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1.	Godbolt, Alison K., et al. (författare) Associations between care pathways and outcome 1 year after severe traumatic brain injury 2015 Ingår i: The journal of head trauma rehabilitation. - Philadelphia : Lippincott Williams & Wilkins. - 0885-9701 .- 1550-509X. ; 30:3, s. E41-E51 Tidskriftsartikel (refereegranskat)abstract Objective: To assess associations between real-world care pathways for working-age patients in the first year after severe traumatic brain injury and outcomes at 1 year.Setting and Design: Prospective, observational study with recruitment from 6 neurosurgical centers in Sweden and Iceland. Follow-up to 1 year, independently of care pathways, by rehabilitation physicians and paramedical professionals.Participants: Patients with severe traumatic brain injury, lowest (nonsedated) Glasgow Coma Scale score 3 to 8 during the first 24 hours and requiring neurosurgical intensive care, age 18 to 65 years, and alive 3 weeks after injury.Main Measures: Length of stay in intensive care, time between intensive care discharge and rehabilitation admission, outcome at 1 year (Glasgow Outcome Scale Extended score), acute markers of injury severity, preexisting medical conditions, and post-acute complications. Logistic regression analyses were performed.Results: A multivariate model found variables significantly associated with outcome (odds ratio for good outcome [confidence interval], P value) to be as follows: length of stay in intensive care (0.92 [0.87-0.98], 0.014), time between intensive care discharge and admission to inpatient rehabilitation (0.97 [0.94-0.99], 0.017), and post-acute complications (0.058 [0.006-0.60], 0.017).Conclusions: Delays in rehabilitation admission were negatively associated with outcome. Measures to ensure timely rehabilitation admission may improve outcome. Further research is needed to evaluate possible causation.
2.	Magaard, Gustaf, et al. (författare) Identifying sub-acute rehabilitation needs among individuals after transient ischaemic attack using rehab-compass as a simple screening tool in the outpatient clinic 2019 Ingår i: Journal of Rehabilitation clinical communications. - : Medical Journals Sweden AB. - 2003-0711. ; 2 Tidskriftsartikel (refereegranskat)abstract Objective: To evaluate comprehensive unmet rehabilitation needs by using a novel graphic screening tool, Rehab-Compass, among individuals in the sub-acute stage after first-ever transient ischaemic attack.Methods: A pilot prospective cohort study investigated 47 individuals with first-ever transient ischaemic attack in an outpatient clinic setting. By using Rehab-Compass, based on well-validated patient-reported outcome measure questionnaires, this study examined comprehensive unmet rehabilitation needs among individuals at 4-month follow-up after the onset of transient ischaemic attack.Results: Rehab-Compass identified that most participants were independent in their daily lives (modified Rankin Scale; mRS 0–1) with a relatively good quality of life (median EuroQol 5 dimensions (EQ-5D) 0.85), but certain limitations in participation in their daily lives. Rehab-Compass showed that, at 4 months after transient ischaemic attack, the most common condition affected was mood (reported by 89% of participants), followed by bladder function (70%), sexual life (52%), strength (51%) and fatigue (26%). Symptoms of depression and anxiety were reported by 6% and 17% of participants, respectively.Conclusion: This pilot study indicates that Rehab-Compass might be a suitable simple screening tool for use in the outpatient clinic setting to identify the multidimensional rehabilitation needs of individuals after transient ischaemic attack.
3.	Rivano Fischer, Marcelo, et al. (författare) Return to work after interdisciplinary pain rehabilitation : one- and two-year follow-up study based on the Swedish quality registry for pain rehabiliation 2019 Ingår i: Journal of Rehabilitation Medicine. - : Foundation of Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 51:4, s. 281-289 Tidskriftsartikel (refereegranskat)abstract Objectives: To investigate: (1) changes in sick-leave benefits from 1 year prior to multimodal rehabilitation to 1 and 2 years after rehabilitation; (ii) sex differences in sick leave; and (iii) the impact of policy changes on sick leave.Methods: All patients undergoing multimodal rehabilitation registered in a national pain database for 2007-11 (n = 7,297) were linked to the Swedish Social Insurance Agency database. Sick leave was analysed in 3-month periods: T0: 1 year before rehabilitation; T1: before start; T2: 1 year after; and T3: 2 years after rehabilitation. Four sick-leave benefit categories were constructed: no sick leave, part-time sick leave, full-time sick leave, and full-time permanent sick leave. The individual change in sick-leave category at each time-period was analysed.Results: Sick-leave benefits increased from T0 to T1 (p <0.001) and decreased from T1 to T3 (p < 0.001). Reductions were significant for both men and women from T1 to T3, but men had less sick-leave benefits at T2 and T3. Positive changes in sick-leave benefits at T2 and T3 were found both prior to and after policy changes, with less sick-leave benefits after policy changes at all time-points.Conclusion: Multimodal rehabilitation may positively influence sick-leave benefits for patients with chronic pain, regardless of their sick-leave situation, sex or policy changes.
4.	Rivano, Marcelo, et al. (författare) Return to work: One and two years follow-up after interdisciplinary pain rehabilitation. A study based on the Swedish Quality Registry for Pain Rehabilitation 2019 Ingår i: Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1651-2081. ; 51:4, s. 281-289 Tidskriftsartikel (refereegranskat)abstract Objectives: To investigate: (i) changes in sick-leave benefits from 1 year prior to multimodal rehabilitation to 1 and 2 years after rehabilitation; (ii) sex differences in sick leave; and (iii) the impact of policy changes on sick leave. Methods: All patients undergoing multimodal rehabilitation registered in a national pain database for 2007–11 (n?=?7,297) were linked to the Swedish Social Insurance Agency database. Sick leave was analysed in 3-month periods: T0: 1 year before rehabilitation; T1: before start; T2: 1 year after; and T3: 2 years after rehabilitation. Four sick-leave benefit categories were constructed: no sick leave, part-time sick leave, full-time sick leave, and full-time permanent sick leave. The individual change in sick-leave category at each time-period was analysed. Results: Sick-leave benefits increased from T0 to T1 (p?<0.001) and decreased from T1 to T3 (p? Conclusion: Multimodal rehabilitation may positively influence sick-leave benefits for patients with chronic pain, regardless of their sick-leave situation, sex or policy changes.
5.	Stenberg, Maud, et al. (författare) Family Illness Trajectory During Seven Years After A Severe Traumatic Brain Injury-Family Interviews 2019 Ingår i: Brain Injury. - : Taylor & Francis. - 0269-9052 .- 1362-301X. ; 33, s. 147-147 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
6.	Stenberg, Maud, et al. (författare) Long-Term Follow-Up Observation Study 7 Years after Severe Traumatic Brain Injury in Northern Sweden 2019 Ingår i: Brain Injury. - : Taylor & Francis. - 0269-9052 .- 1362-301X. ; 33, s. 161-161 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
7.	Stålnacke, Britt-Marie, 1955-, et al. (författare) Long-Term Follow-Up of Disability, Cognitive, and Emotional Impairments after Severe Traumatic Brain Injury 2019 Ingår i: Behavioural Neurology. - : Hindawi Publishing Corporation. - 0953-4180 .- 1875-8584. ; 2019 Tidskriftsartikel (refereegranskat)abstract Aim. To assess the clinical course of disability, cognitive, and emotional impairments in patients with severe TBI (s-TBI) from 3 months to up to 7 years post trauma. Methods. A prospective cohort study of s-TBI in northern Sweden was conducted. Patients aged 18-65 years with acute Glasgow Coma Scale 3-8 were assessed with the Glasgow Outcome Scale Extended (GOSE), the Hospital Anxiety and Depression Scale (HADS), and the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) at 3 months, 1 year, and 7 years after the injury. Results. The scores on both GOSE and BNIS improved significantly from 3 months (GOSE mean: 4.4 +/- 2.3, BNIS mean: 31.5 +/- 7.0) to 1 year (GOSE mean: 5.5 +/- 2.7, p=0.003, BNIS mean: 33.2 +/- 6.3, p=0.04), but no significant improvement was found from 1 year to 7 years (GOSE mean: 4.7 +/- 2.8, p=0.13, BNIS mean: 33.5 +/- 3.9, p=0.424) after the injury. The BNIS subscale "speech/language" at 1 year was significantly associated with favourable outcomes on the GOSE at 7 years (OR=2.115, CI: 1.004-4.456, p=0.049). Conclusions. These findings indicate that disability and cognition seem to improve over time after s-TBI and appear to be relatively stable from 1 year to 7 years. Since cognitive function on some of the BNIS subscales was associated with outcome on the GOSE, these results indicate that both screening and follow-up of cognitive function could be of importance for the rehabilitation of persons with s-TBI.
