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Grant M, Rees S, Underwood M, Froud R. Obstacles to returning to work with chronic pain: in-depth interviews with people who are off work due to chronic pain and employers. BMC Musculoskelet Disord 2019; 20:486. [PMID: 31656184 PMCID: PMC6815386 DOI: 10.1186/s12891-019-2877-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/02/2019] [Indexed: 11/30/2022] Open
Abstract
Background The global burden of chronic pain is growing with implications for both an ageing workforce and employers. Many obstacles are faced by people with chronic pain in finding employment and returning to work after a period of absence. Few studies have explored obstacles to return-to-work (RTW) from workers’ and employers’ perspectives. Here we explore views of both people in pain and employers about challenges to returning to work of people who are off work with chronic pain. Methods We did individual semi-structured interviews with people who were off work (unemployed or off sick) with chronic pain recruited from National Health Service (NHS) pain services and employment services, and employers from small, medium, and large public or private sector organisations. We analysed data using the Framework method. Results We interviewed 15 people off work with chronic pain and 10 employers. Obstacles to RTW for people with chronic pain spanned psychological, pain related, financial and economic, educational, and work-related domains. Employers were concerned about potential attitudinal obstacles, absence, ability of people with chronic pain to fulfil the job requirements, and the implications for workplace relationships. Views on disclosure of the pain condition were conflicting with more than half employers wanting early full disclosure and two-thirds of people with chronic pain declaring they would not disclose for fear of not getting a job or losing a job. Both employers and people with chronic pain thought that lack of confidence was an important obstacle. Changes to the job or work conditions (e.g. making reasonable adjustments, phased return, working from home or redeployment) were seen by both groups as facilitators. People with chronic pain wanted help in preparing to RTW, education for managers about pain and supportive working relationships. Conclusions People with chronic pain and employers may think differently in terms of perceptions of obstacles to RTW. Views appeared disparate in relation to disclosure of pain and when this needs to occur. They appeared to have more in common regarding opinions about how to facilitate successful RTW. Increased understanding of both perspectives may be used to inform the development of improved RTW interventions.
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Affiliation(s)
- Mary Grant
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
| | - Sophie Rees
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.,University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Robert Froud
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.,Institute of Health Sciences, Kristiania University College, Oslo, Norway
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Grant M, O-Beirne-Elliman J, Froud R, Underwood M, Seers K. The work of return to work. Challenges of returning to work when you have chronic pain: a meta-ethnography. BMJ Open 2019; 9:e025743. [PMID: 31227529 PMCID: PMC6596973 DOI: 10.1136/bmjopen-2018-025743] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
AIMS To understand obstacles to returning to work, as perceived by people with chronic non-malignant pain and as perceived by employers, and to develop a conceptual model. DESIGN Synthesis of qualitative research using meta-ethnography. DATA SOURCES Eleven bibliographic databases from inception to April 2017 supplemented by citation tracking. REVIEW METHODS We used the methods of meta-ethnography. We identified concepts and conceptual categories, and developed a conceptual model and line of argument. RESULTS We included 41 studies. We identified three core categories in the conceptual model: managing pain, managing work relationships and making workplace adjustments. All were influenced by societal expectations in relation to work, self (self-belief, self-efficacy, legitimacy, autonomy and the meaning of work for the individual), health/illness/pain representations, prereturn to work support and rehabilitation, and system factors (healthcare, workplace and social security). A mismatch of expectations between the individual with pain and the workplace contributed to a feeling of being judged and difficulties asking for help. The ability to navigate obstacles and negotiate change underpinned mastering return to work despite the pain. Where this ability was not apparent, there could be a downward spiral resulting in not working. CONCLUSIONS For people with chronic pain, and for their employers, navigating obstacles to return to work entails balancing the needs of (1) the person with chronic pain, (2) work colleagues and (3) the employing organisation. Managing pain, managing work relationships and making workplace adjustments appear to be central, but not straightforward, and require substantial effort to culminate in a successful return to work.
