Sex and Age Group Focus on Outcomes after Multimodal Rehabilitation for Patients with Chronic Pain in Northern Sweden.

OBJECTIVES: To investigate the outcomes of a multimodal rehabilitation programme (MMRP) regarding pain intensity, emotional functioning, activity and physical functioning, social response, and health, with regard to sex and age. METHODS: This retrospective longitudinal study was based on data from patients at 2 specialist pain clinics in northern Sweden immediately after MMRP (short-term) and at 1-year follow-up (long-term). Data from 439 patients were analysed according to sex and to age groups 18-30, 31-45 and 46-65 years. RESULTS: The men improved with larger effect sizes (ESs) than women immediately after MMRP. The youngest age group showed improvements with greater ESs compared with the older age groups, both in the short and long term. Social support decreased for both women and men and in all 3 age groups in the long term. Improvements in both the short and long term were found in pain intensity, emotional functioning, and activity and physical functioning, in both women and men, as well as the different age groups. CONCLUSION: Both women and men with chronic pain, and from all of the different age groups, benefitted from MRRP. Since improvements for men were not sustained over time, they may need further support after the programme.

Multivariate correlations between pain, life interference, health-related quality of life and full-time sick leave 1 year after multimodal rehabilitation, focus on gender and age.

BACKGROUND: Chronic pain is a major and complex health condition associated with reduced work performance. A multimodal rehabilitation programme (MMRP) is a common intervention for chronic pain conditions, the goal being for the person to maintain or return to work. AIM: To investigate the multivariate relationships between health-related quality of life, life interference, pain, physiological factors before MMRP and full-time sick leave 1 year after MMRP. MATERIAL AND METHODS: Data were collected from the Swedish Quality Registry for Pain Rehabilitation. The study included 284 participants. Separate analyses were performed for women, men and three age groups. RESULTS: There were correlations between sick leave, physical functioning, pain duration, health-related quality of life, and self-assessed importance of work before MMRP and sick leave 1 year after MMRP. The patterns of factors associated with full-time sick leave varied for women, men and age groups. CONCLUSIONS: These findings indicate that full-time sick leave for patients with chronic pain is affected by a number of interacting factors. Occupational therapy interventions aiming to develop activity skills in relation to work roles and enable patients to develop skills required to manage the physical, psychological and social demands to return to work or maintain work could be valuable to increase the possibility of attaining a sustainable work situation.

Perceived occupational balance in people with stroke.

BACKGROUND: The balance of activities in daily life can become disrupted after a stroke; however, previous research has mainly focused on the performance of daily activities. Therefore, it is important to understand the impact that stroke has on various aspects of balance in activities for working-age people. PURPOSE: To describe how persons with stroke perceived their occupational balance and to explore whether occupational balance was associated with the severity of disability, fatigue and sociodemographic characteristics. METHODS: This cross-sectional study included 63 working-age persons with stroke. The Occupational Balance Questionnaire, Glasgow Outcome Scale and Fatigue Severity Scale were used and analyzed statistically. RESULTS: The majority of participants disagreed or strongly disagreed that they perceived occupational balance in most of the investigated aspects. Moreover, few significant associations were found between total summed occupational balance and injury and sociodemographic characteristics. CONCLUSION: These results demonstrate the importance of considering occupational balance in the rehabilitation of persons with stroke to support their engagement in a variety of meaningful activities that contribute to health.IMPLICATIONS FOR REHABILITATIONRehabilitation need to support persons with stroke to monitor their entire patterns of activities and perceived balance to support wider engagement in meaningful activities and promote health.Balance between all kinds of activities in daily life besides work, needs to be considered in the later phase of rehabilitation in persons with stroke.A majority of the participants with stroke in this study disagreed that they had a satisfying level of occupational balance.Perceived balance between all activities in daily life can together with performance of activities add to the understanding of consequences after stroke.

Perceived occupational value in people with acquired brain injury.

BACKGROUND: It is well known that engagement in occupations becomes restricted after acquired brain injury (ABI), but little is known about how this influences occupational values and occupational balance. AIM: To describe the extent to which persons with ABI perceived occupational value; to explore whether occupational value and occupational balance were associated with life satisfaction, and to explore how occupational value, occupational balance, the severity of disability, fatigue and sociodemographic characteristics influenced life satisfaction. MATERIALS AND METHODS: A cross-sectional study was undertaken with 75 participants of working age with ABI who responded to questionnaires on occupational value, occupational balance, and life satisfaction. Additionally, instruments covering fatigue and severity of disability were administered. Data were analyzed by means of comparisons, correlations and logistic regression. RESULTS: A high perceived occupational value and a high perceived occupational balance were significantly associated with satisfaction with life as a whole, psychological health and somatic health. The logistic regression showed that occupational value, occupational balance and severity of disability significantly impacted satisfaction with life as a whole.Conclusions and significance: Occupational value and occupational balance together with severity of disability, are important areas of focus in the later phase of rehabilitation after ABI to promote satisfaction with life as a whole.

