| 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. |
- Ekdahl, Natascha, et al.
(författare)
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Investigating cognitive reserve, symptom resolution and brain connectivity in mild traumatic brain injury
- 2023
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Ingår i: BMC Neurology. - : BioMed Central (BMC). - 1471-2377. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundA proportion of patients with mild traumatic brain injury (mTBI) suffer long-term consequences, and the reasons behind this are still poorly understood. One factor that may affect outcomes is cognitive reserve, which is the brain's ability to maintain cognitive function despite injury. It is often assessed through educational level or premorbid IQ tests. This study aimed to explore whether there were differences in post-concussion symptoms and symptom resolution between patients with mTBI and minor orthopedic injuries one week and three months after injury. Additional aims were to explore the relationship between cognitive reserve and outcome, as well as functional connectivity according to resting state functional magnetic resonance imaging (rs-fMRI).MethodFifteen patients with mTBI and 15 controls with minor orthopedic injuries were recruited from the emergency department. Assessments, including Rivermead Post-Concussion Questionnaire (RPQ), neuropsychological testing, and rs-fMRI scans, were conducted on average 7 days (SD = 2) and 122 days (SD = 51) after injury.ResultsAt the first time point, significantly higher rates of post-concussion symptoms (U = 40.0, p = 0.003), state fatigue (U = 56.5, p = 0.014), and fatigability (U = 58.5, p = 0.025) were observed among the mTBI group than among the controls. However, after three months, only the difference in post-concussion symptoms remained significant (U = 27.0, p = 0.003). Improvement in post-concussion symptoms was found to be significantly correlated with cognitive reserve, but only in the mTBI group (Spearman's rho = -0.579, p = .038). Differences in the trajectory of recovery were also observed for fatigability between the two groups (U = 36.5, p = 0.015). Moreover, functional connectivity differences in the frontoparietal network were observed between the groups, and for mTBI patients, functional connectivity differences in an executive control network were observed over time.ConclusionThe findings of this pilot study suggest that mTBI, compared to minor orthopedic trauma, is associated to both functional connectivity changes in the brain and concussion-related symptoms. While there is improvement in these symptoms over time, a small subgroup with lower cognitive reserve appears to experience more persistent and possibly worsening symptoms over time. This, however, needs to be validated in larger studies.Trial registrationNCT05593172. Retrospectively registered.
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| 4. |
- Enberg, Birgit, 1956-, et al.
(författare)
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Work experiences of novice occupational therapists and physiotherapists in public sector employment : analyses using two occupational stress models
- 2010
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Ingår i: Advances in Physiotherapy. - : Informa UK Limited. - 1403-8196 .- 1651-1948. ; 12:1, s. 42-49
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate how recently graduated occupational therapists and physiotherapists, employed by the Swedish county councils and municipalities, experience working in public sector healthcare organization. The study group, 262 occupational therapists and physiotherapists who graduated in 1999, is a sub-sample drawn from a national cross-sectional survey. Data were collected in their third year after graduation. The Swedish Demand-control Questionnaire and the Effort-reward Imbalance Questionnaire together with self-constructed questions were used to evaluate psychosocial factors at work. The results reveal that few were exposed to job strain or effort-reward imbalance (ERI). More were defined as having work-related overcommitment (WOC). Logistic regression analyses revealed a significant association between WOC and ERI, sex, degree of effort and degree of reward. One quarter was dissatisfied with their work and this dissatisfaction was significantly associated with ERI, reward (in the ERI questionnaire), control (in the Demand-control Questionnaire) and type of employer. In conclusion, combining the Demand-control model and the ERI model made it possible to describe and analyse varying aspects of the work of novice occupational therapists and physiotherapists in public sector healthcare.
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| 5. |
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| 6. |
- Lindberg, Malin, Professor, 1978-, et al.
