Experiences of rehabilitation coordination among people on sick leave with mental health problems.

PURPOSE: Return to work often requires collaboration between different stakeholders. Rehabilitation coordination is a resource in coordinating efforts during sick leave to facilitate return to work. The purpose of the present study was to describe how people at risk for sick leave or on sick leave with mental health problems experienced rehabilitation coordination. MATERIALS AND METHOD: The study had a qualitative approach using qualitative content analysis as described by Graneheim and Lundman. Eleven semi-structured interviews were conducted with persons at risk for sick leave or on sick leave due to mental health problems and with experience of rehabilitation coordination. RESULTS: The participants experience of rehabilitation coordination were described by the overarching theme Building a bridge with many bricks between the person and society. The theme was formed by four categories and eleven subcategories reflecting the complex context of rehabilitation coordination. The categories were Collaboration in a new setting, Unburdened within certain limits, The way back to work is a joint project and Recognising challenges beyond the person. CONCLUSIONS: People with mental health problems experienced rehabilitation coordination as a meaningful link between healthcare and work. However, rehabilitation coordination needs to be more recognised within healthcare to increase accessibility. It seems important that interventions are directed not only towards the person, but also include the workplace for a sustainable return to work.

It is important to make rehabilitation coordination visible within primary health care and actively inform people on sick leave with mental health problems that it is an option, as they often have difficulties finding information. It will increase their accessibility and enable autonomous decisions.A respectful interplay based on a person-centred care approach seems fundamental for rehabilitation coordination. The interplay with rehabilitation coordinators and with other stakeholders affects the sick leave process and all parties need to collaborate for a sustainable return to work.Three-party meetings with the person on sick leave, the rehabilitation coordinator and the employer, as well as teamwork, may provide better conditions for return to work as this can ensure that all stakeholders are working towards prioritised goals.Targeted interventions at the workplace seem to be important and rehabilitation coordination could be a valuable bridge between healthcare and work for creating sustainable conditions for return to work.

Exercise and health-related quality of life and work-related outcomes in primary care patients with anxiety disorders - A randomized controlled study.

BACKGROUND: Exercise interventions show promise in the treatment of anxiety disorders, but effects on health-related quality of life (HR-QoL), work ability, and sick leave are little studied. We investigated these outcomes in a 12-week randomized controlled trial with a 1-year follow-up. METHODS: Patients aged 18-65 (n = 222) with anxiety disorders from primary care centers in Gothenburg were randomized to a control group or one of two 12-week exercise intervention groups (low-intensity, [LI] and moderate/high-intensity, [HI]); 148 were evaluated at 12-weeks and 113 completed the 1-year follow-up. The EuroQol 5D (EQ5D; index and the visual analogue scale [VAS]), work ability score (WAS), presenteeism, and self-reported sick leave were assessed at baseline, 12 weeks, and 1 year. Improvements were defined by binary cut-offs for each scale. Binary logistic regression with odds ratios (OR) and 95 % confidence intervals (CI) were reported. RESULTS: There were improved scores for EQ5D and WAS in the HI group compared to controls after 12 weeks (EQ5D index: 4.74 [1.91-11.7], EQ5D-VAS 4.00, [1.65-9.72], WAS 3.41 [1.24-7.37]) and 1 year (EQ5D index: 3.05 [1.05-8.81], EQ5D-VAS 3.20 [1.16-8.84], WAS 5.50 [1.85-16.3]). Post-hoc analysis showed higher ORs in participants on antidepressants (n = 75) (12-week EQ5D index: OR 9.95 [2.85-34.8]) and significant improvements in EQ5D scores for both intervention groups after 1 year. There were no between-group differences for presenteeism or sick leave. LIMITATIONS: Discontinuation was high, mostly early after randomization (n = 74), as is common for anxiety interventions. CONCLUSIONS: HI Exercise improves HR-QoL and work ability in anxiety patients, especially when combined with antidepressants.

Work-related stress is associated with low work ability, but not with poor self-rated health: A cross-sectional study in primary healthcare.

