Irene Jensen

The secondary prevention of low back pain: a controlled study with follow-up

&NA; The current investigation studied the effectiveness of a secondary prevention program for nurses with back pain who were deemed at risk for developing a chronic problem. A 2 × 3 repeated measures design was employed with 2 groups and 3 assessment periods. The treatment group received an intervention designed to reduce current problems, but above all to prevent reinjury and minor pains from becoming chronic medical problems, and it included a physical and behavioral therapy package. The control group was placed on a waiting‐list. Results indicated that the treatment group had significantly greater improvements than the control group for pain intensity, anxiety, sleep quality and fatigue ratings, observed pain behavior, activities, mood, and helplessness. These differences were generally maintained at the 6 month follow‐up. In addition, the treatment group broke a trend for increasing amounts of pain‐related absenteeism, while the control group did not. Taken as a whole, the results suggest that a secondary prevention program aimed at altering life style factors may represent an effective method for dealing with musculoskeletal pain problems.

A 3-year follow-up of a multidisciplinary rehabilitation programme for back and neck pain

&NA; The aim of the present study was to evaluate the long‐term outcome of a behavioural medicine rehabilitation programme and the outcome of its two main components, compared to a ‘treatment‐as‐usual’ control group. The study employed a 4×5 repeated‐measures design with four groups and five assessment periods during a 3‐year follow‐up. The group studied consisted of blue‐collar and service/care workers on sick leave, identified in a nationwide health insurance scheme in Sweden. After inclusion, the subjects were randomised to one of the four conditions: behaviour‐oriented physiotherapy (PT), cognitive behavioural therapy (CBT), behavioural medicine rehabilitation consisting of PT+CBT (BM) and a ‘treatment‐as‐usual’ control group (CG). Outcome variables were sick leave, early retirement and health‐related quality of life. A cost‐effectiveness analysis, comparing the programmes, was made. The results showed, consistently, the full‐time behavioural medicine programme being superior to the three other conditions. The strongest effect was found on females. Regarding sick leave, the mean difference in the per‐protocol analysis between the BM programme and the control group was 201 days, thus reducing sick leave by about two‐thirds of a working year. Rehabilitating women has a substantial impact on costs for production losses, whereas rehabilitating men seem to be effortless with no significant effect on either health or costs. In conclusion, a full‐time behavioural medicine programme is a cost‐effective method for improving health and increasing return to work in women working in blue‐collar or service/care occupations and suffering from back/neck pain.

A randomized controlled component analysis of a behavioral medicine rehabilitation program for chronic spinal pain: are the effects dependent on gender?

&NA; The aim of the present study was to evaluate the outcome of a behavioral medicine (BM) rehabilitation program and the outcome of its two main components, compared to a ‘treatment‐as‐usual’ control group (CG). The study employed a 4×4 repeated‐measures design with four groups and four assessment periods (pre‐treatment, post‐treatment, 6‐month follow‐up, and 18‐month follow‐up). The group studied consisted of subjects on sick leave identified in a nationwide health insurance scheme in Sweden. After inclusion, the subjects were randomized to one of four conditions, which were: (1) behavior‐oriented physical therapy (PT); (2) cognitive behavioral therapy (CBT); (3) BM rehabilitation consisting of PT+CBT (BM); (4) a ‘treatment‐as‐usual’ CG. The treatments were given over a period of 4 weeks, PT and CBT on a part‐time basis and BM on a full‐time basis. Outcome variables were sick leave, early retirement, and health‐related quality of life (measured using the Short Form Health Survey, SF‐36). The results showed that the risk of being granted full‐time early retirement was significantly lower for females in PT and CBT compared to the CG during the 18‐month follow‐up period. However, the total absence from work (sick listing plus early retirement) in days over the 18‐month follow‐up period was not significantly different in the CG compared to the treatments. On the SF‐36, women in CBT and BM reported a significantly better health‐related quality of life than women in the CG at the 18‐month follow‐up. No significant differences for men were found on the SF‐36 scales. In conclusion, the results revealed gender differences in the outcome of the treatments and that the components of this BM program yielded as good results as the whole program.

Coping with long-term musculoskeletal pain and its consequences: is gender a factor?

