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1.	Axén, Iben, et al. (author) Can a workplace dialogue impact the perceived influence of neck and/or backpain on everyday activities and performance at work? A secondary analysis from the randomized controlled trial WorkUp 2022 In: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 23:1 Journal article (peer-reviewed)abstract Background: Neck- and back- pain are highly prevalent conditions in Sweden and world-wide. Such pain often has consequences on everyday activities, work- and personal life. One consequence is work absence and decreased productivity at work. Adding a workplace dialogue to structured physiotherapy was recently found to lead to increased workability, i.e., not being on sick leave during the 12th month of follow up. Aim: The aim of the study was to explore the effect of a workplace dialogue intervention on secondary outcomes: perceived impact of neck and/or back pain on everyday activities and on performance at work, and total days of sick leave during 12 month follow up. A further aim was to examine associations between perceived influence of pain, and sick leave. Method: Patients with neck and/or back pain in primary care in the south of Sweden were randomized into structured physiotherapy alone (n = 206) or with the addition of a workplace dialogue (n = 146). Data regarding the pain’s influence on everyday activities and on performance at work were collected using weekly text messages for 52 weeks. The pattern of change in perceived influence of neck and/or back pain on everyday activities and performance at work was compared between the groups with linear mixed models. Cross sectional correlations between perceived influence of neck and/or back pain on everyday activities and performance at work, and days of sick leave, during the preceding four weeks at months 3, 6, 9 and 12 were examined. Result: We found no differences in change of perceived influence of neck and/or back pain on daily activities or perceived performance at work, or total days of sick leave during the 12 months of follow up between the groups with structured physiotherapy with or without a workplace dialogue. There was a weak to moderate positive correlation between days of sick leave and perceived influence of neck and/or back pain on everyday activities and performance at work (rho 0.28–0.47). Conclusion: A workplace dialogue was not found to affect the perceived impact of neck and/or back pain on everyday activities and performance at work. Trial registration: ClinicalTrials.gov ID: NCT02609750.
2.	Bondesson, Elisabeth, et al. (author) Utilization of healthcare and prescription medicines after non-pharmacological interventions for depression - A 3-year register follow-up of an RCT in primary care 2022 In: Preventive Medicine Reports. - : Elsevier. - 2211-3355. ; 25 Journal article (peer-reviewed)abstract Depression is a common, recurrent disorder. There is a need for readily available treatments with few negative side effects, that demands little resources and that are effective both in the short- and long term. Our aim was to investigate the long-term effectiveness of two different interventions; physical exercise and internet-based cognitive behavioural therapy (internet-CBT), compared to usual care in patients with mild to moderate depression in a Swedish primary care setting. We performed a register-based 3-year follow-up study of participants in the randomized controlled trial REGASSA (n = 940) using healthcare utilization and dispensed medicines as outcomes. We found no difference between the three groups regarding proportion of participants consulting healthcare due to mental illness or pain during follow-up. Regarding number of consultations, there was no difference between the groups, except for consultations related to pain. For this outcome both treatment arms had significantly fewer consultations compared to usual care, during year 2-3, the risk ratio (RR) for physical exercise and internet-CBT was 0.64 (95% CI = 0.43-0.95) and 0.61 (95% CI = 0.41-0.90), respectively. A significantly lower proportion of patients in both treatment arms were dispensed hypnotics and sedatives year 2-3 compared to the usual care arm, RR for both physical exercise and internet-CBT was 0.72 (95% CI = 0.53-0.98). No other differences between the groups were found. In conclusion, considering long-term effects, both physical exercise and internet-CBT, being resource-efficient treatments, could be considered as appropriate additions for patients with mild to moderate depression in primary care settings.
3.	Boström, Maria, et al. (author) Health and work environment among female and male Swedish elementary school teachers - A cross-sectional study 2020 In: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 17:1 Journal article (peer-reviewed)abstract BACKGROUND AND OBJECTIVES: Changes in teachers' work situation in Sweden since the 1990s may have contributed to an increase in common mental disorders (CMDs) and burnout. However, there is a lack of research in this field. The aim was to describe how Swedish elementary school teachers experience their health, organizational and social work environment, and the psychosocial safety climate at the workplace, and especially differences and similarities between female and male teachers.MATERIALS AND METHODS: Data were collected with the COPSOQ, OLBI, UWES and PSC-12 from 478 elementary teachers, 81.0% of them women, from twenty schools. The response rate was 96.4%.RESULTS: Teachers reported relatively good general health but experienced high stress, high work pace and emotional demands, low influence at work and a poor psychosocial safety climate. These factors were especially prominent among female teachers. Both women and men experienced good development possibilities and high work engagement.CONCLUSIONS: The results of this study can help us to develop a more sustainable work environment for female and male teachers. A more sustainable work environment might attract more people to the profession and incentivize existing teachers to remain in the profession.
4.	Brogårdh, Christina, et al. (author) Self-Perceived Life Satisfaction during the First Wave of the COVID-19 Pandemic in Sweden : A Cross-Sectional Study 2021 In: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1660-4601 .- 1661-7827. ; 18:12 Journal article (peer-reviewed)abstract Currently, there is limited knowledge on how the Swedish strategy with more lenient public health restrictions during the COVID-19 pandemic has influenced people's life satisfaction. Here, we investigated self-reported life satisfaction during the first wave of the pandemic in Sweden, and perceived changes in life satisfaction in relation to various sociodemographic factors. A total of 1082 people (mean age 48 (SD 12.2); 82% women) responded to an online survey during autumn 2020 including the "Life Satisfaction Questionnaire-11". A majority (69%) were satisfied with life as a whole, and with other important life domains, with the exception of contact with friends and sexual life. An equal share reported that life as a whole had either deteriorated (28%) or improved (29%). Of those that perceived a deterioration, 95% considered it to be due to the pandemic. Regarding deteriorated satisfaction with life as a whole, higher odds were found in the following groups: having no children living at home; being middle aged; having other sources of income than being employed; and having a chronic disease. The Swedish strategy might have contributed to the high proportion of satisfied people. Those who perceived a deterioration in life satisfaction may, however, need attention from Swedish Welfare Authorities.
5.	Eek, Frida, et al. (author) Scientific approach and attitudes among clinically working physiotherapists in Sweden -a cross sectional survey 2023 In: Archives of Physiotherapy. - : Springer Nature. - 2057-0082. ; 13:1 Journal article (peer-reviewed)abstract Background Evidence based medicine (EBM) should be an endeavor within all healthcare professions. Knowledge and understanding of science are important prerequisites of EBM.Objective The aim was to examine and compare perspectives on science and perceived inhibiting and facilitating factors for the assimilation and implementation of scientific information among clinically working specialist- and nonspecialist physiotherapists in Sweden.Methods A cross-sectional survey study was conducted via a web-based questionnaire. Clinically active physiotherapists in Sweden were invited to participate. Attitudes and perspectives were compared between physiotherapists with completed or on-going specialist training, and non-specialists.Results In total, 1165 physiotherapists responded to the survey (75.5%, (n = 870) women, mean age 44.8 (SD 12.1), whereof 25.5% (n = 319) with completed or ongoing specialist training). The majority of participants had a high interest in science but did not consider a general scientific approach to be applied within physiotherapy. The main perceived inhibiting factor for a clinical practice more based on scientific evidence was lack of time. Specialists had in general higher interest and ability to interpret and evaluate science, and prioritized scientific evidence to a higher extent.Conclusion Among respondents, a scientific approach was considered valuable within physiotherapy but not considered fully applied in practice. The higher interest and perceived ability to interpret science among specialists indicates that further education and specialist training can increase both interest and understanding of science among physiotherapists.
6.	Eek, Frida, et al. (author) Scientific approach, attitudes, and perspectives on research among Swedish physiotherapy students—a cross-sectional study 2024 In: BMC Medical Education. - 1472-6920. ; 24:1 Journal article (peer-reviewed)abstract Background: Scientific evidence is important to evidence-based practice. Hence, the application of evidence-based practice requires relevant skills and an understanding of science, which therefore need to be learned and trained during the undergraduate program in physiotherapy. The aim of this study was to investigate attitudes, perceived competence, and conditions for a scientific approach among physiotherapy students in Sweden, and to compare attitudes and perceived competence between students in different program years. Methods: Physiotherapy students from six universities (n = 1499) were invited to respond to a digital survey. The survey contained questions regarding attitudes toward science, perceived competence in research interpretations and open comments regarding requirements for a strengthened scientific approach during education. Comparisons between education years were performed with ANOVA/Kruskal‒Wallis test (scale outcomes) and logistic regression (binary outcomes). Results: A total of 466 students responded to the survey. In total, 57% (n = 266) of the students had a high interest in science. No significant difference in interest in science was found between students in the three program years, but 75% (n = 347) reported increased interest during the program. A perceived high ability to understand the structure and performance of scientific studies was reported by 31% (n = 144), to evaluate the methodology by 16% (n = 72) and to interpret statistical results from scientific studies by 12% (n = 55). The lowest perceived competence was reported among students in their second year (p < 0.05). A majority of the students (88%; n = 410) reported a perceived personal need for strengthened conditions for a scientific approach, with suggested prerequisites during education via increased theoretical and applied understanding of the research. Conclusion: Even though this study does not fully cover physiotherapy students at all undergraduate programmes in Sweden, the results support that a scientific approach and training should be strengthened during education to enable physiotherapists to understand and interpret science and to fully apply an evidence-based approach in upcoming clinical practice. Both theoretical and applied knowledge and understanding are needed.
7.	Ekstrand, Elisabeth, et al. (author) Perceived Consequences of Post-COVID-19 and Factors Associated with Low Life Satisfaction 2022 In: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 19:22 Journal article (peer-reviewed)abstract A significant number of individuals experience post-COVID-19 symptoms, but knowledge of perceived consequences and life satisfaction is lacking. Here, we investigate perceived consequences regarding everyday life, health, physical activity and work post-COVID-19 and factors associated with low life satisfaction. A total of 766 people (mean age 48; 672 women) experiencing post-COVID-19 symptoms at least two months after infection (mean 13 months) responded to an online survey. A majority (≥77%) perceived physical fatigue, mental fatigue, dizziness, reduced work ability, low life satisfaction and a reduced level of aerobic capacity. In the final logistic regression model (Nagelkerke R Square 0.296, p < 0.001), poor work ability was the most important factor for perceiving low satisfaction with life (Odds ratio 3.369, 95% CI 2.040–5.565, p < 0.001, Nagelkerke R Square 0.177). Reduced aerobic capacity, fatigue and living in a city also increased the odds of low life satisfaction. As people with post-COVID-19 report several long-term consequences, this suggests that there is a need for targeted care for this group. The results of this study can serve as guidance for healthcare authorities regarding important long-term consequences that should be considered in rehabilitation programs directed toward post-COVID-19.