BACKGROUND: People seeking care at primary healthcare centres may be exposed to work-related stress, increasing the risk of future sick leave. Thus, it is important to identify work-related stress, and to explore how stress relates to work ability and health. OBJECTIVE: To investigate the association between work-related stress and a) work ability, and b) self-rated health, among working women and men seeking care for physical or mental health complaints. METHODS: This cross-sectional study analyzed baseline data (n = 232) from a randomized controlled trial investigating the effects of a brief intervention to prevent sick leave. Data regarding work-related stress, work ability and self-rated health were analyzed using binary logistic regression models. RESULTS: In models adjusted for age, gender and education, high work-related stress measured by the Work Stress Questionnaire was significantly associated with low work ability. The highest odds ratio (OR 3.27, 95% CI 1.66-6.42) was found between the domain "interference between work and leisure time" and work ability, suggesting a more than three times higher odds for low work ability when perceiving that work interferes with leisure time. No significant association was found between work-related stress and self-rated health. CONCLUSION: Health professionals should explore patients' work-related stress when they seek care for physical or mental complaints in primary healthcare. Patients' perceived balance between work and leisure time seems particularly important to address. Increased awareness might facilitate timely, relevant strategies to reduce stress and promote work ability.

Reaching for connection: a qualitative study of communication and interaction in video-based physiotherapy.

OBJECTIVE: Digital technology has become increasingly relevant in physiotherapy, but little is known about communication and interaction in video-based physiotherapy. Therefore, this study aimed to explore the experiences among patients and physiotherapists, of communication and interaction in digital, video-based physiotherapy. METHODS: A qualitative interview study with a phenomenological approach was conducted. Participants were purposively recruited from primary health care clinics. Semi-structured, in-depth interviews were conducted with 10 physiotherapists and 6 patients. Interviews were recorded, transcribed, and analyzed using a phenomenological approach. RESULTS: The analysis resulted in the overall theme Reaching for connection, which captured the central meaning of the participants' experiences. Four categories emerged from the analysis: 1) Closeness at a distance; 2) Overcoming limited bodily communication; 3) The technology as part of the meeting; and 4) Challenging the physical meeting as a norm. The results suggest that communication and interaction in digital settings differ from physical settings, but there is an ongoing adaptation process to this new paradigm. CONCLUSIONS: The results of this study show that video-based physiotherapy, while having several benefits according to both patients and physiotherapists, affects the communication in several ways. Physiotherapists need to acknowledge these limitations and seek strategies to adapt and to compensate for the reduced non-verbal elements and lack of touch. Attention to the physical room and shifting between positions (face/full figure) are suggested practical strategies, but also to practice awareness and embodied communication to improve receptivity in the interaction.

Belief, hope and help from others: a qualitative study on what facilitates physical activity in people with depression.

INTRODUCTION: Worldwide, there are more than 264 million people with depression, which is the second-leading cause of years lived with disability. Physical activity can be useful in both preventing and treating mild to moderate depression, but few studies have explored patients' experience of physical activity. PURPOSE: To explore experiences of facilitators to initiate and maintain regular physical activity in people with depression. METHODS: Adults of working age with mild to moderate depression participated in semi-structured interviews. Two researchers analyzed the data using qualitative content analysis. RESULTS: Four categories were identified: 1) Getting over the threshold; 2) Hoping for improvement; 3) A wish to be independent but needing help; and 4) Feeling safe on one's own terms. CONCLUSION: The results indicate that knowledge and personal experience of how physical activity affects well-being, and an environment including social support, increase the possibilities for people with depression to initiate and maintain physical activity. To promote physical activity, it is important to be receptive to the person's experiences, desires, and needs and to involve them in the planning and adjustment of physical activity. Follow-up appointments, a stepwise approach, and encouragement are important to increase motivation.

Women's experiences of physical therapy treatment for vulvodynia.

