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Health promoting factors in people with chronic musculoskeletal pain or with rheumatic diseases: a desciptive and interventional study
Högskolan i Jönköping, Jönköping, Sverige.ORCID iD: 0000-0001-5647-086X
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis with a salutogenic approach was to describe health promoting factors in people with chronic musculoskeletal pain and in people with rheumatic diseases, and to evaluate the effects of an intervention study with a self-care promoting PBL-program for people with rheumatic diseases having chronic musculoskeletal pain, sleep disturbances and/or fatigue.

Methods: This thesis is comprised of four samples: a randomly selected sample from a Swedish general population (study I) and three different samples containing people with rheumatic diseases registered at a hospital for rheumatic diseases in the southwest of Sweden (studies II, III and IV). Study I had a longitudinal cohort design with an eight-year follow-up in a general population. There were 1109 participants without chronic pain and 700 participants with chronic musculoskeletal pain. Study II had a longitudinal cohort design with participants with rheumatic diseases (n=185) 12 months after rehabilitation at a hospital for rheumatic diseases. Study III had a descriptive qualitative design with a phenomenological approach based on a reflective life-world perspective. Twelve participants were interviewed about their experiences about health-promoting self-care. Study IV had a randomised controlled design with post-test six months after the one-year self-care promoting problem-based learning (PBL) program for people with rheumatic diseases. The participants were randomly assigned to the experimental group, 54 participants, or to the control group, 148 participants. Data in studies I, II and IV were analysed with statistics. In study III a Husserlian phenomenological approach based on a reflective life-world perspective was used in the data collection and analysis.

Results: Study I: Although participants without chronic musculoskeletal pain reported better health-related quality of life (HRQL) than participants with chronic musculoskeletal pain, similar health factors were found to promote a better HRQL in the eight-year follow-up. The most important factors were feeling rested after sleep and having good sleep structure. Study II: The most important factors promoting better outcome in HRQL 12 months after rehabilitation in participants with rheumatic diseases were having a strong sense of coherence (SOC), feeling rested after sleep, having work capacity, and having good sleep structure. Study III: The meaning of health-promoting self-care as experienced by people with rheumatic diseases was that self-care takes place against a background of continual hope and belief to be able to influence health in positive ways. Self-care was a way of life and implied being ready to understand and respond to signals from the body. Three interrelated constituents elucidated the experiences: dialogue, power struggle and choice. Study IV: At the six month follow-up the participants in the experimental group had stronger empowerment after participation in the self-care promoting PBL-program compared with the control group which only got standard care for people with rheumatic diseases. There were no differences in HRQL, self-care ability, SOC, pain, quality of sleep or fatigue between the experimental group and the control group. The participants in the experimental group also stated that they had implemented lifestyle changes which they had not done without the PBL-program.

Conclusion: The results of this thesis provide a valuable and useful insight in health promoting factors in people with chronic musculoskeletal pain and in people with rheumatic diseases, but also in that people with rheumatic diseases have benefit from taking part in patient education with a self-care promoting PBL-program. These results contribute to evidence supporting the introduction of a more salutogenic approach in rheumatology care and research.

Place, publisher, year, edition, pages
Jönköping: Jönköping University , 2011. , 164 p.
Series
Dissertation series (School of Health Sciences, Jönköping University), ISSN 1654-3602 ; 17
Keyword [en]
Adult, chronic musculoskeletal pain, empowerment, health factors, HRQL, intervention, patient education, problem-based learning, rheumatic diseases, self-care
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hh:diva-28606Libris ID: 12188540ISBN: 978-91-85835-16-4 OAI: oai:DiVA.org:hh-28606DiVA: diva2:822605
Public defence
2011-06-01, Forum Humanum, Hälsohögskolan, Jönköping, 09:30 (Swedish)
Opponent
Supervisors
Available from: 2015-07-28 Created: 2015-06-16 Last updated: 2016-10-21Bibliographically approved
List of papers
1. Health predicting factors in a general population over an eight-year period in subjects with and without chronic musculoskeletal pain
Open this publication in new window or tab >>Health predicting factors in a general population over an eight-year period in subjects with and without chronic musculoskeletal pain
2008 (English)In: Health and Quality of Life Outcomes, ISSN 1477-7525, Vol. 6, 98Article in journal (Refereed) Published
Abstract [en]

Background: Many factors are proposed to be associated with health-related quality of life. Knowledge of health factors associated to development of a good health-related quality of life could be of use in clinical practice and public health work. The aim of this study was to investigate the associations between suggested health factors and health-related quality of life at baseline and in an eight-year follow up in subjects with and without chronic musculoskeletal pain in a cohort from a general population.

