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- Bergström, Gunnar, Professor, et al.
(författare)
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Long-term, non-specific spinal pain: reliable and valid subgroups of patients
- 2001
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Ingår i: Behaviour Research and Therapy. - : Elsevier. - 0005-7967 .- 1873-622X. ; 39:1, s. 75-87
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to identify reliable and valid subgroups of spinal pain patients, using data from the Swedish version of the Multidimensional Pain Inventory (MPI-S). A second aim was to test the generalisability of the three patient profiles described in earlier studies on the MPI (”adaptive coper”, ”dysfunctional” and ”interpersonally distressed” patients). The study base consisted of two samples of individuals suffering from long-term, non-specific spinal pain and the results were validated across these samples. Cluster analysis was used to detect distinct groups of patients and the validity of these subgroups was evaluated on variables not used to generate the cluster solution. One subgroup was characterised by lower pain severity, lower interference with everyday activities, lower affective distress and higher life control than the other two subgroups. This patient profile was similar to the MPI adaptive coper patients. A second subgroup resembled the dysfunctional patient profile, thus displaying a worse adjustment to chronic pain than the AC patients. The third patient group reported significantly lower levels of social support from “significant others” than the other subgroups. This patient profile was similar to that of the interpersonally distressed patient group. Taken together, the results support the reliability, validity and generalisability of three subgroups of chronic pain patients derived from the MPI-S.
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| 3. |
- Bergström, Gunnar, Professor, et al.
(författare)
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The impact of psychologically different patient groups on outcome after a vocational rehabilitation program for long-term spinal pain patients
- 2001
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Ingår i: Pain. - : LWW. - 0304-3959 .- 1872-6623. ; 93:3, s. 229-237
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Tidskriftsartikel (refereegranskat)abstract
- A better knowledge of differential treatment outcomes for subgroups of chronic spinal pain patients may, for instance, help clinicians in treatment planning or pain researchers in treatment outcome research. The purpose of this prospective study was to evaluate the predictive validity of a subgroup classification based on the Swedish version of the (West Haven Yale) Multidimensional Pain Inventory, the MPI-S. Patients referred to a vocational rehabilitation program were classified into one of three groups, labeled ‘adaptive copers’, ‘dysfunctional’ patients, and ‘interpersonally distressed’ patients, and followed over an 18-month follow-up period. The outcome variables were absence from work (defined as sick listing plus early retirement), general health status, and utilization of health care resources. To our knowledge, the predictive validity of the MPI subgroups has not been evaluated regarding sick listing and early retirement after rehabilitation. As hypothesized, the results showed that the ‘dysfunctional’ patient group had significantly more registered absences from work and reported higher utilization of health care, over the follow-up period compared to the ‘adaptive copers’. Furthermore, as hypothesized, the ‘interpersonally distressed’ and ‘dysfunctional’ patient groups report a poorer general health status than the ‘adaptive copers’ over the whole follow-up period. However, contrary to our hypothesis, the proportion of improved patients did not differ significantly between the subgroups. Altogether, the predictive validity of the MPI-S subgroup classification was mainly confirmed. The clinical implications of this study suggest that the matching of treatment to patient needs may enhance treatment outcome, reduce pain and suffering among chronic spinal pain patients and facilitate a better health economic allocation of treatment resources.
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- Homeij, Eva, et al.
(författare)
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No significant differences between intervention programmes on neck, shoulder and low back pain: A prospective randomized study among home-care personnel
- 2001
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1651-2081 .- 1650-1977. ; 33:4, s. 170-176
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Tidskriftsartikel (refereegranskat)abstract
- The effects of two different prevention programmes on: (1) reported neck, shoulder and back pain, (2) perceived physical exertion at work and perceived work-related psychosocial factors, were evaluated by questionnaires after 12 and 18 months. Female nursing aides and assistant nurses (n = 282) working in the home-care services, were randomly assigned to one of three groups for: (1) individually designed physical training programme, (2) work-place stress management, (3) control group. Results revealed no significant differences between the three groups. However, improvements in low back pain were registered within both intervention groups for up to 18 months. Perceived physical exertion at work was reduced in the physical training group. Improvements in neck and shoulder pain did not differ within the three groups. Dissatisfaction with work-related, psychosocial factors was generally increased in all groups. As the aetiology of neck, shoulder and back disorders is multifactorial, a combination of the two intervention programmes might be preferable and should be further studied.
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- Horneij, Eva, et al.