INTRODUCTION: Vulvodynia is a common and complex pain syndrome with a negative impact on quality of life and sexual health. Physical therapy is still an underexplored treatment for vulvodynia. Women's experiences of their physical therapy treatment might shed light on meaningful aspects and essential keys to facilitate change. PURPOSE: To explore and describe women's experiences of physical therapy treatment for vulvodynia. METHODS: A qualitative interview study, using qualitative content analysis. Fourteen women with a median age of 28 years and a median pain duration of 6.5 years participated. Digital interviews were conducted using a semi-structured interview guide with open-ended questions. RESULTS: One theme, four categories and thirteen sub-categories were developed in the analysis. The theme, "Trying to become friends with your vulva," illuminate how the women approached and reconnected to their bodies in physical therapy. The treatment increased their awareness and provided explanations for their symptoms. Four categories described aspects of the theme: 1) untapped resources in a complex healthcare; 2) a matter of trust; 3) a guide to understanding your body; and 4) a new way forward but not the whole solution. CONCLUSION: Women with vulvodynia perceive physical therapy as a promising and yet unknown approach. Physical therapy treatment gives the opportunity to reconnect with the body and vulva in a new way, and to manage pain and muscle tension as part of a multidisciplinary treatment.

Experiences of pain debut and healthcare received in men with chronic pelvic pain syndrome.

BACKGROUND: Chronic Pelvic Pain Syndrome (CPPS) is the occurrence of chronic pelvic pain when there is no proven infection or other obvious local pathology that may account for the pain. It is often associated with negative cognitive, behavioural, sexual or emotional consequences, as well as with symptoms of lower urinary tract, sexual or bowel dysfunction. As there is a close link between psychosocial factors and the development of myofascial pain syndromes it is important for healthcare professionals to have knowledge of how the pain begins and the activities at the debut of the symptoms. AIM: The aim of the study was to explore men's experiences of the process leading to CPPS and healthcare received. METHODS: Information was obtained from semi-structured video interviews with 14 men with CPPS. Interviews were audio-recorded and transcribed. The text was then abstracted into codes and analysed with inductive content analysis. RESULTS: The age of the informants ranged between 22 and 73 (median 48), and the duration with CPPS ranged from 1 to 46 years. Two themes emerged, one with the heading Struggling to pin it down with four subthemes and The helpful and unhelpful healthcare with two subthemes. The four subthemes show that the informants experienced difficulties in their lives in the months before the debut of symptoms, for some it was several years. They had specific triggers for the onset of pain. These included cold, trauma to the perineum, chlamydia infection and possibly secondary to a symptomatic urethral stricture. Confusion and frustration were an important element in the informants' overall experience of CPPS. Healthcare varied widely. The two subthemes about healthcare show expressions of being overlooked or wasting the doctor's time, but also the experience of being validated and being thoroughly examined. CONCLUSION: The informants in our study described clear and specific triggers for CPPS such as being cold, having digestive issues and trauma to the perineum. Stressful events seemed to have a big impact on these informants and very possibly affected the start of symptoms. This information should be helpful healthcare professionals to understand the patient and his needs.

Measurement properties of the Swedish clinical outcomes in routine evaluation outcome measures (CORE-OM): Rasch analysis and short version for depressed and anxious out-patients in a multicultural area.

INTRODUCTION: The Swedish version of the patient-reported Clinical Outcomes in Routine Evaluation Outcome Measures (CORE-OM) has demonstrated high reliability and acceptable convergent validity in explanatory factor analyses. However, the fundamental scale properties have not yet been validated according to item response theory. The aim of this study was to analyze the measurement properties of the Swedish CORE-OM in a cohort of psychiatric out-patients with depression and anxiety in a multicultural area and to explore combinations of items based on shorter versions of the scale (CORE-10, CORE-6D) to improve measurement properties. METHODS: Data from CORE-OM assessments of 337 patients were analyzed using Rasch analysis. The patients had a mean age of 30 ± 14 years, the majority were women (72%). Requirements for measurement properties were checked: overall model fit, item fit residuals, targeting, internal consistency, differential item functioning and thresholds. Sensitivity to change was also analyzed. RESULTS: The CORE-OM showed high internal consistency (person separation index = 0.947) and adequate targeting, but there was overall model misfit (item trait interaction χ2 = 917.53, p < 0.001), indication of local dependency, and differential item functioning in 9 items. The risk items showed problems with disordered thresholds. The emotional component of the shorter CORE-6D showed the best fit for our sample. Adding 3 items to include depressive and trauma-related content resulted in a unidimensional 8-item set with acceptable reliability, model fit, targeting and sensitivity to change. CONCLUSION: For out-patients with diagnosed depression or anxiety in a multicultural area, the Swedish CORE-OM showed high internal consistency, but also validity problems. Based on the shorter CORE-6D version, a unidimensional 8-item set could be an alternative brief measure of psychological distress for this population, but further validity studies are required. Qualitative studies exploring the CORE-OM items in non-native speakers are also warranted.