Finding self-worth-Experiences during a multimodal rehabilitation program when living at a residency away from home.

BACKGROUND: Patients with chronic pain who live in rural areas often need to travel long distances to participate in multimodal rehabilitation programs. To reduce traveling during the programs, patients sometimes live at a residency close to the clinic and thus far from home. AIMS: The aim of this study was to explore how patients with chronic pain experience participation in an multimodal rehabilitation program while living at a residency. METHOD: Twelve patients from two specialist clinics in northern Sweden were interviewed about their experiences of participating in a multimodal rehabilitation program. The data were analyzed qualitatively using a grounded theory method with an emergent design. RESULTS: The analyses resulted in a model with the core category "finding my self-worth" consisting of four categories: "space for myself," "mirroring myself," "I am of value," and "dealing with returning to everyday life." The model illustrates the process whereby participants are given space for themselves and an opportunity to mirror themselves in interaction with other participants. That provided insight about their self-worth that was valuable for return to everyday life at home and work. CONCLUSION: Living at a residency during multimodal rehabilitation provided added value when patients were relived from the obligations of everyday life at home and given time for reflection and interaction with others in similar situations. This contributed to awareness of their own value and the necessity of taking care of themselves. This new insight led to increased motivation to act differently at home.

Contexte: Les patients souffrant de douleur chronique qui vivent en milieu rural doivent souvent parcourir de longues distances pour participer à des programmes de réhabilitation multimodale. Pour réduire les déplacements pendant les programmes, les patients vivent parfois dans une résidence à proximité de la clinique et donc loin de chez eux.Objectifs: Le but de cette étude était de se pencher sur la façon dont les patients souffrant de douleur chronique vivent leur participation à un programme de réadaptation multimodale lorsqu'ils vivent en résidence.Méthode: Douze patients provenant de deux cliniques spécialisées du Nord de la Suède ont été interviewés sur leur participation à un programme de réadaptation multimodale. Les données ont été analysées de manière qualitative en utilisant la méthode de la théorie ancrée et un devis émergent.Résultats: Les analyses ont donné lieu à un modèle dont la catégorie principale, « trouver ma valeur personnelle ¼, consiste en quatre catégories : « un espace pour moi ¼, « mon reflet ¼, « j'ai de la valeur ¼ et « le retour à la vie de tous les jours ¼. Ce modèle illustre le processus par lequel les participants disposent d'un espace pour eux-mêmes et ont l'occasion de voir leur propre reflet, en interaction avec les autres participants. Cela leur a permis de mieux percevoir leur propre valeur personnelle, ce qui a été d'une grande utilité pour leur retour à la vie quotidienne à la maison et au travail.Conclusion: Le fait de vivre en résidence pendant une réadaptation multimodale a apporté une valeur ajoutée lorsque les patients ont été libérés des obligations de la vie quotidienne à la maison et ont eu le temps de réfléchir et d'interagir avec d'autres personnes dans des situations similaires. Cela a contribué à la prise de conscience de leur propre valeur et de la nécessité de prendre soin d'eux-mêmes. Cette nouvelle perspective a conduit à une motivation accrue pour agir différemment à la maison.

Comparison of two multimodal pain rehabilitation programmes, in relation to sex and age.

OBJECTIVE: To evaluate patient-reported outcome measures in 2 different multimodal pain rehabilitation programmes and to determine whether outcomes are related to sex or age at 1-year follow-up. DESIGN: Longitudinal retrospective study. SUBJECTS: Patients who had participated in 1 of 2 multimodal pain rehabilitation programmes at 2 rehabilitation centres. A total of 356 women and 83 men, divided into 3 age groups. METHODS: Data from the Swedish Quality Registry for Pain Rehabilitation regarding activity and physical functions, pain intensity, health status and emotional functions analysed with descriptive statistics. RESULTS: Significant improvements in activity and physical functions, pain intensity and emotional func-tions were found in both multimodal pain rehabilitation programmes. Women improved more than men. The older group improved in all emotional functions (depression, anxiety, mental component summary), while the younger group improved only in depression. The intermediate group improved in all variables except anxiety. CONCLUSION: Patients improved regardless of the design of the multimodal pain rehabilitation programme. Although only small differences were found between men and women and among the 3 age groups in terms of the measured variables, these findings may have clinical relevance and indicate a need to vary the design of the interventions in multimodal rehabilitation programmes for these subgroups.

Stability of person ability measures in people with acquired brain injury in the use of everyday technology: the test-retest reliability of the Management of Everyday Technology Assessment (META).