Methods: The study was designed as a longitudinal study in a Swedish general population (N = 1 849) with a postal questionnaire at baseline 1995 and at follow up 2003. Subjects were divided into two groups, according to their response about chronic musculoskeletal pain at baseline. Health-related quality of life was assessed by the SF-36 together with suggested health factors. The associations between SF-36 subscales and suggested health factors were estimated by OR and 95% CI calculated by multivariable logistic regressions, with adjustment for all health factors, age, sex and baseline SF-36 values.

Results: Although subjects without chronic musculoskeletal pain reported better health-related quality of life than subjects with chronic pain, similar health factors were found to be associated to higher scores in SF-36 at baseline and predicted a better outcome in the eight-year follow up. The most consistent finding was a better health outcome in the eight-year follow up for subjects that were feeling rested after sleep. Other factors that in some aspects predicted a better outcome were belonging to higher socioeconomic group, being a native Swede, having emotional support, having good sleep structure, never being or being a former smoker, and regularly drinking alcohol.

Conclusion: The most important health factor in subjects with and without chronic musculoskeletal pain was feeling rested after sleep, but also emotional support, sleep structure, smoking and alcoholic habits appears to be important components. These health factors could be important to address in clinical work with painful musculoskeletal disorders. Since several health factors are common in both subjects with and without pain there could be a common strategy to be formed in public health programmes.

Place, publisher, year, edition, pages
London: BioMed Central, 2008
Keyword
Health Status, Pain, Quality of Life
National Category
Nursing
Identifiers
urn:nbn:se:hh:diva-2730 (URN)10.1186/1477-7525-6-98 (DOI)000263448900001 ()19014459 (PubMedID)2-s2.0-62649129808 (Scopus ID)2082/3132 (Local ID)2082/3132 (Archive number)2082/3132 (OAI)
Note

This study was supported by grants from the Swedish Rheumatism Association, the Halland County Council, and the Swedish Social Insurance Agency.

Available from: 2009-08-12 Created: 2009-08-12 Last updated: 2016-10-21Bibliographically approved
2. Factors promoting health-related quality of life in people with rheumatic diseases: a 12 month longitudinal study
Open this publication in new window or tab >>Factors promoting health-related quality of life in people with rheumatic diseases: a 12 month longitudinal study
2011 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, Vol. 12, 102Article in journal (Refereed) Published
Abstract [en]

Background: Rheumatic diseases have a significant adverse impact on the individual from physical, mental and social aspects, resulting in a low health-related quality of life (HRQL). There is a lack of longitudinal studies on HRQL in people with rheumatic diseases that focus on factors promoting HRQL instead of risk factors. The aim of this study was to investigate the associations between suggested health promoting factors at baseline and outcome in HRQL at a 12 month follow-up in people with rheumatic diseases.

Methods: A longitudinal cohort study was conducted in 185 individuals with rheumatic diseases with questionnaires one week and 12 months after rehabilitation in a Swedish rheumatology clinic. HRQL was assessed by SF-36 together with suggested health factors. The associations between SF-36 subscales and the health factors were analysed by multivariable logistic regressions.

Results: Factors predicting better outcome in HRQL in one or several SF-36 subscales were being younger or middle-aged, feeling painless, having good sleep structure, feeling rested after sleep, performing low effort of exercise more than twice per week, having strong sense of coherence (SOC), emotional support and practical assistance, higher educational level and work capacity. The most important factors were having strong SOC, feeling rested after sleep, having work capacity, being younger or middle-aged, and having good sleep structure.

Conclusions: This study identified several factors that promoted a good outcome in HRQL to people with rheumatic diseases. These health factors could be important to address in clinical work with rheumatic diseases in order to optimise treatment strategies. © 2011 Arvidsson et al; licensee BioMed Central Ltd.

Place, publisher, year, edition, pages
London: BioMed Central, 2011
Keyword
adult, aged, article, diet, exercise, female, follow up, human, longitudinal study, major clinical study, male, outcome assessment, quality of life, questionnaire, rheumatic disease, Short Form 36, sleep, work capacity
National Category
Nursing
Identifiers
urn:nbn:se:hh:diva-16852 (URN)10.1186/1471-2474-12-102 (DOI)000293015600001 ()21599884 (PubMedID)2-s2.0-79956191676 (Scopus ID)
Note

The study was financed by the Halland County Council, the Swedish Rheumatism Association, the Rheumatism District in Gothenburg, the South Regional Health Care Committee, the Swedish Society of Nursing and the Association of Rheumatology Nurses in Sweden.

