Marie-Louise Schult

Whiplash patients' experience of a multimodal rehabilitation programme and its usefulness one year later.

Objective. The study aimed to explore and analyse how, 1 year after completing a rehabilitation programme, persons with long-term pain due to whiplash-associated disorders (WAD) experienced their participation, and what knowledge and strategies they had gained from it for handling their daily occupations. Methods. The study had an emergent design. Thematised research interviews were conducted with nine informants. The results were analysed according to the constant-comparison grounded-theory method. Results. Data analysis resulted in one core category, ‘learning to manage WAD, a rehabilitation process’, and three associated categories: ‘chaos in life’, ‘a light in the tunnel’ and ‘managing long-term pain’. The core category and the categories describe the process the informants underwent from how they experienced life when starting rehabilitation to one year after completion. Conclusion. The informants described living with long-term whiplash-associated pain as ‘chaos’ before the rehabilitation programme. Participation helped them realise that there was a possible way for them to control their pain, regain their daily occupation and return to work. One year after rehabilitation the informants had started to accept their situation and regain occupations and life roles.

Work technique training for patients with chronic pain in neck, shoulder and arm. A questionnaire pilot study after a comprehensive exercise-oriented rehabilitation program

Syftet med denna studie var att följa upp hur patienter såg på sin arbetsmiljö och arbetsteknik samt hur föreslagna arbetsplatsanpassningar hade genomförts efter deltagande i ett multimodalt intensivträningsinriktat rehabiliteringsprogram. Programmet inkluderade en väsentlig del av individuell ergonomisk analys, individuell ergonomisk rådgivning och specifik arbeetsteknikträning på arbetsterapiavdelningen. Patienterna hade kronisk muskuloskelettal smärta i armen. Efter rehabiliteringsprogrammet skickades ett frågeformulär till 181 patienter, varav 135 patienter (109 kvinnor och 26 män) (75%) svarade. Mer än halften av patienterna rapporterade att de oftere än en gång i veckan tänkte tillbaka på den individuella ergonomiska rådgivningen som gavs i samband med att videofilmen tagen på deras arbetsplats presenterades. Deras skattningar visade på en hög medvetandegrad när det gällde att la mikropauser under arbetet (dvs atl räta upp ryggen kombinerat med muskelavslappning), att arbeta med armarna nära kroppen och att lyfta bördor nära kroppen. Hälften av patienterna hade använt sig av möjligheten att ändra arbetsställning mer än en gång per timme. Resultatet indikerar att patienterna var medvetna om sin arbetsteknik efter deltagandet i rehabiliteringsprogrammet.

Using a profile of a modified Brief ICF Core Set for chronic widespread musculoskeletal pain with qualifiers for baseline assessment in interdisciplinary pain rehabilitation

Aim To describe the use of a “workable” visual profile of function and disability, based on a modified Brief International Classification of Functioning, Disability and Health (ICF) Core Set for chronic widespread pain, for initial assessments in a clinical setting of interdisciplinary pain rehabilitation teams. Method The Brief ICF Core Set was slightly adapted to meet the needs of an interdisciplinary rehabilitation medicine team working in a university outpatient clinic and admitting patients referred from primary care. The Core Set categories were made measurable by means of eg, assessment instruments and clinical investigations. The resulting profile was given a workable shape to facilitate rapid understanding of the initial assessment outcome. Results Individual patients showed different profiles of problems and resources, which facilitated individual rehabilitation planning. At the level of the study group, the profiles for the Core Set component Body Functions showed that most patients had severe impairment in the sensation of pain and exercise tolerance categories of function, but most had resources in the motivation and memory categories of function. Likewise, for the component Activities, most patients had limitations in lifting and carrying objects and remunerative employment, but most had resources in intimate relationships and family relationships. At first, the use of the modified Brief ICF Core Set in the team conference was rather time consuming, but after a couple of months of experience, the team assessment took approximately 30 minutes to complete per patient. Conclusion The profile of the modified Brief ICF Core Set for chronic widespread pain served as a common platform, facilitating cooperation between the rehabilitation team members and providing a uniform language, which helped in structuring the clinical work. The profile also provided an easily accessible, overall view of the patient’s problems and resources, which helped in understanding the functioning situation of the patient.