8.	Forsbrand, Malin, et al. (author) Comparison of the Swedish STarT Back Screening Tool and the Short Form of the Örebro Musculoskeletal Pain Screening Questionnaire in patients with acute or subacute back and neck pain 2017 In: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 18:1 Journal article (peer-reviewed)abstract BACKGROUND: Patients with back and neck pain are often seen in primary care and it is important to provide them with tailored interventions based on risk stratification/triage. The STarT Back Screening Tool (SBT) is a widely used screening questionnaire which has not yet been validated for a population with back and/or neck pain with short duration. Our aim was to compare the concurrent validity of the SBT and the short form of the ÖMPSQ including psychometric properties and clinical utility in a primary care setting.METHODS: Patients who applied for physiotherapy by direct access (January 2013 to January 2014) at 35 primary care centers in south Sweden, with acute or subacute back and/or neck pain, aged 18-67 years, who were not currently on sick leave or had been on sick leave less than 60 days were asked to complete the SBT and ÖMPSQ-short questionnaire (n = 329). We used the Spearman's rank correlations to study correlations, cross tabulation and Cohen's kappa to analyze agreement of patient classification. Clinical utility was described as clinician scoring miscalculations and misclassifications of total and/or subscale scores.RESULTS: Completed SBT (9-items) and ÖMPSQ-short (10-items) data were available for 315/329 patients respectively. The statistical correlation for SBT and ÖMPSQ-short total scores was moderately strong (0.62, p < 0.01). In subgroup analyses, the correlations were 0.69 (p < 0.01) for males and 0.57 (p < 0.01) for females. The correlations were lower among older age groups, especially females over 50 years (0.21, p = 0.11). Classification to high or low risk for long-term pain and disability had moderate agreement (κ = 0.42). Observed classification agreement was 70.2%. The SBT had fewer miscalculations (13/315) than the ÖMPSQ-short (54/315).CONCLUSIONS: The correlation between the SBT and the ÖMPSQ-short scores were moderately strong for individuals with acute or subacute back and/or neck pain. SBT seemed to be clinically feasible to use in clinical practice. We therefore suggest that SBT can be used for individuals with both BP and/or NP in primary care settings but it is important to be aware of that SBT's agreement with the ÖMPSQ-short was poor among females aged over 50 years.TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02609750 Registered: November 18, 2015.
9.	Forsbrand, Malin H., et al. (author) Can the STarT Back Tool predict health-related quality of life and work ability after an acute/subacute episode with back or neck pain? A psychometric validation study in primary care 2018 In: BMJ Open. - : BMJ. - 2044-6055. ; 8:12, s. 021748-021748 Journal article (peer-reviewed)abstract OBJECTIVES: The predictive ability of the STarT Back Tool (SBT) has not yet been examined among acute/subacute back and/or neck pain in a primary care setting in respect to health-related quality of life (HRQoL) and work ability outcomes. The aim of this study was to evaluate the SBT's predictive validity for HRQoL and work ability outcomes at long-term follow-up in a population with acute/subacute back and/or neck pain. SETTING: Prospective data from 35 primary care centres in south Sweden during 2013. PARTICIPANTS: Patients (n=329) with acute/subacute back and/or neck pain, aged 18-67 years, not on sick leave or <60 days of sick leave completed the SBT when applying for physiotherapy treatment. Long-term follow-up measures (median 13 months, range 11-27 months) of HRQoL (EQ-5D) and work ability (Work Ability Score) was completed by 238 patients (72%). OUTCOMES: The predictive ability of the SBT for HRQoL and work ability outcomes was examined using Kruskal-Wallis test, logistic regression and area under the curve (AUC). RESULTS: Based on SBT risk group stratification, 103 (43%), 107 (45%) and 28 (12%) patients were considered as low, medium and at high risk, respectively. There were statistically significant differences in HRQoL (p<0.001) and work ability (p<0.001) at follow-up between all three SBT risk groups. Patients in the high risk group had a significantly increased risk of having poor HRQoL (OR 6.16, 95% CI 1.50 to 25.26) and poor work ability (OR 5.08, 95% CI 1.75 to 14.71) vs the low risk group at follow-up. The AUC was 0.73 (95% CI 0.61 to 0.84) for HRQoL and 0.68 (95% CI 0.61 to 0.76) for work ability. CONCLUSIONS: The SBT is an appropriate tool for identifying patients with a poor long-term HRQoL and/or work ability outcome in a population with acute/subacute back and/or neck pain, and maybe a useful adjunct to primary care physiotherapy assessment and practice. TRIAL REGISTRATION NUMBER: NCT02609750; Results.
10.	Forsbrand, Malin, et al. (author) Long-term effects on function, health-related quality of life and work ability after structured physiotherapy including a workplace intervention. : A secondary analysis of a randomised controlled trial (WorkUp) in primary care for patients with neck and/or back pain 2020 In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 38:1, s. 92-100 Journal article (peer-reviewed)abstract Objective: To study the long-term effects of a workplace intervention in addition to structured physiotherapy regarding self-reported measures in patients with acute/subacute neck and/or back pain. Design: WorkUp – a cluster-randomised controlled trial in 32 primary care centers in Sweden, from January 2013 through December 2014 (ClinicalTrials.gov ID: NCT02609750). Intervention: Structured physiotherapy with the workplace dialogue ‘Convergence Dialogue Meeting’ (CDM), conducted by the treating physiotherapist as an add-on. Reference group received structured physiotherapy. Subjects: Adults, 18–67 years (mean 43.7, standard deviation (SD) 12.2), 65.3% women with acute/subacute neck and/or back pain who had worked ≥4 weeks past year, considered at risk of sick leave or were on short-term sick leave (≤60 days) were included (n = 352).Outcome measures: Self-reported function, functional rating index (FRI), health-related quality of life (EQ-5D-3L) and work ability (Work Ability Score, WAS) at 12 months follow-up. Results: The mean differences in outcomes between intervention and reference group were; −0.76 (95% confidence interval (CI): −2.39, 0.88; FRI), 0.02 (95% CI: −0.04, 0.08; EQ-5D-3L) and −0.05 (95% CI: −0.63, 0.53; WAS). From baseline to 12 months, the intervention group improved function from 46.5 (SD 19.7) to 10.5 (SD 7.3) on FRI; health-related quality of life from 0.53 (SD 0.29) to 0.74 (SD 0.20) on EQ-5D and work ability from 5.7 (SD 2.6) to 7.6 (SD 2.1) on WAS. Conclusion: Despite a clinically relevant improvement over time, there were no significant differences in improvement between groups, thus we conclude that CDM had no effect on self-reported measures in this study.
11.	FORSBRAND, MALIN, et al. (author) Validation of the Swedish Version of Start Back Too Against the Short Version of The Örebro Musculoskeletal Pain Screening Questionnaire in Patients with Back and/or Neck Pain in Primary Health Care 2015 In: Annals of the Rheumatic Diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 74:Suppl 2, s. 1319-1319 Conference paper (peer-reviewed)
12.	Grahn, Birgitta, et al. (author) Motivation for change and personal resources in patients with prolonged musculoskeletal disorders 2001 In: Journal of Bodywork & Movement Therapies. - 1360-8592. ; , s. 160-160 Journal article (peer-reviewed)abstract The purpose of this qualitative 2-year follow-up study was to obtain a deeper understanding of motivation for change towards an active and independent life in patients with prolonged musculoskeletal disorders and to explore and identify personal resources that might influence such improvements. Data collection and analysis were performed according to the qualitative case study design. An initial conceptual framework was developed to bound and guide the study. Twenty patients were selected using purposive sampling with respect to motivational level (highly to latently motivated) to create a sample of maximum variety. Data were collected using repeated interviews and additional quantitative instruments (health-related quality of life, body image, movement ability, postural control, pain rating). The study comprised three data collection periods. Motivation for change was associated with the use of personal resources. The central themes to emerge were body awareness, self-focus, locus of control and coping ability. The results emphasized the indivisible unity of body and mind. The efficacy of rehabilitation might improve if the individual's own resources were taken into account.
13.	Grahn, B, et al. (author) Motivation for change in patients with prolonged musculoskeletal disorders : a qualitative two-year follow-up study 1999 In: Physiotherapy Research International. - : Wiley. - 1358-2267 .- 1471-2865. ; 4:3, s. 89-170 Journal article (peer-reviewed)abstract BACKGROUND AND PURPOSE: The purpose of this study was to obtain a deeper understanding of the process of motivation for change in patients with prolonged musculoskeletal disorders and to identify factors that might influence change resulting in increased independence.METHOD: A qualitative two-year follow-up study. Data collection and analysis were performed according to the qualitative case study design. An initial conceptual framework was developed to bound and guide the study. Twenty patients were selected using purposive sampling with respect to motivation level (highly motivated to less-motivated) to create a sample of maximum variation. Data were collected using repeated interviews and standardized scales. The study comprised three data collection periods.RESULTS: Motivation for change followed different processes depending on the level at entry to the study. The highly motivated patients improved in independence, the moderately motivated ones remained at an unchanged level and the less-motivated patients became more dependent. Central themes of importance to the process of motivation for change were: the utilization of professional networks (healthcare, regional social insurance office), emotional support (nuclear family, close relatives), use of personal coping resources (energy, positive beliefs, problem-solving) and social support at work (employers, colleagues).CONCLUSIONS: The performance of a structured motivation analysis, including questions about emotional networks and social support at work in addition to the clinical examination of the patient, is recommended. This might guide healthcare professionals when it comes to motivation for change in the patient.
14.	Jensen, Anita, et al. (author) Arts on prescription in Scandinavia : a review of current practice and future possibilities 2017 In: Perspectives in Public Health. - : SAGE Publications. - 1757-9139 .- 1757-9147. ; 137:5, s. 268-274 Journal article (peer-reviewed)abstract AIMS: This article reviews current practice relating to arts and culture on prescription in Sweden, Norway, Denmark and in the United Kingdom. It considers future possibilities and also each of the Scandinavian countries from a culture and health policy and research perspective. The United Kingdom perhaps leads the field of Arts on Prescription practice, and subsequent research is described in order to help identify what the Scandinavian countries might learn from the UK research.METHOD: The method adopted for the literature search was a rapid review which included peer-reviewed and grey literature in English and the respective languages of Scandinavia.RESULTS: The discussion considers the evidence to support social prescription and the potential obstacles of the implementation of Arts on Prescription in Scandinavian countries.CONCLUSION: The article concludes that of the Scandinavian countries, Sweden is ahead in terms of Arts on Prescription and has embraced the use of culture for health benefits on a different scale compared to Norway and Denmark. Denmark, in particular, is behind in recognising ways in which art and culture can benefit patients and for wider public health promotion. All three countries may benefit from the evidence provided by UK researchers.
