High Physical Exposure During Female Recruits' Basic Military Training in Sweden-A Descriptive Study.

INTRODUCTION: There is a knowledge gap concerning the occurrence of physical complaints/injuries, i.e., musculoskeletal disorders (MSD), among Swedish women who undergo basic military training (BMT). The aims were to describe prevalence and factors related to MSD and explore physical exposure and performance in Swedish female recruits during BMT. MATERIALS AND METHODS: A total of 144 females (mean age 22 years) who underwent BMT in 2016 participated in this cross-sectional study. Data regarding self-reported MSD, physical performance, physical activity and exercise, motivation and mental and physical preparation, and physical exposure during BMT and perceived health were collected at the end of BMT through the Musculoskeletal Screening Protocol questionnaire. Additional data on muscle strength were retrieved from IsoKai isokinetic lift tests. Descriptive and analytic (paired samples t-test and logistic binary regression) statistics were used. RESULTS: The prevalence of MSD was high, with 33% (n = 48) reporting MSD before BMT, 78% (n = 113) during, and 50% (n = 72) at the end of BMT. Knee and upper back were the most frequently reported MSD locations. Forty-four (30%) participants felt insufficiently physically prepared for BMT. The physical exposure was high with loaded marches/runs and carrying heavy loads as the most demanding tasks. The longest walking distance was reportedly 55 km, and the reported maximum load was 50 kg. Forty-five participants (31%) had carried a load representing over 50% of their body weight. Most participants reported good to excellent health at the end of BMT. There was a small (8 N) but significant (P = 0.045) increase in mean force over time. Two variables, MSD before BMT (odds ratio 2.24, P = 0.03) and being physically unprepared (odds ratio 3.03, P < 0.01), were associated with MSD at the end of BMT. CONCLUSION: This study showed that the prevalence of MSD in Swedish female recruits was high before, during, and at the end of BMT, with knee and upper back as the most frequent locations. Although the physical exposure during BMT was occasionally high, self-rated health was mainly perceived as good to excellent at the end of BMT. Previous MSD and being physically unprepared were related to MSD at the end of BMT. These important and relevant findings indicate the necessity for implementing interventions to increase physical fitness and treat MSD at the beginning of BMT.

Test-Retest Reliability and Translation of the Musculoskeletal Screening Protocol Questionnaire Used in the Swedish Armed Forces.

INTRODUCTION: Musculoskeletal disorders (MSDs) in military personnel are common, and it is important to identify those at risk so that appropriate preventive and rehabilitative strategies can be undertaken. The Musculoskeletal Screening Protocol (MSP) questionnaire is part of the implemented prevention strategy to reduce MSDs in the Swedish Armed Forces. The aims of this study were to evaluate the questionnaire's reliability and to translate it into English. MATERIALS AND METHODS: One-week test-retest reliability of the questionnaire was evaluated in a sample of 35 Swedish military personnel. Reliability was evaluated by calculations of Cohen's kappa or quadratic-weighted kappa. Percent agreement was used as a parameter for measurement error. Translation into English included forward and backward translations and expert committee discussions. RESULTS: Kappa values relating to physical complaints/injuries were excellent (>0.75) except for knee and lower leg MSDs and for the intensity ratings, where Kappa values were mostly interpreted as fair-to-good (0.4-0.75). Kappa values of items pertaining physical performance, physical activity and exercise, eating and tobacco habits, sleep, and perceived health ranged between 0.72 and 1. Kappa values for feeling mentally or physical prepared were 0.47 and 0.65, respectively. Most percentage agreement values ranged between 90% and 100%. The English version was found to be satisfactorily equivalent to the Swedish MSP questionnaire. CONCLUSION: The Swedish MSP questionnaire was found to be highly reliable and was satisfactorily translated into English. This provides support for the questionnaire's ability to trustworthily capture the prevalence of MSDs and perceived health in military personnel. Future research is warranted on the psychometric properties of the English MSP questionnaire.

Is Intervention to Prevent Falls Necessary in Prior Polio Patients?

