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Andersdotter Sandström A, Fjellman-Wiklund A, Sandlund M, Eskilsson T. Patients with stress-induced exhaustion disorder and their experiences of physical activity prescription in a group context. Glob Health Action 2023; 16:2212950. [PMID: 37314383 DOI: 10.1080/16549716.2023.2212950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Physical activity is a useful means to improve symptoms and memory performance to some extent in individuals with stress-induced exhaustion disorder. Individuals in this group commonly do not need to reach the recommended levels of physical activity. Developing methods to support physical activity as a lasting behaviour is important. OBJECTIVE The aim of the study was to explore the processes involved when using physical activity prescription as part of rehabilitation in a group context for individuals with stress-induced exhaustion disorder. METHOD A total of 27 individuals with stress-induced exhaustion disorder participated in six focus groups. The informants underwent a multimodal intervention including prescription of physical activity. The physical activity prescription had a cognitive behaviour approach and included information about physical activity, home assignments and goal setting. The data was analysed with grounded theory method using constant comparison. RESULTS The analysis of the data was developed into the core category 'trying to integrate physical activity into daily life in a sustainable way', and three categories: 'acceptance of being good enough', 'learning physical activity by doing' and 'advocation for physical activity in rehabilitation'. The informants identified that during the physical activity prescription sessions they learned what physical activity was, what was 'good enough' in terms of dose and intensity of physical activity, and how to listen to the body's signals. These insights, in combination with performing physical activity during home assignments and reflecting with peers, helped them incorporate physical activity in a new and sustainable way. A need for more customised physical activity with the ability to adjust to individual circumstances was requested. CONCLUSION Prescription of physical activity in a group context may be a useful method of managing and adjusting physical activity in a sustainable way for individuals with stress-induced exhaustion disorder. However, identifying people who need more tailored support is important.
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Affiliation(s)
- Anna Andersdotter Sandström
- Department of Public Health and Clinical Medicine, Sustainable Health and Medicine, Umeå University, Umeå, Sweden
| | | | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Therese Eskilsson
- Department of Public Health and Clinical Medicine, Sustainable Health and Medicine, Umeå University, Umeå, Sweden
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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Lindelöf N, Nilsson I, Littbrand H, Gustafson Y, Olofsson B, Fjellman-Wiklund A. A focus groups study of staff team experiences of providing interdisciplinary rehabilitation for people with dementia and their caregivers-a co-creative journey. BMC Geriatr 2023; 23:572. [PMID: 37723442 PMCID: PMC10507912 DOI: 10.1186/s12877-023-04269-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/31/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND The World Health Organization claims that rehabilitation is important to meet the needs of persons with dementia. Rehabilitation programmes, however, are not routinely available. Person-centred, multidimensional, and interdisciplinary rehabilitation can increase the opportunities for older adults with dementia and their informal primary caregivers to continue to live an active life and participate in society. To our knowledge, staff team experiences of such rehabilitation programmes, involving older adults with dementia and their informal caregivers has not been previously explored. METHODS The aim of this qualitative focus group study was to explore the experiences of a comprehensive staff team providing person-centred multidimensional, interdisciplinary rehabilitation to community-dwelling older adults with dementia, including education and support for informal primary caregivers. The 13 staff team members comprised 10 professions who, during a 16-week intervention period, provided individualised interventions while involving the rehabilitation participants. After the rehabilitation period the staff team members were divided in two focus groups who met on three occasions each (in total six focus groups) and discussed their experiences. The Grounded Theory method was used for data collection and analysis. RESULTS The analysis resulted in four categories: Achieving involvement in rehabilitation is challenging, Considering various realities by acting as a link, Offering time and continuity create added value, and Creating a holistic view through knowledge exchange, and the core category: Refining a co-creative process towards making a difference. The core category resembles the collaboration that the staff had within their teams, which included participants with dementia and caregivers, and with the goal that the intervention should make a difference for the participants. This was conducted with flexibility in a collaborative and creative process. CONCLUSIONS The staff team perceived that by working in comprehensive teams they could provide individualised rehabilitation in creative collaboration with the participants through interaction, knowledge exchange, time and continuity, coordination and flexibility, and a holistic view. Challenges to overcome were the involvement of the person with dementia in goal setting and the mediating role of the staff team members. The staff pointed out that by refinement they could achieve well-functioning, competence-enhancing and timesaving teamwork.
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Affiliation(s)
- Nina Lindelöf
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, SE-90187, Sweden.
| | - Ingeborg Nilsson
- Department of Community Medicine and Rehabilitation, Occupational therapy, Umeå University, Umeå, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Håkan Littbrand
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Yngve Gustafson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Birgitta Olofsson
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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Ilgunas A, Fjellman-Wiklund A, Häggman-Henrikson B, Lobbezoo F, Visscher CM, Durham J, Lövgren A. Patients' experiences of temporomandibular disorders and related treatment. BMC Oral Health 2023; 23:653. [PMID: 37684660 PMCID: PMC10492274 DOI: 10.1186/s12903-023-03230-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/14/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Temporomandibular disorders (TMD) are common and therefore managed by dentists on a daily basis. However, patients with TMD consistently go undetected and therefore untreated in dentistry. The reasons for these shortcomings have not been fully explored, specifically with regard to patients' perspectives. Therefore, this study aimed to explore patients' experiences of TMD and related treatment, with special focus on the experiences of having TMD, factors related to seeking care, and perspectives on received treatment. METHODS Purposive sampling was used to recruit adult patients at the Public Dental Health services (PDHS) in the Region of Västerbotten, Sweden, during 2019. Individual semi-structured interviews were conducted and analysed using Qualitative Content Analysis. Sixteen patients were interviewed (ten women and six men, 20-65 years). The interviews probed the patients' perspectives of having TMD, seeking care, and receiving treatment. All participants were also examined according to the Diagnostic Criteria for TMD (DC/TMD) and qualified for at least one DC/TMD diagnosis. RESULTS The data analysis led to the main theme Seeking care when the situation becomes untenable, but dental care fails to meet all needs. The patients expressed worry and social discomfort because of the symptoms but still strived to have an as normal daily life as possible. However, severe symptoms and associated consequences compelled them to seek professional help. Experiences of distrust together with challenges to access the PDHS were identified and related to the patients' unfulfilled expectations. CONCLUSIONS Patients' reported experiences indicate that receiving timely and appropriate care is more of an unfulfilled expectation than the current state of management of patients with TMD in dentistry.
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Affiliation(s)
- Aurelia Ilgunas
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, Umeå University, Umeå, Sweden
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | | | | | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Corine M Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Justin Durham
- School of Dental Sciences, Newcastle University, Newcastle, UK
- Newcastle Hospitals' NHS Foundation Trust, Newcastle, UK
| | - Anna Lövgren
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, Umeå University, Umeå, Sweden.
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4
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Wallin S, Fjellman-Wiklund A, Fagerström L. Aging engineers' occupational self-efficacy-a mixed methods study. Front Psychol 2023; 14:1152310. [PMID: 37275701 PMCID: PMC10233145 DOI: 10.3389/fpsyg.2023.1152310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/19/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Engineers' work has become more complex with increased demands in today's changing working life. Self-efficacy is essential to successfully adapt to work-related changes and to cope with adverse job demands. However, less is known about aging engineers' occupational self-efficacy. Therefore, this study explores facilitators and barriers to aging engineers' occupational self-efficacy beliefs to continue working until expected retirement age. An additional purpose is to explore if any of the aspects described by the engineers are more prominent. Methods The study design was exploratory, using mixed methods with a qualitative to quantitative approach. A total of 125 engineers, aged between 45 and 65 years, answered two open-ended survey questions about what positively and negatively affect their occupational self-efficacy beliefs to continue working. First, data was analyzed using an inductive manifest qualitative content analysis. Next, descriptive statistics were performed based on the results of the qualitative study. Results The analyses revealed that health and working conditions that affect health were crucial facilitators and barriers for the aging engineers' occupational self-efficacy to continue working until expected retirement age. Furthermore, the engineers emphasized competence, motivation from meaningful tasks, family and leisure, and private economy. Discussion The aging engineers' own health seems to be prominent in their self-efficacy regarding a full working life; consequently, support still needs to address issues affecting health.