15.	Kwak, Lydia, et al. (author) A randomized controlled trial in schools aimed at exploring mechanisms of change of a multifaceted implementation strategy for promoting mental health at the workplace 2022 In: Implementation Science. - : Springer Science and Business Media LLC. - 1748-5908. ; 17:1 Journal article (peer-reviewed)abstract Background: This study will explore implementation mechanisms through which a single implementation strategy and a multifaceted implementation strategy operate to affect the implementation outcome, which is fidelity to the Guideline For The Prevention of Mental Ill Health within schools. The guideline gives recommendations on how workplaces can prevent mental ill health among their personnel by managing social and organizational risks factors in the work environment. Schools are chosen as the setting for the study due to the high prevalence of mental ill health among teachers and other personnel working in schools. The study builds on our previous research, in which we compared the effectiveness of the two strategies on fidelity to the guideline. Small improvements in guideline adherence were observed for the majority of the indicators in the multifaceted strategy group. This study will focus on exploring the underlying mechanisms of change through which the implementation strategies may operate to affect the implementation outcome. Methods: We will conduct a cluster-randomized-controlled trial among public schools (n=55 schools) in Sweden. Schools are randomized (1:1 ratio) to receive a multifaceted strategy (implementation teams, educational meeting, ongoing training, Plan-Do-Study-Act cycles) or a single strategy (implementation teams, educational meeting). The implementation outcome is fidelity to the guideline. Hypothesized mediators originate from the COM-B model. A mixed-method design will be employed, entailing a qualitative study of implementation process embedded within the cluster-randomized controlled trail examining implementation mechanisms. The methods will be used in a complementary manner to get a full understanding of the implementation mechanisms. Discussion: This implementation study will provide valuable knowledge on how implementation strategies work (or fail) to affect implementation outcomes. The knowledge gained will aid the selection of effective implementation strategies that fit specific determinants, which is a priority for the field. Despite recent initiatives to advance the understanding of implementation mechanisms, studies testing these mechanisms are still uncommon. Trial registration: ClinicalTrials.org dr.nr 2020-01214.
16.	Kwak, Lydia, et al. (author) Developing a practice guideline for the occupational health services by using a community of practice approach : A process evaluation of the development process 2017 In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 17:1 Journal article (peer-reviewed)abstract Background: One way to facilitate the translation of research into the occupational health service practice is through clinical practice guidelines. To increase the implementability of guidelines it is important to include the end-users in the development, for example by a community of practice approach. This paper describes the development of an occupational health practice guideline aimed at the management of non-specific low back pain (LBP) by using a community of practice approach. The paper also includes a process evaluation of the development providing insight into the feasibility of the process. Methods: A multidisciplinary community of practice group (n = 16) consisting of occupational nurses, occupational physicians, ergonomists/physical therapists, health and safety engineers, health educators, psychologists and researchers from different types of occupational health services and geographical regions within Sweden met eleven times (June 2012-December 2013) to develop the practice guideline following recommendations of guideline development handbooks. Process-outcomes recruitment, reach, context, satisfaction, feasibility and fidelity were assessed by questionnaire, observations and administrative data. Results: Group members attended on average 7.5 out of 11 meetings. Half experienced support from their workplace for their involvement. Feasibility was rated as good, except for time-scheduling. Most group members were satisfied with the structure of the process (e.g. presentations, multidisciplinary group). Fidelity was rated as fairly high. Conclusions: The described development process is a feasible process for guideline development. For future guideline development expectations of the work involved should be more clearly communicated, as well as the purpose and tasks of the CoP-group. Moreover, possibilities to improve support from managers and colleagues should be explored. This paper has important implications for future guideline development; it provides valuable information on how practitioners can be included in the development process, with the aim of increasing the implementability of the developed guidelines.
17.	Kwak, Lydia, et al. (author) Implementation of the Swedish Guideline for Prevention of Mental ill-health at the Workplace : study protocol of a cluster randomized controlled trial, using multifaceted implementation strategies in schools 2019 In: BMC Public Health. - : BioMed Central. - 1471-2458. ; 19:1 Journal article (peer-reviewed)abstract BACKGROUND: Given today's high prevalence of common mental disorders and related sick leave among teachers, an urgent need exists for a more systematic approach to the management of social and organizational risk factors within schools. In 2015, we launched the first Swedish occupational health guideline to support a structured prevention of these risks at the workplace. The existence of guidelines does however not guarantee their usage, as studies show that guidelines are often underused. Knowledge is therefore needed on effective implementation strategies that can facilitate the translation of guidelines into practice. The primary aim of the randomized waiting list-controlled trial described in this study protocol is to compare the effectiveness of a multifaceted implementation strategy versus a single implementation strategy for implementing the Guideline for the prevention of mental ill-health at the workplace within schools. The effectiveness will be compared regarding the extent to which the recommendations are implemented (implementation effectiveness) and with regard to social and organisational risk factors for mental ill-health, absenteeism and presenteeism (intervention effectiveness).METHODS: The trial is conducted among primary schools of two municipalities in Sweden. The single implementation strategy is an educational strategy (an educational meeting). The multifaceted strategy consists of the educational meeting, an implementation team and a series of workshops. The outcome measure of implementation effectiveness is guideline adherence. The primary outcome of intervention effectiveness is exhaustion. Secondary outcomes include demands at work, work organization and job contents, interpersonal relations and leadership, presenteeism, work performance, recovery, work-life balance, work-engagement, self-reported stress, self-perceived health, sickness absence and psychosocial safety climate. Process outcomes as well as barriers and facilitators influencing the implementation process are assessed. Data will be collected at baseline, 6, 12, 18 and 24 months by mixed methods (i.e. survey, focus-group interviews, observation).DISCUSSION: The study described in this protocol will provide valuable knowledge on the effectiveness of implementation strategies for implementing a guideline for the prevention of common mental disorders within schools. We hypothesize that successful implementation will result in reductions in school personnel's perceived social and organizational risk factors, mental ill-health and sick-leave.TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03322839 (trial registration: 09/19/2017).
18.	Kwak, Lydia, et al. (author) Integrating evidence-based approaches for social and organizational risk management in a school setting : A randomized trial on implementation effectiveness 2020 In: Implementation Science. - : BMC. - 1748-5908. ; 15 Journal article (other academic/artistic)
19.	Lindgren, Ingrid, et al. (author) Perceptions of everyday life during lenient COVID-19 restrictions in Sweden- an interview study 2023 In: BMC Public Health. - 1471-2458. ; 23, s. 1-13 Journal article (peer-reviewed)abstract BACKGROUND: Both COVID-19 and its associated societal restrictions have affected individuals' health and everyday life. In Sweden, more lenient public health restrictions were implemented, with individuals asked to act responsibly in terms of reducing spread of disease. The majority of studies reporting on experiences of Covid-19 restrictions have been in the context of more substantial mandatory rules aimed at reducing social contact, therefore it is important to describe how more lenient restrictions have impacted individuals' well-being. This study aims to describe perceptions of everyday life during the first wave of the COVID-19 pandemic, perceived by individuals with no underlying medical condition, and living with more lenient public health restrictions in Sweden.METHOD: The participants were recruited from individuals who originally had participated in an online survey about life satisfaction, health, and physical activity. Fifteen individuals (median age 49, range 26-76 years, seven women) in various social situations, such as living alone/cohabiting, having children at home, geographical area and size of city were interviewed. Qualitative content analysis was applied to the data.RESULTS: An overall theme "Both hindrances and opportunities in important life domains were experienced within the same person during lenient Covid-19 restrictions" was derived and covered three categories: "New possibilities of flexibility in work and better health", "Life went on as usual with minor adjustments" and "Everyday life changed and became more difficult" together with eight subcategories. For most participants, both facilitating and hindering important domains in life were described. Unexpected findings were positive experiences regarding working from home, physical activities, leisure time activities and the balance between work and leisure time. In areas where only minor adjustments were made, life was perceived as going on as before. On the other hand, restrictions increased worries and were perceived to have negative effects on social participation.CONCLUSION: The impact of the pandemic and lenient restrictions in Sweden on the participants´ everyday life was multifaceted. Both hindrances and opportunities in important life domains were experienced within the same person. An increased flexibility in work- and leisure activities were perceived having positive effects for health and wellbeing and led to a better balance in life.
