Kristiina Härkäpää

Health locus of control beliefs and psychological distress as predictors for treatment outcome in low-back pain patients: results of a 3-month follow-up of a controlled intervention study

&NA; Association of health locus of control beliefs (HLC) and psychological distress (GHQ‐12) with short‐term outcome of low‐back pain (LBP) rehabilitation was studied in patients with chronic or recurrent LBP (n = 459; aged 35–54 years; 63% men). These patients were randomly assigned to 3 study groups, namely the inpatient, the outpatient and the control group. The results showed a significant decrease in disability due to LBP in the 2 treated groups; in addition, the accomplishment and frequency of back exercises was significantly better in the treated groups. HLC beliefs were associated with a successful outcome; those patients with stronger internal beliefs had gained more from the treatment, had learned their exercises better and had done the exercises more frequently during the follow‐up period. Symptoms of psychological distress were significantly associated with poorer accomplishment of back exercises.

Outcome of a multimodal treatment including intensive physical training of patients with chronic low back pain

A comprehensive 4-week inpatient treatment including intensive physical training was evaluated in 194 chronic low back pain patients of whom 101 were working and 79 were on sick leave. Physical performance was assessed by measurements of spinal mobility, isometric trunk flexion and extension strength, and isokinetic lifting strength. Outcome was evaluated by a functional capacity index and work status changes reported at a 12-month follow-up. There was a 30-50% average increase in physical performance during treatment. At the 12-month follow-up the functional capacity index showed an average increase from 35.4 to 39.3 points (score range 24-48). At follow-up 28% of the sicklisted patients had returned to work and of those employed before treatment 14% were on sick leave. Associations between outcome and the improvement in physical measurements and their level at discharge were determined by stepwise multiple and logistic regression analyses. Among the physical measurements only increase in spinal mobility was associated with functional capacity index in women and return to work in both men and women at the 12-month follow-up. The overall results showed that intensive physical training and improved physical performance did not play crucial roles in the rehabilitation of chronic low back pain patients, at least when return to work was used as the outcome criterion.

Symptoms of psychological distress and treatment effects with low-back pain patients

The aim of the study was to investigate the relationship between psychological distress, the severity of low-back pain and the response of 54-63-year-old male in- and outpatients to low-back treatment. The correlation between the index of psychological distress and the back pain index was statistically significant, but relatively low. In the outpatient group (n = 63) those with fewer symptoms of distress and those not employed benefited significantly more from the treatment. In the inpatient group (n = 88), such clear differences were not found. The effects of treatment for low-back pain were relatively short-lived in both groups, whilst the number of inpatients reporting a large variety of positive effects after the treatment was greater. Differences between the two types of treatment are discussed.

Asymmetry of Lumbar Lateral Flexion and Treatment Outcome in Chronic Low-back Pain Patients

In a study on the treatment of chronic low-back pain (n = 456 patients; 58% men, 35-54 years of age), 3-month treatment outcome was assessed by back pain questionnaires and physical measurements including spinal and hip mobility and trunk muscle strength. Changes in differences between ranges of right and left lumbar lateral flexion and rotation of > 5 degrees from pretreatment to follow-up were recorded. A relative increase in left lumbar lateral flexion was associated with a better treatment outcome according to both back pain and physical performance (p < 0.05-0.001). With spinal rotation measurements no similar connections were observed. The results point to a connection between back pain and asymmetric spinal function, which may have pathogenetic and therapeutic significance.

Client participation in medical rehabilitation for adults with severe disabilities

The Social Insurance Institution (SII) of Finland arranges medical rehabilitation for people with severe disabilities. The rehabilitation process requires collaboration between the client and several organizations and professionals. The study aimed to find out what kind of experiences persons with disabilities had on their possibilities of participation in the planning and process of rehabilitation, and what factors were associated with the degree of their participation in the rehabilitation process. The study group was chosen using stratified sampling from among rehabilitation clients. The data were gathered using a questionnaire survey. Over half of the clients reported having participated actively in the rehabilitation planning and most found that their opinions had been taken into account at least fairly well during the planning phase. The results indicate that special attention should be paid to developing client-driven approaches in the rehabilitation system and to supporting the participation of clients who have difficulties in expressing their needs because of their illness, disability, or educational and social backgrounds.