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Affiliation(s)
- Mary Grant
- Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, UK
| | | | - Robert Froud
- Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, UK
- Department of Health Sciences, Kristiania University College, Oslo, Norway
| | - Martin Underwood
- Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, UK
| | - Kate Seers
- Warwick Research in Nursing, University of Warwick, Warwick Medical School, Coventry, UK
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Neary J, Katikireddi SV, Brown J, Macdonald EB, Thomson H. Role of age and health in perceptions of returning to work: a qualitative study. BMC Public Health 2019; 19:496. [PMID: 31046738 PMCID: PMC6498557 DOI: 10.1186/s12889-019-6819-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 04/15/2019] [Indexed: 11/15/2022] Open
Abstract
Background People aged over 50 years form a growing proportion of the working age population, but are at increased risk of unemployment compared to other age groups. It is often difficult to return to work after unemployment, particularly for those with health issues. In this paper, we explored the perceptions, attitudes, and experiences of returning to work after a period of unemployment (hereafter RTW) barriers among unemployed adults aged over 50 years. Method In-depth semi-structured interviews were conducted with a diverse sample of 26 unemployed individuals aged 50–64 years who were engaged with the UK Government’s Work Programme. Data were thematically analysed. Results Age alone was not discussed by participants as a barrier to work; rather their discussions of barriers to work focused on the ways in which age influenced other issues in their lives. For participants reporting chronic health conditions, or disabilities, there was a concern about being unfit to return to their previous employment area, and therefore having to “start again” in a new career, with associated concerns about their health status and managing their treatment burden. Some participants also reported experiencing either direct or indirect ageism (including related to their health status or need to access healthcare) when looking for work. Other issues facing older people included wider socio-political changes, such as the increased pension age, were felt to be unfair in many ways and contradicted existing expectations of social roles (such as acting as a carer for other family members). Conclusion Over-50s experienced multiple and interacting issues, at both the individual and societal level, that created RTW barriers. There is a need for employability interventions that focus on supporting the over-50s who have fallen out of the labour market to take a holistic approach, working across healthcare, employability and the local labour market, providing treatment and skills training for both those out of work and for employers, in order to create an intervention that that helps achieve RTW and its associated health benefit. Electronic supplementary material The online version of this article (10.1186/s12889-019-6819-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joanne Neary
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, G12 9LX, Glasgow, Scotland.
| | - Srinivasa Vittal Katikireddi
- MRC Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Judith Brown
- Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Ewan B Macdonald
- Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Hilary Thomson
- MRC Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
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de Wit M, Wind H, Hulshof CTJ, Frings-Dresen MHW. Person-related factors associated with work participation in employees with health problems: a systematic review. Int Arch Occup Environ Health 2018; 91:497-512. [PMID: 29700608 PMCID: PMC6002456 DOI: 10.1007/s00420-018-1308-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 04/18/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The objective of this systematic review was to explore and provide systematically assessed information about the association between person-related factors and work participation of people with health problems. The research question was: what is the association between selected person-related factors and work participation of workers with health problems? METHODS A systematic review was carried out in PubMed and PsycINFO to search for original papers published between January 2007 and February 2017. The risk of bias of the studies included was assessed using quality assessment tools from the Joanna Briggs Institute. The quality of evidence was assessed using the GRADE framework for prognostic studies. RESULTS In total, 113 studies were included, all of which addressed the association between person-related factors and work participation. The factors positively associated with work participation were positive expectations regarding recovery or return to work, optimism, self-efficacy, motivation, feelings of control, and perceived health. The factors negatively associated with work participation were fear-avoidance beliefs, perceived work-relatedness of the health problem, and catastrophizing. Different coping strategies had a negative or a positive relationship with work participation. CONCLUSIONS The results of this review provide more insight into the associations between different cognitions and perceptions and work participation. The results of this study suggest that person-related factors should be considered by occupational- and insurance physicians when they diagnose, evaluate or provide treatment to employees. Further research is required to determine how these physicians could obtain and apply such information and whether its application leads to a better quality of care.
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Affiliation(s)
- Mariska de Wit
- Department Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.
| | - Haije Wind
- Department Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Carel T J Hulshof
- Department Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Monique H W Frings-Dresen
- Department Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
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Nguyen C, Boutron I, Rein C, Baron G, Sanchez K, Palazzo C, Dupeyron A, Tessier JM, Coudeyre E, Eschalier B, Forestier R, Roques-Latrille CF, Attal Y, Lefèvre-Colau MM, Rannou F, Poiraudeau S. Intensive spa and exercise therapy program for returning to work for low back pain patients: a randomized controlled trial. Sci Rep 2017; 7:17956. [PMID: 29263353 PMCID: PMC5738382 DOI: 10.1038/s41598-017-18311-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 12/08/2017] [Indexed: 12/29/2022] Open
Abstract
We aimed to determine whether a 5-day intensive inpatient spa and exercise therapy and educational program is more effective than usual care in improving the rate of returning to work at 1 year for patients with subacute and chronic low back pain (LBP) on sick leave for 4 to 24 weeks. We conducted a 12-month randomized controlled trial. LBP patients were assigned to 5-day spa (2 hr/day), exercise (30 min/day) and education (45 min/day) or to usual care. The primary outcome was the percentage of patients returning to work at 1 year after randomization. Secondary outcomes were pain, disability and health-related quality of life at 1 year and number of sick leave days from 6 to 12 months. The projected recruitment was not achieved. Only 88/700 (12.6%) patients planned were enrolled: 45 in the spa therapy group and 43 in the usual care group. At 1 year, returning to work was 56.3% versus 41.9% (OR 1.69 [95% CI 0.60-4.73], p = 0.32) respectively. There was no significant difference for any of the secondary outcomes. However, our study lacked power.