&NA; We did a descriptive study of 121 patients (71 women and 50 men) to explore the role of gender in coping with long‐term intractable pain of the neck, shoulder and back and to determine the consequences of pain. Questionnaires used to assess the dependent variables were the Coping Strategy Questionnaire (CSQ) and the Multidimensional Pain Inventory (MPI). Distinctions were found between men and women. In particular, the coping strategies used by women were those which in previous research had been found to be associated with dysfunction and poor outcome in terms of rehabilitation. Moreover, considering the consequences of pain on daily living, a more complex pattern of related factors was found in women rather than men. Given the high proportion of working women in Sweden with long‐term musculoskeletal pain and considering recent observations in controlled studies showing that the benefits of cognitive behaviourally based treatments are confined to women, our findings suggest the need to tailor rehabilitative strategies differently for men and women and point to a research agenda which pays more attention to the distinctive challenges of women in the workplace when they are affected by chronic ailments.

Reliability and factor structure of the multidimensional Pain Inventory : Swedish language version (MPI-S)

&NA; The psychological assessment of chronic pain is often accomplished using questionnaires such as the (West Haven–Yale) Multidimensional Pain Inventory ((WHY)MPI) which is constructed to capture the multidimensionality of chronic pain. The (WHY)MPI theoretically originates from behavioural and cognitive behavioural theories of pain. It is divided into three parts and measures psychosocial and behavioural consequences of pain. This questionnaire has displayed satisfactory psychometric properties and translations of the original English version into German and Dutch have been demonstrated to be reliable and valid. The aim of this study was to test the reliability and factor structure of a Swedish translation of the (WHY)MPI, the MPI‐S, and also to test the generalisability of the factor structure found for the (WHY)MPI. We performed analyses of internal consistency using Cronbachs alpha, and carried out a confirmatory factor analysis (CFA) employing LISREL‐8 on a population of 682 patients suffering from chronic musculoskeletal pain. Test‐retest analysis was accomplished on a sub‐sample of 54 individuals taken from the aforementioned population. For sections 1 and 2 of the MPI‐S the overall reliability and stability were good, and after the exclusion of four items, the factor structure was similar to other versions of the MPI. For section 3, despite removal of five questions, the proposed factor structure could not be replicated. This part of the inventory is designed to measure the extent of different types of activities, and our results suggest that this section may only be used for assessing general activity level. We conclude that, with a few adjustments, the analyses yielded satisfactory results for sections 1 and 2 of the MPI‐S regarding its factor structure, reliability and generalisability. For section 3 the hypothesised factor structure could not be confirmed.

Coping strategies questionnaire (CSQ): Reliability of the swedish version of the CSQ

Abstract We present a study with the aim of investigating the internal consistency and reliability of a Swedish version of the Coping Strategies Questionnaire (CSQ). The study group consisted of 282 subjects suffering from long term back pain. Internal consistency was investigated by calculating alpha coefficients and test-retest reliability was investigated by a correlation analysis with two different test-retest intervals. The results reveal that the internal consistency of the Swedish CSQ is high (alpha range between 0.7 and 0.8) and consistent with the American version. The test-retest reliability was not equally satisfactory (correlation ranged between 0.4 and 0.9) but the results support the usefulness of the CSQ as a tool in the clinical assessment of pain coping strategies. The test-retest result indicate the need for further research. In conclusion, the results from the present study are encouraging and support the usefulness of the instrument but to improve the utility and application of the Swe...

No significant differences between intervention programmes on neck, shoulder and low back pain: A prospective randomized study among home-care personnel

The effects of two different prevention programmes on: (1) reported neck, shoulder and back pain, (2) perceived physical exertion at work and perceived work-related psychosocial factors, were evaluated by questionnaires after 12 and 18 months. Female nursing aides and assistant nurses (n = 282) working in the home-care services, were randomly assigned to one of three groups for: (1) individually designed physical training programme, (2) work-place stress management, (3) control group. Results revealed no significant differences between the three groups. However, improvements in low back pain were registered within both intervention groups for up to 18 months. Perceived physical exertion at work was reduced in the physical training group. Improvements in neck and shoulder pain did not differ within the three groups. Dissatisfaction with work-related, psychosocial factors was generally increased in all groups. As the aetiology of neck, shoulder and back disorders is multifactorial, a combination of the two intervention programmes might be preferable and should be further studied.

Coaching patients with early rheumatoid arthritis to healthy physical activity: a multicenter, randomized, controlled study.

