopsychosocial approach in assessment and treatment, for improvement of activities and participation, and thereby helping children and adolescents regain health.
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| 3. |
- 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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| 4. |
- Wahlström Edling, Cecilia, 1959-
(författare)
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Besvär i rörelseorganen hos musiklärare och deras syn på musikelevers hälsa : visioner och verklighet på kollisionskurs
- 2017
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the licentiate thesis was to reach a better understanding of music teachers' health, with focus on musculoskeletal disorders, and music teachers' view on young music students' health, from a gender perspective.A cross-sectional study was directed to music teachers employed at a municipality music- and culture school, in order to investigate the relationship between physical workload and work-related disorders among music teachers. Out of 61 music teachers 47 agreed to participate. The study group was divided into two groups depending on if they had an asymmetric or symmetric upper extremity and back playing posture. Musculoskeletal disorders were frequent among the music teachers. Women music teachers reported significantly more musculoskeletal disorders than their male collegues and music teachers with asymmetric work posture had significantly higher amount of musculoskeletal disorders than those who had a symmetric playing posture.A qualitative interview study with semi-structured interviews with 18 music teachers were conducted to explore music teachers' experiences of health and gender among young music students. An interview guide was used, with topic areas concerning experiences and perceptions of positive health aspects and health problems among young music students, taking part in music education. The interviews were analysed with qualitative content analysis according to Graneheim and Lundman. The analysis resulted in an overarching theme "Visions and reality in contradiction" and three categories: "Music making to feel good", "Pressure on girls, acceptance for boys" and "Blame on the individual".Music teachers at music- and culture schools seem to be at high risk of developing musculoskeletal disorders, especially music teachers playing an instrument that requires an asymmetric playing position. Young musicians' teachers need a better knowledge in the field of prevention of music students' health problems and physiotherapists and ergonomists may assist and collaborate in this. A gender perspective in music medicine research may contribute to a better understanding of musicians' health.
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| 5. |
- Andersdotter Sandström, Anna, et al.
(författare)
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Patients with stress-induced exhaustion disorder and their experiences of physical activity prescription in a group context
- 2023
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Ingår i: Global Health Action. - : Taylor & Francis. - 1654-9716 .- 1654-9880. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Physical activity is a useful means to improve symptoms and memory performance to some extent in individuals with stress-induced exhaustion disorder. Individuals in this group commonly do not need to reach the recommended levels of physical activity. Developing methods to support physical activity as a lasting behaviour is important.Objective: The aim of the study was to explore the processes involved when using physical activity prescription as part of rehabilitation in a group context for individuals with stress-induced exhaustion disorder.Method: A total of 27 individuals with stress-induced exhaustion disorder participated in six focus groups. The informants underwent a multimodal intervention including prescription of physical activity. The physical activity prescription had a cognitive behaviour approach and included information about physical activity, home assignments and goal setting. The data was analysed with grounded theory method using constant comparison.Results: The analysis of the data was developed into the core category ‘trying to integrate physical activity into daily life in a sustainable way’, and three categories: ‘acceptance of being good enough’, ‘learning physical activity by doing’ and ‘advocation for physical activity in rehabilitation’. The informants identified that during the physical activity prescription sessions they learned what physical activity was, what was ‘good enough’ in terms of dose and intensity of physical activity, and how to listen to the body’s signals. These insights, in combination with performing physical activity during home assignments and reflecting with peers, helped them incorporate physical activity in a new and sustainable way. A need for more customised physical activity with the ability to adjust to individual circumstances was requested.Conclusion: Prescription of physical activity in a group context may be a useful method of managing and adjusting physical activity in a sustainable way for individuals with stress-induced exhaustion disorder. However, identifying people who need more tailored support is important.
