Silje Maeland

Systematic review of active workplace interventions to reduce sickness absence

Background The workplace is used as a setting for interventions to prevent and reduce sickness absence, regardless of the specific medical conditions and diagnoses. Aims To give an overview of the general effectiveness of active workplace interventions aimed at preventing and reducing sickness absence. Methods We systematically searched PubMed, Embase, Psych-info, and ISI web of knowledge on 27 December 2011. Inclusion criteria were (i) participants over 18 years old with an active role in the intervention, (ii) intervention done partly or fully at the workplace or at the initiative of the workplace and (iii) sickness absence reported. Two reviewers independently screened articles, extracted data and assessed risk of bias. A narrative synthesis was used. Results We identified 2036 articles of which, 93 were assessed in full text. Seventeen articles were included (2 with low and 15 with medium risk of bias), with a total of 24 comparisons. Five interventions from four articles significantly reduced sickness absence. We found moderate evidence that graded activity reduced sickness absence and limited evidence that the Sheerbrooke model (a comprehensive multidisciplinary intervention) and cognitive behavioural therapy (CBT) reduced sickness absence. There was moderate evidence that workplace education and physical exercise did not reduce sickness absence. For other interventions, the evidence was insufficient to draw conclusions. Conclusions The review found limited evidence that active workplace interventions were not generally effective in reducing sickness absence, but there was moderate evidence of effect for graded activity and limited evidence for the effectiveness of the Sheerbrooke model and CBT.

Considerations made by the general practitioner when dealing with sick-listing of patients suffering from subjective and composite health complaints

Abstract Objectives. To explore GPs’ considerations in decision-making regarding sick-listing of patients suffering from SHC. Design. Qualitative analysis of data from nine focus-group interviews. Setting. Three cities in different regions of Norway. Participants. A total of 48 GPs (31 men, 17 women; aged 32–65) participated. The GPs were recruited when invited to a course dealing with diagnostic practice and assessment of sickness certificates related to patients with composite SHCs. Results. Decisions on sick-listing patients with SHCs were regarded as a very challenging task. Trust in the patients own story and self-judgement was deemed crucial, but many GPs missed hard evidence of illness and loss of function. Several factors that might influence decision-making were identified: the patients’ ability to present their story to evoke sympathy, the GPs prior knowledge of the patient, and the GPs’ own experience as a patient and their tendency to avoid conflicts. The approach to the task of sick-listing differed from patient-led cooperation to resistant confrontation. Conclusion and implications. Issuing sickness certification in patients with composite health complaints is considered challenging and burdensome. It is seen as mainly patient-driven, and the decisions vary according to GPs’ attitudes, beliefs, and personalities. Guiding the GPs to a more focused awareness of the decision process should be considered.

Diagnoses of Patients with Severe Subjective Health Complaints in Scandinavia: A Cross Sectional Study

Background. A diagnosis is the basis of medical action, the key to various social privileges and national sick leave statistics. The objectives of this study were to investigate which diagnoses general practitioners in Scandinavia give patients with severe subjective health complaints, and what kind of treatments they suggested. Methods. One hundred and twenty-six self-selected general practitioners in Scandinavia diagnosed nine patients, presented as video vignettes, in a cross-sectional study. The main outcome measures were primary, secondary, and tertiary diagnoses. Results. The nine patients got between 13 and 31 different primary diagnoses and a large variety of secondary and tertiary diagnoses. Fifty-eight percent of the general practitioners chose different primary and secondary diagnoses, indicating that they judged the patients to have multimorbid complaints. The most commonly recommended treatment was referral to a psychologist, a mix of psychological and physical treatments, or treatment by the general practitioner. Conclusion. Scandinavian general practitioners give a large variety of symptom diagnoses, mainly psychological and general and unspecified, to patients with severe subjective health complaints. Referral to a psychologist or a mix of psychological or physical treatments was most commonly suggested to treat the patients.

GPs’ negotiation strategies regarding sick leave for subjective health complaints

Abstract Objectives. To explore general practitioners’ (GPs’) specific negotiation strategies regarding sick-leave issues with patients suffering from subjective health complaints. Design. Focus-group study. Setting. Nine focus-group interviews in three cities in different regions of Norway. Participants. 48 GPs (31 men, 17 women; age 32–65), participating in a course dealing with diagnostic practice and assessment of sickness certificates related to patients with subjective health complaints. Results. The GPs identified some specific strategies that they claimed to apply when dealing with the question of sick leave for patients with subjective health complaints. The first step would be to build an alliance with the patient by complying with the wish for sick leave, and at the same time searching for information to acquire the patients perspective. This position would become the basis for the main goal: motivating the patient for a rapid return to work by pointing out the positive effects of staying at work, making legal and moral arguments, and warning against long-term sick leave. Additional solutions might also be applied, such as involving other stakeholders in this process to provide alternatives to sick leave. Conclusions and implications. GPs seem to have a conscious approach to negotiations of sickness certification, as they report applying specific strategies to limit the duration of sick leave due to subjective health complaints. This give-and-take way of handling sick-leave negotiations has been suggested by others to enhance return to work, and should be further encouraged. However, specific effectiveness of this strategy is yet to be proven, and further investigation into the actual dealings between doctor and patients in these complex encounters is needed.

