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  • 1.
    Bergman, Stefan
    Research and Development Centre, Spenshult, Oskarström, Sweden.
    Psychosocial aspects of chronic widespread pain and fibromyalgia2005In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 27, no 12, p. 675-683Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To study the impact on health status as measured by SF-36 in groups of subjects having chronic musculoskeletal pain with different degree of generalization: No chronic pain (NCP), chronic regional pain (CRP), chronic widespread pain (CWP), CWP with a stricter 'Manchester' definition (CWP-M), and clinically defined fibromyalgia (FM). The study also examines the association between psychosocial and lifestyle background variables, and these pain-groups.

    METHOD: A cross-sectional study with a postal survey to 3928 subjects, constituting a representative sample of the adult general population, followed by clinical examination in a selected group of subjects with CWP. CWP and FM were diagnosed according to ACR 1990 fibromyalgia criteria. Health status was measured by SF-36 Health Survey.

    RESULTS: Patients with CWP, CWP-M, and FM were found to present with more severe impairment of health status than the other two population groups. Several psychosocial factors, such as belonging to a lower socio-economic group, being an immigrant, living in a compromised housing area, having lower educational level, experiencing lower social support and having a family history of chronic pain, were associated with the populations with CWP and FM.

    CONCLUSIONS: The spectrum of impact on health and association to background variables, with respect to a stricter definition of CWP, indicates that these factors are important to attend to in the understanding and management of CWP and FM.

    © 2005 Taylor & Francis Group Ltd.

  • 2.
    Bremander, Ann
    et al.
    Spenshult Hosp Rheumat Dis, Ctr Res & Dev, S-31392 Oskarström, Sweden .
    Bergman, Stefan
    Spenshult Hosp Rheumat Dis, Ctr Res & Dev, Oskarström, Sweden .
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Perception of multimodal cognitive treatment for people with chronic widespread pain: changing one's life plan2009In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, no 24, p. 1996-2004Article in journal (Refereed)
    Abstract [en]

    Purpose.

    The aim of this study was to gain a deeper understanding of chronic widespread pain patients' perception of a multimodal treatment with a cognitive approach.

    Methods.

    A reformulated grounded theory study based on interviews with 16 participants in the programme was conducted at the end of a 6-month treatment period.

    Results.

    The result describes a conceptual model of the informants' perception of the treatment. The core category 'changing one's life plan' comprised of three categories: 'changing one's perception of life', 'depending on support' and 'managing one's life'. Changing one's perception of life could be deep and overwhelming 'overall life changes' or more superficial 'life adjustments'. Support by health professionals and the patient group were of importance. At the end of the rehabilitation program managing one's life was perceived as either 'reorientation' or 'stagnation'. The informants who experienced overall life changes achieved reorientation with support by others, while those who experienced life adjustments did not change their way of managing one's life to any great extent.

    Conclusion.

    The core category changing one's life plan included the categories; changing one's perception of life, depending on support and managing one's life. Informants experiencing overall life changes were more likely to achieve reorientation than those who experienced life adjustments

  • 3.
    Hagel, Sofia
    et al.
    Department of Rheumatology, Lund University and Lund University Hospital, Lund, Sweden.
    Lindqvist, Elisabet
    Department of Rheumatology, Lund University and Lund University Hospital, Lund, Sweden.
    Bremander, Ann
    Spenshult Hospital for Rheumatic Diseases, Research and Development Centre, Oskarström, Sweden.
    Petersson, Ingemar F
    Department of Orthopaedics, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden.
    Team-based rehabilitation improves long-term aerobic capacity and health-related quality of life in patients with chronic inflammatory arthritis2010In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 32, no 20, p. 1686-96Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To examine the effect of an interdisciplinary, out-patient rehabilitation programme for patients with chronic inflammatory arthritis on aerobic capacity and health-related quality of life (HRQOL).

    METHOD: One hundred and seventy-four patients, 115 with peripheral arthritis (PA) (91 women, mean age 53 years, disease duration 16 years) and 59 with spondylarthropathies (SpA), (27 women, mean age 46 years, disease duration 14 years) were consecutively enrolled in 18 days of interdisciplinary rehabilitation. We report data from evaluations at inclusion, at discharge, and at 4 and 12 months using a sub-maximal treadmill test of aerobic capacity and the Nottingham Health Profile (NHP) (t-test).