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Affiliation(s)
- Christelle Nguyen
- Sorbonne Paris Cité, Université Paris Descartes, Faculté de Médecine, 75006, Paris, France.
- AP-HP, Hôpitaux Universitaires Paris Centre, Groupe Hospitalier Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014, Paris, France.
- INSERM UMR 1124, Laboratoire de Pharmacologie, Toxicologie et Signalisation Cellulaire, Faculté des Sciences Fondamentales et Biomédicales, UFR Biomédicale des Saints-Pères, 75006, Paris, France.
| | - Isabelle Boutron
- Sorbonne Paris Cité, Université Paris Descartes, Faculté de Médecine, 75006, Paris, France
- AP-HP, Hôpital Hôtel-Dieu, Centre d'Épidémiologie Clinique, 75004, Paris, France
- INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne Cité, METHODS Team, 75004, Paris, France
| | - Christopher Rein
- Sorbonne Paris Cité, Université Paris Descartes, Faculté de Médecine, 75006, Paris, France
| | - Gabriel Baron
- INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne Cité, METHODS Team, 75004, Paris, France
| | - Katherine Sanchez
- Sorbonne Paris Cité, Université Paris Descartes, Faculté de Médecine, 75006, Paris, France
| | - Clémence Palazzo
- AP-HP, Hôpitaux Universitaires Paris Centre, Groupe Hospitalier Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014, Paris, France
- INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne Cité, ECaMO Team, 75004, Paris, France
- Institut Fédératif de Recherche sur le Handicap, 75013, Paris, France
| | - Arnaud Dupeyron
- Université de Montpellier 1, Groupe Hospitalier et Universitaire Carémeau, Fédération de Médecine Physique et de Réadaptation, 30000, Nîmes, France
| | | | - Emmanuel Coudeyre
- Centre Hospitalo-Universitaire de Clermont-Ferrand, Service de Médecine Physique et de Réadaptation, INRA, Université Clermont-Auvergne, 63000, Clermont, Ferrand, France
| | - Bénédicte Eschalier
- Centre Hospitalo-Universitaire de Clermont-Ferrand, Service de Médecine Physique et de Réadaptation, INRA, Université Clermont-Auvergne, 63000, Clermont, Ferrand, France
| | - Romain Forestier
- Centre de recherche rhumatologique et thermale, 15, avenue Charles-de-Gaulle, 73100, Aix-Les-Bains, France
| | | | - Ygal Attal
- Rue Victor Hugo, 73000, Chambéry, France
| | - Marie-Martine Lefèvre-Colau
- Sorbonne Paris Cité, Université Paris Descartes, Faculté de Médecine, 75006, Paris, France
- AP-HP, Hôpitaux Universitaires Paris Centre, Groupe Hospitalier Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014, Paris, France
- INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne Cité, ECaMO Team, 75004, Paris, France
| | - François Rannou
- Sorbonne Paris Cité, Université Paris Descartes, Faculté de Médecine, 75006, Paris, France
- AP-HP, Hôpitaux Universitaires Paris Centre, Groupe Hospitalier Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014, Paris, France
- INSERM UMR 1124, Laboratoire de Pharmacologie, Toxicologie et Signalisation Cellulaire, Faculté des Sciences Fondamentales et Biomédicales, UFR Biomédicale des Saints-Pères, 75006, Paris, France
| | - Serge Poiraudeau
- Sorbonne Paris Cité, Université Paris Descartes, Faculté de Médecine, 75006, Paris, France
- AP-HP, Hôpitaux Universitaires Paris Centre, Groupe Hospitalier Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014, Paris, France
- INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne Cité, ECaMO Team, 75004, Paris, France
- Institut Fédératif de Recherche sur le Handicap, 75013, Paris, France
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Bartys S, Frederiksen P, Bendix T, Burton K. System influences on work disability due to low back pain: An international evidence synthesis. Health Policy 2017; 121:903-912. [DOI: 10.1016/j.healthpol.2017.05.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 05/26/2017] [Accepted: 05/29/2017] [Indexed: 10/19/2022]
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Rinaldo U, Selander J. Return to work after vocational rehabilitation for sick-listed workers with long-term back, neck and shoulder problems: A follow-up study of factors involved. Work 2016; 55:115-131. [PMID: 27612067 DOI: 10.3233/wor-162387] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Absence from work due to musculoskeletal disorders is a significant problem from a number of perspectives, and there is a great need to identify factors that facilitate return to work (RTW). OBJECTIVE To identify factors related to RTW after vocational rehabilitation for sick-listed workers with long-term back, neck and/or shoulder problems, and to compare the results with those from a previous literature review based on studies from 1980 to 2000. METHODS A literature review based on studies published 2001-2014 in PubMed, CINAHL, EMBASE, ERIC and the Cochrane Library. RESULTS Major risk factors for not returning to work are: higher age, factors related to pain such as higher levels of pain and pain related fear, avoidance of activity, high distress and depression. Facilitating factors for RTW are: lower functional disability, gaining control over one's own condition, believing in RTW and work-related factors such as occupational training, and having a job coach or an RTW coordinator. Compared with the results from the previous review, the present review shows less of a focus on sociodemographic factors and more on psychological factors. Both studies highlight risk factors such as older age, higher levels of pain, depression and less internal locus of control. CONCLUSION Psychosocial and work-related factors are important and should be included in interventions for the RTW of people with long-term back, neck and/or shoulder problems.
