Camilla Ihlebæk

A scoring system for subjective health complaints (SHC)

The aim of this study is to present a complete scoring system for subjective health complaints (SHC) as they are experienced by the lay population. The scoring system records the complaints, and does not map attributions or medical diagnoses. In all, 1,219 subjects (323 men, 896 women) from various occupations were tested with a scoring system, the SHC inventory, previously referred to as the Ursin Health Inventory (UHI). The SHC consists of 29 questions concerning severity and duration of subjective somatic and psychological complaints. The SHC inventory yields scores on single items and a total number of health complaints categorized into five factors: musculoskeletal pain (α=0.74), pseudoneurology (α=0.73), gastrointestinal problems (α=0.62), allergy (α=0.58) and flu (α=0.67). The SHC inventory is a systematic, easy, and reliable way to score subjective health complaints. The prevalence of these complaints is high, and should be considered before conclusions are reached about new diseases and new attributions of environmental hazards.

Localized or widespread musculoskeletal pain: does it matter?

&NA; Although epidemiological descriptions indicate that musculoskeletal pain is often widespread, still a lot of musculoskeletal pain is diagnosed and treated as localized pain. This led us to question whether localized pain exists at all and to evaluate its functional impact compared with that of widespread musculoskeletal pain. Therefore, this study aimed to describe the prevalence of localized and widespread musculoskeletal pain and its association to functional ability. In 2004, questionnaires about musculoskeletal pain were mailed to seven age groups in Ullensaker, Norway: 24–26, 34–36, 44–46, 54–56, 64–66, 74–76, and 84–86 years old. In total, 3325 persons participated (participation rate 54.4%). We excluded the oldest age group and persons who did not respond to any questions about pain during the previous week, thus reducing the participants in this study to 3179. Although musculoskeletal pain occurred frequently in the population, localized pain, in the meaning of single site pain, was relatively rare. Most people having musculoskeletal pain reported pain from a number of sites. Furthermore, experiencing single site pain did not have a large impact on physical fitness, feelings, or daily and social activities. Functional problems increased markedly, in an almost linear way with increasing number of pain sites. These findings suggest that musculoskeletal pain usually coexists with pain in other body regions and that the functional consequences are highly dependent on how widespread the pain is. This should have important implications for future research into musculoskeletal pain, and for clinical and social insurance medicine.

Comorbid subjective health complaints in low back pain

Study Design. Cross-sectional study. Objectives. To compare subjective health complaints in subacute patients with low back pain with reference values from a Norwegian normal population. Summary of Background Data. Comorbidity is common with nonspecific low back pain. We wanted to investigate if these complaints were specific or part of a more general unspecific condition comparable to subjective health complaints in the normal population. Materials and Methods. The study group consisted of 457 patients sick-listed 8 to 12 weeks for low back pain. All subjects filled out questionnaires. The subjective health complaints in the study group were compared with reference values from a Norwegian normal population using logistic regression analysis. Results. Compared with the normal reference population, the patients with low back pain had significantly more low back pain, neck pain, upper back pain, pain in the feet during exercise, headache, migraine, sleep problems, flushes/heat sensations, anxiety, and sadness/depression. The prevalence of pain in arms, pain in shoulders, and tiredness was also high, but not significantly higher than in the reference population. Conclusions. Our findings indicate that patients with low back pain suffer from what may be referred to as a “syndrome,” consisting of muscle pain located to the whole spine as well as to legs and head, and accompanying sleep problems, anxiety, and sadness/depression.

Does the number of musculoskeletal pain sites predict work disability? A 14-year prospective study

Various risk factors associated with disability pensioning have been reported. This study investigated the relationship between the number of pain sites and risk of receiving a disability pension. We hypothesised that risk of work disability would increase as the number of pain sites increased, even after controlling for potential confounders. In 1990 and 2004, questionnaire on musculoskeletal pain was sent via post to six age groups in Ullensaker, Norway. Data on demographic, health and work‐related variables were also collected. After excluding individuals due to reach retirement age in 2004, we followed 1354 (66%) persons who were classified in 1990 as “employed”, “unemployed”, “homemaker”, or “student”. Among them, 176 persons had received long‐term or permanent work disability pension in 2004. Bivariate analyses showed that the prevalence of disability pensions was strongly associated with the number of pain sites. Controlling for gender and age almost unaltered the relationship. However, a model controlling for all significant confounders showed that general health and sick leave previous year captured almost all the predictive power of the number of pain sites on work disability. Since these variables could be seen as intermediate variables and not confounders, they were excluded in a new model which gave a strong “dose–response” relationship between number of pain sites and disability with a 10‐fold increase from 0 to 9–10 pain sites. The predictive validity of the number of pain sites in determining future disability renders this simple measurement useful for future research on musculoskeletal pain and functioning.