    RESULTS: At inclusion, less than 20% of all patients tested had aerobic capacity classified as 'average' or better. At discharge, 41% (PA) and 54% (SpA) reached the 'average' level or better with improvements maintained for 12 months. The total NHP scores improved in both groups (mean change -12 (99%CI -15, -9) for PA; mean change -13 (99%CI -19, -8) for SpA) and were maintained.

    CONCLUSION: Aerobic capacity and HRQOL improved significantly in this interdisciplinary out-patient rehabilitation study, and improvements were maintained for 12 months. The preserved level of aerobic capacity after 12 months indicated a change to a more physically active lifestyle among the participants.

  • 4.
    Hallberg, Lillemor R.-M.
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Hallberg, Ulrika
    Nordic School of Public Health, Göteborg, Sweden.
    Kramer, Sophia E.
    Vrije University Medical Center, Amsterdam, The Netherlands.
    Self-reported hearing difficulties, communication strategies and psychological general well-being (quality of life) in patients with acquired hearing impairment2008In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 30, no 3, p. 203-212Article in journal (Refereed)
    Abstract [en]

    PURPOSE. The aims were to (i) translate the Amsterdam Inventory for Auditory Disability and Handicap (AIADH) into Swedish and evalute its usefulness, (ii) describe hearing difficulties and psychological well-being (quality of life) and (iii) explore variables related to psychological well-being in a Swedish population. METHOD. Seventy-nine consecutive patients, referred to the hearing clinic for hearing examination and audiological rehabilitation, formed the study sample. Along with pure-tone audiometry, the AIADH, the Psychological General Well-being index and the Communication Strategies Scale were used. RESULTS. Men had significantly worse hearing on the high frequencies (2, 3, 4 and 6 kHz) than women but their quality of life was significantly higher than for women. Men scored significantly lower on 'auditory localization' and adopted non-verbal communication strategies less often than women. A stepwise regression analysis showed that 'maladaptive behaviours' and 'intelligibility in quiet' explained 48% of the variance in quality of life. CONCLUSION. Psychosocial consequences of hearing loss, such as lowered quality of life, cannot be predicted from audiometric data alone. The adverse relationship between maladaptive behaviour and quality of life emphasizes the relevance of developing training programs aiming to improve coping with the consequences of a hearing impairment.The AIADH may be useful in assessing self-reported difficulties among patients with hearing problems, but needs to be further developed in terms of psychometric evaluations and reliability testings based on a larger representative sample.

  • 5.
    Helvik, Anne-Sofie
    et al.
    Ear, Nose and Throat Department, St Olav's University Hospital of Trondheim, Norway.
    Jacobsen, Geir
    Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
    Hallberg, Lillemor R.-M.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Psychological well-being of adults with acquired hearing impairment2006In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 28, no 9, p. 535-545Article in journal (Refereed)
    Abstract [en]

    Aim: To study psychological well-being (health-related quality of life) in a population of adults 20 years and over with hearing impairment (HI) and its relation to audiological factors, consequences of the HI, sense of humour, and use of communication strategies.

    Subjects and methods: Consecutive adults (n = 343) at the outpatient Unit of Audiology of a Norwegian university hospital answered the Psychological General Well-being inventory (PGWB), Hearing Disability and Handicap Scale (HDHS), Sense of Humour Questionnaire-6 (SHQ-6), and Communication Strategies Scale (CSS) in relation to an audiological examination and medical consultation.

    Results: Mean PGWB index for the whole sample was 81.4 (SD 14.3) and females reported a significantly lower psychological well-being. In multiple linear regression analyses well-being was negatively associated with high levels of activity limitation and participation restriction. PGWB index was positively associated with high sense of humour, but was neither explained by audiological factors nor use of communication strategies.

    Conclusions: Psychological well-being was associated with the outcome of a standard HI assessment of activity limitation and participation restriction, but not with degree of HI and use of communication strategies.