8.	Söderlund Schaller, Anne, 1967- (författare) Impact of Pain and Evaluation of Education and Self-Care in Patients with Head and Neck Cancer 2018 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract It is not unusual for patients with head and neck cancer (HNC) to suffer from both tumor and treatment-related pain that is difficult to alleviate despite individualized pharmacological treatment.The presence of concomitant various dimensions of pain in patients during the often difficult period following radiotherapy (RT) has not been elucidated. Several aspects concerning the importance of relatives for HNC patients have been addressed. However, little attention has been given to how relatives perceive patients with HNC pain and it is important to further elucidate this sparsely studied topic. Knowledge about health-related quality of life (HR-QoL) in this patient group during early RT is limited and needs to be assessed in relation to diagnosis and treatment. Self-care (SC) refers to what patients do on their own to achieve, maintain, and promote optimal health and may help reduce pain for several pain conditions. The impact of patient education and SC on pain and other common HNC symptoms need further clarification.The aims of this thesis were:to describe experiences and perceptions of pain in patients with HNC shortly after RTto describe how relatives perceived the patient’s situation, especially concerning pain, and how they experienced their own situationto identify factors that impact HR-QoL during early RTto develop effective pain management strategies, maintain activities of daily living, and promote HR-QoL in patients with HNC undergoing RT using patient education and SC instruction.In paper I patients with HNC described existential pain – expressed as fear of death, meaninglessness and guilt – already during and shortly after RT. Physical pain, psychological distress and social withdrawal played a significant role. Patients with HNC who were treated with RT should also proactively be offered treatment for the various dimensions of pain.In paper II relatives described their mental stress in response to a challenging situation that required their active support to help ease the patient's difficult condition. The interviews with relatives also revealed a lack of personal knowledge and frustration over the inability to participate in patient care, as well as inadequate support from the healthcare system. Early interventions from the healthcare system on behalf of the relatives may be necessary to meet these needs.In Paper III regression models revealed that pain intensity and symptoms of depression adversely affected HR-QoL in patients with HNC during early RT. Customized prehabilitation programs aimed at preventing pain and symptoms of depression could help preserve good HR-QoL.Paper IV assessed individual patient education and SC initiatives that resulted in a tendency for lower pain intensity during a portion of RT. One way to potentially enhance the benefits of education and SC could be to improve for example patient motivation and self-efficacy, as well as to optimize supportive efforts from caregivers.In conclusion, by identifying factors that can impact HR-QoL and evaluating the effect of patient education and SC, this thesis contributes to knowledge on perceived pain and the patient’s situation during and shortly after RT in patients with HNC and their relatives. This thesis points to the need for evaluation and further development of patient education and effective SC strategies for pain in patients with HNC undergoing RT, as well as for development and evaluation of support strategies for patients with pain and their families during and after RT.
9.	Ahlgren, Christina, et al. (författare) The meanings given to gender in studies on multimodal rehabilitation for patients with chronic musculoskeletal pain : a literature review 2016 Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 38:23, s. 2255-2270 Forskningsöversikt (refereegranskat)abstract Purpose: The purpose of this study is to assess and describe the meanings given to "gender" in scientific publications that evaluate multidisciplinary, interdisciplinary or multimodal rehabilitation for patients with chronic musculoskeletal pain.Method: A systematic literature search for papers evaluating multimodal rehabilitation was conducted. The PubMed and EBSCO databases were searched from 1995 to 2015. Two or three researchers independently read each paper, performed a quality assessment and coded meanings of gender using qualitative content analysis.Results: Twenty-seven papers were included in the review. Gender was used very differently in the MMR studies investigated but primarily it referred to factual differences between men and women. Only one paper provided a definition of the concept of gender and how it had been used in that study. In the content analysis, the meaning of gender formed three categories: "Gender as a factual difference", "The man is the ideal" and "Gender as a result of social role expectations".Conclusions: The meaning of the concept of gender in multimodal rehabilitation is undefined and needs to be developed further. The way the concept is used should be defined in the design and evaluation of multimodal rehabilitation in future studies.Implications for rehabilitationHealthcare professionals should reflect on gender relations in encounters with patients, selection of patients into rehabilitation programs and design of programs. In rehabilitation for chronic pain the patients' social circumstances and cultural context should be given the same consideration as biological sex and pain symptoms.
10.	Ejelöv, Marina, et al. (författare) “Many obstacles along the way” : follow-up of rehabilitation plans after multimodal pain rehabilitation 2016 Ingår i: European Journal of Physiotherapy. - : Informa UK Limited. - 2167-9169 .- 2167-9177. ; 18:1, s. 18-26 Tidskriftsartikel (refereegranskat)abstract The aim of this study was to explore the content of rehabilitation plans after multimodal rehabilitation (MMR) for chronic pain patients, focusing on occupation-oriented measures. A secondary aim was to study how the individual rehabilitation plans had been carried out and implemented during 1 year after MMR. A multiple methods approach with quantitative and qualitative data was used. The quantitative part was descriptive and examined whether the rehabilitation plans were carried out, the number of recommendations in each plan and the type of measures suggested. The qualitative part constituted a content analysis of interviews. Vocational rehabilitation was the second most common recommendation for the whole group. The analysis of the interviews resulted in seven categories divided into two main categories: impeding factors and facilitating factors for rehabilitation. The compliance of professionals and external parties with the patients’ rehabilitation plans, and the patients’ positive experience of their change in behaviour, contributed to the completion of the rehabilitation plans. In conclusion, lack of follow-up from the professionals and negative bodily signals inhibited the completion of rehabilitation. Flexibility on the part of professionals and external actors regarding patients’ rehabilitation plans as well as their own positive experiences of striving for change facilitated rehabilitation.
11.	Enthoven, Paul, et al. (författare) DO PAIN CHARACTERISTICS GUIDE SELECTION FOR MULTIMODAL PAIN REHABILITATION? 2017 Ingår i: Journal of Rehabilitation Medicine. - : FOUNDATION REHABILITATION INFORMATION. - 1650-1977 .- 1651-2081. ; 49:2, s. 161-169 Tidskriftsartikel (refereegranskat)abstract Objective: To determine whether self-reported pain measures are associated with selection for multimodal or multidisciplinary rehabilitation (MMR) and whether this selection is influenced by sex. Design: Cross-sectional cohort study. Subjects: A total of 1,226 women and 464 men with chronic pain conditions from 2 university hospitals. Methods: Drawing from the Swedish Quality Registry for Pain Rehabilitation (SQRP), data on pain, psychological symptoms, function, health, and activity/participation were collected. Multiple logistic regression was used to investigate association of pain measures with selection for MMR (no/yes) after multidisciplinary assessment. Covariates were: age, educational level, anxiety, depression, working status, and several pain measures. Results: High pain intensity in the previous week (odds ratio (OR) 0.92; 95% confidence interval (CI) 0.86-0.99) and high pain severity (Multidimensional Pain Inventory) (OR 0.83; 95% CI 0.74-0.95) were negatively associated with selection for MMR, whereas higher number of pain quadrants was positively associated with selection for MMR. Similar results were obtained for women, but none of the measures was predictive for men. Conclusion: This practice-based study showed that higher scores on self-reported pain were not associated with selection for MMR, and in women there was a negative association for higher pain intensity and pain severity. Thus, other factors than pain determine whether patients are selected for MMR.
12.	Eskilsson, Therese, 1970-, et al. (författare) Arbetsplatsdialog AD-A : metodstöd för arbetsgivare vid ohälsa och sjukfrånvaro 2019 Bok (övrigt vetenskapligt/konstnärligt)
13.	Gardelli, Åsa, et al. (författare) Folkhögskola : en aktivitetsarena för personer med förvärvad hjärnskada 2016 Ingår i: Hjärnkraft. - : Hjärnskadeförbundet Hjärnkraft. - 1654-7446. ; 3, s. 12-13 Tidskriftsartikel (populärvet., debatt m.m.)
14.	Gerdle, Björn, et al. (författare) The importance of emotional distress, cognitive behavioural factors and pain for life impact at baseline and for outcomes after rehabilitation - a SQRP study of more than 20,000 chronic pain patients 2019 Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter GmbH. - 1877-8860 .- 1877-8879. ; 19:4, s. 693-711 Tidskriftsartikel (refereegranskat)abstract Background and aims Although literature concerning chronic pain patients indicates that cognitive behavioural variables, specifically acceptance and fear of movement/(re)injury, are related to life impact, the relative roles of these factors in relation to pain characteristics (e.g. intensity and spreading) and emotional distress are unclear. Moreover, how these variables affect rehabilitation outcomes in different subgroups is insufficiently understood. This study has two aims: (1) to investigate how pain, cognitive behavioural, and emotional distress variables intercorrelate and whether these variables can regress aspects of life impact and (2) to analyse whether these variables can be used to identify clinically meaningful subgroups at baseline and which subgroups benefit most from multimodal rehabilitation programs (MMRP) immediately after and at 12-month follow-up. Methods Pain aspects, background variables, psychological distress, cognitive behavioural variables, and two life impact variables were obtained from the Swedish Quality Registry for Pain Rehabilitation (SQRP) for chronic pain patients. These data were analysed mainly using advanced multivariate methods. Results The study includes 22,406 chronic pain patients. Many variables, including acceptance variables, showed important contributions to the variation in clinical presentations and in life impacts. Based on the statistically important variables considering the clinical presentation, three clusters/subgroups of patients were identified at baseline; from the worst clinical situation to the relatively good situation. These clusters showed significant differences in outcomes after participating in MMRP; the subgroup with the worst situation at baseline showed the most significant improvements. Conclusions Pain intensity/severity, emotional distress, acceptance, and life impacts were important for the clinical presentation and were used to identify three clusters with marked differences at baseline (i.e. before MMRP). Life impacts showed complex relationships with acceptance, pain intensity/severity, and emotional distress. The most significant improvements after MMRP were seen in the subgroup with the lowest level of functioning before treatment, indicating that patients with complex problems should be offered MMRP. Implications This study emphasizes the need to adopt a biopsychosocial perspective when assessing patients with chronic pain. Patients with chronic pain referred to specialist clinics are not homogenous in their clinical presentation. Instead we identified three distinct subgroups of patients. The outcomes of MMRP appears to be related to the clinical presentation. Thus, patients with the most severe clinical presentation show the most prominent improvements. However, even though this group of patients improve they still after MMRP show a complex situation and there is thus a need for optimizing the content of MMRP for these patients. The subgroup of patients with a relatively good situation with respect to pain, psychological distress, coping and life impact only showed minor improvements after MMRP. Hence, there is a need to develop other complex interventions for them.