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Affiliation(s)
- Stina Wallin
- Faculty of Education and Welfare Studies, Health Sciences, Åbo Akademi University, Vaasa, Finland
| | | | - Lisbeth Fagerström
- Faculty of Education and Welfare Studies, Health Sciences, Åbo Akademi University, Vaasa, Finland
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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Eliasson K, Fjellman-Wiklund A, Dahlgren G, Hellman T, Svartengren M, Nyman T, Lewis C. Ergonomists' experiences of executing occupational health surveillance for workers exposed to hand-intensive work: a qualitative exploration. BMC Health Serv Res 2022; 22:1223. [PMID: 36182924 PMCID: PMC9526985 DOI: 10.1186/s12913-022-08601-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 09/23/2022] [Indexed: 11/26/2022] Open
Abstract
Background In order to reduce work-related upper limb disorders, the Swedish Work Environment Authority introduced an occupational health surveillance targeting hand-intensive work. A process model, aimed at supporting the employers as well as the occupational health service provider (i.e., ergonomist) in the work process with the occupational health surveillance, was developed. The objective of this qualitative study was to explore ergonomists’ experiences of the execution of occupational health surveillance for hand-intensive work when following the novel process model as well as factors influencing the execution. Methods Semi-structured individual interviews were conducted with ten ergonomists on one occasion regarding their experience of following the work process. Qualitative content analysis with an inductive approach was used for analyzing the data. Results The ergonomists’ experiences were summarized in one theme “A joint roadmap supporting a participatory process” and two categories “Clear structure provided by the components” and “The process influenced by collaboration and context”. The ergonomists valued being guided by the systematics of the model, which provided structure and clarity in their work. Factors affecting the execution were related to communication deficiencies and uncertainties regarding expectations between different roles and functions (e.g., ergonomists and contact person, lack of information to workers). Additional factors, for instance, companies’ routines and the ergonomist’s intra-organizational support, such as access to IT-resources, could also affect the process. Conclusions The findings reveal that this process model facilitates the ergonomists’ work and cooperation with a client company. However, the process model needs to be developed and accompanied by a guideline with information related to the process, including e.g., description of a start-up meeting and of the roles/functions of the involved parties. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08601-2.
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Affiliation(s)
- Kristina Eliasson
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden. .,Department of Occupational and Environmental Medicine, Uppsala University Hospital, 751 85, Uppsala, Sweden.
| | | | - Gunilla Dahlgren
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Therese Hellman
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.,Department of Occupational and Environmental Medicine, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - Magnus Svartengren
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.,Department of Occupational and Environmental Medicine, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - Teresia Nyman
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.,Department of Occupational and Environmental Medicine, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - Charlotte Lewis
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
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Wallin S, Fjellman-Wiklund A, Fagerström L. Work motivation and occupational self-efficacy belief to continue working among ageing home care nurses: a mixed methods study. BMC Nurs 2022; 21:31. [PMID: 35081937 PMCID: PMC8793160 DOI: 10.1186/s12912-021-00780-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/29/2021] [Indexed: 12/02/2022] Open
Abstract
Background It is important to support ageing home care nurses (HCNs) to remain in work for longer, since the need for home care services is increasing. Personal resources such as self-efficacy belief contribute to work ability, as does work motivation. Few studies have targeted the ageing workers’ self-efficacy belief to manage their final working years. This study explores ageing HCNs’ work motivation, and occupational self-efficacy, i.e. belief in one’s capabilities, to continue working until expected retirement age. Methods The design of the study is exploratory using a mixed method with a qualitative to quantitative approach. A total of 234 HCNs answered four open-ended questions from a cross-sectional survey, regarding their work motivation and self-efficacy beliefs. First, data was analysed using manifest qualitative content analysis. Next, a quantitative analysis was performed based on the results of the qualitative study, and the categories that emerged were quantitatively ranked. Results The open-ended questions yielded 2339 utterances. The findings showed that several categories concurrently affected both work motivation and self-efficacy belief. When they were well-functioning, they positively affected both work motivation and self-efficacy belief, and when they were insufficient, they negatively affected either or both motivation and/or belief. Meaningfulness, job satisfaction, social support, and work environmental and organizational characteristics affected work motivation most. Perceived health highly affected the self-efficacy belief to continue working until expected retirement age, as well as meaningfulness of work, support from colleagues and home care managers, and work characteristics. Conclusions Through highlighting the meaningfulness of work, and supporting the perceived health, the work community and leadership, both work motivation and self-efficacy belief to continue working might be facilitated among ageing HCNs. However, the still present draining workload must be handled. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00780-3.
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Affiliation(s)
- Stina Wallin
- Faculty of Education and Welfare Studies, Health Sciences, Åbo Akademi University, Strandgatan 2, 65101, Vaasa, Finland.
| | | | - Lisbeth Fagerström
- Faculty of Education and Welfare Studies, Health Sciences, Åbo Akademi University, Strandgatan 2, 65101, Vaasa, Finland.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Grønland 58, 3045, Drammen, Norway
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Nordell K, Hellström K, Fjellman-Wiklund A. To see, meet and adapt - an interview study about physiotherapists' pedagogical approach to dementia. BMC Geriatr 2022; 22:31. [PMID: 34991469 PMCID: PMC8740334 DOI: 10.1186/s12877-021-02697-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022] Open
Abstract
Background Physiotherapists need to use pedagogical approaches and strategies in their work. However, there is no previous definition of what a pedagogical approach in physiotherapy means neither in general nor specifically to dementia. The purpose of this study was therefore to gain greater insight into physiotherapists’ pedagogical approach to dementia by investigating physiotherapists’ views and working methods in contact with older people with dementia, relatives, and nursing staff in elderly care. Methods This was a qualitative study with an inductive approach. Semi-structured individual interviews were conducted with 15 physiotherapists with experience of working with older people with dementia in elderly care. The interviews were analyzed with qualitative content analysis. Results The term “pedagogical approach” could sometimes be experienced as “vague” or “hard to grasp”. Our research nonetheless identified one overarching theme To see, meet and adapt which is based on insights from the interviews grouped in to five categories. This theme can be seen as an expression of the physiotherapists’ pedagogical approach in contact with older people with dementia, relatives, and nursing staff. It captures the participants’ desire to always see the person in front of them, meet them where they are and adapt their own way of working accordingly. Creating a trusting relationship was described as important and made it easier for the participants to adapt their working methods. The participants’ adaptations could apply to the way they communicated with people with dementia, and how they organized tutoring/education of relatives and nursing staff to maximize learning. Learning through experience and reflection was described as a key to advancing the pedagogical approach and the participants experienced their own learning as constantly ongoing. Conclusions This study provides increased understanding into physiotherapists’ pedagogical approach in contact with older people with dementia, relatives, and nursing staff in elderly care and shows that learning through experience and reflection can contribute to the development of the pedagogical approach. Thus, opportunity for reflection should be accommodated in the physiotherapists’ work. The importance of more pedagogical education for physiotherapists both in bachelor and master level were also highlighted. Increasing mobility and physical activity in older people with dementia is important since physical inactivity and sedentary behavior is common. Future research may be directed at further exploring physiotherapists’ pedagogical approach in tutoring/education of nursing staff, with the aim of increasing physical activity among older people with dementia. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02697-7.
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Affiliation(s)
- Karin Nordell
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE 901 87, Umeå, Sweden
| | - Karin Hellström
- Department of Neuroscience, Physiotherapy, Uppsala University, SE 751 24, Uppsala, Sweden
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Lövgren A, Häggman-Henrikson B, Fjellman-Wiklund A, Begic A, Landgren H, Lundén V, Svensson P, Österlund C. The impact of gender of the examiner on orofacial pain perception and pain reporting among healthy volunteers. Clin Oral Investig 2021; 26:3033-3040. [PMID: 34902057 PMCID: PMC8898225 DOI: 10.1007/s00784-021-04286-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/01/2021] [Indexed: 12/03/2022]
Abstract
Objectives Pain on palpation of jaw muscles is a commonly used diagnostic criterion when examining patients with orofacial pain. It is not known, however, if pain reports are affected by the gender of the examiner. Our aim was to investigate if pressure pain threshold (PPT), pressure pain tolerance (PTol), and pain intensity assessed over the masseter muscles in healthy individuals are affected by the gender of the examiner. Materials and methods Healthy, pain-free individuals were recruited on a voluntary basis. PPT and PTol were assessed using pressure algometry. At the PTol level, participants also rated pain intensity on a 0–10 numeric rating scale. Assessments of PPT and PTol were conducted with six repeated measurements performed twice, separately by one female and one male examiner, on each participant. Results In total, 84 participants (43 women; median age 24, IQR 6) were included. With a female examiner, women reported higher pain intensity than men (Mann Whitney U, p = 0.005). In the multivariable analysis, significantly higher PTol was predicted by male examiner. Also, a higher ratio between PTol and reported pain intensity was predicted by male examiner. Conclusions The gender of the examiner influences pain reporting and perception in an experimental setting. This effect on pain perception related to gender of the examiner is probably related to normative gender behaviors rather than to biological alterations within the examined individual. Clinical relevance In clinical and experimental settings, gender of the examiner may affect not only pain perception but also pain reporting, with potential implications for diagnostics in patients with pain.