  • 6.
    Helvik, Anne-Sofie
    et al.
    ENT Department St. Olav's University Hospital, Trondheim, Norway.
    Jacobsen, Geir
    Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
    Wennberg, Siri
    ENT Department St. Olav's University Hospital, Trondheim, Norway.
    Arnesen, Haakon
    ENT Department St. Olav's University Hospital, Trondheim, Norway.
    Ringdahl, Anders
    Department of Audiology, Göteborg University, Sweden.
    Hallberg, Lillemor R.-M.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Activity limitation and participation restriction in adults seeking hearing aid fitting and rehabilitation2006In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 28, no 5, p. 281-288Article in journal (Refereed)
    Abstract [en]

    Purposes: We first aimed to describe demographic and audiological characteristics of adults referred to a university hospital for hearing aid (HA) fitting and rehabilitation. Our second aim was to employ an inventory that assesses life consequences of hearing impairment (HI) in terms of perceived activity limitation and participation restriction for the first time in a Norwegian adult outpatient population. A third aim was to study life consequences by audiological and demographic characteristics.

    Subjects and methods: During one year consecutive patients (n?=?343) were requested to answer the Hearing Disability and Handicap Scale (HDHS) assessing activity limitation and participation restriction in relation to an audiological examination and medical consultation. The mean threshold of hearing (MTH) was ascertained by pure tone thresholds at 0.5?–?1?–?2?–?4 kHz in the better ear.

    Results: Activity limitation and participation restriction were both higher for HA experienced than HA naïve subjects ( p < 0.01). In a multivariable model, the explained adjusted variance of activity limitation (R2) was 43.4% with MTH, perceived duration, and severity of hearing problems as predictor variables. Correspondingly, the explained adjusted variance of participation restriction was 28.4% for a model with MTH, age, gender and perceived severity of hearing problems as predictors.

    Conclusions: As a standard supplement to audiometric tests, HDHS may be successfully applied as a clinical tool among similar hearing impaired outpatients in order to assess activity limitation and participation restriction as part of audiological rehabilitation.

  • 7.
    Helvik, Anne-Sofie
    et al.
    Ear, Nose and Throat Department, St Olav's University Hospital, Trondheim, Norway.
    Thürmer, Hanne
    Blefjell Hospital, Notodden, Norway.
    Jacobsen, Geir W.
    Department of Public Health and General Practice, Norwegian University of Technology, Trondheim, Norway.
    Bratt, Mette
    Ear, Nose and Throat Department, St Olav's University Hospital, Trondheim, Norway.
    Hallberg, Lillemor R.-M.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Psychometric evaluation of a Norwegian version of the Communication Strategies Scale of the Communication Profile for the Hearing Impaired2007In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 29, no 6, p. 513-520Article in journal (Refereed)
    Abstract [en]

    Aim.

    To evaluate the Communication Strategies Scale (CSS) in an adult Norwegian sample with hearing loss.

    Subjects and methods.

    Of 474 invited patients, a total of 337 consecutive adults admitted to the outpatient Unit of Audiology, ENT Department of a university hospital answered the CSS of the Communication Profile for the Hearing Impaired. The inventory assesses the use of three specific coping strategies; Maladaptive Behaviour, Verbal and Nonverbal Communication Strategies. The psychometric evaluation included construct validity by corrected item-total correlation, the internal consistency reliability by coefficient alpha (Cronbach's) and standard error of the measurement (SEM). Internal structure was evaluated by factor analyses using principal factors followed by a varimax rotation.

    Results.

    CSS showed good psychometric properties with acceptable and good internal consistency reliability for the subscales. The internal structure of the entire scale gave main loadings at 24 of 25 items at the same factor as the original one.

    Conclusion.

    CSS may well be used as a clinical tool in the routine assessment of maladaptive and adaptive communication strategies in an unselected adult population of hearing impaired outpatients.