OBJECTIVE: To investigate whether intervention to prevent falls is necessary in prior polio patients, by identifying the frequency, circumstances and consequences of falls among patients in Sweden with prior polio. SUBJECTS: Patients with prior polio diagnosis. METHODS: A falls history questionnaire was completed by patients with prior polio visiting the outpatient clinic at the Department of Rehabilitation Medicine, Danderyd University Hospital, Stock-holm, Sweden, or participating in group activities organized by the patient organization. RESULTS: A total of 80 patients answered the questionnaire; 32 men and 48 women. Eighty-one percent (n = 63/77) of respondents walked outdoors, but rarely more than 1 km, or only inside and near the house. Three-quarters of patients had fallen one or more times over the past year and one-quarter of patients had fallen 5 times or more. The falls often occurred during daytime in an environment known to the patient. Sixty-nine percent (n = 40/58) of respondents had been injured due to falling during the past year. The most common injuries were minor injuries. CONCLUSION: Falls are common in patients in Sweden with prior polio. Interventions to prevent falls in people with prior polio are therefore clinically relevant.

Remarkable increase of musculoskeletal disorders among soldiers preparing for international missions - comparison between 2002 and 2012.

BACKGROUND: Musculoskeletal disorders (MSD) are common among soldiers and constitute the most common reason for discontinuing military service within different military populations worldwide. The aims of this study were to investigate the prevalence of musculoskeletal disorders in two cohorts, 10 years apart, in the Swedish Armed Forces, to explore differences between these cohorts and to determine associated factors with MSD. METHOD: Comparative cross-sectional study. Participants were recruited from the Swedish Armed Forces, i.e. soldiers preparing for international missions in 2002 and 2012. A total of 961 soldiers, 7% women, participated in the study. Data were collected using the Musculoskeletal Screening Protocol (MSP), which includes questions regarding prevalence of MSD in ten anatomical locations (neck, upper back, low back, shoulders, elbow, hand, hip, knee, lower limb and foot). An additional five questions concern perceived self-rated health, i.e. how the respondent perceives their own physical body, mental health, social environment, physical environment and work ability. RESULTS: Over a ten-year period, both point prevalence and one-year prevalence of MSD in any body part increased significantly, with point prevalence increasing from 7.1 to 35.2% (p < 0.001) and one-year prevalence from 27.9 to 67.9% (p < 0.001). The knee was the most common anatomic location for MSD in both cohorts. Across each anatomical location (neck, upper back, low back, shoulders, elbow, hand, hip, knee, lower leg and foot), both point prevalence (p < 0.039) and one-year prevalence (p < 0.005) increased significantly from 2002 to 2012. Most soldiers reported good to excellent perceived health, i.e. self-perception of their physical body, mental health, physical and social environments, and work ability. The odds of reporting one-year prevalence of MSD in any body part was 5.28 times higher for soldiers in Cohort 2012, 1.91 times higher in age group 31-40 and 2.84 times higher in age group 41 and above. CONCLUSIONS: The prevalence of MSD increased remarkably over a ten-year period among Swedish soldiers preparing for international missions. With increasing age as one risk factor, systematic monitoring of MSD throughout the soldiers' careers and implementation of targeted primary-to-tertiary preventive programs are thus important.

Reliability and agreement of the IsoKai isokinetic lift test - A test used for admission to the Swedish Armed Forces.

This study was performed to evaluate the reliability and agreement of the IsoKai isokinetic lift test as it is currently administered in admission to the Swedish Armed Forces. The study included an intrarater (n = 534) and interrater reliability sample (n = 137), of Swedish male conscripts who performed the test on two test occasions about two hours apart. Two-to-four lifts were performed at each occasion, and the highest mean (IsoKaiMF) and peak force (IsoKaiPF) produced (N) were used for evaluation. All intraclass coefficients showed excellent reliability. The interrater analyses resulted in intraclass coefficients of 0.942 (95% CI; 0.920-0.959) and 0.858 (95% CI; 0.806-0.896) for the IsoKaiMF and IsoKaiPF, respectively, while the corresponding coefficients for the intrarater analyses were 0.935 (95% CI; 0.923-0.946) and 0.865 (95% CI; 0.842-0.886). Agreement, the capability of a test to detect changes, was assessed by the standard error of measurement (SEM/SEM%) and the smallest real difference (SRD/SRD%). These estimate indicated that it is possible to achieve measurements relevant to use in real practice with the IsoKai isokinetic lift test. Bland and Altman analyses revealed no systematic errors in either sample. Based on these findings, the IsoKai isokinetic lift test is suggested to be a highly reliable test for maximal dynamic muscular strength. The test could be of use in selection procedures in order to accurately evaluate maximal dynamic muscular strength, and for evaluating longitudinal changes in strength.

Concurrent validity of an isokinetic lift test used for admission to the Swedish Armed Forces.