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Affiliation(s)
- A Lövgren
- Faculty of Medicine, Department of Odontology, Clinical Oral Physiology, Umeå University, 901 87, Umeå, Sweden.
| | - B Häggman-Henrikson
- Faculty of Medicine, Department of Odontology, Clinical Oral Physiology, Umeå University, 901 87, Umeå, Sweden.,Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - A Fjellman-Wiklund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - A Begic
- Faculty of Medicine, Department of Odontology, Clinical Oral Physiology, Umeå University, 901 87, Umeå, Sweden
| | - H Landgren
- Faculty of Medicine, Department of Odontology, Clinical Oral Physiology, Umeå University, 901 87, Umeå, Sweden
| | - V Lundén
- Faculty of Medicine, Department of Odontology, Clinical Oral Physiology, Umeå University, 901 87, Umeå, Sweden
| | - P Svensson
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.,Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - C Österlund
- Faculty of Medicine, Department of Odontology, Clinical Oral Physiology, Umeå University, 901 87, Umeå, Sweden
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Lundberg V, Eriksson C, Lind T, Coyne I, Fjellman-Wiklund A. How children with juvenile idiopathic arthritis view participation and communication in healthcare encounters: a qualitative study. Pediatr Rheumatol Online J 2021; 19:156. [PMID: 34727931 PMCID: PMC8561993 DOI: 10.1186/s12969-021-00642-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/10/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Children report that they do not participate in their healthcare as much as they want, despite having the lawful right to form their own views and the right to express those views freely in all matters affecting them. Children and parents appeared to be more satisfied when healthcare professionals (HCP) use a participatory style in healthcare encounters. AIM To explore how children, adolescents and young adults with Juvenile Idiopathic Arthritis (JIA) and parents of children with JIA view their participation and communication in healthcare encounters with healthcare professionals. METHODS Using a qualitative study design, participatory workshops were held separately for children and young adults with JIA and parents of children with JIA. The workshop data were analysed with Graneheim and Lundman's Qualitative Content Analysis resulting in one main theme and two subthemes. RESULTS The theme "Feeling alienated or familiar with healthcare encounters" illuminates how children felt alienated at healthcare encounters if they found the encounters emotionally distressing. Children could withhold information regarding their health and function from both HCPs and their family and friends. The subtheme "Distancing oneself from healthcare" describe why children felt reluctant to engage in the healthcare encounters and experienced difficulty expressing how they really felt. The subtheme "Being a normal event in life" describe how children felt more comfortable over time engaging with HCPs when they knew what would happen, and felt that HCPs gave them the necessary support they needed to participate. CONCLUSIONS Children's participation in healthcare encounters varied depending if children felt alienated or familiar to the healthcare situations. Children distance themselves and are reluctant to engage in healthcare encounters if they find them emotionally distressing and feel disregarded. Over time, children can become more familiar and at ease with healthcare situations when they feel safe and experience personal and positive encounters. When the children are prepared for the encounter, provided with the space and support they want and receive tailored help they are more enabled to participate.
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Affiliation(s)
- Veronica Lundberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE 901 87, Umeå, Sweden. .,Department of Clinical Sciences, Pediatrics, Umeå University, SE 901 85, Umeå, Sweden.
| | - Catharina Eriksson
- grid.12650.300000 0001 1034 3451Department of Clinical Sciences, Pediatrics, Umeå University, SE 901 85 Umeå, Sweden ,Department of Public Health and Clinical Medicine/Rheumatology, SE 901 87 Umeå, Sweden
| | - Torbjörn Lind
- grid.12650.300000 0001 1034 3451Department of Clinical Sciences, Pediatrics, Umeå University, SE 901 85 Umeå, Sweden
| | - Imelda Coyne
- grid.8217.c0000 0004 1936 9705School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Anncristine Fjellman-Wiklund
- grid.12650.300000 0001 1034 3451Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE 901 87 Umeå, Sweden
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Wallin S, Rauhala A, Fjellman-Wiklund A, Nyman P, Fagerström L. Occupational self-efficacy and work engagement associated with work ability among an ageing work force: A cross-sectional study. Work 2021; 70:591-602. [PMID: 34657840 DOI: 10.3233/wor-213595] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Occupational self-efficacy (OSE) is an appropriate adaption capability to react to continuous changes in work life today. While self-efficacy is an important component in work context, there is less knowledge regarding older workers' OSE. OBJECTIVE This study examined the relationship between work ability, OSE and work engagement among a middle-aged workforce, and whether there were any differences between age groups and between professionals in different work context. METHODS Data were collected by questionnaire, which included Work Ability Index (WAI), Occupational Self-Efficacy Scale, and Utrecht Work Engagement Scale. RESULTS A total of 359 home care workers and engineers (response rate 43%) participated. The average age was 54 (SD±5.3) years, 69%were women. The results of logistic regression analyses revealed an association between WAI, OSE (OR 0.66; 95%CI 0.52 to 0.86) and work engagement (OR 0.61; 95%CI 0.47 to 0.78). Higher OSE and work engagement were related to higher work ability. No difference in OSE (5.9; ±0.8) between professional groups was seen, but the home care workers scored considerably higher work engagement (5.1; ±0.9) than the engineers (4.5; ±1.3). CONCLUSIONS Improving OSE could be worthwhile to support work ability among middle-aged workers, despite dissimilarities in work context and educational level.
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Affiliation(s)
- Stina Wallin
- Faculty of Education and Welfare Studies, Health Sciences, Åbo Akademi University, Vaasa, Finland
| | - Auvo Rauhala
- Faculty of Education and Welfare Studies, Health Sciences, Åbo Akademi University, Vaasa, Finland.,Vaasa Central Hospital, Vaasa, Finland
| | | | - Pia Nyman
- Department of Social Services and Healthcare, Pietarsaari, Finland
| | - Lisbeth Fagerström
- Faculty of Education and Welfare Studies, Health Sciences, Åbo Akademi University, Vaasa, Finland.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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11
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Abstract
The World Health Organization states that gender has implications for health across the course of a person's life in terms of norms, roles and relations. It also has implications in rehabilitation. In this article, we argue the need of gender perspectives in the field of physiotherapy; gender matters and makes a difference in health and rehabilitation. We highlight a number of central areas where gender may be significant and give concrete examples of social gender aspects in physiotherapy practice and in diverse patient groups. We also discuss why it can be important to consider gender from an organizational perspective and how sociocultural norms and ideals relating to body, exercise and health are gendered. Further we present useful gender theories and conceptual frameworks. Finally, we outline future directions in terms of gender-sensitive intervention, physiotherapy education and a gendered application of the ICF model. We want to challenge physiotherapists and physiotherapy students to broaden knowledge and awareness of how gender may impact on physiotherapy, and how gender theory can serve as an analytical lens for a useful perspective on the development of clinical practice, education and research within physiotherapy.
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Affiliation(s)
- Gunilla Stenberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | | | - Maria Strömbäck
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.,Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden
| | - Therese Eskilsson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Carin From
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Birgit Enberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Maria Wiklund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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12
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Fjellman-Wiklund A, Söderman K, Lundqvist M, Häger CK. Retrospective experiences of individuals two decades after anterior cruciate ligament injury - a process of re-orientation towards acceptance. Disabil Rehabil 2021; 44:6267-6276. [PMID: 34388952 DOI: 10.1080/09638288.2021.1962415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Individual perspectives of long-term consequences decades after anterior cruciate ligament (ACL) injury are unexplored. We addressed experiences and the impact on life of former athletes >20 years post-ACL injury. METHODS Individual interviews, analysed using Grounded Theory, were conducted with 18 persons injured mainly during soccer 20-29 years ago. RESULTS A theoretical model was developed with the core category Re-orientation towards acceptance, overarching three categories illustrating the long-term process post-injury. Initially the persons felt like disaster had struck; their main recall was strong pain followed by reduced physical ability and fear of movement and re-injury. In the aftermaths of injury, no participant reached the pre-injury level of physical activity. Over the years, they struggled with difficult decisions, such as whether to partake or refrain from different physical activities, often ending-up being less physically active and thereby gaining body weight. Fear of pain and re-injury was however perceived mainly as psychological rather than resulting from physical limitations. Despite negative consequences and adjustments over the years, participants still found their present life situation manageable or even satisfying. CONCLUSION ACL injury rehabilitation should support coping strategies e.g., also related to fear of re-injury and desirable physical activity levels, also with increasing age.IMPLICATIONS FOR REHABILITATIONMore than 20 years after the ACL injury, the individuals despite re-orientation towards acceptance and a settlement with their life situation, still had fear of both pain and re-injury of the knee, with concerns about physical activity and gaining of body weight.Patients with ACL injury may need better individual guidance and health advice on how to remain physically active, to find suitable exercises and to maintain a healthy body weight.Education related to pain, treatment choices, physical activity, injury mechanisms in participatory discussions with the patient about the ACL injury may be beneficial early in the rehabilitation process to avoid catastrophizing and avoidance behaviour.ACL injury rehabilitation needs to address coping strategies incorporating the psychological aspects of suffering an ACL injury, including fear of movement/secondary injury, in order to support return-to-sport and/or re-orientation over time.