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Igwesi-Chidobe CN, Kitchen S, Sorinola IO, Godfrey EL. “A life of living death”: the experiences of people living with chronic low back pain in rural Nigeria. Disabil Rehabil 2016; 39:779-790. [DOI: 10.3109/09638288.2016.1161844] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Chinonso N. Igwesi-Chidobe
- Department of Physiotherapy, Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College, London, UK
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria (Enugu Campus), Nsukka, Nigeria
| | - Sheila Kitchen
- Department of Physiotherapy, Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College, London, UK
| | - Isaac O. Sorinola
- Department of Physiotherapy, Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College, London, UK
| | - Emma L. Godfrey
- Department of Physiotherapy, Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
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Ernstsen L, Lillefjell M. Physical functioning after occupational rehabilitation and returning to work among employees with chronic musculoskeletal pain and comorbid depressive symptoms. J Multidiscip Healthc 2014; 7:55-63. [PMID: 24489473 PMCID: PMC3904812 DOI: 10.2147/jmdh.s55828] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The aim of this investigation was to assess whether measures of physical functioning after multidisciplinary rehabilitation are associated with return to work among individuals with chronic musculoskeletal pain conditions and comorbid depressive symptoms. Methods Included were 92 employees with chronic musculoskeletal disorders who had participated in a 57- week multidisciplinary rehabilitation program. Their ages ranged from 25–59 years. The Hospital Anxiety and Depression Scale was used to assess depressive symptoms. Different aspects of physical functioning (muscle strength, mobility, endurance capacity, and balance) were measured with single-item visual analog scales, and physical fitness was measured with the validated COOP/WONCA charts. Being on “active work strategies,” such as receiving rehabilitation benefit/vocational rehabilitation or being reported partly or completely fit, was defined as “on their way into/in work”. Cross-sectional associations were measured using logistic regression models, estimating odds ratio with 95% confidence intervals. Results There were no differences between the “on their way into/in work” group (n=70) and the “on their way out/out of work” group (n=22) regarding age, sex, or levels of anxiety or pain. Surprisingly, regression analyses showed that those with higher levels of physical functioning had significantly lower odds of returning to work. Conclusion The findings of an inverse relationship between self-reported physical function and returning to work in this sample illustrate that the return-to-work process among employees with chronic musculoskeletal pain and comorbid depressive symptoms is multifactorial and influenced by factors other than physical functioning at the individual level. Further research, especially longitudinal studies, is needed to assess the occupational trajectories among employees with chronic musculoskeletal pain and comorbid depressive symptoms after participation in a multidisciplinary rehabilitation program.