The aim of this study was to assess the concurrent validity of the IsoKai isokinetic lift test peak force (IsoKaiPeak) in comparison to a submaximal 5-10RM deadlift test (5-10RMDL), and to develop an equation for converting the IsoKaiPeak in Newton (N) to an estimated 1RM (1RMest) deadlift load in kilograms (kg). The participants included 28 males and 16 female employees in the Swedish Armed Forces (20-59 years). Each participant conducted the IsoKai lift test, followed by the 5-10RMDL test at one occasion. The Pearson's correlation coefficient, with a 95% confidence interval was calculated to evaluate the validity between the IsoKaiPeak and the 1RMest deadlift load derived from the 5-10RMDL test. Univariate and multivariable linear regressions were used to derive the equation for calculating the 1RMest deadlift load based on the IsoKaiPeak. The IsoKaiPeak showed good- to-excellent correlation with the 1RMest deadlift weight with a correlation coefficient of 0.84 (0.72-0.91) for the total sample, and 0.65 (0.37-0.83) and 0.81 (0.53-0.93) in males and females, respectively. The final equation, 1RMest deadlift weight (kg) = -51.63 + (0.08 x IsoKaiPeak) + (2.28 x BMI), explained 72% (adjusted R2 = 0.72) of the total variance in the 1RMest, and had a standard error of the estimate (SEE) of 16.57 kg. In conclusion, the IsoKai isokinetic lift test could be considered a highly valid measure of maximal dynamic muscular strength in comparison to the 5-10RMDL. The equation can be used to convert the IsoKai lift test (N) results to an 1RMest deadlift load (kg), but with consideration of the relative large SEE.

Self-reported musculoskeletal complaints and injuries and exposure of physical workload in Swedish soldiers serving in Afghanistan.

BACKGROUND: Musculoskeletal complaints and injuries (MSCI) are common in military populations. However, only a limited number of studies have followed soldiers during international deployments and investigated the prevalence of MSCI during and at the end of their deployment. The aim was to describe the prevalence of MSCI in different military occupational specialties and categorise their most common tasks in terms of exposures to physical workloads during a six-month long international deployment in Afghanistan. METHODS: Cross-sectional survey, including 325 soldiers (300 men), aged 20-62 participating in an international deployment in Afghanistan during the spring of 2012. Soldiers were clustered into different military occupational specialties: Infantry, Administration, Logistics, Logistics/Camp, Medical and Other. Data were collected through the use of the Musculoskeletal Screening Protocol at the end of the international mission. RESULTS: Forty-seven percent reported MSCI during deployment, with 28% at the end. The most common locations of MSCI during the mission were lower back, knee, shoulders, upper back, neck and foot, while the knee and lower back prevailed at the end of the mission. Almost half of the soldiers who had MSCI reported affected work ability. The most common duties during the mission were vehicle patrolling, staff duties, guard/security duties, foot patrols and transportation. Soldiers reported that vehicle patrolling, staff duties and transportation were demanding with respect to endurance strength, guard/security duties challenged both maximum and endurance strength while foot patrolling challenged maximum and endurance strength, aerobic and anaerobic endurance and speed. CONCLUSIONS: MSCI during international deployment are common among Swedish soldiers. The results indicate the need to further develop strategies focusing on matching the soldiers' capacity to the job requirements, with relevant and fair physical selection-tests during the recruitment process and proactive interventions targeting MSCI before and during deployment, in order to enhance soldiers' readiness and promote operational readiness.

Long-term follow-up of patients with prior polio over a 17-year period.

OBJECTIVE: Follow-up of the health of patients with prior polio over a 17-year period. DESIGN: Follow-up study. PATIENTS: Patients with prior polio. METHODS: The study questionnaire was answered in 1995 by 270 patients. In 2012 the questionnaire was sent again to the surviving patients. RESULTS: Of the patients who answered the questionnaire in 1995, 116 (40%) were still alive in 2012. The group of patients who had died was older, and had a mean age of 70 years in 1995. A total of 60 patients participated in the study by answering the questionnaire in both 1995 and 2012. Most of these patients (84%) reported that they felt progressively worse, with poor mobility and increased muscle weakness in 2012 compared with 1995, and more than half reported a lower quality of life in 2012. The number of wheelchair users had increased significantly. Furthermore, the patients experienced increasing problems with activities of daily living (ADL) function. CONCLUSION: More than half of the patients with prior polio had died between 1995 and 2012. These patients were, on average, older than patients surviving in 2012. When interviewed in 2012 most of the patients felt progressively worse, with poor mobility and increased muscle weakness.