20.	Nilsson, Kerstin, et al. (author) 54 forskare: Inte alla klarar höjd pensions-ålder 2017 In: Svenska Dagbladet, Stockholm. - 1101-2412. Journal article (pop. science, debate, etc.)abstract Ett hållbart och acceptabelt pensionssystem måste utformas utifrån personliga förutsättningar och förhållanden i arbetslivet, så att fler klarar att arbeta i högre ålder. Att enbart genom ekonomiska åtgärder höja pensionsåldern är inte långsiktigt hållbart, skriver 54 forskare.DEBATT \| PENSIONForskning visar att cirka var fjärde har en diagnos eller skada orsakad av sitt arbete. Detta gör arbetsorsakad sjukdom och skada till ett betydelsefullt folkhälsoproblem. Att då enbart genom ekonomiska åtgärder höja pensionsåldern för samtliga (yrkes)grupper utifrån deras kronologiska ålder är inte långsiktigt hållbart när individers biologiska ålder är så olika bland annat till följd av arbetslivet. Detta är en demokratifråga. Forskning om äldre i arbetslivet och hållbart arbete visar att man då främst flyttar individer från pensionssystemet till sjukförsäkringssystemet och ökar klyftorna i samhället.Debatt Det här är en argumenterande text med syfte att påverka. Åsikterna som uttrycks är skribentens egna.Vi är 54 forskare som nu gemensamt har skrivit denna debattartikel. Anledningen är att vi är oroade över att cirka var fjärde blir sjuk av sitt arbete samtidigt som man i det förslag som ligger om att senarelägga ålderspensionen i princip utgår ifrån att arbetskraftsdeltagande enbart styrs av ekonomin. Vi vill trycka på betydelsen av åtgärder i arbetslivet för att komma tillrätta med ohälsan, det vill säga inte enbart ekonomiska restriktioner som tvingar folk som inte kan, vill och orkar att stanna kvar i arbetslivet till en högre kronologisk ålder.Pensionssystemet bygger på att vi ska arbeta en viss del av våra liv för att förtjäna möjligheter till pension. Vi bör dock inte enbart utgå ifrån antalet år sedan en person föddes, då korttidsutbildade generellt träder in på arbetsmarknaden tidigare än långtidsutbildade. De har alltså varit en del av arbetskraften från en yngre ålder. Människor med kortare utbildning har oftare ett arbete som innebär påfrestningar som kan inverka negativt på hälsotillståndet och som till och med kan påskynda det biologiska åldrandet. Dessutom lever korttidsutbildade generellt sett inte lika länge som långtidsutbildade, vilket delvis även avspeglar skilda livs- och arbetsvillkor.Den svenska sjukförsäkringsreformen 2008 avsåg att få tillbaka människor i arbete. Men studien fann att den faktiskt bidrog till att fler gick i tidig ålderspension av dem som var i åldern 55–64 år. Ökningen var störst bland korttidsutbildade. Mer än 5 procent fler gick i tidig ålderspension då det blev svårare att få sjukpenning och sjukersättning. Vi kan notera att det är vanligare att manliga chefer tar ut tidig ålderspension, jämfört med kvinnliga maskinskötare inom tillverkningsindustrin. I vissa yrken är det dessutom vanligare att människor, trots pension, både orkar och faktiskt ges möjlighet att arbeta vidare om de har en specialkompetens som efterfrågas. Om vi endast kombinerar ekonomiska morötter med piskor finns en stor risk att vi ökar klyftan mellan grupper som både kan och vill fortsätta att yrkesarbeta och personer som av olika skäl inte längre kan eller orkar.Ta nytta av den forskning som vi har tagit fram. Ett hållbart och acceptabelt pensionssystem måste utformas utifrån personliga förutsättningar och förhållanden i arbetslivet. Ett hållbart arbetsliv för allt fler i vår åldrande befolkning fordrar att vi samtidigt beaktar faktorer som relaterar till biologisk/kroppslig ålder, mental/kognitiv ålder samt social ålder/livsloppsfas och våra attityder som är kopplade till ålder. Vi måste ta större hänsyn till olika förutsättningar och varierande funktionsförmåga och utifrån detta anpassa de åtgärder som gör att arbetslivet blir möjligt och hållbart för allt fler även i högre ålder.”Morötter” är viktigare för en god arbetshälsa och hög produktivitet än en piska i form av oron för en dålig ekonomi.Forskning visar att pedagogik som bygger på ”morötter” oftast är betydligt bättre än ”piskor” för att nå framgångsrika och långsiktiga mål. ”Morötter” i samhället, för organisationer, företag och individer är därför viktiga för god arbetshälsa och fortsatt produktivitet och kan bidra till ett längre arbetsliv även för grupper som tidigare inte ens klarat av att arbeta fram till pensionsåldern. Genom forskning inom området har bland annat swage-modellen utarbetats. Detta är ett verktyg som visar på komplexiteten i ett hållbart arbetsliv och tillsammans med systematiskt arbetsmiljöarbete, handlingsplaner och åtgärder syftar till ett mer hållbart arbetsliv. Morötter är enligt forskningen i detta sammanhang åtgärder för en god fysisk och mental arbetsmiljö, avpassad arbetsbelastning, stödjande teknik, att man kan anpassa arbetstakten, alternativa arbetstidsmodeller vid behov. Det är viktigt att man känner sig trygg och förväntas och tillåts vara delaktig, att man blir sedd av chefen och arbetskamraterna. Att de egna arbetsuppgifterna upplevs som meningsfulla och behövda av andra skapar självförverkligande och tillfredsställelse i arbetet. Att man känner att ens arbetsuppgifter och man själv är viktig för organisationen och företaget. Att man trots högre ålder inkluderas i olika nysatsningar och får tillgång till kompetensutveckling och inte blir åsidosatt eller åldersdiskriminerad. Utvärderingar visar att de äldre medarbetarna som fick några av dessa anpassningar och möjligheter var mer effektiva, utvilade, stimulerade när de var på arbetet samtidigt som sjukfrånvaron minskade. Vilket i sin tur bidrar till ett längre arbetsliv för grupper som tidigare inte klarat av att arbeta fram till pensionsåldern. I organisationer som bygger på en deltagar- och lärandekultur rustas de anställda för att klara omställningar, nya arbetsuppgifter och vid behov även yrkesbyten.Med en åldrande befolkning där allt fler lever allt längre behöver vi arbeta till en högre ålder i framtiden för att pensionssystemet ska hålla. Men ”morötter” är viktigare för en god arbetshälsa och hög produktivitet än en piska i form av oron för en dålig ekonomi. Det kräver också att vi ändrar våra attityder och förhållningssätt till äldre på arbetsmarknaden, vilket vi bäst gör genom att organisationer och företag får incitament till och erbjuder mer individanpassade arbetsvillkor, särskilt för personer i högre ålder. Låt oss därför använda den framtagna kunskapen i praktiken för att göra arbetslivet friskt och hållbart för alla åldrar.
21.	Nilsson, Kerstin, et al. (author) Vi är oroade över senare ålderspension 2017 In: Dagens Samhälle. - 1652-6511. Journal article (pop. science, debate, etc.)abstract Var fjärde person blir i dag sjuk till följd av sitt arbete. Att höja pensionsåldern för alla yrkesgrupper, utan konkreta åtgärder för att minska ohälsan, är därför problematiskt och mycket oroande. Det är, enligt forskarna, inte långsiktigt samhällsekonomiskt lönsamt att utan andra åtgärder höja pensionsåldern för alla. Vi – 54 forskare – är mycket oroade över konsekvenserna av att, som föreslagits, senarelägga ålderspensionen.Förslaget utgår i princip från arbetskraftsdeltagande i princip enbart styrs av ekonomin, medan forskningen visar att det bara är en av flera faktorer som styr hur länge och hur mycket människor väljer att arbeta.Det här sättet att lösa problemet med en åldrande befolkning och ett sviktande pensionssystem är inte samhällsekonomiskt lönsamt på lång sikt, utan riskerar bara att flytta runt folk mellan olika ersättningssystem. Pensionssystemet bygger på att vi ska arbeta en viss del av våra liv för att tjäna in vår pension. Vi bör dock inte enbart utgå ifrån ålder eller antalet år sedan en person föddes då korttidsutbildade generellt träder in på arbetsmarknaden tidigare än långtidsutbildade. De med kortare utbildningstid har alltså varit en del av arbetskraften från en yngre ålder. Människor med kortare utbildning har också oftare ett arbete som innebär påfrestningar som kan inverka negativt på hälsotillståndet och som till och med kan påskynda det biologiska åldrandet. Dessutom lever korttidsutbildade generellt sett inte lika länge som långtidsutbildade, vilket delvis även avspeglar skilda livs- och arbetsvillkor.Ta nytta av den forskning som vi har tagit fram. Ekonomin är självklart viktigt för att vi ska vilja arbeta, men den är som sagt enbart en av flera faktorer med betydelse vårt arbetsliv.Hälsotillståndet, både det fysiska och det mentala, har en avgörande betydelse för hur länge och hur mycket vi orkar arbeta. Ett fysiskt och mentalt belastande arbete är en stark riskfaktor för en nedsatt hälsa i slutet av arbetslivet. Arbetstid, arbetstakt och möjlighet till återhämtning spelar en allt större roll ju äldre vi blir. Andra aspekter är arbetsinnehåll, hur meningsfulla och stimulerande arbetsuppgifterna är, balansen mellan arbete och familjesituation och fritidsaktiviteter. Organisationskultur, ledarskapet, stöd i arbetet och kompetens har stor betydelse för om vi ska kunna och vilja arbeta till en högre ålder. Vi måste ta större hänsyn till olika förutsättningar och varierande funktionsförmåga och utifrån detta anpassa de åtgärder som gör att arbetslivet blir möjligt och hållbart för allt fler även i högre ålder.Ett hållbart och acceptabelt pensionssystem måste därför utformas utifrån personliga förutsättningar och förhållanden i arbetslivet. Ett hållbart arbetsliv för allt fler i vår åldrande befolkning fordrar att vi samtidigt beaktar faktorer som relaterar till biologisk/kroppslig ålder, mental/kognitiv ålder samt social ålder/livsloppsfas samt de attityder som är kopplade till ålder.
22.	Petersson, Ingemar, et al. (author) Clinician-Reported Outcome Measures: Experiences from Multicentre Follow-Up and an Overview of Commonly Used Measures in Vocational Rehabilitation and Disability Evaluation 2015. - 1 In: Handbook of Vocational Rehabilitation and Disability Evaluation. : Application and Implementation of the ICF - Application and Implementation of the ICF. - 9783319088242 - 9783319088259 ; 1, s. 453-453 Book chapter (pop. science, debate, etc.)
23.	Post Sennehed, Charlotte, et al. (author) Blue flags", development of a short clinical questionnaire on work-related psychosocial risk factors - A validation study in primary care 2017 In: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 18:1 Journal article (peer-reviewed)abstract Background: Working conditions substantially influence health, work ability and sick leave. Useful instruments to help clinicians pay attention to working conditions are lacking in primary care (PC). The aim of this study was to test the validity of a short "Blue flags" questionnaire, which focuses on work-related psychosocial risk factors and any potential need for contacts and/or actions at the workplace. Methods: From the original"The General Nordic Questionnaire" (QPSNordic) the research group identified five content areas with a total of 51 items which were considered to be most relevant focusing on work-related psychosocial risk factors. Fourteen items were selected from the identified QPSNordic content areas and organised in a short questionnaire "Blue flags". These 14 items were validated towards the 51 QPSNordic items. Content validity was reviewed by a professional panel and a patient panel. Structural and concurrent validity were also tested within a randomised clinical trial. Results: The two panels (n = 111) considered the 14 psychosocial items to be relevant. A four-factor model was extracted with an explained variance of 25.2%, 14.9%, 10.9% and 8.3% respectively. All 14 items showed satisfactory loadings on all factors. Concerning concurrent validity the overall correlation was very strong rs = 0.87 (p < 0.001).). Correlations were moderately strong for factor one, rs = 0.62 (p < 0.001) and factor two, rs = 0.74 (p < 0.001). Factor three and factor four were weaker, bur still fair and significant at rs = 0.53 (p < 0.001) and rs = 0.41 (p < 0.001) respectively. The internal consistency of the whole "Blue flags" was good with Cronbach's alpha of 0.76. Conclusions: The content, structural and concurrent validity were satisfactory in this first step of development of the "Blue flags" questionnaire. In summary, the overall validity is considered acceptable. Testing in clinical contexts and in other patient populations is recommended to ensure predictive validity and usefulness.