Available from: 2012-01-01 Created: 2012-01-01 Last updated: 2016-10-21Bibliographically approved
3. Experiences of health-promoting self-care in people living with rheumatic diseases
Open this publication in new window or tab >>Experiences of health-promoting self-care in people living with rheumatic diseases
Show others...
2011 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 67, no 6, 1264-1272 p.Article in journal (Refereed) Published
Abstract [en]

Aim: This paper is a report of a study that explores and describes the meaning of the phenomenon of health-promoting self-care as experienced by people living with rheumatic diseases.

Background: People with rheumatic diseases estimate health status as low and health belief and health status influence self-care behaviours. Several self-care behaviours are used in the efforts to mitigate the diseases.

Method: The study had a descriptive phenomenological approach based on a reflective life-world perspective. Data were gathered in 2007 by unstructured open-ended interviews with 12 individuals living with rheumatic diseases.

Findings: The meaning of health-promoting self-care as experienced by people living with rheumatic diseases was that self-care takes place against a background of continual hope and belief to influence health in positive ways. Self-care was a way of life and implied being ready to understand and respond to signals from the body. Three inter-related constituents elucidated their experiences: dialogue, power struggle and choice. Self-care was experienced as dialogues with the body and with the immediate environment. In order to respond to signals from the body, power struggles were required to be entered into when fighting the diseases. Choices were required to be made and things that were beneficial for the body were prioritized.

Conclusion: In this study, the meaning of health-promoting self-care as experienced by people living with rheumatic diseases was that self-care was a way of life. This meant to be ready to understand and respond to signals from the body. Self-care required dialogues, power struggles and choices. © 2011 Blackwell Publishing Ltd.

Place, publisher, year, edition, pages
Oxford: Blackwell Publishing, 2011
Keyword
Adults, Health promoting self-care, Nursing, Phenomenology, Rheumatic diseases, Self-care
National Category
Nursing
Identifiers
urn:nbn:se:hh:diva-16853 (URN)10.1111/j.1365-2648.2010.05585.x (DOI)000290398300010 ()21323976 (PubMedID)2-s2.0-79955730899 (Scopus ID)
Note

Funding: The Swedish Rheumatism Association, the Rheumatism District in Gothenburg, the Halland County Council and South Regional Health Care Committee.

Available from: 2012-01-01 Created: 2012-01-01 Last updated: 2016-10-21Bibliographically approved
4. Effects of a self-care promoting problem-based learning programme in people with rheumatic diseases: a randomized controlled study
Open this publication in new window or tab >>Effects of a self-care promoting problem-based learning programme in people with rheumatic diseases: a randomized controlled study
Show others...
2013 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 7, 1500-1514 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To evaluate the effects of a self-care promoting problem-based learning programme for people with rheumatic diseases in terms of health-related quality of life, empowerment, and self-care ability.

Background: Individuals with rheumatoid arthritis express a great need for education and support in adapting to the disease, but the average qualities of studies about patient education interventions are not high. There is no evidence of long-term benefits of patient education.

Design: Randomized controlled trial.

Methods: A randomized controlled design was selected with test at baseline, 1-week and 6-month post-interventions after completed the 1-year programme. The tests consisted of validity and reliability tested instruments. The participants were randomly assigned in spring 2009 to either the experimental group (n = 54) or the control group (n = 148). The programme was running alongside the standard care the participants received at a rheumatology unit. Parametric and non-parametric tests were used in the analyses.

Results: The participants in the experimental group had statistically significant stronger empowerment after participation in the self-care promoting problem-based learning programme compared with the control group, at the 6-month post-intervention. Approximately, two-thirds of the participants in the experimental group stated that they had implemented lifestyle changes due to the programme.

Conclusion: The self-care promoting problem-based learning programme enabled people with rheumatic diseases to improve their empowerment compared with the control group. It is important to continue to develop problem-based learning in patient education to find the very best way to use this pedagogical method in rheumatology care. © 2012 Blackwell Publishing Ltd.

Place, publisher, year, edition, pages
Chichester: Wiley-Blackwell, 2013
Keyword
empowerment, nursing, patient education, problem-based learning, rheumatic diseases, self-care
National Category
Nursing
Identifiers
urn:nbn:se:hh:diva-20653 (URN)10.1111/jan.12008 (DOI)000319829000006 ()22973890 (PubMedID)2-s2.0-84878623956 (Scopus ID)
Note

Funding: The Swedish Rheumatism Association, the Region Halland, the South Regional Health Care Committee, the Stig Thunes Foundation Fund for Health Care Research, the Norrbacka-Eugenia Foundation, the Association of Rheumatology Nurses in Sweden, and the Spenshult Hospital for Rheumatic Diseases.

Available from: 2013-01-10 Created: 2013-01-10 Last updated: 2017-04-03Bibliographically approved

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Citation style
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  • modern-language-association-8th-edition
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Output format
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