15.	Gerdle, Björn, et al. (författare) Who benefits from multimodal rehabilitation - an exploration of pain, psychological distress, and life impacts in over 35,000 chronic pain patients identified in the Swedish Quality Registry for Pain Rehabilitation 2019 Ingår i: Journal of Pain Research. - : DOVE Medical Press Ltd.. - 1178-7090. ; 12, s. 891-908 Tidskriftsartikel (refereegranskat)abstract Background: Chronic pain patients frequently suffer from psychological symptoms. There is no consensus concerning the prevalence of severe anxiety and depressive symptoms and the strength of the associations between pain intensity and psychological distress. Although an important aspect of the clinical picture is understanding how the pain condition impacts life, little is known about the relative importance of pain and psychological symptoms for individual's life impact. The aims of this study were to identify subgroups of pain patients; to analyze if pain, psychological distress, and life impact variables influence subgrouping; and to investigate how patients in the subgroups benefit from treatments.Methods: Background variables, pain aspects (intensity/severity and spreading), psychological distress (depressive and anxiety symptoms), and two life impact variables (pain interference and perceived life control) were obtained from the Swedish Quality Registry for Pain Rehabilitation for chronic pain patients and analyzed mainly using advanced multivariate methods.Results: Based on >35,000 patients, 35%-40% had severe anxiety or depressive symptoms. Severe psychological distress was associated with being born outside Europe (21%-24% vs 6%-8% in the category without psychological distress) and low education level (20.7%-20.8% vs 26%-27% in the category without psychological distress). Dose relationships existed between the two psychological distress variables and pain aspects, but the explained variances were generally low. Pain intensity/severity and the two psychological distress variables were significantly associated (R2=0.40-0.48; P>0.001) with the two life impact variables (pain interference and life control). Two subgroups of patients were identified at baseline (subgroup 1: n=15,901-16,119; subgroup 2: n=20,690-20,981) and the subgroup with the worst situation regarding all variables participated less in an MMRP (51% vs 58%, P<0.001) but showed the largest improvements in outcomes.Conclusion: The results emphasize the need to assess both pain and psychological distress and not take for granted that pain involves high psychological stress in the individual case. Not all patients benefit from MMRP. A better matching between common clinical pictures and the content of MMRPs may help improve results. We only partly found support for treatment resistance in patients with psychological distress burden.
16.	Godbolt, Alison K., et al. (författare) Subacute complications during recovery from severe traumatic brain injury : frequency and associations with outcome 2015 Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 5:4 Tidskriftsartikel (refereegranskat)abstract Background: Medical complications after severe traumatic brain injury (S-TBI) may delay or prevent transfer to rehabilitation units and impact on long-term outcome.Objective: Mapping of medical complications in the subacute period after S-TBI and the impact of these complications on 1-year outcome to inform healthcare planning and discussion of prognosis with relatives.Setting: Prospective multicentre observational study. Recruitment from 6 neurosurgical centres in Sweden and Iceland.Participants and assessments: Patients aged 18-65 years with S-TBI and acute Glasgow Coma Scale 3-8, who were admitted to neurointensive care. Assessment of medical complications 3 weeks and 3 months after injury. Follow-up to 1 year. 114 patients recruited with follow-up at 1 year as follows: 100 assessed, 7 dead and 7 dropped out.Outcome measure: Glasgow Outcome Scale Extended.Results: 68 patients had >= 1 complication 3 weeks after injury. 3 weeks after injury, factors associated with unfavourable outcome at 1 year were: tracheostomy, assisted ventilation, on-going infection, epilepsy and nutrition via nasogastric tube or percutaneous endoscopic gastroscopy (PEG) tube (univariate logistic regression analyses). Multivariate analysis demonstrated that tracheostomy and epilepsy retained significance even after incorporating acute injury severity into the model. 3 months after injury, factors associated with unfavourable outcome were tracheostomy and heterotopic ossification (Fisher's test), infection, hydrocephalus, autonomic instability, PEG feeding and weight loss (univariate logistic regression). PEG feeding and weight loss at 3 months were retained in a multivariate model.Conclusions: Subacute complications occurred in two-thirds of patients. Presence of a tracheostomy or epilepsy at 3 weeks, and of PEG feeding and weight loss at 3 months, had robust associations with unfavourable outcome that were incompletely explained by acute injury severity.
17.	Grooten, Wilhelmus Johannes Andreas, et al. (författare) Elaborating on the assessment of the risk of bias in prognostic studies in pain rehabilitation using QUIPS-aspects of interrater agreement 2019 Ingår i: Diagnostic and Prognostic Research. - : Springer Science and Business Media LLC. - 2397-7523. ; 3 Tidskriftsartikel (refereegranskat)abstract Background: Many studies have been performed to identify important prognostic factors for outcomes after rehabilitation of patients with chronic pain, and there is a need to synthesize them through systematic review. In this process, it is important to assess the study quality and risk of bias. The "Quality In Prognosis Studies" (QUIPS) tool has been developed for this purpose and consists of several prompting items categorized into six domains, and each domain is judged on a three-grade scale (low, moderate or high risk of bias). The aim of the present study was to determine the interrater agreement of the risk of bias assessment in prognostic studies of patients with chronic pain using QUIPS and to elaborate on the use of this instrument.Methods: We performed a systematic review and a meta-analysis of prognostic factors for long-term outcomes after multidisciplinary rehabilitation in patients with chronic pain. Two researchers rated the risk of bias in 43 published papers in two rounds (15 and 28 papers, respectively). The interrater agreement and Cohen's quadratic weighted kappa coefficient (κ) and 95% confidence interval (95%CI) were calculated in all domains and separately for the first and second rounds.Results: The raters agreed in 61% of the domains (157 out of 258), with similar interrater agreement in the first (59%, 53/90) and second rounds (62%, 104/168). The overall weighted kappa coefficient (kappa for all domains and all papers) was weak: κ = 0.475 (95%CI = 0.358-0.601). A "minimal agreement" between the raters was found in the first round, κ = 0.323 (95%CI = 0.129-0.517), but increased to "weak agreement" in the second round, κ = 0.536 (95%CI = 0.390-0.682).Conclusion: Despite a relatively low interrater agreement, QUIPS proved to be a useful tool in assessing the risk of bias when performing a meta-analysis of prognostic studies in pain rehabilitation, since it demands of raters to discuss and investigate important aspects of study quality. Some items were particularly hard to differentiate in-between, and a learning phase was required to increase the interrater agreement. This paper highlights several aspects of the tool that should be kept in mind when rating the risk of bias in prognostic studies, and provides some suggestions on common pitfalls to avoid during this process.Trial registration: PROSPERO CRD42016025339; registered 05 February 2016.
18.	Hallstam, Andrea, et al. (författare) Patients with chronic pain : One-year follow-up of a multimodal rehabilitation programme at a pain clinic 2016 Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter GmbH. - 1877-8860 .- 1877-8879. ; 10, s. 36-42 Tidskriftsartikel (refereegranskat)abstract Background and aims: Multimodal rehabilitation (MMR) programmes, including, physical training, educational and psychological interventions by an interdisciplinary team are found to be more successful for patients with disabling chronic pain compared with less comprehensive treatments. MMR programmes are based on the biopsychosocial model and the goal is usually to improve function, quality of life and facilitate and enable return to work. As pain clinics traditionally offer conventional medical pain treatment, there is limited knowledge about MMR given in this context. The aim of our study was to describe characteristics of patients with chronic pain, treated with a MMR programme at a conventional pain clinic, to evaluate patient-reported outcome measures (PROM) from start to one year after, and to study possibly associated factors for the improvement of health-related quality of life after one year.Methods: A prospective, observational study with a one-year follow-up was performed.Subjects: A total of 42 individuals (38 females, age 44.0 ± 12.3 years and 4 men age 40 ± 8.5 years) with different pain diagnoses were included. After a team assessment, the patients began a programme that lasted about three months. The MMR programme contained coordinated, individually adapted treatments administered individually or in groups, and was based on cognitive behavioural principles. Questionnaires regarding health-related quality of life (HRQoL) (EQ-5D), insomnia (ISI), mental health (HADS), pain-related disability (PDI), kinesiophobia (TSK), current pain intensity (VAS) and sense of coherence (SOC) were used at the start of the MMR and at follow-up. Demographic data were collected from the patient records.Results: The PROM at baseline showed substantial pain problems with low HRQoL (EQ-5D index of 0.1 ± 0.282, and EQ VAS of 32.67 ± 20.1), moderate insomnia (ISI 18.95 ± 6.7), doubtful cases of depression and anxiety (HADS-depression 9.35 ± 4.1 and HADS-anxiety 9.78 ± 3.95), presence of pain-related disability (PDI 39.48 ±12.64), kinesiophobia (TSK 40.8 ± 9.8), as well as moderate current pain (VAS 61.31 ± 20.4). The sense of coherence was weak (SOC of 51.37 ± 14). At one-year follow-up, significant (p ≤ 0.05) improvement occurred on the EQ-5D index, EQ VAS, ISI, PDI and TSK. In the logistic regression analysis, no significant associations could be identified.Conclusions: MMR for patients with complex pain problems can be a successful treatment alternative at conventional pain clinics.Implications: Since access to rehabilitation clinics in Sweden may be limited, the availability of MMR can increase by providing this type of intervention in pain clinics. Increased knowledge of MMR in different settings can also contribute to increased understanding and collaboration between pain clinics and rehabilitation units.