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Affiliation(s)
| | - Kerstin Söderman
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Mari Lundqvist
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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13
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Ilgunas A, Lövgren A, Fjellman-Wiklund A, Häggman-Henrikson B, Karlsson Wirebring L, Lobbezoo F, Visscher CM, Durham J. Conceptualizing the clinical decision-making process in managing temporomandibular disorders: A qualitative study. Eur J Oral Sci 2021; 129:e12811. [PMID: 34145628 DOI: 10.1111/eos.12811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 11/27/2022]
Abstract
Management of patients with temporomandibular disorders (TMD) appears to be more challenging than for other dental conditions. This study aimed to explore the decision-making process in TMD management, and thereby to conceptualize the decision-making process in dentistry. Individual semi-structured interviews were conducted during 2018 and 2019 with a purposive sample of 22 general dental practitioners from the Public Dental Healthcare Services and private practices in the Region of Västerbotten, Northern Sweden. The interviews were analysed using the Grounded Theory approach of Charmaz. Data analysis resulted in the core category 'Combining own competence and others' expectations in the desire to do the right thing'. The dentists showed interest in and a desire to apply professional knowledge, but also reflected on challenges and complexity in the decision-making process for TMD. The challenges were primarily related to organisational factors and lack of self-confidence. This identifies a need for re-organisation of daily clinical management in dentistry, and a need for more postgraduate training to improve self-confidence. The complexity of the decision-making process for TMD makes the study findings applicable in other dental situations.
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Affiliation(s)
- Aurelia Ilgunas
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, Umeå University, Umeå, Sweden.,Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Anna Lövgren
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, Umeå University, Umeå, Sweden
| | | | | | | | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Corine M Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Justin Durham
- School of Dental Sciences, Newcastle University, Newcastle, UK.,Newcastle Hospitals' NHS Foundation Trust, Newcastle, UK
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14
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Lundberg V, Sandlund M, Eriksson C, Janols R, Lind T, Fjellman-Wiklund A. How children and adolescents with juvenile idiopathic arthritis participate in their healthcare: health professionals' views. Disabil Rehabil 2020; 44:1908-1915. [PMID: 32875956 DOI: 10.1080/09638288.2020.1811406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The study explores how healthcare professionals view participation of children and adolescents with juvenile idiopathic arthritis, in healthcare encounters. METHODS This qualitative study includes focus groups of HCPs from different professions. The interviews were analysed with qualitative content analysis. RESULTS The theme "Creating an enabling arena" illuminates how HCPs face possibilities and challenges when enabling children to communicate and participate in clinical encounters. HCPs, parents, and the healthcare system need to adjust to the child. The sub-theme "Bringing different perspectives" describes how children and their parents cooperate and complement each other during healthcare encounters. The sub-theme "Building a safe and comfortable setting" includes how HCPs address the child's self-identified needs and make the child feel comfortable during encounters. The sub-theme "Facilitating methods in a limiting organisation" includes how HCPs' working methods and organization may help or hinder child participation during encounters. CONCLUSIONS HCPs encourage children and adolescents to make their views known during healthcare encounters by creating an enabling arena. Collaboration and building good relationships between the child, the parents and the HCPs, before and during the healthcare encounters, can help the child express their wishes and experiences. Clinical examinations and use of technology, such as photos, films and web-bases questionnaires can be a good start for a better child communication in healthcare encounters.IMPLICATIONS FOR REHABILITATIONHealthcare professionals in JIA teams experience that they can facilitate communication and participation with children and adolescents in healthcare encounters.When healthcare professionals enable both children, adolescents and their parents to bring their perspectives, these views complement one another and enrich information during healthcare encounters.Children and adolescents are more empowered to participate, when healthcare professionals create a good relationship with the child and their parents, and strengthen the child's knowledge, confidence and autonomy.
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Affiliation(s)
- Veronica Lundberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.,Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Catharina Eriksson
- Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
| | - Rebecka Janols
- Department of Computing Science, Umeå University, Umeå, Sweden
| | - Torbjörn Lind
- Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
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15
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Strömbäck M, Fjellman-Wiklund A, Keisu S, Sturesson M, Eskilsson T. Restoring confidence in return to work: A qualitative study of the experiences of persons with exhaustion disorder after a dialogue-based workplace intervention. PLoS One 2020; 15:e0234897. [PMID: 32735586 PMCID: PMC7394387 DOI: 10.1371/journal.pone.0234897] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 06/04/2020] [Indexed: 12/02/2022] Open
Abstract
Background Stress-induced exhaustion disorder (SED) is a primary cause for sickness absence among persons with mental health disorders in Sweden. Interventions involving the workplace, and supporting communication between the employee and the supervisor, are proposed to facilitate return to work (RTW). The aim of this study was to explore experiences of persons with SED who participated in a dialogue-based workplace intervention with a convergence dialogue meeting performed by a rehabilitation coordinator. Methods A qualitative design based on group interviews with 15 persons with SED who participated in a 24-week multimodal rehabilitation program was used. The interviews were analyzed with the methodology of grounded theory. Results The analysis resulted in a theoretical model where the core category, restoring confidence on common ground, represented a health promoting process that included three phases: emotional entrance, supportive guidance, and empowering change. The health promoting process was represented in participant experiences of personal progress and safety in RTW. Conclusions The intervention built on a health-promoting pedagogy, supported by continuous guidance from a rehabilitation coordinator and structured convergence dialogue meetings that enhanced common communication and collaboration with the supervisor and others involved in the RTW process. The intervention balanced relationships, transferred knowledge, and changed attitudes about SED among supervisors and colleagues in the workplace. The inclusion of a rehabilitation coordinator in the intervention was beneficial by enhancing RTW and bridging the gaps between healthcare, the workplace, and other organizational structures. In addition, the intervention contributed to a positive re-orientation towards successful RTW instead of an endpoint of employment. In a prolonged process, a dialogue-based workplace intervention with convergence dialogue meetings and a rehabilitation coordinator may support sustainable RTW for persons with SED.
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Affiliation(s)
- Maria Strömbäck
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
- Department of Clinical Science, Psychiatry, Umeå University, Umeå, Sweden
- * E-mail:
| | | | - Sara Keisu
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Marine Sturesson
- Department of Community Medicine and Rehabilitation, Occupational therapy, Umeå University, Umeå, Sweden
| | - Therese Eskilsson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
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16
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Eskilsson T, Fjellman-Wiklund A, Ek Malmer E, Stigsdotter Neely A, Malmberg Gavelin H, Slunga Järvholm L, Boraxbekk CJ, Nordin M. Hopeful struggling for health: Experiences of participating in computerized cognitive training and aerobic training for persons with stress-related exhaustion disorder. Scand J Psychol 2020; 61:361-368. [PMID: 31995652 DOI: 10.1111/sjop.12623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 12/16/2019] [Indexed: 11/28/2022]
Abstract
It is important to understand how people with exhaustion disorder (ED) perceive interventions aiming to facilitate cognitive functioning. Therefore, the overall aim of this study was to explore experiences from persons with ED after participating in a 12-week intervention of either computerized cognitive training or aerobic training. Both interventions were performed in addition to a multimodal rehabilitation programme. Thirteen participants, 11 women and 2 men, were interviewed about pros and cons with participating in the training. The interviews were analysed with Qualitative Content Analysis. The analyses resulted in the theme hopeful struggling for health and the categories support, motivation and sensations. It was hard work recovering from ED. Support from others who are in the same situation, family members, and technology and routines for the training were strongly emphasized as beneficial for recovery. Timing, i.e., matching activities to the rehabilitation programme, getting feedback and perceiving joy in the training were important for motivation. Participants in both interventions experienced positive sensations with improved memory performance, everyday life functioning and increased faith in the prospect of recovery. However, it is important to consider various aspects of support and motivation in both computerized cognitive training and aerobic training to enable participants to pursue their participation.