Sick-leave decisions for patients with severe subjective health complaints presenting in primary care: A cross-sectional study in Norway, Sweden, and Denmark

Abstract Objectives. The primary objective of this study was to explore whether general practitioners (GPs) in Norway, Sweden, and Denmark make similar or different decisions regarding sick leave for patients with severe subjective health complaints (SHC). The secondary objective was to investigate if patient diagnoses, the reasons attributed for patient complaints, and GP demographics could explain variations in sick leave decisions. Design. A cross-sectional study. Method. Video vignettes of GP consultations with nine different patients. Subjects. 126 GPs in Norway, Sweden, and Denmark. Setting. Primary care in Norway, Sweden, and Denmark. Main outcome measure. Sick leave decisions made by GPs. Results. “Psychological” diagnoses in Sweden were related to lower odds ratio (OR) of granting sick leave than in Norway (OR = 0.07; 95% CI = 0.01–0.83) Assessments of patient health, the risk of deterioration, and their ability to work predicted sick leave decisions. Specialists in general medicine grant significantly fewer sick leaves than non-specialists. Conclusion. Sick-leave decisions made by GPs in the three countries were relatively similar. However, Swedish GPs were more reluctant to grant sick leave for patients with “psychological” diagnoses. Assessments regarding health-related factors were more important than diagnoses in sick-leave decisions. Specialist training may be of importance for sick-leave decisions.

Subjective health complaints in individuals with Ehlers–Danlos syndrome: A questionnaire study

BACKGROUND Ehlers-Danlos syndrome (EDS) is an inherited connective tissue disorder where symptoms such as hyper mobile joints, fragile tissues, a bleeding tendency and chronic pain are frequent. Consequently, functional disability is common. OBJECTIVE In the present study we investigated the prevalence of subjective health complaints in a Swedish EDS group. DESIGN, PARTICIPANTS AND METHOD: Members of the Swedish EDS Association were invited to respond to the questionnaire Subjective Health Complaints Inventory (SHCI). Of the 365 individuals receiving questionnaires, 250 diagnosed individuals >18 years (mean age 46.15; SD 12) responded. The overall response rate was 68% (females 89.2%; n=223). RESULTS The total number of persons reporting any health complaint was 247 (99%). The mean number of complaints was 16.1 (SD 5.7) in the whole group. The complaints reported were musculoskeletal by 246 (98%), pseudoneurological by 241 (96%), gastrointestinal by 236 (94%), allergic by 182 (73%) and influenza-like by 144 (58%) persons. Substantial complaints were reported by 240 (96%) persons. Women reported a significantly higher number of complaints, mean total SHC, and severity per complaint compared to men and the reference group; the Norwegian general population. CONCLUSION Swedish females with EDS have higher number of and more substantial health complaints like tiredness and different localisations of pain than the compared Norwegian general population. Musculoskeletal, pseudoneurological and gastrointestinal complaints are most frequent in individuals with the hyper mobile EDS type.

No effect on gait function of progressive resistance exercise in adults with cerebral palsy – A single-blind randomized controlled trial

Muscular weakness has long been recognized as a problem in individuals with cerebral palsy (CP), but has been ignored therapeutically until recently. The purpose of this study was to examine the effects of a progressive resistance exercise (PRE) programme of seated leg press (SLP) on gait function in adults with spastic diplegic CP, Gross Motor Function Classification System (GMFCS) level II and III, who experience reduced walking ability, using a single-blind randomized controlled trial. Twelve individuals were included, 6 in the training and 6 in the control group. The training group completed a PRE programme consisting of a 10-min warm-up, followed by SLP 12–15 repetitions maximum (RM) in 4 sets, 3 days a week, for the first 2 weeks, progressing to 6RM in 4 sets, 3 days a week, for the following 6 weeks. Six-RM tests in the SLP machine were performed to determine the training load. The control group continued individual treatment or training as usual. The primary outcome measure was the 6-Minute Walk Test (6MWT). Secondary outcome measures were the Ten-meter Walk Test (10 m), stair climbing, the Timed Stands Test (TST) and isokinetic muscle strength of the quadriceps. There was no significant change, or difference in change between the groups, in any of the outcome measures from baseline to 8 weeks. Adults with CP, participating in an 8-week PRE, did not improve their walking, functional lower limb strength or isokinetic strength. The training group did improve their performance in SLP.