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Affiliation(s)
- Linda Ernstsen
- Faculty of Nursing, Sør-Trøndelag University College, Trondheim, Norway
| | - Monica Lillefjell
- Department of Occupational Therapy, Faculty of Health Education and Social Work, Sør-Trøndelag University College, Trondheim, Norway
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MacNeela P, Doyle C, O'Gorman D, Ruane N, McGuire BE. Experiences of chronic low back pain: a meta-ethnography of qualitative research. Health Psychol Rev 2013; 9:63-82. [DOI: 10.1080/17437199.2013.840951] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Padraig MacNeela
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
- Centre for Pain Research, National University of Ireland, Galway, Ireland
| | - Catherine Doyle
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
| | - David O'Gorman
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- Division of Pain Medicine, Department of Anaesthesia, Galway University Hospital, Galway, Ireland
| | - Nancy Ruane
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- Division of Pain Medicine, Department of Anaesthesia, Galway University Hospital, Galway, Ireland
| | - Brian E. McGuire
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- Division of Pain Medicine, Department of Anaesthesia, Galway University Hospital, Galway, Ireland
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Toye F, Seers K, Allcock N, Briggs M, Carr E, Andrews J, Barker K. A meta-ethnography of patients’ experience of chronic non-malignant musculoskeletal pain. HEALTH SERVICES AND DELIVERY RESEARCH 2013. [DOI: 10.3310/hsdr01120] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BackgroundThe alleviation of pain is a key aim of health care yet pain can often remain a puzzle as it is not always explained by a specific pathology. Musculoskeletal (MSK) pain is one of the most predominant kinds of chronic pain and its prevalence is increasing. One of the aims of qualitative research in health care is to understand the experience of illness, and make sense of the complex processes involved. However, the proliferation of qualitative studies can make it difficult to use this knowledge. There has been no attempt to systematically review and integrate the findings of qualitative research in order to increase our understanding of chronic MSK pain. A synthesis of qualitative research would help us to understand what it is like to have chronic MSK pain. Specifically, it would help us understand peoples' experience of health care with the aim of improving it.AimThe aim of this study was to increase our understanding of patients’ experience of chronic non-malignant MSK pain; utilise existing research knowledge to improve understanding and, thus, best practice in patient care; and contribute to the development of methods for qualitative research synthesis.MethodsWe used the methods of meta-ethnography, which aim to develop concepts that help us to understand a particular experience, by synthesising research findings. We searched six electronic bibliographic databases (including MEDLINE, EMBASE and PsycINFO) and included studies up until the final search in February 2012. We also hand-searched particular journals known to report qualitative studies and searched reference lists of all relevant qualitative studies for further potential studies. We appraised each study to decide whether or not to include it. The full texts of 321 potentially relevant studies were screened, of which 77 qualitative studies that explored adults’ experience of chronic non-malignant MSK pain were included. Twenty-eight of these studies explored the experience of fibromyalgia.ResultsOur findings revealed the new concept of an adversarial struggle that explains the experience of people with chronic MSK pain. This included the struggle to affirm self and construct self over time; find an explanation for pain; negotiate the health-care system while feeling compelled to stay in it; be valued and believed; and find the right balance between sick/well and hiding/showing pain. In spite of this struggle, our model showed that some people were able to move forward alongside their pain by listening to their body rather than fighting it; letting go of the old self and finding a new self; becoming part of a community and not feeling like the only one; telling others about pain and redefining relationships; realising that pain is here to stay rather than focusing on diagnosis and cure; and becoming the expert and making choices. We offer unique methodological innovations for meta-ethnography, which allowed us to develop a conceptual model that is grounded in 77 original studies. In particular, we describe a collaborative approach to interpreting the primary studies.ConclusionOur model helps us to understand the experience of people with chronic MSK pain as a constant adversarial struggle. This may distinguish it from other types of pain. This study opens up possibilities for therapies that aim to help a person to move forward alongside pain. Our findings call on us to challenge some of the cultural notions about illness, in particular the expectation of achieving a diagnosis and cure. Cultural expectations are deep-rooted and can deeply affect the experience of pain. We therefore should incorporate cultural categories into our understanding of pain. Not feeling believed can have an impact on a person’s participation in everyday life. The qualitative studies in this meta-ethnography revealed that people with chronic MSK pain still do not feel believed. This has clear implications for clinical practice. Our model suggests that central to the relationship between patient and practitioner is the recognition of the patient as a person whose life has been deeply changed by pain. Listening to a person’s narratives can help us to understand the impact of pain. Our model suggests that feeling valued is not simply an adjunct to the therapy, but central to it. Further conceptual syntheses would help us make qualitative research accessible to a wider relevant audience. Further primary qualitative research focusing on reconciling acceptance with moving forward with pain might help us to further understand the experience of pain. Our study highlights the need for research to explore educational strategies aimed at improving patients’ and clinicians’ experience of care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- F Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - K Seers
- Royal College of Nursing Research Institute, School of Health and Social Studies, University of Warwick, Warwick, UK
| | - N Allcock
- Faculty of Medicine and Health Sciences, School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Nottingham, UK
| | - M Briggs
- Institute of Health and Wellbeing, Leeds Metropolitan University, Leeds, UK
| | - E Carr
- Faculty of Nursing, University of Calgary, Alberta, Canada
| | - J Andrews
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - K Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Dionne CE, Bourbonnais R, Frémont P, Rossignol M, Stock SR, Laperrière E. Obstacles to and facilitators of return to work after work-disabling back pain: the workers' perspective. JOURNAL OF OCCUPATIONAL REHABILITATION 2013; 23:280-9. [PMID: 23124686 DOI: 10.1007/s10926-012-9399-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Back pain entails considerable costs, particularly because many injured workers are absent from work for long periods. Factors that influence return to work among workers with back pain are still, however, not well understood. This qualitative study aimed at documenting affected workers' perspective on the: 1--difficulties caused by back pain, and 2--most important obstacles to and facilitators of return to work. METHODS Two focus groups composed of workers having suffered from work-disabling back pain were held: a group of participants who had returned to work (n = 9) and a group of participants who had not returned or had recently returned to work (n = 10). The verbatim accounts of the discussions were transcribed and a content analysis was carried out that included a ranking of items. RESULTS Difficulties caused by back pain were related to: (1) personal, (2) family, (3) social, (4) occupational, and (5) financial factors, and (6) health services. Obstacles to and facilitators of return to work were of 4 different types: (1) occupational factors, (2) factors associated with the utilization of health services, (3) clinical, and (4) personal factors. Persistent pain, lack of access to information or support groups, and lack of collaboration and understanding from employer were the most important obstacles identified, whereas knowledge of one's limits and physical training were perceived to be the most important facilitators of return to work, ahead of work-related factors. Differences between groups' perceptions were attributed mainly to control beliefs. CONCLUSIONS Personal, clinical, occupational and health services factors are perceived by workers with back pain to play a crucial role in determining whether they return to work or not.