24.	Post Sennehed, Charlotte, et al. (author) Evaluation of a multimodal pain rehabilitation programme in primary care based on clinical register data: a feasibility study 2020 In: Primary health care research & development. - 1477-1128. ; 21 Journal article (peer-reviewed)abstract Aim: Investigate the feasibility of identifying a well-defined treatment group and a comparable reference group in clinical register data. Background: There is insufficient knowledge on how to avert neck/back pain from turning chronic or to impair work ability. The Swedish Government implemented a national multimodal rehabilitation (MMR) programme in primary care intending to promote work ability, reduce sick leave and increase return to work. Since randomised control trial data for effect is lacking, it is important to evaluate existing observational data from clinical settings. Methods: We identified all unique patients with musculoskeletal pain (MSP) diagnoses undergoing the MMR programme in primary care in the Skåne Health care Register (n = 2140) during 2010–2011. A reference cohort in primary care (n = 56 300) with similar MSP diagnoses, same ages and the same level of sick leave before baseline was identified for the same period. The reference cohort received ordinary care and treatment in primary care. The final study group consisted of 603 eligible MMR patients and 2874 eligible reference patients. Socio-economic and health-related baseline data including sick leave one year before up to two years after baseline were compared between groups. Findings: There were significant socio-economic and health differences at baseline between the MMR and the reference patients, with the MMR group having lower income, higher morbidity and more sick leave days. Sick leave days per year decreased significantly in the MMR group (118–102 days, P < 0.001) and in the reference group (50–42 days, P < 0.001) from one year before baseline to two years after. Conclusions: It was not feasible to identify a comparable reference group based on clinical register data. Despite an ambitious attempt to limit selection bias, significant baseline differences in socio-economic and health were present. In absence of randomised trials, effects of MMR cannot be sufficiently evaluated in primary care.
25.	Saha, Sanjib, et al. (author) Structured physiotherapy including a work place intervention for patients with neck and/or back pain in primary care: an economic evaluation 2018 In: European Journal of Health Economics. - : Springer Science and Business Media LLC. - 1618-7601 .- 1618-7598. Journal article (peer-reviewed)abstract A cluster-randomized controlled trial, WorkUp, was conducted for working-aged patients at risk of sick leave or on short-term sick leave due to acute/subacute neck and/or back pain in Sweden. The purpose of WorkUp was to facilitate participants to stay at work or in case of sick leave, return-to-work. The aim of this study was to study whether the WorkUp trial was cost-effective. Patients in the intervention and reference group received structured evidence-based physiotherapy, while patients in the intervention group also received a work place dialogue with the employer as an add-on. The participants, 352 in total, were recruited from 20 physiotherapeutic units in primary healthcare in southern Sweden. The economic evaluation was performed both from a healthcare and a societal perspective with a 12-month time frame with extensive univariate sensitivity analyses. Results were presented as incremental cost–effectiveness ratios (ICER) with outcomes measured as quality-adjusted life-years (QALY) and proportion working for at least 4 weeks in a row without reported sick leave at 12-month follow-up. From the healthcare perspective, the ICER was €23,606 (2013 price year) per QALY gain. From the societal perspective the intervention was dominating, i.e.. less costly and more effective than reference care. Bootstrap analysis showed that the probability of the intervention to be cost-effective at €50,000 willingness-to-pay per QALY was 85% from the societal perspective. Structured evidence-based physiotherapeutic care together with workplace dialogue is a cost-effective alternative from both a societal and a healthcare perspective for acute/subacute neck and/or back pain patients.
26.	Sennehed, CP, et al. (author) Early workplace dialogue in physiotherapy practice improved work ability at 1-year follow-up-WorkUp, a randomised controlled trial in primary care 2018 In: Pain. - : Ovid Technologies (Wolters Kluwer Health). - 1872-6623 .- 0304-3959. ; 159:8, s. 1456-1464 Journal article (peer-reviewed)
27.	Sennehed, Charlotte Post, et al. (author) Referring to multimodal rehabilitation for patients with musculoskeletal disorders - a register study in primary health care 2017 In: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 17 Journal article (peer-reviewed)abstract BACKGROUND: In 2008, the Swedish government introduced a National Rehabilitation Program, in which the government financially reimburses the county councils for evidence-based multimodal rehabilitation (MMR) interventions. The target group is patients of working age with musculoskeletal disorders (MSD), expected to return to work or remain at work after rehabilitation. Much attention in the evaluations has been on patient outcomes and on processes. We lack knowledge about how factors related to health care providers and community can have an impact on how patients have access to MMR. The aim of this study was therefore to study the impact of health care provider and community related factors on referrals to MMR in patients with MSD applying for health care in primary health care.METHODS: This was a primary health care-based cohort study based on prospectively ascertained register data. All primary health care centres (PHCC) contracted in Region Skåne in 2010-2012, referring to MMR were included (n = 153). The health care provider factors studied were: community size, PHCC size, public or private PHCC, whether or not the PHCCs provided their own MMR, burden of illness and the community socioeconomic status among the registered population at the PHCCs. The results are presented with descriptive statistics and for the analysis, non-parametric and multiple linear regression analyses were applied.RESULTS: PHCCs located in larger communities sent more referrals/1000 registered population (p = 0.020). Private PHCCs sent more referrals/1000 registered population compared to public units (p = 0.035). Factors related to more MMR referrals/1000 registered population in the multiple regression analyses were PHCCs located in medium and large communities and with above average socioeconomic status among the registered population at the PHCCs, private PHCC and PHCCs providing their own MMR. The explanation degree for the final model was 24.5%.CONCLUSIONS: We found that referral rates to MMR were positively associated with PHCCs located in medium and large sized communities with higher socioeconomic status among the registered population, private PHCCs and PHCCs providing their own MMR. Patients with MSD are thus facing significant inequities and were thus not offered the same opportunities for referrals to rehabilitation regardless of which PHCC they visited.
28.	Stathopoulos, Dimitrios, et al. (author) Exploring the environment behind in-patient falls and their relation to hospital overcrowdedness—a register-based observational study 2021 In: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 18:20 Journal article (peer-reviewed)abstract (1) Background: Inpatient falls are a serious threat to patients’ safety and their extrinsic factors are, at present, insufficiently described. Additionally, hospital overcrowdedness is known for its malicious effects but its relation to the inpatient falls is currently underexplored. The aim of this study was to explore the distribution of falls and their extrinsic characteristics amongst a range of different clinics, and to explore the correlation and predictive ability of hospital overcrowding in relation to inpatient falls. (2) Methods: An observational, cross-sectional, registry-based study was conducted using retrospective data from an incidence registry of a hospital organization in Sweden during 2018. The registry provided data regarding the extrinsic factors of inpatient falls, including the clinics’ overcrowdedness. Simple descriptive statistics, correlation analysis and simple linear regression analysis were used. (3) Results: Twelve clinics were included. A total of 870 inpatient falls were registered during 2018. Overcrowdedness and total amount of falls were positively and very strongly correlated (r = 0.875, p < 0.001). Overcrowdedness was a significant predictor of the total amount of inpatient falls (p < 0.001, α = 0.05). (4) Conclusions: The characteristics regarding inpatient falls vary among the clinics. Inpatient overcrowding might have a significant role in the prevalence of inpatient falls, but further high-evidence-level studies are required.
29.	Stigmar, Kjerstin (author) Clinician Reported Outcomes Measures, CROMs, in RMDS. 2015 In: Annals of the Rheumatic Diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 74:Suppl 2, s. 21-21 Conference paper (other academic/artistic)
30.	Stigmar, Kjerstin, et al. (author) How do physiotherapists perceive their role in work ability assessments? A prospective focus group study. 2014 In: Primary Health Care Research and Development. - 1463-4236. ; 15:3, s. 268-276 Journal article (peer-reviewed)abstract BACKGROUND: Work ability and work ability assessments have become important both in health care and in relation to granting sick leave. There are different interpretations of work ability among the different professionals involved, and there is no consensus on how work ability should be assessed. Aim The aim was to analyse how a group of experienced and specially trained physiotherapists (PTs) in primary health care (PHC) perceived their professional role in work ability assessments during 14 months. METHODS: We conducted a prospective focus group study and applied qualitative content analysis to the data. Findings There was a need to emphasise the PTs' role both within PHC and also in relation to others involved. The PHC organisation was not really prepared to direct work-disabled patients to PTs before physicians. In addition, the PTs themselves needed to reorganise to better meet the requirements. The PTs underlined the advantage of their frequent and extended meetings with patients. This made it possible to assess, follow and facilitate work ability and to determine patients' resources. The PTs believed that they could contribute to structured assessments, which was positive for themselves and also in their communication with physicians and patients. The PTs later took more initiatives in work ability questions and believed that they could be responsible for work ability assessments to a greater extent. They found it most valuable to have had the opportunity to reflect on work ability, while working in the focus groups, and also to have been the subjects for further education. This made them more prepared to handle work ability questions when compared with other colleagues.
31.	Stigmar, Kjerstin, et al. (author) Promoting work ability in a structured national rehabilitation program in patients with musculoskeletal disorders: outcomes and predictors in a prospective cohort study 2013 In: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 14 Journal article (peer-reviewed)abstract Background: Musculoskeletal disorders (MSDs) are a major reason for impaired work productivity and sick leave. In 2009, a national rehabilitation program was introduced in Sweden to promote work ability, and patients with MSDs were offered multimodal rehabilitation. The aim of this study was to analyse the effect of this program on health related quality of life, function, sick leave and work ability. Methods: We conducted a prospective, observational cohort study including 406 patients with MSDs attending multimodal rehabilitation. Changes over time and differences between groups were analysed concerning function, health related quality of life, work ability and sick leave. Regression analyses were used to study the outcome variables health related quality of life (measured with EQ-5D), and sick leave. Results: Functional ability and health related quality of life improved after rehabilitation. Patients with no sick leave/disability pension the year before rehabilitation, improved health related quality of life more than patients with sick leave/disability pension the year before rehabilitation (p = 0.044). During a period of -/+ four months from rehabilitation start, patients with EQ-5D >= 0.5 at rehabilitation start, reduced their net sick leave days with 0.5 days and patients with EQ-5D <0.5 at rehabilitation start, increased net sick leave days with 1.5 days (p = 0.019). Factors negatively associated with sick leave at follow-up were earlier episodes of sick leave/disability pension, problems with exercise tolerance functions and mobility after rehabilitation. Higher age was associated with not being on sick leave at follow-up and reaching an EQ-5D >= 0.5 at follow-up. Severe pain after rehabilitation, problems with exercise tolerance functions, born outside of Sweden and full-time sick leave/disability pension the year before rehabilitation were all associated with an EQ-5D level < 0.5 at follow-up. Conclusions: Patients with MSDs participating in a national work promoting rehabilitation program significantly improved their health related quality of life and functional ability, especially those with no sick leave. This shows that vocational rehabilitation programs in a primary health care setting are effective. The findings of this study can also be valuable for more appropriate patient selection for rehabilitation programs for MSDs.