Shoulder function, pain and health related quality of life in adults with joint hypermobility syndrome/Ehlers–Danlos syndrome-hypermobility type

Abstract Purpose To investigate shoulder function, pain and Health-Related Quality of life (HRQoL) among adults with joint hypermobility syndrome/Ehlers–Danlos syndrome-hypermobility type (JHS/EDS-HT), compared with the general population (controls). Method In a cross-sectional study using postal survey, 110 patients diagnosed with JHS/EDS-HT and 140 gender- and age-matched healthy controls from Statistics Norway participated. Shoulder function, pain and HRQol were registered by Western Ontario Shoulder Instability Index (WOSI), Numerical Rating Scale (NRS), pain drawings, 36-item Short Form (SF-36). Results Eighty-one individuals responded, with response rate 34% (JHS/EDS-HT: 53%, controls: 21%). JHS/EDS-HT had lower shoulder function (WOSI total: 49.9 versus 83.3; p < 0.001), lower HRQol on SF-36 Physical Component Scale (PCS: 28.1 versus 49.9; p < 0.001), and higher pain intensity (NRS: 6.4 versus 2.7; p < 0.001) than controls. Neck and shoulder joints were rated as primary painful areas in both groups, with significantly higher frequency in JHS/EDS-HT (neck: 90% versus 27%; shoulder: 80% versus 37%). Further, JHS/EDS-HT most often reported generalized pain (96%). Conclusions Adults with JHS/EDS-HT have impaired shoulder function, increased pain intensity, as well as reduced physical HRQoL compared with controls. Although neck and shoulder were most frequently rated as painful, significantly more JHS/EDS-HT also reported generalized pain compared to controls. Implications for Rehabilitation Adults with JHS/EDS-HT have impaired shoulder function, and most often painful areas in the neck and shoulder joints, which need to be targeted in the treatment strategy. Compared with the general population adults with JHS/EDS-HT have reduced physical HRQoL, supporting a physical approach for this group. Adults with JHS/EDS-HT may present with both specific painful joints and generalized pain.

Functioning, coping and work status three years after participating in an interdisciplinary, occupational rehabilitation program:

Aim: The aim of this study was to explore how functional ability, coping and health were related to work and benefit status three years after participating in a four-week inpatient interdisciplinary occupational rehabilitation program. Methods: The cohort consisted of 338 individuals (75% females, mean age 51 years (SD=8.6)) who three years earlier had participated in a comprehensive inpatient interdisciplinary occupational rehabilitation program, due to long-term sick leave. The participants answered standardised questionnaires about subjective health complaints, functional ability, coping, and current work and benefit status. The relationships between these variables were analysed using logistic regression analyses. Results: At the time of the survey, 59% of the participants worked at least 50% of a full working day. Twenty-five percent received at least 50% disability pension and 16% received other benefits. Poor functional ability (OR 4.8; CI 3.0–7.6), poor general health (OR 3.8; CI 2.3–6.1), high level of subjective health complaints (OR 3.3; CI 2.1–5.2), low coping (OR 2.8; CI 1.7–4.4), poor physical fitness (OR 2.8; CI 1.7–4.6) and poor sleep quality (OR 2.4; CI 1.5–3.7) were associated with receiving allowances. In a fully adjusted model, only poor functional ability and low coping were associated with receiving allowances three years after occupational rehabilitation. Conclusions: Functional ability and coping were the variables most strongly associated with not having returned to work. More attention should therefore be paid to enhance these factors in occupational rehabilitation programs. Part-time work may be a feasible way to integrate individuals with reduced workability in working life, if the alternative is complete absence from work.

Why are general practitioners reluctant to enrol patients into a RCT on sick leave? A qualitative study

Aims: To explore the reluctance of, and examine the arguments given by Norwegian general practioners (GPs), regarding their unwillingness to recruit their patients for a study where sick leave would be based on randomization. Methods: A qualitative study presenting individual arguments from 50 Norwegian GPs, as written responses to a web-based, open-ended questionnaire. The responses, ranging from 3⊟145 words, were analysed with systematic text condensation. Results: The GPs did not want to participate in a study where sick leave was decided by randomization. First, the complexity of clinical judgment was addressed. Would it be ethically acceptable to set the professional and medical assessment aside, and if so, was there any better judge than the regular GP in making this important decision? Second, the arguments dealing with sick leave as a human and legal right were addressed. Will patients feel they have a legitimate right to sick leave and will they be open for discussion with their GP? Third, the risk of jeopardizing the relationship between patient and doctor was emphasized. Would the patients be able to trust their GP if he or she offered the patient entry into a trial where sick leave would be decided by randomization? Conclusions: Randomization of sick leave in general practice in Norway was not viewed as feasible by the GPs themselves because of the importance of clinical judgment, ethical obligations, and the belief that the patients would refuse participation, and thereby, that the doctor‐patient relationship would be disturbed.