Change in the number of musculoskeletal pain sites: A 14-year prospective study

Abstract Musculoskeletal pain that affects multiple body sites is typically regarded as comorbidity to single‐site pain. Pain present in multiple sites, however, is more severe and disabling compared to single‐site pain. This study aimed to prospectively investigate the change in the number of pain sites over 14 years, in addition to identifying predictors of multi‐site pain. In 1990 and 2004, questionnaires about musculoskeletal pain were mailed to six birth cohorts in Ullensaker, Norway. Data on demographic, lifestyle, and health‐related variables were also collected. Participation rate in 1990 was 67.2% and among those 60.4% participated in 2004. A slight increase in the average number of pain sites occurred between 1990 and 2004, but results showed a relatively stable pattern of pain reporting over a period of 14 years. Several demographic, lifestyle, and health‐related variables in 1990 predicted the number of pain sites at follow‐up in the bivariate analyses. However, only sex, age, sleep quality, and educational level remained significant in the final multivariate model after controlling for the number of pain sites at baseline. The final model explained 35% of the variance, of which nearly 80% was accounted for by the number of pain sites at baseline. As the pattern of reporting the number of pain sites appears relatively stable across adulthood and baseline multi‐site pain demonstrated strong predictive utility, studies investigating the occurrence of multi‐site pain in children and adolescents are recommended to determine potential causal factors contributing to the early course and development of multi‐site musculoskeletal pain.

Musculoskeletal disorders as causes of sick leave and disability benefits

BACKGROUND Musculoskeletal disorders make up a heterogeneous group. Our aim was to describe the variation in social insurance benefits for the most prevalent disorders within this group. MATERIAL AND METHODS The study was based on the Norwegian labour and welfare administrations registers on sickness benefits and disability benefits. RESULTS Of the musculoskeletal disorders, low back conditions are the most frequent causes of sick leave and disability benefits, and account for 11 and 9% respectively. Neck and shoulder disorders are also common causes of sick leave, while osteoarthritis and fibromyalgia are common causes of disability benefits and each account for 5% of all new cases. INTERPRETATION The labour and welfare administration should continue to focus on musculoskeletal disorders to prevent long-term sick leave and permanent absence from work.

Beliefs about low back pain in the Norwegian general population: are they related to pain experiences and health professionals?

Study Design. A baseline study of the general population and the health care providers in 3 Norwegian counties. Objective. To investigate if beliefs about low back pain (LBP) are related to personal experiences and profession sought for care. Summary of Background Data. Myths about LBP that are abandoned by health professionals are still alive in the public. Such myths represent pain avoidance beliefs and passive coping strategies that may hinder normal spontaneous recovery from an episode of LBP. Methods. A sample of 1502 randomly selected people was interviewed by telephone, and all the 1105 physicians, physiotherapists, and chiropractors in the area were sent a questionnaire in April 2002. All respondents gave their responses in terms of degree of agreement to 6 statements reflecting beliefs about LBP. Results. Personal back pain experiences were important for beliefs about LBP. People with a history of previous back pain had more faith in the 2 statements “Back pain recovers best by itself” (52.2%) and “In most cases back pain recovers by itself in a couple of weeks” (32.5%) than those with current pain (36.9% and 20.9%, respectively, P < 0.000). There were significant differences in beliefs between physicians and the chiropractors concerning the same 2 statements, and these differences were also reflected in the beliefs of patients treated by the different professional groups. Conclusions. Belief in spontaneous recovery from LBP seems to be positively correlated to previous experience with LBP without current pain. Patients of the various health care providers seem to have a faith in spontaneous recovery similar to that of their health care provider. These differences may frustrate the public and patients who visit more than one provider, and hinder collaboration among professional groups.