32.	Stigmar, Kjerstin, et al. (author) Sick leave in Sweden before and after total joint replacement in hip and knee osteoarthritis patients 2017 In: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 88:2, s. 152-157 Journal article (peer-reviewed)abstract Background and purpose - Little is know about patterns of sick leave in connection with total hip and knee joint replacement (THR and TKR) in patients with osteoarthritis (OA). Patients and methods - Using registers from southern Sweden, we identified hip and knee OA patients aged 40-59 years who had a THR or TKR in the period 2004-2012. Patients who died or started on disability pension were excluded. We included 1,307 patients with THR (46% women) and 996 patients with TKR (56% women). For the period 1 year before until 2 years after the surgery, we linked individual-level data on sick leave from the Swedish Social Insurance Agency. We created a matched reference cohort from the general population by age, birth year, and area of residence (THR: n = 4,604; TKR: n = 3,425). The mean number of days on sick leave and the proportion (%) on sick leave 12 and 24 months before and after surgery were calculated. Results - The month after surgery, about 90% of patients in both cohorts were on sick leave. At the two-year follow-up, sick leave was lower for both cohorts than 1 year before surgery, except for men with THR, but about 9% of the THR patients and 12-17% of the TKR patients were still sick-listed. In the matched reference cohorts, sick leave was constant at around 4-7% during the entire study period. Interpretation - A long period of sick leave is common after total joint replacement, especially after TKR. There is a need for better knowledge on how workplace adjustments and rehabilitation can facilitate the return to work and can postpone surgery.
33.	Stigmar, Kjerstin, et al. (author) Work ability: Concept and assessment from a physiotherapeutic perspective. An interview study. 2011 In: Physiotherapy Theory and Practice. - : Informa UK Limited. - 0959-3985 .- 1532-5040. Journal article (peer-reviewed)abstract The aim of this study was to ascertain experiences and perceptions among physiotherapists (PTs) in Sweden regarding the concept of work ability as well as their perspectives of their professional role in work ability assessments. We conducted an in-depth interview study with four male and twelve female physiotherapists working in the field of occupational health care, orthopaedics, primary health care or rehabilitation. Qualitative content analysis was applied to the data. Work ability was perceived as the ability to perform work tasks as requested. Having the potential to adjust at work and to allocate resources, having an attachment to the workplace and time factors were vital. The physiotherapists were striving for a well-defined role within a multiprofessional team, where work ability assessments were performed in a real work environment. The PTs experienced contradictory roles in relation to the patient but believed they could contribute with valuable material for assessments; this professional help was not always requested. It was noted that there was a need for experience and further education to enable PTs to further engage in work ability assessments. It is important to improve collaboration and to further discuss the work ability concept from the viewpoints of different professionals.
34.	Stigmar, Kjerstin, et al. (author) Work ability - experiences and perceptions among physicians. 2010 In: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; Apr 7, s. 1780-1789 Journal article (peer-reviewed)abstract Purpose. To describe experiences and perceptions of work ability and how it can be assessed among Swedish physicians. Method. We interviewed eight men and six women in the fields of general practice, occupational health, rehabilitation and orthopaedic surgery. Qualitative content analysis was applied to the data. Results. The approach striving to support the patient in mutual confidence was what primarily affected how work ability was understood and how it could be assessed. Two main categories, with sub categories were settled: familiar but vague, with subcategories conflicting expectations and relations and consensus within speciality and the second main category relying on intuition and examinations, with sub categories life as a whole, reasonableness, progression plan, external obstacles and need for knowledge and collaboration. Conclusions. We found that physicians mainly rely on what patients were telling about their work situation when assessing work ability. But it was not clear if they should consider the patient's whole life situation, motivation and wishes. Protecting the physician-patient relationship was seen as important as well as the need for teamwork assessments and increased work place knowledge.
35.	Stigmar, Kjerstin (author) Work ability- Health professionals' perspectives and rehabilitation outcomes 2012 Doctoral thesis (other academic/artistic)abstract The overall aim of this thesis was to deepen the understanding of work ability by analyzing how different health professionals experience and perceive work ability and assessments of work ability, and also by analyzing rehabilitation outcomes that are related to work ability. The focus has been on musculoskeletal disorders with associated psychosocial factors. Method. The general approach was inductive and explorative. In studies I and II, in-depth interviews with physicians (n=14) and physiotherapists (n=16) were conducted, while study III comprised five focus groups within a group of experienced and specially trained physiotherapists (n=7). Qualitative content analysis was applied to the data. Study IV comprised a predefined cohort (n=406), consisting of individuals with musculoskeletal disorders, all included in the national rehabilitation program. All patients were offered multimodal rehabilitation including evidence-based interventions with the aim of promoting work ability. The cohort was studied in order to find out how the patients responded to the rehabilitation and also what factors were associated with health-related quality of life and sick leave. Results. Physicians and physiotherapists shared a holistic view of work ability and wanted to represent and support the patient. They experienced contradictory roles in relation to the patient. More extensive collaboration within health care was desired, but this was not always possible. The physiotherapists wanted to take part in assessments, but felt that they were not always asked to. To be able to take part, experience and further education were needed. Collaboration was also requested with other involved parties, such as occupational health services, the Social Insurance Agency and the employer. There was a need for better knowledge concerning the workplaces. After education and specially training, PTs took more initiatives. They believed that they could contribute with structured work ability assessments and benefitted from continuity. There was need to emphasize the PT role in the organizations. Patients in the national rehabilitation program improved health-related quality of life and function. Patients with no sick leave or disability pension the year before rehabilitation seemed to benefit more from the program. Compared to patients with sick leave or disability pension the year before rehabilitation, a minor proportion within this group reported work ability limitations after completing the program. Limitations with exercise tolerance functions and sick leave history were associated with being on sick leave and having lower health-related quality of life at follow-up.
36.	Sturesdotter Åkesson, Karin, et al. (author) Physical activity and health-related quality of life in men and women with hip and/or knee osteoarthritis before and after a supported self-management programme–a prospective observational study 2022 In: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 44:16, s. 4275-4283 Journal article (peer-reviewed)abstract Purpose: To study differences between men and women in physical activity (PA) and health-related quality of life (HRQoL) before and after participating in a supported osteoarthritis (OA) self-management programme. Materials and methods: A prospective observational study using data from a Swedish National Quality Register. Patients recorded between 2008 and 2013 with hip and/or knee OA with data at baseline, at 3 and 12 months follow-up (n = 7628) were included. Outcome measures were patient-reported PA and HRQoL (EQ-5D-3L). Results: A greater proportion of men (p = 0.002) changed to being physically active ≥150 min/week at 3 months follow-up. The proportion of women being physically active ≥150 min/week was larger than for men at baseline (p = 0.003) and at follow-up at 12 months (p = 0.035). Women reported lower HRQoL than men at baseline (p < 0.001), at follow-up at 3 (p < 0.001) and 12 months (p = 0.010). There were no differences between men and women in change in HRQoL at 3 (p = 0.629) and 12 months (p = 0.577) follow-up. Conclusions: This study showed differences between men and women in PA and HRQoL before and after participating in a supported OA self-management programme. These differences should be considered when supporting PA and HRQoL.Implications for rehabilitation Men with hip and/or knee osteoarthritis (OA) might need more support during rehabilitation in order to maintain or even increase physical activity (PA) in the long run. Women with hip and/or knee OA might need more support during rehabilitation in order to maintain or even increase health-related quality of life (HRQoL) in the long run. Booster sessions might be suggested in order to enable both men and women with hip and/or knee OA to sustain improvements in PA and HRQoL after participating in a supported OA self-management programme.
37.	Toropova, Anna, et al. (author) Effectiveness of a multifaceted implementation strategy for improving adherence to the guideline for prevention of mental ill-health among school personnel in Sweden : a cluster randomized trial 2022 In: Implementation Science. - : Springer Science and Business Media LLC. - 1748-5908. ; 17:1 Journal article (peer-reviewed)abstract Background: There is limited research on prevention of mental ill-health of school personnel and the systematic management of school work environments. The aim of this study was to assess the effectiveness of implementing the guideline recommendations for the prevention of mental ill-health in schools, in particular, whether there was a difference in adherence to guideline recommendations between a multifaceted (group 1) and single implementation strategy (group 2) from baseline to 6 and to 12 months. Method: We conducted a cluster-randomized controlled trial with a 6- and 12-month follow-up. Data was collected from nearly 700 participants in 19 Swedish schools. Participants were school personnel working under the management of a school principal. The single implementation strategy consisted of one educational meeting, while the multifaceted implementation strategy comprised an educational meeting, an ongoing training in the form of workshops, implementation teams and Plan-Do-Study-Act cycles. Adherence was measured with a self-reported questionnaire. Generalized Linear Mixed Models were used to assess the difference between groups in adherence to the guideline between baseline, 6-, and 12-months follow-up. Results: There were no statistically significant differences between the groups in improvements in adherence to the guideline between baseline, 6-, and 12-months follow-up. However, among those schools that did not undergo any organizational changes during the 12 months of the study significant differences between groups were observed at 12 months for one of the indicators. Conclusions: The multifaceted strategy was no more effective than the single strategy in improving guideline adherence. There are some limitations to the study, such as the measurement of the implementation outcome measure of adherence. The outcome measure was developed in a systematic manner by the research team, assessing specific target behaviors relevant to the guideline recommendations, however not psychometrically tested, which warrants a careful interpretation of the results. Trial registration: ClinicalTrials.gov, 150571. Registered 12 September 2017.
38.	Westerweel, Anne, et al. (author) Translation, adaptation, validity and reliability of the Dutch version of the ‘blue flags’ questionnaire 2022 In: European Journal of Physiotherapy. - : Informa UK Limited. - 2167-9169 .- 2167-9177. ; 24:6, s. 339-348 Journal article (peer-reviewed)abstract Purpose: To translate and culturally adapt the Swedish version of the ‘Blue flags’ questionnaire into Dutch and to examine the validity and reliability aspects of the Dutch version. Methods: The ‘Blue flags’ questionnaire was translated and culturally adapted to the Dutch situation. A total of 58 participants filled in the first questionnaire at baseline and 51 participants filled in the second questionnaire sent two weeks later. The data of the participants who filled in the first questionnaire was used to determine internal consistency, structural validity and concurrent validity. The data of the participants who filled in both questionnaires was used to determine test-retest reliability. Results: The internal consistency was good with a Cronbach’s alpha of 0.83. The structural validity was satisfactory with a Kaiser–Meyer–Olkin (KMO) test of 0.75 and a significance of p <.001 for the Bartlett’s test. Four factors were extracted using principal component analysis (PCA) with varimax rotation with an explained total variance of 70.8%. Spearman’s rho for concurrent validity was 0.68 (p <.001). The intraclass correlation coefficient (ICC) for test-retest was 0.80 (p <.001) for the total score. Conclusions: The Dutch version of the ‘Blue flags’ questionnaire showed good internal consistency, satisfactory structural validity, strong concurrent validity (with mixed item representation results) and strong reliability.