Effects of exercise on symptoms of anxiety in primary care patients: A randomized controlled trial.

BACKGROUND: There is a need for high-quality research regarding exercise interventions for persons with anxiety disorders. We investigate whether a 12-week exercise intervention, with different intensities, could reduce anxiety symptoms in patients with anxiety disorders. METHODS: 286 patients were recruited from primary care in Sweden. Severity of symptoms was self-assessed using the Beck Anxiety Inventory (BAI) and the Montgomery Åsberg Depression Rating Scale (MADRS-S). Participants were randomly assigned to one of two group exercise programs with cardiorespiratory and resistance training and one control/standard treatment non-exercise group, with 1:1:1 allocation. RESULTS: Patients in both exercise groups showed larger improvements in both anxiety and depressive symptoms compared to the control group. No differences in effect sizes were found between the two groups. To study a clinically relevant improvement, BAI and MADRS-S were dichotomized with the mean change in the control group as reference. In adjusted models the odds ratio for improved symptoms of anxiety after low-intensity training was 3.62 (CI 1.34-9.76) and after moderate/high intensity 4.88 (CI 1.66-14.39), for depressive symptoms 4.96 (CI 1.81-13.6) and 4.36 (CI 1.57-12.08) respectively. There was a significant intensity trend for improvement in anxiety symptoms. LIMITATIONS: The use of self-rating measures which bears the risk of an under- or overestimation of symptoms. CONCLUSIONS: A 12-week group exercise program proved effective for patients with anxiety syndromes in primary care. These findings strengthen the view of physical exercise as an effective treatment and could be more frequently made available in clinical practice for persons with anxiety issues.

Exploring clinical reasoning in Austrian mental health physiotherapy: the physiotherapist´s perspective.

INTRODUCTION: In mental health physiotherapy, there is a lack of research investigating the assumptions and clinical reasoning strategies of the professionals. A critical view on what is taken for granted within physiotherapy promotes professional development. PURPOSE: The purpose of this study was to explore and describe the essence of clinical reasoning of Austrian mental health physiotherapists, and to illuminate the meaning of their experiences. METHOD: Ten semi-structured individual interviews were conducted with Austrian mental health physiotherapists. The transcripts were analyzed using a phenomenological hermeneutical method. RESULTS: The informants' clinical reasoning emerged as a process of three perspectives: 1) a relational and interactional perspective; 2) a perspective of wholeness; and 3) a perspective of symptoms. The results were then further interpreted using the theories of intercorporeality and bodily resonance. CONCLUSION: To bring the different clinical reasoning perspectives together to one clinical reasoning process, a discourse of reconciliation is suggested as a favorable strategy, which may be useful both in clinical practice and education.

Anxiety severity and cognitive function in primary care patients with anxiety disorder: a cross-sectional study.