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| 6. |
- Lundberg, Veronica, 1966-
(författare)
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Children with juvenile idiopathic arthritis : health-related quality of life and participation in healthcare encounters
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Growing up with Juvenile Idiopathic Arthritis (JIA) can be associated with functional limitations, feelings of being different, and an impaired health-related quality of life (HRQOL). Children’s and parents’ reports of child HRQOL may differ. Children report difficulties in communicating their problems to healthcare professionals and in participating at healthcare encounters. The overall aim of the thesis was to explore similarities and differences in how girls and boys with JIA and their parents reported child HRQOL, and to explore how children can be enabled to communicate their health concerns and participate at healthcare encounters.Methods: Fifty-three children diagnosed with JIA (38 girls and 15 boys), with a median age of 14 years, and their parents, responded to three HRQOL questionnaires and a screening instrument for mental health. Twenty-three healthcare professionals from different professions in JIA teams participated in focus groups. Four children and two young adults diagnosed with JIA and four parents of children with JIA participated in 10 separate workshops. The focus groups and workshops were analysed using qualitative content analysis.Results: No gender differences were found between girls’ and boys’ self-reported HRQOL and mental health, measured with the questionnaires. Girls reported their HRQOL and mental health better than their parents reported their child’s health in several sub-domains. Boys tended to report their HRQOL worse than their parents reported their child’s health. Children and parents reported the same child HRQOL with the disease specific HRQOL questionnaire.The theme “Creating an enabling arena” illustrates how healthcare professionals face possibilities and challenges when enabling children to communicate and participate in healthcare encounters. Healthcare professionals, parents, and the healthcare system must adjust to the child. Children and their parents cooperated and complemented each other during healthcare encounters. Healthcare professionals addressed the child’s self-identified needs and made the child feel comfortable during encounters. Healthcare professionals’ working methods aided child participation at healthcare encounters, but the healthcare organisation could be a hinder.The theme “Feeling alienated or familiar with healthcare encounters” illustrates how the children needed extra support from healthcare professionals and their parents to be able to participate. Children felt reluctant to engage in healthcare encounters and experienced difficulty expressing how they really felt. Therefore, children must feel safe, understood, and respected by healthcare professionals and receive the help they need. Over time, children felt more comfortable at healthcare encounters once they knew what would happen and once they were assured that healthcare professionals would give them the support they needed to participate.Conclusions: Child and parent differences in the assessment of HRQOL may depend on the questionnaire used. Differences between child and parent reports of child HRQOL must be taken into account at healthcare encounters.Healthcare professionals adjust their interaction and communication with the child depending on the child’s maturity, and talk about the child’s experiences and challenges in everyday life. Collaboration between children and parents before a healthcare encounter and between children, parents, and healthcare professionals during an encounter help children express their wishes and experiences. Healthcare professionals enable child participation by creating a good relationship with the child and their parents, and by strengthening the confidence and autonomy of the child.Children’s active participation in healthcare encounters varies depending on if they feel alienated or familiar with the encounter. Children distance themselves and resist healthcare encounters if they find them emotionally distressing and feel disregarded and labelled. Over time, children can become more familiar and at ease with healthcare situations once they feel safe and experience personal and positive encounters. When children are prepared for the encounter, provided with the space and support they want, and receive tailored help, they are more enabled and empowered to participate.
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| 7. |
- Svanholm, Frida, 1979-
(författare)
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Work Interventions in the Context of Interdisciplinary Pain Rehabilitation
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Chronic pain often leads to difficulties performing daily life and work activities. Sick-leave rates are high and work activities are valued both by people in general and patients with chronic pain. Therefore, it is important to find efficient ways to support patients to stay at work and return to work. Interdisciplinary pain rehabilitation programs (IPRP) aim to improve work participation for patients with chronic pain. However, results are diverging and it is unclear to what extent work interventions are part of IPRP. The overall aim with this thesis was to study work interventions in the context of interdisciplinary pain rehabilitation and identify how it can be improved to better support patients with chronic pain in their return to work (RTW) rehabilitation process. Participants were included from IPRPs at both primary and specialist care level in Sweden. Data were collected from focus groups, pair- and individual interviews, questionnaires, and the Swedish Quality Registry for Pain Rehabilitation. This thesis highlight four important factors to consider when planning and performing work interventions in the context of IPRP: Knowledge and understanding of patients and stakeholders, A RTW rehabilitation plan being anchored between stakeholders Tailored solutions in relation to patient’s needs Collaboration, coordination, and continuity during the RTW rehabilitation process. Knowledge and understanding are important as base for solid, concrete, and tailored RTW plans, and for increasing self-efficacy and empowerment of the patients. The RTW plan is a common and important work intervention within IPRP in Sweden. RTW plans need to be more concrete, and include tailored strategies and interventions aimed at the needs of patients. Tailoring interventions also need to consider employment status. In addition, RTW rehabilitation plans should be tightly anchored with stakeholders and followed-up continually during the RTW rehabilitation process. The context of IPRP has potential that should be taken care of, for example when improving knowledge transfer and collaboration. SWEPPE, a new e-health intervention designed to support patients with chronic pain and their employers includes the four factors described above and should be acceptable for users after they complete an IPRP, however, further development of content and identification of patients that best benefit from SWEPPE are needed.
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