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Affiliation(s)
- Clermont E Dionne
- URESP, Centre de recherche FRQS du Centre hospitalier universitaire (CHU) de Québec, Hôpital du Saint-Sacrement, 1050, chemin Ste-Foy, Quebec City, QC, G1S 4L8, Canada.
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Wrapson W, Mewse AJ. Supervisors' responses to sickness certification for an episode of low back pain: employees' personal experiences. Disabil Rehabil 2011; 33:1728-36. [DOI: 10.3109/09638288.2010.544836] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Côté D, Coutu MF. A critical review of gender issues in understanding prolonged disability related to musculoskeletal pain: how are they relevant to rehabilitation? Disabil Rehabil 2011; 32:87-102. [PMID: 21495273 DOI: 10.3109/09638280903026572] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this critical review is to describe the available theoretical models for understanding the gender issues in prolonged work disability related to persistent musculoskeletal (MSK) pain. METHOD A critical literature review was conducted in medicine, health sciences, and social sciences databases (MEDLINE, CINHAL, PsychINFO and SOCINDEX) using specific keywords. After screening titles and abstracts, followed by methodological quality assessment, a total of 55 references were retained for content analysis. RESULTS Gender issues in disability related to persistent MSK pain show that men and women may experience pain and rehabilitation process in different ways. Three main themes were exftracted and further described: (1) the experience of distrust; (2) the self-identity process; and (3) the domestic strain. Each of these themes has a specific and potentially different impact on men and women, and we report that experiential differences may strongly impact the rehabilitation process and outcomes such as return to work. CONCLUSIONS This critical review provides insight into gender issues in the process of rehabilitation and outcomes such as return to work. We suggest that work and family considerations are the two most important issues in the rehabilitation process and that differences between men and women are likely to occur.
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Affiliation(s)
- Daniel Côté
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Université de Sherbrooke, Longueuil, Qubecé, Canada.
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Meziat Filho N, Silva GAE. Invalidez por dor nas costas entre segurados da Previdência Social do Brasil. Rev Saude Publica 2011; 45:494-502. [DOI: 10.1590/s0034-89102011000300007] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 11/14/2010] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Descrever as aposentadorias por invalidez decorrente de dor nas costas. MÉTODOS: Estudo descritivo com dados do Sistema Único de Informações de Benefícios e dos Anuários Estatísticos da Previdência Social em 2007. A taxa de incidência de dor nas costas como causa das aposentadorias por invalidez foi calculada segundo as variáveis idade e sexo, nos estados. Os dias de trabalho perdidos por invalidez decorrente de dor nas costas foram calculados segundo atividade profissional. RESULTADOS: A dor nas costas idiopática foi a primeira causa de invalidez entre as aposentadorias previdenciárias e acidentárias. A maioria dos beneficiários residia em área urbana e era comerciário. A taxa de incidência de dor nas costas como causa das aposentadorias por invalidez no Brasil foi de 29,96 por 100.000 contribuintes. Esse valor foi mais elevado entre os homens e entre as pessoas mais velhas. Rondônia exibiu taxa quatro vezes superior ao esperado (RT = 4,05) e a segunda maior taxa, referente à Bahia, foi de aproximadamente duas vezes o esperado (RT = 2,07). Os comerciários foram responsáveis por 96,9% dos dias perdidos por invalidez. CONCLUSÕES: A dor nas costas foi uma importante causa de invalidez em 2007, sobretudo entre comerciários, com grandes diferenças entre os estados.