BACKGROUND: Deficits in cognitive performance are reported in patients with anxiety disorders, but research is limited and inconsistent. We aimed to investigate cross-sectional associations between cognitive function, with focus on executive function, and anxiety severity in primary care patients diagnosed with anxiety disorders. METHODS: 189 Swedish patients aged 18-65 years (31% men) with anxiety disorders diagnosed according to Mini International Neuropsychiatric Interview were included. Severity of anxiety was assessed using Beck Anxiety Inventory self-assessment scale. Digit span, block design and matrix reasoning tests from the Wechsler Adult Intelligence Scale IV, and the design fluency test from the Delis-Kaplan Executive Function System were used. Multivariable linear regression models were applied to investigate the relationship of anxiety severity and cognitive functioning. Comparisons were also performed to a normed non-clinical population, using the Wilcoxon signed rank test. RESULTS: More severe anxiety was associated with lower digit span test scores (R2 = 0.109, B = -0.040, p = 0.018), but not with block design, matrix reasoning or design fluency tests scores, after adjustment for comorbid major depression in a multivariable model. When compared to a normed population, patients with anxiety performed significantly lower on the block design, digit span forward, digit span sequencing and matrix reasoning tests. CONCLUSIONS: Severity of anxiety among patients with anxiety disorder was associated with executive functions related to working memory, independently of comorbid major depression, but not with lower fluid intelligence. A further understanding of the executive behavioral control in patients with anxiety could allow for more tailored treatment strategies including medication, therapy and interventions targeted to improve specific cognitive domains.

Goal-setting in physiotherapy: exploring a person-centered perspective.

Objective: To analyze definitions and related requirements, processes, and operationalization of person-centered goal-setting in the physiotherapy research literature; to discuss those findings in relation to underlying principles of person-centeredness; and to provide an initial framework for how person-centered goal-setting could be conceptualized and operationalized in physiotherapy. Methods: A literature search was conducted in the databases: CINAHL, PubMed, PEDro, PsycINFO, REHABdata and Scopus. A content analysis was performed on how person-centered goal-setting was described.Results: A total of 21 articles were included in the content analysis. Five categories were identified: 1) Understanding goals that are meaningful to the patients; 2) Setting goals in collaboration; 3) Facing challenges with person-centered goal-setting; 4) Developing skills by experiences and education; and 5) Changing interaction and reflective practice. These categories were abstracted into two higher-ordered interlaced themes: 1) To seek mutual understanding of what is meaningful to the patient; and 2) To refine physiotherapy interaction skills, which we suggest would be useful for further conceptualization.Conclusion: In this analysis, we interpreted person-centered goal-setting in physiotherapy as a process of interaction toward a mutual understanding of what is meaningful to the patient. Future research may explore how to integrate mindful listening, embodied interaction and continuous ethical reflection with different assessments and treatment methods.

A short work-directed rehabilitation to promote work capacity while depressed and anxious: a qualitative study of workers' experiences.

PURPOSE: Most people with common mental disorders are working despite symptoms. This study explores individuals' experiences of a work-directed rehabilitation, provided by occupational therapists and physiotherapists, aiming to promote work capacity in persons with common mental disorders. METHODS: A qualitative content analysis was used, and 11 women and 8 men with depression or anxiety disorder were interviewed. They were 25-66 years old, had different occupations and were working full or part-time. RESULTS: The participants experienced a process interpreted as Increasing belief in one's capacity through supported reflection and practice. This theme reflects the shifting between "reflecting" and "doing" through rehabilitation and the growing hope for change. The increasing belief in one's capacity was developed through three stages, comprised of the categories To be supported by a professional, To realise things about oneself and To try new strategies for change. CONCLUSIONS: Strategies suggested by occupational therapists and physiotherapists have the potential to promote work capacity in people who are working while depressed and anxious. The results may deepen the understanding among rehabilitation professionals about the importance of a person-centred approach to people with common mental disorders, and to combine reflection and practical exercises to support the development of work-related strategies.Implications for rehabilitationWork-directed rehabilitation provided by occupational therapists and/or physiotherapists is beneficial to people with common mental disorders.Rehabilitation professionals should focus on facilitating self-efficacy among people with common mental disorders.An individualised person-centred approach seems important in order to initiate change.

Medical Defibulation as a Possibility-the Experiences of Young Swedish- Somali Women.