39.	Wetterholm, Malin, et al. (author) The rate of joint replacement in osteoarthritis depends on the patient's socioeconomic status : a cohort study of 71,380 patients 2016 In: Acta Orthopaedica. - : Informa UK Limited. - 1745-3682 .- 1745-3674. ; 87, s. 1-7 Journal article (peer-reviewed)abstract Background and purpose - Assessment of potential disparities in access to care is a vital part of achieving equity in health and healthcare. We have therefore studied the effect of socioeconomic status (SES) on the rates of knee and hip replacement due to osteoarthritis. Methods - This was a cohort study in Skåne, Sweden. We included all residents aged ≥ 35 years with consultations between 2004 and 2013 for hip or knee osteoarthritis. We retrieved individual information on income, education, and occupation and evaluated the rates of knee and hip replacement according to SES, with adjustment for age and sex. Professionals, legislators, senior officials, and managers, and individuals with the longest education, served as the reference group. Results - We followed 50,498 knee osteoarthritis patients (59% women) and 20,882 hip osteoarthritis patients (58% women). The mutually adjusted rate of knee replacement was lower in those with an elementary occupation (hazard ratio (HR) = 0.81, 95% CI: 0.72-0.92), in craft workers and those with related trades (HR = 0.88, CI: 0.79-0.98), and in skilled agricultural/fishery workers (HR = 0.83, CI: 0.72-0.96), but higher in the 2 least educated groups (HR = 1.2 in both). The rate of hip replacement was lower in those with an elementary occupation (HR = 0.77, 95% CI: 0.68-0.87), in plant and machine operators/assemblers (HR = 0.83, CI: 0.75-0.93), and service workers/shop assistants (HR = 0.88, CI: 0.80-0.96). The rate of hip replacement was higher in the highest income group (HR = 1.1, 95% CI: 1.0-1.2). Interpretation - There was a lower rate of joint replacement in osteoarthritis patients working in professions often associated with lower socioeconomic status, suggesting inequity in access to care. However, the results are not unanimous, as the rate of knee replacement was higher in the least educated groups.
40.	Wåhlin, Charlotte, et al. (author) A systematic review of work interventions to promote safe patient handling and movement in the healthcare sector 2022 In: International Journal of Occupational Safety and Ergonomics. - : Taylor & Francis. - 1080-3548 .- 2376-9130. ; 28:4, s. 2520-2532 Research review (peer-reviewed)abstract PURPUSE: The aim of this systematic review was to describe interventions which promote safe patient handling and movement (PHM) among workers in healthcare by reviewing the literature of their effectiveness for work and health-related outcomes.METHODS: Data bases were searched for studies published 1997‒2018. Measures was operationalised broadly, capturing outcomes of work and health. Only Randomized controlled trials (RCTs) and cohort studies with control group were included. Quality was assessed using evidence-based checklists by Swedish Agency for Health Technology Assessment and Assessment of Social Services.RESULTS: The systematic review included 10 RCTs and 19 cohort. Providing work equipment and training workers is effective: it can increase usage. Training workers to be peer coaches is associated with fewer injuries. Other effective strategies are participatory ergonomics and management engagement in collaboration with workers, facilitating safe PHM.CONCLUSIONS: This systematic review suggests interventions for safe PHM with an impact of health-related outcomes should include access to work equipment, training as well as employer and employee engagement. The additional impact of multifaceted interventions is inconclusive.PRACTITIONER SUMMARY: In clinical practice, there is a need for employers in healthcare to; 1) provide healthcare workers access to suitable work equipment. 2) provide training on how to use work equipment to prevent work-related injuries. Furthermore, the study also indicates that 3) training and appointing peer coaches can facilitate safe manual handling and movement (PHM) and, 4) It can be beneficial to involve workers in a participatory approach.
41.	Wåhlin, Cahrlotte, et al. (author) Säkrare personförflyttningar : Åtgärder i arbetsmiljön för medarbetare inom hälso- och sjukvård samt omsorg 2019 Reports (other academic/artistic)
42.	Wåhlin, Charlotte, et al. (author) Säkrare personförflyttningar : Åtgärder i arbetsmiljön för medarbetare inom hälso- och sjukvård samt omsorg 2019 Conference paper (other academic/artistic)abstract Vid seminariet presenterar författarna kunskapssammanställningen ”Säkrare person-förflyttningar. Åtgärder i arbetsmiljön för medarbetare inom hälso- och sjukvård samt omsorg” publicerad av Arbetsmiljöverket 2019. Resultatet är baserade på 29 vetenskapliga studier av högre kvalitet. Kunskapssammanställningen visar bland annat att vårdpersonalen gör färre manuella lyft och använder arbetsutrustning, exempelvis taklyftar, i högre grad om de får utbildning i att använda sådan utrustning. Att engagera medarbetarna genom så kallad participativ ergonomi leder också till att utrustningen används mer och till minskad smärta i ländrygg. Enbart utbildning och träning i förflyttningskunskap förebygger inte risk för skada och minskar inte heller smärta i ländrygg. Däremot kan fysisk träning minska smärtan hos dem som redan har ländryggsbesvär. Stöd från chefer är viktigt för säkra personförflyttningar. En framgångsfaktor är att cheferna ger stöd och resurser för att öka medarbetarnas delaktighet i arbetet för säkrare personförflyttningar. Ytterligare en framgångsfaktor är att utbilda och inrätta coacher som kan stödja personalen i det dagliga praktiska arbetet och skapa långsiktiga, hållbara metoder för personförflyttningar. En policy för säkra personförflyttningar kan också vara värdefull för en arbetsplats, men i den frågan saknas forskning av högre kvalitet. Kunskapssammanställningen kan användas för att implementera ny kunskap, där chef och medarbetare samverkar för att skapa säkrare personförflyttningar. Målsättningen är att skapa säkra vårdmiljöer där skador bland både vårdpersonal och patienter kan förebyggas. Vid presentationen finns utrymme att ställa frågor.
43.	Åkesson, Karin Sturesdotter, et al. (author) Empowerment and enablement and their associations with change in health-related quality of life after a supported osteoarthritis self-management programme - a prospective observational study 2023 In: Archives of Physiotherapy. - 2057-0082. ; 13:1 Journal article (peer-reviewed)abstract BACKGROUND: Osteoarthritis is a leading cause of disability worldwide. Current treatment supports coping strategies to improve health-related quality of life (HRQoL). The need to predict response to treatment has been raised to personalise care. This study aims to examine change in HRQoL from baseline to three and nine months follow-up after participating in a Supported Osteoarthritis Self-Management Programme (SOASP) and to examine if empowerment and/or enablement were associated with change in HRQoL after a SOASP.METHODS: Patients participating in a SOASP were recruited consecutively between April 2016 and June 2018. The EQ-5D was used to measure HRQoL, the Swedish Rheumatic Disease Empowerment Scale (SWE-RES-23) (score range 1-5) to measure empowerment and the Patient Enablement Instrument (PEI) (score range 0-12) to measure enablement. The instruments were answered before (EQ-5D, SWE-RES-23) and after (EQ-5D, SWE-RES-23, PEI) the SOASP. A patient partner was involved in the research process to enhance the patient perspective. Changes in outcome were examined with paired sample t-test and standardized effect sizes (Cohen´s d). Multiple linear regression analysis was performed to assess potential associations.RESULTS: One hundred forty-three patients participated in baseline measurement. Mean EQ-5D-5 L index score increased significantly from baseline to three months corresponding to a standardised effect size (Cohen´s d) of d = 0.43, 95% CI [0.24, 0.63] (n = 109), and from baseline to nine months d = 0.19, 95% CI [0.01, 0.37] (n = 119). The average EQ VAS score increased significantly from baseline to three months corresponding to a standardised effect size of d = 0.26, 95% CI [0.07, 0.45] (n = 109), and from baseline to nine months d = 0.18, 95% CI [0.00, 0.36] (n = 119). Neither SWE-RES-23 nor PEI at three months follow-up nor the change in the SWE-RES-23 score from baseline to three months follow-up were associated with change in either EQ-5D-5 L index (p > 0.05) or the EQ VAS (p > 0.05).CONCLUSIONS: Health-related quality of life increased after participating in a SOASP. Empowerment and enablement as measured with the SWE-RES-23 and the PEI were not associated with change in HRQoL among patients participating in a SOASP.TRIAL REGISTRATION: ClinicalTrials.gov. Identification number: NCT02974036. First registration 28/11/2016, retrospectively registered.
44.	Åkesson, Karin Sturesdotter, et al. (author) Enablement and empowerment among patients participating in a supported osteoarthritis self-management programme - a prospective observational study 2022 In: BMC Musculoskeletal Disorders. - : BioMed Central (BMC). - 1471-2474. ; 23:1 Journal article (peer-reviewed)abstract Background: In Sweden, core treatment for osteoarthritis is offered through a Supported Osteoarthritis Self-Management Programme (SOASP), combining education and exercise to provide patients with coping strategies in self-managing the disease. The aim was to study enablement and empowerment among patients with osteoarthritis in the hip and/or knee participating in a SOASP. An additional aim was to study the relation between the Swedish version of the Patient Enablement Instrument (PEI) and the Swedish Rheumatic Disease Empowerment Scale (SWE-RES-23). Methods: Patients with osteoarthritis participating in a SOASP in primary health care were recruited consecutively from 2016 to 2018. The PEI (score range 0-12) was used to measure enablement and the SWE-RES-23 (score range 1-5) to measure empowerment. The instruments were answered before (SWE-RES-23) and after the SOASP (PEI, SWE-RES-23). A patient partner was incorporated in the study. Descriptive statistics, the Wilcoxon's signed rank test, effect size (r), and the Spearman's rho (r(s)) were used in the analysis. Results: In total, 143 patients were included in the study, 111 (78%) were women (mean age 66, SD 9.3 years). At baseline the reported median value for the SWE-RES-23 (n = 142) was 3.6 (IQR 3.3-4.0). After the educational part of the SOASP, the reported median value was 6 (IQR 3-6.5) for the PEI (n = 109) and 3.8 (IQR 3.6-4.1) for the SWE-RES-23 (n = 108). At three months follow-up (n = 116), the reported median value was 6 (IQR 4-7) for the PEI and 3.9 (IQR 3.6-4.2) for the SWE-RES-23. The SWE-RES-23 score increased between baseline and three months (p <= 0.000). The analysis showed a positive correlation between PEI and SWE-RES-23 after the educational part of the SOASP (r(s) = 0.493, p < 0.00, n = 108) and at follow-up at three months (r(s) = 0.507, p < 0.00, n = 116). Conclusions: Patients reported moderate to high enablement and empowerment and an increase in empowerment after participating in a SOASP, which might indicate that the SOASP is useful to enable and empower patients at least in the short term. Since our results showed that the PEI and the SWE-RES-23 are only partly related both instruments can be of use in evaluating interventions such as the SOASP. Trial registration: ClinicalTrials.gov. NCT02974036. First registration 28/11/2016, retrospectively registered.