19.	Hammarström, Anne, et al. (författare) Developing a Tool for Increasing the Awareness about Gendered and Intersectional Processes in the Clinical Assessment of Patients : A Study of Pain Rehabilitation 2016 Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 11:4 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: There is a need for tools addressing gender inequality in the everyday clinical work in health care. The aim of our paper was to develop a tool for increasing the awareness of gendered and intersectional processes in clinical assessment of patients, based on a study of pain rehabilitation.METHODS: In the overarching project named "Equal care in rehabilitation" we used multiple methods (both quantitative and qualitative) in five sub studies. With a novel approach we used Grounded Theory in order to synthesize the results from our sub studies, in order to develop the gender equality tool. The gender equality tool described and developed in this article is thus based on results from sub studies about the processes of assessment and selection of patients in pain rehabilitation. Inspired by some questions in earlier tools, we posed open ended questions and inductively searched for findings and concepts relating to gendered and social selection processes in pain rehabilitation, in each of our sub studies. Through this process, the actual gender equality tool was developed as 15 questions about the process of assessing and selecting patients to pain rehabilitation. As a more comprehensive way of understanding the tool, we performed a final step of the GT analyses. Here we synthesized the results of the tool into a comprehensive model with two dimensions in relation to several possible discrimination axes.RESULTS: The process of assessing and selecting patients was visualized as a funnel, a top down process governed by gendered attitudes, rules and structures. We found that the clinicians judged inner and outer characteristics and status of patients in a gendered and intersectional way in the process of clinical decision-making which thus can be regarded as (potentially) biased with regard to gender, socio-economic status, ethnicity and age.IMPLICATIONS: The clinical implications of our tool are that the tool can be included in the systematic routine of clinical assessment of patients for both awareness raising and as a base for avoiding gender bias in clinical decision-making. The tool could also be used in team education for health professionals as an instrument for critical reflection on gender bias.CONCLUSIONS: Thus, tools for clinical assessment can be developed from empirical studies in various clinical settings. However, such a micro-level approach must be understood from a broader societal perspective including gender relations on both the macro- and the meso-level.
20.	Haukenes, I., et al. (författare) Does pain severity guide selection to multimodal pain rehabilitation across gender? 2015 Ingår i: European Journal of Pain. - : Wiley. - 1090-3801 .- 1532-2149. ; 19:6, s. 826-833 Tidskriftsartikel (refereegranskat)abstract BackgroundStudies have addressed the effect of multimodal pain rehabilitation (MMR), whereas criteria for selection are sparse. This study examines whether higher scores on musculoskeletal pain measures are associated with selection to MMR, and whether this differs across gender. MethodA clinical population of 262 male and 589 female patients was recruited consecutively during 3 years, 2007-2010. The patients were referred from primary care to a pain rehabilitation clinic in Northern Sweden for assessment and selection to MMR. Register-based data on self-reported pain were linked to patients' records where outcome (MMR or not) was stated. We modelled odds ratios for selection to MMR by higher scores on validated pain measures (pain severity, interference with daily life, pain sites and localized pain vs. varying pain location). Covariates were age, educational level and multiple pain measures. Anxiety and depression (Hospital, Anxiety and Depression Scale) and working status were used in sensitivity tests. ResultsHigher scores of self-reported pain were not associated with selection to MMR in multivariate models. Among women, higher scores on pain severity, pain sites and varying pain location (localized pain=reference) were negatively associated with selection to MMR. After adjustment for multiple pain measures, the negative odds ratio for varying location persisted (OR=0.59, 95% CI=0.39-0.89). ConclusionHigher scores on self-reported pain did not guide selection to MMR and a negative trend was found among women. Studies of referral patterns and decision processes may contribute to a better understanding of the clinical practice that decides selection to MMR.
21.	Hållstam, Andrea, et al. (författare) Assessment and treatment at a pain clinic : a one-year follow-up of patients with chronic pain 2017 Ingår i: Scandinavian Journal of Pain. - Amsterdam : Elsevier. - 1877-8860 .- 1877-8879. ; 17:1, s. 233-242 Tidskriftsartikel (refereegranskat)abstract Background and aims: Pain is one of the most common reasons for patients to seek primary health care. Pain relief is likely to be achieved for patients suffering from acute pain, but for individuals with chronic pain it is more likely that the condition will persist. These patients have the option of being referred to specialised pain clinics. However, the complexity surrounding chronic pain patients is not well studied in these settings. This study aimed to describe patients with chronic pain referred to a pain clinic by using the information submitted during their first visit and one year later and also to identify associations between baseline characteristics and improvements in health-related quality of life in the follow-up.Methods: This was a longitudinal observational study of a sample consisting of 318 patients referred to a pain clinic. One group of patients containing 271 individuals (median age 48, 64% females) was assessed and received conventional pain treatment (CPT group) and a second group of 47 patients (median age 53, 64% females) was assessed by a pain specialist and referred back to their physician with a treatment recommendation (assessment only, AO group). Patient-reported outcome measures in health-related quality of life (EQ-5D), pain intensity (VAS), mental health (HADS), insomnia (ISI), pain-related disability (PDI), kinesiophobia (TSK) and sense of coherence (SOC) were collected at the first visit and one year later.Results: At baseline, the CPT group reported a low EQ-5D Index (median (md) 0.157) and EQVAS (md 40) as well as considerable high, current pain intensity VAS (md 58), HADS anxiety (md 8), ISI (md 17), PDI (md 36) and TSK (md 39). The AO group showed similar problems (no significant differences compared to the CPT group), except for ISI, where the AO group reported less severe problems. At the one-year follow-up, the CPT group had a statistically significant improvement in EQ-5D, VAS, ISI, PDI and TSK. In the AO group no significant changes were observed. In the CPT group there was an association between a high ISI level at baseline and an improved EQ-5D Index in the follow-up.Conclusions: The study describes rarely explored groups of patients with chronic pain at a pain clinic. Severe pain problems were present in both groups at their first visit. A statistically significant improvement could be seen in the group that was conventionally treated while this was not the case among those subjects who were assessed and referred. The results imply, that relatively limited treatment strategies were helpful for the patients' health-related quality of life. Despite these improvements, the patients were not fully recovered, pointing to the chronicity of pain conditions and the need of support for many patients.Implications: Increased knowledge about assessment, selection and treatment at pain clinics is important to improve the quality of the work performed at these clinics. Despite limited resources, further efforts should be made to collect comparable, valid data on a regular base from pain clinics in order to develop recommendation models.
22.	Hållstam, Andrea, et al. (författare) "Change is possible" : patients' experience of a multimodal chronic pain rehabilitation programme 2015 Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 47:3, s. 242-248 Tidskriftsartikel (refereegranskat)abstract Objective: To explore patients' experiences of activity, participation and quality of life one year after a rehabilitation programme for chronic pain, and to determine the impact of the programme on their current life situation. Design: Qualitative study with emergent design. Subjects and methods: The 14 informants were patients with chronic pain who had participated in rehabilitation at a pain clinic. Individual semi-structured interviews were analysed with inductive, qualitative content analysis. Results: The core theme "Change is possible" and the themes "A life ruled by pain" (the situation before rehabilitation), "The penny's dropped" (experience during rehabilitation) and "Live a life, not only survive" (the situation at the time of the interviews) emerged from the data. These themes represent a process through which, during and after rehabilitation, the informants integrated earlier disabling symptoms into a functioning lifestyle. Conclusion: Individuals living with disabling chronic pain can create a better life by integrating their illness. A prerequisite is that healthcare professionals empower patients to develop the strength to take responsibility for their daily lives. This process is facilitated by skills to reduce pain and handle life, plus support from significant others.
23.	Hållstam, A., et al. (författare) Living with painful endometriosis - a struggle for coherence : a qualitative study 2018 Ingår i: Sexual & Reproductive HealthCare. - Ireland : Elsevier. - 1877-5756 .- 1877-5764. ; 17, s. 97-102 Tidskriftsartikel (refereegranskat)abstract Objectives: The study sought to examine women's experience of painful endometriosis including long-term aspects, social consequences, impact of treatment and development of own coping strategies.Study design: This qualitative study was based on 16 individual interviews analyzed according to grounded theory. The thirteen women (age 24-48) were recruited at a pain clinic in Stockholm, Sweden.Results: A theory illustrating women's experience of living with painful endometriosis was developed with three categories and one core category. Bidirectional interactions between the categories and with the core category were found. Endometriosis influenced the women's sensations, feelings and reactions, creating a sense of difference from other women (category: Woman with painful endometriosis). The condition led to either helpful or harmful encounters with health care and significant others (category: Dependence). It also had overall physical, social and existential consequences (category: A ruined life). To cope, the women had to struggle for coherence by searching for understanding, coping and meaning (core category: Living with painful endometriosis).Conclusions: Living with severe painful endometriosis signified a struggle for coherence. The women needed to deal with feelings of difference, dependence and a ruined life and thus struggled for understanding, coping and meaning. Health-care providers should promote the struggle for coherence by explaining the feeling of difference, minimizing dependence and supporting the process of disease-related grief.