Effects on Symptoms of Agitation and Depression in Persons With Dementia Participating in Robot-Assisted Activity: A Cluster-Randomized Controlled Trial

OBJECTIVES To examine effects on symptoms of agitation and depression in nursing home residents with moderate to severe dementia participating in a robot-assisted group activity with the robot seal Paro. DESIGN A cluster-randomized controlled trial. Ten nursing home units were randomized to either robot-assisted intervention or a control group with treatment as usual during 3 intervention periods from 2013 to 2014. SETTING Ten adapted units in nursing homes in 3 counties in eastern Norway. PARTICIPANTS Sixty residents (67% women, age range 62-95 years) in adapted nursing home units with a dementia diagnosis or cognitive impairment (Mini-Mental State Examination score lower than 25/30). INTERVENTION Group sessions with Paro took place in a separate room at nursing homes for 30 minutes twice a week over the course of 12 weeks. Local nurses were trained to conduct the intervention. MEASUREMENTS Participants were scored on baseline measures (T0) assessing cognitive status, regular medication, agitation (BARS), and depression (CSDD). The data collection was repeated at end of intervention (T1) and at follow-up (3 months after end of intervention) (T2). Mixed models were used to test treatment and time effects. RESULTS Statistically significant differences in changes were found on agitation and depression between groups from T0 to T2. Although the symptoms of the intervention group declined, the control groups symptoms developed in the opposite direction. Agitation showed an effect estimate of -5.51, CI 0.06-10.97, P = .048, and depression -3.88, CI 0.43-7.33, P = .028. There were no significant differences in changes on either agitation or depression between groups from T0 to T1. CONCLUSION This study found a long-term effect on depression and agitation by using Paro in activity groups for elderly with dementia in nursing homes. Paro might be a suitable nonpharmacological treatment for neuropsychiatric symptoms and should be considered as a useful tool in clinical practice.

Low back pain media campaign: No effect on sickness behaviour

OBJECTIVE To evaluate the effect of a media campaign on popular beliefs about LBP, and eventual changes in sick leave, imaging examinations, and surgery. METHODS Quasi-experimental telephone survey of 1500 randomly chosen people before, during, and after a media campaign in two Norwegian counties, with residents of an adjacent county as the control group. Data on sickness absence, surgery rates for disc herniation and imaging examinations on LBP in the area were collected at the same intervals. RESULTS The campaign led to a small but statistically significant shift in beliefs about LBP in the general public. In particular, beliefs about the use of X-rays, and the importance of remaining active and at work, seemed to have changed in response to the campaign messages. However, this change in attitude and understanding of the condition did not lead to any corresponding change in sickness behaviour. CONCLUSIONS Although the media campaign seemed to somewhat improve beliefs about LBP in the general public, the magnitude of this was too small to produce any significant change in behaviour. PRACTICE IMPLICATIONS A media campaign on LBP should not be limited to small areas and low-budget. A much larger investment is needed for a media campaign to have sufficient impact on publics beliefs on LBP to lead to altered sickness behaviour.

Healthcare provider back pain beliefs unaffected by a media campaign

Objective. Healthcare providers play a key role in transmitting knowledge and beliefs about LBP to their patients. There are differences in back pain beliefs between the various professionals groups treating LBP patients. This study examined whether LBP beliefs changed among the healthcare providers exposed to a media campaign. Design. A quasi-experimental postal before-and-after survey of health professional beliefs following a campaign aimed at improving beliefs about LBP in the general public, and which included specific interventions also towards the healthcare providers. Setting. Two Norwegian counties, with a neighbouring county serving as control. Subjects. A total of 243 doctors, physiotherapists, and chiropractors in primary care. Main outcome measures. Beliefs about LBP before and after exposure to the campaign. Results. A total of 243 doctors, physiotherapists, and chiropractors answered the questionnaire in 2002 and 2005. A general tendency was observed for all providers to have beliefs more in line with guidelines in 2005 compared with 2002, irrespective of exposure status. Some baseline differences in beliefs between the professional groups were not only sustained but in fact seemed to increase from 2002 to 2005. This was particularly as regards LBP as a self-limiting condition. Conclusion. An LBP mass media campaign with educational initiatives aimed at healthcare providers did not result in important improvement in LBP beliefs of providers exposed to the campaign. Important differences were observed between beliefs of the different healthcare provider groups in their view of LBP.