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Affiliation(s)
- Therese Eskilsson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Sustainable Health and Medicine, Umeå University, Umeå, Sweden
| | | | - Elin Ek Malmer
- Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Anna Stigsdotter Neely
- Department of Psychology, Umeå University, Umeå, Sweden.,Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
| | - Hanna Malmberg Gavelin
- Department of Psychology, Umeå University, Umeå, Sweden.,Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne, Australia
| | - Lisbeth Slunga Järvholm
- Department of Public Health and Clinical Medicine, Sustainable Health and Medicine, Umeå University, Umeå, Sweden
| | - Carl-Johan Boraxbekk
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark.,Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Maria Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
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17
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Wahlström V, Fjellman-Wiklund A, Harder M, Slunga Järvholm L, Eskilsson T. Implementing a Physical Activity Promoting Program in a Flex-Office: A Process Evaluation with a Mixed Methods Design. Int J Environ Res Public Health 2019; 17:ijerph17010023. [PMID: 31861424 PMCID: PMC6982266 DOI: 10.3390/ijerph17010023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/13/2019] [Accepted: 12/14/2019] [Indexed: 12/12/2022]
Abstract
The aim of this study was to investigate facilitating and hindering factors when implementing a physical activity (PA)-promoting program among office workers moving to a flex office, by conducting a process evaluation. Additionally, we evaluated self-reported and perceived PA behaviors. With a mixed methods design, analyses were based upon data from interviews with 70 employees and repeated questionnaires from 152 employees. The PA-promoting program was fully implemented and supported by management. There was a strong health promoting culture, encouraging PA in the organization already at the start of the study. The lecture and the office design were rated as the most motivating program components. The use of stairs, breaks during meetings and social acceptance for standing and walking at work increased. Employees described a strive for variation, and how managers, the office environment, productivity and ergonomic aspects influenced sedentary behavior (SB) and PA. The need for the PA-promoting program was questioned, and the timing of the program was debated. To conclude, a strong organizational health culture combined with a facilitating physical environment can create sustainable positive PA behaviors in office settings. A thorough understanding of organizational needs and a participatory process are needed to tailor organizational interventions to decrease SB.
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Affiliation(s)
- Viktoria Wahlström
- Department of Public Health and Clinical Medicine, Section for Sustainable Health, Umeå University, 90187 Umeå, Sweden;
- Correspondence:
| | - Anncristine Fjellman-Wiklund
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, 90187 Umeå, Sweden; (A.F.-W.); (T.E.)
| | - Mette Harder
- Umeå School of Architecture, Umeå University, 90187 Umeå, Sweden;
| | - Lisbeth Slunga Järvholm
- Department of Public Health and Clinical Medicine, Section for Sustainable Health, Umeå University, 90187 Umeå, Sweden;
| | - Therese Eskilsson
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, 90187 Umeå, Sweden; (A.F.-W.); (T.E.)
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18
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Wallin S, Fjellman-Wiklund A. Act with respect: Views of supportive actions for older workers after completion of comprehensive vocational rehabilitation services. Work 2019; 62:585-598. [PMID: 31104047 DOI: 10.3233/wor-192896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The number of older workers will expand during the next decades. Older workers have more long-term health problems and related limitations. OBJECTIVE This study examined supportive actions provided in occupational healthcare services to older workers after vocational rehabilitation. An additional purpose was to explore occupational healthcare professionals' views on how to realize and improve adequate support activities. METHODS Qualitative and quantitative methods were used, including a postal questionnaire and focus group discussions. Sixty-seven occupational healthcare service units participated in the postal questionnaire. Eight occupational healthcare professionals participated in two focus group discussions. The qualitative data was analyzed using qualitative content analysis. RESULTS The qualitative analysis resulted in one theme (Act with respect), and four categories (Need for cooperation, Collaborative resources of involved stakeholders, Individual needs for support, and Gender as homogenous and separate groups). Quantitative results revealed that the workers' initiative strongly influenced the support carried out. Recommendations from the rehabilitation clinic were almost always considered when deciding on supportive actions. Focus group discussions brought up gender differences especially highlighted in the category Gender as homogenous and separate groups. CONCLUSIONS Appropriate support of older workers requires cooperation between involved stakeholders, including occupational healthcare services. Provided support should be based on individual needs, but a mutual practice of determining needed support is requested.
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Affiliation(s)
- Stina Wallin
- Faculty of Education and Welfare Studies, Health Sciences, Åbo Akademi University, Vaasa, Finland.,Department of Community Health and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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19
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Lostelius PV, Ståhle-Öberg L, Fjellman-Wiklund A. Pain in children with cerebral palsy – adolescent siblings’ awareness of pain and perceived influence on their family. European Journal of Physiotherapy 2018. [DOI: 10.1080/21679169.2018.1505946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Petra Vikman Lostelius
- Department of Community Health and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
- Psychosomatic Medicine Clinic, Västmanland County Council, Västerås, Sweden
| | - Lena Ståhle-Öberg
- Department of Community Health and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
- Habilitation, Västerbotten County Council, Umeå, Sweden
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20
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Fjellman-Wiklund A, Nordin E, Skelton DA, Lundin-Olsson L. Reach the Person behind the Dementia - Physical Therapists' Reflections and Strategies when Composing Physical Training. PLoS One 2016; 11:e0166686. [PMID: 27906996 PMCID: PMC5132255 DOI: 10.1371/journal.pone.0166686] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/02/2016] [Indexed: 11/19/2022] Open
Abstract
Dementia is a disease characterized by cognitive impairment and physical decline that worsens over time. Exercise is one lifestyle factor that has been identified as a potential means of reducing or delaying progression of the symptoms of dementia, maximizing function and independence. The purpose of this study was to explore physical therapists' (PTs) experiences and reflections on facilitating high-intensity functional exercise with older people living with dementia, in residential care home settings. The study used a qualitative design based on interviews, individually or in small groups, with seven PTs engaged as leaders in the training of older people with dementia. The interviews were analyzed with a modified Grounded Theory method with focus on constant comparisons. To increase trustworthiness the study used triangulation within investigators and member checking. The core category "Discover and act in the moment-learn over time" reflects how the PTs continuously developed their own learning in an iterative process. They built on previous knowledge to communicate with residents and staff and to tailor the high intensity training in relation to each individual at that time point. The category "Be on your toes" highlights how the PTs searched for sufficient information about each individual, before and during training, by eliciting the person's current status from staff and by interpreting the person's body language. The category "Build a bond with a palette of strategies" describes the importance of confirmation to build up trust and the use of group members and the room to create an interplay between exercise and social interaction. These findings highlight the continuous iterative process of building on existing knowledge, sharing and reflecting, being alert to any alterations needed for individuals that day, communication skills (both with residents and staff) and building a relationship and trust with residents in the effective delivery of high intensity functional exercise to older people living with dementia in care settings.
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Affiliation(s)
| | - Ellinor Nordin
- Department of Community Health and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Dawn A. Skelton
- Department of Community Health and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
- School of Health and Life Sciences, Institute of Applied Health Research, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Lillemor Lundin-Olsson
- Department of Community Health and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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21
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Henriksson T, Vescovi JD, Fjellman-Wiklund A, Gilenstam K. Laboratory- and field-based testing as predictors of skating performance in competitive-level female ice hockey. Open Access J Sports Med 2016; 7:81-8. [PMID: 27574474 PMCID: PMC4994876 DOI: 10.2147/oajsm.s109124] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives The purpose of this study was to examine whether field-based and/or laboratory-based assessments are valid tools for predicting key performance characteristics of skating in competitive-level female hockey players. Design Cross-sectional study. Methods Twenty-three female ice hockey players aged 15–25 years (body mass: 66.1±6.3 kg; height: 169.5±5.5 cm), with 10.6±3.2 years playing experience volunteered to participate in the study. The field-based assessments included 20 m sprint, squat jump, countermovement jump, 30-second repeated jump test, standing long jump, single-leg standing long jump, 20 m shuttle run test, isometric leg pull, one-repetition maximum bench press, and one-repetition maximum squats. The laboratory-based assessments included body composition (dual energy X-ray absorptiometry), maximal aerobic power, and isokinetic strength (Biodex). The on-ice tests included agility cornering s-turn, cone agility skate, transition agility skate, and modified repeat skate sprint. Data were analyzed using stepwise multivariate linear regression analysis. Linear regression analysis was used to establish the relationship between key performance characteristics of skating and the predictor variables. Results Regression models (adj R2) for the on-ice variables ranged from 0.244 to 0.663 for the field-based assessments and from 0.136 to 0.420 for the laboratory-based assessments. Single-leg tests were the strongest predictors for key performance characteristics of skating. Single leg standing long jump alone explained 57.1%, 38.1%, and 29.1% of the variance in skating time during transition agility skate, agility cornering s-turn, and modified repeat skate sprint, respectively. Isokinetic peak torque in the quadriceps at 90° explained 42.0% and 32.2% of the variance in skating time during agility cornering s-turn and modified repeat skate sprint, respectively. Conclusion Field-based assessments, particularly single-leg tests, are an adequate substitute to more expensive and time-consuming laboratory assessments if the purpose is to gain knowledge about key performance characteristics of skating.