  • 8.
    Lydell, Marie
    et al.
    Primary Health Care, Research and Development Unit, Falkenberg, Sweden & Section of Primary Health Care, Department of Public Health and Community Medicine, The Sahgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hildingh, Cathrine
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Primary Health Care, Research and Development Unit, Falkenberg, Sweden.
    Månsson, Jörgen
    Primary Health Care, Research and Development Unit, Falkenberg, Sweden & Section of Primary Health Care, Department of Public Health and Community Medicine, The Sahgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Marklund, Bertil
    Primary Health Care, Research and Development Unit, Falkenberg, Sweden & Section of Primary Health Care, Department of Public Health and Community Medicine, The Sahgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Grahn, Birgitta
    Research and Development Centre, Kronoberg County Council, Växjö, Sweden & Division of Physiotherapy, Department of Health Sciences, Lund University, Lund, Sweden.
    Thoughts and feelings of future working life as a predictor of return to work: a combined qualitative and quantitative study of sick-listed persons with musculoskeletal disorders2011In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, no 13-14, p. 1262-1271Article in journal (Refereed)
    Abstract [en]

    Purpose. The main aim of this study was to describe the thoughts and feelings of future working life related to return to work (RTW) in sick-listed persons due to musculoskeletal disorders (MSD). Further aim was to compare these descriptions with the person’s actual working situation 1, 5 and 10 years after a rehabilitation period.

    Methods. This study consisted of two parts. The first part had an explorative design, and qualitative content analysis was chosen in order to analyse the response to an open question regarding future working life answered before, persons sick-listed due to MSD (n = 320), took part in a rehabilitation programme 10 years ago. The second part had a prospective design and quantitative analysis was used to compare the results of the qualitative analysis with RTW and the working situation 1, 5 and 10 years after baseline.

    Results. Three categories emerged from the data with a total of nine subcategories. In the categories Motivation and optimism and Limitations to overcome, there were significantly more persons who had RTW 1 year after baseline when compared with the category Hindrance and hesitation. There were also some significant differences between the subcategories.

    Conclusions. The question, regarding thoughts and feelings of future working life, may be a simple screening method to predict RTW in persons sick-listed with MSD. This will guide the rehabilitation team to adjust the rehabilitation to each person’s needs and facilitating RTW.

  • 9.
    Lydell, Marie
    et al.
    Research and Development Unit, Primary Health Care, Halland, Sweden & Section of Primary Health Care, Department of Public Health and Community Medicine, The Sahgrenska Academy, University of Gothenburg, Sweden.
    Marklund, Bertil
    Research and Development Unit, Primary Health Care, Halland, Sweden & Section of Primary Health Care, Department of Public Health and Community Medicine, The Sahgrenska Academy, University of Gothenburg, Sweden.
    Baigi, Amir
    Research and Development Unit, Primary Health Care, Halland, Sweden & Section of Primary Health Care, Department of Public Health and Community Medicine, The Sahgrenska Academy, University of Gothenburg, Sweden.
    Mattsson, Bengt
    Section of Primary Health Care, Department of Public Health and Community Medicine, The Sahgrenska Academy, University of Gothenburg, Sweden.
    Månsson, Jörgen
    Research and Development Unit, Primary Health Care, Halland, Sweden & Section of Primary Health Care, Department of Public Health and Community Medicine, The Sahgrenska Academy, University of Gothenburg, Sweden.
    Return or no return – psychosocial factors related to sick leave in persons with musculoskeletal disorders: a prospective cohort study2011In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, no 8, p. 661-666Article in journal (Refereed)
    Abstract [en]

    Purpose. The aim of this study was to compare psychosocial factors between healthy persons and sick-listed persons with musculoskeletal disorders (MSD); both groups with MSD 10 years ago.

    Methods. This cohort study was prospective and 385 persons participated in a rehabilitation program 10 years ago, and 354 persons took part in the follow-up. Of these, 243 persons completed a questionnaire. Two groups were included in the study: a healthy group (not sick-listed) (n = 112) and a sick-listed group (n = 74). Psychosocial factors related to sick leave were compared between the groups.

    Results. In the 10-year follow-up, the healthy group showed a significantly higher quality of life, more control over the working situation, better sense of coherence and unexpectedly more life events. There was no significant difference in social integration and emotional support between the groups.