Immunoglobulin treatment in post-polio syndrome: Identification of responders and non-responders.

OBJECTIVE: To define and characterize responders and non-responders in a group of 124 patients with post-polio syndrome who received a single treatment with intravenous immunoglobulin. DESIGN: Open trial, prospective follow-up study. METHODS: Clinical examination and data from medical records. Short Form 36 (SF-36), Physical Activity Scale for the Elderly (PASE) and visual analogue scale (VAS) measured quality of life, physical activity and intensity of pain, respectively. Data were obtained before treatment and at 6-month follow-up. RESULTS: Two responder groups were identified with the outcome SF-36 Vitality and 3 with Bodily pain, respectively. Forty-five percent were positive-responders, identified before treatment by reduced physical function, muscle atrophy in the lower extremities, higher levels of fatigue and pain, and a VAS pain score above 20. Negative-responders were identified by good physical function and mental health, lesser muscle atrophy in the lower extremities, and low levels of fatigue and pain. CONCLUSION: Intravenous immunoglobulin is a biological intervention, and therefore it is important to be able to identify responders and non-responders. In order to maximize a positive outcome it is suggested that patients with a high level of fatigue and/or pain and reduced physical function are selected.

Content Validity Index and Intra- and Inter-Rater Reliability of a New Muscle Strength/Endurance Test Battery for Swedish Soldiers.

The objective of this study was to examine the content validity of commonly used muscle performance tests in military personnel and to investigate the reliability of a proposed test battery. For the content validity investigation, thirty selected tests were those described in the literature and/or commonly used in the Nordic and North Atlantic Treaty Organization (NATO) countries. Nine selected experts rated, on a four-point Likert scale, the relevance of these tests in relation to five different work tasks: lifting, carrying equipment on the body or in the hands, climbing, and digging. Thereafter, a content validity index (CVI) was calculated for each work task. The result showed excellent CVI (≥0.78) for sixteen tests, which comprised of one or more of the military work tasks. Three of the tests; the functional lower-limb loading test (the Ranger test), dead-lift with kettlebells, and back extension, showed excellent content validity for four of the work tasks. For the development of a new muscle strength/endurance test battery, these three tests were further supplemented with two other tests, namely, the chins and side-bridge test. The inter-rater reliability was high (intraclass correlation coefficient, ICC2,1 0.99) for all five tests. The intra-rater reliability was good to high (ICC3,1 0.82-0.96) with an acceptable standard error of mean (SEM), except for the side-bridge test (SEM%>15). Thus, the final suggested test battery for a valid and reliable evaluation of soldiers' muscle performance comprised the following four tests; the Ranger test, dead-lift with kettlebells, chins, and back extension test. The criterion-related validity of the test battery should be further evaluated for soldiers exposed to varying physical workload.

Quality of life in Swedish patients with post-polio syndrome with a focus on age and sex.

To investigate the health-related quality of life (QOL) in Swedish patients with post-polio syndrome (PPS), with a focus on sex and age. A total of 364 patients were recruited from five Swedish post-polio clinics. Analysis was carried out using SF-36 and data were compared with those of a normal population. QOL was significantly lower in PPS patients for all eight subdomains and the two main scores (physical compound score and mental compound score) when compared with the controls. Male patients had a significantly higher QOL than female patients for all subdomains and also for mental compound score and physical compound score, a phenomenon also observed in the normal population. There was a decrease in QOL in the physical domains and an increase in vitality with age. PPS decreases health-related QOL in both sexes, more in female patients. QOL for physical domains decreases whereas vitality increases with age in both sexes.

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.

Test-retest reliability of the 6-min walk test in patients with postpolio syndrome.

This study describes the test-retest reliability of the 6-min walk test (6MWT) and evaluates the possibility to perform the test three times on the same day in patients with postpolio syndrome (PPS). This was an intrarater test-retest reliability study. A total of 23 PPS patients (nine men, 14 women), mean age 67 years, participated in the study. The patients performed three 6MWT with a 30-min rest between each test. Borg scales were used to evaluate leg tiredness, dyspnea, and exertion before and after each test. The influence of walking aids on the outcome of the 6MWT was also evaluated. All patients (n=23) were able to complete the three 6MWT. The individual distances varied from 140-395 m. The relative reliability was high. The intraclass correlation coefficient (ICC2.1) (95% confidence interval) values ranged from 0.98 (0.95-0.99) (T1-T2) to 0.99 (0.97-0.99) (T2-T3) for the total number of participants. The SEM ranged from 12 to 9 m and the smallest real difference (SRD) ranged from 33 to 26 m for the total number of participants. Data indicate that the 6MWT is reliable for patients with PPS. For the high test-retest reliability, one test may be required. However, as a small learning effect was observed, the best result of two tests can be recommended when evaluating walking ability for research purposes.