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Affiliation(s)
- Tommy Henriksson
- Sport Medicine Unit, Department of Community Medicine and Rehabilitation; The National Graduate School of Gender Studies, Umeå University, Umeå, Sweden
| | - Jason D Vescovi
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | | | - Kajsa Gilenstam
- Sport Medicine Unit, Department of Community Medicine and Rehabilitation
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22
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Wiklund M, Fjellman-Wiklund A, Stålnacke BM, Hammarström A, Lehti A. Access to rehabilitation: patient perceptions of inequalities in access to specialty pain rehabilitation from a gender and intersectional perspective. Glob Health Action 2016; 9:31542. [PMID: 27569592 PMCID: PMC5002397 DOI: 10.3402/gha.v9.31542] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/12/2016] [Accepted: 07/15/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Long-term musculoskeletal pain is common, particularly among women. Pain conditions are a concern in primary health care, and people with severe and complex pain are referred to specialty health care. There is gender bias in access, counselling, assessment, and treatment of long-term pain. OBJECTIVE This study explores patient accounts and perceptions about important (social) factors for accessing specialised pain rehabilitation from gender and intersectional equality perspectives. We aimed to identify potential biases and inequalities in accessing rehabilitation resources at a specialised rehabilitation clinic. DESIGN Individual semi-structured interviews were conducted with 10 adults after an assessment or completion of a specialised rehabilitation programme in northern Sweden. Qualitative content analysis was used to explore patients' perceptions of important factors for accessing rehabilitation. RESULTS One main theme was formulated as Access to rehab - not a given. Three categories of perceived inequality were demonstrated: power of gender, power of social status, and power of diagnosis. Participants perceived rehabilitation as a resource that is not equally available, but dependent on factors such as gender, socio-economic status, ability to work, ethnicity, or age, and more subtle aspects of social status and habitus (e.g. appearance, fitness, and weight). The character of diagnosis received (medical versus psychiatric or social) was also noted. CONCLUSIONS It is crucial that professionals are aware of how potential inequalities related to gender, social status, and diagnosis, and their intersections, can be created, perceived, and have influence on the processes of assessment and treatment. Reduction of social determinants of health and biases remain important within global, national, and local contexts.
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Affiliation(s)
- Maria Wiklund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
- Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden
- Department of Public Health and Clinical Medicine, Social Medicine, Umeå University, Umeå, Sweden;
| | - Anncristine Fjellman-Wiklund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
- Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden
| | - Britt-Marie Stålnacke
- Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
| | - Anne Hammarström
- Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden
- Department of Public Health and Clinical Medicine, Social Medicine, Umeå University, Umeå, Sweden
| | - Arja Lehti
- Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden
- Department of Clinical Sciences, Professional Development, Umeå University, Umeå, Sweden
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Hammarström A, Wiklund M, Stålnacke BM, Lehti A, Haukenes I, Fjellman-Wiklund A. Developing a Tool for Increasing the Awareness about Gendered and Intersectional Processes in the Clinical Assessment of Patients--A Study of Pain Rehabilitation. PLoS One 2016; 11:e0152735. [PMID: 27055029 PMCID: PMC4824419 DOI: 10.1371/journal.pone.0152735] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 01/25/2016] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE There is a need for tools addressing gender inequality in the everyday clinical work in health care. The aim of our paper was to develop a tool for increasing the awareness of gendered and intersectional processes in clinical assessment of patients, based on a study of pain rehabilitation. METHODS In the overarching project named "Equal care in rehabilitation" we used multiple methods (both quantitative and qualitative) in five sub studies. With a novel approach we used Grounded Theory in order to synthesize the results from our sub studies, in order to develop the gender equality tool. The gender equality tool described and developed in this article is thus based on results from sub studies about the processes of assessment and selection of patients in pain rehabilitation. Inspired by some questions in earlier tools, we posed open ended questions and inductively searched for findings and concepts relating to gendered and social selection processes in pain rehabilitation, in each of our sub studies. Through this process, the actual gender equality tool was developed as 15 questions about the process of assessing and selecting patients to pain rehabilitation. As a more comprehensive way of understanding the tool, we performed a final step of the GT analyses. Here we synthesized the results of the tool into a comprehensive model with two dimensions in relation to several possible discrimination axes. RESULTS The process of assessing and selecting patients was visualized as a funnel, a top down process governed by gendered attitudes, rules and structures. We found that the clinicians judged inner and outer characteristics and status of patients in a gendered and intersectional way in the process of clinical decision-making which thus can be regarded as (potentially) biased with regard to gender, socio-economic status, ethnicity and age. IMPLICATIONS The clinical implications of our tool are that the tool can be included in the systematic routine of clinical assessment of patients for both awareness raising and as a base for avoiding gender bias in clinical decision-making. The tool could also be used in team education for health professionals as an instrument for critical reflection on gender bias. CONCLUSIONS Thus, tools for clinical assessment can be developed from empirical studies in various clinical settings. However, such a micro-level approach must be understood from a broader societal perspective including gender relations on both the macro- and the meso-level.
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Affiliation(s)
- Anne Hammarström
- Department of Public Health and Clinical Medicine, Unit of Social Medicine, Umeå University, Umeå, Sweden
- Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden
| | - Maria Wiklund
- Department of Public Health and Clinical Medicine, Unit of Social Medicine, Umeå University, Umeå, Sweden
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Britt-Marie Stålnacke
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
| | - Arja Lehti
- Department of Clinical Sciences, Unit of Professional Development, Umeå University, Umeå, Sweden
| | - Inger Haukenes
- Department of Public Mental Health, Division of Mental Health, Norwegian Institute of Public Health, Kalfarveien 31, Bergen, Norway
- Research Unit for General Practice, Uni Research Health, Kalfarveien 31, Bergen, Norway
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Lehti A, Fjellman-Wiklund A, Stålnacke BM, Hammarström A, Wiklund M. Walking down ‘Via Dolorosa’ from primary health care to the specialty pain clinic - patient and professional perceptions of inequity in rehabilitation of chronic pain. Scand J Caring Sci 2016; 31:45-53. [DOI: 10.1111/scs.12312] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 10/27/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Arja Lehti
- Division for Professional Development; Department of Clinical Sciences; Umeå University; Umeå Sweden
| | | | - Britt-Marie Stålnacke
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine; Umeå University; Umeå Sweden
| | - Anne Hammarström
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
| | - Maria Wiklund
- Department of Community Medicine and Rehabilitation, Physiotherapy; Umeå University; Umeå Sweden
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Ahlgren C, Fjellman-Wiklund A, Hamberg K, Johansson EE, Stålnacke BM. The meanings given to gender in studies on multimodal rehabilitation for patients with chronic musculoskeletal pain – a literature review. Disabil Rehabil 2016; 38:2255-70. [DOI: 10.3109/09638288.2015.1127435] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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26
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Ahlgren C, Hammarström A, Sandberg S, Lindahl B, Olsson T, Larsson C, Fjellman-Wiklund A. Engagement in New Dietary Habits—Obese Women’s Experiences from Participating in a 2-Year Diet Intervention. Int J Behav Med 2015; 23:84-93. [DOI: 10.1007/s12529-015-9495-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Fjellman-Wiklund A, Söderman K, Lundqvist M, Häger C. How does an ACL injury influence life in the long term?—an interview study. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vikman PL, Ståhle-Öberg L, Fjellman-Wiklund A. Pain in children with cerebral palsy—adolescent siblings’ awareness and perceived influence on their family. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Nordvall Strömberg P, Fjellman-Wiklund A, Wadell K. Enhanced information regarding exercise training as treatment is needed. An interview study in patients with chronic obstructive pulmonary disease. Disabil Rehabil 2014; 37:1424-30. [DOI: 10.3109/09638288.2014.972584] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nordin C, Fjellman-Wiklund A, Gard G. In search of recognition – Patients’ experiences of patient participation prior to multimodal pain rehabilitation. European Journal of Physiotherapy 2014. [DOI: 10.3109/21679169.2013.871061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Stenberg G, Lundquist A, Fjellman-Wiklund A, Ahlgren C. Patterns of reported problems in women and men with back and neck pain: Similarities and differences. J Rehabil Med 2014; 46:668-75. [DOI: 10.2340/16501977-1830] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Hammarström A, Johansson K, Annandale E, Ahlgren C, Aléx L, Christianson M, Elwér S, Eriksson C, Fjellman-Wiklund A, Gilenstam K, Gustafsson PE, Harryson L, Lehti A, Stenberg G, Verdonk P. Central gender theoretical concepts in health research: the state of the art. J Epidemiol Community Health 2013; 68:185-90. [PMID: 24265394 DOI: 10.1136/jech-2013-202572] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Despite increasing awareness of the importance of gender perspectives in health science, there is conceptual confusion regarding the meaning and the use of central gender theoretical concepts. We argue that it is essential to clarify how central concepts are used within gender theory and how to apply them to health research. We identify six gender theoretical concepts as central and interlinked-but problematic and ambiguous in health science: sex, gender, intersectionality, embodiment, gender equity and gender equality. Our recommendations are that: the concepts sex and gender can benefit from a gender relational theoretical approach (i.e., a focus on social processes and structures) but with additional attention to the interrelations between sex and gender; intersectionality should go beyond additive analyses to study complex intersections between the major factors which potentially influence health and ensure that gendered power relations and social context are included; we need to be aware of the various meanings given to embodiment, which achieve an integration of gender and health and attend to different levels of analyses to varying degrees; and appreciate that gender equality concerns absence of discrimination between women and men while gender equity focuses on women's and men's health needs, whether similar or different. We conclude that there is a constant need to justify and clarify our use of these concepts in order to advance gender theoretical development. Our analysis is an invitation for dialogue but also a call to make more effective use of the knowledge base which has already developed among gender theorists in health sciences in the manner proposed in this paper.