24.	Lehti, Arja, et al. (författare) Walking down 'Via Dolorosa' from primary health care to the specialty pain clinic : patient and professional perceptions of inequity in rehabilitation of chronic pain 2017 Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 31:1, s. 45-53 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To analyse patient and professional perceptions about (in)equity of care and rehabilitation of chronic pain patients from primary health care to assessment at a specialty rehabilitation clinic.SETTING AND METHODS: This qualitative study consists one focus group interview with eight general practitioners who refer patients to pain rehabilitation clinics, 10 individual interviews with patients who were assessed at a pain rehabilitation clinic and seven interviews with professionals participating in multimodal assessment teams at a pain rehabilitation clinic. Interview analysis was conducted by the grounded theory method.RESULTS: The core category Via Dolorosa, the way of suffering and pain, captured how gender and sociocultural context may contribute to advantages and disadvantages during patient journeys from primary health care to a pain rehabilitation clinic. Patients and professionals perceived pain as a low-ranking illness, and women and men used different gendered strategies to legitimise the pain and to be taken seriously. Being 'a proper patient ready to change' and having 'likeness' between patients and professionals were viewed as advantageous in rehabilitation of pain patients. Patients with higher educational levels were perceived as easier to interact with and had better access to health care. Professional thoughts about gender norms influenced the rehabilitation options. The rehabilitation programme was seen by several professionals to be better suited for women than men, which could lead to unequal care.CONCLUSION: From an equity and gender perspective, our study highlights the complexity in rehabilitation of chronic pain patients - both from patient and professional perspectives. Awareness of gendered and the biased preconceptions and norms is crucial when professionals struggle to offer equitable health care and rehabilitation.
25.	Nilsson, Per A., 1957-, et al. (författare) Life satisfaction among inbound university students in northern Sweden 2019 Ingår i: Fennia. - : Geographical Society of Finland. - 1798-5617. ; 197:1, s. 94-107 Tidskriftsartikel (refereegranskat)abstract Will life satisfaction among international students change after having an experience of studying abroad? Some previous studies indicate inequalities and issues of social mobility embedded in international student mobility. International student mobility implies physical movement and new experiences gained while studying abroad. The ubiquity of international students and their generally successful adaptation makes it necessary to understand how they manage to turn a seemingly difficult situation into satisfying adaptation. One area of such concern that this study sought to explore was the students’ level of satisfaction with life. This study investigated the self-reported life satisfaction of inbound university students upon arrival to a university in northern Sweden and at follow-up six months later. After the study period abroad, the students’ levels of perceived satisfaction with their somatic health and activities of daily living had significantly increased. Higher levels, while non-significant, were found for the domains life as a whole, study situation and economy. These findings may indicate that studying abroad could have an impact on students’ reported life satisfaction, which highlights the value of a period of studying abroad. However, when exploring life satisfaction outcomes among internationally mobile students, it seems pertinent to study student mobility within a context. This study mostly targets international student mobility in a Western/European contex
26.	Nygren DeBoussard, Catharina, et al. (författare) Behavioural problems in the first year after Severe traumatic brain injury : a prospective multicentre study 2017 Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 31:4, s. 555-566 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To investigate the occurrence of behavioural problems in patients with severe traumatic brain injury during the first year after injury and potential associations with outcome. An additional post hoc objective was to analyse the frequency of behaviours with need for intervention from staff.DESIGN AND SETTING: In a prospective population based cohort study 114 patients with severe traumatic brain injury were assessed at three weeks, three months and one year after injury.MAIN MEASURES: Assessments included clinical examination and standardised instruments. Agitation was assessed with the Agitated Behaviour Scale, the course of recovery by the Rancho Los Amigo Scale and outcome by Glasgow Outcome Scale Extended.RESULTS: Agitation were most common at 3 weeks post injury and 28% (n=68) of the patients showed at least one agitated behaviour requiring intervention from staff. Presence of significant agitation at 3 weeks after injury was not associated with poor outcome. At 3 months agitation was present in 11% (n=90) and apathy in 26 out of 81 assessed patients. At 3 months agitation and apathy were associated with poor outcome at one year.CONCLUSIONS: Most agitated behaviours in the early phase are transient and are not associated with poor outcome. Agitation and apathy are uncommon at three months but when present are associated with poor outcome at one year after injury. In the early phase after a severe traumatic brain injury agitated behaviour in need of interventions from staff occur in a substantial proportion of patients.
27.	Ohlsson, Anna (författare) Biochemical brain tissue markers and heart rate distribution in elite female soccer players 2016 Licentiatavhandling (övrigt vetenskapligt/konstnärligt)
28.	Ohlsson, Anna, et al. (författare) Heart Rate Distribution during Training and a Domestic League Game in Swedish Elite Female Soccer Players 2015 Ingår i: Annals of Sports Medicine and Research. - : JSciMed Central. - 2379-0571. ; 2:4 Tidskriftsartikel (refereegranskat)abstract Background: Soccer is a complex sport with high cardiovascular demands. Preparation for the demands of competition often involves game-simulation practice. This is supposed to improve the physiological adaptions. The main purpose of this study was to compare heart rate (HR) distribution among elite female soccer players during in-season training sessions and a game. Methods: Fifteen players were observed during three regular training sessions, and at a domestic league game using Polar Team2 HR monitors. HR was categorized into HR zones to compare intensities of each activity observed. Results: HR values were significantly higher during the game (HRmean: 168±9 beats per minute (bpm), HRpeak: 189±8 bpm) than during training (HRmean: 134±11 bpm, HRpeak: 183±9 bpm, p<0.001). Players spent 55% of the game and 11% of the total training time at high intensity (HR above 90% of HRpeak, p<0.001).HRmean and HRpeak were significantly higher in the first half compared with the second half of the game (p<0.05). Conclusion: The present study demonstrates higher HR values and longer duration at high intensity during game play in comparison with training, which indicates higher demands on the players' internal load during the game. Thus, the results suggest the need to include high intensity exercise sessions during training.
29.	Pietilä Holmner, Elisabeth, 1953- (författare) Multimodal rehabilitation of patients with chronic musculoskeletal pain, focusing on primary care 2018 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Background: Chronic pain is a complex condition that has consequences both for individual people and for society. The individual often experiences impact on function, activity and participation. Society is affected by high healthcare and sick leave costs and a loss of workforce. Multimodal rehabilitation programmes (MMRP) have mainly been provided through specialist care but it is now also available through primary care. The overall aim of this thesis was to evaluate the effects of MMRP in patients with chronic musculoskeletal pain and to explore patients’ and healthcare professionals’ experiences of MMRP.Study I: Aim: To evaluate the effects of an interdisciplinary team assessment and MMRP for patients with chronic pain in a specialist care setting. Design: Longitudinal cohort study. Method: Pain intensity, pain dimensions, anxiety and depression were measured at assessment and at the start and end of MMRP. A total of 93 women were evaluated. Result: Pain and pain-related measures were significantly improved both after the interdisciplinary assessment and after MMRP.Study II: Aim: To explore healthcare professionals’ experiences of MMRP in primary care. Design: Individual interviews, analysed with qualitative content analysis. Method: Fourteen healthcare professionals (11 women, 3 men) were interviewed about their work with MMRP. Result: Healthcare professionals considered that MMRP was useful but also challenging. It was difficult to select appropriate patients, and health care professionals felt they were torn between following healthcare legislation and the goals of MMRP. They had to deal with ethical dilemmas as well as decide what constitutes good results.Study III: Aim: To explore patients’ experiences of participating in MMRP in primary care. Design: Individual interviews, analysed with qualitative content analysis. Method: Twelve former patients (7 women and 5 men) were interviewed about their experiences of MMRP in primary care. Result: Patients in primary care experienced a complex, ongoing process of accepting chronic pain. Obtaining redress, learning about chronic pain, and experiencing fellowship with others with the same condition contributed to the acceptance process.Study IV: Aim: To evaluate the effects of MMRP in primary care at one-year follow-up for all patients together and for men and women separately and to identify predictive factors for being employable at follow-up. Design: Prospective longitudinal cohort study. Method: Pain, physical and emotional functioning, coping, health-related quality of life, work-related factors, sick leave extent and sickness compensation were evaluated prior to and one year after MMRP in 234 patients, 34 men and 200 women. Result: All patients improved significantly in most measures at one-year follow-up, and the effect was larger in women. Sick leave decreased while no significant difference was found for total sickness compensation. Patients’ self-reported rating of current work ability before MMRP was significantly associated with being employable at follow-up.General conclusions and implications: MMRP seems to be effective for patients with chronic musculoskeletal pain, both in specialist care and in primary care. MMRP was more effective for women than for men, and the reasons for this need to be investigated further. An interdisciplinary team assessment could also be beneficial for decreasing pain and pain-related measures. Patients in primary care experience a complex, ongoing process of accepting chronic pain. Healthcare professionals have to deal with conflicting emotions with regard to different commitments from healthcare legislation and the goals of MMRP.
30.	Pietilä Holmner, Elisabeth, et al. (författare) ”The acceptance” of living with chronic pain – an ongoing process: A qualitative study of patient experiences of multimodal rehabilitation in primary care 2018 Ingår i: Journal of Rehabilitation Medicine. - : FOUNDATION REHABILITATION INFORMATION. - 1650-1977 .- 1651-2081. ; 50:1, s. 73-79 Tidskriftsartikel (refereegranskat)abstract Objective: To explore patient experiences of participating in multimodal pain rehabilitation in primary care. Subjects: Twelve former patients (7 women and 5 men) in multimodal rehabilitation in primary care were interviewed about their experiences of multimodal rehabilitation. Methods: The interviews were analysed using qualitative content analysis. Results: Analysis resulted in 4 categories: (i) from discredited towards obtaining redress; (ii) from uncertainty towards knowledge; (iii) from loneliness towards togetherness; and (iv) "acceptance of pain": an ongoing process. The results show that having obtained redress, to obtain knowledge about chronic pain, and to experience fellowship with others with the same condition were helpful in the acceptance process. However, there were patients who found it difficult to reconcile themselves with a life with chronic pain after multimodal rehabilitation. To find what was "wrong" and to have a medical diagnosis and cure were important. Conclusion: Patients in primary care multimodal rehabilitation experience a complex, ongoing process of accepting chronic pain. Four important categories were described. These findings will help others to understand the experience and perspective of patients with chronic pain who engage in multimodal rehabilitation.