(författare)
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Inclusive funding for enhanced impact of social sciences and humanities
- 2019
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Ingår i: fteval Journal for Research and Technology Policy Evaluation. - : Austrian Platform for Research and Technology Policy Evaluation (fteval). - 1726-6629. ; :48, s. 82-87
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Tidskriftsartikel (refereegranskat)abstract
- In order to expand the knowledge on how societal impact of social sciences and humanities (SSH) can be enhanced through public funding of research and innovation, a process of designing digitalised tools for inclusive funding is scrutinised, involving four Swedish funding agencies and an Non-Governmental Organisation (NGO) of SSH researchers. The agencies shared the challenge to attract a broader range of SSH researchers to apply for their funding. Excluding and including mechanisms were identified in the interactions, texts and images of the formulation, communication and processing of calls for funding. The developed tools digitally guide the user through queries regarding the present and potential diversity of SSH representation among applicants, reviewers, agencystaff, etc. and regarding the formulation and communication of call texts, assessmentcriteria and reviewer instructions. The tools thus enhance SSH impact by making funding more available, but fail to demonstrate how concrete interaction with societal actors may enhance this.
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| 7. |
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| 8. |
- Nord, Catharina, et al.
(författare)
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Explorations of urban residential quality : situations of dwelling, ageing and healthcaring. Inquiries of transdisciplinary nature
- 2015
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Konferensbidrag (refereegranskat)abstract
- Many assisted living facilities are located on the outskirts of urban areas. This might be due to lack of available land in central urban areas and the higher land costs associated with central areas of an urban structure. It might also be a result of a presumption that older people need a peaceful and quiet surrounding in old age, close to green areas, which would then be a better alternative than the city centre. However, research has shown that urban living is more health promoting than rural living to older people. This presentation aims to discuss pros and cons of the location of assisted living facilities in central or peripheral urban places. Different aspects will be highlighted with support of the three researchers’ studies of assisted living.
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| 9. |
- 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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| 10. |
- 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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| 11. |
- 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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| 12. |
- 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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| 13. |
- Nordin, Catharina
(författare)
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Patient participation in and treatment effects of multimodal rehabilitation and the web Behaviour Change Program for Activity
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim was to explore experiences of patient participation in pain rehabilitation among patients with persistent musculoskeletal pain, and investigate effects of multimodal rehabilitation (MMR) and a self-guided web-based intervention. Qualitative interviews were conducted with women and men (between 23 to 60 years) with persistent musculoskeletal pain. Their experiences of patient participation prior to MMR, within MMR, and withinMMR in combination with the web Behaviour Change Program for Activity (web-BCPA) were analysed with qualitative content analysis (study I – III). A randomized controlled trial with two intervention arms: 1) MMR in combination with the web-BCPA (MMR+WEB), and 2) MMR, was performed in the primary healthcare to investigate treatment effects of pain intensity (Visual Analogue Scale), self-efficacy to control pain and other symptoms (ArthritisSelf-Efficacy Scale), general self-efficacy (General Self-Efficacy Scale), coping (Two-item Coping Strategies Questionnaire), and patient participation. Adherence, feasibility and satisfaction with treatment were also evaluated. The patients were 85 women and 14 men (mean age 43 years) with persistent musculoskeletal pain for 6.5 years (m) (study IV). The findings showed that patient participation can be understood as complex and individualized (I – III). Patients’ emotional and cognitive resources and restrictions, as well ashealthcare professionals’ attitudes and behaviours were important to patient participation (I, II, III). Experiences of patient participation prior to MMR indicated a search for recognition and an alienation from the healthcare system (I). Patients experienced satisfying patient participation within MMR (II) and within MMR in combination with the web-BCPA (III). Patient participation was to take part in a structured and flexible rehabilitation frameworkcharacterized by co-operation with healthcare professionals (II, III), and solitary work in the web-BCPA (III). Being confirmed in