IVIG treatment in post-polio patients: evaluation of responders.

The aim of this work is to evaluate the outcome of IVIG treatment in patients with post-polio syndrome (PPS) and to identify responders. The study included 113 PPS patients who had received one IVIG treatment in an open trial, prospective follow-up study. Clinical examination was performed and clinical data were retrieved from medical records. The short form 36 (SF-36), physical activity scale for the elderly (PASE), and the visual analogue scale (VAS) were used as measurements of quality of life, physical activity, and the intensity of pain. Data before treatment and at 6-month follow-up were collected. Analysis was performed in subgroups based on demographic and medical parameters. A statistically significant increase of the SF-36 sub domains bodily pain, vitality, social function, role emotional, and the mental compound score (MCS) was found at the 6-month follow-up. A significant decrease of pain was found in patients who reported pain intensity over VAS of 20 mm, in patients younger than 65 years of age and in patients who had paresis in the lower extremities. A trend was found in patients with PPS as the only diagnosis. IVIG leads to increase of quality of life at 6-month follow-up for SF-36 regarding sub domains of bodily pain, vitality, social function, role emotional, as well as for pain. Age below 65 years, paresis in the lower extremities, and lack of concomitant disorders may be the main indicators for a future identification of responders.

Individual risk factors associated with premature discharge from military service.

Research on military populations indicates that failure to complete training is a significant problem for armed forces around the world. The present study estimated the prevalence of musculoskeletal complaints or injuries and potential individual risk factors leading to premature discharge from Swedish military service. Male conscripts, n=469 answered a questionnaire and performed physical tests at the start of their military service. A high prevalence of complaints or injuries in lower back and knee was shown. Logistic regression analyses showed an increased risk of discharge (odds ratio, OR) when reporting current complaints or injuries in any part of the body (OR 4.6), being physically inactive (OR 2.0), cigarette smoking (OR 2.7), or poor mental health (OR 3.6). The findings highlight the need for improved preenlistment examination and/or early preventive strategies addressing both physical and psychological interventions.

Does rehabilitation decrease shoulder muscle activity in fibromyalgia in work or housework tasks? An electromyographical study.

PURPOSE: This study sought to investigate whether patients with fibromyalgia (FM) are able to perform a work task and home care tasks with less muscle activity, recorded as surface EMG, after a rehabilitation programme as compared to before rehabilitation. METHOD: Muscle activity in shoulder and arm muscles was measured with surface EMG during a job task and three housework tasks before and after an individually adjusted rehabilitation programme for 16 female patients with FM. Ten healthy women were measured in the same way. Pain intensity and perception of exertion were assessed with Borg's CR100 scale after every activity. RESULTS: The patients decreased their muscle activity more than the healthy subjects did in the trapezius pars descendens of the non-dominant side during computer typing and ironing. A decrease in pain intensity and perceived exertion after the computer typing and ironing coincided with the decreased muscle activity. CONCLUSION: Patients with FM are able to learn to perform a work task and a home-care task with less muscle activity in trapezius pars descendens after a rehabilitation programme. Decreased pain intensity and perception of exertion may indicate that these two experiences accompany the decrease in muscle activity.

Functional index-2: Validity and reliability of a disease-specific measure of impairment in patients with polymyositis and dermatomyositis.

OBJECTIVE: To revise the content of the Functional Index in myositis (FI) and to evaluate measurement properties of a revised FI. METHODS: Previously performed FI (n = 287) were analyzed for internal redundancy and consistency, and ceiling and floor effects. Content was evaluated and a preliminary revised FI was developed. To evaluate the construct validity of the preliminary revised FI, it was compared with isokinetic measurements of muscular strength and endurance, the Myositis Activities Profile, disease impact on general wellbeing, and creatine phosphokinase levels. Minor adjustments were made and the revised FI was investigated for interrater reliability and intrarater reliability over a 1-week period. After this, some minor, additional adjustments were made leading to the final version, FI-2. RESULTS: Five tasks were removed from the original FI due to ceiling effects. Performance pace and number of repetitions were modified for the remaining tasks. A moderate correlation (r(s) = 0.58) was found between the shoulder flexion task of the preliminary revised FI and isokinetic measurements of shoulder flexion endurance. Intraclass correlation coefficient (ICC) for interrater reliability of the revised FI varied from 0.86-0.99 with no systematic differences. ICC for intrarater reliability varied from 0.56-0.99 with systematic differences (P < 0.05) between test and retest in 3 of the tasks. The sit-up task was excluded due to low intrarater reliability resulting in the final 7-item FI-2. There was a good correlation between tasks on the right and left side suggesting that the FI-2 could be performed unilaterally. CONCLUSION: The FI-2 is a valid and reliable outcome measure of impairment for patients with polymyositis or dermatomyositis. It is well tolerated and the unilateral FI-2 requires a maximum of 20 minutes to perform. Further evaluation of sensitivity to change and testing in healthy individuals needs to be conducted.