OBJECTIVE To investigate the effect of a 1-year coaching program for healthy physical activity on perceived health status, body function, and activity limitation in patients with early rheumatoid arthritis. METHODS A total of 228 patients (169 women, 59 men, mean age 55 years, mean time since diagnosis 21 months) were randomized to 2 groups after assessments with the EuroQol visual analog scale (VAS), Grippit, Timed-Stands Test, Escola Paulista de Medicina Range of Motion scale, walking in a figure-of-8, a visual analog scale for pain, the Health Assessment Questionnaire disability index, a self-reported physical activity questionnaire, and the Disease Activity Score in 28 joints. All patients were regularly seen by rheumatologists and underwent rehabilitation as prescribed. Those in the intervention group were further individually coached by a physical therapist to reach or maintain healthy physical activity (> or =30 minutes, moderately intensive activity, most days of the week). RESULTS The retention rates after 1 year were 82% in the intervention group and 85% in the control group. The percentages of individuals in the intervention and control groups fulfilling the requirements for healthy physical activity were similar before (47% versus 51%; P > 0.05) and after (54% versus 44%; P > 0.05) the intervention. Analyses of outcome variables indicated improvements in the intervention group over the control group in the EuroQol VAS (P = 0.025) and muscle strength (Timed-Stands Test; P = 0.000) (Grippit; P = 0.003), but not in any other variables assessed. CONCLUSION A 1-year coaching program for healthy physical activity resulted in improved perceived health status and muscle strength, but the mechanisms remain unclear, as self-reported physical activity at healthy level did not change.

Risk factors for new episodes of sick leave due to neck or back pain in a working population. A prospective study with an 18-month and a three-year follow-up

Objectives: To identify risk factors for new episodes of sick leave due to neck or back pain. Methods: This prospective study comprised an industrial population of 2187 employees who were followed up at 18 months and 3 years after a comprehensive baseline measurement. The potential risk factors comprised physical and psychosocial work factors, health-related and pain-related characteristics and lifestyle and demographic factors. The response rate at both follow-ups was close to 73%. Results: At the 18-month follow-up, 151 participants reported at least one episode of sick-listing due to neck or back pain during the previous year. Risk factors assessed at baseline for sick leave due to neck or back pain at the follow-up were blue-collar work, back pain one or several times during the previous year, 1–99 days of cumulative sickness absence during the previous year (all causes except neck or back pain), uncertainty of one’s own working ability in 2 years’ time and the experience of few positive challenges at work. After 3 years, 127 participants reported at least one episode of sick leave due to back or neck pain during the year previous to follow-up. The risk factors for this pain-related sick leave were blue-collar work, several earlier episodes of neck pain, no everyday physical activities during leisure time (cleaning, gardening and so on), lower physical functioning and, for blue-collar workers separately, repetitive work procedures. Conclusion: The most consistent risk factors for new episodes of sick leave due to neck or back pain found during both the follow-ups were blue-collar work and several earlier episodes of neck or back pain assessed at baseline. Preventive efforts to decrease sick leave due to neck or back pain may include measures to increase the occurrence of positive challenges at work and to minimise repetitive work procedures. An evidence-based secondary prevention of neck and back pain including advice to stay active is also warranted.

The influence of prognostic factors on neck pain intensity, disability, anxiety and depression over a 2-year period in subjects with acute whiplash injury

&NA; The influence of potential prognostic factors (occupant‐ and crash‐related factors, initial neck pain intensity and headache, whiplash injury severity, helplessness, locus of control, socioeconomic status) on neck pain intensity (VAS), disability (DRI), anxiety and depression (HADS) was estimated in a cohort of 3704 subjects with whiplash injury following a motor vehicle crash. Questionnaires were administered (baseline, 1‐, 6‐, 12‐, 24‐month follow‐ups). VAS was trichotomized; “low” (0–30), “moderate” (31–54), “severe” (55–100). A cumulative logit model with a proportional odds assumption was applied. Results regarding depression differed somewhat from the other outcomes. Overall, initial neck pain intensity was an important prognostic factor, but acted also as an evident effect modifier. Females had slightly increased odds for all outcomes but depression, for which no gender differences were shown. Injury severity was associated with all outcomes, but was most pronounced regarding disability among those who perceived numbness/pain in arms/hands and also had severe initial neck pain (proportional odds ratio [OR] 6.5; 95% confidence interval [CI] 2.5–17.0). Initial headache influenced all outcomes. Income was not related to any of the outcomes, whereas a lower level of education was associated with all outcomes but depression. Locus of control was not a factor of importance. In contrast, helplessness was related to all outcomes, but was most pronounced regarding neck pain intensity and depression for subjects with severe initial neck pain (OR 4.8; 95% CI 2.9–7.8; OR 6.6; 95% CI 2.6–17.0). Associations seem to be established early, and then to be relatively constant over time.