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Coole C, Drummond A, Watson PJ, Radford K. What concerns workers with low back pain? Findings of a qualitative study of patients referred for rehabilitation. JOURNAL OF OCCUPATIONAL REHABILITATION 2010; 20:472-80. [PMID: 20373135 PMCID: PMC2980634 DOI: 10.1007/s10926-010-9237-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Health and workplace strategies to address work loss and sickness absence due to low back pain are urgently required. A better understanding of the experiences of those struggling to stay at work with back pain may help clinicians and employers with their treatment and management approaches. METHODS A qualitative approach using thematic analysis was used. Individual semi-structured interviews were conducted with a convenience sample of 25 low back pain patients who had been referred for multidisciplinary back pain rehabilitation. All were in employment and concerned about their ability to work due to low back pain. Initial codes were identified and refined through constant comparison of the transcribed interview scripts as data collection proceeded. Themes were finally identified and analysed by repeated study of the scripts and discussion with the research team. FINDINGS Five main themes were identified: justifying back pain at work; concern about future ability to retain work; coping with flare-ups; reluctance to use medication; concern about sickness records. CONCLUSIONS In this study, workers with low back pain remained uncertain of how best to manage their condition in the workplace despite previous healthcare interventions and they were also concerned about the impact back pain might have on their job security and future work capacity. They were concerned about how back pain was viewed by their employers and co-workers and felt the need to justify their condition with a medical diagnosis and evidence. Clinicians and employers may need to address these issues in order to enable people to continue to work more confidently with back pain.
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Affiliation(s)
- Carol Coole
- Division of Rehabilitation and Ageing, School of Community Health Sciences, Faculty of Medicine, University of Nottingham, Nottingham, UK
- Division of Rehabilitation and Ageing, B Floor, Medical School, Queens Medical Centre, Nottingham, NG7 2UH UK
| | - Avril Drummond
- Division of Rehabilitation and Ageing, School of Community Health Sciences, Faculty of Medicine, University of Nottingham, Nottingham, UK
| | - Paul J. Watson
- Department of Health Sciences, Academic Unit, University of Leicester, Leicester, UK
| | - Kathryn Radford
- Clinical Practice Research Unit, Faculty of Health, University of Central Lancashire, Preston, UK
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Fadyl JK, McPherson KM, Schlüter PJ, Turner-Stokes L. Factors contributing to work-ability for injured workers: literature review and comparison with available measures. Disabil Rehabil 2010; 32:1173-83. [PMID: 20170279 DOI: 10.3109/09638281003653302] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Despite a range of factors being proposed in research literature to be key to 'work-ability', agreed definitions and boundaries of this concept are lacking. This review sought to identify and clarify key factors thought to contribute to individual work-ability, then compare these against existing measures of work-ability for people with injury. METHOD A literature search was undertaken based on principles of systematic review. MEDLINE, AMED, Scopus and Web of Science databases were searched. All potentially relevant articles were obtained and, if they met inclusion criteria, evaluated for quality. The search was expanded and repeated to identify currently available measures of work-ability for people with injury. These measures were then compared against components from the first search. RESULTS Thirty-four articles were obtained from the first search, and 23 provided information about factors that contribute to work-ability. Six broad categories were identified: physical, psychological, cognitive, social/behavioural, workplace factors, and factors outside the workplace. The follow-up search identified 10 measures. No one measure captured all six identified categories. CONCLUSIONS Components contributing to work-ability go beyond the ability to perform particular work tasks. Measures intended to be used to inform vocational rehabilitation arguably need to consider all these factors to maximise likelihood of a sustainable return to work.
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Affiliation(s)
- Joanna K Fadyl
- Health and Rehabilitation Research Centre, AUT University, Auckland, New Zealand.