Purpose: Infibulation is the most pervasive form of female genital cutting. Infibulated women face difficulties such as obstruction of urine and menstrual blood flow, sexual problems, and birth complications, and may therefore need medical defibulation. This study explores the lived experiences of young migrant women from Somalia and their views on undergoing medical defibulation in Sweden. Methods: A qualitative study was conducted using phenomenological lifeworld research. Data were collected through in-depth interviews with nine young women originating from Somalia, now resident in Sweden. The interviews were analysed to reveal the meaning of the phenomenon of infibulation. Results: The essential meaning of the phenomenon is characterized by a limbo regarding both infibulation and defibulation. There is a strong desire both to handle the Swedish perspective on infibulation and to stay with the Somalian cultural values. These women are being exposed to a tacit tradition that makes it hard to relate to the possibility of medical defibulation. As a result, the women perceive the possibility to undergo medical defibulation as limited or non-existent. Conclusions: Healthcare professionals can be a support to encourage women in need of medical defibulation to reflect on traditional ideals concerning infibulation and defibulation.

Development and Construct Validity of the Work Instability Scale for People With Common Mental Disorders in a Sample of Depressed and Anxious Workers: A Rasch Analysis.

BACKGROUND: Sick leave due to common mental disorders, encompassing depression and anxiety disorders, is high. Capturing early signs of reduced function could aid adjustments of work tasks and environment and, thus, endorse a pro-active approach to occupational and health care interventions to prevent long-term sick-leave spells. However, few measurements exist to identify early signs of imbalance, and none that is illness-specific. The aim of this study was to develop a work instability scale for people with common mental disorders and to test the fundamental psychometric properties of the scale. METHODS: Participants were working adults 18-65 years old with depression or anxiety. The scale development started with qualitative interviews (n = 27) which informed the drafting of a dichotomous, self-report questionnaire. Cognitive debriefing (n = 12) was used to check face validity and modify the draft. Internal construct validity of the draft was tested using Rasch analysis (n = 128). The work ability index was used as a comparator measure. RESULTS: The initial 63-item draft showed poor fit to Rasch model expectations. Items displaying poor fit or local response dependency were stepwise removed, resulting in a unidimensional 34-item scale fitting the model expectations, and with no differential item functioning. Person-item threshold distribution showed that the scale is better suited to measure low to moderate work instability, than to measure high instability. Correlations between the newly developed scale and the work ability index showed a significant, moderately strong correlation. CONCLUSIONS: In the initial target sample, the 34-item scale showed acceptable fundamental properties and internal construct validity. Further validation of the scale in a larger sample, including tests for external validity, is warranted.

Anxiety management: Participants' experiences of a physiotherapeutic group treatment in Swedish psychiatric outpatient care.

Anxiety disorders are among the most persistent mental health syndromes. There is extensive research showing effectiveness of pharmacotherapy and psychotherapy interventions targeting anxiety, while knowledge is still sparse for other treatment options. The aim of this study was to explore how participants with anxiety disorders experience a physiotherapeutic group treatment in psychiatric outpatient care, and their perceived ability to manage anxiety within two months after participating in the treatment. Semi-structured interviews with participants were conducted to explore experiences of the treatment. Data were analyzed using qualitative content analysis, which resulted in one main theme: Reconnecting to the body in the supportive atmosphere of a group. Six categories reflect the main theme: (1) sharing with others supported by the group, (2) grounding oneself in the body, (3) getting to know the body and learning to manage its reactions, (4) learning to tolerate bodily sensations of anxiety, (5) gaining a more compassionate attitude toward oneself, and (6) challenging old patterns to become more active in life. The participants reported that their ability to reconnect to their bodies increased so that anxious sensations became more endurable and acceptable after treatment. The supportive group context was described as valuable, enabling the participants to feel safe enough to start exploring new ways to manage anxiety. In conclusion, this study suggests that a physiotherapeutic group treatment can be a useful add-on treatment to the standard treatment models of anxiety disorders, including psychotherapy and pharmacotherapy, since it targets the embodied, nonverbal domain of anxiety.

Work-directed rehabilitation or physical activity to support work ability and mental health in common mental disorders: a pilot randomized controlled trial.