31.	Rankin, Linda, 1987-, et al. (författare) Differences in Swedish and Australian medical student attitudes and beliefs about chronic pain, its management, and the way it is taught 2018 Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter. - 1877-8860 .- 1877-8879. ; 18:3, s. 533-544 Tidskriftsartikel (refereegranskat)abstract Background and aims: Medical students receive training in the management of chronic pain, but the training is often suboptimal. Considering that the basis for physician’s knowledge is their medical education, it is important to explore the attitudes and beliefs of medical students with respect both to chronic pain management and to their views on current pain education. Therefore, the aim of this study was to compare Swedish and Australian medical student’s attitudes and beliefs about patients with chronic pain, and their perceptions regarding their chronic pain management education.Methods: An online survey was conducted with final year Australian and Swedish medical students from two different universities between December 2016 and February 2017. Attitudes and beliefs towards chronic pain patients were measured using the Health Care Providers’ Pain and Impairment Scale (HC-PAIRS). A thematic analysis was conducted on open end questions regarding their views on their education and important skills for chronic pain management.Results: A total of 57 Swedish and 26 Australian medical students completed the HC-PAIRS scale. The Swedish medical students showed statistically significantly lower total mean HC-PAIRS scores compared to Australian medical students (46 and 51, respectively). Australian students had statistically significantly higher scores than the Swedish students for two of four factors: functional expectations and need for cure, whereas no significant differences were seen for the factors social expectations or for projected cognition. From the open end questions it was evident that final year medical students are knowledgeable about key chronic pain items described in clinical guidelines. However, both cohorts described their chronic pain training as poor and in need of improvement in several areas such as more focus on the biopsychosocial model, working in multidisciplinary teams, seeing chronic pain patients and pharmacological training.Conclusions: Attitudes and beliefs are formed during medical education, and our study exploring attitudes of medical students towards chronic pain and how it is taught have provided valuable information. Our survey provided detailed and cohesive suggestions for education improvement that also are in line with current clinical guidelines. This study indicates that the Swedish final year students have a more positive attitude towards chronic pain patients compared to their Australian counterparts. The majority of students in both cohorts perceived chronic pain management education in need of improvement.Implications: This study highlights several areas of interest that warrant further investigation, for example, the impact of a changed medical curriculum in alignment with these clinical guidelines requested by students in this survey, and correspondingly if their attitudes towards chronic pain patients can be improved through education. Further, we conclude that it would be valuable to align the implementation of the HC-PAIRS instrument in order to achieve comparable results between future studies.
32.	Rankin, Linda, 1987-, et al. (författare) What influences chronic pain management? : A best-worst scaling experiment with final year medical students and general practitioners 2019 Ingår i: British Journal of Pain. - : SAGE Publications. - 2049-4637 .- 2049-4645. ; 13:4, s. 214-225 Tidskriftsartikel (refereegranskat)abstract Background: Chronic pain education is an essential determinant for optimal chronic pain management. Given that attitudes and preferences are involved in making treatment decisions, identifying which factors are most influential to final year medical students’ and general practitioners’ (GPs) chronic pain management choices is of importance. This study investigates Swedish and Australian students’ preferences with respect to a chronic pain condition, using a best–worst scaling (BWS) experiment, which is designed to rank alternatives.Methods: BWS, a stated-preference method grounded in random utility theory, was used to explore the importance of factors influencing chronic pain management.Results: All three cohorts considered the patients’ pain description and previous treatment experience as the most important factors in making treatment decisions, whereas their demographics and voices or facial expressions while describing their pain were considered least important. Factors such as social support, patient preferences and treatment adherence were, however, disregarded by all cohorts in favour of pain assessment factors such as pain ratings, description and history. Swedish medical students and GPs show very high correlation in their choices, although the GPs consider their professional experience as more important compared to the students.Conclusion: This study suggests that the relative importance of treatment factors is cemented early and thus underline the critical importance of improving pain curricula during undergraduate medical education.
33.	Spinord, Linda, et al. (författare) Comparison of two multimodal pain rehabilitation programmes, in relation to sex and age 2018 Ingår i: Journal of Rehabilitation Medicine. - : FOUNDATION REHABILITATION INFORMATION. - 1650-1977 .- 1651-2081. ; 50:7, s. 619-628 Tidskriftsartikel (refereegranskat)abstract Objective: To evaluate patient-reported outcome measures in 2 different multimodal pain rehabilitation programmes and to determine whether outcomes are related to sex or age at 1-year follow-up.Design: Longitudinal retrospective study.Subjects: Patients who had participated in 1 of 2 multimodal pain rehabilitation programmes at 2 rehabilitation centres. A total of 356 women and 83 men, divided into 3 age groups.Methods: Data from the Swedish Quality Registry for Pain Rehabilitation regarding activity and physical functions, pain intensity, health status and emotional functions analysed with descriptive statistics.Results: Significant improvements in activity and physical functions, pain intensity and emotional functions were found in both multimodal pain rehabilitation programmes. Women improved more than men. The older group improved in all emotional functions (depression, anxiety, mental component summary), while the younger group improved only in depression. The intermediate group improved in all variables except anxiety.Conclusion: Patients improved regardless of the design of the multimodal pain rehabilitation programme. Although only small differences were found between men and women and among the 3 age groups in terms of the measured variables, these findings may have clinical relevance and indicate a need to vary the design of the interventions in multimodal rehabilitation programmes for these subgroups.
34.	Stenberg, Gunilla, et al. (författare) Healthcare professional experiences with patients who participate in multimodal pain rehabilitation in primary care : a qualitative study 2016 Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 38:21, s. 2085-2094 Tidskriftsartikel (refereegranskat)abstract Purpose: Exploring healthcare professional experiences of Multimodal rehabilitation (MMR) in primary care.Methods: Fourteen healthcare professionals (11 women, 3 men) were individually interviewed about their work with MMR in primary care. Interviews covered experiences of assessing patients and work with patients in the programme. Transcribed interviews were analysed by qualitative content analysis.Results: The analysis resulted in four categories: select patients for success; a multilevel challenge; ethical dilemmas and considering what is a good result. MMR work was experienced as useful and efficient, but also challenging because of patient complexity. Preconceptions about who is a suitable patient for MMR influenced the selection of patients (e.g. gender, different culture). Interviewees were conflicted about not to being able to offer MMR to patients who were not going to return to work. They thought that there were more factors to evaluate MMR than by the proportion that return to work.Conclusions: Healthcare professionals perceive MMR as a helpful method for treating chronic pain patients. At the same time, they thought that only including patients who would return to work conflicted with their ethical views on equal healthcare for all patients. Preconceptions can influence selection for, and work with, MMR.
35.	Stenberg, Gunilla, et al. (författare) Implementing multimodal pain rehabilitation in primary care : a health care professional perspective 2017 Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 39:21, s. 2173-2181 Tidskriftsartikel (refereegranskat)abstract Purpose: To explore professional perspectives on how to start and work with multimodal pain rehabilitation within primary healthcare. Methods: Fourteen healthcare professionals (11 women, 3 men) were individually interviewed about their experiences of starting and working with multimodal pain. Interviews were transcribed and analyzed by qualitative content analysis. This study was part of a larger project, which aimed at evaluating multimodal pain rehabilitation in primary care. Results: The analysis resulted in six categories. Two categories were about management engagement: putting the focus on rehabilitation and creating appropriate conditions. Three were about professional engagement: importance of driving spirits, creating a program - a process, and good teamwork - not a coincidence. The last category was about professional gain from multimodal rehabilitation (MMR): team work is enriching. Conclusions: To enable implementation of MMR in primary care, managers on all organizational levels must take responsibility for allowing rehabilitation to be a priority. A driving spirit among the professionals facilitates the start, but the entire team is important when processing a program. Creating good teamwork requires hard work, e.g., negotiations for consensus about rehabilitation, and assumption of responsibility by each team member. Collaboration between professionals was perceived to strengthen and enhance knowledge about the patients.
36.	Stenberg, Maud, et al. (författare) Cognitive impairment after severe traumatic brain injury, clinical course and impact on outcome : a Swedish-Icelandic study 2015 Ingår i: Behavioural Neurology. - New York : Hindawi Publishing Corporation. - 0953-4180 .- 1875-8584. Tidskriftsartikel (refereegranskat)abstract Objective. To assess the clinical course of cognitive and emotional impairments in patients with severe TBI (sTBI) from 3 weeks to 1 year after trauma and to study associations with outcomes at 1 year.Methods. Prospective, multicenter, observational study of sTBI in Sweden and Iceland. Patients aged 18-65 years with acute Glasgow Coma Scale 3-8 were assessed with the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) and the Hospital Anxiety and Depression Scale (HADS). Outcome measures were Glasgow Outcome Scale Extended (GOSE) and Rancho Los Amigos Cognitive Scale-Revised (RLAS-R).Results. Cognition was assessed with the BNIS assessed for 42 patients out of 100 at 3 weeks, 75 patients at 3 months, and 78 patients at 1 year. Cognition improved over time, especially from 3 weeks to 3 months. The BNIS subscales "orientation" and "visuospatial and visual problem solving" were associated with the GOSE and RLAS-R at 1 year.Conclusion. Cognition seemed to improve over time after sTBI and appeared to be rather stable from 3 months to 1 year. Since cognitive function was associated with outcomes, these results indicate that early screening of cognitive function could be of importance for rehabilitation planning in a clinical setting.
