Subject(s)
Affective Symptoms/diagnosis , Affective Symptoms/psychology , Personality Disorders/diagnosis , Personality Disorders/psychology , Adaptation, Psychological , Affect , Affective Symptoms/genetics , Cognition , Communication , Genetic Predisposition to Disease/genetics , Humans , Internal-External Control , Interpersonal Relations , Mental Recall , Models, Psychological , Personality Development , Personality Disorders/genetics , Psychological Theory , Risk Factors , Social AdjustmentABSTRACT
Health problems are often associated with activity limitations and participation restrictions, as defined in the International Classification of Functioning, Disability and Health (ICF). This often affects the workplace in the form of sick leave or a reduction in productivity. The question is, "to what extent are participation restrictions at work related to participation restrictions in other domains of life?" A total of 382 primary health care patients (aged 18-65) were asked to provide information on their employment status, perceived health-related workplace problems and sick leave status. Health-dependent participation restrictions across different domains of life were assessed using the Index for Measuring Participation Restrictions (IMET) self rating questionnaire. Currently unemployed patients reported significantly higher degrees of participation restrictions across all domains of life than the employed participants. Employed patients with workplace problems scored higher than patients without workplace problems. The domain of work encompassed the highest level of impairment, while the lowest was observed in personal relationships. Workplace problems occur frequently for primary health care patients. They coincide with participation restrictions in other domains of life. For patients who complain about their capacity to work, diagnosis and treatment must not only focus on the work domain, but also enquire into and consider participation restrictions in other domains of life.
Subject(s)
Activities of Daily Living/psychology , Employment/psychology , Social Participation/psychology , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Primary Health Care , Sick Leave , Workplace/psychologyABSTRACT
This paper presents the results of a prospective observational cohort study investigating referral practices to six specialized pain centres (SPCs) in 303 patients with headache (HD), low back pain (LBP), and neuropathic pain (NP). The study was divided into three parts. Part 1: The pain health care history (contacts with general practitioners and specialists, further referrals, time spans, therapies) before first contact with the SPC. Part 2: Reality of pain therapy and management in the SPC (patients' attrition, interdisciplinarity of therapy and novel therapeutic strategies instigated). Part 3: Follow-up and assessment of pain levels (NRS, SES), disability scores (PDI), QoL scores (SF 12), and anxiety and depression scores (HADS) at 0, 6 and 12 months. Using an ordinal linear regression model, factors predicting a good treatment outcome were identified. On average it took 3 years of pain symptoms before first consultation with GP. The median time period from the first pain sensations until the appointment in the SPC was 12 years. Nearly half of the referrals to specialists or SPCs were initiated by a non-professional. In the SPC the medication was changed in 71% of cases. Care was interdisciplinary in only 32%. At 6 and 12 months after the first contact with the SPC, only 20% of the patients had improved with respect to levels of pain and psychometric data. A high degree of chronicity, a history of pain-associated surgeries and low social support were negative predictors for treatment outcome.