The effect of sampling bias on generalizability in intervention trials after brain injury

ABSTRACT Objective and design: The first objective of this descriptive study was to explore the effect of strict inclusion and exclusion criteria on patient recruitment in cognitive rehabilitation; the second was to analyse the representativeness of study patients for all eligible stroke and traumatic brain injury patients referred to the department from September 2011 to November 2014. Methods: The setting was multi-professional in- and outpatient brain injury rehabilitation in a university hospital. Participants were enrolled consecutively in acute (< 4 months) or sub-acute (4–12 months) phases of rehabilitation after injury. Results: Nine-hundred-and-forty-four patients were screened. Many failed to meet the inclusion and exclusion criteria (acute phase = 90.5%; sub-acute phase = 85.3% excluded). The most frequent exclusion criteria were age and multiple co-morbidity. The most striking differences between eligible participants and non-participants were the latter’s lower educational and occupational levels. Conclusion: Results indicate the need for a closer connection between selection criteria and study aims. Strict inclusion and exclusion criteria render the study population less representative and, thus, reduces generalizability. Data collection is prolonged. This study, instead, advocates the use of broad inclusion criteria and common data elements and the need to report data from the total patient population. Increased awareness of the participants’ socioeconomic backgrounds is also needed when recruiting to research studies.

Qualitative Evidence in Pain

When reviewing qualitative research reports about pain, it is evident that other research questions are explored than those usually posed in quantitative research. In that sense other and more novel, less explored domains are presented. In this chapter, more than 2150 patients and 80 health care providers participated in about 115 studies. The review shows that patients describe that pain seriously affects their life situation, and it is hard to get recognition for this. Patients’ expectations for health care are not met; they often describe resignation and disappointment. The patients who are satisfied describe how they felt respected and recognized. Rehabilitation by interdisciplinary teams was positively perceived by the patients. Health care providers experience problems in meeting the expectations of patients with pain. An important finding is that patients need to be active in the planning of their rehabilitation and in the treatment and rehabilitation programs.

Daily management of attention dysfunction two–four years after brain injury and early cognitive rehabilitation with attention process training: a qualitative study

ABSTRACT The evaluation of intensive cognitive training is usually based on neuropsychological tests and questionnaires. A study of the subjective experience of cognitive training would provide another type of valuable information concerning the effects of rehabilitation. We used grounded theory methods to explore the experience and management of attention dysfunction in daily life two–four years after brain injury. Data were collected by in-depth interviews of 14 adults with moderate-to-mild attention dysfunction after stroke or traumatic brain injury, and working part time or full time at the time of the interviews. The group received 20 hours of attention process training within the context of multidisciplinary rehabilitation early after brain injury. Data were analysed by open coding with constant comparison. The management of attention dysfunction was described by the informants as a dynamic process where strategies are continuously refined and flexibly adjusted as awareness and metacognitive knowledge increases. This process is regulated by situation-dependent factors. Attention process training might provide a suitable starting point for the identification of problem areas, improved specific goalsetting and stimulated self-training. The model describes the dynamic nature of the process, the ongoing struggle, self-training and search for feedback.

Fibromyalgia Syndrome or Chronic Fatigue Syndrome/Myalgic Encephalomyelitis and Factors Influencing Work Disability in Women

Fibromyalgia is a complex chronic pain syndrome characterized by widespread muscle pain, tenderness, and fatigue. Women with fibromyalgia report that symptoms limiting their work ability include pain, tiredness, muscle weakness, and memory and concentration difficulties. Work tasks perceived as “difficult” for women with fibromyalgia are repetitive movements, static muscle work as when holding, standing, or sitting in the same positions for fairly long periods, heavy work, working above shoulder level, power gripping, and frequent carrying and lifting. These difficulties reflect the fibromyalgia pathophysiology. To be able to remain at work, women with fibromyalgia need workplaces, which are flexible and adjustable. They need to be able to change and alternate positions and tasks, take short breaks, and, in many cases, reduce working hours. With appropriate support and adaptation, most are able to continue working to some extent.

Repeated Measures Design : A Methodological Issue of Conducting Research on Patients with Chronic Pain

Chronic musculoskeletal pain is prevalent and canaffect all aspects of a person’s life (Breivik et al., 2006).Activity limitations and/or participation restrictions inthis group are a major problem and have a reportedprevalence of 26% (Mullersdorf and Soderback, 2000).In addition, patients with chronic pain are known to beunderactive and/or overactive (Birkholtz et al., 2004;CunninghamandJillings,2006;Mainetal.,2008),whichmay lead to an unpredictable and/or fluctuating level ofactivity. To re-establish activity limitations and/orparticipation restrictions, rehabilitation is often needed(Main et al., 2008) and multidisciplinary interventionshave been proven effective (Airaksinen et al., 2006).However, it is also known that available interventionsdonotworkforeveryone(Turketal.,2008).Thereasonsfor the different findings may be the methodologicallimitations of research on multidisciplinary rehabilita-tion programmes (Ravenek et al., 2010; Turk, 2002).This paper considers the use of a repeated measuresdesign as an individualized approach when conductingresearch on patients with chronic pain or any othercondition that is known to fluctuate. To assume thatpositive outcomes and research results are related to theintervention provided may be a mistake, as a dependentvariable such as pain or the level of activity may changeand vary autonomously with the independent variable.