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Affiliation(s)
- Anne Hammarström
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, , Umeå, Sweden
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Nordin C, Gard G, Fjellman-Wiklund A. Being in an exchange process: experiences of patient participation in multimodal pain rehabilitation. J Rehabil Med 2013; 45:580-6. [PMID: 23532262 DOI: 10.2340/16501977-1136] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To explore primary healthcare patients' experiences of patients participation in multimodal pain rehabilitation. PATIENTS AND METHODS A total of 17 patients who had completed multimodal rehabilitation for persistent pain were interviewed. The interviews were analysed using qualitative content analysis. RESULTS One theme, Being in an exchange process, and 4 categories emerged. The theme depicted patient participation as a continuous exchange of emotions, thoughts and knowledge. The category Fruitful encounters represented the basic prerequisites for patient participation through dialogue and platforms to meet. Patients' emotional and cognitive resources and restrictions, as well as knowledge gaps, were conditions influencing patient participation in the category Inequality in co-operation. Mutual trust and respect were crucial conditions in patient's personal relationships with the health professionals, forming the category Confidence-inspiring alliance. In the category Competent health professionals, the health professionals' expertise, empathy and personal qualities, were emphasized to favour patient participation. CONCLUSION Patient participation can be understood as complex and individualized. A confidence-inspiring alliance enables a trusting relationship to be formed between patients and health professionals. Patients emphasized that health professionals need to play an active role in building common ground in the interaction. Understanding each patient's needs in the participation process may favour patient participation.
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Affiliation(s)
- Catharina Nordin
- Dept. of Health Science, Luleå University of Technology, 97187 Luleå, Sweden.
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Norlund S, Fjellman-Wiklund A, Nordin M, Stenlund T, Ahlgren C. Personal resources and support when regaining the ability to work: an interview study with Exhaustion Disorder patients. J Occup Rehabil 2013; 23:270-279. [PMID: 23114722 DOI: 10.1007/s10926-012-9396-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE The aim of the study was to explore experiences and thoughts in the process of returning to work in employed patients with Exhaustion Disorder. METHODS Twelve patients with Exhaustion Disorder (burnout) who had been referred to a Stress Rehabilitation Clinic were interviewed. All patients were employed but a majority was on full or part-time sick leave. Grounded Theory was used as the qualitative method. RESULTS A core category, regaining the ability to work, was developed. Alongside, two categories, internal resources and the external support system, were experienced as being important to the process. The internal resources were expressed through three key features (sub-categories), perceived validation, insights and adaptive coping abilities. The external support system was diverse and described by the sub-categories practical/structural and/or emotional support. Four external support actors were identified; the workplace, health care, the Social Insurance Agency, and the union. The supervisor was described as the most important external actor. CONCLUSIONS Internal and external resources are intertwined in the process of regaining the ability to work. The internal resources and external support can directly increase the probability to regain the ability to work. Moreover, these resources can affect each other and thus indirectly have an effect on the process.
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Affiliation(s)
- Sofia Norlund
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, 901 87, Umeå, Sweden.
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Stenberg G, Fjellman-Wiklund A, Ahlgren C. 'I am afraid to make the damage worse'--fear of engaging in physical activity among patients with neck or back pain--a gender perspective. Scand J Caring Sci 2013; 28:146-54. [PMID: 23578006 DOI: 10.1111/scs.12043] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 03/11/2013] [Indexed: 11/30/2022]
Abstract
RATIONALE Neck and back pain are major public health problems in Western societies and cause considerable disability and health service use. Swedish women report more severe neck and back pain compared with Swedish men. Most studies on the aetiology of gender differences in pain deal with biological mechanisms, and less with the role of psychological and sociocultural factors. 'Pain beliefs' is a sociocultural factor and can be expressed in different ways among women and men. It is important to know what pain beliefs are held by neck and back pain patients, especially when medical guidelines recommend that back pain patients stay physically active. AIM Exploring pain beliefs in relation to physical activity among neck and back pain patients consulting primary health care. METHOD Twelve patients (seven women, five men) consulting primary health care for an initial episode of neck or back pain were interviewed before their first appointment with a physiotherapist or general practitioner and 3 months later. The interviews covered patient experiences of neck or back pain, consequences, strategies and treatment experiences. The interviews were analysed with qualitative content analysis from a gender perspective. RESULT One theme 'Fear of hurting the fragile body' was expressed by all neck or back pain patients. Five categories were identified 'The mechanical body', 'Messages about activity', 'Earlier experiences of pain and activity', 'To be a good citizen' and 'Support to be active' supported or undermined beliefs about pain and physical activity. Gender expressions occurred in the categories 'Messages about activity', 'To be a good citizen' and 'Support to be active'. CONCLUSIONS Neck or back pain patients in the study saw the body as fragile and were afraid of hurting it. Notions of gender had an impact on the given advice about activity and on how patients perceived the message about staying active.
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Affiliation(s)
- Gunilla Stenberg
- The National Graduate School of Gender Studies, Umeå University, Umeå, Sweden
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Sturesson M, Edlund C, Fjellman-Wiklund A, Falkdal AH, Bernspång B. Work ability as obscure, complex and unique: Views of Swedish occupational therapists and physicians. Work 2013; 45:117-28. [DOI: 10.3233/wor-2012-1416] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Marine Sturesson
- Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University, Umeå, Sweden
| | - Curt Edlund
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | | | - Annie Hansen Falkdal
- Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University, Umeå, Sweden
| | - Birgitta Bernspång
- Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University, Umeå, Sweden
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Wiklund M, Malmgren-Olsson EB, Ohman A, Bergström E, Fjellman-Wiklund A. Subjective health complaints in older adolescents are related to perceived stress, anxiety and gender - a cross-sectional school study in Northern Sweden. BMC Public Health 2012; 12:993. [PMID: 23158724 PMCID: PMC3533931 DOI: 10.1186/1471-2458-12-993] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 11/14/2012] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Negative trends in adolescent mental and subjective health are a challenge to public health work in Sweden and worldwide. Self-reported mental and subjective health complaints such as pain, sleeping problems, anxiety, and various stress-related problems seem to have increased over time among older adolescents, especially girls. The aim of this study has therefore been to investigate perceived stress, mental and subjective health complaints among older adolescents in Northern Sweden. METHODS Data were derived from a cross-sectional school-based survey with a sample consisting of 16-18 year olds (n = 1027), boys and girls, in the first two years of upper secondary school, from different vocational and academic programmes in three public upper secondary schools in a university town in northern Sweden. Prevalence of perceived stress, subjective health complaints, general self-rated health, anxiety, and depression were measured using a questionnaire, including the Hospital Anxiety and Depression Scale (HADS). RESULTS A large proportion of both girls and boys reported health complaints and perceived stress. There was a clear gender difference: two to three times as many girls as boys reported subjective health complaints, such as headache, tiredness and sleeping difficulties and musculoskeletal pain, as well as sadness and anxiety. High pressure and demands from school were experienced by 63.6% of girls and 38.5% of boys. Perceived stress in the form of pressure and demands correlated strongly with reported health complaints (r = 0.71) and anxiety (r = 0.71). CONCLUSIONS The results indicate that mental and subjective health complaints are prevalent during adolescence, especially in girls, and furthermore, that perceived stress and demands may be important explanatory factors. Future studies should pay attention to the balance between gender-related demands, perceived control and social support, particularly in the school environment, in order to prevent negative strain and stress-related ill-health. The gender gap in subjective adolescent health needs to be further explored.
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Affiliation(s)
- Maria Wiklund
- Umeå Center for Gender Studies, Umeå University, Umeå, Sweden.
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Häggqvist B, Stenvall M, Fjellman-Wiklund A, Westerberg K, Lundin-Olsson L. "The balancing act"--licensed practical nurse experiences of falls and fall prevention: a qualitative study. BMC Geriatr 2012; 12:62. [PMID: 23062203 PMCID: PMC3536659 DOI: 10.1186/1471-2318-12-62] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 09/27/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls are common in old age and may have serious consequences. There are many strategies to predict and prevent falls from occurring in long-term care and hospitals. The aim of this study was to describe licensed practical nurse experiences of predicting and preventing further falls when working with patients who had experienced a fall-related fracture. Licensed practical nurses are the main caretakers that work most closely with the patients. METHODS A qualitative study of focus groups interviews and field observations was done. 15 licensed practical nurses from a rehabilitation ward and an acute ward in a hospital in northern Sweden were interviewed. Content was analyzed using qualitative content analysis. RESULTS The result of the licensed practical nurse thoughts and experiences about risk of falling and fall prevention work is represented in one theme, "the balancing act". The theme includes three categories: "the right to decide", "the constant watch", and "the ongoing negotiation" as well as nine subcategories. The analysis showed similarities and differences between rehabilitation and acute wards. At both wards it was a core strategy in the licensed practical nurse work to always be ready and to pay attention to patients' appearance and behavior. At the rehabilitation ward, it was an explicit working task to judge the patients' risk of falling and to be active to prevent falls. At the acute ward, the words "risk of falling" were not used and fall prevention were not discussed; instead the licensed practical nurses used for example "dizzy and pale". The results also indicated differences in components that facilitate workplace learning and knowledge transfer. CONCLUSIONS Differences between the wards are most probably rooted in organizational differences. When it is expected by the leadership, licensed practical nurses can express patient risk of falling, share their observations with others, and take actions to prevent falls. The climate and the structure of the ward are essential if licensed practical nurses are to be encouraged to routinely consider risk of falling and implement risk reduction strategies.