the interaction with healthcare professionals in MMR (II, III), and in interaction with the web-BCPA (III) was fundamental to patient participation. Being confirmed included to be recognized as a patient and as a person (II, III), as well as to perceive trustworthiness and to be able to identify one-self in the rehabilitation (III).Situations of mistrust and disrespect in contacts with the healthcare professionals were experienced as restrained patient participation (I, II, III). Patient participation included various experiences of knowledge and insights: the patients’ knowledge not being acknowledged (I), experiencing a lack of knowledge (II), and experiences of acquiring knowledge and insights (III). Behaviour change was included in patients’ experiences of patient participation (III). Further, the findings showed that MMR in combination with the web-BCPA decreased patients’ catastrophic thinking about their pain (p = .003) over time, compared to MMR (IV). Also, patients in the MMR+WEB group were more satisfied with their multimodal rehabilitation, at 4 (p = .000) and 12 months (p = .003) (IV).There were no differences between the MMR+WEB group and the MMR group regarding the other six subscales of the Two-item Coping Strategies Questionnaire. Nor were there any differences between thegroups for pain intensity, self-efficacy, and patient participation. However, there were significant decrease of average pain (p = .000) over time in the whole study group (MMR+WEB and MMR) (IV). The web-BCPA adherence was 304 minutes (m), with range between 0 to 1142 minutes, and the patients opened in average 5.1 modules out of eight (IV). Patients rated feasibility and satisfaction with the web-BCPA acceptable to excellent (62 to 93/ 100). Due to the large variation of time spent in the web-BCPA a sub-group analysis oflower (LQ) and upper quartile (UQ) of time spent was performed. The study groups were small (fourteen patients in each group) but the results showed a trend that the UQ had higher scores regarding web-BCPA feasibility and satisfaction, and LQ had lower scores. In conclusion, patients’ emotions and cognitions were in focus in patient participation. Experiences of patient participation prior to MMR were understood as a search forrecognition in the healthcare system. In contrast, patients experienced satisfying patientparticipation and being confirmed within MMR and within MMR in combination with the web-BCPA. Patients in MMR in combination with the self-guided web-BCPA decreased their catastrophic thinking about pain. Also, they were more satisfied with their multimodal rehabilitation.
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| 14. |
- Nordin, Catharina
(författare)
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Patients’ experiences of patient participation prior to and within multimodal pain rehabilitation
- 2013
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patient participation is a concept used to describe the patients’ involvement in their healthcare. The aim of this licentiate thesis was to explore primary healthcare patients’ experiences of patient participation prior to and within multimodal pain rehabilitation. Qualitative interviews were conducted with seventeen patients, 14 women and 3 men, who had completed multimodal pain rehabilitation for persistent pain. Data was analyzed using qualitative content analysis.The findings show that patient participation can be understood as a complex and individualized interaction between the patient and the healthcare professionals. There were both positive and negative experiences of patient participation prior to, as well as within the multimodal rehabilitation. Experiences prior to the multimodal pain rehabilitation indicated a lack of patient participation including a search of recognition and an alienation from the healthcare system. Patients experienced satisfying patient participation within the multimodal rehabilitation, which was described as a continuous exchange of emotions and cognitions between the patients and the healthcare professionals. Patients’ emotions and cognitions were important in the patient – healthcare interaction and for patient participation. A confidence-inspiring alliance with the healthcare professionals, built on mutual trust and respect, was experienced as a basis for patient participation. The patients experienced unfulfilled medical needs, being unconfirmed, and having their point of view disregarded by healthcare professionals, to limit patient participation. Insufficient communication with the healthcare professionals was also perceived restricting patient participation. The patients emphasized that healthcare professionals needed to play an active role to include the patients in dialogue and to build common ground in the interaction. The healthcare professionals’ expertise, empathy and personal qualities were important for patient participation.In conclusion, patients with persistent pain had experiences of poor patient participation from encounters with healthcare professionals prior to multimodal pain rehabilitation. In contrast, these patients then experienced satisfying patient participation within the multimodal pain rehabilitation. Healthcare professionals need to play an active role in developing a relationship and finding common ground, through confirmation and dialogue, to increase patient participation in rehabilitation planning and decision-making.
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