Disability pension despite vocational rehabilitation? A study from six social insurance offices of a county.

Many long-term sick-listed individuals move from vocational rehabilitation to pension, rather than reaching the goal of return to work. There is thus reason to consider whether rehabilitation resources are being used optimally. Individuals receiving disability pensions are consuming financial and personnel resources at the insurance offices and also consume a large amount of health care. The general objective of the study was to evaluate the proportion of individuals granted vocational rehabilitation but then obtaining temporary or permanent disability pensions. All persons receiving any kind of rehabilitation and attending one of six local national insurance offices in a county in Sweden in 1998 and 1999 were studied. A 2-year follow-up was carried out to assess changes in status among those who had received temporary disability pensions. Of all individuals receiving rehabilitation, 46.2% ended up with a disability pension allowance. In addition, a large portion of the temporary disability pensions was transformed to permanent disability pensions within 2 years. For clients with a temporary disability pension, the rate of resuming work was close to nil. Among rehabilitation measures, investigation showed the lowest figures of work resumption while job training showed the best outcome in this respect. The study concluded that a large portion of the financial and personnel resources allocated by the national insurance offices to rehabilitation resulted in disability pensions.

Effects of a multiprofessional rehabilitation programme for patients with fibromyalgia syndrome.

The present study sought to evaluate the efficacy of a 12-week multidisciplinary rehabilitation programme mainly emphasizing physiotherapy, for patients with either fibromyalgia syndrome or chronic, widespread pain. Forty-three non-randomized female patients with fibromyalgia syndrome or chronic, widespread pain were assigned to the programme or served as waiting-list controls. The outcome was assessed with the Body Awareness Scale-Health, the Multidimensional Pain Inventory, the Quality of Life Scale, the Visual Analogue Scale and a pain drawing. Both groups were reassessed after 3 and 6 months, the treatment group also after 1 year. The treatment group improved in quality of movement and in vegetative disturbances according to the Body Awareness Scale-Health after the programme. At the 3-month and 1-year follow-ups the improvements were partly sustained. The control group showed deterioration after 3 and 6 months in three of the main scales of the Body Awareness Scale-Health. This clinical trial of a rehabilitation programme, proved beneficial for improving quality of movement and reducing the experience of vegetative disturbances.

Working environmental conditions as experienced by women working despite pain.

OBJECTIVE: This study looked at female hospital cleaners and home help personnel who continued working despite problems or pain in their musculoskeletal system and where there was a risk of increase in sickness absence. The aim was to determine whether supportive intervention for these personnel at the workplace had an effect on the way that they experienced the physical and psychosocial aspects of their working environments. METHODS: The design was prospective with non-rando-mised intervention and reference groups. A selection of 55 questions about physical and psychosocial working environment from a national survey were used. Comparisons were made between intervention and reference groups and with data on a selection of the Swedish population of people in these professions. RESULTS: The results showed that in the hospital cleaners' intervention group the introduction of new cleaning materials and new cleaning methods seemed to contribute to a reduction in workload during the intervention period, which in turn gave them a better chance of taking rest breaks during working time. In the home helps' intervention group the results showed that the group had had a reduction both in workload and in more responsible tasks, and at the same time the psychosomatic stress reactions reduced after the intervention. CONCLUSIONS: The results indicate that effects on the working environmental conditions as experienced could be obtained by a general multi-component support program at the workplace, but the number of variables influenced by the program was very small. The relatively limited effects may be explained by the fact that the impact of a support program depends on how well the remedial measures fulfil the need for such measures either at the workplace, in a work group or among the individual people at the workplace. This emphasises the importance of designing effective analysis tools for judging what remedial measures are needed before the measures themselves are tried out.