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Ashby S, Richards K, James C. The effect of fear of movement on the lives of people with chronic low back pain. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2010. [DOI: 10.12968/ijtr.2010.17.5.47842] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Carole James
- School of Health Sciences, University of Newcastle, New South Wales, Australia
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Reme SE, Hagen EM, Eriksen HR. Expectations, perceptions, and physiotherapy predict prolonged sick leave in subacute low back pain. BMC Musculoskelet Disord 2009; 10:139. [PMID: 19912626 PMCID: PMC2780378 DOI: 10.1186/1471-2474-10-139] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 11/13/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brief intervention programs for subacute low back pain (LBP) result in significant reduction of sick leave compared to treatment as usual. Although effective, a substantial proportion of the patients do not return to work. This study investigates predictors of return to work in LBP patients participating in a randomized controlled trial comparing a brief intervention program (BI) with BI and physical exercise. METHODS Predictors for not returning to work was examined in 246 patients sick listed 8-12 weeks for low back pain. The patients had participated in a randomized controlled trial, with BI (n = 122) and BI + physical exercise (n = 124). There were no significant differences between the two intervention groups on return to work. The groups were therefore merged in the analyses of predictors. Multiple logistic regression analysis was used to identify predictors for non return to work at 3, 12, and 24 months of follow-up. RESULTS At 3 months of follow-up, the strongest predictors for not returning to work were pain intensity while resting (OR = 5.6; CI = 1.7-19), the perception of constant back strain when working (OR = 4.1; CI = 1.5-12), negative expectations for return to work (OR = 4.2; CI = 1.7-10), and having been to a physiotherapist prior to participation in the trial (OR = 3.3; CI = 1.3-8.3). At 12 months, perceived reduced ability to walk far due to the complaints (OR = 2.6; CI = 1.3-5.4), pain during activities (OR = 2.4; CI = 1.1-5.1), and having been to a physiotherapist prior to participation in the trial (OR = 2.1; CI = 1.1-4.3) were the strongest predictors for non return to work. At 24 months age below 41 years (OR = 2.9; CI = 1.4-6.0) was the only significant predictor for non return to work. CONCLUSION It appears that return to work is highly dependant on individual and cognitive factors. Patients not returning to work after the interventions were characterized by negative expectations, perceptions about pain and disability, and previous physiotherapy treatment. This is the first study reporting that previous treatment by physiotherapists is a risk factor for long-term sick leave. This has not been reported before and is an interesting finding that deserves more scrutiny.
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Affiliation(s)
- Silje E Reme
- Research Center for Health Promotion, Faculty of Psychology, University of Bergen, Norway.
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Magnussen LH, Strand LI, Skouen JS, Eriksen HR. Long-term follow-up of disability pensioners having musculoskeletal disorders. BMC Public Health 2009; 9:407. [PMID: 19903333 PMCID: PMC2777167 DOI: 10.1186/1471-2458-9-407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 11/10/2009] [Indexed: 11/15/2022] Open
Abstract
Background Previously we have conducted a randomised controlled trial (RCT) to evaluate the effect of a brief cognitive behavioural program with a vocational approach aiming to return disability pensioners with back pain to work, as compared to no intervention. One year after the intervention, 10 participants (22%) who received the program and 5 (11%) in the control group reported to have entered a return to work process. The aims of this study were to evaluate long-term effects of the intervention, and compare this effect to 2 reference populations not participating in the original trial. Methods Three groups of disability pensioners were investigated: 1) Disability pensioners having back pain (n = 89) previously participating in the RCT (randomized to either a brief cognitive behavioural intervention or to a control group), 2) 342 disability pensioners having back pain, but refusing to participate in the study and 3) 449 disability pensioners having other musculoskeletal disorders than back pain. Primary outcome was return to work, defined as a reduction in payment of disability pension. Results Only 2 of 89 (2.3%) participants from the RCT had reduced disability pension at 3-years follow-up, both from the control group. None of the participants that had been in a process of returning to work after 1 year had actually gained employment at 3-years follow-up. In the 2 groups not participating in the previous RCT, only 4 (1.2%) and 8 (1.6%) had returned to work after 3 years respectively. Conclusion The number of pensioners who returned to work was negligible in all groups regardless of having participated in a cognitive behavioural intervention or not.
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Magnussen LH, Strand LI, Eriksen HR. Physical and Mental Functioning in Disability Pensioners with Back Pain. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/10582450802672339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
PURPOSE Back conditions are a group of impairments that induce limitation of activities and restriction of participation, in particular delaying the Return to work (RTW). The purpose of this review is to analyse the components involved in RTW. METHOD We have included the studies and reviews about the intervention, assessment tools, variables used to forecast the RTW and the cost-benefit ratio. RESULTS We found a relevant number of studies concerning back conditions and Return to work. The evidence is moderate and the meta-analysis failed to show strong indications of efficacy. The better interventions to facilitate RTW are multidisciplinary, not necessarily intensive but taking into account a bio-psycho-social approach. The predictor of RTW does not only concern impairment (pain, rigidity etc.), but the self-estimation of ability is also important to forecast RTW. Intervention seems to be cost-effective if we calculate the saving cost in pension. CONCLUSIONS Comprehensive bio-psycho-social approaches seem to be the better modality of intervention to facilitate the RTW. More research is needed to obtain more knowledge about these issues. Particular attention should be placed on the choice of outcome measures and the cost-effectiveness of interventions.
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Affiliation(s)
- Mauro Zampolini
- Department of Rehabilitation, Local Health Service (ASL3), Umbria, 06039 Trevi, Perugia, Italy.
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