45.	Åkesson, Karin Sturesdotter, et al. (author) Factors associated with empowerment after participating in a supported osteoarthritis self-management program : An explorative study 2024 In: Osteoarthritis and Cartilage Open. - 2665-9131. ; 6:2 Journal article (peer-reviewed)abstract Objective: To explore factors associated with change in empowerment in patients that have participated in a 3-month Supported Osteoarthritis Self-Management Program (SOASP). Further, to evaluate empowerment in the longer term. Design: An explorative analysis including patients from a cohort study conducted in primary healthcare in Sweden was performed. Univariable linear regression models were performed to assess associations between demographics and patient-reported outcome measures (explanatory factors), respectively, and change in empowerment from baseline to 3-month follow-up (outcome variable). Long-term follow-up of empowerment was at 9 months. Results: Self-reported increase in enablement at the 3-month follow-up was associated with a greater improvement in empowerment (B = 0.041, 95% CI (0.011, 0.07), p = 0.008). Living alone was associated with less improvement in empowerment (B = −0.278, 95% CI (−0.469, −0.086), p = 0.005) compared to living together. Physical exercise >120 min per week at baseline was associated with less improvement in empowerment (B = −0.293, 95% CI (−0.583, −0.004), p = 0.047) compared to reporting no exercise at baseline. No other associations were observed (p > 0.05). Empowerment improved from baseline to the 3-month follow-up (mean 0.20 (SD 0.5), p < 0.001) but there was no change from baseline to the 9-month follow-up (mean 0.02 (SD 0.6), p = 0.641). Conclusions: Self-reported increased enablement may lead to greater improvement in empowerment after SOASP. Greater efforts may be needed to support those that live alone, are physically active, and to sustain empowerment in the longer term after SOASP. More research is needed on empowerment to provide personalized support for patients with OA after SOASP.
46.	Åkesson, Karin Sturesdotter, et al. (author) Physiotherapists' experiences of osteoarthritis guidelines in primary health care - an interview study 2021 In: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 22:1, s. 259-259 Journal article (peer-reviewed)abstract BACKGROUND: Osteoarthritis is a common joint disease, globally. Guidelines recommend information, exercise and, if needed, weight reduction as core treatment. There is a gap between evidence-based recommended care for osteoarthritis and clinical practice. To increase compliance to guidelines, implementation was conducted. The aim of the study was to explore physiotherapists' experiences of osteoarthritis guidelines and their experiences of implementation of the guidelines in primary health care in a region in southern Sweden. METHODS: Eighteen individual, semi-structured interviews with physiotherapists in primary health care were analysed with inductive qualitative content analysis. RESULTS: The analysis resulted in two categories and four subcategories. The physiotherapists were confident in their role as primary assessors for patients with osteoarthritis and the guidelines were aligned with their professional beliefs. The Supported Osteoarthritis Self-Management Programme, that is part of the guidelines, was found to be efficient for the patients. Even though the physiotherapists followed the guidelines they saw room for improvement since all patients with hip and/or knee osteoarthritis did not receive treatment according to the guidelines. Furthermore, the physiotherapists emphasised the need for management's support and that guidelines should be easy to follow. CONCLUSION: The physiotherapists believed in the guidelines and were confident in providing first line treatment to patients with osteoarthritis. However, information about the guidelines probably needs to be repeated to all health care providers and management. Data from a national quality register on osteoarthritis could be used to a greater extent in daily clinical work in primary health care to improve quality of care for patients with osteoarthritis.
47.	Östlind, Elin, et al. (author) Associations Between Physical Activity, Self-reported Joint Function, and Molecular Biomarkers in Working Age Individuals With Hip and/or Knee Osteoarthritis 2022 In: Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. - : SAGE Publications. - 1179-5441. ; 15 Journal article (peer-reviewed)abstract Objective: Previous research has suggested an association between physical activity (PA), joint function, and molecular biomarkers, but more studies are needed. The aim of this study was to explore the associations between PA or self-reported joint function and molecular biomarkers of cartilage and inflammation in individuals with hip and/or knee osteoarthritis (OA). Specific objectives were to explore the correlations between (1) the change over 3 months in self-reported PA/joint function and the change in molecular biomarkers (2) objectively measured PA and molecular biomarkers measured at 3-month follow-up. Design: Working age participants (n = 91) were recruited from a cluster randomized controlled trial. Self-reported PA, joint function, and serum samples were collected at baseline and after 3 months. Serum concentrations of the inflammatory marker C-reactive protein (CRP) and the cartilage markers Alanine-Arginine-Glycine-Serine (ARGS)-aggrecan, cartilage oligomeric matrix protein (COMP), and type II collagen C2C were analyzed by immunoassays. Objectively measured PA (steps/day) was collected during 12 weeks from activity trackers used by 53 participants. Associations were analyzed with Spearman’s rank correlation. Results: There was a weak negative correlation between the change in self-reported PA and the change in COMP (rs = −0.256, P =.040) but not for the other molecular biomarkers. There were no correlations between the change in self-reported joint function and the change in molecular biomarkers or between the average steps/day and the molecular biomarkers at follow-up (rs ⩽ −0.206, P ⩾.06). Conclusion: In general, no or only weak associations were found between PA/joint function and molecular biomarkers. Future research recommends including participants with lower PA, extend the follow-up, and use a design that allows comparisons.
48.	Östlind, Elin, et al. (author) Experiences of activity monitoring and perceptions of digital support among working individuals with hip and knee osteoarthritis – a focus group study 2022 In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 22:1 Journal article (peer-reviewed)abstract Background: Mobile health (mHealth), wearable activity trackers (WATs) and other digital solutions could support physical activity (PA) in individuals with hip and knee osteoarthritis (OA), but little is described regarding experiences and perceptions of digital support and the use of WAT to self-monitor PA. Thus, the aim of this study was to explore the experiences of using a WAT to monitor PA and the general perceptions of mHealth and digital support in OA care among individuals of working age with hip and knee OA. Methods: We conducted a focus group study where individuals with hip and knee OA (n = 18) were recruited from the intervention group in a cluster-randomized controlled trial (C-RCT). The intervention in the C-RCT comprised of 12-weeks use of a WAT with a mobile application to monitor PA in addition to participating in a supported OA self-management program. In this study, three focus group discussions were conducted. The discussions were transcribed and qualitative content analysis with an inductive approach was applied. Results: The analysis resulted in two main categories: A WAT may aid in optimization of PA, but is not a panacea with subcategories WATs facilitate PA; Increased awareness of one’s limitations and WATs are not always encouraging, and the second main category was Digital support is an appreciated part of OA care with subcategories Individualized, early and continuous support; PT is essential but needs to be modernized and Easy, comprehensive, and reliable digital support. Conclusion: WATs may facilitate PA but also aid individuals with OA to find the optimal level of activity to avoid increased pain. Digital support in OA care was appreciated, particularly as a part of traditional care with physical visits. The participants expressed that the digital support should be easy, comprehensive, early, and continuous.
49.	Östlind, Elin K., et al. (author) Patients’ experience of a workplace dialogue in physiotherapy practice in primary care : an interview study 2021 In: European Journal of Physiotherapy. - : Informa UK Limited. - 2167-9169 .- 2167-9177. ; 23:1, s. 27-33 Journal article (peer-reviewed)abstract Purpose: To describe how patients with acute/subacute back pain and/or neck pain experienced a workplace intervention, conducted as a structured workplace dialogue (convergence dialogue meeting, CDM) within physiotherapy practice in primary care. Materials and methods: Semi-structured interviews were performed with 10 patients who took part in the CDM. Qualitative content analysis was applied to the data. Results: Three categories emerged from the analysis: physiotherapist (PT) as a facilitator, the employer as a key stakeholder and lack of transparency and concrete changes. Conclusion: This study describes patients’ experiences of a workplace dialogue in physiotherapy practice. Even though few patients experienced concrete changes at the workplace, they were supportive for the intervention as well as how the PTs conducted the CDM. The patients expressed trust in the PTs who were seen as someone who could facilitate changes at the workplace, being proficient and supportive. The CDM could be a method to facilitate communication between stakeholders and support work ability.
50.	Östlind, Elin, et al. (author) Physical activity patterns, adherence to using a wearable activity tracker during a 12-week period and correlation between self-reported function and physical activity in working age individuals with hip and/or knee osteoarthritis 2021 In: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 22 Journal article (peer-reviewed)abstract Background: A majority of individuals with osteoarthritis (OA) are insufficiently physically active. Self-monitoring with wearable activity trackers (WAT) could promote physical activity (PA), and increased knowledge of PA patterns and adherence to using a WAT is needed. The aim of this study was to describe PA patterns and adherence to WAT-use during an intervention among participants of working age with hip and/or knee OA. The study further explores the correlation between self-reported joint function and PA. Methods: Individuals of working age with hip and/or knee OA who used a WAT, Fitbit Flex 2, for 12 weeks were included. Participants monitored their PA in the Fitbit-app. An activity goal of 7,000 steps/day was set. Steps and minutes in light (L), moderate and vigorous (MV) PA were collected from the Fitbit. Self-reported joint function (HOOS/KOOS) was completed. Data was analyzed with linear mixed models and Spearman’s rank correlation. Results: Seventy-five participants (45–66 years) walked on average 10 593 (SD 3431) steps/day, spent 248.5 (SD 42.2) minutes in LPA/day, 48.1 (SD 35.5) minutes in MVPA/day, 336.0 (SD 249.9) minutes in MVPA/week and used the Fitbit for an average of 88.4 % (SD 11.6) of the 12-week period. 86.7 % took > 7,000 steps/day and 77.3 % spent > 150 min in MVPA/week. Mean daily steps/week decreased significantly over the 12 weeks (β-coefficient − 117, 95 % CI -166 to -68, p = < 0.001) as well as mean daily minutes in LPA/week (β-coefficient − 2.3, 95 % CI -3.3 to -1.4, p = < 0.001), mean daily minutes in MVPA/week (β-coefficient − 0.58, 95 % CI -1.01 to -0.16, p = 0.008) and mean adherence to Fitbit-use per week (β-coefficient − 1.3, 95 % CI -1.8 to -0.8, p = < 0.001). There were no significant correlations between function (HOOS/KOOS) and PA. Conclusions: The majority of participants reached 7,000 steps/day and the recommended 150 min in MVPA per week. However, PA decreased slightly but gradually over time. Adherence to using the Fitbit was high but also decreased during the intervention. Understanding PA patterns and the use of a Fitbit to promote PA could be beneficial in tailoring interventions for individuals with hip and/or knee OA.

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