AIM: To evaluate the test-retest reliability of the Management of Everyday Technology Assessment (META) in a sample of people with acquired brain injury (ABI). METHOD: The META was administered twice within a two-week period to 25 people with ABI. A Rasch measurement model was used to convert the META ordinal raw scores into equal-interval linear measures of each participant's ability to manage everyday technology (ET). Test-retest reliability of the stability of the person ability measures in the META was examined by a standardized difference Z-test and an intra-class correlations analysis (ICC 1). RESULTS: The results showed that the paired person ability measures generated from the META were stable over the test-retest period for 22 of the 25 subjects. The ICC 1 correlation was 0.63, which indicates good overall reliability. CONCLUSION: The META demonstrated acceptable test-retest reliability in a sample of people with ABI. The results illustrate the importance of using sufficiently challenging ETs (relative to a person's abilities) to generate stable META measurements over time. Implications for Rehabilitation The findings add evidence regarding the test-retest reliability of the person ability measures generated from the observation assessment META in a sample of people with ABI. The META might support professionals in the evaluation of interventions that are designed to improve clients' performance of activities including the ability to manage ET.

Interventions aimed at improving the ability to use everyday technology in work after brain injury.

OBJECTIVE: The aim of this study was to explore and describe how client-centred occupational therapy interventions may support and improve the ability to use everyday technology (ET) in work tasks in people with acquired brain injury (ABI). METHOD: A qualitative, descriptive multiple-case study was designed, and occupation-based interventions were provided to three working-age participants with ABI. Multiple sources were used to collect data throughout the three intervention processes, including assessments, field notes, and interviews. The Canadian Occupational Performance Measure and the Management of Everyday Technology Assessment were administered before the interventions, after the interventions and at a follow-up session 2-3 months subsequent to the interventions. RESULTS: The three intervention processes initially consisted of similar actions, but subsequently the actions took on a different focus and intensity for each case. All of the goals in each of the three case processes were achieved, and both perceived and observed abilities to use ET in work tasks improved. CONCLUSIONS: Client-centred occupational therapy interventions might have the potential to improve the ability to use ET in work tasks in people with ABI.

Ability to manage everyday technology after acquired brain injury.

PURPOSE: To investigate and describe how persons with an acquired brain injury (ABI) manage everyday technology (ET) in their daily activities and to explore whether the ability to manage ET was related to the severity of the disability. METHOD: Eighty-one persons with ABI were observed while managing ET by using the Management of Everyday Technology Assessment (META). The Glasgow Outcome Scale-Extended (GOSE) was used to assess the severity of disability after the ABI. A computer application of a Rasch measurement model was used to generate measures of the participants' ability to manage ET and the measures were compared groupwise with analysis of covariance (ANCOVA). RESULTS: The degree of severity of disability had a significant main effect on the ability to manage ET. The groups with severe and moderate disability exhibited a significantly lower ability to manage ET compared to the group with good recovery. CONCLUSION: The result indicates that the ability to manage ET in daily activities can be related to the global severity of disability after ABI. This demonstrates the importance of considering the ability to manage ET to support the performance of activities at home, at work and in society in persons with ABI.

The challenges of everyday technology in the workplace for persons with acquired brain injury.

PURPOSE: To explore and describe how persons with an acquired brain injury (ABI) managed the everyday technology (ET) that they needed to use in their workplace and how this use influences their opportunities to work. METHODS: Nine persons with an ABI were interviewed and observed when managing ET in their workplace. The data were analysed qualitatively with a constant comparative method. RESULTS: The main category, "The challenge of managing ET in the workplace", consisted of three categories, all of which reflected different kinds of discrepancies between the participants' ability to manage ET and the demands that ET imposes on them in work: "Struggling with ET to be able to continue to work; "Depending on strategies to cope with ET to continue in a particular profession", and "Managing ET at work but concerned about keeping up with the changes". CONCLUSIONS: The result revealed discrepancies between the abilities of the persons with ABI to manage ET in relation to the demands that technology imposed on them in their work setting. This indicated that professionals need to consider the role of ET when designing interventions supporting a person's return to work after an ABI.

Experiences of ethical dilemmas in rehabilitation: Swedish occupational therapists' perspectives.

The aim of this study was to describe Swedish occupational therapists' experiences of encountering ethical dilemmas in rehabilitation and strategies they used to handle the situations. Twelve occupational therapists who work with adults with developmental disabilities were interviewed using a semi-structured interview design. Data were analysed using qualitative content analysis. The results showed that ethical dilemmas were common in the occupational therapists' daily work within rehabilitation. Many situations that created ethical dilemmas were related to occupational therapists who worked with clients and their relatives, and other healthcare providers. The results showed further that occupational therapists found it difficult to make decisions and to optimize clients' participation in decision-making, to set limits and act professionally, and to best handle the situation for the client and avoid ethical dilemmas. This study indicates the importance of illustrating experiences of ethical dilemmas within occupational therapy praxis and the meaning of discussing ethical dilemmas with different healthcare providers to reach a divided view of the client in order to develop successful and healthy strategies that will optimize the rehabilitation of clients with developmental disabilities.