Randomized trial on the effectiveness of long- and short-term psychotherapy on psychosocial functioning and quality of life during a 5-year follow-up

Knowledge is incomplete on whether long-term psychotherapy is more effective than short-term therapy in treating mood and anxiety disorder, when measured by improvements in psychosocial functioning and life quality. In the Helsinki Psychotherapy Study, 326 outpatients with mood or anxiety disorder were randomized to solution-focused therapy (SFT), short-term psychodynamic psychotherapy (SPP), or long-term psychodynamic psychotherapy (LPP), and followed up for 5 years from the start of treatment. The outcome measures comprised 4 questionnaires on psychosocial functioning, assessing global social functioning (Social Adjustment Scale (SAS-SR), sense of coherence (Sense of Coherence Scale (SOC)), perceived competence (Self-Performance Survey), dispositional optimism (Life Orientation Test (LOT)), and 1 questionnaire assessing quality of life (Life Situation Survey (LSS)). Short-term therapies improved psychosocial functioning and quality of life more than LPP during the first year. The only exceptions were LOT and perceived competence, which did not differ between SPP and LPP. Later in the follow-up, SOC and perceived competence showed significantly more improvement in LPP than in the short-term therapy groups. No direct differences between SFT and SPP were noted. Short-term therapy has consistently more short-term effects on psychosocial functioning and quality of life than LPP, whereas LPP has some additional long-term benefits on psychosocial functioning.

Health Locus of Control Beliefs in Low Back Pain Patients

Abstract Associations between health locus of control (HLC) beliefs, illness characteristics, psychological distress and self-care behaviour were studied in a group of subjects (n=459) aged 35 to 54 years suffering from chronic or recurrent low back pain (LBP). The results showed that younger subjects and men were more internal in their beliefs, and that duration and severity of LBP, psychological distress, and back care were associated with the individuals beliefs in his/her control over illness. The associations found were, however, of a low magnitude. More conclusive evidence on the development and modification of HLC beliefs are required before practical applications are possible.

Service characteristics as predictors of parents’ perceptions of child rehabilitation outcomes

Medical rehabilitation arranged by the Social Insurance Institution of Finland is provided for children with severe disabilities. The study aimed to find out which service characteristics were associated with perceived outcomes of rehabilitation. Parents whose children had participated in rehabilitation (n = 496) responded to a mail questionnaire that included questions on service characteristics and possible outcomes. Based on factor analysis, four outcome variables were formed. Logistic regression analysis was used to identify the particular service characteristics that were associated with the perceived outcomes. The family’s participation in rehabilitation planning and the child’s willingness to participate in rehabilitation activities were associated with good outcomes. Having a contact person for the rehabilitation process predicted child and family empowerment outcomes. The results emphasize the significance of establishing a good partnership between the professionals and the family; of developing the contents of the rehabilitation program, so that they motivate the child, and of organizing service coordinators for each family.

Changes in studying abilities as perceived by students attending psychotherapy

In rehabilitative psychotherapy, the goal is to support and improve the persons working and studying capacity and to secure his/her staying in or entering the workforce. In this qualitative study, the aim was to describe the changes students experienced in their studying ability and the advancement of their studies as a result of the therapy process. The results of this study showed many kinds of positive changes in the psychological resources and studying ability of students participating in psychotherapy. The results also show that when psychotherapy is arranged with the aim to support the study process, good connections between psychotherapy, study tutoring and career guidance are needed.

Client’s role and participation in stroke physiotherapy encounters: an observational study

Abstract Client participation is a basic principle in rehabilitation encounters. Coping at home after stroke requires self-confidence and autonomy, which can be enhanced by active collaboration and knowledge sharing. Earlier studies show, however, that clients are not always offered the role of an active participant in physiotherapy practice. A contradiction remains between official rhetoric and clinical practice. The purpose of this study was to investigate the interaction between the client and the physiotherapist in stroke rehabilitation sessions. Eight video-recorded treatment sessions were observed after an educational intervention that focused on client participation. Discourse analysis was used to examine the client’s involvement in the sessions. Four discourses were identified: taking on expert talk, inviting the client to participate in self-guided planning, neglecting emotional talk and supporting reflection. The client’s active participation manifested as responding to instructions, making plans, solving problems, expressing feelings, and evaluating personal performance and progress. The physiotherapists preferred the hands-off approach and invited the client to take an active role. However, they found it difficult to deal with the client’s expressions of fear and uncertainty. More attention should be paid to the client’s emotional expressions to enhance the client’s self-efficacy and self-management skills after stroke.