37.	Stenberg, Maud, et al. (författare) Computed tomography and clinical outcome in patients with severe traumatic brain injury 2017 Ingår i: Brain Injury. - : Informa UK Limited. - 0269-9052 .- 1362-301X. ; 31:3, s. 351-358 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To study: (i) acute computed tomography (CT) characteristics and clinical outcome; (ii) clinical course and (iii) Corticosteroid Randomisation after Significant Head Injury acute calculator protocol (CRASH) model and clinical outcome in patients with severe traumatic brain injury (sTBI).METHODS: Initial CT (CTi) and CT 24 hours post-trauma (CT24) were evaluated according to Marshall and Rotterdam classifications. Rancho Los Amigos Cognitive Scale-Revised (RLAS-R) and Glasgow Outcome Scale Extended (GOSE) were assessed at three months and one year post-trauma. The prognostic value of the CRASH model was evaluated.RESULTS: Thirty-seven patients were included. Marshall CTi and CT24 were significantly correlated with RLAS-R at three months. Rotterdam CT24 was significantly correlated with GOSE at three months. RLAS-R and the GOSE improved significantly from three months to one year. CRASH predicted unfavourable outcome at six months for 81% of patients with bad outcome and for 85% of patients with favourable outcome according to GOSE at one year.CONCLUSION: Neither CT nor CRASH yielded clinically useful predictions of outcome at one year post-injury. The study showed encouragingly many instances of significant recovery in this population of sTBI. The combination of lack of reliable prognostic indicators and favourable outcomes supports the case for intensive acute management and rehabilitation as the default protocol in the cases of sTBI.
38.	Stenberg, Maud, 1957- (författare) Severe traumatic brain injury : clinical course and prognostic factors 2016 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Traumatic brain injury (TBI) constitutes a major health problem and is a leading cause of long-term disability and death. Patients with severe traumatic brain injury, S-TBI, comprise a heterogeneous group with varying complexity and prognosis. The primary aim of this thesis was to increase knowledge about clinical course and outcome with regard to prognostic factors. Papers I, II and III were based on data from a prospective multicentre observational study from six neurotrauma centers (NCs) in Sweden and Iceland of patients (n=103-114), 18-65 years with S-TBI requiring neurosurgical intensive care or collaborative care with a neurosurgeon (the “PROBRAIN” study). Paper IV and V were performed on a regional subset (n=37).In Paper I, patients with posttraumatic disorders of consciousness (DOC) were assessed as regards relationship between conscious state at 3 weeks and outcomes at 1 year. The number of patients who emerged from minimally conscious state (EMCS) 1 year after injury according to status at 3 weeks were: coma (0/6), unresponsive wakeful syndrome (UWS) (9/17), minimally conscious state (MCS) (13/13), anaesthetized (9/11). Outcome at 1 year was good (Glasgow Outcome Scale Extended (GOSE>4) in half of the patients in MCS (or anaesthetized) at 3 weeks, but not for any of the patients in coma or UWS. In Paper II, the relationships between clinical care descriptors and outcome at 1 year were assessed. A longer length of stay in intensive care, and longer time between discharge from intensive care and admission to inpatient rehabilitation, were both associated with a worse outcome on the GOSE. The number of intervening care units between intensive care and rehabilitation, was not significantly associated with outcome at 1 year. In Paper III, the clinical course of cognitive and emotional impairments as reflected in the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) and the Hospital Anxiety and Depression Scale (HADS) were assessed from 3 weeks to 1 year together with associations with outcomes GOSE and Rancho Los Amigos Cognitive Scale-Revised (RLAS-R) at 1 year. Cognition improved over time and appeared to be stable from 3 months to 1 year. In Paper IV, clinical parameters, the clinical pathways from injury to 3 months after discharge from the NC in relation to outcomes 3 months post-injury. Ratings on the RLAS-R improved significantly over time. Eight patients had both “superior cognitive functioning” on the RLAS-R and “favourable outcome” on the GOSE. Acute transfers to the one regional NC was direct and swift, transfers for postacute rehabilitation scattered patients to many hospitals/hospital departments, not seldom by several transitional stages. In Paper V, an initial computerized tomography of the brain (CTi) and a further posttraumatic brain CT after 24 hours (CT24) were evaluated according to protocols for standardized assessment, the Marshall and Rotterdam classifications. The CT scores only correlated with clinical outcome measures (GOSE and RLAS-R) at 3 months, but failed to yield prognostic information regarding outcome at 1 year. A prognostic model was also implemented, based on acute data (CRASH model). This model predicted unfavourable outcomes for 81% of patients with bad outcome and for 85% of patients with favourable outcome according to GOSE at 1 year. When assessing outcomes per se, both GOSE and RLAS-R improved significantly from 3 months to 1 year. The papers in this study point both to the generally favourable outcomes that result from active and aggressive management of S-TBI, while also underscore our current lack of reliable instruments for outcome prediction. In the absence of an ability to select patients based on prognostication, the overall favourable prognosis lends support for providing active rehabilitation to all patients with S-TBI. The results of these studies should be considered in conjunction with the prognosis of long-term outcomes and the planning of rehabilitation and care pathways. The results demonstrate the importance of a combination of active, acute neurotrauma care and intensive specialized neurorehabilitation with follow-up for these severely injured patients.
39.	Stålnacke, Britt-Marie, et al. (författare) Is there a gender bias in recommendations for further rehabilitation in primary care of patients with chronic pain after an interdisciplinary team assessment? 2015 Ingår i: Journal of Rehabilitation Medicine. - : Foundation of Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 47:4, s. 365-371 Tidskriftsartikel (refereegranskat)abstract Objective: To examine potential gender bias in recommendations of further examination and rehabilitation in primary care for patients with chronic musculoskeletal pain after an interdisciplinary team assessment. Methods: The population consisted of consecutive patients (n=589 women, 262 men) referred during a 3-year period from primary healthcare for assessment by interdisciplinary teams at a pain specialist rehabilitation clinic. Patient data were collected from the Swedish Quality Registry for Pain Rehabilitation. The outcome was defined as the examination or rehabilitation that was specified in the patient's record. Results: Men had a significantly higher likelihood than women of being recommended physiotherapy and radiological examination, and the gender difference was not explained by confounding variables and covariates (age, marital status, ethnicity, education, working status, pain severity, pain interference, pain sites, anxiety and depression). There was no significant gender difference in recommendations to treatment by specialist physician, occupational therapist, psychologist or social worker. Conclusion: Our findings indicate that the interdisciplinary teams in specialist healthcare may discriminate against women with chronic pain when physiotherapy and radiological investigation are recommended. The team's choice of recommendations might be influenced by gendered attitudes, but this field of research needs to be studied further.
40.	Stålnacke, Britt-Marie, et al. (författare) Skalor och utfallsmått för klinisk verksamhet och forskning inom rehabiliteringsmedicin 2015 Bok (övrigt vetenskapligt/konstnärligt)
41.	Stålnacke, Britt-Marie, et al. (författare) Visst undervisas det om smärta i Umeå och vid KI 2018 Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; :115 Tidskriftsartikel (populärvet., debatt m.m.)
42.	Svanberg, Mikael, 1958-, et al. (författare) Impact of emotional distress and pain-related fear on patients with chronic pain : Subgroup analysis of patients referred to multimodal rehabilitation 2017 Ingår i: Journal of Rehabilitation Medicine. - : Foundation for Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 49:4, s. 354-361 Tidskriftsartikel (refereegranskat)abstract Objective: Multimodal rehabilitation programmes (MMRP) for chronic pain could be improved by determining which patients do not benefit fully. General distress and pain-related fear may explain variations in the treatment effects of MMRP.Design: Cohort study with a cross-sectional, prospective part.Patients: Chronic musculoskeletal pain patients referred to 2 hospital-based pain rehabilitation clinics.Methods: The cross-sectional part of this study cluster analyses patients (n = 1,218) with regard to distress and pain-related fear at first consultation in clinical pain rehabilitation and describes differences in external variables between clusters. The prospective part follows the subsample of patients (n = 260) participating in MMRP and describes outcome post-treatment.Results: Four distinct subgroups were found: (i) those with low levels of distress and pain-related fear; (ii) those with high levels of pain-related fear; (iii) those with high levels of distress; and (iv) those with high levels of distress and pain-related fear. These subgroups showed differences in demographics, pain characteristics, quality of life, and acceptance, as well as the degree of MMRP participation and MMRP outcome.Conclusion: Among patients with chronic pain referred to MMRP there are subgroups with different profiles of distress and pain-related fear, which are relevant to understanding the adaptation to pain and MMRP outcome. This knowledge may help us to select patients and tailor treatment for better results.