(författare)
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Sick leave among home-care personnel: a longitudinal study of risk factors
- 2004
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 5:1, s. 38-38
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Tidskriftsartikel (refereegranskat)abstract
- Background Sick leave due to neck, shoulder and back disorders (NSBD) is higher among health-care workers, especially nursing aides/assistant nurses, compared with employees in other occupations. More information is needed about predictors of sick leave among health care workers. The aim of the study was to assess whether self-reported factors related to health, work and leisure time could predict: 1) future certified sick leave due to any cause, in nursing aides/assistant nurses (Study group I) and 2) future self-reported sick leave due to NSBD in nursing aides/assistant nurses (Study group II). Methods Study group I, comprised 443 female nursing aides/assistant nurses, not on sick leave at baseline when a questionnaire was completed. Data on certified sick leave were collected after 18 months. Study group II comprised 274 of the women, who at baseline reported no sick leave during the preceding year due to NSBD and who participated at the 18 month follow-up. Data on sick leave due to NSBD were collected from the questionnaire at 18 months. The associations between future sick leave and factors related to health, work and leisure time were tested by logistic regression analyses. Results Health-related factors such as previous low back disorders (OR: 1.89; 95% CI 1.20–2.97) and previous sick leave (OR 6.40; 95%CI 3.97–10.31), were associated with a higher risk of future sick leave due to any cause. Factors related to health, work and leisure time, i.e. previous low back disorders (OR: 4.45; 95% CI 1.27–15.77) previous sick leave, not due to NSBD (OR 3.30; 95%CI 1.33–8.17), high strain work (OR 2.34; 95%CI 1.05–5.23) and high perceived physical exertion in domestic work (OR 2.56; 95%CI 1.12–5.86) were associated with a higher risk of future sick leave due to NSBD. In the final analyses, previous low back disorders and previous sick leave remained significant in both study groups. Conclusion The results suggest a focus on previous low back disorders and previous sick leave for the design of early prevention programmes aiming at reducing future sick leave due to any cause, as well as due to NSBD, among nursing aides/assistant nurses. A multifactorial approach may be of importance in the early prevention of sick leave due to NSBD.
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- Jensen, Irene B., et al.
(författare)
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A randomized controlled component analysis of a behavioral medicine rehabilitation program for chronic spinal pain: are the effects dependent on gender?
- 2001
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Ingår i: Pain. - : LWW. - 0304-3959 .- 1872-6623. ; 91:1, s. 65-78
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to evaluate the outcome of a behavioral medicine (BM) rehabilitation program and the outcome of its two main components, compared to a ‘treatment-as-usual’ control group (CG). The study employed a 4×4 repeated-measures design with four groups and four assessment periods (pre-treatment, post-treatment, 6-month follow-up, and 18-month follow-up). The group studied consisted of subjects on sick leave identified in a nationwide health insurance scheme in Sweden. After inclusion, the subjects were randomized to one of four conditions, which were: (1) behavior-oriented physical therapy (PT); (2) cognitive behavioral therapy (CBT); (3) BM rehabilitation consisting of PT+CBT (BM); (4) a ‘treatment-as-usual’ CG. The treatments were given over a period of 4 weeks, PT and CBT on a part-time basis and BM on a full-time basis. Outcome variables were sick leave, early retirement, and health-related quality of life (measured using the Short Form Health Survey, SF-36). The results showed that the risk of being granted full-time early retirement was significantly lower for females in PT and CBT compared to the CG during the 18-month follow-up period. However, the total absence from work (sick listing plus early retirement) in days over the 18-month follow-up period was not significantly different in the CG compared to the treatments. On the SF-36, women in CBT and BM reported a significantly better health-related quality of life than women in the CG at the 18-month follow-up. No significant differences for men were found on the SF-36 scales. In conclusion, the results revealed gender differences in the outcome of the treatments and that the components of this BM program yielded as good results as the whole program.
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| 7. |
- Jensen, Irene B., et al.
(författare)
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Assessing the Needs of Patients in Pain: A Matter of Opinion?
- 2000
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Ingår i: Spine. - : LWW. - 0362-2436 .- 1528-1159. ; 25:21, s. 2816-2823
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. A prospective cohort study including patients with nonspecific spinal pain was performed.Objectives. To investigate whether the use of expert judgment in routine practice can provide a basis for reliable decision making concerning the need for intervention in patients with spinal pain and their ability to benefit from treatment.Summary of Background Data. A wide range of instruments and techniques are used to assess and treat patients with spinal pain. Many instruments are used without being clinimetrically tested.Methods. A questionnaire concerning the patients’ need of treatment and their potential to assimilate it was sent to experts in the health care arena: physicians, physical therapists, social insurance officers. The experts included were those connected with patients participating in a larger outcome study. Two cohorts of patients (sample 1, n = 217; sample 2, n = 257) were followed for 6 and 12 months, during which time the patients’ health and work status were mapped.Results. No acceptable agreement was found between any of the experts’ ratings of patients’ needs and potential for rehabilitation. Logistic regression showed that the experts’ judgments were based almost solely on the age of the patient. The prediction analyses showed that the most consistent predictor of the patients’ status at the 6-month follow-up assessment was the patients’ own belief in the existence of effective treatments and their perceived ability for learning to cope with the condition.Conclusions. Expert judgment as exercised in routine practice cannot be used as basis for reliable decision making concerning the need of the patient with spinal pain for intervention and the patient’s ability to benefit from treatment.
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