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Affiliation(s)
- Beatrice Häggqvist
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE-90187, Umeå, Sweden
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Stenberg G, Fjellman-Wiklund A, Ahlgren C. ”Getting confirmation”: Gender in expectations and experiences of healthcare for neck or back patients. J Rehabil Med 2012; 44:163-71. [DOI: 10.2340/16501977-0912] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Nordström A, Fjellman-Wiklund A, Grysell T. Drama as a pedagogical tool for practicing death notification-experiences from Swedish medical students. BMC Med Educ 2011; 11:74. [PMID: 21955368 PMCID: PMC3198748 DOI: 10.1186/1472-6920-11-74] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 09/28/2011] [Indexed: 05/07/2023]
Abstract
BACKGROUND One of the toughest tasks in any profession is the deliverance of death notification. Marathon Death is an exercise conducted during the fourth year of medical school in northern Sweden to prepare students for this responsibility. The exercise is designed to enable students to gain insight into the emotional and formal procedure of delivering death notifications. The exercise is inspired by Augusto Boal's work around Forum Theatre and is analyzed using video playback. The aim of the study was to explore reflections, attitudes and ideas toward training in delivering death notifications among medical students who participate in the Marathon Death exercise based on forum play. METHODS After participation in the Marathon Death exercise, students completed semi-structured interviews. The transcribed interviews were analyzed using the principles of qualitative content analysis including a deductive content analysis approach with a structured matrix based on Bloom's taxonomy domains. RESULTS The Marathon Death exercise was perceived as emotionally loaded, realistic and valuable for the future professional role as a physician. The deliverance of a death notification to the next of kin that a loved one has died was perceived as difficult. The exercise conjured emotions such as positive expectations and sheer anxiety. Students perceived participation in the exercise as an important learning experience, discovering that they had the capacity to manage such a difficult situation. The feedback from the video playback of the exercise and the feedback from fellow students and teachers enhanced the learning experience. CONCLUSIONS The exercise, Marathon Death, based on forum play with video playback is a useful pedagogical tool that enables students to practice delivering death notification. The ability to practice under realistic conditions contributes to reinforce students in preparation for their future professional role.
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Affiliation(s)
- Anna Nordström
- Department of Surgical and Perioperative Science, Sports Medicine, Umeå University, S-901 85 Umeå, Sweden
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, S-901 87 Umeå, Sweden
| | | | - Tomas Grysell
- Division for Development of Teaching and Learning, Uppsala University, S-751 20 Uppsala, Sweden
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Hariz GM, Limousin P, Tisch S, Jahanshahi M, Fjellman-Wiklund A. Patients' perceptions of life shift after deep brain stimulation for primary dystonia--A qualitative study. Mov Disord 2011; 26:2101-6. [PMID: 21626564 DOI: 10.1002/mds.23796] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 04/21/2011] [Indexed: 11/05/2022] Open
Abstract
Studies of deep brain stimulation for dystonia have shown significant motor improvement. However, patients' perceptions of surgery and its effects have been less studied. We aimed to explore perceptions of changes in life in patients with primary dystonia after deep brain stimulation. Thirteen patients underwent thematic interviews 8-60 months after pallidal deep brain stimulation. Interviews were transcribed verbatim and analyzed with grounded theory. Patients described a profound impact of dystonia on daily life. After surgery, physical changes with a more upright posture and fewer spasms translated into an easier, more satisfying life with greater confidence. Notwithstanding this positive outcome, the transition from a limited life before surgery to opportunities for a better life exhibited obstacles: The "new life" after deep brain stimulation was stressful, including concern about being dependent on the stimulator as well as having to deal with interfering side effects from deep brain stimulation. The whole coping process meant that patients had to quickly shift focus from struggling to adapt to a slowly progressive disorder to adjustment to a life with possibilities, but also with new challenges. In this demanding transition process, patients wished to be offered better professional guidance and support. Even though deep brain stimulation provides people with primary dystonia with a potential for better mobility and more confidence, patients experienced new challenges and expressed the need for support and counseling after surgery. Grounded theory is a useful method to highlight patients' own experience and contributes to a deeper understanding of the impact of deep brain stimulation on patients with dystonia.
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Affiliation(s)
- Gun-Marie Hariz
- Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University, Umeå, Sweden.
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Mulligan H, Fjellman-Wiklund A, Hale L, Thomas D, Häger-Ross C. Promoting physical activity for people with neurological disability: Perspectives and experiences of physiotherapists. Physiother Theory Pract 2010; 27:399-410. [DOI: 10.3109/09593985.2010.519015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Fjellman-Wiklund A, Stenlund T, Steinholtz K, Ahlgren C. Take charge: Patients' experiences during participation in a rehabilitation programme for burnout. J Rehabil Med 2010; 42:475-81. [PMID: 20544160 DOI: 10.2340/16501977-0534] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore the experiences of patients with burnout during a rehabilitation programme. PATIENTS AND METHODS Eighteen patients with burnout were interviewed at the end of a one-year rehabilitation programme. The programme consisted of 2 groups, one with a focus on cognitively-oriented behavioural rehabilitation and Qigong and 1 with a focus on Qigong alone. The interviews were analysed using the grounded theory method. RESULTS One core category, Take Charge, and 6 categories emerged. The core category represents a beneficial recovery process that helped the patients to take control of their lives. The common starting point for the process is presented in the 3 categories of Good encounters, Affirmation and Group cohesiveness. The categories were basic conditions for continuing development during rehabilitation. In the categories Get to know myself, How can I be the one I want to be? and Choice of track, the more group-specific tools are included, through which the patients adopted a new way of behaving. CONCLUSION Patients in both groups experienced group participation as being beneficial for recovery and regaining control of their lives, although in somewhat different way. An experience of affirmation and support from health professionals and group participants is of importance for beha-vioural change.
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Affiliation(s)
- Anncristine Fjellman-Wiklund
- Department of Community Medicine and Rehabilitation, Physiotherapy, UmeA yen University, SE- 901 87 UmeA yen, Sweden.
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Olofsson L, Fjellman-Wiklund A, Söderman K. From loss towards restoration: Experiences from anterior cruciate ligament injury. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/14038190903165120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ståhle-Öberg L, Fjellman-Wiklund A. Parents’ experience of pain in children with cerebral palsy and multiple disabilities – An interview study. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/14038190902906318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dijken C, Fjellman-Wiklund A, Hildingsson C. Low back pain, lifestyle factors and physical activity: A population based-study. J Rehabil Med 2008; 40:864-9. [DOI: 10.2340/16501977-0273] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Fjellman-Wiklund A, Sundelin G. Musculoskeletal discomfort of music teachers: an eight-year perspective and psychosocial work factors. Int J Occup Environ Health 1998; 4:89-98. [PMID: 10026470 DOI: 10.1179/oeh.1998.4.2.89] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Musicians at all levels of performance, especially string players, are known to have a high prevalence of work-related musculoskeletal disorders. The disorders seem to be most common in the neck, shoulders and low back. In 1988, a survey of the work-related musculoskeletal disorders of 36 music teachers was carried out at a music school in northern Sweden. In 1996, the teachers were reinvestigated. The study also included an investigation of the psychosocial work environment according to the Karasek demand-control theory, as well as measurements of upper-arm elevation during a working day in five violin teachers. The results showed that music teachers, like other professional musicians, often experience discomfort in the neck, shoulders, and low back. The discomfort tended to be of long duration, increasing over the years. The psychosocial work environment was characterized by high psychological demands and low authority over decisions. This was compensated for through good social support. The work required skill and creativity but was monotonous. The measurements of upper-arm elevation indicated considerable variations in shoulder positions between teachers. There were also differences in the work done with the right and left arms, with repetitive motions more commonly involving the right arm. Approximately a fourth of the working day was spent with the arm elevated 30-90 degrees. The relationships between upper-arm movements and ratings of discomfort were moderate.
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Affiliation(s)
- A Fjellman-Wiklund
- Occupational Health Care Center, Skellefteâ Municipality, Skellefteâ, Sweden.
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