43.	Söderlund, Anne, 1957-, et al. (författare) Exploring patients' experiences of the whiplash injury-recovery process : a meta-synthesis 2018 Ingår i: Journal of Pain Research. - : DOVE MEDICAL PRESS LTD. - 1178-7090. ; 11, s. 1263-1271 Forskningsöversikt (refereegranskat)abstract Purpose: The aim of this study was to conduct a meta-synthesis to analyze qualitative research findings and thereby understand patients' experiences of whiplash-associated disorders (WAD) and the injury-recovery process.Materials and methods: A qualitative meta-synthesis, which is an interpretive integration of existing qualitative findings, was performed. The databases PubMed, PsychINFO, Scopus, and Web of Science were searched. The Critical Assessment Skills Programme was used to assess the quality of the included studies.Results: Four studies were included. The synthesis resulted in several codes, 6 categories, and 3 themes (distancing from normalcy, self-efficacy in controlling the life situation after the injury, and readjustment and acceptance) that described the participants' pain beliefs, their WAD-related life situation and their future expectations and acceptance. Changes in self-image were difficult to cope with and likely led to perceived stigmatization. Struggling with feelings of loss of control appeared to lead to low confidence and insecurity. Focusing on increasing knowledge and understanding the pain and its consequences were believed to lead to better strategies for handling the situation. Furthermore, recapturing life roles, including returning to work, was challenging, but an optimistic outlook reinforced symptom improvements and contributed to feelings of happiness.Conclusion: The results of the present study provide a comprehensive understanding of patients' complex, multifaceted experiences of WAD, and the injury-recovery process. The findings can guide us in the development of new ways to evaluate and manage WAD. The results also indicate that a more patient-centered approach is needed to determine the depth and breadth of each patient's problems.
44.	Söderlund, Anne, 1957-, et al. (författare) Predictors before and after multimodal rehabilitation for pain acceptance and engagement in activities at a 1-year follow-up for patients with whiplash-associated disorders (WAD)-a study based on the Swedish Quality Registry for Pain Rehabilitation (SQRP) 2018 Ingår i: The spine journal. - : Elsevier. - 1529-9430 .- 1878-1632. ; 18:8, s. 1475-1482 Tidskriftsartikel (refereegranskat)abstract BACKGROUND CONTEXT: Studies have shown that pain acceptance strategies related to psychological flexibility are important in the presence of chronic musculoskeletal pain. However, the predictors of these strategies have not been studied extensively in patients with whiplash-associated disorders (WAD).PURPOSE: The purpose of this study was to predict chronic pain acceptance and engagement in activities at 1-year follow-up with pain intensity, fear of movement, perceived responses from significant others, outcome expectancies, and demographic variables in patients with WAD before and after multimodal rehabilitation (MMR).STUDY DESIGN: The design of this investigation was a cohort study with 1-year postrehabilitation follow-up.STUDY SETTING: The subjects participated in MMR at a Swedish rehabilitation clinic during 2009-2015.PATIENT SAMPLE: The patients had experienced a whiplash trauma (WAD grade I-II) and were suffering from pain and reduced functionality. A total of 386 participants were included: 297 fulfilled the postrehabilitation measures, and 177 were followed up at 1 year after MMR.OUTCOME MEASURES: Demographic variables, pain intensity, fear of movement, perceived responses from significant others, and outcome expectations were measured at the start and after MMR. Chronic pain acceptance and engagement in activities were measured at follow-up.METHODS: The data were obtained from a Swedish Quality Registry for Pain Rehabilitation (SQRPR).RESULTS: Outcome expectancies of recovery, supporting and distracting responses of significant others, and fear of (re)injury and movement before MMR were significant predictors of engagement in activities at follow-up. Pain intensity and fear of (re)injury and movement after MMR significantly predicted engagement in activities at follow-up. Supporting responses of significant others and fear of (re)injury and movement before MMR were significant predictors of pain acceptance at the 1-year follow-up. Solicitous responses of significant others and fear of (re)injury and movement at postrehabilitation significantly predicted pain acceptance at follow-up.CONCLUSION: For engagement in activities and pain acceptance, the fear of movement appears to emerge as the strongest predictor, but patients' perceived reactions from their spouses need to be considered in planning the management of WAD.
45.	Tseli, Elena, et al. (författare) Predictors of multidisciplinary rehabilitation outcome in chronic musculoskeletal pain : a systematic review and meta-analysis, in process 2017 Konferensbidrag (refereegranskat)
46.	Tseli, Elena, et al. (författare) Predictors of multidisciplinary rehabilitation outcomes in patients with chronic musculoskeletal pain : protocol for a systematic review and meta-analysis 2017 Ingår i: Systematic Reviews. - : BioMed Central (BMC). - 2046-4053. ; 6:1 Forskningsöversikt (refereegranskat)abstract BACKGROUND: Chronic musculoskeletal pain is a major public health problem. Early prediction for optimal treatment results has received growing attention, but there is presently a lack of evidence regarding what information such proactive management should be based on. This study protocol, therefore, presents our planned systematic review and meta-analysis on important predictive factors for health and work-related outcomes following multidisciplinary rehabilitation (MDR) in patients with chronic musculoskeletal pain.METHODS: We aim to perform a synthesis of the available evidence together with a meta-analysis of published peer-reviewed original research that includes predictive factors preceding MDR. Included are prospective studies of adults with benign, chronic (> 3 months) musculoskeletal pain diagnoses who have taken part in MDR. In the studies, associations between personal and rehabilitation-based factors and the outcomes of interest are reported. Outcome domains are pain, physical functioning including health-related quality of life, and work ability with follow-ups of 6 months or more. We will use a broad, explorative approach to any presented predictive factors (demographic, symptoms-related, physical, psychosocial, work-related, and MDR-related) and these will be analyzed through (a) narrative synthesis for each outcome domain and (b) if sufficient studies are available, a quantitative synthesis in which variance-weighted pooled proportions will be computed using a random effects model for each outcome domain. The strength of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation.DISCUSSION: The strength of this systematic review is that it aims for a meta-analysis of prospective cohort or randomized controlled studies by performing an extensive search of multiple databases, using an explorative study approach to predictive factors, rather than building on single predictor impact on the outcome or on predefined hypotheses. In this way, an overview of factors central to MDR outcome can be made and will help strengthen the evidence base and inform a wide readership including health care practitioners and policymakers.SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016025339.
47.	Tseli, Elena, et al. (författare) Prognostic Factors for Physical Functioning After Multidisciplinary Rehabilitation in Patients With Chronic Musculoskeletal Pain : A Systematic Review and Meta-Analysis 2019 Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 35:2, s. 148-173 Forskningsöversikt (refereegranskat)abstract OBJECTIVES: This systematic review aimed to identify and evaluate prognostic factors for long-term (≥6 mo) physical functioning in patients with chronic musculoskeletal pain following multidisciplinary rehabilitation (MDR).MATERIALS AND METHODS: Electronic searches conducted in MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, and Cochrane CENTRAL revealed 25 original research reports, published 1983-2016, (n=9436). Potential prognostic factors relating to initial pain and physical and psychological functioning were synthesized qualitatively and quantitatively in random effects meta-analyses. The level of evidence (LoE) was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE).RESULTS: Pain-related factors (intensity and chronicity) were not associated with function/disability at long-term follow-up, odds ratio (OR)=0.84; 95% confidence interval (CI), 0.65-1.07 and OR=0.97; 95% CI, 0.93-1.00, respectively (moderate LoE). A better function at follow-up was predicted by Physical factors; higher levels of initial self-reported functioning, OR=1.07; 95% CI, 1.02-1.13 (low LoE), and Psychological factors; low initial levels of emotional distress, OR=0.77; 95% CI, 0.65-0.92, low levels of cognitive and behavioral risk factors, OR=0.85; 95% CI, 0.77-0.93 and high levels of protective cognitive and behavioral factors, OR=1.49; 95% CI, 1.17-1.90 (moderate LoE).DISCUSSION: While pain intensity and long-term chronicity did not predict physical functioning in chronic pain patients after MDR, poor pretreatment physical and psychological functioning influenced the prognosis negatively. Thus, treatment should further target and optimize these modifiable factors and an increased focus on positive, psychological protective factors may perhaps provide an opening for yet untapped clinical gains.
48.	Wiklund, Maria, et al. (författare) Access to rehabilitation : patient perceptions of inequalities in access to specialty pain rehabilitation from a gender and intersectional perspective 2016 Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 9 Tidskriftsartikel (refereegranskat)abstract Background: Long-term musculoskeletal pain is common, particularly among women. Pain conditions are a concern in primary health care, and people with severe and complex pain are referred to specialty health care. There is gender bias in access, counselling, assessment, and treatment of long-term pain.Objective: This study explores patient accounts and perceptions about important (social) factors for accessing specialised pain rehabilitation from gender and intersectional equality perspectives. We aimed to identify potential biases and inequalities in accessing rehabilitation resources at a specialised rehabilitation clinic.Design: Individual semi-structured interviews were conducted with 10 adults after an assessment or completion of a specialised rehabilitation programme in northern Sweden. Qualitative content analysis was used to explore patients’ perceptions of important factors for accessing rehabilitation.Results: One main theme was formulated as Access to rehab – not a given. Three categories of perceived inequality were demonstrated: power of gender, power of social status, and power of diagnosis. Participants perceived rehabilitation as a resource that is not equally available, but dependent on factors such as gender, socio-economic status, ability to work, ethnicity, or age, and more subtle aspects of social status and habitus (e.g. appearance, fitness, and weight). The character of diagnosis received (medical versus psychiatric or social) was also noted.Conclusions: It is crucial that professionals are aware of how potential inequalities related to gender, social status, and diagnosis, and their intersections, can be created, perceived, and have influence on the processes of assessment and treatment. Reduction of social determinants of health and biases remain important within global, national, and local contexts.

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