OBJECTIVE: To evaluate feasibility and potential effectiveness of work-directed rehabilitation in people with common mental disorders. DESIGN: Pilot randomized controlled trial. SETTING: Primary healthcare, Sweden. SUBJECTS: Working adults (n = 42) of mean age 46.2 ± 11.1 years with depression or anxiety disorder. INTERVENTIONS: Eight weeks of work-directed rehabilitation (n = 21) or physical activity (n = 21). Work-directed rehabilitation included sessions with a physiotherapist and/or an occupational therapist, to develop strategies to cope better at work. Physical activity included a planning session and access to a local gym. MAIN MEASURES: Feasibility: attendance, discontinuation and adverse events. Measurements were the Work Ability Index, the Global Assessment of Functioning, the Montgomery-Asberg Depression Rating Scale, the Beck Anxiety Inventory and the World Health Organization-Five Well-Being Index. RESULTS: Attendance to rehabilitation sessions was 88% (n = 147/167) and discontinuation rate was 14% (n = 3/21). No serious adverse events were reported. Within both groups, there was a significant improvement in Work Ability Index score (mean change: 3.6 (95% confidence interval (CI): 0.45, 6.7) in work-directed rehabilitation and 3.9 (95% CI: 0.9, 7.0) in physical activity) with no significant difference between groups. For the other outcomes, significant improvements were found within but not between groups. Per-protocol analysis showed a trend toward the antidepressant effect of work-directed rehabilitation compared to physical activity (mean difference in depression score -3.1 (95% CI: -6.8, 0.4), P = 0.075). CONCLUSION: Work-directed rehabilitation was feasible to persons with common mental disorders and improved their work ability and mental health. Comparable improvements were seen in the physical activity group. Suggested modifications for a larger trial include adding a treatment-as-usual control.

Adolescents' experiences of being diagnosed with attention deficit hyperactivity disorder: a phenomenological study conducted in Sweden.

OBJECTIVES: To explore adolescents' experiences of being diagnosed with Attention deficit hyperactivity disorder (ADHD). DESIGN: Qualitative interview study, using a phenomenological framework and analysis. SETTING: The children's clinic of a specialised out-care hospital located in a multicultural area of a Swedish city. PARTICIPANTS: 13 adolescents, 7 boys and 6 girls between 14 and 19 years old, who had been diagnosed with ADHD. RESULTS: The participants' experience of being diagnosed with ADHD was interpreted as a process of understanding oneself as being different, for better or worse, like many others. The participants sought acceptance and a sense of normality, while developing an understanding of both the positive and the negative sides of their ADHD traits. These two sides of a coin were inter-related parts of themselves and were shared by many others, which increased their acceptance. Three themes described phases of the process: struggling with vulnerability, responding to a label and manoeuvring social life. CONCLUSION: The results add to previous research, illuminating that the adolescents tried to make sense of both the uniqueness and the vulnerability of the ADHD diagnosis. The findings can be useful for healthcare professionals, in reflecting on the complexity of ADHD and on the adolescents' expectations.

Support to informal caregivers of patients with severe chronic obstructive pulmonary disease: a qualitative study of caregivers' and professionals' experiences in Swedish hospitals.

OBJECTIVES: Informal caregivers of patients with chronic obstructive pulmonary disease (COPD) experience a heavy caregiver burden, but few studies have explored what support they need. The aim of this study was to describe perceptions of healthcare support to informal caregivers, both from the family caregiver's and the staff's perspective. DESIGN: A qualitative interview study involving semi-structured interviews and analysed with content analysis. PARTICIPANTS: In total, 54 participated: 36 informal caregivers of patients with severe (stage 3-4) COPD and 17 healthcare staff. RESULTS: Two main themes emerged from the analysis: (1) Ambiguity impedes provision of support. Both caregivers and staff experienced ambiguity. The informal caregivers needed emotional, practical and informational support but talked about unclear expectations, while the staff described an uncertainty about their duties regarding the families. There were no routines to unburden the families. Moreover, language and cultural barriers hampered their efforts. (2) Knowledgeable and perceptive communication is key to support. Both caregivers and staff described positive experiences of dialogue. The dialogue may facilitate means to caregiver support and was a support in itself. CONCLUSIONS: Our findings suggest that strategies and routines for caregiver support, including communication skills among the staff, should be developed, to move toward the family perspective advocated in palliative- and nursing family care.