    Conclusions. Using the knowledge about the characteristics of the healthy group, adequate rehabilitation for every sick-listed person with a musculoskeletal disorder can be given and therefore facilitate the returning to work process. A multidimensional approach taking into account a person's physical condition and workplace related problems, as well as psychosocial factors, is of great importance for the person and for society. © 2011 Informa UK, Ltd.

  • 10.
    Malm, Karina
    et al.
    Research and Development Center, Spenshult, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. Research and Development Center, Spenshult, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Andersson, Maria
    Research and Development Center, Spenshult, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. Research and Development Center, Spenshult, Oskarström, Sweden & Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
    BARFOT study group,
    Predictors of severe self-reported disability in RA in a long-term follow-up study2014In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 8, p. 686-691Article in journal (Refereed)
    Abstract [en]

    Purpose: Identify factors predictive for severe self-reported disability in patients with rheumatoid arthritis. Methods: Patients (n = 1910) were sent a questionnaire 5-18 years after disease onset. Outcomes were the Health Assessment Questionnaire (HAQ), Rheumatoid Arthritis Outcome Score (RAOS) and physical activity. The tertile of patients most affected by the disease were compared to those less affected. Proposed predictive factors were function, pain, general health, radiographic joint damage, swollen/tender joints and disease activity measures at baseline. Age, gender and disease duration were controlled for in logistic regression analyses. Results: Seventy-three percent (n = 1387) responded to the questionnaire, mean age 65 years (SD 15) and 70% were women. Worse scores in function, pain, general health and tender joints at baseline increased the risk of being in the most affected group, as measured by HAQ and RAOS 5-18 years after disease onset (p < 0.000). Conclusion: High levels of pain and worse reports of function at disease onset were risk factors for being in the most disabled tertile of patients after 5-18 years. Pain and function proved to be predictors of the outcome while some measures of inflammation were not. It is important to recognize these patients who may be in need of multidisciplinary treatments already at disease onset.

    Implications for Rehabilitation

    • Health care providers should be aware of the subgroup of patients with more severe symptoms of pain and impaired function at disease onset since they have an increased risk of being in the most disabled tertile of rheumatoid arthritis patients several years later.
    • Health care providers should assess pain and function and act on high pain and impaired function already at disease onset as they proved to be predictors of patient-reported outcomes controlled for inflammatory parameters.
    • These findings support European guidelines and research findings that patients with high pain and impaired function despite of well-managed inflammatory parameters should early in the disease course be referred to multidisciplinary treatment for supplementary regime.
  • 11.
    Thorstensson, Carina A.
    et al.
    Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Roos, Ewa M.
    Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Petersson, Ingemar F.
    Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    How do middle-aged patients conceive exercise as a form of treatment for knee osteoarthritis?2006In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 28, no 1, p. 51-59Article in journal (Refereed)
    Abstract [en]

    Purpose. To describe conceptions, as registered by a semi-structured interview, of exercise as treatment among sixteen middle-aged patients with moderate to severe knee osteoarthritis.

    Method. Sixteen patients (aged 39 – 64) with symptomatic, radiographic knee osteoarthritis and previous participants in an exercise intervention, were interviewed. The qualitative data obtained were analysed using phenomenographic approach.

    Results. Four descriptive categories containing 13 conceptions emerged: Category 1) To gain health included five conceptions; to experience coherence, to experience well-being, to be in control, to experience improved physical functioning, to experience symptom relief; 2) To become motivated included three conceptions; to experience inspiration, to be prepared to persevere, to experience the need to exercise; 3) To experience the need for support included three conceptions; to have structure, to receive guidance, to devote time; 4) To experience resistance included two conceptions; to hesitate, to deprecate.

    Conclusion. Patients with knee osteoarthritis and knee pain, previously participating in exercise intervention, are aware of the health benefits of exercise, but have many doubts and concerns about exercise as treatment. These aspects should be considered when designing patient information and treatment programmes. Furthermore, a hesitative and resistive perception of exercise as a concept could have major influences on the implementation of health programmes. © 2006 Taylor & Francis.

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